May 18, 2023 –

Tammy Alvarez, BSN, is ACPA’s 2023 Donna Pruzansky Memorial Fund for Maternal and Child Health Nursing (DPMF) Grant winner. She and ACPA invite you to read the story of how she came to the profession and what it means to her every day.

When I was 17 years old, my cousin and best friend was in a terrible accident. He was taken to the Pediatric Emergency Department by rescue where my family received the news from the doctor that we had lost him. Our family was shaken to the core. This is when we realized that when the doctor gets to walk away, the nurse is the one left behind. She’s left behind with the sudden anger of our family’s loss and the mess of our emotions left unchecked. The nurse LEFT BEHIND with my family that night showed such a degree of compassion and empathy that her presence alone changed our lives forever. She couldn’t ease the pain of the loss we felt, but she helped us to feel free to grieve and say our goodbyes without pressure. She cried with us and she waited with us until we could muster the strength to walk out of that room and leave our cousin/friend/child/grandson/nephew for the last time. We don’t know her name, and have never seen or spoken to her again, but the impression that she made on my family has lasted for the last 25 years. I was so moved as a young person at how impactful her presence alone had been on my family, that I knew, this was what I too needed to do. What greater difference can you make in the world than to sit with someone in their most difficult time?

This loss is what led me to pediatric nursing, but destiny is what led me to Pediatric Cleft and Craniofacial nursing. Sharing tears with a mom who has discovered prenatally that her baby will have a facial difference, sharing in her frustration when her baby is not gaining weight at the speed he/she is expected to (because we share this same goal and are pursuing it together), leading a parent in what to expect when they FINALLY reach their first surgery date, helping them to accept after that first surgery that it may not be the last, empathizing with a parent when they feel like their baby belongs more to their surgeon than it does to them, empowering a parent to advocate for what their intuition tells them their child needs…..this is what it looks like to be the one LEFT BEHIND, and I WANT to be there. I WANT to be the one  who doesn’t get to walk away because THAT is where the difference is made.

As nurses, we are expected to examine the patient, gather the information the physicians need, develop the care plan, and evaluate the goals. We want to do all of those things and do them well. In fact, we want to do them perfectly, because that’s just who we are as a profession and as people. And the extent to which we care about “our” kids will not let us give them anything less than perfection.

But when we slow down during that physical exam, we begin to see that this isn’t JUST an open lip or palate to this parent. This is a shocking and unexpected shift in what they had thought seeing their baby for the first time would make them feel like. It’s not the overwhelming joy they had anticipated, but it is a tremendous fear of the unknown about what the future now holds. When we “gather the information”, if we listen, we begin to hear more than the facts of the birth or the details of the last surgery. We hear the things they don’t want to speak out loud. “Will my child ever look or sound like his friends?”. When we sit down to develop the plan of care, if we read between the lines, we will begin to think outside of surgery timelines and post op information. Our plan of care begins to look more like “call mom just to check in on HER today”, “ask dad how this is affecting HIM”, “hold the baby for a few extra minutes so mom can take a deep breath and have one moment alone to be with her thoughts”. When we begin to evaluate the goals, we don’t just view success or completion through the lens of a surgeon, but through the lens of a parent who has now come to believe that their child IS as “normal” and beautiful as any other child, and their future is BRIGHT, and things will be OK. We watch as they begin to realize that THEIR child will be the one with more empathy than their friends because they know how it feels to be different. We are encouraged when we see them realize that their child will be the one who accepts people as they are because all they have ever wanted is to be accepted. They begin to see the blessings in what has at so many times felt like a curse. THAT is “GOAL MET” in the ultimate care plan.

As advocates for our patients and families, nurses always want to have the answers or the information needed to HELP in whatever they are experiencing. I feel so privileged and blessed to be this year’s recipient of the Donna Pruzansky Memorial Fund Grant for Nurses because now I feel CLOSER to those answers and that information. This scholarship is allowing me the opportunity to attend the ACPA conference and learn from the best in my field so that I can be the best possible resource to the families that I serve. It is allowing me the opportunity to speak with my peers who I may not otherwise get to who are light years ahead of me in this cleft journey and have walked this path with many more families than I have had the opportunity to walk with. It is allowing me to make connections with people and resources that will ultimately result in the best for “my” kids and families. While I have been in nursing for many years, I have only been in cleft nursing for 8 months. I still have so much to learn and so much growing to do. And while I may not have all of the answers after today either, I feel like because of this scholarship and ACPA, that I am now closer to them.

For more information about our professional scholarships, visit