Billy Rosa is a nurse, in much the same manner in which, oh, Michael Jordan played basketball. He doesn't work at it as much as he lives it, breathes, has it for breakfast, agonizes over it and then, well, lives it some more. And then writes about it. In fact, it's kind of hard to believe Rosa came to nursing as a second career, but it's true.
"I really am a second-career nurse," he said. "I hold a Bachelor of Fine Arts degree in drama from NYU's Tisch School of the Arts. I was a dancer, singer and actor for years, and until I was 23, performed in several regional theater performances and well-known shows like the Radio City Christmas Spectacular. During a particularly grueling contract, I sustained a repetitive motion fracture to my left hip and wasn't walking for months.
"At first I went to massage therapy school, taking time for myself to heal and be quiet, to reacquaint myself with this body — this instrument — in which I no longer felt at home. The students training with me were exceptional healers. It was a very special time in my life. When I would work in the clinics as a massage therapist, I was amazed by how patients would respond to clinical massage. One woman had struggled with chronic asthma since her childhood and shared that she rarely knew a day without having to use her rescue inhalers. I spent an hour working on her intercostals, scalenes, upper trapezius and abdomen, paying attention to the area around her diaphragm. She wrote a letter to the clinic some weeks later saying she had never experienced such ease of breathing as she did the week after her massage. Better yet, she hadn't used her rescue inhalers one time over the following seven days.
Discovering nursing
"The ability to help heal and have such an impact on people is a powerful thing, and I decided I wanted to help people."
But — and this is a common theme for Rosa because, as he says, "I'm just wired a little weird" — he wanted more.
"Over time, I learned that my ability to impact the outcomes of clinic patients went beyond physical techniques and, many times, it was my presence, willingness to listen and kindness that made the biggest difference. I wanted to find a job where I could fuse this art and science of caring that I had learned as a massage therapist and maximize my contributions to the public. A friend suggested I look into nursing ... and there you have it."
And it's a good thing for us that we do. A short list of Rosa's accomplishments would be an oxymoron. He has edited two books, including Nurses as Leaders: Evolutionary Visions of Leadership. He has been published more than 60 times across a variety of publications, media and platforms. A recipient of AACN's Circle of Excellence award at the 2016 NTI conference, he was nominated as a finalist in Prevention magazine's America's Most Amazing Nurse competition.
Going to Rwanda
But much of that, he will tell you, pales in comparison to the work he continues to do in Rwanda.
"I had never participated in service missions, and to be honest, was skeptical of the brevity typically associated with their outreach," he explained. "There were several ethical considerations for me in choosing a global initiative to commit to that I felt was representative of my values. For example, I did not want to go to a low-income country for two weeks, build a clinic, recommend treatments, give antibiotics and vaccinations, and then disappear into the ether.
"But when I heard about the Human Resources for Health (HRH) Program in Rwanda, the goals of the initiative resonated deeply with me: increase the quantity of doctors and nurses in Rwanda, improve the quality of available education, increase autonomy of the healthcare workforce and Ministry of Health, and decrease overall dependence on foreign aid over a seven-year period. This was about empowering a people to be independent and take ownership of their nation's health with the confidence that education, increased access to resources, and transnational collaboration could provide."
Rosa found that this was much more than the typical short-term service project.
"This wasn't about me taking over or putting a Band-Aid on the international human resources for health crisis by temporarily filling a staff nurse role; it was about being an advocate for human-centered healthcare in true partnership with Rwandans who were passionate about improving the quality of their providers, systems, and the lives of their 12 million fellow citizens.
"The role also required me to live abroad for a one-year minimum contract, offering me the opportunity to engage in the Rwandan context with my whole self, learning firsthand about the culture, and being exposed to the socioeconomic, political, and historical factors that contribute to the various indicators of health in a post-conflict country."
A life-changing experience
It was truly a life-changing moment for Rosa.
"I lived and worked in Rwanda from August 2015 through August 2016. I served as a critical care unit Clinical Educator at Rwanda Military Hospital, and as visiting faculty at the School of Nursing and Midwifery, University of Rwanda in the country's first-ever Masters of Science in Nursing (MScN) Program.
"Every aspect of this experience can be summed up in two words: humbling gratitude. I went with an idea that I had much to teach, and came home overwhelmed with the gift of how much I had learned. Being in Rwanda really taught me, on a fundamental level, beyond the mere concept of a shared humanity, just how interconnected we all are. One of my favorite thought leaders says it best: 'I am not my brother's keeper, I am my brother.'"
But Billy being Billy, he wanted — again — to do more.
"I desperately wanted to find a way for the emerging MScN students to be connected to a global community of nurses through professional association membership. Their government hopes for them to become leaders in healthcare, but I noticed that they did not have the resources available to them to sustain access to continuing education, guidelines, literature databases, social media forums, and specialty core curricula that might serve as a springboard for the development of their own culturally relevant practices and protocols.
"I am eternally grateful to AACN and several other nursing associations who heard my plea and came to the rescue. AACN offered 16 critical care MScN student three-year virtual gratis memberships, granting them access to all that we as members share. Can you imagine? What these nurses will be able to accomplish, with the help and support of AACN, is a testament to the fact that our professional associations believe in empowering the global community of nurses, not just those in resource rich environments."
But if the nursing experience there was life changing, time spent away from the work was downright liberating.
"In the six weeks before we came home, my husband Michael and I traveled across South Africa, Namibia, Bostwana, Zambia, and Zimbabwe, deliberately facing our fears and breaking through all of our own self-imposed nonsense," said. "We cage-dived with great white sharks, went skydiving — 'just amazing' — bungee jumping — "never again' — walked with lions, went white-water rafting and had daily adventures that this native New Yorker had never imagined.
"The day we left Rwanda, I cried like a baby. I was inconsolable. I was overwhelmed with that humble gratitude I mentioned earlier. So incredibly blessed to meet and know people that I otherwise would never have known existed."
A good fight
Rosa eyes the completion of his Palliative Care Nurse Practitioner Fellowship and will start full-time PhD studies in the fall of 2017. He's arming himself for good fight. A noble one. And he speaks like a man on a mission.
"Working in Rwanda last year with colleagues from throughout Africa, India, and several other parts of the world, I was most disturbed to see and hear how little attention is given to pain management in the settings of advanced illness and end of life. The alleviation of suffering is a human right. Governments responsible for allocating healthcare dollars in low- and middle-income countries primarily fund programs to decrease the prevalence of communicable diseases, such as malaria, tuberculosis, and HIV/AIDS.
"However, we must help policy makers in these settings to understand the need to redirect monies towards those suffering from a host of intractable pain and associated symptoms in order to improve the dignity of life and living, and also to potentially extend the patient's contribution to society if pain is adequately managed."
Writing — a lot
And to further lend his bold voice to this grand endeavor, he is writing. A lot.
"I hope to continue to publish on emerging considerations for the profession. My second book, A New Era in Global Health: Nursing and the United Nations 2030 Sustainable Development Agenda, is done and I am currently compiling my third text with a team of incredible co-editors, an expansive and inclusive volume that will invite nearly 40 years of research, education, practice and theory development related to caring science scholarship.
"Ultimately, I want to be able to take what I know to be true from a nursing lens and communicate that across sectors and disciplines to create a truly unified healthcare system. In this way, I want to make nursing's contributions evident and also create new models of inter-professional collaboration that strengthens system and stratifies care. I want to make a strong stand for ridding ourselves of outdated paternalistic approaches to healthcare delivery, and role model cultural humility in fostering durable and dynamic workforces."
The future of nursing
If you couldn't already tell, Rosa is passionate, not just about nursing, but the part it must play in the future administration of global healthcare.
"I want to say two things to my fellow critical care nurses.
"First, write! Publish! Share what you know! I believe it is an ethical obligation to write. To see what we see on a daily basis, and know what we know about the myriad dimensions of the human dilemma, and not share that wisdom across disciplines and specialties is a tremendous loss to healthcare and patient betterment. Critical care nurses engage with patients and families during, quite arguably, the most vulnerable moments of their lives. Believe that what you have to say is important enough for others to hear. Be amenable to editorial feedback that calls you to grow as a communicator, and helps you to hone your message so that diverse audiences can readily and graciously receive it.
"Second, educate yourself on the transnational agendas impacting global health access and delivery, and the worldwide nursing and midwifery collective. Familiarize yourself with documents such as the World Health Organization's Global Strategic Directions for Strengthening Nursing and Midwifery 2016-2020, the United Nation's 2030 Sustainable Development Agenda, and the work being done by the Global Advisory Panel on the Future of Nursing, Sigma Theta Tau International.
"If humanity is to survive, we must understand the gravity of planetary health and the environmental, humanitarian, and the sociopolitical global action items that we, as nurses, play a key role in helping to implement. It is time for nurses to take off their bedside blinders and engage with populations as the advocates, leaders, and healers they were always intended to be. Being a 'global nurse' does not mean packing a bag and moving to Rwanda; it is a shift in consciousness that allows us to understand the more global implications of what we say and do, what we choose not to say and do, and identify a plan to procure safety, peace, health, and well-being for all life on the planet for generations to come."