A NURSE IN COMMAND: When she entered the army in 1983, shortly after receiving her BSN from the University of North Carolina, Horoho says she couldn’t have imagined rising to the ranks of surgeon general because “at the time, nurses had no chance to command.” Now she is the commander of a worldwide staff of 140,000, operating in 29 executive agencies and 480 facilities.

MOVING UP THE RANKS: Her rise to the top of army medicine has included experience commanding hospitals, medical systems and the Western Regional Medical Command. In 2007, she assumed command of the Walter Reed Army Medical Center (now the Walter Reed National Military Medical Center) after the media firestorm and resulting government investigations into conditions there. Horoho has worked on policy matters in the Pentagon and transformed the Army Corps of Nurses as its chief, instituting the Patient Caring Touch System based on five elements: patient advocacy, enhanced communication, capability building, evidence-based practice and management, and healthy work environments. She also fostered development of nurse leaders and nurse researchers. “The army is way ahead of the curve in how nurses are valued,” says the surgeon general. She remains committed to fostering a culture of collaboration and respect, where care is compassionate and accountability is measured by impact on the patient—not just the final outcome, but also the process.

A NEW APPROACH: Moving Army Medical Command from a healthcare system to a system of health is a top priority for the surgeon general. Soldiers—and civilians—spend, on average, 100 minutes a year with a doctor, nurse or other healthcare provider; that leaves 525,500 minutes a year the surgeon general terms the “white spaces” of a person’s life. “To influence health,” says Horoho, “you must influence the white spaces.” That’s the time someone eats a double cheeseburger, smokes a cigarette or has one too many drinks. As the military and the nation battle the healthcare crisis, nurses are well-equipped to serve on the front lines. “They have the opportunity to make a difference in a variety of roles. We are very key partners in the healthcare team,” says Horoho.

ONCE A NURSE, ALWAYS A NURSE: The summer before she was sworn in to become the 43rd army surgeon general, Horoho—then a major general—was deployed to Afghanistan as the leader of a team assessing frontline healthcare. In between tours of medical facilities and meetings with soldiers, she rolled up her sleeves and got to work in a trauma unit. At the end of the day, she called her husband to tell him it was the most rewarding and exciting experience she’d had in years. After returning from Afghanistan, the surgeon general had the chance to connect with one of her trauma patients at a Super Bowl party, where he was part of a contingent of wounded warriors. “The ability to connect with a patient is exactly the reason I went into the profession,” Horoho says.

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Photography by Pablo Corral Vega

From the Fall 2012 issue of Scrubs

They came from New Jersey and New Mexico, Kansas and Kentucky, Colorado, Utah and Texas. For most, it took three flights and a full day of travel to reach Ecuador. By midnight, all 16 members of the Healing the Children Southwest (HTCWS) mission—six of them nurses—had arrived. They were not a light-traveling bunch. In addition to their personal luggage, they brought 32 large bags packed with surgical supplies, anesthesia gas, medications, clothing, toys and other items to donate.

Early the next morning, the bags were loaded onto a bus, and by 7 a.m., the group—most of them strangers—had settled in, alternately chatting and napping, for the five-and-a-half-hour ride to Bahía de Caráquez. They headed out of the sprawling city of Guayaquil on highways bearing the scars of the devastating floods that had recently hit the country. As highways gave way to roads, concrete buildings, run-down stores and ramshackle homes, some made from a patchwork of materials, dotted the lush landscape. Vendors hawked their wares, children played and dogs ran on dirt roads that sprouted off the main drag. On occasion, a parade of livestock brought the bus to a standstill.

At 2 p.m., they arrived at the Hospital Miguel H. Alcívar. “Then we hit the ground running,” says nurse Linda Harper. Team members took up their assignments, conducting patient evaluations, setting up the ORs and recovery rooms, entertaining restless kids and calming anxious family members. More than half the children evaluated that day were scheduled for surgery, some were put on a waiting list, others were given referrals or explanations as to why surgery was unnecessary. “We also identified two children we plan to bring to the U.S. for very complicated, multiple-stage, facial reconstructive surgery,” says Roberta Krehbiel, the medical team coordinator for the southwest chapter of Healing the Children (HTCSW). From the bridge of his nose down, it’s a mismatched canvas, no symmetry in sight. But his soulful eyes held the attention of anyone who really looked, with a captivating gaze.

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Lose weight, save money, start exercising, stop procrastinating, get organized, go to grad school, give up reality TV, take up the piano…no matter what your goal, you need willpower to achieve it. But when you’re tired, stressed or hungry, your self-control wanes—and that may make you particularly susceptible to temptation.

“Willpower is not a constant feature of your character, as was once thought,” explains Roy Baumeister, PhD, the Florida State University psychologist who wrote the book on willpower (actually, he cowrote Willpower). “It’s a level of energy that fluctuates over the day as it is used and replenished.”

The problem is the system that fuels willpower is also the one you rely on for concentration, decision-making and self-control. Trying to sift through a pound of information to relay the most salient facts about a patient in distress? Energy-sapping. So is selecting the items you want included on your wedding registry. Taming your nervousness when giving a presentation, mustering the focus you need to multitask, keeping your cool when your teenage daughter picks a fight, whatever—all deplete the energy needed to resist whatever leads you into temptation.

The good news is, we’ve learned a lot about the physiology of self-control, and although it’s an expendable resource, it’s also expandable. Exercise and meditation have been shown to build neural pathways that bolster self-control. Adequate sleep and a diet that keeps blood sugar on an even keel are also important. Okay, sometimes it’s a catch-22: It often takes willpower to increase your willpower. But like a muscle, it can be built up with simple self-control exercises–like using your non-dominant hand to open doors or brush your teeth, sitting up straight instead
of slouching, or using whole words rather than contractions— practiced over the course of weeks have been shown to boost willpower. Whenever possible, practice energy conservation, “Pick your battles and really let go of the others,” suggests Dr. Baumeister. “Also beware of the trap of trying to do everything. That will exhaust you severely.”

You don’t have to be a nurse to feel overwhelmed on occasion, but there are very specific roadblocks to self-control that nurses experience day after day. Being aware of them—and the ways around them—are key to keeping you on your path to achieving all your goals and feeling good about yourself.

THE DRAIN: Sensory Overload

Poor lighting, a cacophony of sounds, and the smells…working in a hospital can be an assault on your senses. Getting used to the environmental stressors that are part and parcel of the job doesn’t mitigate the negative effect they can have on your body; in fact, they can tax an already overloaded system with stress. In fact, a 2010 study looked at the environmental stressors nurses face and found that the noise level of a hospital contributed to burnout. What to do?

RESTORE: Take a Nature Break

If your workplace has a green space, take advantage of it during breaks. There’s a wealth of research that demonstrates the restorative power of nature. Merely gazing out on greenery has been shown to speed recovery time for surgical patients, reduce hostility in prison inmates and improve self-discipline in girls. Exposure to nature can also increase your capacity to concentrate and lessen stress. Revive your willpower by finding creative ways to bring nature to work—set your screen saver to a seascape or a flower-filled meadow, download an app that depicts sounds of nature for a 30-second time-out, and if a patient has a room with a view, direct your attention outdoors for a mini-break.

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Lt. Gen. Patricia Horoho, Army Surgeon General, visits with Staff Sgt. Andrew C. Fain at Landstuhl Regional Medical Center. (Photo by LRMC PAO)

She’s the Surgeon General of the U.S. Army, who broke a 236-year tradition by being the first non-male, non-physician to assume the post. She’s a 52-year old nurse, daughter, wife, mother of three, and a three-star general. And that’s just for starters. In a telephone conference with reporters, she spoke about her priorities, challenges and her background. Get Scrubs’ full coverage of Horoho by picking up the Winter 2013 print edition.

The summer before she was sworn in to become the 43rd Army Surgeon General, Patricia Dallas Horoho, RN. was deployed to Afghanistan as the leader of a team assessing frontline health care. In between tours of medical facilities and meetings with soldiers, she rolled up her sleeves and got to work in a trauma unit. At the end of the day, she called her husband to tell him it was the most rewarding and exciting experience she had had in years. Many months later, in a telephone interview, there was still a trace of excitement in her voice as she said, “The ability to connect with a patient is exactly the reason I went into the profession.”

Direct patient care may not be part of the Surgeon General’s job description, but her experience with patients has informed every step of her rise to the top rank of U.S. Army Medical Command. She cites the ability to think critically and focus on teamwork as some of the strengths of nursing, which have translated to every post she’s held.

From Basic Training to Command
Patricia Dallas was born at Fort Bragg in 1960, but boot camp for her illustrious military career began with her training as a nurse, at the University of North Carolina, Chapel Hill, where she received her BSN, in 1982. A year later, she joined the Army. She says she couldn’t have imagined rising to the ranks of Surgeon General, because at the time, “nurses had no chance to command.” Now she is the Commander of a world-wide staff 140,000, operating in 29 executive agencies and 480 facilities.

Horoho assumed the post of Surgeon General at a particularly challenging time, when Army medicine faces escalating health care costs, government budgetary constraints, and the continued care of soldiers physically and psychologically scarred from a decade of battle on a two-front war. Traumatic brain injuries, multiple amputations, PTSD, chronic pain and a high rate of suicide are some of the aftereffects of war.

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When Vicky Wiencek moved from Maine to Oregon, she missed having a nearby scrubs shop, someplace that offered variety as well as personal service. That is, until three and a half years ago, when the ER nurse and her husband, an ER physician, opened Scrub Hub: The Uniform Place in Phoenix, Ore.

A few years earlier and a few thousand miles away in Orlando, Fla., Kathy Geres was thinking about starting a business she could operate when she left nursing. In 2003, her thoughts materialized into Scrubs 4 U. Retirement (from nursing, anyway) came a few years later, but that doesn’t mean Geres has hung up her scrubs. She models the merchandise every day at work.

Halfway between the Oregon and Florida shops, in Kearney, Neb., another nurse, Mary Kulhavy, opened Scrubs PRN in 2002, because she knew “there was a real need in this area.”

On the face of it, being a nurse and managing a retail store may seem to require two totally different skill sets, yet these women beg to differ. “Good customer service is a lot like patient care,” says Kulhavy, who still works on an as-needed basis for an orthopedic practice. “You’re trying to make people feel comfortable and you have to listen to what they say.”

“Dressing a nurse is like outfitting a special kind of athlete,” says Wiencek. Clothing has to help—not hinder—performance. That means no dangling bits of fabric to catch on bedrails or door handles, enough coverage to avoid flashing skin when you bend over and pockets that allow you to securely stash the tools of the trade. Oh, and of course, comfort, durability, affordability and a fit that flatters.

All three nurses are rewarded by providing a service to healthcare workers. The daily interaction with other nurses is a bonus. “I can commiserate about work, recall my days on the floor—without the stress. And I don’t have to get up at 5 a.m. to do it,” laughs Geres. Bumping into long-lost colleagues can turn Kulhavy’s workday into a mini-reunion. It’s work, but it’s fun.

For Wiencek, the relaxed pace of retail is a nice change from the ER, where she still works three or four shifts a month. It’s a good balance for another reason. “Working in an ER, you see life-or-death situations all the time”—and that, she says, helps keep retail stresses in perspective.