Once a nurse always a nurse? "I believe that wholeheartedly," said Jacqueline Bolda, RN, who realized within a few years of graduating from the South Chicago Community Hospital School of Nursing that the profession can consume a life, if you let it.

"I absolutely loved what I did," she said of her years as a med/surg and orthopedic nurse, both in Chicago and as a traveler. "It might have been frustrating and very tiring. The hours weren't that great, but I loved it. I'm just a firm believer in caregiving."

For the most part, though, caregiving didn't extend to herself. And Bolda, 41, sensed she had a standing invitation to burnout.

"The rest of my life outside my career did not exist," she said. "It was difficult having continuity, lunches or relationships when I was switching between two weeks of midnights and two weeks of days," or other rotating shifts. "It was impossible to cultivate any kind of care for myself, where I felt nourished and supported."

To ward off burnout, Bolda, of Lansing, Ill., turned to pen and paper before the era of personal computers. She found herself to be the only adult in a weekly class at a local art center, and she changed the focus of her nursing practice.

"I like … handwriting. It's like a release," Bolda said of journaling, which is her outlet for the emotional and physical stress of nursing. Among the writings she has revisited for inspiration is the story of Susan, a 17-year-old prom-night car accident victim who came to Bolda in 1988 in the midst of a four-month assignment in Hartford, Conn.

"No one volunteered a commitment to take on Susan as her primary nurse," Bolda wrote. "She was overwhelming on paper. Then something inside me said, 'Jackie, go for it.' This little shell of a girl who had been isolated and cocooned for over a month came to me like a sack of potatoes. She didn't want to leave the noisy comfort of the ICU. She was terrified and grossly deconditioned, disfigured from the trach and limb amputation. …

"She told me to 'Go away.' … From that moment, we were both 'on' for the challenge of our lives. … We negotiated and bartered for lengths of time she was to sit in the wheelchair. … When she took the initiative to propel her wheelchair away from me down the hall to investigate her surroundings and the unit, I stood back and watched her go as the tears streamed down my face. [Susan] wanted to explore and she wanted to do it without me. Maybe in spite of me. …

"Sitting outside with her, she told me she wanted to go home. There! I had it, right from her mouth-leverage to motivate her to really take on her recovery. It was 'Let's make a deal' time. …

"My contract with the hospital ended one week prior to her discharge. She had a paralyzed vocal cord and just a whisper of a voice. When we were saying our goodbyes, Susan smiled and told me that when she could talk again she would call me on the phone and swear at me. I loved it! True affirmation from a teenager who got her spunk back. I told her to 'Please call me-I'll teach you how to swear!' "

Bolda said she's never had a vision of being published, but she believes that in every person, Susan and herself included, there is a book.

"I can only speak for myself, but I had to cultivate an outside life," Bolda said. "I found myself looking for experiences I'd never done before. Some people love horseback riding and other people love ceramics and painting." She said her pearl of wisdom for nurses is "Just find something to do that is not work, that is nurturing."

Besides writing, the creativity of cartooning filled the bill for Bolda. She was a 30-something adult, the only grown-up in a classroom of 10-year-olds learning to cartoon. While the kids were wonderfully talented in creating warriors and superheroes, Bolda said she was drawn more to bubbly, lighthearted caricatures.

Asked about the possibility of a nursing-themed comic strip, she said her career has shown her both humor and tenderness so that she can envision a panel along the lines of the popular "Love Is ..."

Bolda also moved her nursing career to the insurance industry and away from hospital rotating shifts. Nine years ago, she began performing utilization review for a Chicago company that handles self-fund insurance plans. She now assesses claims and appeals, working to cut red tape and secure cost-effective treatment for patients.

For instance, when a patient may benefit from experimental or investigational treatment, such as a transplant that is not covered by an employer's self-funded managed care plan, she often negotiates for coverage, asking employers to apply health care dollars that would be authorized for more conservative treatment.

"I always find it interesting when people say 'Oh, you're not in nursing anymore,' " Bolda said. "I always use my knowledge. Just because it's not bedside care doesn't mean it's not nursing."

To keep her fingers in direct care, though, she returned to school a couple of years ago and became a certified massage therapist. She benefits, as well as family, friends and co-workers. "I get something out of hands-on healing," Bolda said, "and they are getting something out of it as far as feeling that they're cared for and nurtured."

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