I had the tremendous pleasure and honour to give the keynote address at this year’s ONS Congress which is something I never would have imagined in a million years. The topic of my keynote was about nursing invention and nursing innovation and all of the ways that nurses have been innovating and inventing, really for generations, and how that has not necessarily always been recognised for the value that it brings.

Can you tell me about your background and the unique perspective you have as not only a nurse but also an inventor?

My background, I am an oncology nurse by training. My first job was in bone marrow transplant at Johns Hopkins Hospital in Baltimore but I wasn’t always a nurse, I originally went to school for something else. I don’t think I really knew what I would be but I had some notion that I needed to be of service in the world. So I got into the US Navy and the US Peace Corps in the same week and I ended up joining the Peace Corps and moving to West Africa where I was embedded with nurses and midwives who were providing primarily rural communities all of the care. They were essentially working on their own and figuring out creative ways to make it work in a space where resources were quite limited, where there was next to no technology and where they didn’t have nearly the same health infrastructure to back them up. So they really inspired me, their expertise, truly, in what they did, to consider nursing as a profession. So after that experience I came back to the United States, I trained as a nurse and that’s how I ended up working in the cancer centre in Baltimore.

I didn’t use to call myself an inventor, that’s something I’ve only started doing recently, even though, when I think back on it, things that teams I’ve worked with have been doing for quite some time and things that nurses have been doing forever all fit that definition. But it was through working very closely with computer scientists and engineers and business people at my current university, all of whom will just effortlessly call themselves inventors and use this language of innovation and give themselves titles, that I realised what they’re doing and what we’re doing is not so different. It’s just that I was never taught to claim that for myself or for our profession, really. At the end of the day most of what nurses do is just try to make things work for the patients and families and communities we care for. We don’t necessarily take any credit for that, we just call it doing our jobs even though it requires all the same skills that you use in what other people call invention.

What did you invent?

It’s hard for me to answer that question with an ‘I’ because I always have to say ‘we’ and not because I don’t believe in myself but because the reality is it has always been teams. All of the ideas have always come from people that I have encountered, that we in nursing have encountered and worked with in the course of providing care. So we’ve been working on a number of things: we have a digital platform that we’ve been trying to build to allow people to assess their home interiors and apply some pretty well-established tools for understanding how the way that space is built affects accessibility and safety in the home and how they could maybe modify that space to be able to continue to live in their home and be as capable as they can be in that space.

We’ve been working on some microfluidic devices, some people call them lab on a chip devices but right now the prototypes look just like pregnancy tests, to allow cancer patients to essentially know when certain chemotherapies have fully left their systems because especially therapies taken at home people have this fear that they’re going to expose their loved ones to some type of risk because of the toxic by-products that sometimes pass out of their systems. So they stop doing things that may be very important to them like anything from breastfeeding to sharing beds and bathrooms to physical intimacy with their partners. There just hasn’t been a lot of science done around that and whether or not it’s always well justified just completely stopping these things. The lack of evidence also makes it harder to give advice. So we wanted to have a device that could help people better establish that and help us make better guidelines.

Then we’ve been working on a toolkit, like a subscription box service, trying to think about how do we not continue to burden nurses and other healthcare providers by adding seven more things they should be doing when working with patients. So how do we put behavioural interventions that we know support wellness during cancer survivorship in a box? How do we meet particularly goals that survivors are telling us are important to them, including sexual wellbeing after cancer therapy and managing sleep and energy and staying active in ways that are realistic for them? How can we deliver those even to remote places or tailor them in such a way that a group that hasn’t gotten a lot of attention, like men with breast cancer which is about 1% of all breast cancer cases, they tend to be spread out across the world. So, as a result, nobody has built a programme specifically for them, so how do we deliver something that works for them and acknowledge that they’re here with us too?

Then we have another project that we’ve been working on. There’s the toolkit, there’s the digital platform, there’s the microfluidic devices; we worked with computer science on some eye-tracking technology, Google glasses basically. All we really wanted to see was could we capture the very real, measurable, functional impacts of invisible symptoms like fatigue in a way that would make them more visible to others and that would also help combat the kind of medical gaslighting that some people experience when they have a really real symptom that’s just not as easy to see as a surgical scar or losing your hair. 

So it’s been things like that that we’ve been working on. Again, we try to have patient advocates as part of that process at every stage, directing what it is we should be building, whether or not it’s something that necessarily has been identified as a strategic priority. Usually we can find a way to make that objective that the patients have shared with us fit into one of the priorities that’s already out there.

What did you invent?

So when someone asks me, ‘What have you invented?’ I have a hard time answering that question with an ‘I’ statement because it has never been just me. It’s always been ‘we’, it’s always been a team and usually a team that also includes patients that we’ve worked with, caregivers, members of the community and then all these other people who have expertise that I will never possess but who know how to come together with us to solve problems, whether that’s engineers or computer scientists or people from the humanities. I’ve even worked with people in the theatre department at my university to think about how is theatre, how is art, a healing force and how could we also use, whether that’s technology or other tools we have, to help capture that and show the value of that.

How do you describe a nurse inventor?

I think that there are already nurses who are inventors and have been for a long time. Nurses do so much that isn’t necessarily recognised publically. The public thinks they know what nurses do and there are certain things they are aware of but the invention and the innovation that nurses have been doing for ever isn’t a story that always gets told. So part of my mission in showing up at ONS Congress this year wasn’t to say to nurses, ‘You need to do more innovation,’ or ‘You need to do more of anything that you’re currently doing.’ It was really just to acknowledge, ‘You are already innovating.’ I can’t tell you, after my talk was finished, how many nurses came up to me and told me stories of things that they had done in their clinics or in their communities or that a colleague had done that are essentially inventions, it’s just that they hadn’t called them that.

One of the nurses told me about a colleague, they were caring for a very young patient, a child, who had a condition that caused their skin to be incredibly sensitive to any kind of touch. So the types of things that would traditionally be used in the clinical space to secure IV lines or devices to their skin, or the tape, it just was impossible and incredibly painful. So the nurse caring for this child just in an effort to make life better for that individual took the child’s blanket which they could have against their skin and fashioned a garment out of it that would allow all these other devices and lines to be secured without ever having to touch the child with a piece of tape. The product of that was not only did the care get delivered better but the child had something that they associated with comfort and everyone’s needs were met. If anyone else had done that, if a business student had done that or even like a physician innovator had done that, they would call it an invention – ‘Look at this thing that I created.’ But the nurse was just doing what they thought would benefit this child and I think there are so many things like that out there already. They haven’t necessarily been commercialised or patented but people are using them. I would like the rest of the world to know more about that so that some of these great ideas don’t have to stay just in the unit or in the space they’re being created, they can be amplified and disseminated and help more people.