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Leaving Ireland for Oregon at 19 helped to open up to Barbara McKenna the kind of opportunities she says she could not have found here in the 1980s. The 56-year-old from Kilmacud, Co Dublin, was trained at Temple Hill children’s hospital in Blackrock, which has since closed down. She took her undergraduate degree at Walla Walla University in Portland, Oregon, and her master’s at Washington State University. She is now a clinical nurse specialist and still loves living in the Pacific Northwest.
Why did you decide to leave the country?
In 1979 when I left it was not unusual to do so, emigration was common among my generation. My uncle was a Catholic priest in the United States and he invited me to join him for a year in Oregon. I never went back, I fell in love with the US. I was young, naive and freedom was great at that age. The US was so very different from Ireland then. It was an overwhelming experience.
What kind of work do you do now?
Today I am a clinical nurse specialist. I am the manager of a Heart Assist Device programme. In this role I manage all aspects of care for people getting a heart assist pump for end stage heart failure. They get this pump to keep them going until they can have a heart transplant or, for those who are not transplantable, they live out their lives with it. This role is very broad and autonomous, I coordinate the care of these patients from their pre-pump days, in the operating room, in the intensive care unit, in the outpatient clinic and during their life outside the hospital. I am a resource for patients, medical and healthcare staff and community members.
Do you think you would have had the same opportunities if you had stayed?
No, not in 1980. Nursing roles were limited and so were the opportunities for growth in nursing. As were roles for women in the job market in the 1970s and early 1980s. I don’t have enough experience to fairly compare working in the two countries since I was 19 when I left and life was very different then. But the little experience I did have was so very different from what I experienced when I started nursing the US.
How does the health service in the US compare to Ireland’s?
I can answer this from a very personal perspective. I came home a few years ago to take care of my father who had been diagnosed with cancer. This was a sudden diagnosis and a very tough month for my father and the family. I was exposed to healthcare at its best and at its worst. As a healthcare provider, it made matters more difficult when I asked for information. I was referred to as “the American nurse”. What I learned was that the Irish patient in general does not question the authority or the decisions of the team.
I am sorry to say but the conditions in the hospitals, especially the emergency rooms, and the attitudes of the healthcare staff made me very disappointed and angry. I was surprised how little information is given to the patient and the family in order to feel inclusive and the centre of the team.
I was dismayed with the workload and the attitudes of the nurses. They all appeared to be too busy and overworked. That said, there was great tenderness and compassion given to my father in his last days by the few nurses I remember.
What impresses you about the US system?
In the US I am a recipient of healthcare as well as a provider. I think where you live in the US can influence the quality of care people receive. I live on the west coast and my experience has always been positive for myself and my loved ones. In my own practice, the patient is at the centre of the team. They are included and informed.
What are the negatives?
Good healthcare in the US is out of reach for many who cannot afford to pay for insurance and use the emergency rooms for primary care. This I witnessed in Ireland also. There are significant disparities in healthcare throughout the US and addressing issues of access, affordability and prevention is at the top of this list on a state and federal level especially in a election year.
What is your life like in the US?
I live in Portland Oregon with my family and dog. I love living in Oregon, it’s a beautiful state. I enjoy hiking and gardening and family. The city is one hour away from Mt Hood and great skiing and hiking, and two hours from the Pacific Ocean. The Pacific Northwest is a friendly and geographically a very diverse region.
What are your future plans for the short and the long term?
I will be home next August for a family wedding. I have six siblings so there are always events to come home for. Hopefully I can retire from my current position in eight years and explore the next chapter of my life. I don’t have plans to return to live in Ireland. That time has passed for me
Do you think Irish healthcare workers like yourself would like to move back to Ireland?
I can speak only for myself. No I wouldn’t, the main reason is I have been gone too long which would be a struggle for anyone considering returning after such a long absence. Life has changed. Ireland is not the country I left. Secondly, I don’t believe I would have the same autonomy in my practice as a nurse in Ireland as I do here.
Given your experience abroad, what suggestions do you have for the Irish health service?
The role of the nurse in shaping healthcare is understated in Ireland. Nurses have the ability to influence health, shape policy and create care environments that are better for the people who need care. Put the patient at the centre. Don’t restrict access to information or services. Hospitals need to be the centres of healing not centres where care is fragmented, conditions are poor for the suffering and old attitudes towards medicine and wellbeing are still very prevalent.
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