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, 19th 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 6th
and ends on Nightingale's birthday on May 12th)? 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.
