November 5, 2014

leslie nicollThis post is written by Leslie H. Nicoll, PhD, MBA, RN, FAAN  a passionate nurse, wife, and mother. She lives in Portland, Maine where she owns her own business, Maine Desk LLC. She is the Editor-in-Chief of CIN: Computers, Informatics, Nursing and Editor of Nurse Author & Editor. Dr. Nicoll is an advocate for the poor and vulnerable in our society and lives this mission by working 2 1/2 days per week as the Coordinator at the Portland Community Free Clinic. Dr. Nicoll was very proud to be inducted as a Fellow in the American Academy of Nursing in October 2014. 

Kaci Hickox, the nurse who was quarantined in a tent in New Jersey for four days, has become a household name—sort of. What isn’t as well publicized are her educational credentials and expertise. Nurse Hickox is presented as “just a nurse” and if one is to believe the comments written about her in public discourse (newspapers, Facebook, Twitter) she is the worst kind of nurse: selfish, narcissistic, ambitious, egotistical, and negligent. Definitely not the sort of nurse someone would want at their bedside when they are in extremis, if you are inclined to agree with the opinions that many anonymous writers have shared.

I’ll be honest, I didn’t start paying close attention to Nurse Hickox’s story until she left New Jersey and came home to Fort Kent, Maine. But once her situation became local news (I live in Portland), I couldn’t ignore it. “QUARANTINED NURSE” was the lead headline for the past week.

One thing I noticed, right off the bat, is that all stories about her gave the bare minimum of information—her name and sometimes, her age (33). That’s it. No mention of her employer, education, expertise, or experience. Reporters did talk about her boyfriend, Ted Wilbur, 39, a nursing student at the University of Maine at Fort Kent. It was surreal to feel like I knew more about Ted than I did about Kaci, who really was the person of interest at the heart of this story.

Limited info about Nurse Hickox didn’t stop the online “pitchforks and torches” crowd from attacking her, however. Think of the nastiest thing you can say about someone and multiply it by ten—that will give you a sense of the vitriol that has been posted on the websites of the Portland Press Herald and the Bangor Daily News. I ventured to a Kaci Hickox Facebook page and read more of the same, including this comment: “Bet this fanpage isn’t working out the way you expected it would, bitch!!”

Things reached a head, at least in my head, when I read a series of posts from people claiming to have contacted the Maine Board of Nursing demanding that her license be revoked and finding out that she isn’t even licensed to practice nursing in Maine! This caused even more outrage, with comments suggesting that she is not a “real RN” and that she was “practicing medicine” [sic] in Africa illegally.

So, who is Kaci Hickox, really? It turns out she is extremely well educated and well qualified for the work she is doing: BSN from the University of Texas at Arlington (2002), MPH and MSN from Johns Hopkins University (2011), a diploma in tropical nursing from the London School of Hygiene and Tropical Health, plus a two year post-graduate fellowship in applied epidemiology with the CDC. Nurse Hickox is a paid volunteer by Doctors Without Borders (Médecins Sans Frontières, MSF) and under their auspices, has traveled to work in Myanmar, Nigeria, and most recently, Sierra Leone. She has a very definite career path to work with poor and vulnerable populations throughout the world. Interestingly, she was turned down by MSF for a job in 2004 because she didn’t have enough experience. That motivated her pursue her tropical nursing diploma and dual master’s degrees, all while gaining international experience in Indonesia and other countries.

Clearly Nurse Hickox is a smart, assertive, and intelligent woman who knows how to stand up for her rights and fight for what she believes in. But the press seems determined not to show us that side of her—instead, they keep her anonymous and vague. In headlines she is often nameless, to wit:

  • Judge in Maine Eases Restrictions on Nurse (New York Times, October 31, 2014)
  • Unapologetic, Christie Frees Nurse From Ebola Quarantine (New York Times, October 27, 2014)
  • Tested Negative for Ebola, Nurse Criticizes Her Quarantine (New York Times, October 27, 2014)

In videos that I have watched of Gov. Christie (NJ) and Gov. LePage (ME) discussing the situation—Nurse Hickox is never mentioned by name but always referred to as “her” and “she.” Gov. LePage goes on to say that “that woman” has “violated every promise” and that “we can’t trust her—I don’t trust her.”* He has also warned that she might be attacked if she leaves her home, which I heard as a veiled threat and bullying tactic.

I posted a comment in response to a New York Times article on October 31 that detailed some of her education because I was tired of the lack of information about her. So many commenters were assuming that she was undeducated and unprepared for the job and that she had gone to Africa on a lark with an urge to become famous. I wanted to do my little bit to get accurate data into the public record. 

People thanked me for  my post, saying that this information had not been shared before and was not “common knowledge.” Was I truly the first person to investigate Nurse Hickox’s background (which took about two minutes of Googling)? Turns out I wasn’t—there was an article in the New York Times on October 25 with this background, but it was buried on page A24. It was a standalone piece and none of the information contained in that article has been referenced in subsequent articles written about her. I also found alumni articles from Johns Hopkins and the University of Texas at Arlington** but has this material been shared generally? Sadly the answer is no.

So, what is my takeaway on all of this? One—the world out there: the public, reporters, governors and everyone else—see “nurses” as a commodity, one in million, who do not need to be named and identified by education and experience. Knowing this, we need to be vigilant to provide names, degrees, and credentials, for both ourselves and our colleagues. Note that in this post I have explicitly used Nurse Hickox rather than “Kaci” or “Ms. Hickox.” I believe this is a small way to be respectful and also get the fact that she is a nurse right out front.

Two: nursing education is confusing. This, unfortunately is a problem we in the profession have created but for people who aren’t pursuing a degree in nursing, it can be simplified and made clear. Most everyone knows what a bachelor’s degree is, likewise a master’s or PhD. Use those terms. “Kaci Hickox has two master’s degrees from Johns Hopkins.” People will understand that Nurse Hickox must be “wicked smart” (to use a Maine term!) to have accomplished this.

Three: career options in nursing are wide and varied (good for us who are looking to do different things) but again, the public seems to equate nursing with being at the bedside in a staff nurse role. There were many opportunities in the Nurse Hickox story where misconceptions were not corrected: she has a definite career plan, she has the education and expertise to serve in complex public health situations, and she did not go to Africa on a whim.

Fourth: strong, assertive nurses (and women) are not bad people. Nurse Hickox stood up for her rights and was publicly shamed for it. This is not acceptable and we must be vocal and support our colleagues. Interestingly, Monica Lewinsky has recently come forward with a mission to stop cyberbullying and public humiliation, based on her experiences of the past 16 years.*** Cruel, heartless online posting, from people who can hide behind a screen name are abhorrent to me and unfortunately, the incidence seems to be increasing. We must do what we can to stop this practice. Getting on the right side of the Nurse Hickox story seems like a good place to start.

Fifth: modern nursing is not the profession that many envision—docile, subservient nurses dressed in white and working in the hospital. Instead, we are creative, educated, and intelligent men and women who work in settings unimagined a generation ago. Each of us has a responsibility to correct misconceptions about our profession and career and should do this at every opportunity. When asked what I do, I always say that I am a nurse first, then add, “I own my own business,” “I am the editor of a professional journal,” or “I am the coordinator at our local free clinic.”

I was heartened this morning when the headline in the Maine Sunday Telegram did identify Nurse Hickox by name. Of course, she was called “Ebola nurse” in the same headline. Sigh…one step forward, one step back.

Written by: Leslie H. Nicoll, PhD, MBA, RN, FAAN


*Gov. LePage:

Gov. Christie: