This is the second part of our interview with Nurse of the Week Richard Onyait, RN. Richard was an orthopedic clinician in Uganda (where a clinician is equivalent to a PA in the United States), when at age 32 he had to flee the country to protect himself and his family. He came to the US six years ago, determined to start a new life, and no less determined to continue caring for patients.
After arriving in Wisconsin to provide live-in care for a Madison resident, he used his first few paychecks to enroll in a CNA program. From there, he continued caring for his live-in patient while also working full-time in an assisted-living facility. Once he had saved enough, he enrolled in the BSN program at Herzing University-Madison, where he continued as a live-in caregiver while studying for his BSN. He graduated in December 2020, and is now working in the ED of a Madison hospital. Click here to see Part One of the DailyNurse interview with Richard.
DailyNurse: Now, you were an orthopedic clinician long before you enrolled in nursing school. So, during your four years at Herzing U-Madison, the classes must have covered a number of things that you already knew from experience and your original training. I’m just wondering, in addition to the value of earning your BSN and license, were there times when you thought, “I’m glad for myself that I’m studying this and learning this?”
RichardOnyait: Yes, there is a lot that I learned. I would like to say I had the basic template, but I needed to build on it. My prior training gave me the template, as it were, for nursing, anything in health care, physical therapy, as a physician, and so on.
I had to shift my thought process to a nursing perspective. Because during training, even during exams, I had the instinct to go for the physician’s options, which are not the nursing options, and I struggled with that. But eventually, I trained my mind to think and act exactly like a nurse. It’s part of the basic template of keeping the patient safe, professionalism, respect, integrity, compassion, empathy, beneficence, veracity. I just needed to put [those elements] in the right place and using them as a nurse.
DN: The pandemic started during your last year of school? How did that affect your senior year?
Richard: Well, it was an interesting one, because I was doing a mental health clinical, and they had to stop the in-person, clinical sessions. We were almost at the end of it, with maybe two or three weeks to the end of the clinical. And then we had to transition from in-person clinical to virtual clinicals.
My school created a program that still allowed us to do some clinical work, except it was virtual, which was a big shift. Because I love the interaction with my patients. It’s beyond just administering medication. It’s a relationship. There is something every patient has that is unique to them. Just like each of us, has something unique in us. And if you are able to interact with a patient, you can create a harmony or harness that inner being in them. And I missed that a lot during the virtual clinic. Because you are talking to a screen image, and you miss the human presence of the patient. In person, you can see their feelings, and they can feel your emotions too.
There is a therapeutic occurrence that communicates beyond just ‘I have your ciprofloxacin to help with the bacteria that’s affecting you.’ When you say those words, there is an inner being in you, that speaks to the silent inner being of that patient. And it creates healing. So this is something that I really appreciate during in-person clinicals.
DN: Can you recall one of your most meaningful interactions with a patient?
Richard: Oh, yeah. During my last internship rotation, about two months ago, I had a patient in the oncology unit who decided to leave against medical advice. She signed the form and was ready to leave my preceptor. I tried to talk to her and explain the ins and outs of leaving against medical advice, that you won’t be able to access this, you’re going to miss that. Still, she said that she was leaving.
DN: Why did she want so desperately to leave?
Richard: Well, she was frustrated. They were doing all these tests but couldn’t seem to figure out exactly what was going on with her. She felt like she just needed to GO. But she had many things going on with the cancer. She had respiratory issues.
So, I asked my preceptor, ‘Can I go in and give it another shot?’ And she said, ‘She’s all yours.’ I knocked at the door, thinking it was gonna take 10-15 minutes, but we talked for an hour. Somehow, she opened up about how she felt, and I shared some of my own personal experiences, telling her, ‘Hey, we’ve had a lot of difficult times, but you have come about five steps along your own journey. We don’t know how many steps are left ahead. But you can choose to take those five steps back and go back to square one, by leaving. And then you’ll have to start all over—if you’re lucky enough to start again—and you will start from zero. Or you can choose to build on the five steps you have already taken. Take one more, and hope that that is the last one and take the next one. And hope that is the last one and take the next one and just keep building on it. Because you don’t know how many more you have left to go. But we know that if you take the next one, it’s going to make it better. And the next one will make it better. And every day you take that step it keeps getting better, until you are at a point where you actually are good to go in a very good and stable situation.”
DN: And did she stay, or did she go?
Richard: Eventually she still decided to leave. I escorted her to her car and everything. And I told her, ‘You know, if you can get back here, please do, because we need to take care of you and help you feel better.’
She went home and in two days, she had to call an ambulance to pick her up. She made it back to the same unit, and I was able to interact with her again. And one thing I remember her saying, is ‘The thing that brought me back was not the medication, but the words that you told me. That’s what gave me the strength and courage to come back and seek treatment.’ And she bought me a box of chocolates [and after some back-and-forth, the bemused Richard gratefully accepted it]. And she kept telling me, ‘just be the person that you are. What you say speaks to me in a special way. Pills can’t do that.’
DN: That’s why people trust nurses so much. When you need it most, their special combination of communication skills, empathy, and emotional IQ can lift you up. And so many patients must feel like that woman.
Richard: It happens everywhere. It happens in the ER, all the time. For instance, with patients who have been brought in after an overdose. The way the nurse interacts with them [can be healing] and remind them that their lives matter, they’re not just ‘drug overdose cases.’ We don’t always have a lot of time, for sure. But I always believe there is a silent talk that goes on between the nurse and the patient, even when you just offer somebody a pill. ‘Hey, I brought your Tylenol for the pain.’ The way you say and offer it can help heal the person as much as the pill itself.
“In life we all have a purpose for ourselves, but you also have a purpose as part of humanity. We have to do something special for each person, for the greater good of humanity. And for me, I find my purpose in caring for people whose lives are challenged by sickness, disease, disability. That’s where I fit in, in the jigsaw. I don’t fit anywhere else.”
DN: How is the COVID situation in Madison? Have they told you to expect when you start on Monday?
Richard: Well, the numbers have fairly been on a downward trend, but I expect to take care of COVID patients. The interesting thing about COVID is, when it struck, it kind of reminded me of the Ebola epidemic in Africa.
There is a lot of similarity. And I remember having this conversation with the gentleman I was taking care of when he was asking me, ‘Why do you want to go out and be an ED nurse in the middle of a pandemic?’ I told him, one of the things I feel I do best is helping people stay focused or stay calm and helping them recover in those moments.
I mean, in life we all have a purpose for ourselves, but you also have a purpose as part of humanity. We have to do something special for each person, for the greater good of humanity. And for me, I find my purpose in caring for people whose lives are challenged by sickness, disease, disability. That’s where I fit in, in the jigsaw. I don’t fit anywhere else.
Our latest Nurse of the Week has a truly American story. A freshly graduated BSN from Herzing University-Madison, he began work in January as an ED nurse in Madison, Wisconsin. Richard Onyait was born in Uganda and worked there as an orthopedic clinician (roughly equivalent to a PA in the US). Six years ago, Richard came to be regarded as a dissident by authorities and was forced to flee the country for the safety of himself and his family. Upon his arrival in the US, he decided to become a nurse. DailyNurse spoke with Richard shortly after he took his NCLEX. To see the second part of this two-part interview, click here or use the link at the end of this post.
DailyNurse: So, how did the NCLEX go?
Richard: I was issued the license this morning.
DN: Congratulations! And you have a position already as an emergency department RN?
Richard: Yeah. They were basically waiting for my license. I will be starting on Monday.
DN: With your previous experience as an HCP, I guess you sort of knew you were going to pass the NCLEX.
Richard: Yes, I believed in myself.
DN: Do you still have family in Uganda?
Richard: Yes. I actually don’t have family in the US.
DN: Have you been going back to visit since you moved here?
Richard: I grew up in a city of about a million people. [Which we are concealing to protect his family in Uganda. -ed].
I was born an only child. And then somewhere along the way at 10 years old. I lost my dad. Which was part of the inspiration that drove me to study nursing and healthcare in general.
DN: What happened to your father?
Richard: Well, when I was 10 years old, my father was involved in a motor vehicle accident and sustained multiple injuries. He was treated at the local hospital. And it was during that time when the nurses took care of him that I was inspired by the compassion, the care, the love they showed in caring for him. Eventually, he succumbed to the injuries and passed on.
But that was where my inspiration came from to enter nursing school and study healthcare. So it was a painful moment for me to lose my dad, but it was also an inspirational moment that opened my eyes to serving humanity when they are broken down by illness, disease, accident, or old age. I like to call it the time that I received my calling into service.
“It was a painful moment for me to lose my dad, but it was also an inspirational moment that opened my eyes to serving humanity when they are broken down by illness, disease, accident, or old age. I like to call it the time that I received my calling into service.”
DN: You were only 10 years old?
Richard: Yeah. That wasa hard time. Because my father was my everything. He was the breadwinner at home. My father provided for everything I needed. From clothing to eating to going to school, he was a friend of mine. So it was a hard thing for me.
DN: At that at that age, too. You lost the person who just seemed to make the world safer.
Richard: (With some emotion) Yeah, it still brings tears to me sometimes. It’s a loss.
DN: So, you experienced two major life events at the same time, and when you grew up, you worked as an orthopedic clinician in Uganda. Did you work in your hometown?
Richard: No, I ended up working in the capital city, Kampala, at the National Referral Hospital.
DN: When and why did you decide to leave and come to the US?
Richard: Well, my journey to the US wasn’t one of choice. It was one of escaping the claws of a dictatorship that is currently ravaging Uganda. I had to find another home, not by choice, but by necessity.
DN: It sounds almost inconceivable to someone who has never lived outside the US. We know that Uganda is a dangerous and repressive police state, but the reality is hard to fathom.
Richard: It’s a story that I have come to be able to verbalize, but I only share it with a few close friends I’ve made here. They’re the only ones who understand where exactly I came from and what happened to me.
But what is happening to many young men in Uganda is unthinkable, and some of them are not lucky like I was. It’s still happening. It’s not like it’s over. And, for the sake of the safety of my family, I prefer not to share too many details in public. Because my family still lives in Uganda and giving out a lot of those details would simply be too dangerous for them.
“What is happening to many young men in Uganda is unthinkable, and some of them are not lucky like I was. It’s still happening… And, for the sake of the safety of my family, I prefer not to share too many details in public.”
DN: Well, we won’t even mention the name of your hometown. But how did you end up in Wisconsin?
Richard: When I came to the US, I lived in Boston with the friend of an acquaintance who knew what had happened to me. It was the bitter cold winter of 2015. [Having come from Africa,] I remember feeling like my ears were dropping off, and the cold biting my fingers!
Then, I met a lawyer who suggested I go to the Boston Medical Center for refugee health and humanitarian rights. He recommended me and I set up an appointment. I went, and one young lady there, Jenna, even taught me how to dress for the cold. She was an amazing lady.
It took over a year and a half to get any work authorization. Oh, boy. I was craving to do something to contribute to the home that was hosting me, and I just didn’t have the means.
DN: So what was the very first job you got paid for here?
Richard: I was hired to take care of a gentleman who had MS. I got the job through a friend who was caring for that man but had to take some time off. Because he knew about my orthopedic degree, he asked if I could take over for him after I got work authorization.
Once I saved enough money, I enrolled at a small school in Framingham to get a CNA certificate. I was just trying to start. And this way I could work in an assisted living facility, which was more stable employment. So, I took the very first money I earned and paid it to the CNA school.
DN: Did you find a nursing home position?
Richard: Yes, in Framingham, a place called Valley Farm. I worked there for some time. This was also when I met the gentleman who ended up bringing me to Wisconsin.
DN: Nursing in assisted living is hard, hard work for not very much pay.
Richard: Yeah. It is hard work. I was trying to make ends meet, get a second job, so I applied to multiple agencies. One of them recommended me to this gentleman, who, unfortunately, had gotten shot in Wisconsin. He likes to say he was in the wrong place at the wrong time, but he was shot in his face and got paralyzed from the neck down.
DN: How old was he at the time?
Richard: I think he was 50 years old. And he was doing rehabilitation at Spalding. So the agency referred me to his family in Boston, and I met with them and met him as well. He needed care during the day, about 8.00 am to 4.00 pm, while his family was at work. I took care of him during those hours, drove him to his rehabilitation appointments and other appointments that he had during the day. And during that time, of course, we interacted, built a relationship, and became friends. For a few months down the road, after finishing with him at 4.00 pm, I then went to the nursing home and worked from 7.00 pm to 7.00 am.
DN: (Sigh) Nurses seem tireless!
Richard: Well, I basically was not sleeping. I left his place at four. I went home, took a shower. You know, if I took a nap for an hour, and then got ready to go to the nursing facility and work.
DN: So, why did the gentleman end up going to Wisconsin—with you in tow?
Richard: That’s where he originally lived, and he wanted to go back to be closer to his daughter. He asked if I could go with him for two months, allow him to settle in and get a new caregiver, then train the new person, come back to Boston, and move on.
I hadn’t been anywhere [in the US] except Boston, so I told myself, give it a try. You never know what you find there. But after I came to Wisconsin on my two-month contract, he wasn’t able to find another caregiver. There was no one else to care for him and he was living alone.
DN: At that point, did you decide to settle down in Wisconsin and study for your BSN?
Richard: After two months, he said, ‘Hey, I still haven’t found somebody. Can we extend this agreement for another month or so, until I can find somebody? Or would you be willing to move to Wisconsin and live here for whatever time that you can be here with me?’ I thought about it, asked a few friends, and it felt like a move that would help me gain some independence… and get some sleep!
When the man asked me to stay, I told him that I have ambitions, so I don’t think I can [be his live-in caregiver] for the entirety of my life. I have a profession I’ve always loved. And by that time, I had told him what had happened to me in Uganda, and the situation that led me to the US. So he knew I would try and push myself and start going to school so I could do more.
So, I went back to Boston, to pick up the few things I had there, and came back to Wisconsin to live with him as a home caregiver. And that’s what I’ve been doing all through nursing school, until about two weeks ago, when I moved out.
DN: Did your home-care patient finally find someone who could maybe not replace you, but take care of him?
Richard: Yes; he found a person about a month ago. Since then, we’ve been training and going over the routines with the new caregiver – you know, everything that needs to be done until they get comfortable together.
DN: When you have a talent or affinity for something like nursing, you feel the need to exercise it.
Richard: Yes. I felt like there was a lot I could offer, but I didn’t have the credentials. Even when we went to appointments—for instance, one Sunday at a hospital appointment, his suprapubic catheter got blocked. The hospital was trying to find a urologist to come and change it, scan it, and so on.
As it was a Sunday, though, we waited a long time, and they kept going around. I was there looking at him, like, ‘this is something I can basically do in less than five minutes.’ But they are trying to find somebody and it’s taking hours. And I know that he’s in distress from the retention, is feeling uncomfortable, and I can see he’s a little sweaty. So I asked them, ‘hey, do you have any catheters around?’ They said, ‘we do have cutters, but the urologist has to do it.’ I told them, “Well, this is between me and my patient. He knows I can do it, and he trusts me. Can you just get me the catheter, and everything that I need? And we’ll do it on our own in our room.’
DN: What did they say?
Richard: They refused to do it, at first, but then [my patient] demanded it. Mm-hmm. Eventually, they succumbed. And they gave me a catheter, sterile gloves. I did it, and he was good. The next day, they went in and redid everything! But at least it was okay for the day.
DN: I thought they would have screamed about insurance and things like that.
Richard: Oh, there was a lot [of screaming]. I think my patient had to sign off on some documentation.
Tending to anxious parents is a daily challenge of nursing in a pediatric hospital, but how do you cope when you’re the anxious parent and the patient is your own 8-year-old daughter? At American Family Children’s Hospital (AFCH) in Wisconsin, Nurse of the Week Windy Smith, MSN, RN is in this strange position while her daughter Ellie is undergoing chemotherapy for Langerhans cell histiocytosis, a rare cancer that causes tissue lesions.
While Langerhans cell histiocytosis can damage organs or cause tumors to form, most patients can be expected to survive. When the illness is more extensive, though, treatment can be grueling, and Smith’s little girl has been undergoing a year-long course of steroids, antibiotics, and hospital visits for chemotherapy treatment. Fortunately for Ellie and her mom, however, the 8-year-old’s favorite nurse has been available to provide care. Smith, a managing nurse at AFCH, says that Ellie “has to get labs before her chemotherapy and she has wanted me. She has a port in her chest, and so she has wanted me to access her port.” Her daughter explains her preference simply: “[It’s] just cause I sort of trust you more.” Smith reflects, “It’s like a heart-breaking privilege I have.”
Being able to participate in your own child’s treatment is indeed a privilege, but the experience has nonetheless been extremely stressful. “It’s all-consuming,” says Smith. “And while I know Ellie’s treatment is essential, it breaks my heart every time I access her port.” Their mother-daughter bond has helped to sustain them when things are hard. Noting that May is Mental Health Awareness Month, Smith remarks, “We have had some challenges with some depression and anxiety. It took us a while to actually start talking about it, start talking about feeling sad and feeling kind of angry about some of these things, but it’s really normal, so I’m glad she felt comfortable to open up and talk to us about it.”
Happily, Smith’s dual role will be over quite soon, and Ellie is eagerly looking forward to the end of her chemotherapy treatments, which will be marked by a Make-a-Wish trip to Disneyland and Universal Studios.
A video interview with Windy Smith is available at WKOW.
UW Health’s nurse residency program
takes one year to complete and is comprised of groups of 20-40 nurse residents
who have graduated from an accredited nursing program. Residents are used to
fill vacant spots left by retired nurses as well as to fill new positions.
Program Manager Kim McPhee tells uwhealth.org, “We’ve really tried to be proactive, so that we don’t feel the shortages as much as some other sites have felt…Before we had this nurse residency program, we were experiencing what everyone experienced around the country, where up to 60 percent of new graduate nurses left the profession in the first year. That’s a huge concern.”
The UW Health nurse residency program
is one of 29 programs recognized by the Certified Commission on Collegiate
Nursing Education. The residency program has hired over 2,000 nurses in the
past 13 years, accounting for two-thirds of the current UW Health staff.
According to the Bureau
of Labor Statistics, job growth for registered nurses will increase 15
percent from 2016 to 2026, from 2.9 million registered nurses in the workforce to
3.4 million nurses. They also project that 203,700 registered nurses will be
needed annually to carry out new positions and replace retiring ones.
The UW Health nurse residency program currently holds
3,152 nurses and added 572 nurses in 2019. The most recent class of resident
nurses graduated in February.
To learn more about UW Health’s announcement to expand
its nurse residency program to meet increased demand in the state and
nationwide, visit here.
Our Nurse of the Week is Becky Zimmerman, a nurse in the Neonatal Intensive Care Unit (NICU) at a Wisconsin hospital who was recently nominated for a DAISY Award by one of the families she cared for. Her patient, Whitney Driver, went into labor at 26 weeks, almost three months before her due date, and gave birth to twin boys who weighed just under two pounds.
Zimmerman was assigned as the primary care nurse for the twins, named Hudson and Hayden. Zimmerman and Driver both report growing close during the Driver twins’ 89 day stay in the NICU, but the family truly formed a connection after they lost one of their sons, Hayden, at just 17 days old.
Driver was overcome by postpartum depression and grief
from losing her son, but knew she needed to find a way to be there for her
other son. Zimmerman became a huge part of helping Driver manage her emotions
and get the help she needed.
Zimmerman tells nbc15.com, “I’ve taken care of a lot of babies. But this story is the kind of one that really clenched my heart.”
The Driver family eventually nominated Zimmerman for a
DAISY Award, a program that honors exceptional nurses. To learn more about Becky
Zimmerman, a NICU nurse from Wisconsin who was recently nominated for a DAISY Award
by one of the families she cared for, visit here.
Dietrick completed her nursing education almost entirely online and through clinicals at an area hospital, but very rarely stepped foot on campus. The flexibility of UW-Madison’s online nursing program was integral to her success. When Dietrich started nursing school, she had an associate’s nursing degree and a full-time job at St. Mary’s Hospital, plus a part-time job with the Wisconsin Air National Guard, with two young children to take care of at home.
While most students take two and a half years to complete the program, Dietrick completed the program in one, even though she spent four of those months serving in Afghanistan. Dietrick was halfway through the nursing program at UW-Madison when the Guard called on her to deploy to Afghanistan. At the time, her youngest child wasn’t even one year old yet and she feared that a poor internet connection overseas might delay her studies and self-imposed deadline to graduate.
Dietrick tells madison.com, “I kind of overextended myself, but feel like I do better when my plate is full.”
During her time overseas, Dietrick made a video call home to her kids at the end of each of her shifts, and then threw herself into her coursework, finishing five classes before returning home. She says she wanted to get as much done as possible so that she could spend time with her family when she came home. When her deployment was extended from three months to four, Dietrick still had 60 required hours of clinical observation that were unmet and she would only be weeks from graduation when returning home in November. Thankfully her mentor was willing to pick up extra shifts so that Dietrick could shadow her to get the hours she needed to complete her degree.
Despite all of her setbacks and challenges, Dietrick managed to finish her clinical hours and walk across the stage this past December with her bachelor’s degree in nursing from UW-Madison. To learn more about Cassie Dietrick, a mother of two who worked two jobs and overcame a deployment to Afghanistan, but never stopped working toward her nursing degree, visit here.