May 13, 2008 — Time and again, undergraduate students find their university experiences to be transformative, as they learn lessons about themselves and their place in the world. For a Ph.D. student who already is well-established in his or her career, that's more unusual. However, there are exceptions.
For Francie Bernier, who will receive her doctorate from the University of Virginia School of Nursing on May 18, her transforming experience came in a class that she was not really interested in taking. In fact, she remembers being a bit annoyed that a class devoted to nursing history was required. For a self-described "driven clinical researcher," a 30- to 40-page paper would require a huge amount of time that she could otherwise devote to research that would more directly benefit her career goals.
"The project was huge for the amount of time and interest I had," Bernier said.
She was still working professionally with a medical device company as the nurse educator, so business travel fortunately afforded her "golden time" away from phones and e-mail to devote to the 15 credit hours she was taking that semester.
The assignment for the nursing history class was to find a "piece of nursing history and document it." As she pondered options for project topics, she remembered a box of old photos her mother, now in her 90s, had entrusted to her. The long-forgotten box, the contents of which Bernier had not seen, turned out to contain photos that dated back to her mother's time serving as a nurse in World War II.
"My mother always told us growing up that her experience in the war was in Hawaii," Bernier said. "She always talked about how much she loved Hawaii."
As Bernier began sifting through the box of photos that were stashed away for 50 years in her mother's attic before languishing for more than a decade on the top shelf in Bernier's closet, she discovered pictures of her mother, 1st Lt. Edythe Goldstein Pallin, B.S., R.N., training with a gun and huddled in a foxhole with a wounded soldier, plus images of bombed-out airplanes on Okinawa, and other memorabilia — the "night nurse" sign that she attached to her tent, her military documents and even her targets from artillery practice sessions.
Bernier said she had no idea her mother "was skilled in shooting a gun. She never told us."
Bernier decided to research her mother's war experience and to place it in the context of nurses and their contributions to the war and to nursing. That decision began an emotional journey for both Bernier and her mother.
"It was also a great gift," Bernier said. "I got to know my mother more during that time and to understand her better. I also wonder if other daughters of other nurses in World War II really know what their mother’s did while serving in the armed forces."
To gather information for her paper, mother and daughter spent Sunday mornings on the phone long-distance, while Bernier matched up photos with her mother's memories of the time.
Bernier learned that her mother was ordered to Okinawa in April 1945, arriving aboard a transport ship flying a neutral Dutch flag while fighting between American and Japanese forces still raged on — and in the skies above — the island. The ship waited in the harbor for American troops to secure the island; when it was deemed safe for the medical teams to come ashore, Pallin described to her daughter how they climbed down rope ladders on the side of the ship to tenders that took them closer to shore, where they waded through water strewn with the corpses of American and Japanese soldiers.
When Bernier asked her mother how she dealt with such an incredibly disturbing experience, she said her mother responded, "We did the best we could," a refrain Bernier said she heard over and over as they talked about the photos and that time in Pallin's life.
The Japanese continued fighting to regain territory secured by the Americans, and it quickly became clear that conditions were not safe for a field-and-evacuation hospital on Okinawa. The medical teams were evacuated to nearby Ie Shima in the Ryukyu Island chain.
"Ie Shima — I never heard those words from my mother growing up," Bernier said.
They endured great hardships on Ie Shima, they lived eight nurses to a tent with stinking latrines, cold showers, little or no electricity, long days attending patients and even longer nights huddled in foxholes, where they moved the patients for safety during continued Japanese air attack.
But they also set the groundwork for advances in the nursing profession, Bernier said. "They were the first advanced practice nurses — practicing without the physicians nearby, triaging patients and using set protocols. My mom even saved the protocols!"
To place her mother's experience in a larger historical context, Bernier visited the Military Archives in College Park, Md. and interviewed a military nursing expert. To her surprise, she was only able to find one photo that corroborated her mother's war experience in the Pacific theater.
"There were no other records," Bernier said. "There were some gaps in the documents related to that period of fighting in the Pacific."
"Francie's paper makes a significant contribution to nursing history in that it fills the gap in the literature about a small group of nurses serving in Ie Shima. Prior to her work, the story had been missing in the military archives," said Arlene Keeling, director of the U.Va. School of Nursing's Center for Nursing Historical Inquiry and Bernier's professor for the course.
Her overarching research on military nursing during the war revealed that even with shortages of instruments, supplies and medications, the survival rate during World War II was directly attributed to the quality of post-operative care provided by the nurses, who were continually given expanded responsibilities as doctors were occupied in surgery. They forged new collaborative relationships with physicians that "advanced the scope of nursing and redefined their role. It was a change that raised nursing to a 'new professional nursing role,'" Bernier wrote in her paper.
Recognizing the value of the photographs, Bernier persuaded her mother to donate them to the Center for Nursing Historical Inquiry, one of only two university-based nursing history centers in the country. Bernier hopes the gift will contribute to changing the perception of nursing while describing how World War II nurses expanded their role within the health care community.
"Doctoral level education, by definition, focuses on scientific research. … While Francie's work is not directly related to her clinical research focus, I am convinced she learned how to gather data, analyze those data and support her argument. These skills, as well as her respect for the complex contextual issues which the profession must face today, will serve her well in the future," Keeling said.
Just as her mother's World War II experience shed light on the expanding role of nurses in the medical field, Bernier is committed to raising the visibility of research done by nurses. While studying for her master's degree, she attended a conference where she learned that the National Institutes of Health would never consider a research-grant proposal from a nurse without a Ph.D. That solidified her decision to pursue a Ph.D.
"Research is my passion," Bernier said. "Many nurses are uncomfortable doing research. It can be overwhelming.
"Something I learned from my mother, who was a nurse and served in the trenches, is that it's nice to know there is someone out there who understands," she added. Bernier has recently shifted jobs within the medical corporation and is now part of a team that creates research while encouraging nurses to expand their role by becoming active in these research projects.
Thus, she is making her own contribution to changing the perception of who nurses are and what they do. "I'm there to help when they start their research projects and support them all along the way through the entire process," she said.
For Bernier, research is a passion, but she also views it as "a professional responsibility to create, complete and publish research findings."