By Matt Skoufalos
Although motherhood awakened the feelings of caregiving that first led Paula Axtell to consider pursuing a career in nursing, it was confidence in her academic abilities that inspired her to believe she could be successful at the job.
“After I started having children, I felt like a natural caregiver,” Axtell said. “My own test was, I took a medical terminology class and a certified nursing assistant class. I felt like if I could do that part of the work, I could do the rest.”
“I felt like having a college degree was necessary in my life, and I wanted to be a good role model for my children,” she said.
Her college degree empowered her to eventually become the interim senior director of perioperative services with St. Mary Medical Center of Long Beach, California. Her nursing journey, however, actually began with some weekly 700-mile treks.
While her family was stationed at U.S. Army Fort Riley in Kansas, Axtell and a trio of other military wives enrolled in nursing school at Kansas Wesleyan University and commuted there together, an hour each way, throughout the program. When her then-husband was transferred to Fort Sill, in Lawton, Oklahoma, Axtell took a year off, but returned to complete her program at Kansas Wesleyan as a commuter. Once a week, she made the 700-mile round trip from Oklahoma, staying with friends from Sunday through Wednesday while she went to classes.
To boot, Axtell was pregnant with her fourth child at the time.
“There were a few times that I was making that drive back, and I would pull over and vomit beside the road, and clean myself up and keep going,” Axtell said. “It just became part of what you do to push through.”
More than once, she felt like she was on the verge of quitting. But some timely intercession from an instructor – “You’ve got this; all you have to do is show up” – helped inspire her to stay the course.
“I am so thankful today for those words,” Axtell said. “It’s changed my life.”
After completing her associate’s degree, Axtell went directly into the operating room at Southwest Medical Center in Lawton, “because I knew that was where I belonged.”
“I never looked back from there; it’s always felt like home [in the OR],” she said. “These are the most vulnerable times that our patients will ever experience; they’re truly putting their lives in our hands. We have to ensure their safety.”
Axtell’s commitment to providing the highest quality of care in the safest manner was honed from the earliest days of her career; even now, she said, “That’s the message I send to my team.”
“When it comes to safety and quality, we never waver,” she said. “That’s a hard line, and I think teams need to hear that. They need to know that it’s important, and it’s at the forefront of everything we do every day.”
“There’s so much of what we do in the OR that could easily become redundant,” Axtell said. “If you don’t stay on your toes, it’s easy for your practice to become complacent. We have to remind our teams that this is someone’s mother, someone’s sister, someone’s child. We treat our patients the way we would want to be treated.”
After three years in Lawton, the family was transferred to Korea for a year; when they returned, Axtell joined Jackson County Memorial Hospital in Altus, Oklahoma. From Oklahoma, they moved to Albuquerque, New Mexico while her mother-in-law battled terminal cancer, and Axtell took on multiple roles with the Lovelace Health System there.
“That’s really where I got my start in leadership, and had the opportunity to grow as a leader,” she said. “I worked with some really good leaders who saw potential in me, and helped me advance into managerial positions.”
In her managerial roles, Axtell works to build relationships with her staff and find ways to strengthen partnerships among members of her team. She counts that skill among the most critical to her roles in nursing leadership today. Conferring a sense of presence and support to those she supervises and under whom she works instills their confidence in her work among a variety of stakeholders.
“You have to listen actively,” Axtell said, “you have to be present; you have to gain that respect and build those relationships. When you start to partner, then it gives you the ability to interact more collaboratively.”
“The relationship you have with surgeons is completely different from that with the nurses on the floor,” she said. “They’re just people too. They expect the OR and their team to be ready for procedures. They want you to answer questions. They want you to critically think. And as long as you do that, you’ll gain their respect, because we’re a team.”
Axtell eventually parlayed her leadership experience into interim assignments at health care facilities across the country; since 2016, she’s been working on short-and long-term contracts in a variety of settings from Idaho to California. By the spring of 2017, Axtell had gotten divorced, and was working to complete her bachelor’s degree from Grand Canyon University; working full-time and writing papers at night, “just trying to figure out who I really was.”
“For 30 years of my life, I had been a wife and a mother, and now I was just me, an empty-nester, a student, single and working full-time,” she said. “But I had some of the best times in my life, and some of the best growth that I had personally and professionally.”
Axtell also had the unfortunate experience of seeing nursing care from the patient perspective after her oldest son was fatally injured in a car accident. While donor services worked to find recipients for his organs, the attention that the hospital staff at HonorHealth Deer Valley showed him refreshed her perspective on her chosen profession.
“They were so wonderful,” Axtell said. “We waited in ICU for four days to find organ recipients, and his level of care never changed. He had such severe head trauma that he couldn’t sustain life on his own; but for moments during that time, I looked at the monitor and I looked at him.”
“If I had to remind myself that he’s not here and there’s no hope, what must it feel like for laypeople who look at the monitor and don’t understand?” she said. “That part was a little challenging, at times, to accept.”
As a travel nurse, Axtell didn’t expect to find a traditional level of support in her grief from coworkers at Glendale Memorial Hospital, the facility where she was working at the time. Yet those peers supported and embraced her unexpectedly, providing a comfort she hadn’t anticipated.
“People who didn’t even know me just came up and hugged me,” Axtell said. “It was such a comforting feeling. I’ve always felt like God picks me up and puts me where I’m supposed to be, and that’s how I choose my contracts and my assignments. That one for sure was where I was supposed to be.”
When she’s not working, Axtell enjoys traveling for fun as well as for work. Five years into her career on the road, she’s still invigorated by the opportunity to learn, explore and connect with people along the way. And, in September 2019, she got to realize a lifelong travel dream: participating in a medical mission to St. Mary’s Hospital Lacor in Gulu, Uganda.
“That’s why I do this,” she said. “It gives me the opportunity to give back. And everywhere I go, I’m still learning. It’s hard to leave the teams when you work so closely with them, but I have so many new colleagues and friendships that I’ve met along the way. It’s a wonderful experience.”
“My son did leave me a gift: a beautiful little grandson, Caleb, and he’s three now,” she said. “I think maybe finding a permanent position at home where I can finish my master’s might be the next thing on the agenda for me.”