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After 38 years of active duty and reserve enlistments, Karen Flaherty-Oxler, MSN, RN, GNu’85 is now leading one of Philly’s largest medical centers—and bringing health care to 60,000 other veterans.
Becoming Lady Macbeth at a high school Shakespeare festival was one of many character roles that affected Rashika Kaushik’s decision to become a nurse. There were no great medical emergencies; it was something more intuitive than that.
“I wanted to be an actor my whole life,” Rashika says. “I had a huge imagination and loved role playing. The key to being a good actor is being relatable, and to be relatable one has to be understanding. Both disciplines [nursing and theatre] require a great deal of empathy and the ability to put yourself into someone else’s shoes—to understand someone even if you’ve never experienced what they’re going through.”
It helped that Rashika had great role models working in public health—her grandmother was a nurse, and her grandfather was a physician; both were involved in public health work in India, where Rashika spent her childhood before immigrating to the United States when she was nine.
While Rashika knew a career in nursing would suit her, it is her passion for disease management at the intersection of public health and health policy that drove her toward a Masters at Penn Nursing and a specialization in the field of cardiology—she is currently a Nurse Practitioner at the Hospital of the University of Pennsylvania’s cardiac unit. “Heart disease is the leading cause of death for Americans,” she says, “carrying a morbidity of about 28 million—about 11 percent of the population, the pathology is very interesting, the solutions are constantly innovating, and with the problems at hand being so vast, I think it’s a great place to be right now.”
She chose this career path because she is invested in innovating the patient experience. “Historically, the system has created categories of care and expected patients to fit into them,” Rashika says. “I foresee that infrastructure dramatically changing in the near future. Patients now have access to more information than ever before, large corporations are annihilating the barriers to care—recently I had a patient who gets his autoimmune disorder medications from Amazon, for instance. This shift in access puts patients in the driver seat. It gives them power to chose and guide their care. It is our responsibility, as providers, to safely empower our patients and fortify them as leaders in their care. I see myself taking part in that transition. ”
Making connections and breakthroughs that empower patients calls on the empathy that Rashika learned in acting. “Recently I had a patient with heart failure admitted from the ER. The man was extremely short of breath and had a reduction in his functional status; he wasn’t able to walk as much as he usually does. We talked about clinical management for his heart failure, and I told him that his heart wasn’t contracting as well as it should be, that’s likely why he had extra fluid in his lungs. Our conversation digressed when he showed me pictures of his grandkids and his family. He paused for a moment and said, ‘Is the fluid the reason I can’t carry my grandson as far?’ To which I said that it’s very likely, and he delightedly responded ‘Well then give me all the medication I need—look at this cutie! I have to get back to him as soon as possible!’ Moments like that are part of the innovation experience just as much as more wholesale changes in healthcare.”
Rashika may point to her acting experience as a foundation for her ability to empathize, but she credits Penn Nursing with setting her on the right path. “Penn Nursing gave me the words to articulate what I wanted to be when I grew up. From ‘care to change the world’ to ‘innovating for life and living,’ Penn Nursing has validated to me that it takes a great deal of strength to be empathetic, and it takes a great deal of empathy to drive change.”
Random fact: During college Rashika acted in a short film directed by a friend that went on to show in a major film festival; as a result of that experience she gained her own IMDB page .
Caroline Dillon, a member of the new freshman class, has always been drawn to nursing. During a fourth-grade field trip to Boston’s Museum of Science, she saw an exhibit on childbirth that featured graphic videos. “My 10-year-old classmates were grossed out,” she recalled, “but I said I want to deliver babies.”
The more Shruti Iyer learns, the more she understands that social justice and health equity go hand-in-hand. As a part of Kaiser Permanente’s Office of Equity, Inclusion, and Diversity, she is committed to embedding principles of equity within the company’s workplace, care delivery systems, and community health efforts.
She says, “With steady demographic and geographic transformation and increasing urgency of health disparities and social needs, this is yet another time in our country’s history to be the change we want to see.”
Being the change is something that that has been part of Shruti’s mindset long before knew she wanted to be a nurse. “As a child I wanted to be a veterinarian,” she says, “As the child of an internist and chemical engineer, I grew up in a household heavily influenced by the STEM fields, and wanted to channel that energy towards veterinary sciences. No matter which field I chose, I wanted to make a positive difference among vulnerable populations.”
It was Shruti’s own back and neck pain in middle and high schools that drove her toward health care, however—and resulted in her being featured as a 14-year-old public health activist in the American Journal of Public Health for her research findings on the correlation between back pain and backpacks. The feature notes:
“Shruti turned her investigation into a science fair project and subsequently expanded the study, making it quantitative and international. She then went beyond science fairs, presenting her findings at professional society meetings and in publications, and she initiated a wide-ranging public health campaign. All this in less than 5 years: Shruti entered 10th grade in the fall of 2000.”[i]
“That public health exposure was pivotal for me,” Shruti says, “and it informed my interest in the Nursing and Health Care Management dual degree program at Penn. It was an honor to be trained at top ranking schools of nursing and business. As dual degree students, we directly cared for patients with limited access to healthcare at a micro level, while observing market forces that affected them at a macro level. The program offered me fluency to speak two very unique languages, to build bridges across disciplines, and to serve diverse audiences.”
“The community health experiences I had at Penn changed the way I saw my own future,” she continues. “We would drive out to West and South Philly communities through a home health agency to serve patients in their own spaces. I realized here that my clinical training and scope of practice would only allow me to go so far. Many of these patients needed food security, access to transportation, a social network, and a safety net to promote total health. It was my first exposure to the social determinants of health, health disparities, and the need for systems-based solutions that impact upstream influences on health.”
But one clinical experience in particular solidified her thinking that health equity and social justice work were her ultimate career goals:
“While working on the cardiac step-down unit at HUP, I cared for a man who was homeless—he had heart failure and was labeled a ‘frequent flyer.’ He’d come in, receive hundreds of thousands of dollars in services, and be discharged “to the street,” over and over again. The system spent so many downstream resources on this man but could not create an upstream solution to sustainable support and stable housing. It was at this moment I started thinking beyond treating one patient at a time and began focusing on creating healthy societies. As nurses, we are important change agents in facilitating that kind of change.”
Since graduating from Penn Nursing and The Wharton School, Shruti has earned a Masters in Public Health from the Johns Hopkins Bloomberg School of Public Health (JHSPH), and is currently pursuing a DrPH in Health Equity & Social Justice from JHSPH on a part-time basis while working for Kaiser Permanente. “I will be beginning my doctoral dissertation shortly,” she says. “I plan to investigate race and ethnic differences in factors known to exacerbate hypertension, with the hope to use results to influence equitable care programs at Kaiser Permanente.”
“After my DrPH,” she continues, “I will be committed to four major goals: first, denaturalizing health disparities and addressing them in a socially conscious and culturally humble way; promoting paradigm shifts through multi-sectoral collective impact models that address transportation, housing, food, livable wages, etc. as factors for health; third, emphasizing preventative measures for chronic disease, moving the dial from volume to value in healthcare service delivery, and maintaining the triple aim of quality, lower cost, and population health; and fourth, developing a new generation of educated, empowered, and accountable communities for health. I have the appetite and passion to apply research in real time and tackle issues with rigor and soul. I am eager to meld evidence, activism, and community values in addressing pervasive domestic health challenges of our day. In short, I hope to be a servant leader, creating equitable pathways for those who deserve a life of health.”
Random fact about Shruti: She is a classically trained violinist and dancer.
[i] Guyer, R. L., PhD. (2001). Backpack = back pain. American Journal of Public Health,91(1), 16-19. doi:10.2105/ajph.91.1.16
Warren Shaulis wanted to be a garbage man when growing up. “I loved the idea of riding on the footboard of the truck—which I’m sure later translated into a desire to be a firefighter when I realized that they, too, ‘ride the boards,’ so to speak.”
That desire for the excitement of “riding the boards” has translated into a life of public service and, unintentionally, emergency situations. Warren is an ER/Hospitalist Nurse Practitioner with Crook County Medical Services District in Sundance, Wyoming, as well as an Emergency Nurse Practitioner for Lead-Deadwood Regional Hospital in Deadwood, South Dakota. However, he came later in life to nursing—in his late thirties. In addition to working as a firefighter (for which he was awarded Firefighter of the Year in 2005), he was a military law enforcement officer, including numerous commitments at Arlington National Cemetery and protection details for President Ronald Reagan, Vice President George H.W. Bush, and Prince Charles and Lady Diana; military flight medic; and a civilian Paramedic, instructor, and service leader.
“I hadn’t really considered nursing as a potential career,” he says, “until I had spent a few years in Emergency Medical Services. A lot of people in those two professions don’t understand the similarities, instead focusing on the differences. I always viewed them as two twigs of the same branch. The program I worked for paired a Flight Nurse and Flight Paramedic on every flight. The premise was that we would work as equals; however, each bringing a different background and experiences, teaching each other, so as to provide optimal care.”
That experience also gave Warren exposure to the role of Nurse Practitioners (NP). As someone who has always been hungry for more knowledge, Warren came to regard the role of NP as an opportunity to learn, as well as an opportunity to gain more autonomy and decision-making capability. “I ultimately decided that Family Nurse Practitioner (FNP) role would be more useful, allowing me to see patients across the lifespan. It was also the preferred preparation and certification to work in an Emergency Department.”
“Given my background, the FNP certification allowed me to provide quality care—especially since my work has taken me, since graduation, to the Emergency Departments of three different Critical Access Hospitals.” A Critical Access Hospital designation is a designation available to rural hospitals, where residents would otherwise be a long distance from emergency care. Warren also completed a post-masters certificate in Emergency Medicine to prepare him for the Emergency Nurse Practitioner certification (ENP-C). However, the Wyoming Board of Nursing interpreted the 2008 APRN Consensus Model document to mean that FNPs working in the hospitalist role function outside the scope of practice—which brought Warren to Penn Nursing.
“Penn Nursing’s Adult Gerontology Acute Care NP program seemed to be tailored for people in my exact situation—and because the streamlined program is online, it didn’t require me to take an extended leave of absence from my current position, which I enjoy immensely and which would have had a significant impact on our hospital’s ability to provide much needed care and coverage to our community and visitors.”
In a rural area like Deadwood, South Dakota (with a population of less than 1,500), visitors to the community might seem like an inconsequential concern—however, Sturgis, South Dakota and its Sturgis Motorcycle Rally that draws over half a million visitors each year are only a short distance away. It’s an event that requires health care professionals with emergency experience and cool heads. Hospitals, clinics, and urgent care facilities throughout the Black Hills are put on high alert for the ten-day event. Both Warren and his wife are involved with the ambulance service in Sturgis for the rally.
“You never know what kind of call you’re going to get during a rally,” Warren says. “In one of the years past, the ambulance I was working with got paged around midnight to a campground where some rather drunk people accidentally rolled their full-size, lifted pick up truck down a hill and over a tent. While backing up, they dragged the tent (and the quite surprised person that had been asleep inside) into the wheel well. The scene was surreal: the patient was arched backward over the front wheel and tire, with the patient’s head sticking out of the wheel well and feet sticking out from under the front bumper. I was sure we were looking at a patient with a broken back in multiple places. My ambulance crew worked with local firefighters and the Life Flight helicopter we’d called—and I later found that the patient had been discharged with only some abrasions and muscle strain—the patient was very flexible and very lucky. We try to practice lots of scenarios in our Emergency Department and with our EMS team to help us prepare for the unexpected as best as possible, but that was definitely unique.”
With Warren’s ability to remain calm under pressure, something he attributes to his education, mentoring, and military experience, what’s next for him may include a move toward a faculty position. “I am fortunate to work with two academic Emergency Nurse Practitioners, a husband and wife team who have expressed interest in my working with them in a faculty capacity at their respective programs, which would mean a return to school to complete my Doctor of Nursing Practice degree.”
Random fact: Despite the fact that Warren flew on helicopters for 16 years and has been involved in rock climbing, high angle rescue and rappelling, as well as climbing ladders in the fire service for much of his adult life, he is terrified of heights.
This series features short, impactful stories from students, alumni, faculty, and staff showcasing the wonderful, transformative work nurses do. This series is an opportunity to embed new narratives about what it means to be a nurse and how nursing impacts everyone’s life.
To read more Humans of Penn Nursing stories, or submit your own story, visit www.nursing.upenn.edu/humans.