Nurses: On the Front Line of Care


Talking to nurses about their career paths, certain themes recur.
They love the work.
They especially love the variety—the fact they can segue from specialty to specialty, setting to setting, if they so choose.
Job juggling is common. Many double as nurses and teachers, or patch together several part-time gigs (school nursing alongside hospital nursing, for example).
None of this is terribly surprising. What is surprising, perhaps, is that none of the nurses profiled for this story grew up dreaming of being the next Florence Nightingale. Some were on their way to other careers when a fork in the road appeared, and others grew up in an era when a woman’s career options were limited and chose nursing because it seemed the least odious.
It’s a proud profession, an important profession and, too often, an undervalued profession. While no one is remiss to rave about a doctor’s good work, nurses’ contributions tend to slither under the radar. We sometimes forget that without them, none of the medical miracles that happen on a daily basis would be possible.


R.N., M.S.N. Pediatric nurse

While growing up in Susanville, there was one thing Denise Wall Parilo knew for sure: She wasn’t going to become a nurse, like her mother. “When there was a car crash and my mom would be taking care of all those people, I would say, ‘How can you do that, with all that blood?’” she remembers. “I just didn’t get it.” Today, the 41-year-old Wall Parilo’s résumé tells a different story. She’s been a pediatric nurse for nearly 17 years at Sutter Memorial, is an associate professor of nursing at Sac State and in June expects to receive her Ph.D. in nursing from UCSF.

Originally, you were dead-set against being a nurse. What changed?
One day, my mom invited me to come and shadow someone at the hospital. So I spent a day in the ER, where my mom was working, and one of the physicians let me observe as he took care of a patient who had almost severed the thumb off of his hand in a logging accident. The physician let me help to irrigate the wound, and he was teaching me about the anatomy of the guy’s thumb, and I thought it was the coolest thing.

Your first post-college nursing job was in pediatric ICU at Sutter. Why pediatrics?
When I finished college, the first thing I thought I wouldn’t do was pediatrics (laughs). I just ended up in pediatrics because that’s where the job was. But I ended up loving it. The best part about it is that you’re working with the families.

You work part time (per diem) at Sutter and teach full time at Sac State. Why did you stop full-time nursing?
After about a year or two of nursing, I developed an allergy to latex and realized I couldn’t continue full-time bedside nursing. I thought, “Now what do I do?” So I went back to get my master’s so I could teach. I haven’t had a reaction to latex in years, but I need to limit my exposure. I wouldn’t want to get out of nursing entirely because everything changes so fast—new treatments, new equipment.

Any nursing stories to share?
When I was in the PICU, there was a young child, maybe a toddler. I don’t remember the diagnosis, but the child was critically ill. It just so happened that the patient was Hmong, and I remember the father was at the bedside most of the time and had limited English. I remember how deeply concerned he was about his child—it brings tears to my eyes thinking about it. At some point, the child went into kidney failure and developed edema and puffed up, so the staff removed the red string bracelet the child was wearing, because it was cutting into the wrist. But the father was so devastated when that happened, because in Hmong culture wearing red string has all these implications of warding off evil spirits, of protection. So by removing the bracelet, the family thought we were “unprotecting” the child. Once we realized the cultural implications and significance of that bracelet, we just put it back on and kept it looser, and everything was smoothed over. But I learned so much about cultural care through that experience.


Nurse practitioner, school nurse, lactation consultant

Some of Terri Fox’s patients confuse her with a doctor. That’s because she’s a nurse practitioner, able to diagnose and treat patients. “When I say, ‘I just wanted you to know I am a nurse practitioner and not a doctor,’ they say, ‘But I still consider you my doctor,’” Fox says. Still passionate about the work after more than 30 years in the field, the 56-year-old Fox currently juggles three jobs—credentialed school nurse at Sac City Unified, nurse practitioner at Shingle Springs Tribal Health Program and lactation consultant (per diem) at Kaiser.

Why did you choose nursing?
At the time I was growing up, the three things women thought about doing were teaching, nursing and secretary—or marry a doctor (laughs). But I do have to say I’ve always loved walking into hospitals.

You spent 17 years as an R.N. before getting a master’s degree and becoming a nurse practitioner. Why the switch?
I was ready for more responsibility, more challenge, more learning.

What can you do as an N.P. that you couldn’t as an R.N.?
As an N.P., I have the ability to help my patients more directly. I can diagnose; I can treat; I can write prescriptions.

You clearly love the work.
I really do. I love my patients, and I feel very fortunate to be doing this work. Nursing has let me do so many things within the scope of nursing. A doctor would usually become, say, a urologist, and that’s what he or she does for an entire career. But as a nurse, you go in as a generalist and choose a specialty, or change specialties.


Graduating this spring and rarin’ to go

“Nursing school has beat my butt,” admits Crystal Johnson.

But Johnson, 25, is not one to give up. The child of a broken home—her father went to prison when she was 13, and she last lived with her mother when she was 6—she’s been supporting herself since age 14.

She’s also the first member of her family to graduate high school. “I knew the only way out of that cycle was to get an education,” says Johnson.

In May, when the Bay Area native graduates with her bachelor’s degree in nursing, it will be the culmination of a long and winding road that has taken her through a brief stop at UC Davis, a medical-assisting program at Institute of Technology, two associate’s degrees from American River College and, finally, Sacramento State. From the time she was 8, Johnson dreamed of becoming a doctor. But when her academic adviser at ARC suggested she first become a nurse as a steppingstone, she thought the idea made sense. She applied to three state universities. Her high grades, strong test scores and bonus points (for things such as passing AP Spanish in high school and an economically disadvantaged background) earned acceptance letters from all three.

It was kismet. Johnson fell in love with the nursing program and established herself as a leader among her fellow students, including a turn as president of the Sac State chapter of the California Nursing Students’ Association.

At first, she envisioned herself as an ER nurse. But when her clinical fieldwork rotations took her into the world of neonatal care, Johnson was hooked.

“I got totally sucked in,” Johnson says. “The smallest NICU baby I saw was this tiny 1-pound baby. You could see his lungs moving, his heart racing.”

She’s not worried about finding a job, she says, because she’s willing to do whatever it takes. “I would prefer to stay in Sacramento, but I am definitely willing to relocate,” Johnson says. “Wherever I get a job is where I’m going.” Nursing student Crystal Johnson, shown at her internship at Mercy San Juan Medical Center, will graduate in May and has confidence she will find a job.


Hospice and critical care nurse

As a hospice nurse for VITAS, Ted Skiera holds the hands of dying patients as well as their family members. The hard part is letting them go. “Through the time you spend with them, you develop relationships with the families, too, so after the patients pass away it’s kind of tough to walk away,” says Skiera, 55. Previously, Skiera worked at Mercy General, first in oncology (briefly), followed by 18 years in cardiac ICU nursing.

Why did you choose nursing?
I was studying physical anthropology at the University of Oregon in Eugene when I realized I wasn’t the Ph.D. candidate type. So I started looking for other careers to pursue. When I was younger and living overseas with my dad—he was in the military—I had met several G.I.s who had been nurses.

You were in cardiac ICU for a long time. Why did you switch to hospice?
Some of my family members died without hospice care, including my father. But when my sister died of a brain tumor in her 40s, we were able to get hospice care for her. So that kind of planted a seed. My mother-in-law also had hospice care when she was dying of cancer.

What are some of the biggest challenges of the work?
I walk into a situation that’s been pretty traumatic for patients and families. The hardest part is to sit with a patient who has been struggling for years with a disease like cancer and they’re finally told, “There’s no cure.”

It must be so emotionally draining.
In all the fields of nursing I’ve done, this really is the most difficult and the most rewarding. As opposed to what I’ve seen in the hospital, where patients have not been given the choice for hospice or palliative care, and seeing what a horrible death they’ve had, with hospice care we can relieve their physical and emotional suffering. It’s wonderful to be able to walk into the situation, work with physicians to get their medications changed or whatever needs to be done, and to see them have a decent quality of life, however they define it.


Certified registered nurse anesthetist

For many patients going under the knife at midtown’s Chrysalis Cosmetics, Marilou Wagner’s face is the last one they see before succumbing to Propofol-induced sleep. That’s because Wagner is a C.R.N.A., or certified registered nurse anesthetist. At 63, Wagner now works part time after 33 years at Kaiser Permanente. After retiring in 2007, she found she missed the work. “Retirement was great,” she says. “But I wasn’t ready to give up my profession.”

Why did you choose nursing?
I didn’t want to be anything. I wanted to be a beach bum (laughs). I applied to nursing schools only because I could avoid “regular” college where you have to take all the general ed stuff. I went to a three-year program at Homestead Hospital School of Nursing in Pennsylvania. I loved it, and I even graduated as “outstanding nurse.”

How did you get interested in anesthesiology?
After working as a floor nurse (at Montefiore Hospital in Pittsburgh) for about a year, an an anesthesiology.” I said, “No way.” But when the class for anesthesia was about to start, there was a no-show, and he told me, “You gotta go.” And I did.

Isn’t it kind of scary to put people “under”?
nitially, it was. When you’re new at anything, you have a fear. And you never know how a patient’s going to react to a medication, so when new drugs come out, you never know how it’s really going to work until you use it.

Your patients must get nervous.
How do you prepare them for what’s ahead? I like to call them a few days ahead of time, if I can, to ask them my list of questions and to get their medical history. I ask them to clarify what kind of surgery we’re doing, to make sure they understand. If it’s breast augmentation, I’ll ask, “Is it silicone or saline?” and “Where is the incision?”

Working in a cosmetic-surgery practice is kind of an unusual gig.
It’s wonderful, because the patients want to be there. They’re not there because they’re sick. They’re there because they want to be.


Clinical geriatric nurse; director of quality and compliance

“I have a lot of passion for the older population,” says Teri Tift, who has dedicated her career to serving them. After starting out in bedside geriatric nursing, Tift moved up the ranks into management and clinical education positions at skilled nursing and assisted living communities. A lifelong student who has collected a master’s degree and a doctorate along the way, Tift, 58, currently teaches part time in the gerontology department at Sac State alongside her full-time job as director of quality and compliance at Eskaton.

You were 41 when you finished nursing school. What led to the decision to pursue nursing at that point?
I’ve always been drawn to the sciences. When I first came out of junior college, I did chairside dental assisting for eight years. Then I taught dental care for four years, on a TV show in Colorado. After spending 8 ½ years doing administrative work for Burger Rehab in Folsom, I started thinking I wanted to go back to school. So I entered Sac State’s nursing program.

What drew you to geriatrics?
I was always very close to my grandparents. When my grandmother had a few ministrokes and my grandfather was getting older and having health problems, that’s when it hit me: I want to be a geriatric nurse and to work in skilled nursing facilities.

Being a quality and compliance director, as you are now, is very different from hands-on bedside nursing.
My daughter, who also is a nurse, will say, “You’re not a nurse, Mom—you’re an administrator.” But I’m still using what I learned in nursing school. I’m still looking at the residents in our community—looking at their medical records, their lab values and assessments. But in this role, I have a broader scope of influence.

Any advice for people coming into the field?
New nurses need to come in with an open mind. Find out what you really like and what you don’t like, so you can rule things in or out. Find the thing that really hits you in the gut and go for that.



The party line has always been thus: Be a nurse, and you’ll always have a job. (Not to mention great pay and benefits.)

But in this turbulent economy, it’s not necessarily so. Despite the much-talked-about nursing shortage, the recession has stopped many veteran nurses from retiring, resulting in a shrinkage of openings for new grads.

Another factor: Training costs for new nurses are high, so hospitals in hiring mode are saving money by turning instead to experienced nurses who are ready to rock.

What does this mean for local nursing students?

It means that, like other grads, it may take them a while to find work—“maybe six months to a year, post-graduation,” according to Denise Wall Parilo, an R.N. and associate professor of nursing at Sac State.

Five years ago, Wall Parilo says, it was a different story.

“Back then, many of them had a job secured while they were still finishing the [nursing] program,” she recalls. And the deals were extra-sweet. “They were getting hiring bonuses, day shifts at the exact unit and facility they wanted.” But with the economy’s decline over the past three years, nursing grads are learning to adjust their expectations.

Although the numbers look bright—a 25.7 percent jump in jobs is projected for registered nurses in California between 2008 and 2018, according to the state Employment Development Department—the Sacramento region, with numerous nursing schools (four community colleges, Sac State and private colleges) is saturated with nursing school grads.

The situation is prompting some to look outside the region—and even out of state—for that first job. That’s what one of Wall Parilo’s students did last semester. “She was dead-set on pediatrics, and since there wasn’t a lot of hiring going on in Sac or the Bay Area, she ended up getting a job at St. Jude’s in Tennessee, and she loves it.”

Some graduates of Sierra College’s associate’s degree in nursing program also are casting a wider net, says Nancy Schwab, interim dean of the program. In the past four years that she’s been teaching at Sierra, Schwab says, she’s seen grads land jobs in places such as Reno, Oregon and Washington. “Some are even going just as far as Marysville,” she says.

Nursing grads with bachelor’s degrees are likely to fare better in a competitive market than those with an associate’s, says Wall Parilo. Frustrated grads need to remember that the market can’t stay down forever, she adds. “When I got into nursing school, there were jobs aplenty, but by the time I graduated, they were laying nurses off,” she says. “These things are always cyclical.”