Safety First Nursing

Safety First Nursing

Guest Post by: Kristi Sanborn Miller

Safety First Nursing Blog #1  June 19, 2017

First things first: Bonswa! Welcome to Safety First Nursing. My name is Kristi Sanborn Miller and I started this company to support the physical, psychological and emotional safety of patients and nurses.  I will be bringing you continuing education and patient safety resources based on up-to-date research and information on patient safety.  All blogs are also podcasts, and you can find references and resources for everything I talk about on my website at  You can comment on social media: facebook and linked in, as well as twitter (@safetyfirstNRS) and you can email me at I welcome and encourage your feedback. I am collecting stories of safety and harm – please share with me so we can turn your story into a learning experience that might support patient and nurse safety

There are so many things I am working on right now, but the most important is sending Rose Katiana to nursing school. I will tell you more about this delightful, intelligent Haitian woman, after I talk a bit about my motivation and give you some background on Haiti.

I have always wanted to make a difference. I am the child of a left-wing, liberal, tree hugging hippie who continues to write her representatives about the environment, march on Washington, and create shows about endangered species for local public radio. I could have done an Alex Keaton from Family Ties, but instead I have basically become my mother – with perhaps a more well-rounded, open minded sense of other ways of knowing and being (no offense, mom). I try to see all sides of an issue, maybe to a fault.

I ended up as a molecular biologist in my first life, macerating zebra fish heads to extract DNA, looking for molecules that might make a difference. I filled a garbage bin daily with plastic and radioactive refuse from my quest.  I eventually ended up teaching biology and as I got to know my students, became increasingly intrigued by the field of nursing.  Here is a way to get my hands dirty, I thought – to really make a difference on a tangible, physical level. The idea of becoming a nurse gave me a sense of efficacy. Whenever I would see a disaster on the television, I would wish I had something to offer – a real skill that might help people recover from difficult situations. I never felt like my arrival brandishing a pipette and a rack of test tubes would comfort someone whose house had just been swept away in a flood.

And so my second life as a nurse began, and what an experience that was (more on being a scientist in a nursing classroom later). After finishing nursing school, I felt ready to embark on my lifelong dream of DOING SOMETHING, not just sitting by and saying “someone should DO SOMETHING”.  I took a job as an oncology nurse in a local hospital, on the night shift, and learned to give chemo, hang IVs, change a Foley and do a head-to-toe assessment proficiently, but mostly I learned how to listen and be present for people in the unhappiest, most frightening moments of their lives.  I fought so hard to support a patient’s goal to live with dignity and independence, and then supported them as they died, helping family members to understand the process so they could be really present for an event as important and momentous as birth.

My husband supported me through all of it…I have to tell you about Wes, because none of this would be happening if I hadn’t met him. We met mountain biking heart break ridge – I beat him up the mountain (it’s important to him that you know his back was injured) followed by asking him out – who wouldn’t want to date a bald guy with a goatee? Eventually we got married, as people do, and then got pregnant, as people do, and the SOMETHING I ended up DOING was having the baby in Chicago while my husband did a year-long fellowship in manual therapy at the University of Illinois (he is an amazing physical therapist who treats chronic pain – more on THAT later as well).

While we were living in Chicago, a magnitude 7.0M earthquake decimated Haiti in January of 2010, when our daughter Riley was only a few months old. By January 24, 52 aftershocks measuring 4.5 or greater were recorded. The death toll was somewhere between 100,000 and 316,000. Haiti is a country plagued by national debt, with poor housing conditions and a high level of poverty that contributed to the death toll (Human Rights Watch – Haiti World Report – 2017). When we finally returned to Asheville, North Carolina in the summer of 2010 I was determined – NOW I WILL SAVE THE UNIVERSE. I contacted a group called Mission Manna (which later became Consider Haiti) and asked how to get over there and help.  In the spring of 2011, when Riley was only 19 months old, I finally realized my dream and traveled to Haiti as part of a medical mission trip in April of 2011 while my husband stayed home with the baby (thank you times 10, my love). The trip was based in Montrouis, about an hour from Port-au-Prince. I have never worked so hard in my life. I will blog some more about that trip, but for now – let’s just say it was incredible, and hard, and dirty and rewarding and everything I had hoped it would be. I felt like I was really making a difference as I fed children worming medicine, slipped a $20 into the purse of a woman who had lost her entire family in the earthquake, and weighed and measured babies showing great improvement from malnourishment. And then we left.  I got to go home to my warm bed, roof over my head, running hot and cold water and easy access to health care, and Haiti remained.  I wasn’t sure I wanted to return, feeling like the most important way I could support Haiti was through fund raising for Consider Haiti. And we got involved in making a difference at home by adopting a very white, very local sibling group of three, surrendered to foster care due to parental drug addiction.

Fast forward to fall of 2016 for my second trip to Haiti, this time with a group of RN-BSN students getting clinical hours for community service. I went to show them how to do mobile clinics in rural areas. We went right after large floods from Hurricane Matthew caused death and damage to much of western and central Haiti. We didn’t know what to expect when we arrived in the northeastern part of Haiti – at a clinic in Terrier Rouge. Luckily that part of the country was spared the devastation of the flooding. My experience on my second trip was completely different (again, more on that later) in some aspects, but the same in that I put bandages on deep wounds that would likely re-open after we left.  I made a difference in the moment, but what about long term? In the 5 years since I had been to Haiti before, not much had changed that I could see.  Daily, grinding poverty was the norm.  According to Haiti net, Haitian women have a life expectancy of 62.8 years, but women in neighboring Dominican Republic live an average of 75.5 years. The infant mortality rate is one of the highest in the world at 630 per 100,000 live births. Women delay seeking treatment due to the time it takes to reach a clinic, the lack of available resources or physicians at clinics, and lack of funds.  I came away with a renewed sense of purpose that if we don’t help Haitians make a difference in Haiti, nothing will ever change.

I returned home and started Safety First Nursing.  The definition of safety that I have adopted is to keep people free from harm.  I am a big fan of the Patient Risk Detection Theory by Despins (2010), stating that education and training can reduce harm to patients.  Additional research (Progress of the World’s Women 2015) shows that when we train WOMEN, we are even more likely to reduce harm. According to USAID Empowering women, investing in gender equality and women’s empowerment can unlock transformational human potential.  Women account for one-half of the human capital in any economy and Haiti is no different. Women make up more than 40 percent of the agricultural workforce, but only 3-20% are landholders. Only 22% of women in Haiti go on to Secondary school, but studies have shown an extra year of secondary school can increase future earnings by 10-20 percent. Countries investing in girl’s education have lower mother/baby death rates, lower AIDS and HIV rates and better child nutrition. When women participate in politics, governments become more open, democratic and responsive (Poto Mitan – Haitian Women – Pillars of the Global Economy).

Starting a business is terrifying.  My husband had started his business, AntiFragile Physical Therapy, 3 years before and it has been a big success. It is “our” business, but it is really “his” business.  At first I didn’t think it was even possible, and I will blog about the process and journey of being a nurse entrepreneur, but let’s just say that without the support of my friends, family and Mountain Bizworks (including my coach, Emily Breedlove) I wouldn’t be writing this blog.  One of the things I did first was to search the internet for likeminded people and businesses to see how they operate.  I was incredibly inspired by Bombas – they make socks and for every pair they make, they donate a pair to someone in need. I thought, why can’t I do that? And so I am.  10% of all my profits will go to Consider Haiti. And then I thought, instead of just a generic donation to CH, why not send a Haitian woman, to nursing school? She could be from the communities CH serves, providing a much needed additional community health worker. Would that be a wacky idea?

When I first met with the board for Consider Haiti, they weren’t sure if my idea of sending a Haitian woman to nursing school would be the most helpful thing to the communities that are served by Consider Haiti. We talked to Eddy (CH Staff, and all around amazing guy) and asked for his input. He loved the idea, and within 24 hours had found both a candidate for the SFN scholarship, and a nursing school. The funds needed to send Rose to school for the first year are $2400 – this includes room and board, books, tuition and other costs. I went ahead and sent half to secure her a spot in the upcoming class beginning in October of 2017. She will be attending UNASMOH (Facebook page) – the American University of Modern Sciences in Haiti in Saint-Marc.  I haven’t found an up-to-date webpage for UNASMOH (Universite Americaine Des Sciences Modernes D’Haiti – this page is outdated, and doesn’t list the 4 year program for infirmiéres ~ French for nursing), but will post when I do.

Consider Haiti is a non-profit organization based in Asheville, North Carolina with one objective – to promote the health and welfare of children in Haiti. Efforts are concentrated on medical care, community health agents, sustainable nutrition and clean water programs. They have been working for over 15 years to empower Haitian communities to help the future of their county by supporting grass roots efforts. The people of Haiti are the best agents to serve their people, so Consider Haiti provides resources and support. 95% of all contributions are utilized directly in Haiti. Consider Haiti is a 501C3, and all donations are tax deductible. All Consider Haiti staff are volunteers, and they are a local charity with local support.

Rose has given me permission to share her story and photos with you; she wants to do whatever she can to encourage more support for Consider Haiti. She is a 23 year-old woman, whose parents have both died (I have asked for that story when she is ready to tell it).  She was born in Lanzac, a small village in Montrouis, and has completed her “classical studies”  (similar to High school in the US).  She lives with her older sister, two cousins and a niece in a house that she says is “under construction” – pictures coming soon.  A typical day may not involve food – they sell goods at the local market, but I don’t yet know what those goods are or where they come from.

I asked Rose to tell me a story about helping someone else so you can see what kind of person she is.  Here is a translation of that story:

I was 12 years old (and my mother and my father were still alive at the time this story happened). The neighbors had a little girl named Sandra, who was 8 years old, we were close; her family could not afford to gave her everything she needed. So I had known for several months that she had only 2 small dresses. I asked her father about this. He tells me that his family had no money to buy other dresses for her. That made me feel so badly -I was constantly thinking about it. When my birthday arrived sponsor me gave me $ 100 as gifts. Immediately I thought of Sandra, I told myself it is not necessary for me to celebrate when my friends do not have clothes to wear. So I decided to go to give Sandra all what I received as gifts for birthdays-my godmother gave me $50 as a gift also. I was all set with $150 in an envelope and I gave it to Sandra’s mother. I said “here is money for you to buy clothes for Sandra”. Sandra’s parents were weeping to see how Sandra had a good friend. I was also crying but also I was delighted – I helped someone in need.

I have been communicating with Rose and she is excited about going to school and about giving back to families in need in the community of Montrouis and surrounding areas.  I am still learning about her – she doesn’t have her own email account, so I am talking to her through a Consider Haiti staff member, Eddy in Haiti. Both times I was in Haiti, the nurses I met did not speak English, so conversation was limited. The ability to teach the Haitian people what we know is limited by translators. It is so frustrating to have 15 people ready to help, and only one translator – the bottleneck means patients wait for hours to talk to a Doctor at the rural Haitian mobile clinics run by the Consider Haiti team. The only translators I have met so far have been male. I am interested to see how compliance with medicines and healthcare treatments changes when information is presented by a female.

Rose says she likes to read books about health and the bible and participate in debates, watch documentaries and she listens to gospel and American-style music.  This seems like pretty generic stuff right now – I am sure she is nervous about opening up to a complete stranger. I am looking forward to getting into the details – to the part where we open up to each other and share the interesting bits. I have been telling her my story as well. Questions I am asking Rose: Where did you go for your “classical studies” and did you like school?  Tell me about how your parents died. Do you have any brothers and sisters?  What sorts of things do you sell at the market?  Please send pictures of your house and family. Right now we are working on getting her set up with English lessons. I will update this blog regularly with information about Rose’s journey, including more photos.

I am inserting snippets of some of our letters back and forth as translated by google translate for your amusement– I am glad we have bilingual friends to help, because I am pretty sure Rose is not in Armenia (for some reason Google translates “Consider Haiti” to “Consider Armenia”).  My Haitian is good enough to get me in a lot of trouble, and it allows me to find out where it hurts, when to change the bandage, and when to go to the clinic…but daily conversation is beyond me. Rose and I both have a lot to learn!  She has asked me when I will be visiting Haiti again, and I am hoping to go next year for a visit – I want to see how Haitian nursing schools are run.  I want to meet Rose and her family and give them all big hugs. I want to follow along as we see how Rose is making a difference in Haiti. Maybe she will become a nurse practitioner and deliver babies safely; maybe she will run the Consider Haiti clinic some day.  SFN is her sponsor, but I want for her, whatever she wants for herself – empowerment is the goal.  As I get to know her, and I see the pictures she is sending of herself, I feel a strong sense of hope that she will kick some serious ass; that she will make a difference.

“Nothing that happens in Haiti would ever happen in the United States.  The depth of human suffering is unimaginable.  In the mountain villages where we hold pediatric clinics, we are the only healthcare these children receive each year.”

Brenda C. – Board Member & Spring Trip Volunteer – Consider Haiti

Mési anpil.


Despins, L. A., Scott-Cawiezell, J., & Rouder, J. N. (2010).

Detection of patient risk by nurses: A theoretical framework. Journal of Advanced Nursing, 66(2), 465-474. doi:10.1111/j.1365-2648.2009.05215.x


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