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Through births, deaths, serious diseases, injuries, and cold and flu season — nurses are there.

The question “What do nurses do?” seems to have a simple answer: Nurses take care of people. But perhaps the better question is “How?”

Nurses work as an advocate for patients. Nurses perform tests and check vital signs. They’re record-keepers and care coordinators. Nurses promote wellness through nutrition and exercise and help patients understand their medications and treatment plans. Nurses help ease fears and provide support — physically, emotionally, and spiritually — to patients and their families.

The primary role of any nurse is to provide safe and high-quality care, but they also work as educators.

“People don’t know how to navigate healthcare, and we’re the translators,” said Kim Brown Sims, chief nursing officer and chief patient care services officer for Queen of the Valley Medical Center.

When a patient is admitted to the hospital, they are “arguably experiencing one of the worst times in their lives,” said Jessica Hernandez, a registered nurse who works in Critical Care at Queen of the Valley.

“These patients are vulnerable and sometimes without any family or friends to be at their bedside,” Hernandez said. “I take pride in knowing that I can be their advocate and their support system when they need it most.”

To honor the role of nurses throughout the country, National Nurses Week is celebrated every year May 6-12, on the birthday of Florence Nightingale, the founder of modern nursing.

At Napa Valley College, nursing faculty will put on a breakfast for their students, and the campus will also offer blood pressure checks and other basic screenings to honor the nursing profession.

While defining a nurse’s role may not be easy, the abundance of job opportunities nursing provides help make it one of the most popular career paths in America.

According to the U.S. News and World Report’s “25 Best Jobs of 2019,” nurse anesthetists, nurse practitioners, nurse midwives and registered nurses are some of the best-paying and most widely available jobs in the country. The healthcare industry, as a whole, dominated the “Best Jobs” list, which also predicted continued growth and ample opportunities in the healthcare field.

“The realm of what a nurse can do is pretty endless at this point in time,” said Janice Ankenmann, a certified critical care nurse and family nurse practitioner, who is also a nursing professor and the nursing program director at Napa Valley College. “There’s plenty of job opportunities depending on your experience.”

Napa Valley College offers an associate’s degree in nursing and prepares its students to pass the California Board of Registered Nursing exam. The college admits 40 students per year to its nursing program. Last year, they received about 100 applications, Ankenmann said.

Students who have completed all the prerequisite courses are admitted on a first-come, first-serve basis once every spring. The nursing program previously kept students on a waitlist, but the college did away with this system years ago after finding it was not benefiting students or the program.

The nursing program takes two years to complete and costs approximately $5,500, which includes books, uniforms, and tuition. Students are still responsible for regular college tuition and fees, and the cost of the nursing program does not include transportation, parking, or living expenses.

Nearly half of all students enrolled in Napa Valley College’s nursing program are Napa natives. But the school has enrolled students from as far as Santa Rosa, Oakland, and Reno. Many of the school’s graduates are offered job opportunities in Napa because it is where the students perform most of their clinical work during their studies, Ankenmann said.

Students who want to choose a specialty in nursing — such as pediatrics or critical care — may do so after passing the Board exam. Many nurses learn their specialty during on-the-job training.

Choosing a specialty is about understanding your own personality — your strengths and weaknesses — and what gives you the most internal gratification, Ankenmann said.

The emergency room, for example, is the perfect environment for someone who enjoys adrenaline and can work under the pressure of a lot of people coming in and out the door, Ankenmann said. The intensive care unit is good for people who want a quieter, more controlled environment, where they work with only one or two patients at a time. The operating room is a good fit for someone who likes routine and working closely with a physician, Ankenmann said.

Ankenmann has worked as a nurse for more than 40 years. She is a registered nurse who specializes in critical care and has worked at Queen of the Valley as a nurse/manager in the ICU as well as at hospitals in Florida and Southern California.

“There’s a picture of me at 3 or 5 years old in a nurse’s uniform with a bag and cape,” Ankenmann said. “I was indoctrinated at a very early age. I always knew I was going to be a nurse. I can’t imagine doing anything else.”

Ankenmann is the daughter of a nurse. Her mother’s friends, many of whom were more like family, also worked as nurses.

As a child, Ankenmann learned the importance of washing her hands and keeping things clean and orderly. She also learned to put others before herself and to not pass judgment on any person — good or bad.

She remembers her mother wore a cape and cap to work. She worked as an Operating Room nurse, and Ankenmann recalls her mother having a glass syringe and a sharpening stone. Before disposable equipment became common practice, nurses and doctors were responsible for the sterilization and maintenance of tools, like syringes and needles.

“Things were very different back then,” Ankenmann said.

In addition to managing the nursing programs at Napa Valley College, Ankenmann also works as a part-time nurse practitioner. She said her passion for nursing extends beyond the parameters of her work life.

“It’s not just your career,” she said. “It becomes part of who you are.”

Not for the weak of heart (or stomach)

Let’s face it: Nurses have to handle gross, nasty stuff. Most nurses interviewed for this story spoke frankly about bodily functions like blood, mucus, vomit, and, as one nurse put it, “the squirts.”

“We can’t make this stuff up. There are horrific body fluids we have to deal with,” Brown Sims said. “It’s part of who we are as humans, and it, too, washes off.”

Good hand hygiene is essential.

“Be prepared to change your scrubs,” Brown Sims said. “And put on your splash guards.”

While a sense of humor (and, perhaps, a strong stomach) help many nurses get through the day, some of the most important qualities for the profession are compassion, empathy, patience, and resilience.

“We care for people in their most vulnerable state,” Brown Sims said.

Every patient deserves “tenderness,” she said.

Even with the best intentions, there are days — like any other job — when the challenges pile up and the work becomes draining.

“You can plan your whole day out perfectly, but stuff changes in a minute,” said Jill Ford, a registered nurse, who works in Queen of the Valley’s telemetry unit, which monitors patients’ heart function.

Waiting for test results or facing a daunting diagnosis can bring a patient’s anxieties and fears to the forefront. Under such stressful circumstances, some patients are difficult to work with.

“When people don’t feel well, they’re not always the nicest and kindest,” Ford said.

This is where compassion, empathy, and a calm demeanor play an important role, she said.

“A nurse needs to have awareness and be able not to take things personally when a patient expresses an emotion such as anger,” said Claudia Provedor, a registered nurse and nurse supervisor for OLE Health. “It is usually not a personal issue against the nurse, but probably involves many other factors of their (patient’s) life.”

Nyna Vo works as a psychiatric nurse in the Senior Behavioral Health unit at Adventist Health St. Helena, formerly known as St. Helena Hospital, and some of her patients have little to no insight into their own mental health.

“Some of the patients are non-compliant with their treatment, which can be detrimental to their well being,” Vo said. “Though working on a mental health unit can be rewarding, non-compliance is a big challenge when providing care as it can be mentally and emotionally draining.”

Despite the challenges, Vo said her favorite part of the job is building rapport with her patients.

“I think it’s a privilege to be able to work with a vulnerable population and to have them trust me with their care ...” Vo said. “It’s rewarding and fulfilling to see the improvements and progress in patients on the Senior Behavioral Health Unit.”

Sacred moments

Jill Ford became interested in nursing later in life, after her best friend’s mom was diagnosed with cancer and ended up in hospice care. She helped feed her ice chips and assisted whenever she could at her bedside.

“I felt compelled to help,” Ford said.

In Queen of the Valley’s telemetry unit, Ford works with patients who need heart monitoring.

With Napa being a small community, Ford said it’s not uncommon for patients to recognize her outside of the hospital, give her a hug, and say how much they appreciated her care. She describes these moments as one of the greatest joys of her career.

“You’re riding this roller coaster with them (patients),” Ford said. “You’re bonding with these people on a different level.”

Jonathan Garza, a registered nurse and the heart and vascular unit manager at Adventist Health St. Helena, was inspired to become a nurse during high school. His two older brothers were in nursing school, urging Garza to follow in their footsteps.

“Around that same time, my grandfather, who suffered from crippling Parkinson’s disease, moved in with our family and I took care of him after school every day. I helped bathe him, I took him to the bathroom, helped him walk around the house as best he could,” Garza said.

His grandfather had also developed dementia. One night, as Garza was tucking him into bed, he grabbed his grandson’s arm and told him how thankful he was for all of his help.

“That was a really special moment – one I’ve always kept close to my heart,” Garza said. “My grandpa passed just before the end of that school year, but the experience of caring for him stayed with me and ultimately informed my decision to apply to nursing school here in Napa Valley at Pacific Union College.”

Many nurses interviewed talked about the “gifts” or “sacred moments” they get to share with patients.

“It’s the ‘gift’ of other people,” Ankenmann said. “People share things with you. It’s a significant reward to nursing.”

Before working in executive leadership at Queen of the Valley, Brown Sims worked with premature infants in a Neonatal ICU. She still receives cards, she said, from families thanking her for helping their children, who have now grown into adults.

“I’m eternally grateful for those miracle moments,” Brown Sims said. “Every time a child was born, it was a miracle. I was blessed to be a part of that experience with a family.”



Like mother, like daughter

Jessica Hernandez always had a strong desire to help others, but the admiration she had for her mother, who works as a labor and delivery nurse, was her biggest motivator.

“In my youth, she would come home and rejoice in what a wonderful, blessed night she had witnessing a baby being born into the world,” Hernandez said. “My mom was the utmost inspiration to me as I grew up. I saw her work ethic, commitment, determination, and most importantly her dedication to her patients.”

Her mother, Regina Orozco, always loved science, but as a mom to three young children, spending years in medical school was out of the question. Attending a nursing program was a much better fit.

“I absolutely love my career,” Orozco said. “I’m glad I didn’t choose to become a physician.”

Orozco has worked as a registered nurse for 15 years. She specializes in labor and delivery and currently works at the Kaiser hospital in Santa Rosa. Orozco is also a nursing professor at Napa Valley College, where she has worked for 12 years.

“It’s funny, my whole life my mom told me to never become a nurse,” Orozco said.

Back then, a nurse’s role was to follow orders and do a lot of cleaning. Nurses weren’t expected to use critical thinking skills, Orozco said.

“It’s grown into a profession,” she said.

Orozco is currently working on her Ph.D. at UC Davis, where she is studying Nursing Science and Healthcare Leadership with a focus on nursing education.

As a labor and delivery nurse, Orozco said she enjoys the one-on-one connection with expectant moms and the positive difference she can make during their hospital stay.

Some women are scared, either because it’s their first child, or their previous birthing experience was “terrible,” she said.

“I’m here to keep you safe,” Orozco said.

Orozco’s job does not end after a baby is born. Some mothers have difficulty breastfeeding. Some have emotional struggles or lack family support. As a nurse, Orozco said she works hard to provide the physical and emotional care women and their babies need.

The goal, she said, is “healthy mom, healthy baby.”

Hernandez remembers as a child joining her mother at work and admiring the rapport her mother had with patients.

“She made her job seem so effortless and her patients would look to her as if she had all the answers, and to me, she did have all the answers,” Hernandez said. “That is when I knew I wanted to follow in her footsteps.”

About 10 years ago, Orozco suffered a serious medical problem that put her in the ICU.

“From the moment we got to the hospital, the nurses were at our side updating and explaining everything to my family and me,” Hernandez said. “They encouraged us to participate in her care, so we could give her the positive energy she needed to survive.”

Hernandez recalls the experience as “overwhelming,” but the uncertainties and fears her family faced were eased by the ICU staff.

“They were so calm, so organized, so smart — they made their job seem effortless, and now I knew I wanted to take part in that area of specialty and be a nurse just like them,” Hernandez said.

Today, as a critical care nurse, Hernandez works alongside some of those same nurses who helped her mother. Becoming one of their colleagues, Hernandez said, is a “privilege and honor.”



Social media and healthcare

Before becoming a nurse at Queen of the Valley, Jill Ford worked in the hotel industry in Sonoma County for about 15 years and also spent about six years as a nanny. She credits her customer service experience and working closely with families as excellent preparation for nursing.

“It taught me how to manage a work environment, while also being in someone’s intimate space,” Ford said, adding that she’d “be a different nurse” if she hadn’t gained those customer service skills first.

Ford said that the future of healthcare should be more customer service-driven. Most people have a choice of where they receive healthcare, she said. People talk about their experiences, and that impacts how a community views an organization.

“In the social media world, people can tweet their experience at their bedside,” she said.

Every interaction with a patient or their family members has the potential to become a social media conversation, Brown Sims said.

“The public turns to social media even more than surfing the web now,” she said.

To enhance a patient’s experience, many in the nursing profession say they believe that nurses need to be given more decision-making power.

One of the biggest challenges of the nursing profession, Orozco said, are the guidelines and restrictions that give nurses less autonomy. It’s an awkward position for nurses when they have the professional knowledge to know what is right, but they don’t actually have the authority to make those decisions, Orozco said.

Brown Sims agreed that it’s important to give nurses a voice and allow them to share their knowledge — especially if it can lead to better health outcomes.

“If you have experts, which all of our nurses are, give them an avenue: Is there a better way to do what we’re doing in a safe manner?” she said.

For hospital executives, Brown Sims said the key to success is to hire “the best of the best and empower them.”

“If you empower the frontline staff, you typically get better results,” she said.



Caring for the “whole person”

Caring for the “whole person” is an expression often used in healthcare. But what does it mean?

“As you know, us humans are a complex species – we are layered like onions! We all have mental, spiritual, and emotional needs beyond what our physical bodies need,” said Garza at Adventist Health St. Helena.

Garza has worked in the hospital’s Heart and Vascular unit for more than 10 years.

A patient admitted for atrial fibrillation or heart failure may need new medications or a procedure to restore their normal heart rhythm, and hospitals can provide those services “very easily,” Garza said.

“But making that human connection with these patients – sitting with them, listening to their stories, praying with them, holding their hands – that is how nurses care for the whole person,” he said.

The skills needed to “care for the whole person” often come with maturity and job experience, Brown Sims said.

New nurses, particularly those who are younger and have grown up with technology, are more “task-oriented” — more concerned with checking off the boxes than checking in with a patient on a more personal, emotional level, she said.

Task-oriented, or “transactional care,” as Browns Sims calls it, is more likely to lead to burn-out, she said.

But as new nurses mature in their profession, they often learn how to be more interactive with patients and how to create better relationships. It can be as simple as shaking hands and making eye contact, Brown Sims said.

“It gives the patient that immediate dignity and respect,” she said.

Garza agreed that nurses need to approach every patient with kindness and understanding because it’s “never anyone’s best day” when they’re hospitalized.

“Every person who comes in deserves compassion and caring,” he said. “Sometimes patients just want a listening ear to tell stories to. Others just need a squeeze of their hand or a kind smile.”

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