The twin towers of New York City's World Trade Center collapsed under terrorist attack, and the world watched in horror. Nurse practitioner Maria Gatto took action. On September 11, 2001, she was among the first Ground Zero responders and dove in to set up and operate the First Command Post/Medical Triage Unit. A palliative (end of life) nursing expert, Ms. Gatto provided medical care to those wounded, and offered solace to the dying and comfort to those surrounded by destruction and devastation. "My role there that day was about trying to save lives, but it was also about honoring those lives lost and providing support for the aftermath of death," she explains.
Ms. Gatto's entire career has focused on palliative nursing with a holistic focus. A graduate and president of the class of 1987 at William Paterson University, she has worked in various palliative care settings, including oncology and hospice. Her return to nursing school at New York University led to master's and post-master's degrees and board-certified palliative care management nurse practitioner (BC-PCM, NP) and holistic nurse practitioner (HNP) designations. Additionally, she holds credentials as a Certified Hospice & Palliative Care Nurse (CHPN), advanced practice registered nurse (APRN) (state sites differ) and as an Advanced Holistic Nurse, Board Certified (AHN-BC). She has received numerous awards, scholarships and honors. In both graduate nurse practitioner programs, she was named both Distinguished Palliative Care Nurse Practitioner and Advanced Post Master Holistic Care Nurse Practitioner by NYU.
As the director of palliative care services for the Bon Secours Health System Inc., Ms. Gatto's charge is to create a standard of integrated holistic palliative care service programs throughout the continuum of care. This includes assessing system-wide needs, establishing education and policy standards, and integrating all processes that relate to the continuum of care.
During her graduate work at NYU Palliative Care Nurse Practitioner Program she created a complementary alternative pain management protocol for Mount Sinai Medical Center Pain Task Force Committee, was involved with complementary alternative education for the NJ Task Force on Aging and Cancer, and was part of the government's Public Health Emergency Preparedness Center for Primary Care, Prevention, and Clinical Partnerships Taskforce, where she was chosen to be part of the expert palliative care panel that developed and authored the center's medical response and the redefinition of palliative care as it relates to a mass casualty event and disaster response.
When did your interest in the field of nursing start?
I always knew at a very young age that I was meant for caring, to help people heal. When I was very young, I told my mother I wanted to be a nurse, and I was told no. She was and still is my biggest inspiration, even at the youngest age. Saying no to me was her way to provide challenge, support, and development of my spirit if this was my chosen path in life. My mother was a head nurse at a nursing home. She knew that it was a calling, not a profession, and unless you have that calling, that it's best not to go forward.
Describe your current role as the Corporate Director of Palliative Care at Bon Secours Health System.
My role at the Bon Secours Health System is the director of palliative care services throughout the entire healthcare system, which is a not-for-profit Catholic Health System that includes 19 acute-care hospitals with a total of 4,850 licensed acute beds, one 54-bed psychiatric hospital, one independent living and six assisted living facilities, numerous ambulatory and community health services, and six long-term care facilities with 1,189 licensed beds. Bon Secours Health System consists of more than 20,000 caregivers helping people in 12 communities in nine states.
You were a trailblazer in the integrated palliative and holistic care field after attaining nurse practitioner degrees in both specialties. Tell us about your experiences.
It was very fortunate that I was able to work in the first New Jersey Palliative Care Service at Monmouth Medical Center under an earlier graduate of the Palliative Care Nurse Practitioner Program. They supported the integrative holistic palliative care concept, but needed someone to create the process and do the practice. I practiced IGM® acupressure along with being the palliative care practitioner with the palliative and hospice patients.
From my practicum, I went to work at Flushing Hospital Medical Center in New York as a palliative nurse practitioner. It was a palliative care service that was grant funded, therefore I had to show outcome reports at 6 months and end of year. It was the most challenging environment; the area was extremely multi-culturally diverse. From there, I had many other jobs, all encompassing my holistic and palliative care background. I went through all the levels, up to corporate. I also taught and co-developed the IGM® holistic modality curriculum. One of our graduates was a Bon Secours palliative nurse that I knew all during my student years, leading me to my opportunity there.
You were a first responder at Ground Zero following the Sept. 11, 2001, attack on the World Trade Center. What impact did your involvement have on your outlook and career?
It was very amazing to me that on the biggest day of death and destruction in American history, the first nurse to get to Ground Zero was a palliative care nurse. My role there that day was not only about trying to save lives, but it was also about honoring and support of death and grief right on site and providing support for the aftermath of death in the community.
The impact showed me there is no such thing as a limitation in your career. In our culture and society of terrorists, of mass casualty, mass death, tragedy, the palliative care nurse is always instrumental. It's powerful to stand on the biggest gravesite in human history, Ground Zero, not only trying to bring what is left home to mourn, but also supporting those who are the messengers. That's looking death in the face and saying, "I can help." We had to support a nation in mass grieving; who else would understand that but a palliative care nurse?
Your outreach to the nursing/healthcare profession and to the general public through lectures, presentations and article publication is extensive. What drives your involvement in such efforts? What messages do you offer?
I believe in public service and have served extensively as a guest speaker for high school health topics, at university level allied health careers, and at advanced directive healthcare planning workshops for senior citizens.
Over the course of your schooling and career, you have received numerous awards and honors. What does such recognition mean to you on a professional and personal level?
The recognition and the honor goes to the people who taught me. The greatest teachers are the patients throughout the years. I am nothing without the patients and people that supported me to bring me here, I am not acting alone. I can be the messenger, I can be the vessel, but I'm honoring them.
What do you consider your biggest accomplishment thus far in your career?
When I think about this, I see it as two fold of accomplishment and opportunity. I originally assessed Bon Secours palliative care physicians' education for palliative and holistic care and found they had none.
On behalf of Bon Secours, I attended an American Board of Holistic Medicine conference and an integrative holistic medical professional review course… to create a partner initiative to tap into a grant opportunity to launch a pilot of the first integrative palliative education for physicians throughout Bon Secours palliative care services.
What are some of your personal and/or professional goals for the future?
I'm to bring a message to all of humankind about a new paradigm and shift for a how we care for each other and integrated, holistic healthcare. Holistic health is about the optimal potential at all stages of your life; people have to learn to care for themselves in their lives and their deaths. My future goal is to bring a new awareness of compassion and love and healing to the profession of palliative care, its medical community, and beyond.
What do you enjoy most about your career?
Dealing with mortality opens the view of the soul like no other. When facing death, life is more precious; we understand and are more open to life. As they say, if you were to live this day as if it were your last, what would you do? How do you look at it? That's what I'm about, to spread the message, to give a vision, to know that we can care for each other at all moments of our lives.
What are the biggest challenges?
The most challenging role of a palliative care nurse is to have an immediate connection to your patient in those first five or 10 minutes. You need to get the patient's trust and emphasize when you are addressing the biggest points of mortality, something they haven't even communicated to their family or loved one. That's the most challenging role: to have the true skills of listening and communication.
How has the popularity of the Internet affected the nursing profession?
It has an impact; you see online degrees, online education, everything is done through the web and internet, my job and position is dependent on it. We have to be internet savvy, whether we like it or not. It's integrated into nursing education, and clinical documentation is going electronic across the country; it's in every facet of what we do.
Best patient care tip for a novice?
If you are not sure, that is not a failure; if you don't know what to do, always reach out to to your staff, to your mentors, your preceptors, your colleagues. Always strive to improve. We're always students, we're always learning. I've always stopped and asked for help when unsure Never be afraid to ask the question and to challenge if necessary. A big part of the job is to be the educator and be a resource for information.
What led you to pursue master's level nurse practitioner educational opportunities? How did you choose NYU?
As I was working in hospice, I went through a divorce, and as part of my "what can I do make this part of a positive," outlook, I knew I must follow my passion. I was already a certified hospice nurse and palliative care nurse. I called the national organization and asked "What more can I do to further my education?" It turned out there was a new program at New York University, the palliative care nurse practitioner program. I called the head of the program, Dr. Debra Sherman and we had an immediate telephone interview. She told me, "I hear a passion in your voice… you need to give up what your thought your life was, for the life that is planned for you."
When is it a good time to pursue post-graduate nursing studies?
I would caution 'new' nurses that go straight into the advanced practice program. Sometimes I feel they need more experience before they go to that level; I would like nurses to give themselves time to give bedside care and feel solid experiencing their role before going to the next level. Basic nursing skills gives the nurse more of a sense and experience, a foundation to move on. Lacking the bedside nursing skill, immediate gratification at the next higher level might take away from a nurse's best perspective and basic skills. I knew of "brand new nurses" that went right to the practitioner program and did not feel as competent in the NP role as a nurse of many years and experience. This might not be true for everyone; however, this was just my observation.
What factors should prospective students consider when choosing a school? Are there any different considerations for those who know that they want to specialize in a certain field of nursing?
To think about their specialty, their goals, and what they want to accomplish. It has to match your spirit. It has to be about not just what you do, but who you are.
What are some of the most respected and prestigious nursing schools, departments or programs?
I might not have gone to the most prestigious schools; it's the people that make it. Meet the instructors, graduates, students, talk to them, I know some people who went to the highest-ranked schools, but they couldn't wait to leave. The most respected and prestigious schools are the ones that speak to you "inside" the most.
What can students applying to nursing schools or programs do to increase their chances of being accepted?
A certain GPA is required, you have to show community involvement, commitment; it's very important that you have experience in the field beforehand. Being a nursing assistant so young helped me to show that young initiative and commitment. Look for jobs that are going to help train you for that role. You need good academics, aptitude in caring for people. What does a nurse do, and how have you reflected that in your life?
How could the nursing education system change to better serve society?
We should be bringing our nurses back to the bedside, not teaching them to be a nurse of tasks, but teaching them to be a nurse of caring. Nursing students need to learn how to perform caring human interaction, communication, interaction and compassionate skills, support of life as well as end of life, and holistic skills. If you are taught how to be a holistic nurse at all stages of life,that would serve patients better.
What other advice can you give to prospective students thinking about an education and career in nursing?
I believe the best advice is to love your work, have fun at your job; you have to smile. If you don't love going to your job everyday, why go? People in palliative and hospice care know that it isn't depressing. You are not going in as the grim reaper; you are going in as Mary Poppins; we do more laughter and healing than any other nurses.
Do you feel that is important for someone to be passionate about the healthcare field in order to be successful as a nurse?
If there is no passion, please walk away and find your passion. It is a prerequisite. Something has to move you spiritually, passionately to deliver the greater good. If you don't feel it from within, please find it somewhere else, you do a disservice to patients otherwise, and yourself, as well.
Is there anything else you can tell us about yourself, your career, or the profession that would be interesting or helpful to others aspiring to succeed as a nurse?
My closing remark is namaste -honor each other and the universal connection that we have.
Editor's Note: If you would like to follow-up with Maria Gatto personally about this interview, send an email to Maria_Gatto@BSHSI.com.