Chief Nursing Officer Raises the Bar for Nursing in Haiti

Marc Julmisse doesn’t take well to evasions of responsibility.

If a nurse on her staff claims that something isn’t part of the job, she has a story: A patient lost control of his bowels at University Hospital in Mirebalais, Haiti, and she was one of the few nurses on duty. So she put on her gloves and got to work.

On her team, anything a patient needs is part of the job.

Julmisse is the Haitian-American chief nursing officer at the hospital, which Partners In Health operates in partnership with the Haitian Ministry of Health. As her title suggests, she’s part of an effort at PIH to empower nurses at the hospital, motivated by research that shows better nursing consistently leads to better outcomes for patients.

“It’s not very often you get a chance to influence the health of a nation. I call this our ‘Nightingale moment,’” Julmisse says. Florence Nightingale, considered the founder of modern nursing, advocated for high-quality patient care against all odds, which is what Julmisse wants her staff to do. “This is our chance to change nursing for the better and set new standards of care.”

A citizen of the world

Julmisse didn’t set out to be in this role—or in Haiti.                                                       

She was born in Haiti, grew up living in Michigan, New York, and Florida, and then began her nursing career in Massachusetts, later moving to California. She describes herself as a “cultural mutt.” Depending on who she’s talking to, she might sound like she’s from any one of those places.

The vision of this hospital is to work with the Ministry of Health to change the practice of health care in Haiti. How could I not want to be part of something that would outlive me?

Julmisse specializes in nursing in neonatal intensive care units—caring for newborn babies whose lives are most in danger—but she has worked in many other areas of health practice. For several years, she alternated between working as a nurse in the United States and then traveling to rural communities in Ecuador, Mexico, Peru, Nepal, and Brazil, where she worked in community capacity building.

Julmisse became involved in health care in Haiti in 2008, when she conducted a hospital assessment for a facility outside the PIH network. After the country’s 2010 earthquake, the hospital’s administrators asked her to join their team to help develop a strategic plan to strengthen the facility. She signed a one-year contract, and stayed two and a half years.

She was ready to leave for the United States when a colleague recommended her for a position at University Hospital, before it opened in early 2013. Even though she planned to return home, she was intrigued by the opportunity to work for PIH. She had studied PIH’s work in Haiti in her public health classes, and the hospital was the organization’s most ambitious project to date. Then she spoke by phone with Sheila Davis, chief nursing officer at PIH in Boston and a tireless advocate for nurses.

“I always say, ‘Sheila had me at hello,’” Julmisse said. “The vision of this hospital is to work with the Ministry of Health to change the practice of health care in Haiti. How could I not want to be part of something that would outlive me?”

Chief Nursing Officer Marc Julmisse leads nursing rounds at University Hospital in Mirebalais. Rebecca E. Rollins/Partners In Health

The chief

As CNO, Julmisse is on the same level as the chief medical officer of the hospital—unusual not only in Haiti but also in the United States. Gradually, she’s spreading the idea that nurses are advocates for patients, and their voices can improve patient care.

Studies have shown that good nursing care improves patients’ outcomes. But nurses aren’t always involved in decisions about how wards are set up, how many nurses will staff them, or how to improve the quality of care in a facility. The goal of a chief nursing officer—and the Nursing Center of Excellence opening in May as a home for all of PIH/ZL’s nurse advancement efforts—is to allow nurses to take part in decisions that affect patients. To be “at the table,” as Julmisse puts it.

While these efforts require more opportunities for nurses to be in leadership positions, they also require nurses themselves to step up. Julmisse says she doesn’t want the nurses on her staff to be “task-oriented,” but rather, “patient-oriented,” to focus on the people rather than the illnesses. She believes good nurses can anticipate potential problems and what to do to help.

As she advocates for the role of nurses, she demands that her staff meet a high standard.

To help shift their thinking and practice, the hospital nursing staff has recently begun conducting nursing rounds for each department once a week. Julmisse questions the nurses on duty about patients’ diagnosis and treatment, the overall plan of care, and problems they should be anticipating—bedsores, side effects, gradual changes in a patient’s status, complications of an illness, secondary health problems that may aggravate the patient’s condition, dehydration, and nutritional needs.

Julmisse is quick to praise the nurses on her staff. She extols their efforts to go beyond the letter of their jobs in the interests of patients, staying late to help a new nurse on duty or volunteering to be on call. But she’s quick to hold them accountable to fulfill their duties. As she advocates for the role of nurses, she demands that her staff meet a high standard.

Julmisse believes she has a key leadership role to play in modeling patient advocacy, interdisciplinary communication, and nursing leadership. She hopes the example she sets will help bring the nursing voice to the table, to inspire nurses to be active participants in identifying issues and work on solutions that impact hospital functions and patient care. Her goal is to work herself out of a job.

“I want to be replaceable, because my job is to train the next team coming forward,” Julmisse says.