One morning in 2018, Alejandra Cuevas was coming off her 12-hour night shift as a nurse in the Intensive Care Unit (ICU) at Keck Hospital of USC when she met fellow nurse Jacob Spruill. As Spruill was starting his 12-hour day shift, Cuevas was giving report on a patient she had been caring for overnight. The patient was about to be put on dialysis and Cuevas offered to stay and help. Spruill was struck by her extraordinary offer to stay on following a 12-hour shift. This was an act of devotion and kindness that immediately impressed Spruill, and he and Cuevas became fast friends.

Spruill, a Triple Trojan with a Master of Gerontology and Master of Science in Global Medicine from Keck School of Medicine and a Master of Science in Nursing (MSN) from the USC Suzanne Dworak-Peck School of Social Work, has been with Keck Hospital since he became a registered nurse in 2013. Prior to Keck, Cuevas spent much of her 16-year nursing career as a traveler nurse in ICU, including cardiothoracic and lung and heart transplant, and is now pursuing her MSN at USC thanks to encouragement from Spruill.

Their dedication to patient care brought them together, but their camaraderie helped them navigate through a global pandemic and identify the direction in which they wanted to grow their careers.

Pandemic stress for nurses

In early 2020, the ICU at Keck became a COVID ICU, almost overnight. Spruill had recently decided to enroll in the MSN program at USC Social Work and make the transition from bedside nursing to an advanced practice role. The irony of this decision was that just as he was ready to move away from hands-on care he was thrust into the most intense period of demand for the nursing profession in over a century, and it stretched his resilience to the limit.

“I started the MSN program in the middle of COVID,” Spruill said. “It was somewhat serendipitous because my body was telling me it’s time to transition from bedside, but I still worked the whole pandemic. Alejandra and I definitely have some shared scars."

When Spruill began the MSN program to become a nurse practitioner in January 2021, Cuevas was also feeling ready to leave bedside nursing and return to travel nursing outside of a hospital setting.

“The pandemic really took a toll on me because patients were very, very sick and most of them didn’t survive,” Cuevas said. “I was feeling overwhelmed by the mortality rate in our unit.”

Cuevas shared her thoughts on leaving the hospital with Spruill, having no idea he had already decided to pursue his advanced nursing degree. Spruill tried to convince Cuevas to join him in the MSN program, but she was wary of going back to school after so many years, and not sure she could fully devote herself to studies in the middle of an unprecedented health crisis.

“The patients couldn’t have any family with them,” Cuevas said. “We were the families for our patients and we were the comfort for the families who were separated from loved ones. It was horrible for patients, it was horrible for their family members and it was horrible for us.”

Moving forward

Once the pandemic began to wane, Cuevas did take the advice Spruill had given her and enrolled in the MSN program. Now she is looking forward to receiving her degree in May 2024, and gives full credit to Spruill for giving her the confidence to pursue her advanced nursing degree.

“She blames me every day,” Spruill said, jokingly. “But now that she sees the light at the end of the tunnel, it's all coming to fruition and it means a lot.”

Both Cuevas and Spruill laud their professors as extremely supportive and great role models.

“One of my professors, Dr. Janett Hildebrand, was foundational in making me the nurse practitioner I am today,” Spruill said. “She helped me to really understand the scope of being a nurse practitioner.”

Both also appreciated the importance the program places on cultural sensitivity and being bilingual in Spanish. For her clinical rotation, Cuevas was placed in an underserved community where nearly all of the patients only spoke Spanish. Being bilingual enabled her to explain treatments so that patients fully understood their care options and her patients were grateful for this connection.

“Because we're part of a school of social work, there is a lot of emphasis on comprehending the holistic approach to patient care,” Cuevas explains. “You need to take the social determinants of health into account — the patient’s community, income, education level, work. All of this I will take away from this program.”

Spruill adds that the program encourages and emboldens students to function at the highest level of their ability and experience, and to understand the role that nurse practitioners can play in research, policy development and advocacy beyond the clinical application of knowledge. As a result, Spruill has a sense of responsibility for being directly involved in the decision-making process for how patients are impacted in clinical care and policy practice.

Cuevas hopes to encourage other nurses who may be years out from receiving their undergraduate nursing degrees through her own positive experience in the MSN program.

“I’m very happy I’m almost there,” Cuevas said. “Every time I have patients at the primary care level I know I’m in the right place. I wanted to give my nursing career a ‘second life,’ have a relationship with my patients and see them thrive.”

Spruill is prepared to educate people on what nurse practitioners do, including allied health professionals and physicians.

“We deserve a seat at the table,” Spruill said. “We can assess, diagnose, treat, prescribe, and do all of these things for our patients right alongside other medical professionals as part of a multidisciplinary team.”