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Bill Klaproth: From a farm in Illinois to Vietnam to 19 other countries, we get to share the experience, the insight and wisdom of Winnie Fritz. Winnie has a long storied career of service in nursing and nurse leadership. And she is the current COO, Senior Vice President of Clinical Operations and Services at HCCA Management. And we're going to talk about the care of homeless veterans and the struggles that they face. We're also going to discuss outreach to other vulnerable populations that has been nurse-led. And Winnie will tell a stories of her time as a combat nurse, purchasing and staffing an RV to send out to care for homeless vets and more.

This is Today in Nursing Leadership, a podcast from the American Organization for Nursing Leadership. I'm Bill Klaproth. Winnie, it is great to talk to you. Thank you so much for spending some time with us. You have a very interesting story, a very interesting background. So let's start with that. Can you share with us your experience of being a combat trauma nurse with your many stays throughout different countries? How that shaped your worldview of the plight of our veterans, refugees and other vulnerable population that you obviously have interacted with throughout your career?

Winnie Fritz: My own experiences in my career, I began my career as a US Army nurse. Shortly after graduation, after going through officer basic and Vietnam jungle training, I was then sent to Vietnam. There, as all the nurses did, all the physicians did, taking care of a lot of trauma, a lot of mutilation, I think we were all amazed, horrified at the mutilation that we encountered with several patients.

As a part of that, each of us, I think I will say me personally, I developed what I described as a plexiglass plate under my skin. I thought I never want to hurt this much anymore. And so if I form no relationships, I can be this fine-tuned machine and give exceptional care. But I won't hurt.

I returned from Vietnam on a stretcher back for care at Walter Reed and recovered there. And then was enrolled in a Harvard Psychophysiologic lab study. They began asking questions about what's going on with these Vietnam veterans. They began to study the infantry, soldier and the army nurse that had served in Vietnam.

And as I begin to understand each of our traumas and ways that we were trying to manage those traumatic situations, they began to realize a couple of things and one was that each of us was sent on our own journey. We did not go in as units. I didn't go with the 56th Medical Group. Each of us was sent in individually.

And one of the things they learned out of the study, aside from helping each of us individually to heal, they said, "You were each sent in one at a time, not in a unit. You were each on your own journey." We have learned that relationships and teams are essential always, but especially when facing these traumatic situations. That was my first introduction to not only, if you will, what it feels like to be a veteran but also a nurse caregiver in such a circumstance.

Off and on in my career then, I've spent a lot of time working internationally especially in the Middle East since 1972. I worked in 19 different countries. And many of those are countries in which there are a lot of refugees and asylees, people fearing combat, fearing of fleeing war zones for their lives. And seeing that picture again and again of veterans and military from various countries trying to respond and the toll its taking on those lives. So that would be my background, my introduction to responding to feeling like a veteran and then how do we begin to build from that to not only personally heal but to help those efforts in the future.

Bill Klaproth: That is a fascinating story. I don't think I've ever quite talked to anybody like you before, Winnie, with such an interesting background and someone who has traveled the world and seen some of the things that you have seen certainly when you're talking about your time in Vietnam and developing what you called a plexiglass plate under your skin to ward off the pain. Let me ask you this, did that work?

Winnie Fritz: It worked for a period of time. But then people around me who knew me, my parents and others said, "You're laughing or you're functioning like a fine-tuned professional, but you seem to have no feeling. When we ask you, you don't cry. When emotional things come up, you don't cry or express emotion." And through the care that I received in that Harvard Psychophysiological lab study, I learned that it's better to feel and cry than to not feel. And so I do, I cry.

Bill Klaproth: I could see where that would be helpful to let it out instead of kind of walling it off like you tried to do. I think that's probably a survival instinct to try to wall it off and not to feel, so you don't feel the pain. But in the long run, the pain is still in there and it's going to come out and manifest itself in different ways. Is that right?

Winnie Fritz: Absolutely. And it obviously impedes or prevents future relationships that could be so important. You move about as this fine-tuned machine. At Walter Reed while I was trying to heal before assuming then some leadership positions, they had me starting IVs on the oncology unit. They said, "You've learned to start IVs where we didn't know there were vessels, et cetera. So we're going to try to give you purposeful activity so that you can begin to maybe build relationships and remember who you are beyond being a fine-tuned machine."

Bill Klaproth: So seeing what you've seen in the aftermath of combat and what that leaves behind, feeling what you've felt, you said you can relate to what a veteran goes through and feels like. So let's talk more about that. You certainly would know of the isolation and the trauma that veterans feel. And we know that 22 veterans per day commit suicide and that was even before the pandemic hit. So how do we reach this group? How do nurses and nurse leaders care for this group? What have we learned? What do we know? What do we need to do?

Winnie Fritz: As you asked that question, things that go through my mind are the following, that we can have a plan, sit and kind of develop and strategize and obviously involve veterans in doing that. But the answer I'm also going to give is that you do it one life at a time, one relationship at a time.

As a CEO of a hospital in Arizona, I mean this as an affectionate positive term, we had veterans living under the five viaducts under interstate highways. They were frequent flyers into the hospital, into the emergency room. The hospital staff, the physicians all knew that I was a Vietnam veteran and they would call me and they would say one of yours is here. The police have brought them in. Not that they committed a crime, but the buddies would wave them down, the police down and say, "Charlie's having problems." So they would bring Charlie in and "Charlie is now in congestive failure. He's in acute distress. He's admitted to our ICU and we're caring for him."

And the pattern had been, "Okay. Let's treat Charlie." But then, Charlie goes back to the street. So as I got to know the veterans, obviously that's a trust and a relationship building and it was easier, if you will, for me as a veteran. I could relate and many of them were from Vietnam, so we could talk about Da Nang and about Cu Chi and about the Delta, places I had been.

One of the things I did was to get a used RV. We staffed it with a nurse practitioner and an EMT and said, "Your job everyday is to do nothing but go to the five viaducts. Make sure Charlie takes his Lasix, so that he pees and doesn't come in in congestive failure. Make sure Sam, who was a diabetic, is getting his blood sugar checked and is maintaining some control, so that in a couple of months, we're not dealing with peripheral vascular disease and maybe an amputation."

"And I always want four rooms at Motel 6 on Frontage Road so that if somebody is injured or very ill, that we can discharge them there and stabilize them a bit with 24-hour, let's say, LPN or CNA care before they go back to their buddies on the street."

And as we develop relationships with them, then we can begin to ask them the questions and deal with other social determinants of health such as, "Can we get you in a shelter? Why is it you don't want to go to those particular shelters? What are the other issues we can do to help the quality of your life?" But first, we got to keep them out of the ICU.

Bill Klaproth: Such a great story, Winnie, about identifying a need and then coming up with an idea to take care of that need. You went and bought the RV. You got the EMT, you got the nurse practitioner. You had it drive around to the five viaducts. You got the rooms at the Motel 6. An incredible story about bringing care to the people. That is devotion and dedication. And that gets me thinking, you brought care to the people. In this country, we always go to the healthcare institution. Should we be thinking about bringing care to the people instead of them coming to us?

Winnie Fritz: Yes, very definitely. I think we've had some practice doing that with the pandemic. It's taught us much more about how to get care even virtually through consultations and so forth, telehealth and such. But I think we have more examples to put into place. I think ways in which with mobile care or ways in which-- As an aside, the place I first learned that was caring for Bedouins in the Middle East. Bedouins move with there animals to the water sources. So when I was back here I thought, "Well, why don't we move and take the care to them like we did taking the vans out and following the Bedouins as they migrate around the desert." Try to think of ways to get the care out there instead of veterans coming in the hospital.

We've had other programs. These are very isolated examples, but working with hospice and palliative care programs on how to really connect with and care for veterans. Things as simple as how do we keep them at home and what does home mean for them. What is the language of their rank? And if you're talking to a soldier and not a Navy guy calling him a soldier, but a sailor. I mean learning some of the language that relates to veterans from all the various branches of service.

I've been working with a powerful program called VHP, Veteran Heritage Project. And that is an effort to connect students with veterans. Many of these veterans have never told their story. I've done presentations and walked around the room when we did those in-person presentations. I've gone around the room and met veterans. And I said, "Thank you for your service." And I've had veterans 35 years old, 45 years old, 75 years old, begin to cry and say, "Thank you. Nobody has ever thanked me for my service."

So VHP, Barbara Hatch, history sociology teacher developed that, she's here in our community, and now we work with her in connecting students and veterans. Students interview us. They spent four or five hours interviewing and filming me. And my story, they wanted to look at all the photos, anything that was remembrance of times that I had served. They were so well-prepared with interview questions. And then they write a chapter for a book and edit the film and that becomes a part of the Library of Congress.

These young high school and middle school students began to know veterans. Barbara said, "Why am I teaching all the Vietnam history? I never was there. Why am I teaching Korean conflict? Why am I teaching Iraq and Afghanistan? Let's have veterans come and teach them." Very powerful program, very powerful.

And now, we're working again trying to enlarge the collaboration of organizations here in the Phoenix area with Freedom Funds and the Veteran Heritage Project. There's a Reveille Foundation that tries to provide navigators to help veterans, those leaving the service and those who've been out for awhile to find resources. We're trying to develop virtual and an online system of kind of a 1-800-I-need-help. "I need housing. I need food. I need healthcare. My kid is autistic, I don't know what to do." And so we're pulling them together, reaching out to the VFW, the American Legion and trying to discern how can we use virtual options to reach and connect with these veterans that may be homeless and also in rural areas.

We have a wonderful partner that has said, "I want to help you." It's an organization called MeU Care. The head of that organization is in California. And Kendall was the head internationally of all of Disney's Interactive Media. And he said, "Whatever it is you want, I'll make it happen. You dream the care and the connections that you need and I will make it happen." So those are just examples of ways that we're trying to reach the veterans from different eras and all of those many social determinants of health.

Bill Klaproth: You are telling us great examples of how nurses can lead the way and care for our veterans. And you're very inspiring, Winnie. And it still seems like this is very raw and close to the surface for you as we can we can hear the emotion in your voice. That plexiglass wall certainly is down. And we can hear that in your voice as you get emotional when talking about these veterans and the care that you're providing and these stories as well. Let me ask you this, what drives you? Why is this so important to you?

Winnie Fritz: I think at first obviously it would be that kind of I've been there. And I think the other-- Well, not I think-- I'm sure that another driving force is a message that my parents gave my brother and me both when we left the farm heading off to our careers, left the farm in Illinois, that farm is still in our family seven generations later. And my parents, when I left to become an army student nurse at University of Missouri Columbia, said "Go where there is no path and leave a trail. Go where there is no path and leave a trail."

Bill Klaproth: That's powerful That's inspiring. And you've done that.

Winnie Fritz: Well, at the end of each day, when we were having as a family, having those devotions, we always spend a little time in meditation and prayer at the end of each day. I'm going to give you a question that we talked about. This sounds heavy for children, but it didn't feel at the time. My parents, after some time of devotion and prayer, we would all kind of take a turn and ask. My parents might say, "Wanona," that's my birth name, "Wanona, is the world a better place because you were here today?" And my answer could be as a little grade school kid, "Yeah, mommy. I think it is. Daddy, I think so. I helped Mrs. Smith find her sweater. That's one of her favorite sweaters and she couldn't find it and I helped her find it." And obviously, as you grow, those answers become more complex. But each of us kind of thought about that at the end of each day. Is the world a better place?

Bill Klaproth: Well, you are making the world a better place. And as you went around and thank the veterans, we thank you for your service. This is amazing what you've done and thank you for sharing this information with us, even the quote you just gave us, "Go where there is no path and leave a trail," that is so powerful and this story about your parents as well asking you, "Did you leave the world a better place today?" This is great. And I know that all nurses everywhere probably feel that way when they go into work every day. "Am I going to help this person and help the world feel better as we care for the sick and underprivileged and people like our homeless veterans?"

Winnie, I've got one last question for you and thank you again for your time. This has been amazing. What's your final thoughts on this as we've been speaking about veterans and vulnerable populations and having to deal with COVID-19 in the past year? This has been a heavy weight and toll for many people. As you reflect back through your experience in your life and what we've just been through as a country and still are going through quite frankly, although there is light at the end of the tunnel and we're happy for that, what is most important to remember about all of this? What is most important to you that you want to share with us?

Winnie Fritz: I guess as you mentioned, yes, there is some light at the end of the tunnel and I think both personally and as a nurse, maybe especially at this moment as a nurse, hopefully our preparation helps us to really understand and encourage and build relationships. In my school of nursing back there at Mizzou, University of Missouri, they focused a lot on collaborating and critical thinking. Work together as a team relationships are essential, interdisciplinary teams and also the notion of collaborating and critical thinking.

They kept asking, "What are you going to do if..." "What are you going to do if-- this is a good plan of care but what are you going to do if he starts to bleed? What are you going to do if?" And I think we've seen that throughout this past year and probably, let's say, in our careers that, "Okay. If we're running short of PPE, then what are we going to do? Let's see maybe we could run the lines outside the room and then it'd be easier for us to save PPE if we begin to move some equipment outside of the room with some leads that go into the patient. How are we going to use virtual." It's the idea of, "Okay, what are you going to do if..."

The punting and the innovation that probably as nurses we've been called upon to do many times in our careers and it probably times three in this past year. But not only for our patients do we know that we want to bond with them and develop relationships. We want them to know that we care. But I think we also need to remind each other that that's important for our own relationships at work.

I have a colleague, Sue Scott back at University of Missouri. She is Dr. Sue Scott and she has written and studied a lot about resilience and about second victim phenomena. And clearly, it's one of those being sure we'd look at each other and say, "Are you doing okay? Is there anything I can do for you right now that we need to also remember, if you will, to take care of each other?"

When I arrived in Vietnam, infantry colonel had in the jeep and he was taking me to my quarters for the evening. I had just been the commanding officer with 199 Infantry. They were my troops, that I was in the aircraft responsible for taking them to Vietnam. The colonel now is taking me in that jeep and we're bouncing through some monsoon rains. He said, "Ma'am, I'm not healthcare but could I offer you two priorities for the year. I've been here a couple of tours and I'd just like you to focus on these two things. And I said, "Yes, sir. I'm open to whatever you have to say."

He said, "Here are your two priorities, ma'am. First priority, ma'am, is save your own butt. Don't do anything stupid. Take care of yourself. Stay healthy. Don't fly with first-timer pilots, they'll try to show off for you. And two, ma'am, you want to save as many other butts as you can and the rest, ma'am, is all crap. Stay focused on your two priorities."

That was wisdom for then and oftentimes is now. We need to remember to take care of ourselves so we can care for others, and then go out and take care of as many others as we can.

Bill Klaproth: Save your own butt and save as many other butts as you can. Amen to that. Winnie, this has really been fascinating and enlightening and, quite frankly, inspiring. And it has been great to talk with you and thank you for sharing your stories of being a nurse in situations we can't even imagine, and being a nurse leader and, quite frankly, just a leader overall and what you have done for underserved populations and especially our homeless veterans. Winnie, we are better for hearing you today. So thank you so much for your time. We really appreciate it.

Winnie Fritz: Thank you very much. It's my honor. Honored to serve.

Bill Klaproth: That's Winnie Fritz. And for more information, you can visit AONL.org. And if you found this podcast helpful, please share it on your social channels. Spread the great information that Winnie told us today and check out the full podcast library for topics of interest to you.

This is Today in Nursing Leadership. Thanks for listening.