Patients, not customers

Sr. Consuela talks with a nurse

“Basically, ultimately, essentially, nursing is relationship.”
– Sister Consuela White, R.S.M.

As a staff nurse on the burn unit at Massachusetts General Hospital, Doreen Klee '88 cares for patients facing the darkest moments of their lives. Haunted by memories of horrific car accidents or house fires, they must adjust to unthinkable losses: missing fingers, faces disfigured by scarring, and sometimes the death of a loved person.

"I work at night when people are the most scared and the most vulnerable," says Klee, recalling the screams of patients who awaken from dreams of being trapped in burning buildings. "We would just sit there and listen and let them talk through it until they were ready to go back to sleep."

For Klee and many fellow graduates of the Saint Joseph's College nursing program, human connection lies at the heart of their profession. From the time of its inception in 1974 under the direction of Sister Mary Consuela White, R.S.M., the program has not only prepared students for the rigors of nursing with coursework in anatomy, physiology, pharmacology, and some 800 hours of clinicals, it has stressed relationship with the patient. This holistic philosophy aims not only to treat disease, but to respect the humanity of the whole patient - body, mind and spirit.

Such caring may seem difficult to achieve in a profession known for staffing shortages and a high burnout rate. Today's nurses face multiple challenges: drastic cuts in hospital stays and evermore- sophisticated outpatient services mean more acutely ill patients are the ones in the hospital. Sister Consuela agrees with several of her graduates, however, that the most therapeutic interventions for patients often do not involve costly equipment.

"I believe that the relationship the nurse establishes with the patient on the first encounter should be one that initiates a sense of trust and reverence with that person," says Sister Consuela, 85, interviewed at Mercy Hospital in Portland, Maine, where she continues to have a daily presence. "I think the most good can be done for the patient if there can be a trusting relationship set up from the beginning."

Different setting, same connection

When Jean McMann first heard about the devastation caused by Hurricane Katrina, she hastily arranged a leave of absence from her nursing job at Mercy Westbrook Express Care. A registered nurse for 40 years, McMann is working toward her B.S. in Nursing through the Saint Joseph's College distance education program.

Jean McMann

Jean McMann dropped everything to go help out in New Orleans days after Hurricane Katrina hit last summer. A registered nurse for 40 years, her greatest healing tool in Louisiana turned out to be a hockey bag for a family that had nowhere to put their few remaining possessions.

When she looks back on three weeks of volunteer nursing in Louisiana late last summer, she recalls that one of her greatest healing tools was not an IV bag, a vial of medication or a digital heart monitor. It was a hockey bag.

Before leaving Maine, McMann spent $200 on two hockey bags, measuring 3 feet by 5 feet, and filled them with medical supplies donated by Mercy Hospital. She used the bandages and medicine during 12-hour shifts in the ER and medical-surgical units at a hospital in Baton Rouge. She was then asked to serve at a makeshift shelter set up in the field house of Louisiana State University.

In that cavernous building crammed with cots and homeless people, McMann spotted a man, accompanied by his mentally disabled son and other family members, who looked especially lost. They were surrounded by boxes and paper bags - their only remaining possessions.

"I sat beside him and said ‘What is your biggest need right now? How can I help you?'" recalls McMann. The man answered that he couldn't imagine how to carry their belongings to a relative's home in Texas. McMann said she had just what he needed. She gave him one of the hockey bags as a parting gift. "He smiled from cheek to cheek in disbelief that anyone would ever do anything like that for him. He must have hugged and kissed me five times," she says. She credits her education at Saint Joseph's and Sr. Consuela's influence for helping her to develop an intuitive sense for her patients' needs, even anticipating needs that may not be verbalized. "You have a gut feeling that maybe someone has to be with a patient all night, so you stay with them," she says. "You see the need and you fulfill the need."

That sentiment is echoed in Sister Consuela's memories of some 60 years of service as a nurse and administrator. Her Depression-era youth in rural Canada inspired sensitivity toward those who struggled with illness or poverty. After earning her degree from the Madigan Memorial School of Nursing in Houlton, Maine, she helped deliver babies, "irrigated" infected wounds, and calmed patients' fears at hospitals in Maine and New York.

Later, with a master's degree in nursing from Boston College, Sister Consuela emerged as a leader. She served as Director of Nursing and oversaw the nursing schools at two programs: Madigan Hospital for about six years, and Mercy Hospital in Portland, Maine, for more than 20 years. She was then named founding chair of the Saint Joseph's College Department of Nursing, a post she held for more than 10 years.

She downplays the talent that thrust her into leadership roles. "There were not many Sisters who were nurses and they needed someone in those positions. That's how it happened," says Sister Consuela, who wears a traditional black habit and the pewter cross of the Sisters of Mercy.

Others view such statements as evidence of her perpetual humility. "...She was far and wide recognized for her steely insight into what the issues were (as Director of Nursing at Mercy Hospital)" says Eileen Skinner, president and CEO of Mercy Health System of Maine. "Mission and patient care were always her directional compass."

Deep respect says it all

When asked what has motivated her humanistic approach to nursing, Sister Consuela answers with four words: "establish reverend, participatory relationships." Though she didn't coin the phrase, she feels it conveys an attitude of deep respect for other persons and an effort to honor the unique human interaction of the moment. "We're all made in the image and likeness of God. We all have a bit of divinity in us," she says.

Her former students recognize Sister Consuela as a source of guidance through the challenges of nursing school and practice. "Sister Consuela just gave everybody her love and compassion - it didn't matter if you were a patient, or a visitor, or on the staff," says Jean McMann.

Sue Henderson and Sharon Martin

Saint Joseph’s professors Sue Henderson (left) and Sharon Martin confer about a public health issue. Along with clinical skills, nursing faculty emphasize deep respect and a caring presence.

At Saint Joseph's College, nursing faculty strive to make the Sisters of Mercy philosophy live on. "We take it seriously and articulate it clearly to our students," says faculty member Susan Henderson, who was one of the first faculty members Sister Consuela hired when she began the Saint Joseph's nursing program. "However, as health care changes through the years, nurses have to surmount a variety of obstacles to maintain the connection with patients," she adds.

Era of cost containment

Eleanor Dudek '95 knows why career burnout is so common among nurses. Cost containment often cuts back on nursing staff, and she recalls working on a medical-surgical unit and being assigned as many as nine acutely ill patients during one 12-hour shift. If one of her patients went into a medical crisis, she'd have to devote her attention to getting that person stabilized, yet still have to be concerned with getting the other eight patients the care they needed. "...Even though I love (medical-surgical) nursing, I can't practice it in a way that feels good to me," she says.

Ellie McCarty, who taught nursing at Saint Joseph's College from 1989 through 1994, witnessed many trends over the course of her 48-year career in nursing. When she worked as a staff nurse in a Boston hospital in the mid-1950s, nurses had more time to interact with patients and provide personal care such as back rubs and bed baths. As technology grew more sophisticated, it demanded increasing attention from nurses."There is just not time to spend a lot of time talking with patients," she says. "It's not a skill the insurance companies will pay for and not a skill that the hospital will pay for. You have to make a more concrete intervention that you can document."

McCarty also served as a nurse during the Vietnam War, where "all you're really doing was working with acute trauma," she says. Though the soldiers clearly experienced emotional distress, nurses had no opportunity to address it, which took a toll on the nurses because they couldn't help their patients with the suffering in the manner it deserved.

Finding Ways to connect

Many nurses have diversified their skills in order to practice a type of nursing they find rewarding. McCarty worked for more than 10 years as a nurse practitioner, which gave her the luxury of extra time with each patient. Doreen Klee, the burn-unit staff nurse, made the decision to work at night because the slower pace allows for more interaction with patients.

Eleanor Dudek

Eleanor Dudek ’95 recalls being assigned as many as nine acutely ill pateints during a shift. Drastic cuts in hospital stays and ever-more-sophisticated outpatient services mean more acutely ill patients are typically the ones in the hospital.

Eleanor Dudek earned a master's degree in psychiatric and mental health nursing, and teaches nursing at Southern Maine Community College.

She considers the mental health field more therapeutic than medical-surgical care - for nurses and patients alike. "I am comfortable, in good part because of my education at Saint Joseph's, at being okay with people at their worst moment," says Dudek. "I can be there - I don't have to fix it. I can just be there."

While Henderson realizes the constraints on making a connection with patients given the current health care system, she says nurses have never given up on "reverend, participatory relationships." When there's little time to make a connection, then you have to do it in that little time, she says. How? By really looking at a patient, when asking how they are. "If someone sees you're really looking at them, they'll tell you how they are," she says. "It's about presence... you have to establish that you care."

According to Henderson, the Saint Joseph's nursing department teaches presence throughout its curriculum. She also says that in an environment of cost containment, nurses have to be "highly knowledgeable, technologically competent and able to document their worth." Nurses are getting better at making their value known, she says, as research has shown a relationship between nursing care and positive patient outcomes. Hospitals and insurance companies pay attention to that, she notes.

Sister Consuela applauds efforts to make human connections with patients despite the obstacles posed by the current health care system. She sees the challenges and changes in the nursing profession as symptomatic of broader changes within society. As the population grows more overstressed, self-indulgent, and reliant on drugs and alcohol, patients arrive with ever-increasing levels of need.

She hopes that growing numbers of people will begin to see the value of healthy ways of living - through diet, exercise, rest, relationships and spiritual growth. As a nurse for 60 years, she has observed the human condition in all of its manifestations - from birth to death, and robust health to tragic injury. Through it all, she maintains optimism and practicality.

"You do the best you can with the time you have and leave the rest to God," she says. "If your intentions are good, it will turn out okay."

by Michele Pavitt