A doctor in Montgomery, Alabama, once told a young Marian Bach that if you’re a good pediatric provider, you’re going to have dirty knees. You get down on your young patient’s  level.

More than five decades later, she still hasn’t forgotten.

• “I remember that so much,” Bach said. “It was like, yes, you have to get on the child’s level. And it’s the same with what we tell our nurses here with patients. Sit down and get on their level, because that makes a big difference.”

Bach, who spent 55 years in nursing and nearly 35 of those with HCA Healthcare, stepped down from her role as MST Director at HCA Florida Twin Cities Hospital on Feb. 22. She is transitioning to a PRN house supervisor role, picking up night shifts, helping with projects and teaching classes for staff.

Fully walking away, she said, was never the plan.

“They’re going to let me work a day or two here and there,” Bach said with a laugh. “If I had to totally let go, it would have been even more traumatic.”

A military kid who wanted wings

Bach grew up as a military kid, her father an Air Force servicemember who moved the family from base to base before retiring to the tri-state area near West Virginia, Ohio and Kentucky. She spent her high school years there but couldn’t wait to leave.

Her goal was clear from the start: become an Air Force flight nurse.

She attended Riverside White Cross School of Nursing in Columbus, Ohio, a diploma program where students lived in the hospital for three years, and joined the Air Force immediately after graduating.

She got her wish. 

Within her first year, Bach was selected for flight school. But a new assignment never came through. Stationed at a base in Louisiana, she met a guy. Mike Bach, a C-130 pilot who would become an Air Commando in special operations. The two married.

They moved to Eglin Air Force Base. And then the Air Force opened up its nurse practitioner program.

• “Since I wasn’t hearing back from the flight assignment, I applied for that and got in immediately,” she said.

In 1976, Bach became one of the earliest pediatric nurse practitioners to graduate from the program. The Air Force had only begun training them the year before.

“People weren’t quite sure what to do with you,” she recalled.

The Air Force used nurse practitioners as physician extenders, sometimes placing them at locations where they were all the medical staff a base had. Bach spent the rest of her military career in the role, serving at Eglin, then overseas to Okinawa, Japan, back to Eglin again, then to the Philippines for nearly six years.

She and Mike raised their children across three countries with the same group of military families, an unusual bit of continuity for military kids.

“They basically grew up with the same kids in three countries,” she said.

Twice told no

Midway through her career, Bach tried to leave the Air Force. She was overwhelmed. She was raising children largely on her own while Mike was deployed, managing the demands of military nursing, figuring out childcare plans that required having someone ready to take her kids back to the states within four hours if needed.

The Air Force said no. She was at a critical career point, and they wouldn’t let her go.

It happened again at the end of her career. She was set to retire in August 1991, but the Gulf War had just started. Because of her flight nurse training, the military held her.

• “They said, no, you’re not leaving. We gotta see what’s gonna happen,” Bach said. “But fortunately, it was a short war, so I got out at the end of October.”

Building something in Fort Walton Beach

After retiring as a major with 20 years of service, Bach went back to school to finish her degree. Nurse practitioners were still new enough in the civilian world that clinics weren’t widely using them, so when she met the chief nurse at what was then Fort Walton Beach Medical Center, she asked about a nursery job.

They didn’t have one. But they had an OB manager opening.

She started in 1992 and never left HCA.

Over the next 24 years at the Fort Walton-Destin Hospital, Bach’s responsibilities expanded and contracted as the facility grew. At one point, she was director of acute care, overseeing medical surgical units, oncology, OB, labor and delivery, nursery and pediatrics. As new wings were built and new directors hired, her sole focus and passion became women’s and children’s services.

During her tenure, the hospital delivered roughly 1,100 babies a year. Bach was there for many of them.

• “I’m one of those hands-on directors,” she said. “I like taking care of patients. I was often in deliveries, or if they had an emergency in the middle of the night, I’d come in. I lived just a couple doors away from the hospital.”

She also spent 13 years as the Viking Band nurse at Fort Walton Beach High School.

Expanding Labor & Delivery Care

In 2010, Bach helped expand labor and delivery care at HCA Florida Fort Walton-Destin Hospital, a project she counts among the most meaningful of her career.

At the time, babies requiring intensive care were sent to Pensacola. Then-CEO Wayne Campbell pushed for the unit. When Eglin Air Force Base decided to renovate its hospital, its obstetric patients were temporarily embedded in the Fort Walton unit, giving the hospital enough delivery volume to secure the state certificate required to open a NICU.

“The first two years we were working with having the Air Force in the middle of our unit,” Bach said. “So that was kind of exciting.”

From there, it was a matter of buying equipment, training nurses, recruiting neonatologists and renovating the unit to handle higher-acuity deliveries. Staff were trained to go on transport missions, traveling to Crestview, Eglin and surrounding areas to pick up babies and bring them back.

• “It was exciting getting it started,” she said. “The nurses were all young and excited and eager to learn. It was a neat experience.”

‘I should never ask somebody to do something I can’t do’

In 2015, Bach moved to HCA Florida Twin Cities Hospital, where she led the MST unit to four HCA Healthcare Unit of Distinction recognitions. The unit finished in the top 5% nationally in 2016 and 2021, and earned honorable mentions in the top 10% in 2022 and 2024.

When asked what set the unit apart, her answer was simple.

“The leadership cares about the staff. So then the staff care about the patients,” she said. “When you do that, then you have good outcomes. It’s a trickle effect.”

One doctor told her she was a “fixer.” If there was a problem, she’d solve it. Others called her a participatory leader, someone who would pass medications, answer call lights and sit with patients rather than manage from behind a desk.

• “I’ve always felt I should never ask somebody to do something that I can’t do,” Bach said.

She fought hardest, she said, for staffing. She’d push for extra nurses when patients were difficult, then justify the numbers afterward.

“I do fight for them,” she said. “That’s where my passion is, that we need to be taking care of the nurses so that they can take care of the patient.”

The moments that stay

Asked if there was a patient who sticks with her more than any other, Bach described a young mother at Fort Walton whose baby was born anencephalic. The brain had not developed, and sadly, the baby didn’t survive.

“When something like that happened, we’d always dress the babies, bundle them up, put them in a warm blanket, and go and sit with the mom,” she said.

The mother came back years later and had a healthy baby, and thanked Marian for being with her during that previous, very difficult time.

Bach said the losses are the moments that stay with her the most. The families who come back afterward and tell you what a difference you made during the worst experience of their lives.

“I don’t do this job for pats on the back,” she said. “I get a lot of gratification just by watching them and helping them.”

She paused.

“I think the ones that affect me the most are the ones that come back later and tell you what a difference you made for them in that experience.”

Not quite done

Bach’s decision to step back came after a difficult year. Her husband, Mike, was sick for about nine months before he passed away. Their three children, two daughters in Tennessee and a son in Washington state, rallied around her, rotating in for weeks at a time.

Afterward, they pushed her to slow down. Between settling affairs, renovating her house and trying to be present for her family, she was stretched thin.

• “I was spinning,” she said. “I was pulled too much between the two.”

She plans to spend summers at the family’s cabin in Ontario, Canada, a primitive spot in the woods near the lakes, and more time with her kids. But she’s keeping her foot in the door at Twin Cities, working night shifts as a house supervisor and teaching classes.

“I’m a nighttime person,” she said.

Asked what she’d tell young nurses starting out, Bach didn’t hesitate.

• “Get as much experience as you can. I think all brand new nurses should spend at least a year or two on med surg (the surgical recovery floor),” she said. “And then just keep the patient in mind. That’s your whole focus.”

She rattled off the possibilities: school nurse, hospice nurse, computer nurse, nurse informatics, working in a lawyer’s office. Then she made a pitch for the profession itself.

“The beauty of nursing is there’s someplace for everybody,” she said. “I encourage people that don’t know what to do to look at nursing, because there’s so much you can do.”

Looking back on 55 years, Bach said her career was never planned. She wanted to be a flight nurse. She became a nurse practitioner instead. She asked about a nursery job and ended up running an OB department. She tried to leave the Air Force and they told her no. Twice.

• “Things just fell into place for me rather than me planning it out,” she said. “Sometimes things happen for a reason. You’re put in a place for a reason, and people are put in front of you for a reason.”

Asked what 55 years of nursing has meant to her, Bach started to answer and couldn’t finish.

“Being a nurse has meant a lot,” she said tearfully. “That’s all.”