Meet Vicky Ruffing, nurse manager at the Johns Hopkins Arthritis Center and former president and founder of the Rheumatology Nurses Society, and Sheree Carter, current president of the Rheumatology Nurses Society and clinical assistant professor at the University of Alabama in Huntsville College of Nursing. Here’s what they have to say about rheumatology nursing.
MP3 Audio Podcast
Jamie Davis: Sheree and Vicky, welcome to Nursing Notes Live and thank you very much for coming on the show today. So I’ll guess start with Sheree. Sheree, why don’t you tell us a little bit about your background in nursing? Why you wanted to become a nurse and something about the progression of your career through nursing school and to where you are today?
Sheree Carter: I would love to. How much time do you have because this a long history. I’ll tell you what, and I’m going to give away my age, I’m in my like 50s. So back in the Dark Ages, we had a choice to go in to be a nurse or to be a teacher or – Home Economics was another great field that young girls went into. But I chose nursing or either it chose me. I tell you when I was a big young child growing up, my neighbor on one side was the director of nursing at Druid City Hospital in Tuscaloosa and on the other side of me was a professor at Druid City Hospital’s School of Nursing. So I think that was my earliest influence were two my neighbors and saw what they did on a daily basis. Their crisp white uniforms and how neat and professional they looked at all times. Yes, so I decided early on that the medical profession is where I needed to be. Nursing is where I needed to be. I started looking because I was champion of the underdogs as a kid growing up and orthopedics, in particular, was an area that nobody wanted to go into because everybody was stuck in bed and strung up and had casts and whatever. I love that. So I decided I was going to go into the area that nobody wanted when I went into nursing school the first time. So, yes, right out of high school, went to Druid City Hospital’s School of Nursing right here at Tuscaloosa, Alabama and absolutely fell in love with Orthopedic Nursing, just fell in love with it. I knew this what I wanted to be. And then I graduated from nursing school and went straight into orthopedics and then decided, “You know, I really do need to get that baccalaureate.” At that time, the American Nurses Association was saying, “You know, we want the entry level to be a baccalaureate.” So I gathered my little horses together and got my baccalaureate from Auburn University at Montgomery and fell in love with that at that time with the concept of teaching and the theory and that aspect of the nursing profession. Still stayed in orthopedics, neurosurgery and started getting in to rheumatology at that time, some of the rheumatic disease patients that we would see on the orthopedic floor. Later on, I got my Master’s from the University of Alabama at Birmingham. Seeing that that was yet another step that I needed to make toward being the best that I could be as a nurse that was following down at administrative type path at that time. And still having that love of research and love of teaching, I decided that I needed to go ahead and get my PhD. And I’m almost finished with that now. Still working on that. It’ been a work in progress. Been working on that for four years. I should be able to finish it this year. And it’s been a decision that I’ve never regretted. It’s all throughout going from a diploma all the way up through a PhD in Nursing and I’ve kept it all. Nursing has been the best career decision that I feel that I’ve made. With each step, with each progression, you learn so much more and the world of nursing opens up just like a beautiful pearl, an oyster with a pearl for you. So I would encourage all the students out there to continue to seek education all levels moving forward.
Jamie Davis: I think that’s so important Sheree because you really need to be a lifelong learner in all the health professions but nursing certainly supports that. Whether it’s continuing to advanced degree or just getting a specialty in your nursing practice and carrying that specialized certification, it really lends to your passion for what you do.
Jamie: So Vicky, how about you? What was your background in nursing and how you got started?
Vicky Ruffing: Well, it’s interesting. My mother was a nurse. So I was determined not to be a nurse. I thought I just can’t possibly do what my mother’s doing. And so my bachelor’s degree is actually in Technical Theater. I thought for sure that I was going to design costumes and sets and go to New York and it would just be a wonderful life. Of course, things didn’t turn out that way. So I did do a little bit of work in the theater and realized this is way too hard, way too political and egos are way too much. So I decided I come and going back to school. And I would just look at nursing and see if that’s what I want to do. And I found out, just like Sheree, it’s like once you start, you’re sucked in. You just have that passion for nursing and that’s how it works out. So I got my AA in Nursing and worked in the operating room for about three years. It was very interesting how much it was like the theater. I was dealing with egos. And I thought this is not a good job for me. This is not – I just had a problem with that. I’ve always sort of like the idea of teamwork and this was not teamwork. It was too much hierarchy in the operating room. But I do feel that that experience has given me an incredible background in anatomy. Like Sheree, I worked in orthopedics. I did work with knee replacements and hip replacements and replacements of the NCPs and I worked – every Wednesday, I remember clearly working with a hand surgeon and just being fascinated by that. So after the operating room, I went to work at a Hopkins’ affiliate, Kennedy Krieger. It’s a hospital. It’s actually like an institute for children with brain injuries. I went there and ran the spina bifida clinic. And it was great. So it was so interesting because my role was so broad. Not only did it have clinical care of my kids with spina bifida. I also dabbled in case management. I was able to go to their schools and advocate for them. You take on a role of nurse and social worker with these kids. Trying to advocate for not just community services but access to medications and access to care. So after eight years of doing that though, I got a little burned out. Because there’s really not – I don’t want to say there’s no hope – but you don’t see much difference in their lives. It’s a constant battle. And I wanted to see something where there was really improvement. And I was asked to sort of multidisciplinary clinic in rheumatology. And that was 14 years – well, 14 years. So in 2000, I went to the rheumatology department position of Hopkins and there was no way to start a multidisciplinary clinic because at that time there were so many issues with insurance. The idea of a multidisciplinary clinic would be that they would be one-stop shopping for the patients almost where they would come to see their rheumatologists but there would also be an orthopedist there, occupational therapy, et cetera. But because of people’s insurance may not cover the orthopedist or they may not cover the occupational therapist. It really didn’t work out that way. But I decided that I like the patients so much and I really like rheumatology. It’s fascinating and things were just growing. That was the onset of biologics and you really could see a difference in the lives of these patients that I figured out a way that I would try to make myself indispensable so I wouldn’t lose my job. There was no nurse before me so I was able to create my own position. And the background that I had from working with the kids as far as access to care and access to services came in very handy. So that sort of how I got into rheumatology and sort of cloaked out my space for that. And so I’ve never regretted it and I love it as much today as I did – I’m now in my 15th year here – I love it just as much. So that’s where I am. And what I would say is nursing – I don’t know another field where you can change and you can find different places where you fit or you can continue to change till you find the one place that fits. We’re so lucky to have a field where there’s such a diversity and it’s worked out as well. It’s worked out for my family. I was able to raise two daughters of my own. Of course, I had got married, divorced and everything in between but it’s worked really well for me. That’s what I have to say.
Jamie: You know it’s interesting. I feel the same way and landed as a journalist in there in the midst of a nursing. So there are so many opportunities out there. And one of the things I found, and perhaps you’d like to share with this either of you, is that every step along the way contributed to where I am today.
Vicky: Exactly. And I would say that’s sort of it was especially true for me because I’ve been able to build on what – I can take pieces from every job I’ve had in the past. So fortunately my experience with orthopedics has really helped me understand rheumatoid arthritis, for example, and exactly what is happening. And then, of course, what I learned with the kids and my job there, it got me to where I can figure out how to fight for different services and what’s out there to try to help our patients there.
Sheree: I agree. I think being in the nursing field in each step we have along the way with our different experiences. I know we’re here talking specifically about rheumatology nursing but along my career path, I’ve been able to take some detours from time to time and one was working as a health services coordinator for the Southern Electric System. So my nurse background allowed me to be a health services coordinator for that system and doing and working with the mandatory fitness for duty program that came before all of the nuclear power plants in the Southern Electric System which is fascinating type of work there. And also a little stint working for as a pharmaceutical representative. The nursing background definitely helps you. So each step along the way I’m taking teases of what I’ve learned from outside the traditional hospital nursing role into my next endeavor and probably one of the most fascinating jobs that I had in nursing so far was in clinical trials research, being the administrator of rheumatology clinical trials research at the University of Alabama in Birmingham. So, yes, different and diverse with each step. You’re exactly right, Jamie, you take pieces with you along the way and you just excel as a nurse in all these different fields.
Jamie: So Sheree, we’re going to talk about Rheumatology Nursing today, specifically with both of you, and I guess I’ll ask you first. Can you give us an overview? Because rheumatology nursing doesn’t just include things like rheumatoid arthritis which – I have a daughter that has rheumatoid arthritis and we’ve dealt with that and have great relationships with rheumatology nurses – but you obviously deal with a whole host of diseases in that field.
Sheree: Absolutely. There are over 109 different diseases that are in the rheumatic diseases. The most popular or the most well-known would be the rheumatoid arthritis or the lupus erythematosus, gout, dermatomyositis, osteoporosis, osteoarthritis. Those are the most well-known, more that you would see probably in your nursing school setting. These diseases are chronic. They know no boundaries. They will go from childhood to geriatrics. So we see the entire lifespan affected by the rheumatologic diseases. They are painful; they’re chronic; disabling. Many of them can be life-threatening. That’s where rheumatology nursing especially can excel now. We have an opportunity to see and take care of these patients from the lifespan, understand their disease process, understand the mechanism of action of these newer drugs that I have been a privilege. I know Vicky has been privileged of being the cutting-edge clinical trials before in the progress that we’ve made with the rheumatic diseases. Vicky, you probably have a lot more to add to this too, right?
Vicky: Yes, I would say it’s interesting for me especially because at John Hopkins our Division of Rheumatology is very strong. So it’s nice to be in academics. I find that that’s a really great theater and I know that’s true with Sheree when she was in charge of the clinical trials at UAB. They’re able to see these different diseases and being in an academic center, I think, we kind of see the worse of the worst because people will approach you from community rheumatologists consulting with these difficult cases. So I find it fascinating. How many diseases there are? At Hopkins we have different centers for different diseases. So for example, I’m the program manager of the Arthritis Center and I can really focus on the procedures of rheumatoid arthritis, ankylosing spondylitis and psoriatic arthritis. So we pretty much have the inflammatory arthritis spectrum in our clinic. But there’s also a lupus clinic. So the people there can focus on lupus. There’s a scleroderma clinic, myositis clinic, vasculitis clinic, et cetera. So I feel very fortunate that I’m able to see all these diseases yet focus primarily on a few of the diseases. So I really feel that I’ve struggled as well to be able to meet the needs of my particular patients. But I have to say it’s just – the field of rheumatology, I think what Sheree was alluding to, is growing and growing and growing. And it’s great to feel that we’re at that cutting-edge of something here. And I hope we will see some cures to these diseases in our lifetime. I feel like we’re close.
Jamie: I’d like to think so, at least, for my personal reasons if for no other reason. It’s interesting how I’ve seen the nursing process applied to patients with these types of chronic illnesses because so often it’s those little changes that lifestyle changes and adjustments to how you do certain things in your life that really make a huge difference for patients with diseases like this. And I know that a lot of those tips have come to at least in my family from the rheumatology nurse we deal with and we love our rheumatologist but it’s the contact and constant information we get from our nurses that help us say, “Oh, this is a better way to handle this particular activity that we have to accomplish.”
Sheree: That’s a great thing to here. Yes.
Vicky: Yes, I think you’re right and I think that part of that is because there’s a shortage of rheumatologists in this field. It is not a sexy, money-making field to go into. And so nurses have been able – there’s so much nursing that we need in this field. There’s so much education attached to these diseases and the treatment. There is such a need for self-management of disease and it’s just the perfect place for nurses to fit in when it comes to helping our patients.
Sheree: You’re right, Vicky, even the access to care because there’s not enough rheumatologists. I don’t know, Jamie, if you know this but not every state in the 48 contiguous states have a pediatric rheumatologist. There’s still a probably, I think the Arthritis Foundation, their 2013 statistics had about anywhere between 9 and 11 states still not having a pediatric rheumatologist not access to care for those patients. So how much more so with the pediatric rheumatology nurse and the pediatric nurse practitioner in rheumatology care is important in those areas. Well, important in every state for that matter.
Jamie: Yes, I’m well aware of that because we’re blessed to live right smack-dab between Hopkins and AI DuPont Hospital for Children. And we actually are up near Delaware so we go up to AI DuPont. But we know that there’s a shortage of rheumatologists especially pediatric rheumatologists and it’s something we’re well aware of. That access to care that is important for all patients with specialized illness needs but certainly rheumatology, like you said, is one where I think nurses can really hopefully fill some of that void. Do you agree?
Vicky: Yes. That gap is a perfect place for nurses. As we move towards more patient-related outcome research, it’s so obvious that the nurses are what can really make the impact on patient outcomes. It’s still a young-enough field that we don’t have a lot of data on it yet but there has been some works in Europe, we can look at our colleagues in Europe, to see the nursing research that’s done there and the impact overall on the patients with rheumatic disease. The impact of nurse involvement is incredible. So this is a great open field for us to really make the difference in our patient’s lives.
Sheree: It really is. We just received, and Vicky can attest to this, we just received national recognition by the American Nurses Association as for rheumatology nursing being a specialty practice, a recognized specialty practice. And that’s just been recently. Correct me if I’m wrong, Vicky, we recently got the okay November/December 2012, is that correct?
Vicky: November of 2012. Actually it really wasn’t a specialty until – an official specialty.
Sheree: Recognized in nursing. Absolutely. So this is a brand spanking opportunity for nurses to consider especially if you’re interested in the chronic care and the rheumatic diseases which are really fascinating. The mechanism, the immunology is absolutely fascinating. It’s like – especially when you have like a lupus patient. Let’s say, for example, when the patient comes to you with all of this disparate signs and symptoms, it’s like putting together a piece of a puzzle and trying to figure out on every unique individual basis for that patient what’s going on, how can you best help them navigate through every point in their life and their lifestyle. You become so involved and so – well, I don’t know, Vicky, how I need to – help me on the…
Vicky: You do become involved. It’s interesting work. And I think each rheumatology nurse probably is going to work a little differently yet the same but we may have different duties.
Jamie: Both of you are very actively involved with the professional association for rheumatology nurses and one of you is the current president, the other is a past president and founder and I’m very thrilled to have both of you here on the show. Because one of the things I try to talk about when I do these episodes on different specialties each month is the importance of being actively involved with your profession association whether it is emergency nursing or rheumatology nursing or vascular nursing. What would you have to say for those people out there that are in some other specialty and had never looked at joining their professional association or attending a conference in nurse association specialty?
Sheree: Well, I have to encourage, and I do encourage even my student nurses, to become involved in their specialty practice because that’s where you’re going to get the information that nursing schools absolutely cannot cover. There’s not enough time. There aren’t enough hours in the day. There aren’t enough courses that can prepare you for everything. As you go into a specialty practice, your specialty organizations are where you’re going to have your camaraderie, your networking, your education, and it’s important for them to be involved not only for what they can get out of it as far as an education is concerned for what they can provide back to the society and advancing the profession of nursing. We need desperately to be able to validate ourselves in the literature. We need to substantiate where we matter and where we make a difference in nursing and, especially, organizations. I’m absolutely thrilled to have met Vicky and the other – Elizabeth Grace, the other founder of the Rheumatology Nurses Society, because we met through some advisory boards for new medication that was getting ready to be launched within the field of rheumatology. So that was my first foray to meeting other nurses, not feeling like I was isolated in what I was doing in rheumatology all by myself. But that gave me an exciting sense of purposes, a direction to go with my society, with my nurse colleagues. And I’m not going to steal any thunder from Vicky. I’m going to go ahead and let her talk about the profound work she’s done with the Rheumatology Nurses Society. So, Vicky, I’ll let you in here.
Vicky: Well, I have to say, it’s a little different for us. I feel that our Rheumatology Nurses Society is almost imperative for nurses in rheumatology to be members. Because it’s difficult to get all of the information that you need in a field that’s so rapidly changing. Originally, what happened was – and as Sheree said, we had all met at an advisory board, and we would see each other at repeated advisory boards for new medications that were being launched. Pharmaceutical companies would bring us together to find out what was the education that nurses would need. What training would they need to do new medications that were coming out? What we found in discussions amongst ourselves was that there were very many nurses especially in private practice that had no idea – how do you use these medications? What are the ramifications would be with some of these medications? And we really felt that we owed our nurse sisters and brothers a place to get that education. So that was sort of the idea when we started this society. We are hearing over and over and over again from our members how much they didn’t know and how much this is helping. I think more than anything else, to be able to network and share best practices and those ideas with each other is really one of the best parts of a society. And I have to tell you, I have met the best friends through the society that I could ever have in my life because we all have these common goals.
Make sure you check out the entire January, 2014 issue of Nursing Notes, where we look at the career specialty of Rheumatology Nursing. You can read the entire issue online at www.discovernursing.com and don’t miss the other Nursing Notes Live episode this month with our Get-To-Know nurse interview with Jan Revella, Director of Research and Education at the Sonoran Spine Center in Phoenix, Arizona. You’ll find this and other episodes of Nursing Notes Live in the podcast area on iTunes.