STATEN ISLAND, N.Y. -- When Donna Proske first started working at Staten Island Hospital in 1972, back in the building known as The Castle in Tompkinsville, the nurse's station was in a converted bathroom and there were four patients to a room.
The move to Ocean Breeze in 1979 came with what was then state-of-the-art equipment and technology.
"I thought you couldn't get any better than that," said Ms. Proske, whose lengthy career led to her appointment in September as the first female executive director of what is now Staten Island University Hospital.
A lot has changed since those early years with her new role coming at a time when healthcare is at the forefront of national debate.
"Our challenges used to be internal," Ms. Proske said. "Now, there are a lot of external challenges. It's an exciting time to be in the healthcare industry.
"The Affordable Care Act brings many changes in the delivery and my job is really to position the hospital so we are able to respond to those changes in a timely manner, and in no way effect the quality of care, but at the same time work towards improving it."
But as Ms. Proske faces those external challenges, including billion-dollar reductions to hospitals and smaller reimbursements from insurance companies, she has promised to keep intact the ideals she had when she first entered the profession at the age of 22.
"The story is I used to baby-sit for a thoracic surgeon," said Ms. Proske, a 63-year-old Westerleigh resident. "I was always sort of fascinated with what he did. I went on and became a candy striper out in a hospital on Long Island and I decided to pursue that as a career."
Ms. Proske moved to Staten Island from her native Long Island to attend Wagner College, where she earned a bachelor's degree in nursing.
She also holds a master's degree in nursing from Rutgers University.
Her time at the hospital has taken her from a staff nurse to head nurse of the medical surgical unit and to head nurse of the ICU.
In 1997, she was named senior vice president of operations and chief nurse executive.
In 2007, she was appointed chief operating officer.
She takes on the new role of executive director the same way she has every position she has held at SIUH.
"I view myself as responsible for the quality of care that's delivered in the hospital and in the community," she said.
Recently, that came into play during Hurricane Sandy and previously Hurricane Irene -- both the Ocean Breeze and Prince's Bay campuses sit in flood zones.
"We actually evacuated 100 percent of the patients during Irene," Ms. Proske said. "I was the incident commander at the north site. It was quite an event. I thought it was a once-in-a-lifetime experience."
That was until Hurricane Sandy.
"The night the storm hit, it was surreal. The water was coming down Seaview Avenue and right up to the door of the hospital and we weren't sure if it was going to stop. It was an experience you don't recover easily from."
Only high-risk patients were evacuated during Sandy, mostly those on ventilators, including babies in the neonatal care unit.
"The outcomes of the patients that were evacuated and those that remained there were not impacted at all," Ms. Proske said.
Ms. Proske's plans include maintaining SIUH's presence in the community.
Lectures by physicians in the Regina M. McGinn, M.D., Education Center are well-attended by borough residents and a mobile unit still addresses Sandy-related health issues.
"I always say when I went into nursing school, I never aspired to be an administrator," Ms. Proske said.
"There are a lot of unknowns out there which makes it all the more challenging. I think that's part of what I really love about what I do -- how do I figure out what to do next."