Nurse Activists Strive for Change
Four nurses make activism a part of their nursing practice.

By Cathryn Domrose
April 25, 2005

Activism has been a part of Sally Mata’s life for almost as long as the San Jose, Calif., RN can remember. In 1954, labor leader Cesar Chavez — who would later bring international attention to the plight of migrant farm workers — helped her father, a Mexican immigrant, return to Mexico to get documents allowing him to become a U.S. citizen and hold skilled, higher-paying government contract jobs. When her father asked how he could return the favor, Chavez told him to “pass on the generosity to other people, and when you see anyone who needs help, help them,” says Mata, president of the Greater San Jose Chapter of the National Association of Hispanic Nurses (NAHN) and senior staff nurse and consultant at the Gardner Family Health Network, which serves low-income families and undocumented immigrants in San Jose. “That’s how we keep it strong.”

Nurses have been activists since medieval times, when members of religious and secular nursing orders looked after lepers, orphaned children, and poor men and women whose families couldn’t or wouldn’t care for them. Nurse activists of previous centuries, including Florence Nightingale, Dorothea Dix, and Margaret Sanger, pushed for and achieved tremendous health care improvements in their lifetimes.

In these days of heavy workloads, increasingly sicker patients and the demands of balancing work and family lives, many nurses find it hard to get through a work week, much less push for change or look for ways to give back to their communities.

But some seem to hear a call so strong that they cannot resist. These nurse activists don’t consider themselves special or heroic. They see their work — educating people about child abuse, providing a safe environment for patients who have been sexually assaulted, working to increase childhood immunizations in their community — as something they must do for those in need.

Chavez’s philosophy has stayed with Mata throughout her nursing career. She helped set up diabetes education programs for low-income families and undocumented migrant workers; she still teaches diabetes education classes as a volunteer. Mata has flown to Mexico with an international medical organization to work in village clinics. She has joined neighborhood residents protesting a hospital closure in a low-income neighborhood. As part of her work with NAHN, she has helped create scholarship programs and educational support for Latino nurses.

Few such programs existed when she was struggling to get through nursing school in the 1970s as a young, recently divorced woman, she says. “In those days, there wasn’t any help for girls anywhere,” she says. When she joined NAHN — then called the Association of Chicana-Latina Nurses — she met the women who would shape her life as an activist.

“I thought, ‘Why couldn’t I have found something like this when I was going to school?’” she says. Now Mata proudly lists her group’s success stories, such as the single mother in her 40s from a poor rural Mexican family attending nursing school with NAHN support. “I want people to know there’s help out there,” she says. “They shouldn’t give up.”

Change takes persistence

Twenty-eight years ago, Anita Ruiz-Contreras, RN, MSN, CEN, MICN, SANE-A, rode in an ambulance with a young girl who had been raped, beaten, and shot. It was her first experience with sexual assault, and she never forgot it.

“She was somebody I could have known,” says Ruiz-Contreras, who was 20 at the time. Ruiz-Contreras is now ED staff developer for the Santa Clara Valley Health and Hospital System.

As an ED nurse at Santa Clara Valley, she frequently saw at least one patient a night (and often more) who had been sexually assaulted. Though her heart went out to them, Ruiz-Contreras felt she never had much time to talk during examinations or forensic evidence collection. She had other patients, with serious burns or severe trauma, who also needed her attention.

Patients who had been sexually assaulted had to wait alone or with the police for physicians to examine them, often getting passed from staff member to staff member and forced to answer the same painful questions over and over, she says. “They used to say that the hospital examination could be almost like a re-rape situation.”

In 1983, she read an article about nurse-led sexual assault response teams (SART) in Texas. Nurses performed examinations, collected evidence and offered information on sexually transmitted diseases and pregnancy prevention to patients. Patients were treated with dignity and respect. She wrote a proposal to create a similar program at her hospital. Four years later, after changes in state law mandated coordinated care for sexual assault survivors, hospital administrators gave approval for creation of a SART program, which became a model for others in the area.

Now, on-call nurses work in teams with advocates from a local rape crisis center. Patients who have been sexually assaulted are never left alone. Though the nurses can’t change what has happened to patients, Ruiz-Contreras says, they can now help keep the patients from feeling even worse.

During the four years of researching, writing proposals, and repeatedly taking her plans to administrators, Ruiz-Contreras says she never got discouraged. “I just thought it was going to happen at some time,” she says, “and I kept on going.”

Creating change is not easy, she says, especially in the wake of harsh economic situations that have caused many hospitals to tighten their budgets. “I think there are ideas out there, but people are not sure what the next step is. We’re not doing extra things now. We’re doing what we can to survive.”

But that’s all the more reason to work for change, she says. “I always think you should keep on trying.”

Needed: Community partners

When she became director of student health services for Children’s Hospital/ Austin Independent School District in 1997, Judy Frederick, RN, immediately realized she had to do something about immunization rates. Texas had one of the lowest childhood immunization rates in the country, she says, and areas of the Austin school district had rates much lower than acceptable.

Frederick began by redesigning a system for collecting and managing immunization records. She worked with school administrators to tell parents that if their children did not follow state immunization requirements, they would be sent home from school. She and school officials held press conferences with Austin’s mayor to announce that schools would comply with state immunization regulations.

But when parents came to her saying that they couldn’t get appointments to have their children immunized, she realized that boosting immunization rates would take more than her efforts alone.

Supported by administrators at Children’s Hospital, she worked to organize a community collaboration of all who had an interest in childhood immunizations —public and private health care providers, firefighters, school officials, state health department officials, and EMS personnel. She became the group’s facilitator.

At its meetings, Frederick discovered immunization services in the area were fractured and uncoordinated. Physicians often referred patients to public health clinics because of reimbursement problems. At the clinics, two nurses gave shots mostly by appointment only. Private and public clinics gave immunizations only to their own patients. People without insurance or who came from outside the country often had nowhere to go.

Frederick’s group began looking at ways to make immunization more accessible. Firefighters and emergency service workers started offering clinics. The Children’s Hospital pediatric van, which travels from school to school, now offers immunization. Public and private clinics have geared up to increase immunizations during the summer, when parents enroll their children. Parents receive detailed calendars explaining where and when they can get their children vaccinated. An extensive advertising campaign has also raised awareness about the need for immunization and where to get shots.

Immunization rates in the district are now 95%, and many areas have 99% and 100% compliance, Frederick says.

But more needs to be done, she says. The group is working with the statewide Texas Immunization Partners to get an increase in the reimbursement rate for childhood immunizations and a law that would make sure schools did not get penalized financially for sending home children who did not have proper immunization documentation.

The improvements in immunization rates could not have happened without cooperation from community partners, Frederick says. “Fifteen different entities came together and realized that immunization is important, but none of us can do it alone,” she says. “It’s truly a community effort. Our mission is to advocate for each individual child and not rest until every barrier to optimal health is removed.”

Standing up for one’s beliefs

Pamela Rowse, RN, a quality care consultant for Saint Rose Dominican Hospitals in Henderson, Nev., had been active in nursing issues for many years. But in 1997, a family tragedy pushed her to the forefront of an education campaign to prevent what was then a little-known form of child abuse — shaken baby syndrome.

Her 14-month-old granddaughter, Kierra, was killed by a licensed day care provider who shook her. The provider had received her license in spite of previous child abuse charges, says Rowse.

Rowse decided to use her training and education as a nurse to protect other children and parents from shaken baby syndrome. Through the Kierra Harrison Foundation for Child Safety, she began working to teach health care providers, law enforcement officials, social workers, and anyone else in contact with children how to recognize shaken baby syndrome. She’s worked with prosecutors in trials involving deaths and injuries of shaken babies.

Rowse teaches high school classes about child abuse and shaken baby syndrome. She gives workshops for nurses about how to recognize and report it. She has pushed for state-guided regulations for child care facilities.

Almost three years ago, she founded the National Shaken Baby Syndrome Coalition, a support group for families. Last year she attended the first North American shaken baby syndrome conference in Montreal as a representative of the coalition.

Babies who are shaken don’t look like abused children, she says. They have no bruises or cuts or other signs of abuse, but they have severe head trauma that can cause brain damage and death. This is why nurses and other health care providers need to know how to ask the right questions, she says.

Until three or four years ago, many nurses and physicians had never heard of shaken baby syndrome, says Rowse. She herself had never heard of it until Kierra’s death. Her ignorance still haunts her as she wonders how many cases she might have missed as an ED nurse.

“I think about it all the time — that there were things that I missed,” she says. “But I just didn’t know. I should have known, but nobody ever talked about shaken baby syndrome.”

As awareness of the syndrome grows, Rowse hopes, incidents will drop as dramatically as those of sudden infant death syndrome did when people became aware of SIDS and took steps to prevent it. But, adds Rowse, “Nurses have to stand up and say to a physician or an administrator or even their nurse manager, ‘This is where we need to go.’ Unless nurses work together, change is not going to happen.”

Get active

Nurse activists have these suggestions for getting involved:

• Join an association. Nursing associations are great resources for ideas, networking, and sharing concerns and solutions. They also provide important moral support.
• Put your ideas in writing. Having a written proposal shows you have researched a problem and thought about solutions. Supervisors and managers are more likely to take your suggestions seriously if you have put obvious work into them.
• Be persistent. Changing people’s minds can take years. Don’t be discouraged by the first “no’s” and “we can’ts.”
• Build community alliances. Human rights groups, crisis centers, parents, educators, social workers, and law enforcement officials can be good allies. They will welcome the expertise of a nurse, and you will be able to show your cause is important to a wide range of people.
• Pay attention to new legislation. Often changes in laws will spur administrators or local officials to action on problems they previously ignored or put off.

Cathryn Domrose is a senior staff writer for NurseWeek.