The job of nursing is at once among the most recognizable and the most misunderstood professions there is. Virtually everyone who has had an interaction with the health care system on any level encounters a nurse and the images from 2020 of nurses standing their post to the brink of collapse during the COVID-19 pandemic are still fresh in many Americans’ memories.
Most people also know that nurses are a human resource in short supply. The 2024 State of Nursing Report released last month by nurse.org found 84 percent of nurses queried in 2023 felt the nursing shortage was getting worse, the three main reasons for which being burnout, poor working conditions and low pay, respectively. In fact, the survey found nearly 1 in 3 nurses had a secondary form of income to make ends meet.
On the other hand, there is a lot about nursing that the general public does not understand or appreciate. Nursing is hard physical work in the moving, shifting, transporting, lifting and occasional restraint of patients in various states of distress. The job is also emotionally draining, and the toll it takes can stealthily multiply for even the most seasoned nurse.
Last year, the Michigan Journal reported a record number of nurses, 729, died by their own hands between 2017 and 2018, and the rate had not slowed much by 2023, when 16 registered nurse suicides per 100,000 was the second-highest mark on record.
Another often-unknown fact about nursing is how versatile a nursing degree can be and how widely nurses are dispersed throughout society. Yes, there are still millions who work in hospitals and clinics, directly serving patients, but a surprising number of people with nursing degrees put that education to work away from the bedside. Nurses can be found working in research labs, schools, the classroom, pharmaceutical companies, insurance companies, law firms, and even ministry and as entrepreneurs.
The State of Nursing Report found that while bedside nurses felt less like changing jobs in 2023 than in past years, about 1 in 4 reported their view of their current career path was to stay in nursing but not in a patient-facing role. About 23 percent of those looking to make any change in their career listed leaving the bedside as their primary motivation.
Arkansas Money & Politics interviewed four local nurses at various stages of life whose careers are playing out in nontraditional settings. We sought to discover why they chose the path they did, what unique experiences they encountered and how their choice of venue affected the day-to-day responsibilities of being a nurse.
Kelley Hamby
1. Kelley Hamby, Baptist Health
Administration
Kelley Hamby never planned to be an administrator, let alone the first system chief nursing executive with responsibility for all nurses in the Baptist Health system. In fact, she did not start with the health care system in a nursing role at all, although that would soon change.
“I joined Baptist in 1990 as what today we call a unit customer service specialist, or the secretary of the nursing unit. I came to work here on our nephrology unit,” she said. “Health care was a goal; I was blessed to be a volunteer at Arkansas Children’s Hospital [in Little Rock] where I spent summers volunteering.
“I knew from that I wanted to be in health care, and I thought I wanted to be a nurse, I wasn’t 100 percent at that point. I just knew I wanted to be in health care for sure.”
After a year of employment, Hamby enrolled in the nursing curriculum at Baptist Health College through the hospital’s scholarship program. After earning a bachelor’s degree in nursing from the University of Arkansas Little Rock, working and taking some time off to raise her children, she completed two master’s degrees, one in nursing and one in business.
About five years into her nursing career, she began to find herself gravitating to management roles. As her education advanced, so did her opportunities, but she also said moving into leadership positions took some adjustment.
“One of the biggest things about that is just understanding that you’re responsible for the care that’s delivered to the patients, whether you’re independently delivering the care or someone else underneath you is delivering the care,” she said. “Then, obviously, the 24/7 responsibility is a big piece of it. As a leader, you’re on call 24/7 for whatever may go on in your department. That was a big adjustment.”
In 2022, she reached the summit of the company in her current role, for which she has direct and indirect responsibility over some 2,200 employees.
“The first thing I would say about it is I’m humbled,” she said. “I really believe and know that I owe my career to Baptist Health for helping me to go to nursing school and to obtain my nursing degree and then obviously to God, who has put me here and has opened doors for me to go through to continue to prosper and to be able to grow in my role.”
Her advice for the next generation of nurses is to study hard and think big.
“The beauty of health care and the beauty of nursing is that there is such a vast variety of what you can do with a nursing degree,” she said. “Whether it be in a hospital setting or outside of a hospital setting, it sets you up for life because there will always be health care, there will always be a need for health care, and you can do pretty much anything you want to do, from touching a patient to doing informatics. You can work for pretty much any different aspect of the business world.”
Col. Elizabeth Hoettels
2. Col. Elizabeth Hoettels, U.S. Air Force
Military
The path that led Col. Elizabeth Hoettels into a career in military nursing — a career which, in turn, found her assigned to multiple domestic and international duty stations, the latest being Little Rock Air Force Base in Jacksonville — was a winding one indeed. The child of Army personnel, she graduated high school and headed for the service herself.
“I joined the military because, one, I needed money for college,” she said, “and two, I wanted to see the world, and I needed somebody to help me pay for it.”
She enlisted in the U.S. Army as a Medical Service Corps officer, a role she described as more administrative in nature, while she earned a degree in international relations. While deployed in Afghanistan, she decided to add nursing to her knowledge skill set.
“Even though I was a medical administrator, we were expected to have a certain level of care capabilities, combat lifesaver and a few other things,” she said. “I spent a lot of time on my last Army deployment in Afghanistan, working with the minister of public health. I was great at managing projects, but I really loved working with people, so I went back to nursing school.”
Hoettels knows her dossier looks unconventional — for starters, leaving the Army only to enter the Air Force and completing her nursing degree at age 31 — but such was the depth of love she had for the nursing profession, especially used to benefit America’s fighting men and women.
“I love my military family, and being able to take care of my military family, our nation’s sons and daughters, is incredibly important to me,” she said. “If somebody needs care, I want to be the one who’s there to take care of them. I want to be the person who’s flying somebody home to their family. I believe everybody has the right to be able to get home to American soil and be with their family.”
Adding a doctorate in executive leadership to her resume led her to roles that have taken an even broader view of military health care and the development of medical teams. That work helps set the framework for best practices from training to triage to help ensure a uniform standard of care.
“In the Air Force, one of the great things is that you can do clinical types of things,” she said. “That’s where I was out supporting Naval Special Operations and all sorts of other folks. We can also be leaders in areas such as nurse scientists. I have found a love of leadership and taking care of people, and I translate being a nurse leader as you’re still taking care of people; they just might not be actively bleeding but still need support.
“One of the things I’m doing is making sure that the young nurses coming in are getting trauma training, they’re getting exposure to all sorts of things. I’m investing in them as a leader, but I’m also investing in them, especially my nurses, as a clinician.”
Gage Lewis
3. Gage Lewis, Harding University student
Medical Missionary
A life-threatening episode on a Boy Scouts canoe trip as a youth opened Gage Lewis’ eyes to the power of nursing. When a member of the group became seriously incapacitated, requiring the troop leader to get him to medical help, Lewis was left in charge of getting the rest of the group back to base camp.
“We managed to get everyone back, and the kid was OK. He was just really sick for a while,” he said. “I got everyone back, and that very next semester, I took a wilderness course, and I fell in love with it.
“My original plan was to be a backpacking guide, and then I realized that my favorite part of backpacking is when something goes wrong, so I did a dual enrollment EMT class in Colorado, and I fell in love with medicine. I wasn’t always a great student, but I was top of my class on that one.”
After high school, at his parents’ insistence that he get a college degree of any kind, he enrolled in the nursing program at Harding University in Searcy.
“Ever since then, it’s been 110 percent medicine. I have found a huge passion for it,” he said. “It’s really, truly been my calling ever since that pretty disastrous day.”
Something that enhanced his love of caring for others is the school’s medical missions program, of which he has completed two.
“Being a Christian school, Harding has a huge focus on mission work,” he said. “Long before my time, a couple of nursing students went down to Haiti to help with disaster relief over spring break. Today, that’s become a 10-day-long excursion where you’re setting up mobile clinics in Nicaragua.
“It’s very unique from American health care. The Nicaraguan system is a socialistic system that has technically ‘free’ health care. The only issue with it is they don’t have enough providers, so while there might be a free clinic, it’s a six-day walk to get there, and since staffing is irregular, there’s not super-consistent hours.”
The Harding group worked hand in hand with local doctors to bridge the gaps in health care as best they could within the scope of their training and expertise. Participants learned how to minister to people the old-fashioned way, with compassion and skill, even in the most rudimentary surroundings.
“We’ve done clinics out of churches underneath a mango tree,” he said. “We would drive anywhere from 15 minutes to the local school to help set up a little building to the side, all the way to four hours on a 4X4 trail into these super rural communities.
“The whole experience is geared towards having students find their ‘why’ in medicine. A lot of med students will come and join us, and if there’s anything true about medical school, you don’t get to do something. Like, you don’t get to perform your passion or do anything medical for four years. This trip gives students that opportunity while providing a service to the wonderful people of Nicaragua.”
Amy Hester
4. Amy Hester, HD Nursing
Entrepreneurship
Nursing has always been in Amy Hester’s blood. The Benton native earned her nursing education from the University of Arkansas Little Rock and University of Arkansas for Medical Sciences in Little Rock. She graduated with a bachelor’s degree in 1994 and later earned both a master’s and Ph.D.
She spent two decades-plus in the classic nursing career track, serving patients in UAMS’ trauma, burns and surgical units and moving up the leadership ladder, ultimately reaching the level of director of nursing research and innovation.
As with any nurse at bedside, every day was an opportunity to impact a life, but what happened along the way opened the door for Hester and her coworker and fellow nurse, Dees Davis, to serve thousands of patients nationwide.
“We’d had a young man fall on our ortho unit, and he died from it. That was a very public case for UAMS and just a really tragic situation,” she said. “That was the genesis for us. We asked to see the hospital’s data, and UAMS was next to the bottom in the nation in falls with injury. It was not something we were proud of, and we knew we needed to be better.”
The system the two nurses created provided a data-driven way to assess and evaluate each individual patient’s risk for falls and then, based on that, provided a care plan for personnel to follow that proactively served each patient accordingly. The impact of the system on hospital performance was dramatic.
“We took the program that we developed for the neuro unit, and we pushed it out to the rest of the house the following year,” Hester said. “We pushed ourselves from the 98th percentile to the 11th percentile in our national ranking of falls with harm.”
Hester said she did not initially think of turning the system into a business, but the potential for the system eventually led her to retire from nursing and, with Davis, she launched HD Nursing, where Hester is now chairwoman and CEO, in 2012. Today, the company’s full program covers about 50,000 inpatient beds and about 15,000 emergency department bays. She has seen her nursing education at work throughout her time in business.
“It really helps you understand risk, time management, helps you prioritize needs in very complex situations and helps you understand when you need to pivot,” she said. “Direct patient care is hard. It’s about being able to manage and juggle and reprioritize in a constantly changing environment. You know, I’ve made my plan for how my shift is going to go. I can see the writing on the wall that I need to do something different, and then I provide crisis management for that situation.
“My advice for anyone in nursing is to stick with your education. Get it done, get good clinical experience behind you, and know that there are a lot of different ways that you can serve patients. There’s just so much opportunity and flexibility that the sky’s the limit for what you want to do.”
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