National Nurses United

health nursing to promote the wider health of society, regardless of people's incomes, employment, or socioeconomic status. In her late teens, Castillo volunteered in the intake area of a free medical clinic in her hometown of Sacramento, Calif., and admired the work of the nurses and nurse practitioners there. "I was pretty strongly attracted to public health," said Castillo. "The clinic was getting more and more general medical cases because people had no insurance, no healthcare. I thought, 'This is where I want to be. I want to be providing healthcare for free.'" Castillo had not planned on going into acute-care nursing after graduating from nursing school in 1984, but she soon found herself practicing and thriving on critical care nursing. She worked at a variety of ICUs in the area and soon became a leader of the campaign to unionize her hospital, Mercy San Juan Medical Center, along with four other Sacramento-area hospitals owned by what was then Catholic Healthcare West, now Dignity Health. At the time, management had embarked on a massive restructuring campaign to put fewer RNs in charge of care and speed up and overwork the ones who were left. "Just like now, they wanted us to make do with less, and put us in very precarious situations that compromised the safety of our patients and ourselves," said Castillo. "And there was so much favoritism and inequitable treatment going on." The nurses won their union, joining the California Nurses Association in 1996. Because both her parents were active union members (her father a railroad worker and her mother a state worker) and part of the early Chicano movement, Castillo was no stranger to To donate to or volunteer progressive political for RNRN, please visit movements. Her work www.RNResponseNetwork.org. organizing the nurses at NOVEMBER 2013 her facility naturally evolved into work organizing nurses across California when she became a staff organizer for CNA in 1997. "As an organizer, I was able to integrate both my politics and my nursing in a way that just seemed organic," said Castillo. "It seemed like just the next stage of my professional career. I realized I was needed in a different capacity to resist on a larger scale and fight back against the corporatization of healthcare." From that position, Castillo quickly rose through the ranks, becoming a lead organizer, then the director overseeing representation of RNs working at Sutter Health, a major hospital chain in California, and then the government relations director coordinating the fight in the legislative arena against the hospital industry and its hospital association lobbyists. In 2004, a huge tsunami hit Sri Lanka and other islands in the Indian Ocean. Less than a year later, Hurricane Katrina ravaged the Gulf Coast, flooding New Orleans and wiping out coastal communities in several states. CNA/NNOC quickly coordinated RN volunteers interested in using their nursing skills to help victims of these disasters, sending a small group to Southeast Asia and eventually more than 300 RNs to the Gulf Coast to work in hospitals, clinics, and other settings that desperately needed RN staff. These efforts became formalized into the RNRN program, which distinguished itself from other disaster-relief efforts, such as the Red Cross, by placing registered nurses in volunteer positions where they could actually practice to the full extent of their nursing skills instead of being relegated to passing out water bottles, bandages, and aspirin. RNRN was formed because "we couldn't just wait for the next disaster. It's not a matter of 'if,' but of 'when,'" said Castillo, who was the natural person to head the program. She pointed out that there are natural disasters that often are exacerbated by manmade disasters. Scientists have warned that climate change, which is caused by people burning fossil fuels in predominately firstworld countries, is precipitating increasingly severe weather events, whether they are monster typhoons like Haiyan or droughts. And then on top of the catastrophe itself, many states and nations are unprepared and lack the healthcare infrastructure to handle the medical challenges that arise afterward. "Nursing practice transcends all state and international boundaries," said Castillo. "Nursing is undervalued but should be included as part of response planning for the long term. The kinds of skills needed in the weeks and months following a disaster are nursing skills. People need everyday care, medication, basic first aid, wound care, infection and contagious disease prevention, education. Nurses are at the heart of a long-term recovery effort." RNRN's work has put in sharp relief the fact that nations that have national healthcare systems tend to be better prepared for these types of disasters because they have a coordinated system that can work together and because the overall population is in better health because everyone has already been receiving regular medical care all along. When RNRN volunteers provided medical care to victims of Hurricane Katrina, they reported that many patients said the care was the first time they had been examined by a health professional in decades or sometimes their entire life. "If the United States had a real healthcare system like single payer, every community would be better prepared for disaster," said Castillo. W W W. N A T I O N A L N U R S E S U N I T E D . O R G N AT I O N A L N U R S E 13

• Cover