In March of 2023, Nicole Carson found herself driving across the island of Guam in a total blackout at two o’clock in the morning. Electricity across most of the island was out following a super typhoon that had hit the previous week. A mere three weeks earlier she had arrived on the island with her husband and four-year-old daughter. It was an unexpected change of assignment for her husband, a chief navy diver in the U.S. Navy. On this particular early morning she was slowly driving through the blackened streets to get to a high-end hotel that still had internet access in order to make her online class at the USC Suzanne Dworak-Peck School of Social Work which began at three a.m. — in her time zone. Carson was in her first year of the Master of Science in Nursing (MSN) program to become a family nurse practitioner (FNP), and she was determined not to let a little thing like a typhoon stop her! 

But a natural disaster was not the only obstacle in Carson’s path to obtaining an MSN from the middle of the Pacific Ocean. To start, Guam is 17 hours ahead of Los Angeles, so she regularly attended her classes online in the wee hours of the morning.  As Carson is the first MSN student from USC to study on the island, the Department of Nursing at USC Social Work had no previously established clinical rotation options with medical facilities in the area. Carson called every hospital, private practice, clinic and public health provider in Guam to find supervisors and facilities willing to provide clinical placement experience. 

“The faculty in the MSN program did everything they could,” Carson said. “They were very available and spent what tiny bit of free time they had talking to me. They never discouraged me from continuing to try.”

Despite her heroic efforts to secure a clinical placement, it all collapsed when the typhoon hit and took out the electricity and access to water. For Carson and her family on the base, this lasted about nine days. For the rest of the island, including the qualified facilities for a clinical rotation, it was up to four months. Without an option for clinical experience, Carson was forced to drop two of her courses in her second semester that were contingent upon those clinical rotations, which extended the timeframe for completing her degree.

“I probably drove my instructors crazy with my relentlessness,” Carson said. “I'm sure at some point they thought ‘dear girl, give up the ghost!’”

Determined to become a family nurse practitioner

Prior to USC, Carson worked as a nurse in behavioral health for several years at a hospital in San Diego. During the COVID-19 pandemic, she transferred to the inundated emergency department to help. There she witnessed a surge of patients who had not been receiving the basic care they required prior to the pandemic. Patients could not refill their blood pressure medication, had missed dialysis or skipped preventive health screenings. This lack of access to basic care put them in dire circumstances that could have been prevented.

“That really motivated me to become a nurse practitioner,” Carson said. “So I could try to be one more person to fill that spot between a patient going untreated and ending up needing emergency care.”

Carson decided to pursue her advanced degree and was accepted into the MSN program at USC. She began her online studies in fall 2022 from Hawaii, where her husband had just been stationed for three years. However, only a few months into his assignment in Hawaii, he received orders to relocate to Guam due to heightened international tensions. Carson had barely begun the spring 2023 semester and first round of clinical rotations.

“I managed to get some of my clinical hours expedited at a general practice because I knew we would be moved quickly,” Carson said. “I cranked out as many hours as I could prior to us being shipped out.”

By fall 2023, despite most of Guam still suffering from typhoon-related issues, Carson finally secured a clinical rotation within an OB/GYN clinic. She was able to train under a doctor, nurse practitioner and midwives.

“Thankfully they had their own generators for electricity and internet,” Carson said. “The babies were coming, they didn’t care!” 

Simultaneously, Carson split her rotation hours working under a pediatrician at a larger clinic. But in spring 2024, her next scheduled clinical placement contract fell through. Once again, she had to drop courses and extend her degree completion. 

“Nicole actively helped us not only find clinical placement sites for herself, but also advocated for other military families to open up Guam to future students,” said Cynthia Sanchez, associate teaching professor in the Department of Nursing. “She overcame all the barriers placed in her way without complaining or asking for any special consideration.” 

Looking ahead 

After three years, two major moves and surviving the disruption of a typhoon, Carson received her MSN degree in December 2024, a proud member of the Class of 2025. She passed her board examinations to become an FNP, and recently accepted a job as a federally contracted civilian nurse practitioner serving on the naval base in Guam. Carson will provide general practice care to the service members and their families. Having also been a patient at the same clinic on base, she has never been disappointed by the care she received.

“The thing that is very difficult when you're stationed on an island with limited resources is that some of those limited resources are the medical providers,” Carson said. “Sometimes you have to wait months to be seen, unless it's urgent care. I'm excited to be able to be one more option for somebody that really needs to get that basic care.”

She views this new opportunity as the beginning of a great career, especially since her family will likely be moved again on military orders. Wherever Carson and her family are stationed, she looks forward to being a provider for marginalized groups, whether they are in the military, a small community or a large metropolitan area. 

“I do feel a call to help those people, especially tying into what I saw in the pandemic,” Carson explained. “They already have so much adversity working against them, and health can go south very quickly. I can be one more provider that can take on another 10 to12 patients. That is something I feel called to do.”