The letter from an old box of personal things was dated 1967 and addressed to “My Little Nurse.” It was from Margaret Potvin, RN, seven years before she died at age 82 in Vermont.

Potvin’s daughter, Teresa Simonella, was an RN, and “My Little Nurse” was Simonella’s daughter, Potvin’s granddaughter, Philomena Simonella. Little did 11-year-old Philomena know that grandma’s letter was prophetic: that she, too, would become a nurse.

One family, three generations of RNs, beginning with Potvin in 1946.

Their careers, Potvin’s in Vermont, Teresa Simonella’s in New Hampshire and Philomena Simonella’s in Southern California, are a testimony to more than 50 years of changes in nursing and society.

Technology, of course, stands out for Philomena Simonella, RN, who was certified in obstetrics with Kaiser Permanente in 1983 and worked with high-risk pregnancies, preterm labors and multiple births. The 45-year-old Channel Islands Harbor, Calif., nurse is an independent contractor, still working in labor and delivery as well as in the operating room and with plastic surgeons.

“I hate to say gadgetry,” Simonella said of computerization, electronic monitoring systems and high-tech infusion pumps. But she said her mother, who retired in 1985, observed that in today’s hospitals, “you have to be part engineer and part nurse.”

Simonella also said medications are more sophisticated than they were a generation ago. “Just a minor variation could be a fatal dose.” And they’re administered to a more acutely ill population. “Patients are a lot sicker and they stay [for a much] shorter period of time,” she said.

Patients who would have been admitted to the hospital the night before surgery and given a sleeping pill in her mother’s day now come in at 5 a.m. with their lab work already done, or they have outpatient surgery, Simonella said. “There’s a lot more responsibility put on the family or the caregiver to look after the patients now.”

Simonella said her mother spent the majority of her career after 1965 as a private-duty nurse, working in home care through a nurse-run registry or assigned by a physician to the care of a single hospitalized patient.

“It was really kind of cool … an independent nursing thing that kind of fell by the wayside,” Simonella said of her mother’s practice. “What she would do is continue to take care of the same patient until the patient was either well or the patient passed away. She would work 3 to 11 every single day until the case was no longer active. If she wanted a day off, she’d have to get somebody to cover for her. But all the nurses kind of knew each other because they were local.”

Simonella graduated from the nursing diploma program at Catholic Medical Center in Manchester, N.H., the same nursing school her mother attended as Sacred Heart, before the merger of two small Catholic hospitals.

Simonella recalled her mother’s graduation story in which the physician who addressed the class of new RNs told them that he may not remember their names but that they were free to call on him if they needed help professionally or personally. The physician made good on the invitation when Simonella’s mother called him in Boston for a last-minute second opinion that ultimately saved Simonella’s grandmother’s leg from amputation for diabetes.

“My mom would never, ever, ask for anything for herself, but anything for her mom,” Simonella said.

She said her mother encouraged her to further her education but toward no particular career. It was the nurturing environment in which she was reared, including helping care for her grandmother, that made nursing a logical choice, she said. Besides, nursing met all of Simonella’s requirements: a hands-on career in which she could work with people, work almost anywhere and express herself.

Because she was so young at the time, Simonella said she doesn’t know much about her grandmother’s career, other than that she became an RN in 1946 in Shelburne, Vt., and that she had been a widow for about six years with eight children to care for. One story Simonella does have, via her mother who was the youngest of the eight, goes to a time when the fabric of communities was much more close-knit than today.
She said her grandmother worked private cases to take care of the family. And among her long-term patients was an elderly Burlington, Vt., man.

“My grandmother was worried about her house, about getting storm windows on her house, which was out in the country,” Simonella said. But the man kept insisting, “Oh, Mrs. Potvin, you don’t need to worry about that really.”

“Come to find out, all along he had planned on leaving her [his] house,” which he did, Simonella said. “I think back in the olden days, people tended to care or look after each other more.”

Nursing, though, is one place where the ethic of advocacy—looking out for others—has survived.

“I still enjoy my patient care,” Simonella said. For herself and others, she said, “I think what I would really focus on is: Do what’s right for the patients. Always stand by your patients’ needs and wants. Be the patients’ advocate more than anything.”