A Nurse’s Journey

by Sam Romero

Spring 2004

Nothing in Marcia Raines’ speech or demeanor would have hinted that today was different from any other. She was collecting mid-terms from her nursing students, and the subjects on the table for this class were “toxic” mentors, the perils of being a nurse who works wherever he or she is needed (what the profession calls “floating”) and the relationship between novice and expert. Why should today be different? Reality, while certainly daunting at times, wasn’t all-powerful or all-consuming all of the time, and the reality was, for Marcia, that she drew energy from being engaged.

It all fit perfectly. Her work as chair for Cal State San Bernardino’s nursing department, a post she assumed in 1999, kept her as busy as anyone in the two-county area of San Bernardino and Riverside. Like many healthcare leaders around the country, she was wrestling with nursing shortages, the search for qualified nurses, the need to improve local healthcare. Since becoming chair she had also implemented the Earlier the Better program to improve children’s health in the region. She garnered funding from San Bernardino Community Hospital, St. Bernardine Medical Center and Riverside Community Hospital to hire more faculty, and she secured support from these and other area hospitals to bring baccalaureate nursing students into their clinical settings for training.

With assistance from other faculty in her department, she also succeeded in raising enrollment in the RN- to-BSN nursing program from 180 students three years ago to 265 students last winter quarter. And this fall her department will introduce the first three online courses in a series of 10 for students in the Coachella Valley.

Her energy and activity was enough to impress the Robert Wood Johnson Foundation’s Executive Nurse Fellowship Program, which named Marcia one of its new fellows two years ago. “We see them as significant leaders in the field,” says Mary Dickow, associate director for the program. Only 20 applicants, who come from throughout the country, are named fellows each year by the foundation, the nation’s largest philanthropic organization dedicated to healthcare.

Still, in December of last year, the reality for Marcia also was that, after holding finals, posting grades and with the holiday season running at full tilt, she needed to take time for the doctor. The visit was routine, a visit long overdue, and during it the doctor “noticed something.” He ordered tests. When the results came back, they revealed both endometrial and cervical cancer. The news didn’t entirely surprise Marcia. “From family history,” she says, “I thought I might have to deal with this, but I didn’t expect it to hit in my mid-50s.”

Marcia’s surprise at her diagnosis, however, was inherently different from the sudden jolt she felt one day back in high school, an experience that set the machinery in motion on her nursing career. World events had already begun to rough-cut Marcia’s future by the age of 10. The launch in 1957 by the Russians of the basketball-sized Sputnik, the first artificial satellite to orbit Earth, sent her flying into every math and science class she could take in junior high school. At Barstow High School she took and loved physics labs and joined the Mathletes team. Following the assassinations of John F. and Robert F. Kennedy and Martin Luther King Jr., Marcia leaned toward work that also embraced the human side. But the pivotal event came in 1965. The oldest of three children, she had just graduated from Barstow High when her sister, only 16, died after going into a diabetic coma. “I was so struck by the loss of my sister from a disease that should have been diagnosed and treated,” Marcia says, “that I immediately reacted by planning to do something that would prevent other young people from losing their lives in such an avoidable way.”

Assisted by a University of California Regents Scholarship, Marcia enrolled as a pre-med student at the University of California, Riverside, then transferred to the nursing school at UCLA. There she camped for 25 years, first as a nursing student, then as a children’s psychiatric nurse with the Neuropsychiatric Institute, and finally as the mental health clinical nurse specialist at the UCLA Medical Center.

Those Bruin days were the days of plump budgets and greater specialization. When Marcia speaks of them, they almost sound apocryphal. “Believe it or not, there were 35 clinical nurse specialists at UCLA at that time,” she says, nostalgic at the thought of so many co-workers with master’s degrees in pediatrics and respiratory care and obstetrics.

“I mean, there were 35 of these wonderful people. We used each other as consultants. We were very proud to improve the quality of care … Those kinds of positions are hard to come by now because of the cutbacks in healthcare,” she says, and adds that hospitals only receive 70 cents on the dollar for what it costs to treat a patient.

“I realize now, being in academia as a chairperson, that to help our students be prepared to work in a healthcare environment where those kinds of resources may not be available, they have to be a little more independent. They have to use their own judgment, because those kinds of backup consultants – expert nurses – are not always available in today’s healthcare settings. So it’s a challenge for people like myself, in my generation as a nurse, to help our new, young generation of nurses feel as good about healthcare -- about their role in nursing -- as we felt back then.”

In fact, what Marcia’s generation had back then were more mentors (not of the “toxic” sort she was discussing with her class) and good expert-and-novice relationships. The connections, Marcia believes, go to the heart of what new nurses understand least about nursing now. Six, seven, eight months into their new profession some graduates come to her – distressed – saying they’re not ready for some of the responsibility they’ve been handed, or lack the experienced support or resources they need to handle the responsibility.

Preparing qualified nurses who can think more independently is the new reality. In Southern California, easily one of the most -- if not the most – culturally mixed regions in the U.S., there is the added need for qualified health professionals who reflect and understood the traditions or issues unique to those different groups. That’s true, too, of the nurses the university is training. The university’s goal, says Marcia, is to address the issues that arise in a program as diverse as CSUSB’s nursing program.

Another goal is to increase the number of nurses who stay in the area and work after they graduate, says Laurie (sp?) Rogers-Eberst, chief nurse officer at St. Bernardine Medical Center. She serves on the hospital’s board of directors with Marcia, and after many talks with her husband, Richard Eberst, a CSUSB health science professor, about the difficulty in finding more highly trained nurses, he then talked to Marcia, who called Laurie. From that conversation eventually came the initial monies from St. Bernardine and San Bernardino Community Hospital to hire new faculty.

“Marcia’s truly committed to San Bernardino and truly committed to our nursing program,” says Laurie, who adds that Marcia knows what the area needs. “I feel very devoted to helping meet the healthcare needs of the people in San Bernardino County and the inland region,” Marcia says. She’s pondering the issues from two fundamental angles – both as a nurse and now as a patient. “After hearing those words something inside changes,” she says of her doctor’s diagnosis. “It’s like a door opens and you see things in a different light. It’s a different level of understanding.” Talking about the cancer doesn’t embarrass or frighten her. “I’m a nurse. I deal with illness. I don’t think it’s a sin to be ill.” Nor is it sin to fear, and she has a good notion on how to parry it.

“The people who were most positive about their outcomes were those who remained active in their families and who had a purpose in their lives. … It’s kind of a spiritual support system,” a system which, in Marcia’s case, consists of her own family, her own vision for the CSUSB nursing department and for community health as a whole, and now the 2,000-3,000 cancer patients she worked with over her 20 years at UCLA. “I often reflect on my sister’s death, what she would have done in her life. I hope she is pleased with the work her too-early death pushed me to consider.”