Fear no evil

Obituaries highlight work of nursing leaders Liz Scanlan Trump and Vernice Ferguson

December 21, 2012 -- Recent obituaries for two extraordinary nursing leaders show how far nursing has come in the last half-century and, to some extent, how far it has yet to go. On June 9, the Baltimore Sun published Frederick Rasmussen's long, generally good obituary for Elizabeth Scanlan Trump, the co-founder and longtime nursing director of the University of Maryland's Shock Trauma Center, arguably the finest trauma center in the world. The piece portrays Scanlan Trump as "the first trauma nurse" and as the driven "full partner" of the pioneering trauma surgeon R Adams Cowley. Cowley is generally given sole credit for founding the Trauma Center. The piece has good quotes from the Trauma Center's current heads of nursing and medicine, as well as from Cowley's widow. They make clear that Scanlan Trump was a remarkable nurse who fought to establish the Trauma Center and to improve nursing education, though we could have used more detail on that and Trump's role as a nurse manager. The obituary also has a couple bits of handmaiden imagery that are especially unfortunate for a piece about someone so fierce. We noticed that the Trauma Center bears Cowley's name alone, though the obituary suggests that Scanlan Trump effectively co-founded it. We reached out to the chief nursing officer of the University of Maryland Medical Center and the Vice President of Nursing of the Shock Trauma Center and suggested that the hospital consider adding Scanlan-Trump's name. In a cordial meeting, CNO Lisa Rowen, RN, DNSc, and Shock Trauma VP of Nursing and Operations Karen Doyle, RN, MS, MBA, persuaded us that Scanlan-Trump's contributions, though great, did not merit that recognition in terms of trauma care innovation. However, the nursing leaders did agree to take other permanent steps to highlight Scanlan Trump's contributions to nursing, including naming one of the conference rooms in Shock Trauma's new trauma tower after her. And today, the New York Times ran a shorter but very good obituary by Daniel Slotnick for Vernice Ferguson. She "fought for greater opportunities, higher wages and more respect for nurses as a longtime chief nursing officer" of what became the U.S. Department of Veteran Affairs (VA), supervising more than 60,000 nurses. When Ferguson left in 1992, after 12 years, the number of VA nurses with at least a bachelor's degree had more than doubled. Ferguson's nursing career required a bit of drive as well. When the African-American graduated from the nursing program at New York University in 1950 with an academic prize, the director of nursing reportedly refused to shake her hand. The piece has several telling quotes from Ferguson, and it effectively conveys the male-physician-dominated environment that Ferguson worked hard to change. The item also notes that Ferguson conducted and supervised nursing research, including at the National Institutes of Health; we could have used more detail on those aspects of her career. But on the whole, both obituaries are powerful reminders that nurses can better their profession--and the world.

The first trauma nurse: Liz Scanlan Trump

Whatever the boys have: Vernice Ferguson
 

The first trauma nurse

Frederick Rasmussen's June 9, 2012 obituary in the Baltimore Sun is entitled "Elizabeth S. Trump: Longtime director of nurses at Maryland Shock Trauma Center worked closely with founder Dr. R Adams Cowley" The piece says says that Scanlan Trump "played a pivotal role in [Shock's Trauma's] establishment with Dr. R Adams Cowley more than 50 years ago." (That's not a typo--Cowley's given name was simply "R".) The obituary includes some background about the nursing leader, born Elizabeth Scanlan, who "was a fresh graduate of the St. Agnes Hospital School of Nursing when she came in 1957 to work at what is now the University of Maryland Medical Center, for Dr. Cowley, who was a pioneering thoracic and vascular surgeon performing open-heart surgeries." Actually, we hope Scanlan Trump was working "for" the senior nurses at the hospital, and ultimately for the patients, rather than for a physician. This is a common misperception by the media and the public, who may see nurses standing beside physicians in an operating room and assume the nurses are there simply to assist physicians. Nurses' real role is to provide autonomous nursing care, which includes advocating for patients and protecting them for any threat, including misguided physician care plans.

The piece notes that Cowley (right) believed, presumably in part because of his experience as a combat surgeon in World War II, that severely injured patients should be treated in the "golden hour" by "specially trained doctors and nurses [who] could save them in a uniquely equipped surgical unit and setting." Scanlan Trump reportedly shared that vision, and the piece says that "after grueling days on her feet in the operating room [she] spent hours writing grant proposals late into the night to help Dr. Cowley establish such a setting." The obituary says that "Dr. Cowley opened a two-bed research center called Clinical Shock-Trauma Unit in 1961," when "the survival rate of accident victims was only 40 percent." And "to distinguish trauma nurses from the hospital's regular nurses, Dr. Cowley had them wear pink scrubs, which has continued to the present." These passages make it sound like Scanlan Trump worked hard and accomplished a lot, but she and the other nurses basically reported to Cowley alone, right down to the clothes they wore. We realize this was the 1950's and 1960's, but even then we know that there were nurse managers. Isn't that what Scanlan Trump herself was?

Fortunately, the piece relies mainly on quotes from Cowley's widow and from the current chief nurse and chief physician at Shock Trauma, and these quotes show that Cowley and Scanlan Trump were true partners in pioneering trauma care. Thomas Scalea (right), Shock Trauma's current "physician-in-chief," offers a series of powerful encomiums:

Liz and R A. started and matured what is considered by everyone the most sophisticated trauma center in the United States, if not the world. . . She was the first trauma nurse, which is now a sub-specialty. They both had a remarkable vision and could not possibly have known what it would eventually become . . . Shock Trauma is Liz's legacy . . . R A. used to say, "Surgeons are a dime a dozen, but a good nurse, that is hard to find," and that was Liz." She never backed down and she knew the value of education. She set up a nursing education program in Maryland that was a huge accomplishment.

The "dime a dozen" quote is of course a compliment to Scanlan Trump, though it can also be taken to mean that most surgeons are at least OK, if nothing special, whereas most nurses are lousy, which is why finding a good one like Scanlan Trump is so remarkable. In any case, the remainder of the remarks portray Scanlan Trump as nothing less than a global leader in trauma care.

For more on Trump's leadership, the piece consults Karen E. Doyle, Shock Trauma's current vice president of nursing and operations.

Liz was the Mother of Trauma Nursing and now there is a cadre of trauma nurses across the world because of her. . . . She was driven, tenacious and tough and came from a time when nurses were handmaidens and subservient, but Dr. Cowley treated her as a full partner. She set the stage more than 40 years ago and was a true visionary. . . . Florence Nightingale wrote: "You ask me why I do not write something. . . . I think one's feelings waste themselves in words, they ought all to be distilled into actions and into actions that bring results." This personifies Liz Scanlan [Trump].

Doyle also said that Scanlan Trump was a "very private person who didn't like public recognition." That aversion fits well with nursing's traditional code of self-effacement, although it can also make it harder for the profession to get the resources and respect it needs. And of course, we can hardly fail to mention that apart from this obituary, Scanlan Trump does not seem to have been credited publicly very often for the founding of Shock Trauma or trauma care, judging by what we see online (including Cowley's obituary in the Baltimore Sun) and the name of Shock Trauma itself. Public recognition is rarely difficult for nurses to avoid.

The piece includes still more testimonials from Roberta Schwartz Cowley, the surgeon's widow, who "founded and was director of the communication sciences and disorders program at Shock Trauma." She too compares Scanlan Trump to Florence Nightingale, and notes that Cowley himself

gave all of the credit for the founding of Shock Trauma to Liz, and often said, "Without her, it would not have been." He said he could "never thank her enough for what she had done for him." … Liz believed in him and his vision at a time when the mortality rate was abysmal. She was his advocate.

A nurse advocating for a physician is not something we hear about too often; presumably, Scanlan Trump was primarily advocating for trauma patients by pushing forward the vision for the Trauma Center that she shared with Cowley. It certainly does sound like she was an effective advocate in putting together the grant proposals and pushing for creation of the Trauma Center.

A large part of the obituary covers the sometimes "tempestuous and argumentative" relations between Scanlan Trump and Cowley, who were both "strong personalities." Cowley referred to himself as a "son-of-a-bitch," albeit a "lovable" one, while his widow describes Scanlan Trump as "blunt to a fault." In a 1982 Sun interview, Scanlan Trump herself reportedly said that Cowley

can be very charming socially and in first impressions. Obviously he knows how to manipulate people. He couldn't have accomplished what he has otherwise. The people he likes and respects the most he'll have these yelling matches with. People he doesn't really respect he rarely raises his voice or reprimands.

Blunt, yes. After one such conflict with Cowley, Scanlan Trump apparently returned to her office to find a "gift" from Cowley on her wall reading: "Yea, though I walk through the valley of the shadow of death I will fear no evil. For I am the meanest son-of-a-bitch in the valley" (a General George Patton quote). These details may seem personal, but they suggest that Scanlan Trump was a tough person who stood up for herself despite coming from a time when nurses were considered "handmaidens."

The piece portrays Scanlan Trump as a globally influential pioneer in trauma nursing and trauma care generally, and as a full partner in the founding of Shock Trauma by Cowley's own account, even though Cowley generally seems to receive sole credit. Not all of the tributes are great; apart from the double-edged "dime a dozen" quote, the reference to Scanlan Trump as the "Mother of Trauma Nursing" reinforces the profession's traditional but unhelpful association with maternal imagery. And despite a couple suggestions that Scanlan Trump and the other Shock Trauma nurses were working "for" Cowley, there is also plenty here to show that she was far from a handmaiden. The piece might have benefited from more detail about what Scanlan Trump did in her years as the head of trauma nursing, beyond furthering the vision she and Cowley shared. Readers will not get the sense that she must have actually commanded a large number of skilled professional nurses at Shock Trauma, as opposed to mostly being Cowley's associate. Did Scanlan Trump help to empower her nurses relative to physicians? And what was the "nursing education program" that Scalea mentions?

In any case, despite these issues, the obituary has very helpful information about a remarkable nurse, and we thank Frederick Rasmussen and the Baltimore Sun.
 
  

Whatever the boys have

Daniel Slotnik's December 21, 2012 obituary in The New York Times "Vernice D. Ferguson, Leader and Advocate of Nurses, Dies at 84" identifies Ferguson as a "leader and advocate of nurses," and the first paragraph explains that she "fought for greater opportunities, higher wages and more respect for nurses as a longtime chief nursing officer for the Veterans Administration." The piece shows that Ferguson faced real challenges right from the start:

At a time when few black women attended college, Ms. Ferguson graduated from New York University with a nursing degree in 1950 and was awarded the Lavinia L. Dock prize for high scholastic standing. At the awards ceremony, the director of nursing refused to shake her hand, [according to Pivotal Moments in Nursing: Leaders Who Changed the Path of a Profession, by Beth Houser and Kathy Player].

After college, Ferguson first worked at a National Institutes of Health-funded research unit at Montefiore Medical Center in the Bronx and later went on to work at several other hospitals. The piece notes that she was a co-author of papers in The American Journal of Nursing, The Journal of Clinical Nutrition and The Journal of Clinical Investigation. From 1972 to 1980, she was the chief of the nursing department of the Clinical Center at NIH. Her tenure leading nurses at the Veterans Administration lasted from 1980 to 1992, after which she "was appointed senior fellow at the University of Pennsylvania School of Nursing." It would have been good to hear more about these non-VA positions and achievements, particularly what her research interests were. However, the piece does establish that she was a clinical researcher, publishing in journals, and by extension that nurses can do such things, which does not always seem to be well understood.

The obituary has more detail about the VA job. When Ferguson took over leadership of "the agency's more than 60,000 nurses nationwide," the nation faced a nursing shortage:

Historically, the nursing ranks were overwhelmingly female, but as job opportunities began to expand for young women in the late 1970s, nursing, with its prospect of strenuous work, irregular hours and relatively low pay, was losing its appeal. Doctors, most of whom were men, were paid far more and rarely discussed medical treatments with nurses, despite nurses' hands-on knowledge of patients.

Ferguson's response, as she related it to authors Houser and Player, was: "What is good enough for the doctor is good enough for me and the nursing staff . . . Whatever the boys have, I am going to get the same thing for the girls." And in 1981 she told the National Journal that hospitals "are going to have to rethink and restructure their policies to let nurses perform nursing services and let others attend to 'hotel' services," like making beds and handling phone calls. The piece notes that Ferguson also "helped establish [a VA] scholarship program to recruit and retain nurses and made educational programs that had been restricted to doctors open to nurses as well." When she retired from the Department of Veterans Affairs in 1992, the number nurses there with a bachelor's degree had more than doubled. And the piece also seems to suggest that Ferguson's advocacy played a role in the rise in nursing salaries nationwide over the course of her career, noting that nurses' average annual pay rose from $26,826 in 1980 to $66,973 in 2008 as expressed in 2008 dollars--that is, removing inflation from the data--a remarkable rise.

This obituary portrays Ferguson as a tough and effective fighter for nursing--and one who was not averse to public recognition, at least in service to the profession. She reportedly used her considerable authority to push for parity with physicians in educational and other benefits and to resist having nurses perform non-nursing tasks, which limit their ability to do nursing and send the message that they are low-skilled. (This focus seems similar to Lydia Hall's work at Montefiore Hospital in the 1960's, though the piece does not credit Hall with this push toward leaving the nursing to nurses, an idea that is now regaining importance at institutions such as Philadelphia's Hahnemann Hospital, which has an all-RN staffing model.) Sadly, "hotel services" are just the kind of tasks we still see nurse characters doing on current Hollywood shows. On the other hand, a problem U.S. nurses and patients have confronted in the two decades since Ferguson retired from the VA is that hospitals have less-skilled workers doing nursing tasks, like taking vital signs, as a short-sighted, ineffective cost-cutting measure. The obituary's account of Ferguson's achievements is impressive on its own, but it also reminds readers of the progress nurses have made since she entered the profession. Of course, perhaps needless to say, real parity with physicians--in terms of power, resources, and respect--remains far away. Physicians are still paid "far more" and many still do not respect nurses' expertise to the extent they should, despite the improved gender balance of the medical profession. But Ferguson's career shows how much progress a tenacious advocate can make.

We thank those responsible for both obituaries of these remarkable nursing leaders.