Transforming Health Care and Health Professions Education in Times of War, Pandemic, and Disaster: Lessons from Two Founding Mothers

 From the 5/7/2021 newsletter

Director’s Corner

 

 

Transforming Health Care and Health Professions Education in Times of War, Pandemic, and Disaster: Lessons from Two Founding Mothers   

 

 

By Adina Kalet, MD MPH

 

 

This week, the Transformational Times celebrates National Nurses Week with contributions from MCW nurses and nurse practitioners. Dr. Kalet reflects on the lives and contributions of the founding mothers of the modern nursing profession, and how they remain exemplars of the character, caring, persistence, and grit needed to emerge from the COVID-19 pandemic with a health care system that is both more humane and scientifically cutting edge …

 

 

As a little girl, I was enthralled with biographies. I read a slew of stories with simplified messages where the “(s)hero” triumphed over adversity, had eureka moments, left the world a better place, and – usually - lived happily ever after. Two of these stories have stuck with me. Clara Barton and Florence Nightingale, both self-educated, 19^th century nurses, profoundly transformed health care and health professions education during times of crisis.  

  

Two amazing, transforming women

Clara Barton - a American public-school educator, humanitarian, and abolitionist who knew Susan B. Anthony, Frederick Douglass, and several presidents - is recognized for being remarkably clinically innovative in the face of scarce resources and overwhelming need during and after the Civil War. For her omnipresence and habit of reading to and writing letters for wounded soldiers, she was known as the “angel of the battlefield.”  Barton went on to found the American Red Cross and establish its preeminence in international disaster response and relief starting with the horrific Johnstown Flood of 1889.

Florence Nightingale - an upper-class British social reformer - became an icon of Victorian era British society for her work organizing care for wounded soldiers during the Crimean War. At the time, she was dubbed, “the lady with the lamp,” for her tireless, ever present, compassionate, and attentive individualized care to those in need. The image was sensationalized in the press, but Nightingale’s true brilliance was as a statistician, epidemiologist, and transformative educational leader. Her "Diagram of the causes of mortality in the army in the East," a complex pie chart defining the field of hospital epidemiology, was a remarkable distillation of data that remains among the first health infographics (along with Charles Joseph Minard’s “Napoleon’s March to Moscow Map”). Her work is credited with driving dramatic reductions in deaths from hospital acquired infections long before the discovery of antibiotics. For this intellectual accomplishment, she should be, but is not, called the mother of medical informatics. 

Barton and Nightingale were unlikely leaders. They shared the experience of nursing very ill family members early in their lives. As privileged women from wealthy families, they were likely expected to marry well and raise families but, because they were both unusually well-educated and independent, they forged their own paths. They each had rare access to political influence. They carried deep convictions about social justice issues and displayed unusually fierce empathy and compassion for the poor and oppressed. They both were “out of the box” thinkers, unafraid of hard work, eager to try new things, meticulous and scientific in their methods, and able to persuade others to support and join them in their work. They both served bravely under awful wartime conditions for extended periods of time, and continued to serve faithfully through long, productive careers despite obstacles, challenges to their leadership, and their own personal quirks (Barton was known to be “difficult”). Both remained single and, as far as I can tell, supported themselves through their work (I ordered a few books and will let you know).

The same years Clara Barton was designing, funding, supplying, and running mobile battlefield hospitals, Nightingale was establishing the first secular nursing school in the world at St Thomas' Hospital in London. Although each was a prolific writer and lecturer, they never met but likely did know of each other’s work.

In honor of their legacies and brilliance, newly minted nurses all over the world take the Nightingale Pledge on graduation and Clara Barton remains among the most celebrated of American women of all times, both as a nurse and as a leader. 

  

Who will lead us through the post-COVID-19 transformation?

Why tell these stories during National Nurses Week (which begins on May 6^th and ends on Nightingale's birthday on May 12^th)? Is it because I am a feminist history nerd?  Perhaps, but I also see them as role models for anyone who seeks to do the transformative work that will surely emerge from the COVID-19 pandemic.  Cataclysmic events, such as wars and pandemics, can accelerate innovation and change in both health care and education, but only with the right kind of leadership.

 

The COVID-19 pandemic is not a war

The national zeitgeist in spring of 2020 made us all want to celebrate the mighty battles against the virus and the heroism of our health care professionals and frontline workers. As a society, we look to our COVID-19 heroes the way the Victorians raised up the “Lady with a Lamp” or the “Angel on the Battlefield.” Those of us working away from the front lines express gratitude for the sacrifice of others.

But, if we stop to reflect, war imagery only partially defines what has occurred. Medicine is not a war. Most physicians, nurses, respiratory therapists, first responders, and other essential workers went to work because they had to, because that was what they were trained to do, and because that is what everyone expected. Our front line friends and colleagues remain vulnerable human beings that are called to head into the unknown, not in armor, but in PPE. Many of our colleagues experienced real consequences of their dedication.

We mourn those who became gravely ill or died. Too many colleagues suffer lingering physical, spiritual, and moral distress. As such, we must pledge to support our colleagues as they rest, recover, and take stock. I hope we can help them heal.

 

 MCW Nurses inspire

As Louis Pasteur reportedly said, “luck favors the prepared mind.” There is no doubt that there are many well-prepared Clara Bartons and Florence Nightingales out there who will emerge from our global pandemic experience and become leaders. We must provide them resources, break down barriers, watch them grow, and celebrate their work. Health care professionals are exquisitely prepared, well-educated, persuasive, and able to step up, serve, take advantage, and innovate when opportunities arise.

COVID-19 has already provided many opportunities. For some local examples, read Clinical Nurse Specialist Jennifer Popie’s inspiring description of about how the Froedtert & the Medical College of Wisconsin nursing leadership honors the exhausted staff members who persist, innovate, inspire, and provide compassionate care as the pandemic rages through the ICUs. Be prepared to be humbled by the vaccination clinic experiences of volunteer nurses, and consider joining Kelly Ayala, DNP, BSN, in a Hack-a-thon to address access to care issues.

 

 Thanks to our nurses!

For this year’s National Nurses Week, I personally extend my respect and appreciation for my hard-working nurse colleagues and family members (my brother, sister-in-law, and brother-in-law). I know it has been a remarkably difficult year and, despite all the spectacular innovation, it is not over yet. When the history of this time is written, I believe we will say with pride that we knew the heroic nurses and staff who showed up and, in the spirit of Clara Barton and Florence Nightingale, saw a need, pitched in, educated and rallied others to care for those who were suffering and created long lasting transformative institutions.  I know for a fact that our nursing colleagues make us all better because they showed up.  

 

 

Adina Kalet, MD MPH is the Director of the Robert D. and Patricia E. Kern Institute for the Transformation of Medical Education and holder of the Stephen and Shelagh Roell Endowed Chair at the Medical College of Wisconsin.