My Scope of Practice: A Nurse with a Mission

   For the most part, the government of Indonesia frowns on a nurse making house calls. The people in the mountainous region of North Sumatra must travel for a distance and come to her one-room home that doubles as a clinic.

People from the village begin arriving early and sit with no complaint, sometimes all day. Children do not run around. There are no lines -only a tacit understanding of who is next. An American nurse is visiting and helps provide palliative care to the elderly and advice on rehydrating babies to new mothers. A young man has an abscessed tooth. She can offer only acetaminophen and warm compresses; he needs a dentist. He doesn't understand the American nurse's limitations - she is a medical person, isn't she? She brings basic medication and supplies donated by vendors and physicians, leaving behind any extra when she departs the country. When they run out, there are no more.

   Shawneen Schmitt, RN, BSN, MS, CWOCN, through her work with two missionary groups (Missionary Outreach for Short Term and the Lutheran International Medical Mission), has provided nursing care in some of the most backward regions and adverse conditions. Her day job is CWOCN Consultant for Aurora Sinai Medical Center, Milwaukee, Wisconsin -a 386-bed, licensed major teaching hospital that provides healthcare to the central city. A state-of-the-art, technologically advanced healthcare facility, Aurora was identified in 1999 by U.S. News and World Reports as a leader in providing inner city community care and serves a diverse population, providing millions of dollars in charity healthcare. Recently, Aurora received the Magnate Nursing Service Recognition Award from the American Nursing Credentialing Center. Shawneen, drawn to Aurora's philosophy and compelled to extend her charitable efforts farther from home, negotiated time with her employer to do "outside nursing" as a medical missionary.

   "My desire to do missionary work started in college," the University of Wisconsin-Milwaukee nursing school graduate explains. "I was moved by a speech by Lillian Carter (President Carter's mother) on her trip to India through the Peace Corps. I inquired about the Ship of Hope, but I never completed the application. Graduate school and raising my children, Lisa and David, took precedence. But in 1997, when the Red River flooded 90% of Grand Forks, North Dakota, I went to help. I lived in a tent for a week. I was unable to shower and had to boil water to drink. I realized that if I can do this, I can help in other remote places."

   Meeting people and seeing their courage in facing life's adversities, along with her strong Christian ideals, empowers Shawneen. "I couldn't work on a tall building or walk on an eye beam. Nursing, especially as a wound and ostomy nurse, is what I have the capacity to do. I am proud to care for the underserved."

   Shawneen continues, "I have a passion for people. I see them as individuals - I don't like the cookie-cutter approach to healthcare. I look at people individually and holistically. Everyone is gifted, blessed, and special. It is a human being who has that wound and/or ostomy. Any alteration of a person's quality of life can affect healing of the body, mind, and spirit."

   Shawneen is an advocate of the belief in teamwork, effective communication, and mutual respect for one another, which are vital to any program. Currently, she is the only CWOCN at Aurora Sinai Medical Center. She receives physician referrals, evaluates and cares for inpatients with wounds and ostomies, and maintains an outpatient nursing wound/ostomy care clinic. She loves to teach and has done professional education on the college and technical level. The University of Wisconsin, Madison, School of Medicine, is affiliated with Aurora Sinai Medical Center and physicians have shadowed her. She also provides inservice programs to physicians on wound care. Soon she will be precepting her third WOC candidate. "I want to get the wound and ostomy word out," says Shawneen. "I want to promote WOC programs to get nurses certified. As the population ages and comorbidities increase, we will see a rise in wounds. Demand is critical for skilled wound care nurses." Shawneen also notes that help is needed in disadvantaged areas of the city, where people lack the means to obtain care and consequently come in for treatment very sick. "The medical center has two free clinics and in time I hope to be a volunteer there."

   Shawneen also serves as a parish nurse at Brookfield Lutheran Church, offering patient education, health screening, and counseling to a congregation of more than 1,000 people. "They know my specialty," she says. "It is a wonderful way to provide spiritual and health care. In the hospital, I'm approached curbside, and at church, I do pew-side consultation." She went to the home of a church member needing wound care after foot surgery and helped another parishioner manage her ostomy. "My duties don't end inside the hospital."

   Nor do they end in her city. In 1998, Shawneen traveled to Latvia, a country that, regarding provision of healthcare, is locked in the 1950s. "I watched a nurse wash syringes in polluted water," she relates. "The healthier patients took care of the sicker ones. A teenager sustained a facial wound and the hospital had to find a needle small enough to stitch the wound. There was no topical anesthetic." In Kazakhstan in 1999, she was seen as a miracle worker, albeit with limited supplies. With scant medications (no antibiotics) available, infected wounds were usually resolved by amputation. Operations were performed by daylight because electricity is limited and there are no generators. In one hospital, nurses had to haul in well water up two flights of stairs. The mobile clinic Shawneen worked on provided treatment to children from rural farm villages. One year later in Mexico, Shawneen had to instruct a woman with diabetes about the basics of cleanliness when she was seen washing her leg wound in the river runoff from a landfill. Socialized medicine limited the availability of medical care to high-risk patients. This year's trip to Indonesia underscored the paradox of doing/not being able to do enough.

   Wherever she serves, Shawneen demonstrates respect for the culture of the country. "Healthcare providers have to work with what is on hand," she says. "People are so appreciative of what little we can provide, knowing we can only do so much before we leave. I am so humbled. The nurses in all the countries I have been to touch my heart. They do it all with dignity and grace, from the most menial tasks caring for their patients to management, all with limited resources. The nursing shortage is everywhere."

   While the changes imposed by middle age force many women to question who they are and where they are going in life, Shawneen has found a niche where she hopes to continue to provide care and educational programs as a CWOCN. "I'm very happy and content in my career. I want to continue to do mission work, see the world, and help people as long as I am able. Each day I learn more about myself. Life is rich and couldn't be better in my scope of practice."

   My Scope of Practice is made possible through the support of ConvaTec, A Bristol-Myers Squibb Company, Princeton, NJ.