1. Ferrell, Betty PhD, RN, MA, FAAN, FPCN, CHPN

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As a new nursing graduate in 1977, I began my career as a clinical nurse on an oncology unit. I quickly observed the horrendous state of cancer pain management which was fraught with Demerol, prn medications, and placebos. Soon after, I would learn about a nurse, Margo McCaffery, in California, who was changing the practice of pain management through her words. In 1968, she wrote that pain is "[horizontal ellipsis]what the experiencing person says it is, existing whenever he or she says it does."


Over the next decade, Margo's writing would inspire me and give me the courage to advocate for patients in pain. That commitment to relieve suffering was central to my decision to leave inpatient oncology to start a hospice program in 1980, continue my education, and complete Master's and Doctoral degrees with a research focus on pain. I believed what Margo was advocating: nurses were the leaders in advancing the relief of pain.


Ten years later in 1987, I left my home in the Midwest and moved to California. Soon after, I got the courage to contact Margo and ask if we could perhaps get together. I wanted to meet the nurse whose words were echoing around the world. When we met, I suggested that we might work together by joining my research interests with her work in educating nurses about pain management. In our first meeting, Margo was clearly very hesitant. Who was I and what did I want? And what in the world did she need with a researcher! Margo reluctantly agreed to work with me on some research to demonstrate the importance of nursing attitudes and beliefs on pain management decisions. Our research would document that nurses had very significant misconceptions and biases about pain. From the first findings, Margo was sold on research.


Over the next 25 years, I continued to work with Margo and she became the most ardent advocate for evidence-based practice ever. I clearly had created a monster! Margo knew that having data-whether it was data about the prevalence of pain, outcome data following pain treatments, or data about clinicians' beliefs-was the key to changing practice. As we often discussed, having data means that nurses are not left to advocate for patients based on personal opinion.


Margo McCaffery had an illustrious career and was truly a pioneer in pain management. She became a member of the World Health Organization Cancer Pain Relief Committee, was a founding member of the American Society for Pain Management Nursing, and published numerous papers and books which led the field of pain management. Many of us learned from Margo that the commitment to better pain management was the first step toward a commitment to the broader field of palliative care. Margo's work impacted not only nursing, but every discipline involved in caring for people in pain.


Without a doubt, Margo's best days were the ones she spent traveling the country lecturing to nurses at hundreds of pain conferences. Margo thrived on connecting with nurses "in the trenches," setting them on fire with her passionate and evidence-based lectures. Margo collaborated with Chris Pasero to write the classic textbook, "Pain Assessment and Pharmacologic Management." I challenge anyone to find a better textbook, with a stronger foundation of evidence and a voice for patients.


Anyone who knew Margo would also say she was quite a character. The nurse from Corsicana, Texas was outspoken, irreverent, independent, and marched to the beat of her own drum. When I hear the saying "Well Behaved Women Seldom Make History," I think of Margo. She had the willpower of a Texas tornado, but at her core, she was a nurse's nurse - dedicated to the patient and ready to take hostages to get the job done.


Margo died in January 2018, leaving behind generations of nurses and others who also became committed to relieving pain and suffering. I am eternally grateful to have learned from her, worked with her, and quite simply, to have known her.



Betty Ferrell, PhD, RN, MA, FAAN, FPCN, CHPN




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