THE NURSES' JOURNAL

NURSE POWER: FIND IT, KEEP IT, GROW IT, SHARE IT! - INTRODUCTION

2007-04-24T20:53:00.000-07:00

Nursing is a dynamic and ever changing field. The millennium has brought a flood of new technologies and new challenges to the nursing profession. This book was written to unite, inspire and illuminate the stories of nurses working in the current healthcare industry. Within their stories, they’ve shared their advice, their coping mechanisms, and insights by sharing their experiences. All of the nurses interviewed work from the perspective of personal power and a desire to work for the good of all their patients.

With the advent of electronic medical records, technology that assists safe prescribing practices, outsourcing, and corporate takeovers of small medical practices, the world of nursing has been turned on its head. The good news is that today, more than ever, there is growing diversity in the nursing corps. More men are joining the ranks, a new influx of immigrant nurses are playing a strong role, Bachelor’s and Master’s Degree entry nurses are finally pursuing their heart’s desires later in their careers, and nurse practitioners are operating their own clinics.

The biggest challenge the medical field will be facing in the coming years is directly related to the general populations’ ever increasing need for medical care. Whether in the areas of Hospital Inpatient Care, Ambulatory Care, Nursing Home Care, Home Health Care, Hospice Care, or Preventive Care the demands placed on our healthcare providers in the coming years will be tremendous. The need for nursing services is increasing and the issues nurses contend with will only become bigger. Leadership and management are working hard to create solutions to these challenges with the institution of on-call traveling nurses, outsourcing, and 12 hour shifts, but these solutions are neither cost effective nor human effective. Finally, no crystal ball is needed to predict what is about to happen to the health care industry, the quality of care patients receive, and the costs they will pay if the industry continues on in this downward direction.

With every challenge comes opportunity. I believe nurses, when trained to operate from a common set of interpersonal skills and a sense of purpose and direction, can become the powerful force needed to change the face of healthcare. With the right training, they can make a difference, wherever healthcare is being delivered. Together, they can create the kind of work place where the staff feels nourished, new hires can flourish, and other professionals are welcomed. These skills can be taught and it will take a personal commitment from each of these professionals to create, invite, conduct, and sustain this change. Dollars are plentiful for this type of training but medical staff simply doesn’t have the time to take part. They need faster ways of training so that they can “get it” and move forward. The layout of this book is based on this need for time efficient training.

I realize many organizations offer communication and leadership style workshops in an attempt to teach employees how to better relate to others. Course outcomes are frequently tied to employee and patient satisfaction and performance evaluations. These are great, but they don’t go far enough. They need to be presented as fundamental to learning more about oneself. Ultimately, if you don’t know who you are and don’t respect your own needs, how in the world can you expect anyone else to know and respect you?

The development of nurse identity is reflective of how nurses see themselves personally and professionally. For example, their identities can be affected by non-billable status, gender bias, a label of angel, and a persona of mother. These points lead to a ”one-down” or “secondary” status in the leadership decision-making model.

The reality is that we expect nurses more than any other health care provider to limitlessly care for and care about others no matter what they have to endure. No one can maintain a positive team attitude in the face of total disregard. Yet these nurses are taught to “buck-up”, measure your worth by your stamina, “break” in new nurses, and in the process, they also leave their jobs at a rate of 60% in their first year.

It doesn’t take a rocket scientist to do the math. Compare the demographics of the nursing population to the aging population. What is predicted is the worst shortage of healthcare workers, specifically nurses, which the health care industry has seen. The whole society has been changing, patients are more self-centered, less empathetic, and more demanding and nurses are in for a very stressful future if immediate action is not taken to remedy these situations.

My intention is not to perpetuate a conversation about what’s not working, but to reach out to individual nurses, discuss the nursing profession and its inherent dignity, as well as to provide tools for leaders to take charge. I am proposing a wholeness approach to reclaim the nurses who have left the profession, to re-inspire those who are bedraggled, and empower new nurses to make the workplace a professional and healthy environment.

The ability to fix “it” resides in each of you. The situation can no longer be framed within an environment of fault and blame. Critical thinking and communication are the key skills to getting problems identified and handled with the utmost respect. I’m talking about a change that starts with the premise of assessing and valuing the contribution of nurses. Nurses are not angels, minions, or servants. This seems so fundamental, but the effects of these limiting attitudes are pervasive. Nurses are evaluated by the shared professional mandate of patient safety and care in all circumstances. That sometimes means that their own personal needs are of little consequence in the meeting of the mandate. They may not even notice, and worse, they may not be aware of how they are actually perpetuating this expectation. These professional healers need to ask themselves where their role ends, and where someone else’s begins. They also need to ask who is in charge of them, and where their own focus of control lies. Nurses have to comply with the rules….and yet, there is often flexibility in some areas of these organizations that allow them to start making strides toward wholeness and balance. Getting to the truth of where the flexibility lies can help nurses retain and gain empowerment over their working environments.

Between February and November 2006, over 100 nurses spent time with me to reflect on their past achievements, challenges, and hopes and dreams. I asked them to contribute their stories in hopes of creating a better vision for the future of healthcare.

The pages that follow tell their stories. There are nurses who have risen above the perils of the profession and followed their own path. Some trembled with emotion, literally, when they talked about why nursing is meaningful to them, I am still not sure if this was from fear, sadness, hope or if they just felt they weren’t permitted to express their feelings on this subject. Others breathed so shallowly that their words went skittering across the conference table like pebbles. There are stories of nurses who have transcended all the hierarchy, regulations, and focus on minutia in order to touch their own souls, their patients, and their colleagues. Those interviewed were all career nurses, who having been living with this medical model for 15, 20, even 30 years. In my mind, no one story is more important than another. Each story presented an intersecting point in the web of lives that creates this picture of the nursing profession.

Together these stories have revealed the power of nursing. They have also illuminated 11 points of pressure that appear to be consistent stressors within the workforce.

These points include:

values conflicts

power struggles with leadership

educational hierarchy

physical and productivity demands

inadequate staffing levels

lateral oppression and bullying

interpersonal, leadership

work and life balancing skills deficits

the changing face of patients, allied health care providers, and physicians

The influx of immigrant nurses

society’s views and value of women

the gender shift within the profession.

It also became clear that what was missing from the picture they shared was the landscape of self-identity and acknowledgement of what patients, administrators, and the profession as a whole commanded from them.

The following stories are arranged according to the eight motifs that the nurses themselves brought to the surface. These themes became the organizing outline for the chapters in this book. The interviewees agreed that the key to nursing is critical thinking. They also expressed the belief that finding a niche in nursing requires imagination, creativity and perseverance.

Through their stories nurses identified the following themes:

Nurses are the eyes and ears of the doctor.

Nursing is all about reaching out. The power of nursing is in the hands. That feel and touch can heal.

Nursing is all about heart, empathy, connecting, and respecting.

Others have said they personally are the voice of nursing and vocal advocates for the patients, their families, for other nurses and the nursing profession as a whole.

Other stories share experiences of taking a stand, in spite of being afraid of the consequences for the sake of justice, respect and dignity. They shared tales of courage, integrity and the importance of having a strong backbone.

And lastly, there were nurses who said that nursing is their form of spiritual connection, however that can be defined.

I’ll be writing directly to you whatever part you play in the medical profession of nursing.

If I, as your future patient, have any hope of being healed you must take action now to build your leadership skills so you can take your place at the policy table, surgical table, and bedside; in our community meeting rooms, our homes, the school room, and every other venue in which you practice the art and science of your chosen field as a whole being.

I believe that you all realize that the medical model as we know it is at the breaking point and you can and need to make the changes necessary to bring this transformation a reality. That’s right, YOU! Time is of the essence and I ask you to realize that your dissatisfaction with your profession is probably not only about wages. I think that it probably is about your desire for more tangible evidence of respect, dignity, safety and personal sovereignty for your selves and for your patients. Sovereignty is all about self-authorizing and establishing personal sanctity within your chosen boundaries; as well as taking ownership of your negotiating power. Defining your own power and taking personal responsibility for it can free you to see new opportunities. Understanding where this power comes from, how to get it, keep it, and how to use it so that you and others can benefit from your insight is what this book is all about.

These stories contain moments of inspiration, ideas for personal motivation and practical advice, from one nurse to another. I provide information, tools and exercises to help you explore your thoughts, goals, and dreams. You can do this work on your own and I have designed the exercises so that you can do them during your 30 minute in-services. I encourage you to take time to focus on your own personal development, to be accountable for getting what you need to learn and grow, and to start talking with each other and begin the journey toward a better medical model.

Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it's the only thing that ever has - Margaret Meade
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Nurse's Story: Susan - The Symphony

2006-12-22T14:52:00.000-08:00

Susan -

I spent a lot of time as a hospice nurse. Expert hospice nurses know how to advocate for the dying patient. It doesn’t matter what my perception of dying is, or the family’s perception, it’s the dying person who needs to be able to go out the way they want to. As a hospice nurse I was like the conductor of a symphony. I needed to make sure everybody was on the same song. I couldn’t have some people playing the Star Spangled Banner and others playing songs by the Dixie Chicks and somebody else playing Kenny G. I would take up the baton and say, “Listen everybody. Here’s the song we’re playing. This is the person who has decided what the song will be.”

I’ve spent the last 15 years of my career in education. It’s the longest I’ve ever worked for one employer. I’m currently the associate dean for nursing at a community college. We are close to 200 nursing students, not counting the pre-nursing students. We base acceptance on grade point, I do the numbers and that is how I decide where to place the few that get in the program. We had 835 applications last year to fill less than 100 nursing student positions. So it’s a numbers game, and I love numbers.

I’ve been at this job for so long because I discovered it is where I need to be. I’m very good at it. People will say, Oh, you must love your job.” It’s not so much I love it, it’s just where I’m supposed to be because this is what I do well.

Patricia Benner wrote a book called Novice to Expert. She talks about how nursing maturation happens . It’s like a pebble dropped in the water with concentric circles going out from the point of entry. Novice nurses can only attend to that one spot in the middle, and it’s hard for them to see the greater parts that are out there. When I was a novice nurse, I didn’t know what I didn’t know. I saw one way of doing things and didn’t even think there could be a different way. I worked in an operating room where it was okay for doctors to literally throw things at me and to make sexual comments. It was like a dysfunctional marriage and I was a battered wife.

It was only after working in several different organizations and in various jobs that I learned how nurses should be treated and developed the confidence to stand up for myself and demand respect. We now know to educate our daughters to realize what civility looks like and how they should be respected at work and in life.

Sometimes students will say to me, “That clinical instructor was really mean. I don’t understand why she’s doing this. I listen to the student, then I ask them to flip to the shoes of the clinical instructor.”“I make a point of never answering any of their questions. I always ask another question. It helps to pull the inner strength out of them, by getting them to think and resolve their own issues.” I ask, “Why do you think she would do that. What do you think you should do about that?” I make a point of never answering any of their questions. I always ask another question. It helps to pull the inner strength out of them, by getting them to think and resolve their own issues. I feel it’s my job as an educator. It goes back to giving the student power. I believe many of the women coming into nursing have subservient personalities. They are co-dependent in some way. We say we want to empower nurses so they’ll be stronger, but we’re not finding strong women to come into nursing, some tend to be weak. They come to nursing to be cared for, not primarily to care for others.

If we find dysfunction in the nursing profession, we have to ask if it is the workplace’s responsibility or is it education’s responsibility or is it the nurse’s responsibility? On one hand, I think we can bring a person along and try our best to make them the nurse we want them to be, but they have to have something there to start with, some things that are innate. It’s like bringing a potential student to my door with a deficit in math skills and telling me I’ve got to fix it. It’s not always a matter of bringing them up to speed in math. Sometimes we have to go all the way back to elementary school and give them the positive math experiences that allow them to want to learn math. I can build on a math strength, but I can’t fix a math deficiency. The same holds true for personalities and learned behaviors.

As an educator, I tell students, “if you think nursing is all about holding and coddling your patients and all you do is take care of them, then you’re not in the right program. I tell them their job is to empower their patients to heal. And I empower the students. I give the students the right to fail, but if they make the wrong choice, they need to deal with the consequence. No matter what they are struggling through, I’ll be there to support them but I’m not going to take it over. I don’t allow faculty to embrace and care and take over when the going gets tough, because then they disempower students. We need to teach students to stand on their own two feet, so they feel powerful when they leave the school. We want to give the student the ability to conduct their own nursing symphony.

Power Strategies: Empowerment, Leadership, Strength
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Nurse's Story: Paula - Could I Really Help People?

2006-12-19T10:35:00.000-08:00

Paula -

At the age of 16 I had stomach surgery. My ICU nurse, Terri, was wonderful. She inspired me to be a nurse. I admired what she did, but I wasn’t sure I could handle it. Could I really help people? Would the blood and body fluids bother me? The only way to find out was to try it. I worked as a nursing assistant the following summer and I loved it!

That summer, Noreen, my mentor, was terrific! She was the mother of one of my friends. When she was 40, she decided she wanted to be a nurse. She got her BSN and then started nursing in our small town. Her demeanor impressed me the most; how she was with me and the patients. She was good at listening, and her manner was soft and encouraging. She nurtured, supported and guided me. When I think of a professional, I still see her in my mind. She made me feel special because she allowed me to perform tests and took the time to help me learn and understand.

I worked in several areas of nursing, and met another influential person who saw my leadership qualities and convinced me to go into nursing administration.“I want the public to continue to put their trust in nurses to protect their loved ones, their bodies and their very being.” I took several administrative positions around the country and eventually ended up in my current job, in which I oversee licensing and discipline of nurses in our state and making sure nursing schools meet standards. The public needs to trust that when students graduate from a nursing school they have achieved a certain level of competence. It helps me to stay focused on my real desire, to effectively help people in their most vulnerable situations. What we do at the state ensures that patients can trust the nurse to help them when they can’t help themselves.

This job is rewarding because I have seen people completely change their way of practicing. We have a rehabilitative focus in our profession. If someone makes a mistake, we do what we can to help the nurse become a good, safe professional. I get to use problem solving skills to have an impact on nursing and people’s healthcare in general. Sometimes nurses don’t even recognize they have problems in their practice. Because patients put so much trust into nurses, I take my job very seriously. I want to keep the profession admirable. I want the public to continue to put their trust in nurses to protect their loved ones, their bodies and their very being.

As a regulatory body we struggle with the question of who is responsible to provide continuing competency. It’s important for nurses to continually learn new skills because of the constant changes in nursing. We all agree the growth needs to happen, but is it a personal responsibility or an employer responsibility? Should it happen every three years or every five years? Right now nurses renew their license every year, but what that really reflects is that someone paid the fee and stayed out of trouble last year.

Issues like continuing competency and others need to be addressed by the profession, and we need nurses to come forward and help find reasonable solutions. Unfortunately, nurses give so much in their jobs many don’t feel they have energy to devote to forming regulations or standing up for their beliefs. Many times nurses won’t step up, instead they wait to be invited. Rather than saying, “We need to be here,” and recognizing the power they have as nurses, they melt into the background. I try to empower nurses and encourage them to take up their own issues, rather than have the nursing commission go in and fight their battles. I would like to go out and say to every nurse, you need to be there. However, I might succeed in getting them there by rephrasing my plea to say, “I need you to be there. I want you” because that will better speak to the giving, nurturing, nature of the nurse.

Over the past month I’ve been reviewing my professional portfolio. It’s an exercise where I asked myself, “What are my goals now and where am I going? What do I want to be and do?” I’m reformulating my goals, and as much as I love my job in licensing and regulation, I’m missing patient contact. So I’m looking to bolster my skills and talents, both managerially and administratively, but most importantly, I want to return to cardiac nursing. I’ll need to learn what’s happened in the last 10-15 years since I’ve left that area, but I’m excited to update and expand my knowledge.

I will be a nurse all my life. I was going through licensing records recently and looking at the ages of current licensed nurses. There were people 80 years old who still hold their licenses. Once you “get” nursing you never want to let it go, because it’s too hard to get. I heard one story about a man who paid his wife’s license even after she died. He said she worked too hard and it meant so much to her, that he believed she would want him to keep her license current. My message to nurses, current and future is, “Patients need you. People need you. Come in. Come back. Nursing is the most rewarding career you can have.”

Power Strategies: Encouragement, Accountability, Trust
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Nurse's Story: Margaret -A Certain Light

2006-12-19T09:36:00.000-08:00

Margaret -

Actually, I always wanted to be a doctor but didn’t want to go through the twelve years of schooling that was required for it. I went for what I saw as the next best thing, which was to get my BSN. Although there are times when I wish I would have challenged myself to continue my schooling, I have no regrets about becoming a nurse. There have been many moments when I have watched what physicians do and it makes me glad that I chose nursing.

After doing floor nursing for a while, I went straight to the OR. As a child, I always knew that I wanted to see what the inside of the body looked like, so I had no trepidation about going into the OR. For the past five years, I’ve been doing open-heart surgery.

The number one thing people considering going into nursing need to know is not to take things personally. And number two – it’s always about others first. It’s a profession in which you handle other people’s lives and emotions. You get a whole personal perspective about them. You need to stay humble and open, take criticism constructively, always do self-assessment, and just hang in there.

It’s really the people that inspire me in my career. I truly love the variety of people that I can meet in one place doing one thing. It’s hard sometimes to explain what keeps me going, to be honest, because there’s a lot of grief and misery that we witness. But there are also many moments, for instance, when an 80-year-old gets up and goes home and continues to mow the lawn. That is rewarding enough.

Besides my sense of humor, I think what really saves me is my spirituality. You really can’t see everything from the human perspective; as far as I’m concerned, you have to see that what really gives us our humanity is our spiritual perspective. It helps in cases where things cannot be solved; where we just absolutely get stuck. You have to see life continuing and beautiful beyond the physical means that cannot be helped. The medical field cannot do anymore, so something needs to continue to beyond that.

Once in the lunchroom I told a story to my fellow co-workers about the books I’d read on life beyond death. In many instances, elderly people with Alzheimer’s or who were really sick seemed to be schizophrenic or going between several worlds, but every moment would come back and say hi to their daughter or son.“You have to see life continuing and beautiful beyond the physical means that cannot be helped.” I read a story that claimed sometimes these folks are actually looking for us, the family members, to give them permission to pass on. I had a co-worker who was going through this with her mother. We all suggested that maybe the mother was looking for her daughter’s permission to go. The mother had been suffering from a very long illness, teetering on the brink of death but not passing on.

Well, we had this lunchroom conversation on a Friday. The following Monday the co-worker came in to work, gave me a big hug and said thank you. Her mother had died on Sunday. She had talked to her mother, given her permission, and she had finally passed on after all those years.

Nurses are really a container for the grief of patients and their families. In many instances, when you get off your shift and go home, you are grieving. You take that home with you. In my case, you work on someone 13 hours a day in open-heart surgery and you do everything that you can, but they just don’t make it. They pass right in front of you. How can you not take that home to process? You go home, you cry. Maybe sit in a hot tub or run a hot bath. You sleep, and you just deal with it. When you’re ready, you can discuss it with your co-workers if you want. But everyone has a different way of handling grief.

People tell me I bring a certain light wherever I go. That to me is a great strength in nursing, especially to a highly stressed OR team or unit. There’s a certain aura that people carry with them and we all have our own. Mine is this light, and having the ability to make people laugh, too, because I’m so straightforward. I just tell it like it is, which people seem to find refreshing.

Like in any career, you get to the point to where you know when you’ve accumulated so much knowledge in certain areas and you are ready for a bigger challenge. You’d think open-heart surgery would be the greatest challenge, but I’m about to make a move over to critical care because I have a desire to work with a bigger picture. Whole systems – respiratory, metabolic, circulatory – along with the medications given, is a challenge for which I feel I am ready. I want to be able to put one, two, three and four together, and get a greater perspective. It’s time to move on, and I’m fortunate to be in a career that makes it possible for me to do that.

Power Strategies:
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Nurse's Story: Sharon - Witness a Case of Burnout - Saying No is Hard to Do

2006-12-19T09:31:00.000-08:00

Sharon -

From first grade I knew I wanted to be a nurse, so imagine the toll it took on me to find myself burned out after 20 years from trying to cover the staff shortages by working 10 days in a row, sometimes 16 hours at a time or trying to herd 80 patients through exams a day. And to top it all off, when I couldn’t the impossible, I got replaced by someone younger they thought was faster!

My burnout came about because in every job I had, they worked me until I dropped. If I could work ten hours, they wanted me to work 12.“Nursing is a calling, if you don't answer it keeps calling.” If 12 works, then why not 16? If I could work five days, then they wanted me to work ten days in a row, and then when my skills weren’t as acute as they had been when I was working fewer hours, they replaced me with somebody younger and faster. I was working as hard as I could, yet I was a failure in their eyes.

I repeatedly said I needed more help and I was overwhelmed, but no relief came. I needed to work, so I moved to another hospital but the conditions were the same. They would tell me the budget was limited, yet they kept building new wings and getting new equipment. Nurse staffing was not a priority. So after enduring those circumstances as long as I could, I changed jobs and worked for a private practice and money wasn’t an issue to them. But one doctor I worked for wanted to see 80 patients a day. We had an MA, an LPN and I was the only RN, and he was angry because we couldn’t get that many patients in and out of his office in one day. He called me to task and asked, “Is there any way we can see more patients?” I said, “Only if they get naked in the waiting room.” He was furious with me. Shortly thereafter, he decided he could find somebody else, and that was fine with me.

I worked for awhile in a feminist clinic where even the doctors were women. During that time I felt I had power and people respected me for me and what I could do. I was empowered to say, “You know, I think this recovery room would work better if we did this,” and five women would say, “That’s a pretty good idea. Let’s try that.” If I had said that at the hospital, a doctor would have said, “We’ve always done it this way and that’s how we will continue to do it.” The feminist clinic had a teamwork atmosphere, without the competition that I found in the hospital. We all respected one another. We nurtured each other. We would go to lunch together every Saturday and share things about our lives.

My last nursing job was at a long-term care facility. I liked working with the seniors because they appreciate the tiniest things I would do for them. But after working there for a short time, I started getting calls at 3 a.m. “The day shift nurse can’t come in. Can you do her shift as well as your 3-11 shift tomorrow?” I would explain to them that I wouldn’t have time to sleep, but then they would ask if I could work an extra half shift. They would ask over and over again and I was not good at saying no. I felt if I didn’t work when they asked me to, there would be repercussions. If I didn’t play along, I wouldn’t get pay raises or promotions. I soon realized that even though I did what they asked, I still didn’t get the pay raises or promotions. I felt unappreciated. That’s when I left nursing to open the bed and breakfast.

Running a bed and breakfast is very much like nursing. My husband would tell people, “Sharon gets to give lots of TLC, nourish people’s bodies, and change beds, the only thing she doesn’t have to do is bathe them.” I say nursing is a calling, if you don't answer it keeps calling, so I found this way to heal. To me the bed and breakfast is as spiritual as nursing. I believe everybody who stayed came to bring me a gift or to receive a gift. People told me incredible stories from their hearts and souls. I felt I made a difference just by listening. I even nurtured my housekeepers. I listened to their problems and helped them in any way I could. I encouraged them to move on to better jobs, because I saw more potential in them than they could see in themselves. I helped them build confidence. I think nursing gave me the gift to help people feel good. The empathy I developed throughout my nursing career has made me a better host, mother and friend.

I always felt there was a spiritual aspect to nursing. My job was to make patients comfortable and help them heal. Sometimes I knew I said the right thing at the right moment, and that would fulfill me. I remember a non-English speaking patient I cared for. I didn’t speak Spanish, but in the back of a nurse book I had was a list of a few Spanish phrases, so I grabbed the book and made an attempt to communicate with him. I had enough information to ask him if he was in pain, where the pain was, and if I could give him something to ease the pain. He had been laying there suffering for quite awhile, and the nurses hadn’t picked up on his discomfort – or they were too busy to care. I know I made a difference for him that day.

I loved nursing when I was able to really care for the patients, but most of the time competing and conflicting pressures got in the way. I believe that cost me on a spiritual level. I’m sure it attributed to my burnout. I try to keep my sense of humor, and posted a quote from Dear Abbey to keep myself laughing:

We the Willing
Led by the Unknowing
Are doing the Impossible
For the Ungrateful.

We have done So Much
With So Little
For So Long
We are now Qualified
To do Anything
With Nothing.

Anonymous

I can’t find the cutting I had posted so I googled it for my story. Most likely, Abby printed a nurse altered version. I would think most nurses would be adverse to using the ungrateful line, for fear others might interpret it as referring to the patients instead of management. I don't believe any of my patients were ever ungrateful. I was willing to tolerate the conditions in order to have the opportunity to give them the best care I could, the care they deserved. Many times I went to work exhausted fearful if I didn't go to work that day, that my replacement wouldn't be as caring or tender with them as I would.

I was a hospital patient recently and found it interesting how nursing has changed in the 10 years since I left the profession. I saw a difference between the young nurses and the older nurses. The young nurses are technologically-oriented. They came in, looked at the computer, read all the dials, made their notes on the computer and then left. I felt like I was a piece of equipment when they were in the room. The real nurses, who tended to be older, came in, asked me how I was doing, and then looked at the machines and entered data.

I had one really bad night when I was in a lot of pain. The next day I was supposed to have a chest x-ray. The charge nurse called x-ray and asked them to bring up the portable x-ray machine, but they refused and said I had to go to x-ray. I explained to her that I didn’t want to go to the x-ray department, because they kept me there forever and I have to have the oxygen on underneath the mask. The mask gets hot and after awhile, I can’t breathe. She decided to take me to x-ray herself. It took a long time and she could see that I was having a hard time. She reached over and held me and comforted me. That made a big difference for me. I was so happy to have a real nurse caring for me.

I no longer have the bed and breakfast, and my recent hospital experience inspired me to return to nursing. I may return in an educational capacity. I know I’ll be able to find a niche somewhere, and I’m motivated and excited to care for people again.

Power Strategies: Dedication, Loyalty, Service
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Nurse's Story: Carolyn - I Never Imagined I Would End Up Here

2006-12-19T09:27:00.000-08:00

Carolyn -

I began my career as a dental assistant, but it wasn’t a good fit for me. After all that, I found looking into people’s mouths unappealing. What’s ironic is I don’t mind looking inside people’s bodies – just not their mouths. I have more of a sense of accomplishment working in surgery than I did when I was working on teeth.

I chose nursing for the people contact. When I was in nursing school this poor lady was getting ready for a colonoscopy and she had to drink the stuff to clean out her intestines. She was sitting on the little commode and I kept getting her warm blankets. She said, “Oh, this is so nice.” We were laughing and joking and she said, “I guess if I was going to have to have someone with me while I was doing this I would want you to be the one.” I was glad to make her uncomfortable experience a little more pleasant. Another lady had a radial neck procedure and she started coughing and the tube was coming out and it made me sick to my stomach. I was over in her sink gagging and thinking, oh, my gosh, I’m going to vomit! I can’t be a nurse if this happens! The lady started laughing and by the time we were all done we were both laughing. I said, “I’m so sorry,” and she started laughing. She said, “I would have done the same thing.”

Everybody has vulnerabilities and if I’m able to identify where the patients are coming from and let them know that I’m not perfect either, then I can relate to them better.

I am so fortunate to be working with the open heart surgery team. It was really a fluke that I came here, and it wasn’t something I thought I wanted to do. I worked as a technician in surgery while I went back to school for my nursing degree. After college I worked on the floor for awhile, thinking eventually I would work as an OR nurse. While working on the floor I also worked occasional evenings in open heart surgery, so I got some cross training.

Things change fast in the workforce. They were begging for nurses when I first went into nursing school, but after I graduated and spent a few months on the floor, suddenly there was a reduction-in-force in the OR. Because I had the open heart experience, they said I could either go to open heart or find a job elsewhere. I didn’t think I wanted to work in open heart, but I also didn’t want to search for another job. As it turned out, the move to open heart was the best thing that could have happened to me.

Working in this department wasn’t always rosy. One of the surgeons was very difficult and all of the nurses were afraid of him.“Everybody has vulnerabilities and if I’m able to identify where the patients are coming from and let them know that I’m not perfect either, then I can relate to them better.” Nobody wanted to speak up about how hard it was to work in the environment he created, because we watched him fire someone who talked back to him. But things have changed and the environment is great now. We’re doing this thing called med teams where everybody listens to each other and takes responsibility to check and double check things. As nurses we’ve always done that, but we’ve never done it with the doctors. Now it’s okay to say to the doctor, “I’d like to double check that. Are you sure that’s what you meant? Can you please clarify that?” Instead of just going along with what they say.

Open heart surgery is something I never would have imagined myself doing. I am amazed by the heart muscle. Sometimes I look at a patient’s heart and think, “I can’t believe we just did all that stuff to this guy’s heart and it’s still beating.” It’s fascinating! It’s also hard work, but at the end of the day when my shift is over, I like to play hard too.

My husband and I have jet skis and I can get rid of a whole week’s worth of tension by getting on the jet ski and going fast and twirling around in the water. The jet skis and my dog are both great stress relievers. So is a TGI Friday with the girls. My release comes from fun and exhilaration and by diverting my focus from work to play. I think you have to feel good about yourself in order to feel good for others and to help others. I feel good about my work, and my play, and I really love helping people.

Power Strategies: Engagement, Courage, Diversion
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Nurse's Story: Linda - The Intention to Comfort

2006-12-19T09:18:00.000-08:00

Linda -

The core of being a nurse is, to me, the intention to comfort and bring healing. It can be physical, spiritual or emotional, but with that intention you can literally change a person’s life in one shift. As I walk in from the parking lot to my job each day I think to myself, what is it that I want to get out of my day today? And I answer, I want to be joyful; I want to bring healing and comfort to whomever I come in contact with.

As a person who sees the cup half full instead of half empty, I created a daily commitment. I focus on finding the good deeds that people do every day and recognize those. I find two people each day to acknowledge the work they do or the way they do it. The surprised looks of appreciation are an incredible reward of joy for me.

In my current role as care coordinator, I make daily rounds with the medical team which consists of an attending, residents, interns and medical students. I had noticed that a young medical student seemed particularly shy and overwhelmed during rounds.“I want to be joyful; I want to bring healing and comfort to whomever I come in contact with.” This often invites more questions and there seemed to be a harshness from some of the senior teaching staff toward her. One particular morning, I could just see that this young woman was really struggling with this pressure. So, after she finished presenting her patient I said, “I just loved the way that you advocated for that family when you were giving your report this morning. It really tells me that you consider communicating with families a priority.” She burst into tears and said, “ You are the first person who has told me I was doing a good job.”

From that point on, every time she was reporting on a patient, she’d catch my eye and I’d give a nod of affirmation to her. The next year she was chosen to be part of the Residency Program. The first time she was assigned to my team as a resident, she gave me a hug and said she wished she had written to me to let me know that I made a difference in her life. The morning that I told her she was doing a good job, she was questioning her ability to become a physician. But I had helped her to see that she was doing the right thing and continue. For me, it was just a sincere observation and a comment given so willingly. But for her – it was life changing.

Nursing is one of the most rewarding career fields you can choose. As a nurse, you are involved in the most intimate experiences in your patients’ lives as you witness everything between birth and death. It is a courageous profession. It takes courage to walk into a room where you know that someone has just been diagnosed with a life- altering condition, and to meet them wherever they are at that moment, whether it’s to sit and cry with them or help them plan how they’re going to live. It is to be the privileged witness as they take their last breath.

I was blessed to work in pediatric hospice. It was the most challenging and meaningful work that I have ever done. One night I’d been at a house until about 8:00 p.m. with a child who was actively dying. The on-call nurse was going to make a visit after I left when the family felt like they needed support. I got a call about 2:00 a.m. that the on-call nurse was on her way out there and her car broke down. The family needed her right away because the child was dying. I agreed to go back out, but in the dark of the night I got lost and was not there when their daughter died. I could tell it was disappointing for them when they didn’t have the support they had counted on.

At the parents’ request, I went in and bathed the child. When I walked in the door, the mother was sitting in a rocking chair in another room just rocking, back and forth, back and forth, and she could not even look at me. She was just incredibly angry. They had other children, and they wanted to make sure that the body was taken before the siblings were awake. I finished bathing her and contacted the funeral home. They came out and at the family’s request, I carried her out to the vehicle. I could have gone back home at that point, but my work was not complete. My credo to always comfort had not been accomplished.

And so, I went in and sat at the feet of this grieving mother and waited. I waited until her rocking got slower and slower and she finally started to cry. As she started to sob, she let me take her in my arms and comfort her. There’s something about waiting in silence at the feet of a grieving mother. You can't do anything until she begins to let go. But it was my intention that compelled me to go to her and wait, patiently, until she could accept the open arms of comfort.

Power Strategies: Service, Empathy, Love
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Nurse's Story: Kathleen - The Nursing General

2006-12-19T09:13:00.000-08:00

Kathleen -

I want to elevate nursing in the eyes of the entire United States of America, and hopefully the world. I want to change the way people look at our profession forever. There are more nurses in the United States than soldiers in the military. What an incredible power! What an undaunted force we would be if we had one voice, if we could only unite.

I held many jobs before I came into nursing. I was an executive administrator for a chamber of commerce, an administrative analyst for a corporation in Los Angeles, a seventh grade school teacher and I made old radio commercials on an AM station in New York. When I got into nursing at the age of 38, I thought it was more difficult than being president of the United States. It is physically, emotionally, psychologically and spiritually taxing. I’m spun around so much every day I don’t even know where my car is when it’s time to go home. Because so much happens during the day, I’m a cacophony of emotions that I can’t sort out.

I have written several books about nursing and I speak to many nursing groups. My goal with the books and speeches is to help nurses raise their collective and individual self-esteem. Nurses need to understand the problems they face in the workplace.“I want to change the way people look at our profession forever.” For example, there is the dysfunctional physician-nurse relationship. Nurses don’t realize there is a power difference, and until that is understood, it can’t be fixed. When a physician asks, “Where is the chart?” We say “Oh, I’ll get that for you.” We begin our phone calls to the doctors with, “I’m sorry to bother you,” as a child walking into a room would to a parent. We need to get adult communication going between the nurses and the physicians, and give nurses examples of how it has been done. It takes so much courage for nurses to talk with physicians on an adult level.

Last December, I quit my job as the manager of a 57-bed orthopedic unit. I was working 70 hours a week. I was stuck. I was a victim and I was a martyr. I couldn’t get out of it, partly because I loved what I did so much. Every nurse feels that conundrum. They love what they do, so they don’t leave. After giving up my manager job, I sat down and wrote a book for three months. Then I returned to work as a staff nurse and I found myself unconsciously falling back into the subservient behavior. I have to consciously stand up for myself and not allow the doctors to order me around like a child.

Nurses don’t want to acknowledge their subservience. It’s quite a daunting task to take this entire culture and this entire profession and try to help it. In organizational psychology there is the one half of one percent rule. That is the momentum needed to move an organization. I figured that one half of one percent of nurses in America amounts to 40,000 nurses. I’ve already spoken to 10,000. I only have 30,000 to go and the wheels will be in motion! Culture changes happen at glacial speed, in really small increments. But when nurses walk back onto the floor after hearing what I have to say, they aren’t able to act the way they have in the past. It’s impossible. I just love it!

It’s really all about empowerment for nurses. When I was a manager, I got my charge nurses together for a retreat. During the retreat they came up with a philosophy for our floor. It was only seven sentences long. We presented it to the staff and said, “You have three choices. You may edit it, sign it, or leave the department.” Every person signed it and now they are living it. Because it’s in writing and everyone agreed to it, people remind each other. It made an enormous difference in how the nurses behave and how they treat each other.

When I give voice to the experience of nursing in my speeches, one of the points I make is that nurses do not have time to process what they’re feeling, and the lack of reflection causes people to be at work with unprocessed, unfiltered emotions and no idea how they are affected.

Last year I worked the floor around Christmas. I got to know one patient very well because I admitted her for surgery. I could tell you everything about her. The day after her surgery, Christmas Eve, I was the charge nurse and didn’t have her as a patient. I walked by her room and could see she was doing great. She was up with physical therapy walking the halls. She returned to her room and suddenly her nurse grabs me and says, “Come quick. Something’s wrong with my patient.” He was scared to death and wouldn’t even enter the room. I knew she was dead as soon as I arrived at her door. I could tell from ten feet away. So I tell the nurse to call the code. I start CPR and continue even when the code team comes. I was counting out loud and the ICU nurse turns to me and says, “What are you counting out loud for?” I answered, “I’m just trying to center myself.” “Well, count to yourself,” she says. Very mean, very angrily. I understood that she was very upset that we hadn’t brought the patient back and her anger had nothing to do with me. We all finally realized we couldn’t bring her back. The nurse who was attending to her falls apart. He had never had a patient die. So I’m the charge nurse and I have a dead patient, a nurse who is distraught, and three other patients to attend to. All this, with very few resources on the day before Christmas. I have trouble getting in touch with her family and have to continue to try to reach them throughout the day. Later that day I call the organ donation people and I say to the lady on the other end of the phone, “How are you doing?” She said, “Shitty.” I said, “I’m doing shitty, too. Tell me your story.” And she tells me the last two calls she received were a 13-year-old who skied into a tree at Snoqualmie Pass and another young child who was found dead by her mom that morning. She said, “I have more organs that I would ever want for Christmas Day.”

Suddenly I’m grieving my patient and I’ve picked up the deaths of these children. I swipe my badge, struggle to find my car and go home. Four days later I’m in the gym. I’m counting as I pump the barbell, and I fall apart.

The work of a nurse is the work of the heart and nowhere is it documented how much I care. No one documents the energy and thoughtfulness I put into my day. It’s just task, task, task and cover your ass charting. Thirteen pages of charting and nothing to represent what I actually did. I know nurses make a difference; I’ve seen it happen so many times. I honor this profession so much, and I grieve for the people that are leaving, and the people who are coming that don’t want it, so they don’t stay.

The next article I want to write is about the collapse of nursing; the extinction of the nursing profession. Why we are the next endangered species. You can say that nursing is dying because of the shortage or any other reason you want, but the truth is the nurse and patient no longer have any time with each other. The time together heals not just the patient, it also heals the nurse. Because nurses are stretched so thin and can’t focus their care on the patient, they feel like androids in a factory. Move patients in, move patients out. There’s no time and there’s no honor.

The goal of the next book I’m writing is to elevate nursing in the eyes of the entire population. There is so much anger and depression in nursing, most of it coming from learned helplessness and frustration. My future desire is to create a position called nursing general. The person in this position would be in charge of the nursing profession and would give 15 minute updates every week for all the nurses in the country. They would lead the troops and give nurses some voice, a way to speak up. With baby steps, I’m hopeful for positive changes for our profession. I’m only one person, but I’m dedicated to being a part of force.

Power Strategies: Influence, Leadership, Passion
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Nurse's Story: Chuck - Committed to Consumer Education and Advocacy

2006-12-19T09:08:00.000-08:00

Chuck -

My nursing career began when I was in high school. I was in a health occupations class and was mentored by a nurse anesthetist in a veteran’s hospital. I worked with him three days each week, for two hours in the morning, throughout my junior and senior years of high school. It was a great experience and all the medical personnel encouraged me to continue my education in medicine. I was not a stellar student in school and am dyslexic, so I had never envisioned going to medical school.

I enjoyed playing football and was recruited at Southern Oregon State College. I went there to play football, but after a year decided to apply to nursing school at Good Samaritan in Portland. I started there in my sophomore year. But I don’t think I was quite ready for college. I dropped out, bartended and did some other odd jobs for awhile. When I was 22, I applied again to nursing school and wasn’t accepted. I reapplied and finally was accepted and this time finished my three-year diploma program.

Nursing jobs were scarce when I graduated in 1983. After working in a nursing home for awhile, I took a job in rehabilitation. I wasn’t sure that was what I wanted to do, but once I got into it, I fell in love with it. In 1989 I joined the Army Nursing Corps and was deployed in 1991 to Germany for Desert Storm.

That’s where I met another one of my mentors. She was the chief nurse when I was with the 396th Army Reserve Nurse Corps. She had served in Bosnia and was one of the first nurses ever to be a healthcare commander of a combat military unit.“I want the entire healthcare system to take responsibility for better consumerism.” At the time, those positions went to doctors only. She was a person of extreme integrity. She had a good sense of humor, but was also consistent and fair. She gave me insight into my own sense of integrity and modeled exemplary leadership behavior. She inspired me to follow her lead and become a person focused on a mission. She led by example, and I felt I could emulate how she worked. Because of what I learned from her, I will always “walk my talk.”

My master’s degree focused on organizational change and my goal is to obtain a position where I can influence consumer advocacy. Sadly, consumers are ignorant about the healthcare system and that puts them at risk. Many patients simply say, “Doctor, just tell me what to do.” This is not a good strategy for managing health. Patients need to know their options and what they can expect from their various choices. My role is to help educate consumers. I want the patients to know how to pick good providers and good hospitals. The entire healthcare system should take responsibility for better consumerism. This would require changes in the system.

I’ve recently applied for a director position with a nursing executive’s organization. I’m also on a task force that’s exploring reorganization of the health system quality assurance program. I want to do my part to improve healthcare quality, including patient safety and positive patient outcomes. I would like to see improvement in the way the regulations are set up. Right now, nurses are held to a minimum standard or a minimum competency. I would like to see the standard raised so instead of nurses being minimally qualified, they are expected to maintain practice excellence.

My current mission is helping nurses work toward a common goal, with that common goal being focused on the patients. It seems nurses work harder at fighting each other than they do at working together. If I succeed in obtaining a position where I can influence this area, one of my initiatives will be to create a “greater good” philosophy. I want to help nurses develop a more noble view of their profession. Nurses really make a difference when they help patients achieve their goals, and that’s why people go into the profession. With everything else happening in healthcare, nurses lose sight of why they chose their careers. I want to help them come together to say, “We have a common goal. We are all patient advocates. We are all promoting a holistic approach to healthcare.”

Power Strategies: Advocacy, Integrity, Leadership
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Nurse's Story: Susanne - Build Leadership in the Nursing Profession

2006-12-01T21:29:00.000-08:00

Susanne -

My husband and I recently traveled to India. Four days into the trip, my husband was attacked by a bull. He sustained injuries and became a patient in an intensive care unit, one hundred kilometers away from the accident. Although my focus was totally on him, I couldn’t help but be impressed with the skills and competencies of the nurses. For what India appeared to lack in technology, they made up for in care and service. The nursing competencies and their attention to the patient and family were remarkable.

It was a memorable experience and an incredible witness to their passion for their profession and holistic approach to care. The nurses valued family as an integral part and success to healing the patient. Embedded into their practice were the body, mind and spirit. The spiritual component transcended all beliefs.

In considering foreign nurses and their entry and practice to the U.S., I think of our care experience in India.“ feel drawn to making it different for nurses, by helping them to contribute more..” I believe the opportunity to exchange knowledge between the cultures is significant and beneficial. While I know and understand this, I would also be sad to bring them here, as I would not want to deny their own country the richness of their expertise.

These memories serve as reminders for why I went into nursing. I see my role as a vehicle to serve others, the patients, families, staff and physicians. As a healthcare leader and learner this is my mission and vision.

In the western world, I believe we have lost some of the momentum in nursing. The need for good role models, mentors, and coaches helps us nurture our profession, particularly new nurses, as well as our tenured nurses. Nurses deserve to be inspired, motivated, respected and honored. As a nursing leader, my desire is to build upon nursing professionalism to move it forward and prepare nurses for future leadership positions.

Nurses are great resources and we have the tools and knowledge to affect successful change and practice. I’ve realized first hand and through being there for others to support them, nurses’ knowledge is not always well-received or honored. I learned leaders need to listen. Nurses are problem-solvers and innovators, all in care and service to their patients and families. They need to be valued and recognized.

As a result I have developed a passion for leadership. There is a difference between being a manager and being a leader. Managers have the ability to operationalize day-to-day activities and leaders provide the bigger picture and vision. I feel drawn to making it different for nurses, by helping them to contribute more. I participated in leadership training, read leadership books, looked into research-evidence practices for leaders and continued moving forward in my education, which now finds me seeking a Ph.D.

Because of earlier experiences, I became determined to engage my staff collaboratively with my holistic and open-door approach. But, I realized people don’t automatically embrace change. Trust is a factor and must be acquired through building safe and real relationships.

I want people I work with to become accustomed to engaging in decision-making and to be willing to try something different. I had to recognize we need time to prove this method can be successful. Afterall, I’ve seen a lot of leaders come and go myself and they may not see the value in following my lead until I’ve proven myself.

After a year and many mistakes I began to earn their trust. Early on I mistakenly assumed everyone wanted to take part in decision-making. I think this is true, but they said their experiences of being excluded shut them down. Leadership is about coming alongside to learn, teach, collaborate and coach others into their work and ultimate satisfaction. Integrity and being present are important parts in developing relationships so that people feel they can contribute and make a difference.

After 30 years of nursing and learning, I have no regrets about my career choices. I am never bored and I always feel motivated. My career has led me to where I am today - continually learning, growing and stretching in all directions. I love what I do and at the end of the day I measure my impact. When my efforts make a difference, I feel extremely satisfied.

Power Strategies: Leadership, Inspiration, Relationshipsgo back to main page

Nurse's Story: Nancy - Not Everything that Counts can be Counted

2006-12-01T15:05:00.000-08:00

Nancy -

When I was about eight years old, my sister fell and sustained a serious head injury. My mother immediately called the nurses who lived in our neighborhood. This nurse came on the scene and managed everything beautifully – calmed my mother down, put my sister in the car, transported her to the hospital, and kept in touch with my mother by phone to let her know what was happening so that my mother could stay with her other children.

For a relatively young child, that made a big impression on me. This nurse just seemed to know exactly what to do, but at the same time had such a calming influence on my mother. It wasn’t just that she cared for my sister. She was able to look at what was going on with the rest of my family, too. It was really inspirational to me to see that combination of intelligence and caring, but it would be years before I would be able to articulate why that was so. (IS THE CALMING INFLUENCE THE REASON WHY IT WAS SO INSPIRATIONAL?).

In college, I started out as a Music major. I’ve always loved music, and even to this day I still play (WHICH INSTRUMENT?) whenever I get the chance. At the time, I was juggling several part-time jobs while going to school, and it wasn’t working out very well. Eventually I got a job as a ward clerk in the local hospital to replace all the other jobs. That really was my first exposure to nursing as a practice, and I found it extremely enlightening.

The nurses’ work on that ward made the difference between life and death in many cases and provided people with comfort and dignity along the way.“I like to help people understand the impact of just their physical presence..” It was also the sixties, an era when many people were trying to do socially relevant work. What could be more socially relevant than using your brain to care for another human being’s health? My university was just starting a bachelor’s in Nursing program, and I ended up applying for it. So Nursing became my major, but I was able to get a minor in music, too.

I ended up going all the way to get my PhD, which I never would have imagined when I first began my studies. I have taught nurses, and now I advise them as the Dean of the School of Nursing at the University of Washington. Through the years, I have probably influenced thousands of nurses going into the field through my various roles. I like to help people understand the impact of just their physical presence. Imagine the comfort we can offer by simply being there as a patient goes through a difficult procedure or hears an unwelcomed diagnosis.

It was Albert Einstein who said, “Not everything that counts can be counted,” and I believe that applies to the care that nurses provide. As the health care system goes through changes in this country, some will be looking to quantify the work that nurses do, to turn it into billing codes. But how will physical presence be billed? What code will they give “being there” at the patient’s bedside to sustain them while they experience something that may be very difficult for them?

Nurses definitely have a professional purpose for being at the bedside. The work of nursing is knowledge work. And skilled nurses bring their knowledge and empathy together with boundaries. The people who provide nursing services are there because of their ability to make important decisions and judgments about people’s health, as opposed to simply being there to support other health professionals.

Throughout my career, I have changed the form of my instruction, but have essentially remained a teacher. And it’s a role I enjoy immensely. At the end of my deanship, I can foresee returning to the classroom to continue working with students and continue the research we’ve done. Grooming people is at the core of everything I do.

We are entering an era in which nurse practitioners will most likely be providing much of the primary-level care in the country, particularly in underserved areas. Our health care system can’t be sustained with the scarce numbers of professionals currently available, and who are anticipated to be available in the future. So we’re moving into an era of unbounded opportunity, and that’s a great period in history for us. I don’t think there’s any more question about whether or not nurses are necessary. Our contributions to healthcare are extremely well recognized. To imagine a world without nurses is very frightening indeed.

Power Strategies: Influence, Power, Teach
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Nurse's Story: Andrea - Between the "Ladies Home Journal" and the "Wall Street Journal"

2006-12-01T15:00:00.000-08:00

Andrea -

I’m amazed I made it through nursing school. Never a cake walk, many students dropped out half way through the nursing program back in those days. Geriatric nursing weeded out students lacking stamina. We started work at 7:00 a.m., a lot earlier than other students, and were in a separate course track, isolated from others in our cohort. It was a residence program, so we took care of elderly patients -- people who needed to be fed, couldn’t respond, and needed lots of physical assistance. Half of my class dropped out. I wanted to prove I could stick it out. It was a matter of pride.

After receiving my bachelor’s degree, I joined the military with 12 other nursing graduates. Some of us didn’t even realize there was a war going on in Southeast Asia, but we quickly learned how to set up tent hospitals and fire a rifle and care for people with gunshot wounds. I also cared for people who had lost arms and legs in Vietnam. Fresh out of school, I suddenly had to behave as an adult. My idea of nursing was completely changed. I was really taking care of patients – not only caring for them, but also figuring out how to help them transition back to civilian life with major wounds.

I developed an affinity for orthopedics and rehabilitation through my Vietnam experience. And, I had the GI Bill to help me get to graduate school. I wanted to get my master’s, but wasn’t sure if I wanted to continue my nursing education and move up that track, or change my focus to a business track.

I remember the day I decided to go the MBA route. I was working at the hospital when a young teenager who had lost her leg in an automobile accident was being discharged.“I’m committed to sharing my knowledge and transferring my skills to others, so when I’m ready to fully retire, I know I’ve done my part to strengthen the nursing profession." Her family was presented with a huge bill as they were leaving the hospital. They were upset, and the teenager was distraught because she had cost them so much money. I kept thinking that all the rehab work I had done with this patient was going down the tubes. I took off my cap when my shift was over, put it in my locker and said, “I think I’m going for the MBA because I can’t deal with this cost issue.” That was in 1970. When I signed up for the course I still had my nurse’s uniform on. I received a lot of weird looks, like “What are you doing here?”

After passing the test to get into the MBA program, my quandary became how to get out of the MBA program. I found it difficult and different. It wasn’t like nursing at all. There were only ten other women in the class of more than 300 students, and I was the only nurse, so my orientation was very different from the other people in the class. The other students did not perceive the world through their feelings as I did. Everything we did was quantitative, not qualitative. Business and health care are two different worlds. It was hard to balance the two and I always said I’m halfway between the “Ladies Home Journal” and the “Wall Street Journal.”

After settling into the MBA program, I realized nursing really did prepare me for the business environment. One of the first things nurses are taught is to observe. In nursing school I was tested on my observation skills. I was told to walk into a room and out again and then asked how much water was in the vase? Where was the vase? What did the sheets look like? What did the patient look like? The point was to hone observation skills because I needed to know very quickly if the IV was still running, the oxygen was still on and if the patient was perspiring or looked uncomfortable. In business you use those same observation skills, you simply observe different things. You still look at the situation, assess it and decide what to do.

I retired from healthcare about ten years ago. At the time I thought I would work a little bit, and only when I really found something I wanted to do. I decided to work with health care organizations that needed to make system changes. Instead of working like a consultant, observing a system and then writing a paper to convey what needs to be changed, I work alongside a staff to teach them how to implement changes that have been recommended. I teach staff how to do things, and once they’ve learned it all, I walk away.

I’m pleased with the multi-dimensional path my nursing career has taken. In addition to consulting work, I work in a project that helps people without health insurance have access to health care. So I care for patients, for the community and for nurses. I use my nursing skills and my business skills. I’m now 62, and I don’t want to work as much as I used to. That’s why I feel strongly about orienting other people to do this work. I’m committed to sharing my knowledge and transferring my skills to others, so when I’m ready to fully retire, I know I’ve done my part to strengthen the nursing profession.

Power Strategies: Facilitation, Community, Diversity
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Nurse's Story: Janice - With One Voice

2006-12-01T14:49:00.000-08:00

Janice -

There are two sides to nursing: the technical and the emotional. Both sides are equal in importance, and should be recognized for what they bring to patients. That’s a message I’ve always wanted to share with nurses, but wasn’t in a position to do it on a large scale.

After thinking about how I could best share my voice and vision for nursing, I decided to go back to school for a master’s degree in business. I knew that degree would lead to jobs in nurse management, which is how I thought I could have a voice in the future of the profession. I felt like that was where I could help nursing move forward and help nurses to have a voice. Sometimes nurses feel subservient, or that they’re not heard or they’re not powerful. I have fantasized about how powerful we could be if we could come together with one voice.

One of my most important contributions has been to keep one particular message alive, and that is that it’s critical to have nurses – not just physicians – involved in the decisions made about patients.“The nurse pulls all of the pieces together.” Nurses bring a different level of care. Where the physician comes in to diagnose and treat, the nurse manages the whole patient, checking in on the details of the care, the progress made, the social needs. The nurse pulls all of the pieces together. Voicing that message will help make a stronger health care team for patients and will help ensure nurses’ work is valued, which will make a difference in keeping and attracting quality people to the field.

I know it takes determination for nurses to stick with their work through the challenges they face. I have found that where nurses work – a hospital setting versus a clinic or other outpatient facility – may contribute to how hard it is to stay dedicated to the profession. For nurses, hospital work can be especially physically demanding. They may also end up feeling that their work is undervalued and that they don’t have enough time with patients. They may sometimes feel like they do more paperwork than they do patient care, and believe me, that’s not what keeps them coming back to work. Nurses come to work to care for patients and use their intellect – not to be stuck with reams of paperwork, or pushing pills. That does not fulfill their dreams or even their most basic goals.

My goal has been to ____________. There are people who have inspired me along my path, and one of them was the head nurse from the diploma program I completed many years ago. It was at a Catholic hospital, and that was at a time when many of the nurses were nuns. This woman – Sister Martha Joseph – is now in her nineties and lives in a nursing retirement home. I saw her recently and she said to me, “I work a shift. I sleep a shift. And sometimes I do crafts on one of the other shifts.” I thought to myself, how nice it is she still feels like nursing at ninety.

But I can understand her dedication, because it’s what I feel as well. It’s part of my being. No matter what job I do, I am a nurse. And I bring that to whatever I do. I just feel like I’m a nurse at my core. It’s rubbed off, too, my daughter is now studying to be a nurse, and she recently reconnected with an old friend from high school who is also a nurse. He wrote to her and said, “Nursing school is hard, but don’t be discouraged. Hang in there. It’s worth it in the end.” And my daughter said to me, “That’s the same advice you gave me, Mom.”

It’s important for nurses not to be discouraged about some of the barriers they’ll run into, because you run into them in every profession. Life never goes quite as smoothly as you think it’s going to go. “Don’t get too upset about the bumps in the road, but keep pursuing your dream. You are a voice for nursing in everything you say and do. Keep trying to make it better, if it’s not already what you want it to be.”

Power Strategy: Learning, Persistence, Solidarity
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Nurse's Story: Julie - Listen

2006-12-01T14:43:00.000-08:00

Julie -

I feel I’ve been called to promote a higher standard of nursing care. It gives me great satisfaction to be an instructor in a nursing program where I can make an impact on future nurses, and provides meaning to my own life. I am also fortunate to have a clinical practice where I can make a difference in the lives of patients. The opportunities that nursing has given me, and the interactions I’ve had with people throughout my career, make me feel truly blessed.

My commitment is to produce the best nurses, and make sure they not only have a strong skill set, caring behaviors as well. I think it’s imperative for nurses to have a conscience. I impress upon my students the value of learning good technique and their responsibility to maintain the high standards we teach.“I think it’s imperative for nurses to have a conscience.” When I see that light bulb turn on for them, I feel as though I have truly accomplished something. There are those individuals who are inspired by motivations other than healing and are less likely to uphold the standards of nursing. They tend not to care about developing good technique, either. So quality of care slips a notch and it’s because they think nobody’s watching, or they conclude no one else holds up the standard, so why should they?

One skill I especially emphasize teaching is communication, primarily listening and questioning. Nurses need to know how to listen well to their patients, to hear their stories, to be compassionate but also to detect evidence of discomfort, symptoms and other clues to the whole patient. But also because sometimes you can’t do anything else for a patient other than just listen.

In my clinical practice, I saw a gentleman who has experienced the gamut of back surgeries, and despite the large amount of narcotics he takes still has excruciating pain. I took time to just sit with him while he cried. Afterwards, he told me it was more important for him to have someone just listen than to have any other procedure done to him. It was clear he hadn’t felt heard by anyone up to that point; most likely the caregivers felt they had nothing more to offer him.

Communication is more than just listening and expressing compassion; it also requires asking the right questions. If you don’t, you may miss important clues about circumstances in patients’ lives that affect your ability to help them heal. As nurses, we need to be aware of those circumstances. I once discharged a patient with pain medications only to find out two days later that things weren’t going very well because this patient couldn’t afford the prescription. Had I persisted in my discharge planning a little deeper, I might have been able to get the prescription changed and the person wouldn’t have had to experience such prolonged discomfort.

Back pain is complex. I once saw a patient whose diagnosis was eventually ovarian cancer. That diagnosis came about as a result of asking the right questions about her symptoms and then thinking critically about the responses. I was able to rule out the back as a source of her pain and referred her on to a provider who then moved forward with the diagnosis. No time was lost in her case, but the consequences of not listening, of not questioning, are scary to contemplate. The worst thing that can happen is to miss an intervention, so the worst-case scenario is always in the back of my mind.

Nursing is just like any profession, filled with people who just want to do their jobs and who think on a day to day basis. They don’t want to think about the long-term effects of the way our country finances health care. They don’t want to get into management or the political debate of insurance versus care. They either have found an avenue of nursing that completely suits them or they are flying under the radar, just punching the clock, hoping no one will notice.

So we have to listen to each other, too; ask good questions to detect the symptoms of our own burnout individually and any slips in our professional standards. We not only have to advocate for the patients, but for nursing as a profession. There is a need for nurses who will speak out on public issues and open the door for change.

In looking at communication, we as nurses have to be aware of our own bias that we carry with us. I had a patient whose religious beliefs did not allow her to receive blood products. She was involved in a motor vehicle accident and broke both femurs. We took care of her nearly 50 days because her lab values were too low to safely proceed with surgery. Had she taken blood, she would have been out of the hospital in seven days. I had a really hard time reconciling my desires to heal her, to be efficient and to respect her beliefs. In the end, by being patient-focused and ignoring biases, a plan of care was developed. I tell my students that with all their knowledge and experience, one of the highest attributes of a good nurse is respect the patient’s beliefs.

Power Strategies: Connection, Curiosity, Order
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Nurse's Story: Maggie - A Certain Light

2006-12-01T14:37:00.000-08:00

Maggie -

Actually, I always wanted to be a doctor but didn’t want to go through the twelve years of schooling that was required for it. I went for what I saw as the next best thing, which was to get my BSN. Although there are times when I wish I would have challenged myself to continue my schooling, I have no regrets about becoming a nurse. There have been many moments when I have watched what physicians do and it makes me glad that I chose nursing.

After doing floor nursing for a while, I went straight to the OR. As a child, I always knew that I wanted to see what the inside of the body looked like, so I had no trepidation about going into the OR. For the past five years, I’ve been doing open-heart surgery.

The number one thing people considering going into nursing need to know is not to take things personally. And number two – it’s always about others first. It’s a profession in which you handle other people’s lives and emotions. You get a whole personal perspective about them. You need to stay humble and open, take criticism constructively, always do self-assessment, and just hang in there.

It’s really the people that inspire me in my career. I truly love the variety of people that I can meet in one place doing one thing. It’s hard sometimes to explain what keeps me going, to be honest, because there’s a lot of grief and misery that we witness. But there are also many moments, for instance, when an 80-year-old gets up and goes home and continues to mow the lawn. That is rewarding enough.

Besides my sense of humor, I think what really saves me is my spirituality. You really can’t see everything from the human perspective; as far as I’m concerned, you have to see that what really gives us our humanity is our spiritual perspective. It helps in cases where things cannot be solved; where we just absolutely get stuck. You have to see life continuing and beautiful beyond the physical means that cannot be helped. The medical field cannot do anymore, so something needs to continue to beyond that.

Once in the lunchroom I told a story to my fellow co-workers about the books I’d read on life beyond death.“You have to see life continuing and beautiful beyond the physical means that cannot be helped.” In many instances, elderly people with Alzheimer’s or who were really sick seemed to be schizophrenic or going between several worlds, but every moment would come back and say hi to their daughter or son. I read a story that claimed sometimes these folks are actually looking for us, the family members, to give them permission to pass on. I had a co-worker who was going through this with her mother. We all suggested that maybe the mother was looking for her daughter’s permission to go. The mother had been suffering from a very long illness, teetering on the brink of death but not passing on.

Well, we had this lunchroom conversation on a Friday. The following Monday the co-worker came in to work, gave me a big hug and said thank you. Her mother had died on Sunday. She had talked to her mother, given her permission, and she had finally passed on after all those years.

Nurses are really a container for the grief of patients and their families. In many instances, when you get off your shift and go home, you are grieving. You take that home with you. In my case, you work on someone 13 hours a day in open-heart surgery and you do everything that you can, but they just don’t make it. They pass right in front of you. How can you not take that home to process? You go home, you cry. Maybe sit in a hot tub or run a hot bath. You sleep, and you just deal with it. When you’re ready, you can discuss it with your co-workers if you want. But everyone has a different way of handling grief.

People tell me I bring a certain light wherever I go. That to me is a great strength in nursing, especially to a highly stressed OR team or unit. There’s a certain aura that people carry with them and we all have our own. Mine is this light, and having the ability to make people laugh, too, because I’m so straightforward. I just tell it like it is, which people seem to find refreshing.

Like in any career, you get to the point to where you know when you’ve accumulated so much knowledge in certain areas and you are ready for a bigger challenge. You’d think open-heart surgery would be the greatest challenge, but I’m about to make a move over to critical care because I have a desire to work with a bigger picture. Whole systems – respiratory, metabolic, circulatory – along with the medications given, is a challenge for which I feel I am ready. I want to be able to put one, two, three and four together, and get a greater perspective. It’s time to move on, and I’m fortunate to be in a career that makes it possible for me to do that.

Power Strategies:
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Linda - Not a "Bleeding Heart Nurse"

2006-11-26T18:35:00.000-08:00

Linda -

I’ve never done the same job twice, ever. It wasn’t by design, I just didn’t have a plan. When I was getting my nursing degree, my fellow students and I used to say that we would never go back to school again once we graduated. We all thought that by the time we reached our fifties, we’d be working as the nursing director in some nice, quiet little two-hundred bed hospital, and people would think we were wise and benevolent and that’s how we’d end our careers. But I realized in my early years of working that I could end up fifty years old and one of those poor, broken down night-shift house supervisors too. And I observed that all of what I called the “interesting jobs” went to people with more education. So it came to me in a blinding flash of the obvious that I would have to go to graduate school after all! It was a very pragmatic thing for me to do, because at the time the government was encouraging nurses to get advanced degrees by paying for their education and even giving them a stipend. And sure enough, once I had my degree, doors started opening up for me.

Throughout my career, I’ve consistently had a hand in the directional decisions of the organizations for which I’ve worked, at least where it affects patients and nurses. For example, twice in my career I have successfully argued against management attempting to save money by not paying nurses who worked in the ambulatory clinics as much as the ones who worked in the hospital. In both cases, I felt I made a fairly assertive, eloquent argument and I won against more powerful figures by pointing out that reducing the individual to the hours they worked totally ignored the basic qualifications that they were asking people to bring to the work – a certain level of education, critical thinking skills, independent decision making – and if they didn’t bring that, then you didn’t need a nurse to do that work.

One thing that I have never been, though, is a so-called “bleeding heart nurse.” The bleeding heart nurse believes everything revolves around nursing and that nurses are always the smartest and best. Of course the work we do is important, but not necessarily more so than that of a pharmacist, or physical therapist or physician. It’s different work and it takes different education.“You can’t help but learn, which is good for the mind as well as the soul.” But it’s harder to articulate its value, because for example with a pharmacist, there’s a tangible thing that he or she gives you – your medication. The care you receive from a nurse is not as tangible or quantifiable. Part of the problem is the inability to adequately describe that care, and why it is unique to nursing. And yet, it’s only a portion of what nurses do. People don’t understand all the critical decision-making that goes on every minute a nurse is working with a patient or thinking about a patient, all the things they’re sorting in their minds that they don’t write down and tell everyone about.

Many women my age went into nursing because our career options were limited to one of three areas – secretarial, teaching, or nursing. Of course, the women’s lib movement changed all of that, but it took a while for young women to break through that kind of thinking and realize they had more choices. But I have never regretted going into nursing. It’s been a great career, and I would still encourage people to go into it because if you’re halfway interested in the profession, it’s extremely meaningful. You make such a difference in people’s lives. You’re invited into the most intimate times of their lives – births, deaths, serious illness, bad news, disabilities, and they let you help them. From a pragmatic standpoint it’s actually a fairly decent wage. You can work anywhere in the world. If you had a hundred people in a room, you might find at least fifty of them were nurses. They might not be working as nurses but it’s somewhere in their background. So everywhere you go, you touch people who are nurses even if you don’t know it.

What I like most about nursing is that you’re always learning. You can’t help but learn, which is good for the mind as well as the soul. When I was in school, I didn’t especially like the OB-GYN part, but I did love births. I can still remember the first birth I ever saw. It was at an inner-city hospital where almost all the patients were young, unmarried African-American women. A young woman gave birth to twins, and for me it was so wonderful and emotional to witness these two beautiful black babies being born. I’ll never forget that. It was so exciting and I just wished that everybody could have experienced it. I’ve seen lots of other births since then and it’s always exciting, but I will never forget that first set of twins I helped welcome into the world.

Of course, the healthcare world aside from nursing is also a work world. One of the things I’ve noticed about other fields compared to healthcare is that healthcare is populated by all kinds of extremely well-educated and diverse people. You work with engineers, accountants, architects and psychologists. It’s a very rich world in that way. That became clear to me when I met a new human resource professional who was brought into a hospital where I worked. He came out of manufacturing, and one day he said to me, “Wow. Healthcare is so different. You know, in manufacturing if you have ten people in the whole organization with Bachelors degrees, you’re blessed. Everybody else is a good worker and they’re on the line doing whatever the work is.” He was just impressed with how educated the healthcare workforce is. And it was affirming because that’s one thing I have always liked about my career – meeting interesting people who know lots of things I don’t know, and learning from them. The intellectual stimulation – nothing else matches that for me.

Power Strategies: Mastery, Influence, Adventure
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Al - A Better Team Member

2006-11-26T18:32:00.000-08:00

Al -

I was born and raised in the Philippines, and while in high school I began to think about going abroad to work in the medical field. I didn’t want to be a physician because it required too many years of schooling with no guarantee that it would lead to a job in another country. Nursing, on the other hand, sounded like a better fit for me. I learned as a child the value of caring for people. As the youngest of the siblings in my family I was always the recipient of very tender loving care. In the Philippines, family is very solid and mine is a very close extended family, so I grew up able to appreciate others caring for me. I guess I wanted to return that same kind of caring. At the same time, I wanted be able to work abroad for a better future educationally and financially.

It looked like the profession belonged to the female gender. My class at the university had initially eighteen male nursing students, but only four of us were able to graduate. I was elected the president of the nursing class for two years in a row, and when I graduated from that university, I became the alumni president. It was very fulfilling to have that kind of recognition from my fellow classmates, especially since so many of them were women.

My experience going through a program dominated by females made me more confident that I’d be able to interact with nurses of either gender more professionally. It gave me a broad understanding of how people react to one another. If I had entered a male-dominated profession I may have built a relationship with my colleagues through “male bonding.” Instead, I understand the personality differences between the genders better, and how those differences affect behavior. It makes me a better team member, I believe.

As the years progressed, I have become very comfortable and satisfied with my career choice.“I grew up able to appreciate others caring for me. I guess I wanted to return that same kind of caring to others.” My impressions of nursing changed dramatically when I came to the United States. In the Philippines, nurses follow the doctors’ orders and do not ever question them. Here nurses are more empowered to share their opinions and observations and patient care is better here because there are more professionals lending their expertise.

Those entering the field should get as much experience as they can in different areas. They shouldn’t settle too quickly on one specialty so you can get a good feel for what you would like the best by trying them all. Additionally, exposure to only one area can lead to burnout. I have personally experienced burnout after a certain number of years.

Burnout can jeopardize the quality of care that you give to patients. When it happened to me I had to take action to be fair to myself, my co-workers and to the recipients of my care. What I did at that time was to cut back gradually on my work hours. I’m now a per diem nurse, but not too many people can afford to reduce their hours like that. I was able to do it because of the income from a business that I started years ago, which is an elder care facility.

My wife and I opened the facility when we were ready to begin a family, so that she could quit her nursing job. For me, caring for the elderly comes naturally, because it is what we do back home. Families stay together, and the young care for the old. It was natural for me to take that kind of caring and turn it into a successful family business. I feel fortunate to have both that and my regular job, which is with the open heart surgery team at the hospital.

The tradition in my family of caring for each other is partially cultural, and I’m grateful that it helped lead me to this profession. There’s an automatic desire within me to do this, because I was immersed in an atmosphere of caring which began from inside our family circle. But I don’t see it as a gift or a calling; it is just part of my life – it’s who I am – someone who cares about other people.

Power Strategies: Ethics, Achievement, Adventure
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Pam - Love and Pride

2006-11-26T18:29:00.000-08:00

Pam -

As a nursing student, I discovered I had the ability to really look into people’s eyes and connect with them. It’s a gift, but I didn’t necessarily understand its implications at the time. Then, about fifteen years ago when I was working in a geriatric unit, I discovered that I could see the youth in an older person’s eyes. Even though they were decades older than I was, I could relate to them on some level. I could see the life inside their old, frail bodies. And I could see what they still wanted – the yearning, the passion for life – even though they were on their deathbeds. I saw them for who they really were, and it moved me.

Since seventeen, when I entered nursing school in Australia, I have loved the connections I made with people. My impressions of nursing have changed over time. Today, there’s just so much technology. Sometimes it feels like a barrier to what we do best. When I first started, everything was handwritten – the charts, the notes. Today we check off boxes, so it’s not as personal. Even though in some respects technology has given us more time, it has also taken more time away from what is, for me, the heart of nursing: the time you spend with a patient, one-on-one, helping them to heal.

In terms of day-to-day work, nursing is always hard. There’s so much to do. Apart from the workload, it’s also difficult when a patient dies. However spiritual or religious anyone may be, it’s just a moving, emotional experience. From racing someone with an ectopic pregnancy from the ER to surgery and hoping that you don’t lose her, to someone who’s had cancer for a long time and is withering away and everybody knows the end is near – it’s one of the toughest parts of the job.

I clearly remember a gentleman who was told by the surgeon that he had forty-three days to live. So he got one of those tiny little notebooks and kept track of every single day. His wife stopped coming to visit because they had come to the agreement that she didn’t need to be there for those forty-three days. The hospital staff became his family, and would you believe that man actually died on the forty-third day? Just to walk with him on that path was an incredible experience. How he could direct his life like that made such an impact on me.
“It’s funny because my hands are so old and dry looking, but as a nurse I cherish the wisdom of those hands.” He had pancreatic cancer, so he was in quite a bit of pain and I remember just trying to help him get through those days – not to convince him that he could go on longer, just being with him. There came a point where he saw things in the corners of the room – almost like angels were there – and he would speak to them. He would say, “No. No. Forty-three. No. Sixteen? Hmm. No. Forty-three.” This man had been an accountant, so I felt it was like the numbers coming back to him, and the angels were perhaps trying to negotiate a bit. But he was so set in his ways and would just sit there so seriously, yet talking to something in the corner of the room that nobody else could see. I felt honored to be a part of that, to be present and to witness it, but I didn’t ever think about changing his mind.

Although my eyes have played a big role in my nursing style, my hands have also always been healing for people. In fact, for many years I have been using therapeutic touch as part of my work. If I touch someone they’ll often say to me, “Your hands are warm, they’re soft; I feel the caring coming through in them.” It’s funny because my hands are so old and dry looking, but as a nurse I cherish the wisdom of those hands. And touch is really powerful medicine.

These days, my career path has a new direction because I have chosen to go back to school to become a nurse practitioner. Some people think they’re the new breed of nurse, but that’s not really the case. Nurse practitioners have been around for at least a quarter of a century. What’s changing is that they are starting to have their own practices. Some say nurse practitioners are actually competition for family practice physicians these days. But are we really competition, or are we the mid-level providers? I think that’s all sorting itself out right now.

Now more than ever I’m excited about being a nurse, although, there has never been a time when I have felt like leaving the profession. My love for nursing is too strong. And I am proud to be nurse. If I can educate someone or help them move along in a more positive direction on their path, I take a lot of pride in that.

Power Strategies:
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Barbara - The Original Healers

2006-11-26T18:24:00.000-08:00

Barbara -

I always wanted to be a nurse; I never wanted to be anything else. I filled my high school curriculum with science so I could go to nursing school. But my mother insisted I go to university, so after completing a three-year nursing program, I went through a baccalaureate program specifically for nurses. I wound up getting a degree in history. Two years later, I got my master’s degree, and eventually sought a doctorate in healthcare administration and women’s studies.

I chose women’s studies because historically there has been a lot of male/female tension between doctors and nurses. Until very recently, physicians have been predominantly male while nurses historically have been and continue to be about 97% female. Although the gender demographics in medicine is changing, there’s been this on-going tension around collaboration that some people would like to continue to attribute to doctors being mostly male and nurses mostly female. I was of the belief that it couldn’t be just a male/female thing; that there had to be more to the tension than gender.

I did a lot of work on the history and evolution of nursing in the United States throughout its 100-plus year history. I wanted to be able to rethink the relationship between physicians and nurses and account for the communication challenges, status differences, and the perception that being a doctor is more important than being a nurse, or that nurses are subservient to doctors. I wanted to explain it in a way that was different than simply saying, doctors are boys, nurses are girls.

My research showed that women were the original healers during ancient times, but that during the course of our history men usurped their roles. I learned traditionally men had access to formal education that women didn’t have. Things have changed over time. For example, hospitals in the US were traditionally run by women – mostly nuns – until the 1940’s. Around the late 1940’s and early 50’s, following World War II, men returned to the workforce and took over hospital administration roles. It was a job opportunity for them, and it was lucrative to run hospitals.

Prior to that, women were very much at the forefront in hospital administration and the application of science to care - Florence Nightingale’s work is a strong and popular example. Women had played a leadership role for which they obviously didn’t get much credit. Today, many people think hospitals have always been run by men, but because of my doctoral research I know that is not the case.

Getting a PhD in this area has helped me to see the leadership world through a different set of lenses. It gives me the ability to interact and communicate more effectively with my colleagues, most of whom are men.“The work that nurses do is not more or less valuable than what the physician does – it’s just a different contribution.” I’m a chief nurse now, and although the nurses I supervise are mostly women, the heads of the organizations I deal with are mostly male. We probably have the same goals and objectives, but we have different ways of getting there and we figure out a mutually agreeable way to arrive. It is safe to say physicians categorically and clearly want to do the right thing by the patient. They want to give the best care and to be good at what they do. Most physicians recognize that nurses have the exact same goals. They just haven’t always appreciated us as a partner in healthcare. The work that nurses do is not more or less valuable than what the physician does – it’s just a different contribution.

Nurses’ work has been described as being “invisible.” People don’t see it, not in the way they do a physician’s work. If you can’t see it, you can’t count it. It’s hard to quantify. And if you can’t quantify it, you can’t attach a cost to it. And if you can’t attach a cost to it, you don’t necessarily want to pay for it. So in the end, you don’t understand its value.

It has only been in the last 20 years or so that nurses have come to understand this and have begun the effort to quantify their work in order to demonstrate its value. If you ask people what they think about the work of nurses, those who can best respond are the ones who’ve had experience with nursing care. Either they or a loved one has been very sick, and they’ve seen what nurses can do to take care of that person. But if you haven’t experienced nursing care personally, it’s hard for most people to understand.

I’m really passionate about the value that nurses bring to the care of patients. I think that physicians are very good at diagnosing and treating, but it’s really nurses who shepherd the patient through the journey, particularly those patients who have an acute situation or a chronic illness. For most people, significant health issues are not something they have to confront. But for those who do, it’s a hard journey and it requires WORD WAS UNINTELLIGLBE support. And that, I think, is what nurses do.

Power Strategies: Knowledge, Leadership, Unity
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Marta - A Basic Human Right

2006-11-26T18:10:00.000-08:00

Marta -

My first degree was not in nursing at all; it was a liberal arts degree. We studied many subjects at Hampshire College, humanities and arts, social science, communications and cognitive science, and natural science. By the time I’d graduated I had focused in on photography and sociology, a humanities and arts and social science mix, and I used that education to go into photojournalism. Originally, I became a photojournalist because I wanted to do something that I felt was socially responsible. My assignments took me to Africa a couple of times, and while there I witnessed humanitarian work and non-governmental organizations in action. I especially gained a lot of appreciation for the health care areas of this kind of work.

As I got more into my job as a photojournalist, I began to feel like I wasn’t making as direct an impact as I really wanted to. And when I came face-to-face with health care workers in developing countries, working in crisis situations, it made me realize that what they were doing was very direct, patient-centered, and human-rights oriented. The idea of it appealed to me, and I began to consider nursing as a career option. It was a journey I was destined to take.

Back home, I found out from a friend about master’s entry programs into nursing, and felt like that type of nursing program would be perfect for me. I applied to three, and was accepted by the college of my choice. Currently, I’m in the middle of my master’s program. It can be very challenging at times, especially since unlike many nurses who get their master’s degree, I don’t have experience out in the field yet. I’m just at the beginning of my career, and everything is very new.

I have discovered nursing is very scientific and very much about critical thinking. For me, it’s about accumulating a lot of tools for a toolbox and then using the tools appropriately. The most difficult part of my learning curve is not only accumulating this toolbox, but also realizing I have to know which tool to use when.

When I finish nursing school, I anticipate staying in the area for a few years to get some experience. But I know my long-standing interest in human rights will take me right into international health and work abroad. For me to use my skills, especially in Africa, would be ideal. I have a lot of personal ties to Africa from my previous visits, and it feels like the right thing to do. Becoming a nurse and developing that part of my career has been richly rewarding because it feels like a calling.

The feeling comes from deep within me. It’s the most natural thing, and it is really satisfying to finally be on this path. I’m so excited to get out there and start working with people in a nursing role.“When I think about nursing in Africa, I think of helping to provide a basic human right.” Initially, and still, when I first became attracted to nursing, I was thinking of it in an international service context. It was powerful for me to recognize that I may be able to help somebody achieve better health, and that would, in turn, enable them to affect development by being an involved mother or an active community member. When I think about nursing in Africa, I think of helping to provide a basic human right.

I am just astounded by how difficult this career is. I mean, not that I thought it would be easy, but coming into it – it’s incredible. The more I get into it, the more respect I have for nurses. Sometimes it’s admittedly a bit intimidating to talk to a nurse who has come from a more traditional route in their education. Unlike me, they have gone through a longer, more step-wise approach to learning their job. It’s easy to think someone like that, who has that type of education and years of experience, would not appreciate the way that I’ve become a nurse. But the truth is, we can all learn from each other. Discovering the personal story behind each nurse’s background, and what she went through in her educational journey, is valuable information. Just knowing their stories makes me feel more comfortable. In turn, more experienced nurses need to understand that the field is growing and changing, and people are coming into it through different channels. Today, there are lots of ways to enter the nursing field.

I’m excited to have a life-long career in nursing. It is a wonderful profession. You gain a lot of really powerful knowledge. Knowing about health is applicable anywhere and to anybody. You can travel internationally, or take advantage of opportunities in your own backyard. For me, the minute I entered my nursing program I had this feeling of, “Oh, this is what I should be doing.”

Power Strategies: Service, Vision, Commitment
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Carolyn - Making a Difference in a Different Way

2006-11-26T18:05:00.000-08:00

Carolyn -

I came to nursing as a second career. For years I worked in the field of business accounting. It was something I fell into, but it left me professionally unfulfilled. I felt called to nursing, and specifically to emergency room care. I wanted to impact the lives of those who need care in a hurry, and that’s why the ER caught my attention.

I was drawn initially to the diverse nature of the patient population in emergency work. A nurse doesn’t care what the patient's background is or how much money they make. We don’t care what they did to land in the ER. We’re just there to take care of that person and we’re going to give them the best care we can.

Knowing that I make a difference – that’s what keeps me in my field. Nurses know we have an impact on people's lives; there’s no doubt about it. That's why nursing fulfills me in a way that accounting never could.

In a health care facility, the nurses work closely with physicians and other interdisciplinary folks--that's essential, but the nurse is the one who actually manages the hands-on, every day care. Maybe we should be called Care Managers because we manage all aspects of what happens in the patient’s room, including the patient.

I’m a toucher. I reach out and comfort patients by touching their hands or their forehead. It's how I extend my respect and humanity. When patients are lying on the gurney, they’re at their most vulnerable state, and they're frightened. Sometimes they can’t talk, but they can see you and feel you. Sometimes all they need is eye-to-eye contact and a touch that shows someone is there for them.

Although I loved the work, I got burned out on emergency care. After a few years of full-time work, I felt myself “hitting the wall.” I had high expectations for myself and felt the need to pick up any unfinished work, which, when coupled with an understaffed ER, led to my exhaustion. My cup was empty.

Yet, if there’s no one else to do the work, there’s no other option except to do it yourself. You don’t abandon your patient.“I’m a toucher. I know how to comfort a patient by touching their hands or their forehead. It's how I extend my respect and my humanity.” We have technicians, but patients need a nurse with critical thinking skills, experience, and expertise to care for them when they're ill. Right now our patient population is getting sicker and sicker. It's frightening. Because they have no insurance, patients either use the emergency room for primary care which bogs down the system or others wait until they’re terribly sick and then they need emergency department.

The irony of the health care system is that nurses drain themselves in order to give the best possible care to their patients. A nurse's needs as a human being always come second. We don’t do a good job of taking care of ourselves as care providers.

When it got to a point where I was just too tired to keep giving, I stepped away from bedside nursing. But I found a way that I could still provide care and at the same time keep my own cup filled: working in education and prevention where I can make an exponential difference in the number of cases seen at the emergency room…alcohol abuse education.

Working in the trauma bay, I'd seen people with serious injuries, people with disabilities, families torn by injuries, most of them due to alcohol-related car crashes. At my present job, I work to reduce alcohol use among adolescents. I’m nursing and tending to people’s needs outside of the hospital but in the community, helping lay the groundwork for healthy lives. I no longer feel drained and discouraged. I'm keeping myself healthy and doing work I know helps save lives.

Power strategies: Responsibility, Making a Difference, Community
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Debi - Lessons from Frank

2006-11-26T18:02:00.000-08:00

Debi -

It was my mother who really inspired me to be a nurse, and not just because of her white dress and cap. She would discuss her day with us when we’d be sitting around the dinner table, telling us all the different things she had experienced. As she described her patients and the different situations she faced, she used those stories as lessons for my siblings and me: this particular person got shot because he was in the wrong place at the wrong time. They were cautionary tales. But I was always more interested in where the bullet went, how deep it went, and how it was removed.

So when I first got into nursing, my mom was the image I had in my mind. But things were different back in her day. At that time, nurses followed whatever the doctors said, no questions asked. They just went along with it. Today we have changed so much. Nurses are now thinking machines. We’re not just listening employees anymore. We go to school. We analyze things. We work together as teams. And we work together with doctors as partners. Nursing also used to be a profession that only females chose. But today, males and females are getting into it, and both of them are using the opportunity to its fullest.

I was very fortunate to have a fantastic mentor when I started nursing. She was always there to answer questions for me and help me through things. And she chose to tell me, “Never leave here without learning something each day.” At first, I didn’t truly understand what she meant by that. I just thought she meant as long as I was a newbie, I should be learning something every day. But she actually meant that for the rest of my career. And she was right. There is so much out there to learn and every time you think that is all, there’s something else coming around the corner.

Today’s graduates – I’m not sure if they’re seeing the real world versus seeing it on paper. On paper it looks like it follows a pattern, but nursing really doesn’t. You have to be flexible. You may start off in one direction but head off in another, all before you can take a coffee break. I see the challenge these new nurses face trying to grasp all of the information being thrown at them. That’s why mentors are so important.

I think new nurses create other problems for themselves by wanting to specialize too soon. They want to do pediatrics, for example, and they think that’s what nursing is. But that’s just one small piece of it.“it’s OK to push the limit, to make a decision for myself … do whatever it takes to promote healing” When I hear them complaining that they have to float, I always tell them to look at it as a learning experience. Who knows, maybe after they get up there on that new floor, they may actually like it. But I tell them now is not a time to settle. Now is a time to explore and find out what’s out there. I am in orthopedics now, but it’s not a specialty I would have chosen. I was never attracted to orthopedics, actually, I learned I actually liked it while I was being a float. I can do all the other areas of nursing, but orthopedics is where my heart is.

One of the biggest lessons I learned early on in my career was that it’s OK to push the limit, to make a decision for myself. This lesson didn’t come from my mom or my mentor, but from a man named Frank. I was a new RN and new to the floor and he was a patient that I could hear crying at night. One night he was crying out pretty loudly. He wasn’t my patient, so I went to his nurse and asked what was the matter. His nurse said, “He’s dying in his room, so we pulled the curtain around him.” So I asked, “Can’t we go in and do something?” And she said, “No, there’s nothing else to do for him. The family elected to let him go.”

I went into his room anyway because his crying really got to me. He held onto my hand and looked at me and said, “I just don’t want to go alone.” In that moment, my work got pushed behind and I spent his final hours with him holding his hand until he finally closed his eyes and settled down. I didn’t care if I had to stay three hours, or through the next day, as long as Frank was comfortable. That is why I went into nursing in the first place, to care for people. So I think that was the best thing I’ve ever done in nursing – to hold Frank’s hand when he needed me to do so. He died the following morning and I stayed with him the whole time. I felt like I had done my job that night. I couldn’t prevent him from dying, but I could help him emotionally by holding his hand.

The other nurse didn’t resent me for what I did. In fact, she was grateful. She was a senior nurse and didn’t have the time to do what I did. But I have to say that if the same situation occurred to me today, I would still make time for the patient.

I’ll always remember Frank. He’s my guide that makes me stop sometimes and think, “Hey, wait a minute. Remember the patient.” We have to help the patient all the way around. We can’t just take care of the pain, or the wound, or the illness. We have to help every single part, including the emotions. To me that plays a big role, because if a patient cannot handle what’s going on emotionally, he’s not going to heal. I need to do whatever it takes to promote healing. If that means staying late to hold someone’s hand like Frank’s so he could die well, well then that’s exactly what I will do.

Power Strategies:
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Norma - These are the Things I've Learned

2006-11-20T18:32:00.000-08:00

Norma -

I have a nursing degree and an education degree. Most of my career has been in education and administration. I regret I haven’t had more direct bedside experience. As a director and an educator, I’m considered a “white coat.” According to nurses, white coats don’t do real jobs, they do education. There’s a certain lack of respect because I haven’t been in the trenches.

I’m slowly moving my career into coaching, particularly with nurses. Coaching can be a real blessing to the health care field. Health care organizations are hiring coaches and organizational development specialists to teach their people to work together. Health care workers provide so much care and support for their patients, but health care hasn’t historically been a work environment that fosters care and support of its workers. Because the system is broken, it is wonderful organizations are finally seeing the contributions coaches can make toward fixing the problem.

Most of the nurses I work with don’t feel respected. The disrespect comes mostly from other nurses and I grieve about that. Its sad nurses would have such low regard for each other.“I’d like to see nurses develop the capacity to feel secure in each other’s capacity – to enjoy and acknowledge each other’s successes.” They should be there to lift each other up. Nurses alienate each other. I see the numbers that say a million nurses are needed and I see how we’re robbing developing countries to fill the nursing needs here, yet we don’t do things to make sure nursing has a good reputation. I’m often asked if I would recommend nursing as a career choice. I do on some levels, but I’m also very guarded about my recommendation because I know the strength new nurses will need in order to survive.

There’s a gap in the health care system. Nurses have abilities and knowledge and courage to provide quality care for patients. But health care organizations don’t tap into all the skills nurses possess, so the power rests elsewhere. Nurses aren’t recognized for what they can bring to the table, and it becomes apparent as early as nursing school. Not everybody who enters nursing school has the feeling of being powerless from the beginning. It happens somewhere in the nursing education process.

I would like to see the nursing profession become whole. By whole I mean healthy and secure in itself, where every nurse recognizes their gifts, strengths and wisdom. They bring strength to their organization and a strong, caring and wise voice. It will take education to bring power to nurses and the education needs to be in school or after school, over the long term, either one nurse at a time, or with a group moving forward together. The change that needs to happen is at the pith, the core the foundation of the way a nurse views herself and his or her own power and contribution.

It’s also something that can come from the top down. I know a phenomenal nurse manager who took the time to learn as much as possible about organizational development, and then shared her knowledge with her staff. She had a very high-functioning team. She was successful because she encouraged everyone who worked with her to be successful. She wanted her staff to be knowledgeable, because the more they knew the better care they gave to the patients and to each other. So many nurses think, “If I acknowledge you are doing well, I’m taking something away from myself. I can’t enjoy your success because your success may make me less than you.” I’d like to see nurses develop the capacity to feel secure in each other’s capacity – to enjoy and acknowledge each other’s successes. Once that starts happening, nursing can become whole and nurses can bring heart back into their environment and their profession.

Power Strategies: Respect, Power, Calm
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Gretchen - Profound Healing: Answering the Call

2006-11-20T18:28:00.000-08:00

Gretchen -

What does it mean to be a nurse? I no longer work as a nurse in the traditional sense, but feel I do more nursing now than I’ve done in some previous conventional settings. I operate at the root of nursing, which is nurturing–I’m helping people with profound life changes. To me, that is the essence of nursing.

After working for a number of years as a nurse, while I was in the midst of graduate school, I was invited to apply to the first nurse practitioner program in the State of Washington. It was a brand new field then, and the focus was on nurses getting training to provide primary care.“I’m helping people with profound life changes. To me that is the essence of nursing.” Darrington, a small rural community in the North Cascades, was the site of the first pilot FNP program in Washington. Another nurse and I were selected as the first two trainees. The training was seven weeks and very intense followed by years of on-going Cont. Ed and lots of “on the job training!” After helping the Darrington FNP clinic get started I returned to the UW to complete my masters in the nurse practitioner program and then was on faculty for seven years, working mostly with students in rural areas.

In the early 70’s prior to entering the nurse practitioner program, I had an epiphany that came to me in a dream while on a trip to Europe. I had a wonderful meditation that gave me the sense that I needed to one day create an educational, recreational and therapeutic community. At the time I didn’t know what that meant. I envisioned some sort of wellness center, but I wasn’t sure. I started getting my masters in social work because I thought I could combine that with being a public health nurse to have more skills for whatever this calling was. Even though I had received this calling, I was not ready to do anything about it at the time it came to me.

After teaching at the UW for seven years, I got exhausted and depressed. There was a lot of pressure to do high-level research and publish as well as teach. I loved the teaching, but the rest was more difficult. I felt out of balance because I was putting my work above everything else in my life, not taking care of myself and getting depleted at many levels—and I was in an environment where working intensely long hours was the norm.

I began feeling I didn’t belong in that setting. I went on a research expedition to Nepal with hopes of pleasing the tenure committee. I realized while on that trek I wasn’t willing to put myself in a position of potential harm to meet the requirements of the university. It was a wake-up call. I resigned when I returned from Nepal.

The next couple of years were spent healing myself and focusing on the question, “What is my life all about?” It was a dark time—I was in an uncertain place. Sure, there were lots of things I could do with my nurse and nurse practitioner skills, but I wanted to know what my calling was. What is my passion? Who am I and what is uniquely mine to do in the world?

I went on a retreat and became aware that I was being called to revisit the dream I had while in Europe. I surrendered to divine sources, trusting there is a guidance we all get if only we’re willing to listen. Sometimes you have to be broken before you can be renewed and ready for a new path. Hopefully it doesn’t go that far for most people, but it did for me. I finally found a way to listen for guidance in my meditation, and then take action to follow my calling, noting the signs that showed me the way.

The culmination of my quest was Harmony Hill. In the beginning, Harmony Hill was the vision from my earlier dream, an educational, recreational, and therapeutic community. It became a retreat for people seeking wellness in their lives.

A major turning point occurred in the early 1990s when I discovered the internationally acclaimed Commonweal Institute Cancer Help Program when viewing Bill Moyer’s PBS documentary, Healing and the Mind. As soon as I saw the program I was intrigued with the prospect of helping people with cancer learn coping tools to get through their journey. I participated in Commonweal’s first training for other centers, and soon after that Harmony Hill offered our first five-day residential cancer program. We’ve now provided more than 80 cancer retreat programs serving over 800 people since 1994. Each retreat is quite magnificent.

The cancer program lets me use my nursing perspective and all the self-care knowledge I built while trying to heal myself. Stress management is the bottom line, as is diet and exercise. However, a person doesn’t have to have cancer to come to Harmony Hill. We also offer space for group retreats, and provide wellness classes for those interested. For example, some of our weekend retreats are labyrinth workshops, which provide spiritual renewal. We also offer a lot of yoga classes. Business groups have an opportunity to listen to their own calling and connect deeply with their mission in ways that aren’t possible in the thick of things.

Because of my background, I encourage Harmony Hill to provide renewal resources for health professionals. A group of volunteers who are nurses, physicians, and other health providers serve as “house moms” for the cancer programs. That group has become support for each other, and is now developing burnout prevention programs for people in the helping fields.

Harmony Hill isn’t conventional in its approach, and for a long time it was considered “out there.” Even though we didn’t change, times have, and we’re now considered “leading edge” with our body-mind-spirit integration focus, as alternative and holistic health approaches demonstrate their value and are embraced more and more by the mainstream.

I’m fortunate for the opportunity to follow my calling. Because of past experience, I’m committed to living life fully and joyfully, and continuing to listen for my next direction. I’m passionate about reaching out to others and helping them in whatever way I can. I want to provide people with tools to take good care of themselves, their families, and the people they work with. I want to help them move toward wholeness.

Power Strategies: Nurture, Leadership, Wellness, Healing
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Angela - Putting Patients First

2006-11-20T18:25:00.000-08:00

Angela -

I’m really excited about my new role – I’m a charge nurse, and I really like that a lot. Problem solving and helping other people figure out how they can do their job better are things I enjoy. There are a lot of younger nurses on this floor, who maybe only have a couple of years’ experience, and it’s really hard for them sometimes to start off on med/surg, because the patients can be very demanding. Things don’t always go smoothly.

We recently had a patient - a lady in her 90’s. Mentally she was still quite sharp, but she was legally blind. I was the charge nurse on the day this lady was supposed to be discharged. Transportation arrangements had been made for her, but she got tired of waiting and decided she was just going to walk home. Here she is, legally blind and attempting to walk home.“We can’t always fix the physical things. But we can help lift people’s spirits.” We had to call security to return her to the hospital and keep her there until she could be discharged into someone’s care. Meanwhile, I discovered the nurse who was handling the discharge hadn’t filled out any of the paperwork. Additionally, when I told her what was going on with the patient, she said she needed to take a break. I was incredulous! It seemed like this nurse was putting her needs over those of her patient. Ultimately, I ended up going downstairs myself and going over the discharge instructions with the lady, and then helped get her into a cab.

I’ve been a charge nurse for just a short while, and in retrospect, I should have denied the nurse right there in that moment and told her it was not the time to take a break, and that she had to take care of her patient. But at the time I was just more frustrated than anything and I was focused on ensuring the lady’s safety and getting her discharged. But the episode kind of got to me. For me, the patient always comes first.

I’m passionate about the chance I have to make people feel better. We can’t always fix the physical things. But we can help lift people’s spirits. Nobody likes to be in the hospital, so you might as well try to make people happy while they are there. Or at least just make it tolerable for them.

When I first started in this career, I thought it was going to be mostly about stitches and medicine. I’ve found it’s more intellectual than I anticipated. Yes, there is still quite a lot of physical work, of course, like medications and dressing changes. But, at least on this floor, it’s more about supporting your patients and trying to make their lives better for them.

Still, there are days when I count down the hours to the end of my shift. Everybody has those. But in general, I feel like I’m making a difference, not just for my patients but for the staff too. I try to bring listening skills and a compassionate method sort things out to meet most of everybody’s needs. I know you can’t please everybody all the time, but I try to do my best to meet people halfway. Sometimes I get positive feedback like, “I love having you as charge nurse.” That’s my reward.

Power Strategies: Achievement, Responsibility, Compassion
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Amy - Genuine Care

2006-11-20T18:21:00.000-08:00

Amy -

Perhaps my grandmother is the reason I went into the home health care field. She had nurses come to care for her in her home, and I remember as a young girl being in awe of them. I think I was admiring the compassion that they had for her, as well as the knowledge they seemed to have. They knew exactly how to treat the different ailments from which she suffered. But I also admired that these nurses recognized the importance of family. They always encouraged us kids to play around Grandma, and they never scolded us for anything. My grandmother passed away when I was thirteen, but I never forgot those nurses who had cared for her up to the end of her life.

Now I am one of those nurses. I feel like I am trying to convey to my patients and their families the same thing that I saw take place when my grandmother was ill. I want them to feel very comfortable around me, and able to ask me anything. I want them to feel comfortable with the care that I'm giving, and to realize that I know what I'm doing.

With home care, it's easy to develop a really close relationship with patients because it’s just them and their families. In a hospital or nursing home setting, it's harder for that kind of trust to form, because you're not with those patients all the time.“I don’t believe it takes a special kind of person to do home health care. I think anybody can do it if they really have the heart for it.” In my job, I am fortunate to have the time to build relationships, and often my patients let me know what a difference I have made in their lives. For instance, I had a client for about a year who was a paraplegic. He had wounds that I treated, and when they were finally healed, it was really sad for both of us because it meant I wouldn’t be coming out there anymore. To this day, we still keep in touch. He will send me birthday and holiday cards, and sometimes he calls me. He expressed his appreciation and let me know that I had done a good job. It’s not unusual for me to develop those kinds of close bonds with my clients.

I don’t believe it takes a special kind of person to do home health care. I think anybody can do it if they really have the heart for it. You have to care what the client feels like. You have to ask them, “How's your day going?” And you have to care about their answer. You have to be patient. You must be able to adapt well to their personality or to their surroundings. I have met other home health care workers who say they don’t want to go back into so-and-so's home because it's a mess, or they don't want to deal with so-and-so because they got yelled at last week. I’m not like that at all. Sure, I might have a couple of difficult patients, but after I've known them for a couple of months, we develop a relationship. They might have a bad day and yell at me, but I forgive them for it, and we act like nothing ever happened ...the same thing you do with your spouse and kids.

My style of nursing has always been one of genuine caring. Not just for the patient, but for his or her entire family. My first year out of nursing school I worked in a nursing home, and on the very first shift I worked by myself I had a patient who passed away. It was very shocking for me. I left the room to call the family and found when I returned that the aides had wrapped a towel very tightly around this lady’s neck. They said it was to prevent the neck from breaking when the funeral home people picked up the body. I was horrified, though, because the towel looked like a noose, and I knew the family was coming to see their loved one for the last time. I didn’t want them to see her like that, so I told the aides to remove the towel. For them it was no big deal, because they did this all the time. But for me it was unacceptable for this family to have to see that, and in the end I prevailed. The experience instilled in me a strong desire to care not only for the patients, but to extend my caring all the way to their families as well.

I am happy where I'm at right now in my career, and have no desire to go for any bigger title. Home care is the right fit for me, and I would be content to stay in this field until I retire. If you’re considering going into this profession, know that it's probably going to be the hardest job you’ll ever have. There are going to be times when you're going to feel very unappreciated. You’re going to work very hard and feel like you’re getting nothing in return. But for every one bad experience you have with a patient or a family member or a doctor, there will probably be five good experiences. So just bide your time with the bad stuff, because the good stuff is there, too. It’s been my experience that if you don't have the heart for nursing, you'll give it up pretty quick, because it's a tough field to stay in. Those of us who have the heart, we know we're there to help people. And we know that if a patient is really demanding, it’s probably because they need attention and they're not getting it. The nurses that care – we realize that. And we give them the attention they need.

Power Strategies: Pragmatism, Empathy, Wisdom
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Mike - An Outstretchd Hand

2006-11-20T18:18:00.000-08:00

Mike -

When I first began working as a nurse, I had a lot of doubts and anxiety. I questioned whether or not I could really do it. The responsibility of having a people’s lives basically in my hands nearly paralyzed me with fear.

Now that I’ve gained some experience, however, I’ve also gained more confidence. I have faced the worst thing that can happen to a nurse, which is when somebody dies on your watch.
“When a new nurse reaches out his or her hand to you, all you have to do is reach yours back..” In this case, I was transferring a man from his wheelchair and he collapsed in my arms. It was a dramatic situation, and rather surreal because I had been working as an LPN for a couple of years but had never even seen a dead body before. For a moment I just froze, and then suddenly everything kicked into action. I called for help and an RN responded, I was just so grateful that she was there. She took control of the situation until the physician’s assistant arrived and was encouraging me throughout the whole ordeal.

Once you get through the sequence of a full code, your confidence builds and things just kind of progress naturally. Afterwards, she continued to support me, which was really great because this man had been involved in a car accident and I ended up having to talk to the police medical examiner. This nurse told me, “Everything’s going to be OK. Don’t worry about things. Just think back and make sure your charting’s good.” It was really nice to feel like somebody was on my side.

I’m much more confident today, but there are still times when I feel like I don’t know everything. It’s a healthy fear of the unknown, though. That’s what drives me to keep learning. Even on my off days, I’ll pick up a nursing book and read. You can never know enough.

One thing I want to guard against is becoming desensitized. I have to constantly re-examine myself, check my sincerity, and check in with myself that I truly care about the person lying in that hospital bed. I remind myself that the person has a family that cares about them. I have to care about them, and it has to go beyond the paycheck, I want to care, and I think all nurses should want to care. If you get to the point where you don’t care anymore, I think it’s time to reassess your job because it really affects how successful you are as a nurse.

When I’m having a hard day and I feel myself shutting down, I try to take a moment out for myself. If I have a patient who is lashing out at me, I don’t take it personally, even though sometimes it’s difficult not to. Just because you don’t like somebody doesn’t mean you can’t respect them or give them their dignity. That’s the hard part for people in the medical field, as well as for police officers and firefighters. It just doesn’t matter who you’re dealing with; you have to always remember it’s still a human life.

You have to inspire yourself sometimes. I’ve got a family at home with kids. I’d much rather be with them than in the hospital sometimes, but that’s what inspires me. If it was me lying in that bed, I would sure want somebody who was dedicated and really focused on what they need to do to care for me. There have been times when I have gone back, after punching out for the day, and just sat and talked to some patients – mostly homeless men. The experience I want them to have is the feeling that somebody actually gives a damn. They’re not just a room number.

I’ve been an RN for a little less than a year, and I have just begun precepting – that is, mentoring new nurses. When I orient someone, I emphasize the importance of being positive. The people in the bed really need that, but your co-workers certainly need it too. I want to help others become the most well-rounded nurses they can be, do things in moderation, be diligent and focused, but not too focused, because you can lose the caring aspects of your personality. And what I mean by moderation is to study hard and give the job everything you’ve got, but remember, you have a life out there, beyond people who are sick or dying.

Nurses who have been around for a while need to remember what it was like for them when they first got on the floor. They should remember how scared they were because, let’s face it, everyone is scared at the beginning. I bless that RN who supported me when that man collapsed and died in my arms – she is the shining example of how mentorship can be such a positive influence. And it doesn’t take much effort. When a new nurse reaches out his or her hand to you, all you have to do is reach yours back.

Power Strategies: Boundaries, Tenacity, Mastery
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Janice - A Nurse Forever

2006-11-20T18:14:00.000-08:00

Janice -

It bothers me when people ask, "What did you do when you were still a nurse?" In my opinion once you become a nurse, you're a nurse forever … until the day you die.

It takes a lot of giving to be a nurse. Most people could not do the kinds of things that nurses do unless they really cared for others. We deal with the most awful kinds of situations and the worst physically circumstances that can happen to people. We do it because we care and there's nobody else who can stomach it.

My career has actually included very little bedside nursing. I’ve provided patient education, nursing education and clinical work. In the last couple of years I have found that the people providing bedside care don’t seem to be as attuned to the basic kind of care that I remember learning as a beginning nursing student. There's so much more documentation demanded from nurses these days. Some things have become easier because of computers, but on the other hand, so much more is demanded. It’s partly because hospitals are trying to shield themselves from anything that could go wrong. Our litigious society makes it hard for people to care and to give in a way that is totally unconditional because they have to worry about consequences.

I’m concerned about the quality of care in the future as our population ages. A lot of RN's just are not doing the kind of care in nursing homes that we need, I think it's a financial problem.
“by giving up the white uniform and cap, we’ve given up some of our symbolism that helps to identify us and empower us.” Nursing homes are hiring aides at lower costs, but they’ve had just a few months of education. Their preparation cannot match that of an RN going in and doing a head-to-toe evaluation of a patient. I'm a little worried about all 75 million of us baby boomers who are going to need end-of-life care in the next 20 years. How will we provide care for this many people with any kind of real quality? I sometimes joke that every family should raise one or two nurses, for their own self-interest!

Recently, I went back to nursing school for my 35th class reunion. The planners staged a “fashion show”. We saw nursing uniforms dating back in the 1890's through the present time. It was fun, but it also made think. I’m not saying we should wear caps again or even nylons, but by giving up the white uniform and cap, we’ve given up some of our symbolism that helps to identify us and empower us. Now patients sometimes say, "I don't know how to tell a nurse from an aide because everybody wears scrubs.”

Although it’s been many years since I’ve worked in a hospital setting, I can still remember the most difficult situation I ever had to face. I was working in the ICU and a woman came in who had suffered a botched abortion. She actually had to go into isolation because she was highly infected. You’d walk in the room and the odor was just awful. I would go in and she would say, “I don't know how you can stand to come in here, because I can barely stand to be in this room with myself." But she and I were not very far apart in age, and somehow we just connected psychologically. Ultimately, though, she ended up dying from the abortion. That made a huge impression on me. I just felt so awful at how she suffered.

On the other end of the spectrum, I had an extremely uplifting experience working with a mother who suffered from postpartum depression. When her second child was born, she was able to get effective treatment and did not have to suffer like she did the first time. She was able to go home and care for her two boys, and was just a healthy and wonderful person.

Those two very different patient outcomes really underscore how nursing can affect your psyche and your emotions. Anyone going into the profession should have good friends who will love and support them, whether those friends are nurses themselves or not. They should be involved with some sort of a support network, so that they don't feel like they're out there working by themselves. It’s important to have somebody to connect with.

Power Strategies: Connection, intimacy, Compassion
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Jackie - The Ministry of Healing

2006-11-20T18:10:00.000-08:00

Jackie -

I started my career in the Army Nurse Corps and went to Vietnam after a year stateside. There I was – so young, bright-eyed and fairly naïve – being sent into a war zone. I’m sure my naiveté kept me in some ways safe, because there were things I just didn’t know. Some of the inherent dangers of the situation just didn’t occur to me at the time.

My military occupational specialty, or MOS, was pediatrics. The children we cared for were Vietnamese. We treated everything – war wounds, burns, amputations. That was primarily what I did over there. Of course, I also had to help with the triage of soldiers. It was twelve-hour days, and very demanding work. But I enjoyed it.

It would not be the last time I would work overseas as a nurse. After completing my tour in Vietnam, I returned to the States and worked for over a decade in nursing jobs. At a certain point, I began to desire change again.
“…nurses really have to be aware of their bodies, hearts and minds, and take care of those things when they need a break.”> There was this sense of, what am I going to do with my life? Graduate school was one option, but at that time an American organization was heavily recruiting for nurses to go to Saudi Arabia. A year earlier, if you had asked me to find Saudi Arabia on the map, I would have had to really look hard. But I thought, Wow. This sounds like something I might be interested in doing. I applied for the program and was accepted. And the newborn nursery manager position opened up shortly after I got over there, so I ended up doing that for two years.

It was another incredible experience. So many times we as Americans go to a foreign country and expect their people to adapt to us. I don’t have that philosophy. I went over as a guest in their country, played by their rules, and did just fine. Women are treated very differently in that society but it wasn’t a problem for me. I didn’t feel like I had to prove that the American Way is the best way. I just enjoyed seeing what I could see of the country despite the restrictions placed on me. And I met the man who would eventually become my husband while I was over there, so it was a very significant time in my life.

One thing that really brings joy to my heart these days is my involvement with parish nursing, which is an approach to health care that involves the whole person – body, mind and spirit. The focus is on wellness and disease prevention. Parish nurses do a lot of educating, such as holding blood pressure clinics or classes on various health issues. But there is not a clear-cut path for what you have to do. I’ll sit and pray with people, or I’ll visit them in the hospital if I’m asked to do that. I’ve done home communion. These are all lay ministry activities that you don’t have to be a parish nurse to do, but it does roll into it very nicely. It was through my church community that I first heard about parish nursing, and my interest led me to take a class in it. My regular, full-time job doesn’t leave much time for such volunteer work, but I look forward to being able to devote more time to it in retirement.

Spirituality in whatever form can be very healing for nurses, particularly when they experience the death of a patient. As the manager of an inpatient pediatrics unit that included cancer patients, I once planned a memorial service for my staff because we lost seven kids in one year. That was a lot because it is a small unit, and it was hard on everyone. The social worker and I planned an opportunity for the staff to come together, to talk and share stories about these kids. And it was incredible, just a wonderful time of laughing, and crying, and letting go. Not a religious event, but a spiritual one. That ministry of healing is what I feel called to do, and in this case it was ministering to my staff. I would love to be able to do more of it.

There are so many different ways to be a nurse. Most people go into nursing for the same reasons – helping others, compassion, and healing. You have to love it, because otherwise it’s just too hard. And the inpatient setting is really draining – physically, emotionally, and spiritually. It takes its toll. So nurses really have to be aware of their bodies, hearts and minds, and take care of those things when they need a break.

My experiences being a nurse in other countries have taught me resilience and flexibility. I know that life can be lot tougher in other places than it is here. My career began in a war zone, helping children to heal. People ask if it was tough for me to see some of the things I did. Of course it was, but at the same time my own youth kept me unaware of how tough it really was.

Nursing is an incredible profession. For people that are going into it, the opportunities are wide open. I’m now a clinical manager for consulting nurses in a large HMO. Nursing is definitely going to change a lot in the next few years, but opportunities will only continue to expand. It’s a great place to be.

Power Strategies: Spirituality, Community, Healing
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Paul - Putting Patients at Ease

2006-11-15T18:24:00.000-08:00

Paul -

My dad inspired me to become a nurse. He was a nurse anesthetist in the Navy. He was very good at his job and received many awards for his achievements. He sounded so knowledgeable when he talked about what he did. It made me want to do the same thing. What I admired most was his dedication and attention to detail. He took the time to really know his patients and cater to all their needs. If he was working with young children, he would put bubblegum smell inside their mask. He took special care to make his patients feel at ease.

My father was a nurturer, so naturally he passed that on to me. I have three girls and I’m affectionate and nurturing with all of them. I want to model the way they should be with their children. I learned by Dad’s examples. I always go the extra mile for my family and my patients. If patients have questions, I take the time to explain things to them, even if the surgeon and everyone on the other side are saying, “Come on Paul, let’s go.” It’s important for the patients to feel comfortable.

Like Dad, I was a Navy nurse for seven years. After I got out of the Navy, I quit nursing for a year-and-a-half and worked as a pharmaceutical representative. I didn’t like the business aspect of that job and I missed the patients. So I returned to med/surg nursing and then transferred to surgery and have been there ever since.

When I wasn’t nursing, I missed the patients’ appreciation for the assistance I gave them. My reward is doing something that helps them get better. Family members are appreciative and I receive many thank you letters.“Nursing isn’t all medications and dressing changes; it’s also getting to know the patient and I find people fascinating.” I enjoy talking with the patients. I like the med/surg floor because many of those people are older and they have incredible stories to tell. I met guys who are World War II veterans and they told the most interesting tales. Nursing isn’t all medications and dressing changes; it’s also getting to know the patient and I find people fascinating. The more they tell me about themselves, the more familiar they feel with me. That closeness is good for the well-being of the patient and it makes me feel good too. It makes me want to come back the next day and learn more about the person.

Nursing has evolved over the 20 years I’ve been in the profession. Nurses are recognized as professionals now. We have learned to balance both of our roles; the nurturing role and the patient advocacy role. To advocate for my patient, I need to be able to communicate on a professional level with the surgeon and the anesthesiologist and anyone else involved.

For a long time I found it difficult to assert myself to advocate for my patients. Because I come from a military background, I was used to a rank structure. My mother was also a powerful figure in my life because my father was often away on ships. If a female had power over me, it was hard to express myself and be assertive with her. It has taken some time, but I challenge myself to practice speaking up and I’ve become much better at it. The current female department head I work for is easy to talk with, so that has helped raise my confidence. I’m finding it easier to assert myself with surgeons and other health care workers as well.

My future vision includes getting my master’s degree. I’m leaning toward business administration because I would like to be in management. I’ve been in patient care for almost 20 years and I’m ready to take my career to the next level, but slowly. Right now I’m a charge nurse but I see myself being a Chief of Nursing. No matter what my title, my commitment will always be to do all I can for the patients. That way my career will continue to be rewarding and give me a feeling of accomplishment.

Power Strategies: Nurture, Communication, Intimacy
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Leoni - Holistic Nursing Renewed my Passion

2006-11-15T18:20:00.000-08:00

Leoni -

I went into nursing because I wanted to a midwife, so I started out being a childbirth educator. I received my nursing degree and became involved in home births. Then I found myself in the hospital pushing people through - I became disillusioned with my job. I didn’t feel the system provided much support for people birthing their babies, and I strongly considered leaving nursing.

When I was about ready to move on to something different, I discovered the concept of holistic nursing. I attended a holistic nursing workshop and found myself sitting with a hundred other nurses who shared similar visions as mine. Up to that point, I had lived a holistic lifestyle, but my lifestyle and my job were separate and the way I worked did not connect with the way I lived.

Suddenly, I saw a new way of nursing. Holistic nursing gave me an identity shift that renewed my passion for nursing. On the outside it didn’t look like I’d changed. I would still go to the hospital and take care of women in labor. The shift was inside of me and changed the way I perceived myself and what I was doing. I always believed that working with women in labor was valuable and it was something that was deeply part of who I was. But after what I call my “midlife crisis” and my quest towards holism, I was not embarrassed to be a nurse. Instead, I started honoring what I did.

In the early 1990s when I found the concept of holistic nursing, the American Holistic Nurses Association was gaining momentum. I took a very comprehensive certification course in holistic nursing.“The more present you are, the more you’re able to have your own heart open, the better you’re able to connect with your patient.” It was a very personal journey and I devoted a lot of time and energy for the three years it took me to complete. Once I graduated from the certification course, I submitted a portfolio to the AHNA to become a certified holistic nurse. About the time I was ready to apply to the AHNA for my certification, everybody was saying by the year 2000 all nurses would have to have a bachelor’s degree. At that point, the AHNA made it a requirement that as of the year 2000 you could no longer become a certified holistic nurse unless you had your bachelors.

Of course, all the associate degree nurses, including myself, were rushing to finish their certifications by the year 2000 so they could be grandfathered in. I wanted badly to be certified as a holistic nurse. I wanted it on my name badge. But I didn’t agree with the AHNA’s requirement. I was uncomfortable with it because it was becoming obvious the bachelor’s degree requirement for RNs was not going to happen. It also made me uncomfortable when I thought about an associate degree nurse walking up to me and asking me to talk about my holistic certification, and I would have to say, “You can’t be this anymore.” The third issue was ny belief that holism is inclusive and holistic. It’s saying that inherently, nurses are holistic, and so are the heart and the spirit of what we do. To me the organization that represented the concept of holistic nursing was saying, “You can’t be a holistic nurse unless you have your bachelors.” That struck me as the height of hypocrisy.

I had everything completed and ready to submit in December of 1999. Instead of submitting my portfolio, I wrote them a letter and said, “You’re wrong. I don’t agree with this policy. It strikes me as the height of hypocrisy that you’re talking about holism but you’re going to be exclusionary. I don’t buy it and I don’t want your certification. I’m a holistic nurse, period.” I felt I needed to stick to my principles, and to do this day I don’t have any regrets.

I see a lot of people who choose to get into nursing because they open the newspaper and see 20 want ads for nurses at $30.00 an hour. They know they can go anywhere and have a job and they have a perception that it’s a job that won’t be outsourced. But I also see those people burning out much faster. People really need to find something inside of them that gives them passion for what they do, instead of training for a job simply because it provides money and security. The nice thing about nursing is there are 1,001 different ways you can be a nurses, both with different work environments and different focuses. So somewhere you have to find the piece that is your passion; your dharma. I just precepted a PLU student and it was quite frustrating because she was just putting in the time. I don’t think birth was necessarily her thing. She was technically good, but she was disengaged from the patients. When it was her time to comfort, connect and calm a patient, she just wouldn’t do it. I tried to coach her but I don’t think I ever got through to her. It was disheartening.

Being present is the heart of nursing and the presence needs to be a reflection of whatever the patient and his or her circle of people needs. For some patients it might be the 3 C’s; comfort, care and calm. For someone else it might be giving information. For another patient it might be creating a safe place for them to be scared in. It’s being present for whatever is right in front of you.

There is a myth that by being present or opening your heart your energy is going to get sucked out of you. Part of what I teach in my workshops is the way energy and information moves in a circle. The more present you are, the more you’re able to have your own heart open, the better you’re able to connect with your patient. And the great news is it’s also the best way to walk out the door at the end of the day with your batteries full. It’s the opposite of the myth. Not being present and having our hearts closed costs us as individuals.

I’m a different nurse everyday, based on the connection I make with each individual patient. But at the end of every day, even if I’m on my feet for 12 hours and I’m physically tired, my heart and my spirit feel great. When someone asks me what I do, their eyes light up when I tell them, because my eyes light up when I talk about it. They didn’t used to. But now I’ve found a richness and honor in all I do.

Power Strategies: Passion, Presence, Dignity
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Sally - Hold Each Other Accountable

2006-11-15T18:16:00.000-08:00

Sally -

When I was three I wanted to be either a nurse or an Indian maiden. I’m not Native American, so I became a nurse. Now, however, I jokingly tell myself I’m in the Indian maiden stage of my life. I say that because I am more adventurous and not fearful of the future. I’m able to lead in uncharted territory. I have a vision, but I’m also open to new ideas and experiences. So, in a way, I’m realizing both of my dreams.

I believe people must be genetically wired to be nurses. Did you know there are almost three million nurses in the United States? I find I bump into other nurses and I just know, “That’s a nurse.” Nurses nearly sparkle and seem to have an aura about them and it helps us to be drawn to each other. I connect with nurses all the time in places that are not medically oriented. It’s not like I can look at an entire room and say, ‘There’s one.” But many times there has been an immediate bonding that happens during casual conversation when I encounter another nurse. I think it’s almost spiritual – like we’re drawn to each other.

I, like many other nurses, have been told, “You should have been a doctor.” What people don’t understand is I chose nursing for a reason. Nurses tend to look at the world in a more holistic manner. We have a rich history of being able to provide care in a broad context. We do that by taking the time to understand the patients and the world they live in … who their families are. Nurses have this intuitive sense that there is more to a person than just the heart rhythm on the monitor. Nursing is bigger than medicine. That’s not to say physicians don’t care, because they do. But nurses look at the whole pie; the bio, social, psycho and spiritual.

Often nurses will say, “Well, I’m just a nurse.” I wonder why they would belittle their role in the health care partnership. I have never been inclined to minimize my contribution and I don’t think nurses should try to make their profession feel less than somebody else’s.“Nursing is bigger than medicine.” Nursing is the most trusted profession. It has been the most trusted for as long as trusted professions have been surveyed, except for after 9/11. That one year firefighters and police officers came out number one and nurses were number 2. But now nurses have returned to the top spot. So why, if the public thinks so highly of you, would you think so little of what we do?

Not only do nurses belittle their profession, sometimes they just won’t be there for each other. When a nurse is reaching burn out, or is in over his or her head, usually many nurses will rally and provide support to that individual. But there are other times when no help is available and you’re there alone. Maybe the nurses have their reasons for not being supportive, but I always feel two or three together can handle a lot more than one.

In addition to supporting each other, nurses need to hold each other accountable. I mean sometimes something doesn’t go well or somebody says something inappropriate or something doesn’t get done that needs to get done. We really need to step up to each other and make sure things get corrected. So many nurses write problems up and hand them to administration to fix rather than deal directly with each other. Educationally we need to help people be more comfortable with communication. Teach nurses to say, “You know, when I came on duty yesterday I noticed this didn’t get done. Can you help me understand why this didn’t happen?”

The irony is nurses listen to patients all the time. Why can’t they listen to their colleagues? Maybe the “offender” forgot or had some other crisis they didn’t think to mention to you. Maybe they didn’t know the duty was suppose to be done because nobody ever told them. There could be a million reasons. But there needs to be an opportunity to have that dialogue instead of just running it over to somebody else to fix.

Accountability is something I’ve been very interested in recently. The Institute for Healthcare Improvement has a 100,000 lives initiative. It was spun out of a book called To Err is Human which said that 98,000 people die annually in American hospitals because of medical mistakes. So this group has come together to set a target for saving 100,000 lives by putting into place certain practices that are proven to save lives. I was struck when I reviewed the practices because many of them are simply basic, good nursing care. They just had the celebration for over 122,000 lives that were saved.

What mystifies me is, it took a campaign in 2005-2006 to get people’s attention? I think the accountability piece is missing because of a fear of conflict. People don’t like to confront each other. Nurses aren’t trained to have good, confrontational conversation without sounding negative. I don’t know why some nurses may not confront. Maybe they are burned out, or maybe they are just mentally ticking off the tasks and not putting together the whole story. They aren’t realizing why this task is so important in relationship to the whole picture for the patient. So maybe a task gets missed because of a lack of critical thinking. It’s wonderful this has become a focus, but it’s something we should have been paying attention to all along.

I recently left my job as a nurse administrator to complete my doctorate degree. As I journeyed into nursing my dad pointed out there will always be people who are sick. You will always have a job. As I enter new, uncharted territory in my career, I know nursing will continue to provide exciting adventures for me.

Power Strategies: Accountability, Adventure, Communication
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Tracy - A Witness to Injustice

2006-11-15T18:13:00.000-08:00

Tracy -

When I tell people I work in a burn center, most of them cringe and say, “I could never do that.” But really, it just takes an ability to see past all the bad things. These people come to us in such bad shape, but we can get them to a point where they’re better. A lot of other units have these ups and downs, in which people are sick, then get better, and then get sicker again; but in the burn unit, we mostly start at the worst moment and move up from there.

It takes a toll. We have a high turnover rate because it takes such a physical and emotional toll. A lot of people get depleted quite quickly, because they don’t realize how much it’s going to take out of them and they don’t last very long. One day I was taking it hard and I asked myself, “Why am I still doing this?” I think I’m one of those people who are just cut out for this kind of nursing and I don’t think I’ll ever go anywhere else. I don’t see myself ever wanting to do anything different – maybe something in addition to it, but not ever giving up my burn unit, as I call it.

The ultimate motivation for me to continue what I’m doing is passion for what I do - I love my job. Speeding one patient’s recovery is enough motivation to keep me going for months, because it is so rewarding to see somebody go from such a low point to full recovery.

Our patients’ circumstances can be so terrible, it’s hard to hear. Sometimes these are criminal assault cases and high profile so I won’t say too much. One patient who was already in a wheelchair had been assaulted. He was with us for over 10 months and we learned he had always taken great pride in his appearance. So in the process of trying to save his life and heal his skin, we also wanted to give him a body image that would help him maintain his appearance and standard of living.

After three and a half months, we had gotten to a point where he was ready go to a rehabilitation facility.“I’m an educator … I’m a counselor … I’m a friend … I’m an advocate … I’m a coordinator of care. But I also serve as a witness to the terrible injustice that is sometimes done to people.” His skin was healed and he was doing well. But then he choked on some food, contracted aspirational pneumonia and began a downward spiral in his recovery. At that point, the burn care was really minimal because skin-wise he was nearly healed. But he was so sick he almost died. We had never cared for somebody so close to dying. And now, against the odds, he has again made a full recovery. He says, being that close to death – twice – and making it through has made him feel like there is a purpose for him in this world, but sometimes he doesn’t know how the purpose could be worth it.

My experience with that patient made me more aware of the different roles I play as a nurse. I’m an educator, educating people on what has happened to them and what is going to happen. I’m a counselor. I’m a friend. I’m an advocate. I’m a coordinator of care. But I also serve as a witness to the terrible injustice that is sometimes done to people.

It feels soul-robbing at some times. But the same situation can give you hope about the nature of humankind and our survivability in the worst of circumstances. It also just reminds you of your complete mortality because we have all these things, like hot water and fire, that are meant for so much good and yet they can cause so much suffering to innocent people. When you’ve seen some of the things I’ve seen, you’ll never look at a fireplace the same way again.

Those of us who are caring for patients need to broaden our perspective. Meet with the administrators who make the decisions affecting patient care, and our ability to deliver that care and tell them how it is. They need to hear from us so they know what our patients need. Nurses should be out in the community as well, educating, sharing knowledge and explaining what people need to do to remain healthy. Until it personally affects them, most people aren’t aware of what it’s like being in the healthcare system. I think nurses could change that.

I’m strongly committed to maintaining an impervious standard of exceptional care for patients. Sometimes, I see people who are willing to let go of our standard because of financial pressures or because they are physically, mentally and emotionally exhausted. We need to be there for each other, I don’t ever want to quit on that. That’s always number one with me.

Power Strategies: Humanity, Achievement, Dedication
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Thom - Come Back Home

2006-11-15T18:10:00.000-08:00

Thom -

Most people assume that bringing men into the nursing profession will help raise not only the standard, but the pay as well. It’s actually a false assumption. Men are just looking to have the same rights that women do in the profession – the scheduling issues, the training opportunities, the advancement. There is still this pervasive attitude that only men have power, and that women should remain subservient in health care. But let’s take a broad look at the global issue. We have more women in the advanced practice roles, and in the administrative roles. While they’re making their own career choices and advancing, they are helping us, the men, further our own personal beliefs that we can care; its okay for a man to cry, it’s okay if we only want certain shifts to take care of our children, just as women do.

In dealing with that, the women unconsciously mentor us in return. While they’re trying to push us forward, we want to stay within our own comfort zone. When we’re ready, we’ll step forward. But as much as we would like to move forward, we don’t have the opportunities women do. It seems much harder for men to get into the advanced practice roles. You hear things like, “Well, you’ll always need a female chaperone,” or, “That’s not a specialty that men really should get into.” So it becomes a gender issue instead of a nursing issue.

When I was a nursing student, I had faculty who were very supportive of me. They would place me in opportunities where I could excel.”“Human first. Nursing later.” One instructor said to me, “I can put you in any environment, and you can figure it out on your own. At the time, I was just trying to pass the class, frankly. But then, when it was all over and done with, the same instructor came back to me and said, “You will be a great nurse. You may not be the best test-taker, but you will be a nurse that people will remember.”

I know that I am the face of the American nurse, and as an instructor myself now, I’m going to change the global perspective of “nurse.” Nursing is not about the technical skills. It’s about how you nurse. You take the perspective of the person for whom you are caring. Having been a nurse who has experienced good and bad outcomes, sometimes it’s not what you do with your hands, but what you do in the silence of your delivery. Are you just standing there listening? Are you offering that touch? It could be that simple foot rub that relieves pain for someone without you ever saying a word. You’ve done something human. “Human nursing” is so far behind. We have so many obstacles against us; the resources, the staffing, the money, the availability of things. Why take the human factor out of it? This is a human being. They have their own special needs. Against your own grain, you do what you need to do to take care of them, because it’s about them.

To me, it doesn’t matter if you’re an associate degree nurse, a baccalaureate-prepared nurse, or a master’s-prepared nurse. I lump everybody together in the same category. No matter how many credentials you have, you’re still a nurse. You just have more refined skills. I’m fond of saying, “Come back home…you’re a nurse.”

In today’s healthcare, it’s hard to beat the system. But it makes a difference if you keep that human factor in there. Once as a traveling nurse, I was in a 90-day assignment that I couldn’t wait to finish. As I was nursing in the hallway with no resources, I was given this listless child who was about to go. So I first just comforted this child, and did what I had to do as a human being. I even told everyone around, “I’m going to be very busy right now. If you have something else, I will get to you, but let me work with this child first.” And then I brought that child back to life who was actually very badly dehydrated and running a fever. That child had pneumonia but the mother, a non-English speaker, didn’t know how to communicate. So in the emergency room, the triage nurse had gotten frustrated with her and thought, “Well, it’s just another childhood sickness.” Based on that wrong assumption the child waited too long, and basically needed fluid volume resuscitation very quickly. When I heard his first cry come back, it confirmed to me that I was human enough to make that difference, and I could nurse later. Human first, nursing later. And everybody around me was crying and saying, “I’ve not ever known another nurse who would do that in this place.” That was my qualifier that no matter how horrible a place was going to be for the remainder of my time there, the community would know that a good nurse had stepped in.

My validation for my whole nursing career was when I was standing at Ground Zero on 9/11 and looking at what I was supposed to do, either as a nurse or a human being. And I said, “I don’t have to be a nurse here. I can be a human being.” I chose to not do the nursing sector on that day. I actually volunteered giving foot massages, working in the chow line, and just listening to people and letting them know it was okay. It’s a day I want to remember for the rest of my life. Most people want to forget bad things, but this is something I want to remember. And I share the experience with my students, or, as I call them, my little chickadees. I tell them there comes a point where you need to leave the textbook behind. They need that real-world experience sometimes, in a good storytelling way, so they can learn from it.

Power Strategies: Connection, Influence, Power
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Nancy - Heart, Mind and Soul

2006-11-15T18:06:00.000-08:00

Nancy -

Nursing was such a great career choice for me because I have always been able to work it around my family. I dropped out of high school and became a mom at the age of sixteen, but by the time I was in my early twenties I knew I needed to figure out what I was going to do career-wise to be able to support my family and get my life on track. Going back to school was the obvious choice, and nursing seemed like a good fit because it combined two things I really love – science and working with people. I started out going to LPN school, and eventually ended up getting my Bachelor’s degree. Today, I am a nurse administrator in a brand-new hospital, and I’m also in the process of working on my Master’s degree.

Hospital nursing faces some challenges in the 21st century. If I learned anything as an instructor, it’s that not everyone is destined to be a hospital nurse. We have to consider that every five years we’re going to turn over a whole new batch of nurses because the ones that are going into nursing today want to be nurse practitioners, or they want to manage something, and they see hospital nursing almost as an entry level to their true profession. We as leaders have to be ready for that turnover and quit thinking we’re going to have that twenty-year career nurse. We might have a few of those, but not like we’ve had in the past. That’s the sense I get in talking with young people entering the profession.

Nursing as a profession has struggled to articulate to the world what it is all about. There have been these approaches to try to get it out there but they were developed in language that only nurses understood.“I read articles that ask, ‘Is nursing a dying profession?’ And I think, no, it’s very alive.” It’s such an amazing career, and yet most people don’t understand it or have a good idea of what nurses really do. And the people who are running hospitals that deliver nursing care are not nurses themselves. They may be wonderful, bright people, but they don’t have a good idea of what nurses do, what they need, and what they deal with every day. These executives listen to the doctors’ complaints, but they have no clue that the nurses are working under those same challenges every day and yet we’re able to succeed. It’s such a nod to the strength of nursing and, in my mind, women and their ability to work under all kinds of conditions and succeed.

I think nursing is really designed for young people. It’s high-energy. It takes a quick mind. You have to be able to work twelve hours. And yet young people are not always ready for the responsibility or how complicated the role is, so they need to have mentors. They need to have guidance from the older nurses. It’s the senior nurses that make the best mentors, if they have the right attitude. I read articles that ask, “Is nursing a dying profession?” And I think, no, it’s very alive. But it’s a changing profession. We have to create the environment to keep it.

I often speak to young people who are considering nursing as a career, and I tell them how nursing touches your heart, mind and soul. It’s physical. It’s interactive. There’s a lot of critical thinking and detective work involved: what’s wrong with this patient? How come this isn’t all fitting together? I can’t think of another profession that offers all of that.

My daughter has a degree in sports marketing. I’ve never talked to my children about becoming nurses because I feel they should pick their own life path and I didn’t want to be a major influence. But she came to me about six months ago and said, “I want to do what you do. I like what you talk about when you come home, and I want to feel what you feel about work, Mom.” So now she’s going into nursing. Isn’t that wonderful?

Power Strategies:
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Kelley - Meaningul Work, Purposeful Life

2006-11-11T17:57:00.000-08:00

Kelley -

After I entered college I became friends with a pre-med student. He was an orderly at the hospital and had amazing stories. I became fascinated and decided to try nursing. Nursing school was difficult in the beginning when we had to do the most basic nursing care -- bed baths and beyond! It required such intimate care right from the start. And I still had no idea what the complete picture of nursing looked like. Because I hadn’t yet had opportunities to deal with people so closely in my young life, touching people was new to me. Caring for my patients and entering the domain of their privacy was difficult. I didn’t mind doing it, but I had to learn to get comfortable with it.

Nursing is a huge responsibility and there is so much to learn. I have explored many areas of nursing and have appreciated each one. With each specialty I develop new skills and gain more knowledge. In addition to acquiring and practicing a variety of nursing skills, I have grown personally by learning to set boundaries and by taking care of myself. I don’t work five days a week anymore, and the parenting classes I’ve recently joined are great for learning to deal with all ages!

Aside from the education, my personal goal is to find a way to look more closely at the patients and co-workers I come into contact with; to really see them and to be present.“My spirituality and nursing go very well together. I am fortunate to have found nursing and it is my honor to care for people.” his was demonstrated to me while working in detox, my first nursing job. I will always remember and be thankful to Margaret and Wilma for being real. They were genuinely caring and present, not only for their patients, but for all of us who worked together. That job was home for me. I felt like I belonged there. Some days it’s hard to find enough time or energy to be close. There’s only enough time to care for physical needs and no opportunity to provide emotional support for the patients or their families, let alone for each other. But I want to try.

I truly love to learn what’s important to each person; what’s inside. I want to know what they are feeling and thinking, what they believe and are genuinely interested in. As a nurse I can only strive to meet people’s needs, but I wish I could do more. I would love to give people hope. I get my hope from God and I want to share that in whatever way I can.

I sense the fear patients feel that goes along with a loss or change in one’s body, or having to be in an unfamiliar place and at our mercy. There’s no escape from some of the physical and emotional pain in this life. The patients and their families need comfort and reassurance. They need someone to walk with them. My goal is to provide comfort, both from the pain they are experiencing and from the fears in their hearts. My spirituality and nursing go very well together. I am fortunate to have found nursing and it is my honor to care for people.

I am not just a nurse, I’m a person, and I need to know who I am and how to take care of myself. It’s important for nurses to know we are valued as more than just employees. If a hospital wants a healthy work environment, they will invest in their workers by encouraging and teaching healthy interpersonal and communication skills. I am content and everything doesn’t have to be perfect if I feel like I’m heard and trust that my work efforts are valued.

Nursing has given me a purpose and I’m glad I have something to give to other people. I serve God by serving people. I believe God gave me the interest and I’m thankful to be in a place where I love what I do and feel like I’m contributing at the same time. I’m honored and privileged to be a nurse. I love to tell people who are going into nursing that they can create the perfect life through this career. There are so many specialties and so many work environments from which to choose.

In 20 years I’ve worked in surgery, progressive care, emergency and detox. OB and Oncology are my next goals. My other interest for the future is medical-surgical missions. Right now I’m raising three boys, but one day I would love to work overseas and immerse in other cultures. The vision of being on a mission motivates me to continue to build my skills, knowledge and expertise so I have more to give as a nurse, whether it’s here at home or in other countries.

Power Strategies: Comfort, Hope, Service
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Diane - Maximizing Strengths and Weaknesses

2006-11-11T17:54:00.000-08:00

Diane -

Mom would tell me stories about her work as a nurse, so I always knew that was what I wanted to do. In junior high I started working as a nursing assistant, right beside her and working together created a special bond between us. I’ve been a nurse for 40 years now.

Back when I was in junior high there were more nursing assistant opportunities than there are now, so it was easier for people to “try on” a nursing career and experience different levels of nursing. The nursing education is different now and it’s hard for people to sense what it’s really going to be like until they graduate and start working. I think some are disappointed when they actually become nurses.

The tragedy is the art of nursing is almost lost. As Chief of Nursing, I strive to help young nurses experience the heart of it. If they have the technical skills but don’t seem to grasp the caring aspect, I match them with someone who has the skills and the heart. It takes careful assessment of each person’s strengths and weaknesses. But if I take the time up front to carefully coordinate our mentorships, one person’s strengths support the other’s weaknesses so together they are a strong team.

Young nurses have an advantage when they come to our organization. I staff very well, so my nurses are not run ragged. That means they can actually spend time with patients; to talk with them and find out what it is they need for support. We can all start IVs and take patients to X-ray and yes, the patients all need that. But nursing is the love of making experience better for the patient. The students that come here see our staff model compassionate behavior, and they learn from our examples.

My nurses also have the permission to say, “I can’t do that right now because I need to spend time with my patient.” They ask for help when they need it. I’ve encouraged my nurse leaders to allow staff to be honest with them. I had one nurse come to me and say, “You know, I’m really frustrated. All I do is lift and pull and tug. Can we please get some nursing assistants or orderlies to help me with the physical part?” I told her that was not in our model at the moment, but let’s talk about it and figure out what that would look like and what it would cost. So we did. We worked up a proposal and it took about six months but now we have nursing assistance, side by side with the nurses. It’s more of a team nursing approach where two or three people are caring for the same patient.

Early in my career the expectations for nurses were very different than the model I have created for my nurses.“I encourage nurses to enjoy their mission, because that is what it is. To fight when they need to, but not go into the world fighting.” Nurses were not at liberty to say, “I can’t do everything.” Back then, we had to stand up when the physician came in the nursing station. Many nurses in other organizations still work under that model. I learned that model has its failings. I’m a person who loves change, so I could easily let go of the old ideas when I realized what worked yesterday isn’t necessarily what will work today.

One of the best things I ever did for myself was to take a Human Effectiveness course. It gave me permission to be who I am. Everyone has weaknesses, so in order to compensate we need to find ways to help each other to improve those weaknesses. I’ve passed the skills learned in that course to the nurses on my staff. They have permission to make decisions. A boss once who told me, “Don’t be afraid to make a decision. There’s no decision you can make that I can’t undo.” I tell my nurse leaders the same; don’t be afraid – go forward.

One of the things I’ve always struggled with is putting the organization before the individual. I’ve had to learn that I can’t always please the nurses. Even though I want to fix everyone’s problems, the way one person wants things to be is not always in the best interest of everyone else. I do what I can, because I want them to be happy in their work, but I have to think about the organization as a whole and that has been a definite struggle for me.

I believe in rewarding people by allowing them to take education courses. I have fairly strong resources that I allocate every year for growth. Every RN is entitled to four days of paid education leave and they can use it however they wish. I also provide three or four retreats every year for my staff. The retreats allow staff to feel validated, refreshed and rewarded.

I try to touch my nurses everyday the way I try to touch patients and the way I want them to touch patients. I will make rounds several times a day for my staff. I look into their eyes and I’m not afraid to say, “It looks like you’re struggling.” Then, if they want one, I’ll give them a hug. If it’s something major we’ll have the grief counselor come in. I’ll buy them pizza every once in awhile, if that’s what they need. It affirms them and relieves the tension from within, so they can focus on caring for the patient. I encourage nurses to enjoy their mission, because that is what it is. And I encourage them to fight when they need to, but not go into the world fighting.

Power Strategies: Affirmation, Rewards, Self-Care
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Zoe - I Found my Perfect Job

2006-11-11T17:50:00.000-08:00

Zoe -

It took me some time to decide what kind of nursing I wanted to do. I knew I didn’t want to work in the psych ward, or in OB/GYN. I didn’t want to work in a hospital because I dreaded the shift work and didn’t want to work nights. I began my work in a remote clinic where I was able to do a lot of community health nursing. I became involved in pediatrics and really enjoyed working with children. I guess when you work with children you’re allowed to be a kid too. It’s a good excuse, in the seriousness of life, to be like a kid at work. It also encourages me to approach certain aspects of my life and work with child-like enthusiasm.

When my husband and I moved to Seattle I ended up taking a hospital job. There were about seven months of sacrifice because the only position I was able to get when we first moved was a day/night rotator. After seven months I was in the right place at the right time and a day position in the pediatric oncology clinic became available. It has been the perfect job for me. Even though I work with kids and families with cancer, I enjoy my work, the people, the institution and the unpredictability of the day-to-day work.

I love working with children because they are so innocent. Sometimes they are easier to talk to than adults.“When you work with children, you’re allowed to be a kid too.” I can explore their feelings a little bit more and sometimes take my cues from just a simple gesture. They’re fun. I’m hopeful I can make a difference in their lives, whether it’s helping them through the journey of cancer and all the treatments involved or just make a difference overall. If I can make them smile, that’s satisfaction. I wouldn’t give up what I’m doing in a heartbeat.

I was inspired to pursue nursing by a friend of my mother’s named Sandy. She drove me 12 miles to high school. Every day on the trip to school, with her three screaming children in the back seat, I helped her study by asking questions out of her nursing book. Sandy was determined to push forward and better herself, to improve her life and the welfare of her children, despite the chaos in her life. I had an alcoholic stepfather and I thought, “I can create a career in nursing too, despite the chaos in my life.” I left home at 16 and supported myself by working at a fast-food restaurant. I soon realized I couldn’t get by on $3.35 an hour, which was the minimum wage in the mid-80’s. So I entered the nursing program at the local community college. I hated it the first week, but I persevered. After I began my career with my LPN certificate, I returned to school every couple of years to further my education and now I’m a BSN.

Nursing keeps me busy every day. Sometimes it’s difficult to learn about patients who have died or who are dealing with a relapse of their cancer. Many times I’m exhausted at the end of my shift. But no matter how hard the day, I have learned to leave work at work and realize tomorrow’s a new day. I’ve found balance in my life by pursuing hobbies outside of work. I think all nurses need that. They need to take time out for themselves, have a self-care plan and find delight in what they do.

I still have the same “bring it on” attitude that carried me into my career. I look forward to the challenges and the process of figuring out how I can contribute to smooth out the difficulties. That’s what keeps me going and motivates me.

I try not to get involved in healthcare politics. I think the healthcare system is doing the best it can and is constantly moving forward. I leave the politics and policies for the overall system up to those who make the bigger picture their passion. I believe if I start to worry about all of that then I will lose sight of why I went into the profession. It will become overwhelming. I want to be accountable for the clinic and the activities and patient care process in my immediate surroundings.

I also strive to provide a fun environment. I’m on a Cheers for Peers committee with a colleague. It’s a peer recognition program that provides encouragement and ongoing regard for co-workers. It’s a way I can participate to improve the system I work in. I think participation is important for all nurses. Nurses don’t have to be involved in every committee, but they should find something to have a voice about. Or they might get involved with something they want to know more about. The best way to learn more about a process you don’t understand is to join a committee. It might make a difference in their outlook and in their career. It might help them discover new talents and new ways in which to make a difference. It might also lead them in new directions and help them to find the perfect nursing fit, as I did.

Power Strategies: Participation, Accountability, Tenacity
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Darlene - I've Always Seen Life Through the Eyes of a Nurse

2006-11-11T17:45:00.000-08:00

Darlene -

I had just graduated from high school in 1961 and was dating a boy who planned to go to medical school. I wasn’t sure what career I wanted to choose at that time. Shortly after graduation, my boyfriend was killed in a accident, which injured two others who spent most of the summer in the hospital. I visited them everyday and through the sorrow and grief and watching the care my two friends received, I decided to become a nurse.

After working as a nurse for a few years I began dating a doctor. We married, moved to Anacortes, and had two children.“I’m an activist at heart, and I am an advocate for the profession.” I wanted to work as a nurse at the hospital in Anacortes, but their policy prohibited a nurse from working in the same hospital aher husband. However, they would let me volunteer. I wasn’t happy with the policy, but they didn’t have a candy striper program, so I designed one and ran it with other volunteers for about three years.

I’m a natural caregiver, so I used my compassion and knowledge in other areas of the community. I was active with my children’s school and became an advocate for the nursing profession. All my volunteer work has been around public health. I’ve been on the Board of the American Lung Association of Washington for ten years and was recently elected to the National American Lung Association Board. I also ran for Seattle City Council on a public health agenda. My theme was, “You can trust a nurse for City Council.” I’m an activist at heart, and I am an advocate for the profession. I encourage other nurses to become advocates as well. Nurses are natural advocates for their patients, but they don’t get involved much with the nursing associations to lobby for better pay, better hours, and more slots in nursing schools. Those are the things that will help move the profession forward and encourage people to become nurses.

Even though I was using my nursing experience to serve the community, I decided since I couldn’t work as a nurse to try something different. I grew up in Kansas and now found myself living in Puget Sound and decided I wanted to know more about marine life. I returned to college and got a master’s degree in marine biology. I found that my education in nursing, which taught me to look at people holistically – the whole person, the whole family and the whole surroundings – carried over into biology and ecology. My master’s thesis concerned public health interests related to shellfish toxins. It was published and presented at an international conference. I then taught at Western Washington University and, after a few years, started my own consulting firm that helps people navigate through the “people side” of environmental issues.

I’m now 62 years old and plan to take a nursing refresher course next January and renew my nursing license so I can work in public health. My nurse friends say they need someone like me in the profession – mature, experienced and energetic. So, when I renew my license next spring, I will have come full circle in my nursing career. Nursing has always been a part of my journey, even though I wasn’t actively practicing for a number of years. I know I have had a rich life because of my circular travels.

Power Strategies: Advocacy, Community, Service
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Thelma - I Was An Unlikely Nursing Student

2006-11-11T17:41:00.000-08:00

Thelma -

I had no intention to be a nurse. My baby was delivered by midwives, so I thought I wanted to train to be a midwife. I wanted it enough to overcome my blood phobia. I was so afraid of blood I would pass out in the veterinarian’s office. I didn’t even have to watch what they did to my dog, they would just tell me about it and I would faint. It was not likely I would get through any kind of medical training, and my parents were against me pursuing a medical career, but I was so impressed with the women who delivered my son I decided I wanted to give it a try.

What impressed me most about the midwives was that they were so engaged. There are so few places in life where you can actually change someone’s life, affect the outcome of something and make a real difference, and I felt midwifery was one of those places. At the time I didn’t even know that nurses do the same thing in the delivery room. Now that I’m a nurse, I feel so lucky to walk into people lives when they are in total chaos and help in every way possible. I witness the most powerful moments all the time; every day.

After I graduated from nursing school I wanted to work for the Indian Health Service but they wouldn’t hire new graduates.“I’ll never be famous for anything good or bad, but I get to make a difference in one life at a time, and that’s enough. That’s more than most people get, so that’s why I do it.” I needed work experience. So I ended up on the Hopi reservation and fell in with a man who eventually did a cardiology fellowship. We worked on the Hopi Heart Grant from the American Heart Association, which allowed us to provide education to the Hopi people. That work got me hooked on cardiology. When I left my work at the reservation I did an intensive care unit residency and I’ve been working in intensive care ever since. So my career has been sort of accidental and evolutionary, but it’s worked out to be the perfect fit for me. I’ll never be famous for anything good or bad, but I get to make a difference in one life at a time, and that’s enough. That’s more than most people get, so that’s why I do it.

It took me awhile, but I finally got over my fear of blood. When I was still in nursing school I would get up early the mornings I had to go to surgery and pray that if I threw up I would turn around first, and if I fainted, I would faint backwards. My goal was not to contaminate the sterile field. What I discovered was once the patient was prepped and draped they were not human anymore and the procedure became very interesting. It wasn’t ever as gruesome as I thought it would be. I haven’t fainted in 15 years.

Much of my work has been in not-for-profit health organizations. The idea of making money on illness seems immoral to me. Profiting from suffering is not right. When working in a for-profit organization, the care is different. You are encouraged to cut corners because the focus is the bottom line. I haven’t worked in a lot of for-profit organizations, but with the experience I’ve had I don’t think I want to work for them again.

I’ve been furthering my nursing education and have been disturbed by some of the techniques used in my class. Sometimes the instructors are nurses who seem to be tired of working night shift or are tired of patient care so they become nurse educators. They get the book, study for the lesson, and tell you what’s in the book. They may be expert in some part of nursing, but they have no background in education.

I believe I think very quickly, but I have a lot more to think about than a 21-year-old does. I have a lot more experience from which to gather information that’s going to help me make this or that fact useful. The fact is nothing until it is applied. So I complained to the nurse educator that they were blasting through the curriculum at breakneck speed and I was becoming afraid of how little background the students, including me, were getting. They do it all in PowerPoint, so it’s in outline form and they leave it to us to fill in between the bullet points. They’re also notorious for saying, “Well, you know, I bet if we hurry, we can get out of here at 2:30.” Just once I want somebody to say, “You know, if you really want to learn this materials, I’m willing to stay until 7:00, how about you?” The question becomes, do you want to be good at this when you’re done or do you want to check the boxes and walk out of here knowing nothing more than when you walked in?

The most important lesson I’ve ever learned was while I was doing hospice care. Through that I learned the only thing that matters at the end of your life is that you loved someone, and they loved you back. When you work hospice you see people when they are the least inhibited and controlled. You see it both in patients and their families. Working in hospice care is about dignifying those moments as best as you can, provide comfort and care.

One message I want to give to other nurses is, “Be nice to each other. You’re going to be together for a long time. You’ll feel better about your career if you’re a nice person, instead of being defensive and placing blame on other people all the time.” If somebody makes a mistake, I like to say, “I’d like to help you do a better job. This was a problem for me once too, and I don’t think what you did is what you meant to do. Let’s look at how we can make this work better.”

Power Strategies: Courage, Patience, Integrity
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Carolyn - I Never Imagined I Would End Up Here

2006-11-11T17:36:00.000-08:00

Carolyn -

I began my career as a dental assistant, but it wasn’t a good fit for me. After all that, I found looking into people’s mouths unappealing. What’s ironic is I don’t mind looking inside people’s bodies – just not their mouths. I have more of a sense of accomplishment working in surgery than I did when I was working on teeth.

I chose nursing for the people contact. When I was in nursing school this poor lady was getting ready for a colonoscopy and she had to drink the stuff to clean out her intestines. She was sitting on the little commode and I kept getting her warm blankets. She said, “Oh, this is so nice.” We were laughing and joking and she said, “I guess if I was going to have to have someone with me while I was doing this I would want you to be the one.” I was glad to make her uncomfortable experience a little more pleasant. Another lady had a radial neck procedure and she started coughing and the tube was coming out and it made me sick to my stomach. I was over in her sink gagging and thinking, oh, my gosh, I’m going to vomit! I can’t be a nurse if this happens! The lady started laughing and by the time we were all done we were both laughing. I said, “I’m so sorry,” and she started laughing. She said, “I would have done the same thing.”

Everybody has vulnerabilities and if I’m able to identify where the patients are coming from and let them know that I’m not perfect either, then I can relate to them better.

I am so fortunate to be working with the open heart surgery team. It was really a fluke that I came here, and it wasn’t something I thought I wanted to do. I worked as a technician in surgery while I went back to school for my nursing degree. After college I worked on the floor for awhile, thinking eventually I would work as an OR nurse. While working on the floor I also worked occasional evenings in open heart surgery, so I got some cross training.

Things change fast in the workforce. They were begging for nurses when I first went into nursing school, but after I graduated and spent a few months on the floor, suddenly there was a reduction-in-force in the OR. Because I had the open heart experience, they said I could either go to open heart or find a job elsewhere. I didn’t think I wanted to work in open heart, but I also didn’t want to search for another job. As it turned out, the move to open heart was the best thing that could have happened to me.

Working in this department wasn’t always rosy. One of the surgeons was very difficult and all of the nurses were afraid of him."Everybody has vulnerabilities and if I’m able to identify where the patients are coming from and let them know that I’m not perfect either, then I can relate to them better.” Nobody wanted to speak up about how hard it was to work in the environment he created, because we watched him fire someone who talked back to him. But things have changed and the environment is great now. We’re doing this thing called med teams where everybody listens to each other and takes responsibility to check and double check things. As nurses we’ve always done that, but we’ve never done it with the doctors. Now it’s okay to say to the doctor, “I’d like to double check that. Are you sure that’s what you meant? Can you please clarify that?” Instead of just going along with what they say.

Open heart surgery is something I never would have imagined myself doing. I am amazed by the heart muscle. Sometimes I look at a patient’s heart and think, “I can’t believe we just did all that stuff to this guy’s heart and it’s still beating.” It’s fascinating! It’s also hard work, but at the end of the day when my shift is over, I like to play hard too.

My husband and I have jet skis and I can get rid of a whole week’s worth of tension by getting on the jet ski and going fast and twirling around in the water. The jet skis and my dog are both great stress relievers. So is a TGI Friday with the girls. My release comes from fun and exhilaration and by diverting my focus from work to play. I think you have to feel good about yourself in order to feel good for others and to help others. I feel good about my work, and my play, and I really love helping people.

Power Strategies: Engagement, Courage, Diversion
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Linda - I Left Nursing after One Year

2006-11-05T18:53:00.000-08:00

Linda Johnson -

Most of my family members worked in the medical field, so I didn’t think about doing anything different. I felt that the Lord had called me into the nursing profession. I am fascinated by the body and how it works and what happens when it doesn’t do what it is supposed to do. But, when I graduated from college, I wasn’t prepared for the reality of the nursing floor.

Hospital nursing wasn’t what I expected. I felt unprepared and was frustrated by the expectations to know everything. Preceptoring was a concept that was in its infancy, so I didn’t have anyone to mentor me along the way. I was under the impression most of my time would be with patients, but I spent so much time charting that I wasn’t able to connect with patients and their families, or to feel like I was making a difference. I wanted to help educate people, but there was no time.

Not much has changed since I entered nursing. The panic is still there for new nurses. My daughters are both nurses, with my youngest just graduating from nursing school a month ago. They have the same concerns I had; they feel totally inept. I tell them, “You’re not alone. Keep going. What you’re feeling is normal. Just keep learning.” and “Keep praying.” I encourage them to connect with someone and provide support for each other. I wish somebody would have given me the same advice 28 years ago.

Experienced nurses have so much knowledge and could be wonderful mentors, but they are tired. They don’t feel they have time to share their knowledge with the new grads. However, we need to support new nurses in order to keep them in this profession.

Improvement may come when more nurses from the trenches move into administrative positions. Administrators with business backgrounds don’t have the knowledge base that experienced floor nurses have. Nurses know what it’s like to work on the floor; they know the caseload, the needs of families and everything that needs to be dealt with.

After nursing for two years, my oldest daughter is just now feeling comfortable in her job.“I love building trust with each child and having time to touch each life.” I was so overwhelmed I left after only one year, deciding I was not cut out to be a nurse in a hospital. I had no one to talk to if I had a question or was stressed about learning a new procedure. Like many new nurses, I was afraid to ask for help or admit feeling incompetent, because I thought I would lose my job.

However, my desire for nursing never left me. I still felt that God had led me to be a nurse, but I hadn’t found my niche yet. When my mom was diagnosed with diabetes, I had the opportunity to work part-time in a diabetes clinic. I really enjoyed the experience, but it still wasn’t quite the right fit. As I would later discover, many avenues are open to nurses, and just because hospital nursing was not the right fit me, I would soon find the area in which I could use my nursing skills and thrive.

Currently, I am a nurse in an elementary school and I love it. I think it is important for children to see a nurse in a place where people aren’t sick. Of course, we have children come in with the occasional broken bone, contusions and the normal scrapes and bumps, but sometimes children come to see me because they need a place to take a break, or someone to talk to about their day or what is going on in their life. They may have stomach aches because their parents are divorcing, or anxiety because their father has just been deployed to Iraq. Or they may just need to talk to someone and know they’re not going to be in trouble. My job allows me to advocate for children and their families, to develop relationships and trust.

A diabetic student who’s been with me since kindergarten has now gone on to middle school. I felt like I was sending one of my own children off to middle school. She asked me, “Mrs. Johnson, can’t you come to middle school with me? Maybe you could trade places with the nurse who is at the middle school.” I love building trust with children and their families. If I can be an advocate for a child who does not have a voice and make a difference in that child’s life, it makes it all worthwhile. To me, that is what nursing is all about.

I also love teaching the children about healthy lifestyles. One example is teaching kindergarteners about hand washing and the importance of washing their hands before eating and after using the restroom. The next day they come to me and say, “I remembered. I’m doing what you told me. I’m singing Twinkle, Twinkle Little Star and washing my hands until I’ve finished the song.”

I’m thankful I didn’t give up my nursing career forever after that first frustrating year and I’m glad I stepped out in faith and kept on, even when I wasn’t sure where I would end up. Nursing provides a place for people who are compassionate, and there’s no better way to make a difference. School nursing allows me to do what I feel nursing is all about. Students ask me if I like being a school nurse and I tell them, “I love it. It’s different everyday. I get to talk with you and your parents and I wouldn’t choose anything else.” Two students have said they want to be a school nurse and help others like I have helped them. Sometimes the days are long and hard, and there are days when I feel unappreciated. But, it only takes one child or one family member to say, “Thank you for your help” or “Thank you for taking the time to listen.” It sounds so simple, but when I’ve made a difference in someone’s life for the better, it makes it all worthwhile.

Power Strategies: Support, Competence, Influence
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Marcia - Humor and Self-Care

2006-11-05T18:50:00.000-08:00

Marcia -

I work on the cardiology floor as a staff nurse. We take care of everyone from a 13-year-old who overdosed on drugs to a 107-year-old woman who's had a heart attack. We never know who's going to be there when we arrive. Once we had a pregnant 18-year-old who had overdosed on her heart medications, so we had two patients to worry about. Teenagers really tug at my heart.

My first responsibility is to give the medication the patients need, and then to offer comfort, information, and sometimes a little something to laugh at. I love the humor part, because I'm a clown, a registered clown. I love to play Let's Pretend and to escape into a role. I have a werewolf character, an Easter bunny, and a Frosty the Snowman. Becoming one of these characters allows me to escape temporarily from too much thinking for awhile. When I come back, my edges aren't quite so raw. I take care of myself that way.

I need that kind of self care, because working in cardiology can be emotionally draining."Look at yourself, see the imperfections, and laugh. That's the rule I live by." We had a 33-year-old woman who was riding in the car with her husband, and she just collapsed. Help arrived within ten minutes, but she was brain dead. She stayed with us for two weeks until her body let go. Her two children were just little--three and five. Of course they didn't understand. All they knew was that mommy wouldn't wake up.

On the opposite end, we had a fellow who coded. I was the first responder, and we worked on him for an hour and a half. We got him back. But when he got to our floor after his stay in ICU, he swore at us up one side and down the other for saving his life. That really cut.

So I deal with hard things in cardiology. It's funny, because my first impressions of nursing were, "Ooh, yuck. You do what?" But then I started working as a nurse's aide, and eventually I came around to thinking, "OK, I can do this. There are other areas of nursing where I don't have to be so involved with blood and other body fluids." But somehow I haven't quite made my way there yet! I'm working on it.

At some point, I'd like to move into cardiac rehab or diabetes education. I would still have the face-to-face contact that means so much to me. Because I'm a diabetic myself, and my mother died of diabetes, it's a personal issue, and I'd love to help people manage their disease. Educating people to avoid an onset of the disease, and helping them live more fully within the confines of the disease process--that would be very satisfying.

I try to educate myself about medical issues. A group of us have a journal club which meets over the lunch hour. We read articles on a specific topic and then discuss what we've read. That way, we keep up on the latest research evidence for a particular part of our practice.

When I go to a conference, I try to bring back information that will help our staff. We have a tendency to do things the way they've always been done, but we need to keep up with all the changes. Evidence-based practice, mentorships, clinical leadership--these are important topics in the nursing field right now.

"Every RN is a clinical leader," one presenter said at a conference I went to recently. When people hear "clinical leader", they usually think of nurse managers, nurse educators, directors of nursing, and so forth. But she had a different definition: "Every RN is a clinical leader. And you need to step into the role."

I like that definition. For myself, I try to step into the role of clinical leader by reaching out to nurses who are recent graduates and giving them support, both technical and emotional. The other night, a nurse who graduated only six months ago experienced her first patient death. I noticed that she seemed shaken, as if she wanted to cry but wasn't sure if she should. I put my arm around her and just said, "You doing OK?" She sniffed a little bit and said, "Yeah, I think I'm going to be OK now."

All the experienced nurses on a floor need to be mentors, so that no matter who's there, the new nurses can come and say, "I need help" without fear of being ridiculed.

I participate in a college preceptor program. The clinical portion of the students' final quarter is spent one-to-one with an experienced nurse. I have two students right now, and both of them are eager learners and capable workers. Student nurses aren't necessarily young people--some are displaced loggers and mill workers.

I'm also a mentor to the people I work with, because people always need help with something, especially computers. I happen to be a computer system "super user," so if it's acting up, somebody says, "Find Marcia!"

For me, what's central in all I do is to keep the ability to laugh. We get too serious about ourselves, we lose the ability to reach out to someone else. Look at yourself, see the imperfections, and laugh. That's the rule I live by.

Power Strategies: Creativity, Humor, Delight
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Beng - Change a Constant in Nursing

2006-11-05T18:10:00.000-08:00

Beng -

Nursing practices have changed in many ways since I first entered the profession. One of the changes involves the time we have with a patient. Years ago when I was in orthopedic nursing, patients who had hip surgery would stay in the hospital for 15 to 18 days. Now it's two days, which means we have to do everything within that time frame, including blood transfusions. We used to wait three or four days to give transfusions; now we do it the day after surgery. Care has become compressed into a smaller time frame, which makes it harder for the nurses.

Nursing is becoming more demanding because of new technologies. Nurses are not fully benefiting from some of the positives advances. For instance, in my unit, we still use pen and paper for almost everything except entering an order for a lab or ex-ray. Nursing care plans are not on the computer, even though that would help make our work more efficient.

In addition to integrating new technology in our work, it would be useful for nurses to learn better communication skills. I hear nurses complain about work situations, but I don't see them negotiating their complaints. They just let them go. Nurses need leadership training and interpersonal communication skills, but hospitals don't usually pay for that kind of educational experience.

Communication skills would improve the situation during union negotiations with management, because the two sides often end up attacking each other, then time runs out, and a decision has to be made in a hurry, which isn't necessarily the best one. I am frustrated by how often this happens.

I was involved in a situation where negotiation skills were helpful. We lost a business secretary position, which made the nurses' work very stressful. We had to answer the phones, then run to the patient, and back to the phones. It was a destructive working condition for the nurses, and for the patients as well.

I decided to step up and negotiate the matter with the manager, which was quite a process. I thought about the issue, wrote it up, and took the petition around to get signatures. Finally, we got the secretarial position back.

We have to take the initiative if we want changes, and that takes energy and commitment. The administration will listen to us, but we need to present good reasons and specific evidence.

I have a lot of ideas about technology, negotiation, and professionalism in nursing, but most important to me is the satisfaction I get from caring for patients. It is so good to see someone who is really sick get better, because of what we did for them. They come in to the hospital feeling miserable, and two or three days later, they can smile. After all my years as a nurse, I feel that I know how to help people with my expertise.

When I first went to oncology, I saw many people die."We have to take the initiative if we want changes, and that takes energy and commitment." It made me feel really bad. I even thought to myself, "I hate nursing." But I started moving to different floors, like orthopedics, where I could see patients improving and going home. So I felt better about nursing. And eventually I began to come to terms with my feelings about dying.

Now I work in neurology, and people do die, of course—from brain cancer or a stroke. Still, I can help them, even in their last days, or moments. I can help emotionally just by talking to them, connecting with them. And they can be made comfortable with medicines that are available.

I grew up in Burma, where attitudes toward death and dying are very different from here. Over there, when someone is obviously dying, doctors don't try to resuscitate. People accept death as something natural, both the dying people themselves and their families. Everyone knows that when death is inevitable, it's time to let go.

But here, sometimes a family member wants the patient kept alive, no matter what it costs. Even though the doctor explains the patient's condition and prognosis, often families don't want to hear it. We have to respect their feelings and values. Sometimes I talk to family members, away from the patient, and I talk to them from my experience with similar situations. Of course, they make the final decision.

I'm not afraid to take the initiative in those conversations, because I know that sometimes family members were absent when the doctor explained things, and sometimes the doctor did not explain things fully in a way they could understand. And, frankly, sometimes family members just have a hard time hearing … and that’s also my way of caring for them. … helping them hear.

Power Strategies: Leadership, Clarity, Care
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Bill - Cut the Mustard

2006-11-05T18:06:00.000-08:00

Bill -

I became a surgical assistant after a long journey from hospital housekeeper, to orderly, to surgical technologist, to nursing school and a RN, and then to surgical assistant training. It's a satisfying position; I feel that I do a good job, and the people I work with confirm that.

When I wake up in the morning, I don't dread going to work--on the contrary. When I'm busy at work, time becomes irrelevant, because I'm not watching the clock. I'm focused on what I'm doing and I'm concentrating on the work. It wasn't like that when I started out. After the first day as a surgical assistant, my whole body was tense and sore. But I told myself things would get better, because I knew skills take time to develop. As I began to relax, I enjoyed myself more, had more confidence, and my body loosened up.

I found out that surgeons are not bashful. They're not afraid to tell you you've done it wrong. But after awhile, as my skills developed, they actually became complimentary, and told me they enjoyed working with me. Eventually, I would be greeted with "Thank God you're the one that's on call tonight." Which is a big ego boost. And so different from the early unskilled jobs I had, where I was the outsider looking in. I'm glad I put time and effort into getting training to improve my skills.

I once had the experience of working with a surgeon who was impossible to please, for me anyway. At one point I felt I couldn't tolerate his treatment of me, so I spoke up. We talked privately, and I refrained from telling him off. I just said, "Obviously, we're not doing well together. What is it I need to do so things will be better between us?" After that we understood each other better and things were smooth.

One of the things that's frustrating about being an RN is the necessity for having a written or verbal order for so many things we do, even simple, obvious things. Some physicians don't seem to understand that, because I hear them complaining, "Those nurses can't even do this without calling me." They don't seem to understand that this is a legal requirement.

This creates a power issue, but not all physicians buy into that. I remember someone calling one of the physicians "the boss," but he didn't want that title. He said, "I've been to school longer than you have, but we're all here together. We're all working for the patient." He didn't think of himself in a hierarchical role. As it happens, he is part of a cooperative, and they seem to be more laid back, or more realistic – more cooperative.

The higher the academic degree, the farther up in the hierarchy you go. I'm an associate degree nurse, but I also have a bachelor's degree in another subject, English literature."I say what needs to be said, and usually people are so glad they're not getting screamed at, they say "Ok. Cool. No problem." I have an issue with the whole system of degrees in nursing. The nurses who graduate with a two-year degree have already earned at least 65 credits before they enter the program, including courses in all the basic sciences and liberal arts. After two years in the nursing program, they usually have from 150 to 165 credits, and a lot of patient skills. The four-year degree people start with zero credits and graduate with 180 credits and a BSN. There's no acknowledgement of what it takes to get a two-year degree. If I were a young man without a family, starting from the beginning, I'd become a nurse practitioner.

I've always felt that the profession of nursing as a whole has an inferiority complex. Maybe it's because it's been a predominantly female field, and they felt overpowered. There's no denying that. On the other hand, I've worked with female docs who seem to feel that I, as a male, could do nothing right. Of course there are more male surgeons than women, so what you see more often is women being put down. But I'd say the gender issues work both ways.

Conflict isn't only gender-based; it is not unusual to see it between nurses and doctors. Some docs are very ego driven, and they don't want to be told there's another way of doing things. "By God, this is my way and this is how we're gonna do it, and that's all there is to it."

I don't have trouble asserting myself, maybe because I don't feel threatened. If someone doesn't do something quite right, I don't feel like they're stepping on my turf. It's not personal. I can say "This isn't quite right," because I believe I know what's right for the patient. I say what needs to be said, and usually people are so glad they're not getting screamed at, they say "Ok. Cool. No problem."

But in any case, what's missing in the profession, in my opinion, is a lack of identity as a group, and a valuing of the nursing field. We're very fragmented. For instance, I'm an RN, but I seldom think of myself as an RN. I think of myself as a surgical nurse and a first assistant. I'm in a class with myself, and nursing is not my identity. My identity comes from the work I do in the operating room.

Power Strategies: Pragmatism, Excellence, Unitygo back to main page

Janis - Making a Difference Keeps Me Coming Back

2006-11-05T18:00:00.000-08:00

Janis -

I love diversity. The job changes I’ve made throughout my career allowed me to stretch myself to learn new things and take on challenges. I’ve worked in various nursing specialties, and in numerous communities. In each experience I gained new knowledge and skills, which I was then able to take into the next adventure.

My many experiences have been the building blocks for my self-confidence. Many times I found myself in situations where I doubted my ability to meet the expectation. In Alaska, I was hired as a charge nurse in a 24-bed hospital on a remote island where we had to do everything from OB to ER, whatever came through the door. In that job I discovered both my strengths and my weaknesses. Mostly, I found I was able to do much more than I ever thought I could.

Nights on the floor were isolating, I was the only RN and the hospital was locked up.“Yes, nursing is about the patient, but it’s also about the doctor and your co-workers and taking care of each other.”When the doorbell rang, I always hoped for an ER instead of an OB patient because it was crystal clear the situation was urgent and I had to take fast action whether the doctor was there or not. Babies and OB aren’t my comfort level and they don’t wait so I did two deliveries by myself. I’ve participated in many deliveries on a team, but only two by myself. I was scared out of my mind dealing with two different patients. And, was incredibly thankful and relieved (and proud of myself) when it was over. When you have no choice, you draw on everything you know and bring your skills and knowledge to bear to rise to the occasion to the best of your ability.

I left that job to move with my husband, a law student, and our children back to Washington State. When we arrived, there was an abundance of nurses and it was difficult to find work. I held a series of positions until I was hired as charge nurse at a clinic, where I’m still employed. This job stretched me again, because I have never worked in a clinic and it’s up to me to manage the staff and run the internal medicine unit. Again, I faced a learning curve and it was somewhat challenging because it is certainly different than any other work setting I’ve done.

I’m very up front with people and I believe you need to have fun in your work; otherwise, you have to ask why you are doing it? I mean, I’m serious about what I do and what I want to happen, but I also like to have fun. If you don’t lighten up a bit, work in health care can be overwhelming. It seems the group here has responded well to my management style. We have our ups and downs, and I feel good about the way everything is progressing. We just have to do the very best for the patients, for the doctors, for each other, and for ourselves.

The quality I cherish most in my profession is patient advocacy. I’m proud when I truly make an impact, when I know I’ve stepped in and said something, did something, organized something, or whatever it was, to make a difference. Whether it was pointing someone in the right direction or saving someone’s life, making a difference is what keeps me coming back.

I often remind myself to treat the young nurses with a firm, yet gentle, hand; to point them in the right direction. We all need to embrace the concept of taking care of people, and nurturing them too. Yes, nursing is about the patient, but it’s also about the doctor and your co-workers and taking care of each other. There have been people in my career who nurtured me, and I really appreciate them.

Nursing is constantly changing. If you don’t like change, don’t go into nursing, because it’s been changing since the first day I stepped on the ward 36 years ago. The “we always did it this way” attitude doesn’t fly in the field of medicine. Look at it as being on the cutting edge of a very exciting field. Embrace change, and you’ll find nursing an extremely rewarding career.

Power Strategies: Challenge, Change, Capability
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Gwen - Knowledge Lets Me Trust My Intuition

2006-11-05T17:56:00.000-08:00

Gwen -

I’ve always striven to learn everything I possibly can. It’s important for nurses to continually study and learn new things throughout their careers, because the larger your knowledge base, the more confidence you have in your intuition. There is so much more to know than what is in the textbooks at nursing school.

Intuition comes naturally to me. I walk into a room and know immediately if a patient is not doing well and if I should call a doctor. I’ve learned to trust myself and my instincts and pick up on the little nuances, like maybe their blood pressure is within normal limits, but it’s a lot higher or lower than it was then they came in. Or the patient is breathing a little harder or their skin color isn’t good. Being able to pick up on those things helps me advocate for the patient. I know what they need, even when they don’t ask for it. I can sense things about people, like when they are uncomfortable or sad. Some nurses will hesitate to call the doctor to say this patient isn’t doing well because they don’t have enough knowledge to be able to put the pieces together.

I’ve called doctors at night and told them that this and this and this is wrong. Then the doctor gives me an order, or maybe they don’t. I’ve told those doctors, “You know what? You need to come in here. This patient needs medical intervention, not nursing assessment.” And every time the patient I called about ended up with some big medical procedure that needed to be taken care of right away.

I don’t hesitate to put my arm around my patients and give them a hug, hold their hand, or whatever I feel they need to make them better. Sometimes nurses get so focused on physically taking care of the patients that we forget the patients’ emotions and spirit; their need for contact and love and to know somebody cares. I always cry with families when someone dies. People appreciate that their family member was important to me and it matters to me that they died.

I once had a surgery patient I saw all the way through his procedure. I got him ready for surgery, recovered him and provided patient teaching along the way. When I was sending him home he reached over and took hold of both of my hands and said, “You know things and you use that to help people.” It made the hair stand up on the back of my neck because I knew that, but I never heard it verbalized.

He was right. I do know things about people and I use that in my practice and in my life. It’s made a big difference in the outcomes for my patients. I’ve worked with other nurses whose values I appreciate and try to emulate. I’ve worked with nurses who have a wonderful sense of humor and no matter how mean and ornery their patients are, they walk into the room and just crack up laughing. They have a way of using humor to connect with their patients. They don’t take it personally. It’s a great talent to develop.

I’ve been impressed by nurses who were completely non-judgmental. They never judge people because of their lifestyle or culture – everyone they encounter is treated wonderfully. Every patient has worth.“I’ve learned to trust myself and my instincts and pick up on the little nuances that help me be a strong advocate for the patient. I know what they need, even when they don’t ask for it." I’ve worked hard to be like those nurses. My ability to nurse is enhanced by my respect for cultural differences. If a patient’s culture has taught them to defer to a certain family member for answers, then I have to respect that and go to that family member and involve them in planning the patient’s care. If a patient’s culture has taught them to be modest and they believe in being covered, then I have to take special care during their bath or dressing change to keep everything as covered as I can. If I see a doctor come in and whip off the covers and lift the gown to check out their dressing, I position myself so I can get the gown pulled down as far as possible or cover their legs with the blanket, to help support their cultures, beliefs and standards.

I’ve always seen myself as a professional. I know some nurses believe they are below the physicians, but I’ve never felt that way. Nurses are separate and distinct from doctors. We have different legal privileges, because they can write the orders and write prescriptions, but on the same hand I have the ability not to follow those orders if they are detrimental to the patient. Nurses provide a lot of care for the patients that the physicians don’t know how to provide. We need both physicians and nurses to work as a team for complete care of the patient. I present myself as an asset and a part of the team, so the physicians always treat me that way. Physicians will ask my opinion as much as I will ask theirs. I feel respected and sought after by everyone I work with. I’ve always thought of myself as a consultant, advocate and practitioner – more than just a worker.

My confidence comes from very early in my career. One of my first jobs was in a little 40-bed hospital. After working there about four months I took the night shift supervisor position and for two years I did everything. I was the ER nurse at night and I relieved the floor nurse for breaks. The hospital had a 4-bed ICU and I relieved the ICU nurse for breaks. When a patient came into the ER, I set up the breathing treatments and drew blood and put it in the centrifuge to spin and called the lab technician that was on call and turned on the X-ray machine and called the X-ray person who was on call and got the supplies from the storeroom and food from the cafeteria. It was a great base for experience.

I’ve always been a “teacher” and whether I’m teaching things to my patients or to other nurses, I use my intuition to teach without making people feel like they are stupid or have a knowledge deficit. I see other nurses being abrupt or demeaning or condescending when they try and explain something that they think people should know. I don’t think they even realize that they’ve assumed a discouraging attitude with people. That can be detrimental to new nurses. You can’t teach someone if they don’t feel you respect them as a person.

Nurses are just like everybody else. Some are more nurturing than others. Some learn more easily and some are more motivated. The population of nurses is a reflection of the population in general. Personally, I think having good people skills is good for your whole life. It helps you relate to everybody better. But it’s especially important for bedside nursing and especially for those who are preceptors and mentors and teachers of our students. Nursing instructors need to have a passion for nursing and for learning. It’s important for them to convey that to students. It’s important for the managers and nursing instructors to work together to make sure students get mentored by the nurses that are nurturing. I see nurses that have been working for 30 years and are very good at nursing, but they’re not good with new graduates. Some new nurses give up early in their career, not because of the patients or physicians, but because other nurses don’t help or support them. We need to recognize the bad teachers and limit students’ contact with them as much as possible.

I love nursing; it’s my life. I am passionate about quality in nursing and in nursing education. Some of my son’s friends want to be nurses and I always make a point to tell them that it is a great profession and I’m very happy to be a nurse. It’s all I ever wanted to do. There isn’t even a word to describe how I feel inside about what I do. I have tried and tried to find the right word, but every time I think about it, all I come up with are tears of joy. I’m honored to have found my calling.

Power Strategies: Intuition, Passion, Respect
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Gertrude - Retired, but Still Nursing

2006-11-05T17:50:00.000-08:00

Gertrude -

I grew up in the south during days of segregation, and had to leave home at eighteen to attend nursing school in another city because I was not allowed to attend the school in my hone town. I made up my mind nursing was what I wanted to do, and no sacrifice was too great. I attended a three-year nursing school in Kansas City, MO, and received my diploma in 1951. My father died that last year of my training, and at the urging of a sister living in Seattle, where my mother and two teenage sisters had also relocated, I moved to the Pacific Northwest to help my mother.

I was offered a position shortly after my arrival in 1952 in the operating room, which was my first love in nursing, so I was happy to find a position there. It was a real awakening for me; I had never worked in an environment of desegregation. It took me awhile, but I adapted well.

After working for eight years as a staff nurse, I took the opportunity to promote to assistant supervisor. Back then dedication and hard work were the standards used for promotion.“Nursing is part of my spirit and has made my life full.” I did not have to interview for the position, I was chosen by my supervisor, even without a college degree. My supervisor saw potential in me I never knew existed. I’m grateful to her for her foresight. Her vision helped me grow into the person I am today.

Harborview was a teaching hospital and I enjoyed the student nurses. Over the years there were many student nurses, exchange nurses from other countries, medical students, and newly hired RN’s and surgical technicians to train. This was stimulating to me. I loved teaching and watching growth. I tried to keep them confident in their ability to perform. At the end of the day I wanted them to know they had done a good job.

I also was the peacemaker among staff. I was taught to treat people the way I would like to be treated and it bothered me to see people being harsh with co-workers, because I knew if that same burden were put on them they wouldn’t be able to take it. I think I did more peacemaking than almost anything else because people discovered they could talk with me.

Things have changed a lot since I first became a nurse. In the early years we were so busy setting up the room for surgery we did not take time to speak with our patients until they were wheeled into the operating room, and many times they were already sedated. I was so happy when that changed and we were required to do a pre-op visit with our patients, either the day before and/or in the surgery waiting area. To me, the patient connection is what makes nursing meaningful. Nursing is part of my spirit and has made my life full.

Nursing is why I was put on this world. I love the people I work with and I love the patients. I feel passionately that it is what I’m supposed to do, and I feel spiritually connected to the patients. Many times, when patients had difficulty facing surgery, the staff would ask me to talk with them. Sometimes I would pray with them or say the 23rd Psalm. I’m a dedicated Christian and providing comfort to patients is a gift God gave me to use.

I retired from nursing after 30 years. But I didn’t stop working entirely. I continued part-time work as a staff nurse and thought I would continue working until I didn’t want to work anymore.

Part-time work can be a problem because there are days when the staff is short and I was constantly asked to work extra days. I would fill in even though I knew I was getting too many hours to keep my retirement status. I just couldn’t say no. I was finally told to either return all the money I had received for retirement, or quit. So I quit. I was only 52 and not ready to retired. I loved my job so much, and was sad to leave. I tried not working for a while, but finally decided retirement wasn’t for me. I took an operating room position and worked for 13 more years. I would have kept working because I enjoyed my job, but at 65 my arthritis was progressively getting worse.

By then equipment and instrumentation was getting so technical, I was ready to really retire. I came into nursing during the days when we were sterilizing instruments by boiling and making our own saline solution.

After my final retirement, I spent my days visiting nursing homes and people who were sick in their homes. This was a commitment I made long before I retired. I called on people in the evenings and on Saturdays, but after I retired I had even more time to do it.

The best nurses have a calling to help, or contribute, or give. They are able to put themselves in the patient’s place. When I was in the hospital last year I had many nurses, but only remember two who really showed that they cared about me as a patient and a person. The rest would come in and change bottles and put up medications, but even if they asked, “How are you?” they didn’t look at me or wait for an answer. I didn’t feel respected by them. The two that showed they cared would come in and spend time talking with me. They were reassuring and took time to answer my questions and talk with me about my concerns.

My advice to those who want to enter the nursing field is to think hard about it, speak with veteran nurses and get a feel for the profession. Don’t take the same route I did to decide my future. I spotted a billboard with a nurse in a white uniform, looking so professional, and decided that day I was going to be a nurse. I decided without ever having been in a hospital. I now feel God was with me as I decided, because while still a student I knew this was what I was called to do. That conviction never changed, only grew stronger.

Power Strategies: Achievement, Commitment, Compassion
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Tami - Honoring the Spirit of the Patient

2006-11-05T17:46:00.000-08:00

Tami -

I’m a pre-admission testing nurse. I help patients get everything organized prior to their surgeries. I either visit with them face-to-face or on the phone and review everything they will experience from preparation the night before surgery through expectations after their return home. I be sure to show them where there power is over what’s happening, because many feel powerless when they find themselves needing surgery. I love my job because I can give patients options by educating them about the choices they have in their care. Knowledge is freedom. When the patient is empowered, they feel better about their procedure.

Recently, I had some health problems and almost died. My experience in the hospital was an eye opener. It was a really bad experience and has changed the way I function as a nurse. It taught me to be more humble; more appreciative. I now want to be more attentive to the people I care for. When my patients leave the hospital I want them to say, “Hey, she was pretty cool and she did a good job.”

Because of my horrible hospital experience I am adamant that we, as a staff, do better. I want nurses to be accountable for what we do. I wasn’t looking to be treated special when I was in the hospital just because I was a nurse. But I did want to be cared for in a nurturing way. I had earlier experiences in hospitals where I was treated awesome. But this last experience told me it was time to verbalize the problem and be part of the solution.

Some veteran nurses have become calloused. They don’t have emotions. They don’t focus on patient care, just on the technical aspects of the job. Nurses need to become humane again.“Doctors heal the patient’s condition; nurses heal the patient.” Be healers and teachers. Focus on making patients and their families more comfortable. We need to find the root of the nursing profession again; compassionate patient care, showing emotion and empathy and all those things that make people connect spiritually. Even if you don’t believe in religion, you still have a spirit inside of you. Take two minutes, sit down and let your spirit connect with somebody else’s spirit.

Sometimes the patients I talk to on the phone are elderly and don’t have many people to talk to. They’ll say, “Oh, I’m keeping you.” I always tell them, “You are not keeping me, this is my job. I want you to tell me what you’re thinking.” I’ll take the time that is needed to be on the phone with a patient so they get their questions answered and their fears allayed. Sometimes it takes a long time, but it takes as long as it takes. And, the patients remember my name, they call me when they have a crisis, and at least they know they have a person who is going to listen.

Nurses still have to think with their heads for the things that need to be dealt with intellectually. For example, if somebody comes in bleeding, the first thing I’m going to do is stop the bleeding. But then I remember that is not just a wound I’m attending to, it’s also a person who is hurting.

I am not a doctor. Doctors heal the patient’s condition. Nurses heal the patient. I look at the patient and think how I would treat the patient if it were my mom or dad or anyone else I really cared about. Would I slap something on the wound and walk away? No! It literally takes just a few minutes to ask, “How did this happen? Are you okay? Can I get you something?” We are not so busy that we have to skip that personal contact.

The insurance companies may think economically it’s better to fix the immediate problem and shove people out the door. I believe if we get to the basis of what’s going on with the patient, we’ll actually save money. If we simply slap a Band-Aid on the wound, that patient will be back over and over again and we end up spending more money because they are repeat customers. If we take the time to get the patient’s history and deal with everything that is going on, we may solve the underlying problems and not see the patient back for quite some time.

Once a patient came into emergency with an injury – he had been stabbed or something, I don’t recall. The anesthesiologist walked up to him and asked, “What kind of drugs do you do?” The man told him, “I don’t do drugs.” I then sat next to the man and asked, “What have you been doing today? Did you do some cocaine? I’m only asking because the drugs you have in your system may affect your anesthesia. It could affect your recovery or even your life. You could die if you’ve taken something and you don’t tell us.” I didn’t approach him gruffly or judgmentally. I simply treated him as a human being and presented the facts. My spirit was asking him to tell me so I could help him. He then listed about ten medications he’d gotten off the street. The end result was better, less expensive care for him. And the process it took me was not time consuming.

It doesn’t matter if a patient is homeless or the richest person in the world, they will get the same care from me. My calling is to heal the patients’ spirits, their very beings. I want to show up and be part of their process. They may not remember me ten years down the road, but they will remember they had really good care.

Power Strategies: Spirit, Purpose, Connection
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Glenna - Teamwork in the OR

2006-10-30T19:47:00.000-08:00

Glenna -

I work as an operating room nurse, and I have never wanted to work anywhere else. For the last 20 years I have been a manager, and currently I am Director of Surgical Room Services. It's a scary job in the sense that I'm responsible for people's lives, for physician and surgeon satisfaction, and for the hospital's bottom line. And of course for good outcomes for patients in our community.

As a manager, I try to find out what jazzes my people, and then give them opportunities to do that."When you scrub in on a case, when you lay hands on a patient, all the things you do to get ready--it's like a dance to me." I recognize people on a daily basis for specific things they do: "Thank you for staying over last night; it really made a difference in the patient's outcome." I try to send a thank-you note to their home once in a while, to say I've noticed something special they've done. Or I give them a day off, or take everyone to breakfast. I inquire about their families. I want to know if they're hurting emotionally. Things to let them know they're more than staff, they're people to me. It keeps them motivated.

In the operating room, it's important that my staff have the equipment and supplies they need, so they can do a good job for the physicians. When they tell me about a problem, I try to act on it right away. We are practicing a very technical form of nursing, and we need specific things to do the jobs successfully. If it all works, and if I get a compliment from the physician, I pass it on to the staff. I'm their cheerleader, and they're mine as well.

I need the same things they do. Recognition, team work, and cooperation make me glad to be at work. Having a physician say, "You made me feel like a king today." Staff giving each other a high-five in the corridor after they've done a good job. Seeing people take care of each other and buoy each other up, rather than tearing each other down. That's what jazzes me.

I'm also very intrigued by the technical aspect of operating room nursing: fixing something that's broken, the actual mechanics of it. And making a difference in someone's life because of how well the technical part is working.

On the human level, I know that patients are more vulnerable in the operating room than at any other time during their stay in the hospital. In the operating room, they're asleep, and can't advocate for themselves. Being there for them and being their champion, and doing it on a one-to-one basis, is very satisfying to me.

The surgery process itself is rewarding. When you scrub in on a case, when you lay hands on a patient, all the things you do to get ready--it's like a dance to me. There's a progression--passing the instruments to the surgeon who is operating on the patient, and you being part of that, making it smooth, making it flow. You have a bond with that team and with that patient and with what's happening at that moment.

When things don't go well, there's an emotional toll. Sometimes everyone's working hard, and you find that the patient is going to have a bad outcome no matter what you do. Though it's not what you hoped, it's something you share with your team in that moment. It's part of you now. You make an agreement to go in and stay until the end and you are part of the dance.

In spite of the seriousness of surgery, we try to keep the room lighthearted when we're working. We try not to do anything negative, because I believe that even though a patient's asleep, it affects them. When the anesthesia is taking effect, we hold their hand and say, "I'll be here. I'll take care of you. Don't worry." Patients want to hear that. I don't care if it's a 200 pound biker, or a skinny 86 year old lady.

We look at their physical state during the surgery, too. Are they warm? Is there pressure anywhere that might cause a sore when they wake up? How's their fluid and electrolyte balance? And then we communicate about that with the physician. So we're making sure everyone has what they need to do the technical parts, and at the same time we're keeping the atmosphere in the room comfortable.

The physicians know that everyone on the team plays a vital part. Nobody is less, nobody is more. The surgeon performs, but other people provide the necessary means to make the ballet happen.

For me, I've always been compelled to do something that has meaning. We're part of such a large world, and we're just tiny insects by comparison. If I can build a team that will do excellent work and give to the community, then my life will matter. I need to give what I can. And in doing that, I feel fortunate. I feel like the luckiest person in the world.

Power strategies: Symbiosis, Love, Influence
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Dawn - Social and Political Activism: A Form of Caring

2006-10-30T19:35:00.000-08:00

Dawn -

I'm proud that I'm a nurse, but it took going back to school and broadening my view of what nurses do to feel that pride. Returning to school helped me discover the community and leadership aspect of nursing by experiencing community work and being challenged to make a concrete difference. When a nurse executive in a hospital where I worked early on advised me to get a Bachelors degree, I was skeptical. I was a terrific nurse, why would I need a BSN? Later I had to go back and tell her "Thank you. You were so right."

I learned the values of our profession from the nurses on the faculty at the University of Washington-Tacoma. They broadened my world to extend beyond the bedside. One of the first papers I wrote was Social and Political Activism: a Form of Caring. And now I'm in the Washington State House of Representatives.

I chair a long-term care taskforce for the State of Washington, and we've been going around the state holding Town Meetings."If all the caring professions in this nation got together, they would be a powerful force. I'm talking about social workers, firemen, policemen, physical and occupational therapists, mental health professionals and others - the people in caring professions." A man spoke up at one of the meetings and said, 'I'm a conservative Republican and I agree with everything my friend the liberal Democrat just said about the need for long term care." Not all Republicans would agree, of course, but there's a growing consensus that we must do better in the health care area. I try to be open and listen for what we have in common. Nurses are educated to be advocates and that is what I do when advocating for affordable quality health care as a lawmaker - health care tragedies affect all families. We all want to live our lives with dignity whether we are disabled or elderly or ill.

One year the state had a huge budget deficit, and the only solution offered by big business was to cut education, health care and workers that provide care for elderly and individuals with disabilities and only give business tax breaks. I challenged them to become part of the solution - while we must grow the economy we can’t bankrupt our children’s future and neglect our vulnerable. A budget is a moral document in that it reflects the values of those who write it. A nurse asked me the other day if I could identify the biggest problem we have in this state and in the nation. And I said, "Pure unadulterated greed." It's in health care and everything else. How much money is enough?

The big pharmaceutical lobbyists say to me, "Dawn, you don't believe in free enterprise." And I say back, "I don't believe in obscene profits at the cost of lives." That's what we're really talking about. People's lives.

It's not OK to be forced to choose between staying home to take care of a sick child or losing your job. It's not OK if your child gets sicker because you don't have health insurance and you end up at the ER. There are more kids with asthma now than ever, and it has to do with poor air quality and environmental toxins. These are political issues.

A journalist who covers the state house told me, "I've noticed a change in the legislature since the nurses have been there; a softness has happened." Of course, all of us were
laughing because we don't think we're soft. What we do is, we tell our stories, the very personal stories that reflect what we see and what we hear. What we know. Don’t ever ask this nurse legislator to give health care coverage to only “some children”.

The nursing voice in the legislature--there are eight of us now--has made a difference, because when we tell a story about someone who died because they couldn't afford their medication, the legislators have to listen. They can't argue with it. We have powerful human stories.

If all the caring professions in this nation got together, they would be a powerful force. I'm talking about social workers, firemen, policemen, nurses, physical therapists, occupational therapists, mental health counselors - all the people in caring professions. But they can't seem to get together. They get torn apart by issues like abortion while working together for a just society would help us solve many moral dilemmas. We don't realize the power we could have.

Nurses on the job need to learn that too--what our real power is. I say to nurses, "Walk into that room and take their hand and say, 'I'm Dawn Morrell and I'm the registered nurse on duty and I'm in charge of your care tonight. I'm the person who's here to help figure out what you need. Can you tell me what's at the top of your list?'" We need to let patients know who's in charge of their care, and we have to demand acknowledgment of the importance of that. I have a button on my nametag that says “you need a nurse to save your life.” It is true, who is the person responsible for catching the error at the bedside that may harm your or your loved one? The nurse.

We have to talk about empowering the people who work at the bedside and letting them make the decisions. And we have to be respected and paid for that. It amazes me that hospitals are willing to pay inordinate amounts for traveling nurses and agency nursing, but they try to save money by cutting back on overtime for the regular nurses.

The other night I took my heart attack patient down to the ICU, and the charge nurse said, "I'm here by myself with a floor full of travelers and agencies who can't get into the computer. They don't have codes. They don't know the doctors. And I have my own patient load." I told her, "You need to write a quality assurance memo right now. Say, "I am in an unsafe situation. Send it up and keep a copy." But sad to say, most nurses won't to do that, and there is precious little time to do the paperwork. I've said to my nurses, "You know what? I'm gonna get damn portable backbones and pass them out to you guys!" Stand up for yourselves and your patients. Nurses have powerful voices when they speak individually or collectively. That is what I do as a legislator in Olympia I stand up and advocate for the people I serve.

Power Strategies: Community, Collaboration, Influence
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Gail - Caring for One Another: That's What it's All About

2006-10-30T19:31:00.000-08:00

Gail -

I worked for thirty years in obstetrics in different capacities, including charge nurse and supervisor. I saw many changes through the years in OB. I remember delivering pre-term triplets one night, wrapping them in blankets and running down the hall to the nursery with three babies in my arms. How things change! In those days no family members could be in the labor rooms with the mothers. Husbands could visit, but only briefly. Nowadays, anyone the mother wants can be in the labor room. Once we had both the husband and the boyfriend in there, and they got in a fist fight by the nurses' station. We had to call security.

After being a regular staff nurse, then supervisor, I worked as director of the unit for a year. I found that pushing papers didn't suit me. I worked 12-hour days, and even at home I would be answering questions on the phone and doing paper work. I was on a whole bunch of committees where people were playing games. I had to do a lot of smiling when I didn't mean it. I felt like a puppet on a string.

Taking care of patients is what makes nursing satisfying for me. I like making a difference in people's lives, by helping them to be courageous and by helping them get well. I like to work with a good team--the surgeons and anesthesiologists, and the nursing staff.

When I was a child, I spent many weeks in the hospital with long episodes of pneumonia, so I was all-too-familiar with oxygen tents, penicillin shots, and bedpans. Some of my care was good, and some was questionable. I haven't forgotten the lessons I learned from the good and bad nursing I received. And, it has become my mission to provide a good hospital experience to the people I see.

As nurses, we see people die sometimes. That's difficult. I remember when I was a student, I took care of a middle-aged woman. She had been carrying groceries across the street when she got hit by a car.
"We will all need the help of nurses someday, in one form or another. As a nurse, I try to care for each person as I would want to be cared for." I was in the ICU trying to help her, but she ended up passing away. I had to go out and talk to the daughter and tell her that her mother had passed away. We sat on the bench and both of us cried. That was very hard, and sad. But if I couldn't feel sad, I don't think I could be good nurse. You've got to have an open heart and you have to be compassionate. You have feelings as a human being. You empathize with the family members left behind, and you cry. And then you move on, but it's an experience you don't forget.

Actually, I suppose not all nurses are compassionate, or they don't react the way I did. I've had nurses take care of me who weren't very sympathetic.

The job is always different. I like being on my feet, moving around, though I do get tired at times because I work three night shifts a week, 7 p.m. to 7 a.m. When I'm feeling exhausted, I remind myself that I'm making good money, and I can go home in a few hours. When I come home, my husband has the bed all made for me, with my electric blanket turned on, and the window curtains pulled. He makes sure it's quiet, since I sleep during the day. I really don't have any reason to complain.

For the last six years, I've worked in the operating room. I've seen quite a few changes in the years I've been a nurse. Advances in technology mean nurses have to keep learning. Nurses are pressured to learn and need more technical skills, as well as nursing skills. Good judgment has always been important, but now everything is more complex.

I see quite a few problems in the nursing profession these days. The shortage of nurses is a problem. Nurses are overworked on the job, and the quality of care for patients is lowered. Nurses are being replaced with nurse technicians, who have entirely different training. The ratio of patients to nurses has increased. We have some nurses from other countries who have difficulty with the English language, which makes it hard for them to understand the patients' needs, and to communicate with doctors.

Nursing schools are harder to get into these days, and yet more nurses are needed. Especially in geriatrics, in nursing homes. Most of them are run by one or two RNs and the rest are aides. The aides work hard, but they just can't provide total nursing care--physical, psycho-social, and spiritual care while the RNs are busy doing the paperwork.

The honest truth is that we will all need the help of nurses someday, in one form or another. As a nurse, I try to care for each person as I would want to be cared for. Caring for one another: that's what it's all about.

Power Strategies: Care, Empathy, Commitment
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Mandy - Learning in a NICU

2006-10-30T19:28:00.000-08:00

Mandy -

Working in a neonatal ICU is a real challenge. Especially as a new nurse, I had so much to remember, so much to know, because many things can go wrong with a newborn baby. It took me a long time to develop my skills and my judgment, but eventually things began to flow naturally. It just took time. Once I got more comfortable, I could think more easily, and know how to care for babies and their families more skillfully. But at first it was overwhelming.

Sometimes I could catch a problem with a patient before anyone else. That was amazing. Once I was transitioning a c-section baby, and I discovered an arrhythmia. After a work-up, it was determined the baby was fine and went home on schedule. I felt good because I had acted in a medical role by listening to the baby's heart, like every nurse should. From then on, I listened to infants' hearts with the memory of that incident always with me.

I had some supportive preceptors who helped me through the process of adjusting, and I'll always treasure those relationships. But some other people around me were not always helpful. They expected me to know everything right away--at least that's how it felt to me. I got a few rude comments, such as, "You should know this by now." That was hard to hear.

I also heard encouraging words, which were priceless. Both experienced and inexperienced nurses have told me, "It's gonna be OK, and you're gonna get through this day." Hearing that in the middle of a frustrating or difficult shift makes a huge difference. When I have a supportive group of nurses and doctors around me, I feel empowered.

In our NICU unit, nurses have a lot of autonomy. The doctors trust us to do the right thing, which makes us want to work even harder, to do an even better job. In a good unit, the doctors respect the nurses, especially as they get to know us over time. The camaraderie that develops is wonderful, and it makes for less of a power struggle. I know that tension and clashes do happen, but in my unit we work well together.

What drew me to nursing in the first place, is simple: helping people. I know that's a cliché, but it's true. I try to make a difference to a patient or family during every shift. I want to know that someone's experience in the hospital will be better because of how I cared for them. To transform a traumatic time in a family's life into something positive, or at least bearable--that's my mission.

It gives me joy to help someone through a hard time. With the babies, I can make them calm or take away their pain."It's gonna be OK, and you're gonna get through this day." With families, I can do more: like encourage them to laugh about something, maybe. I can listen while they share what they're feeling. I'm a stranger, their baby's nurse, so when they open up to me, it's a privilege. But when they begin to trust me, I feel good about myself.

When my best friends delivered their baby girl two months early, she had multiple anomalies and ended up in my NICU. All of a sudden the roles changed and I wasn't a nurse there. I was an outsider, looking for answers to unanswerable questions. I had a glimpse at what parents must feel when their baby is in intensive care. She lived for almost three days, with unfailingly loving and gentle attention from the nurses. I'm so grateful my friends and my god-daughter received that kind of care. More than I can say.

I'm not working as a nurse right now, because I resigned to stay home and take care of my kids. After they all get in school full time, I'll go back to nursing. But for now, I want to focus on my family. My husband is a policeman, and he understands about my job. Working at the NICU, I saw some of the same people he had seen. Some of my moms were down- and-out; some were drug addicts he had encountered in his work.

Nurses and policemen are both trying to make a difference, in our own ways. My husband thinks of his work as protection, not punishment. Just like I protected the little ones in the NICU. Those babies were in my care, and I did the best I could to help them so they can grow up healthy. That's what I want for our own kids, and that's what I try to do for their kids.

Power Strategies: Making a Difference, Family, Humor
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Cathy - Beyond Perfectionism

2006-10-30T19:24:00.000-08:00

Cathy -

It’s taken some maturity on my part to put my focus on what really matters – my desire to serve others. Even when I get called in the middle of the night, I stop whining, change my perception and tell myself I'm lucky to be able to help someone live another day. I had to learn to ask myself what’s more important, "my night's sleep, or showing up for the person who's on the table hemorrhaging."

Having hit bottom in my personal life a few years ago forced me to do some core work on myself and on my attitude toward life. The choices I made and the positive changes in me as a result are reflected in my nursing practice - how I deal with coworkers, physicians, everyone I meet professionally. I try to let people be who they are.

I have a different perspective on people because of what I've been through. I don’t engage in blaming or criticizing anyone else because I myself was the person with the chip on my shoulder, the person in a coat of armor and really, I didn't want anyone to know how scared I was. I think that’s how a lot of people are. Now I can be more compassionate.

And it’s a good thing because my specialty is cardiac surgical nursing. The hardest thing about it for me is dealing with the personalities of people who work closely together, physically, for hours at a time. Even though I can handle it most of the time, I do get stressed. I've had to learn to lighten up – not be such a perfectionist – and take care of myself emotionally, physically and spiritually.

I had a transformational experience as a volunteer on a medical mission to Bolivia. Serving there on a cardiac team helped me see things very differently. I've never worked so hard with so few resources for so many hours. It was totally volunteer and the payoff was tremendous. I would pay to do it again. It changed me in every way.

The people there were incredibly helpful and grateful. I was stunned to see how they did so much with so little. They were appreciative of everything we did. I streamlined their instrumentation and set up and showed them ways to pack supplies more efficiently.

I was astounded at their generosity. I make more in a day than they make in a week, but they kept giving us gifts."She gave. She helped me. She made a difference in my life." I still have the earrings one of the technicians gave me. We returned four years later to volunteer again and the people in their OR were still using methods I had showed them. I got to make a big difference in those trips. My husband, who is also a nurse, and I have discussed doing extended missions after our kids graduate from college.

Being a cardiac nurse requires me to be totally engaged. When I’m at work I don't think about other stuff. I try to check my own issues at the door, and focus on the team and the patient and what I'm doing here, right now. I get very present and that makes me feel alive to what I’m doing. Sometimes I need that reminder, not only that I’m saving a life, but that my life is happening and it has meaning.

I also need encouragement; everyone does. Once I worked for a charge nurse at a trauma center who had a very difficult and stressful job. She delegated hard projects to me and held me accountable for outcomes. Sometimes I thought I would buckle under the pressure, but for some reason, she believed in me. I asked her, "Why do you always give me these kinds of difficult projects?" She said, "Because you do them so well." I had to stand back and think about that. I realized I did do them well, and I still do. Her acknowledgement of my skills gave me confidence in my competence.

After all this I realize being in service to others, rather than being on the clock has provided me with a sense of purpose. I feel enriched because I have something I can give to other people and it makes a difference. When I'm dead, I don't want people to think, "She made a lot of money." I want them to think, "She gave. She helped me. She made a difference in my life."

My experience as a nurse seems like it bounces around a lot and may not even look cohesive to some people. But through my own personal journey I have learned that we all need compassion, patient or nurse, and I feel like I am able to offer both.

Power Strategies: Courage, Introspection, Accountability
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Elizabeth - Why I'd Rather be a Nurse

2006-10-30T19:20:00.000-08:00

Elizabeth -

Even when I was a candy-sriper at 45, I always enjoyed the challenges in nursing, but it gets difficult at times. Sometimes I wake up in the middle of the night, wondering if I checked the allergy band on a patient. I have actually called the floor from home in the middle of the night to ask if the patient was OK. The mental stress is hard. I'm always thinking, "Did I double check that med before I gave it?"

The part I like most is when patients say, "Thank you so much for taking care of me." I know I make a difference, even if it's just comforting someone by holding their hand when their family's not there. Or helping someone pass away peacefully. Or helping them get back to their pre-hospital state. All that makes me happy. But, what really makes me happy is the preventative education of patients.

It takes a toll when things go poorly and I write in my journal to process. I talk to my fellow nurses, who are my dearest friends. If I have a rough go of it or a disagreement with a physician, I talk about that. Or I might take a run around the track for five miles and free my mind by not think about anything.

Physicians are under a lot of stress, too. Patients sometimes take out their frustrations on their doctor when things aren't going right. I work with some wonderful physicians, but they can get cranky and take it out on the nursing staff. I don't have a problem with confronting them in a professional way – one care giver to another.

But some physicians don't take nurses seriously. They make comments like, "How many letters do you have after your name?" They don't see nursing as a real profession. Now that there are more male nurses, I've had the opportunity to watch their interactions with doctors. It's very different; the male nurses get more respect. There's no good reason for that.

I wish they could see it like I do … the doctors are like the architects of a building, but the nurses are the ones who hire the crew and order the materials and actually raise the building … or in our case, raise the level of care to make healing happen. I've had people ask me if I wouldn't like to be a doctor someday. My answer is: absolutely not. I wouldn't want to be the diagnostician who just comes in and then leaves. I prefer to provide the care.

We are using our critical thinking skills more now than in the past. We review charts, look at labs, and try to grasp the whole picture. In the past, nurses were oriented toward accomplishing each separate task. They didn't worry about causes and effects--the big picture. Now we are more competent and we have a larger role, which sometimes causes a rift between the generations of nurses.

I have great respect for the older nurses in our community. They work hard. But they're convinced they can do anything, and they don't need help. If they're supposed to pass meds to 30 patients, they do it. Young women will say, "I don't think so. That's not safe."

The younger nurses are saying they don't want to have 16 or 25 or 30 patients and pass meds to all of them. They don't want to get burned out. The older ones say, "Oh, get over it" because that's what they had to do. They see the younger nurses as lazy. We see ourselves as professionals, not hand maidens to the physicians or slave labor.

The women I work with and I are a good team."People on the outside hold nurses in high esteem, but nurses are still undervalued in the medical community itself." We work together well and are respected by our administration. A few years ago, we were emphasizing recruitment of nurses rather than focusing on retaining the quality nurses we had. So we made a list of concerns, with suggestions for improvement, and took it to an administrator. One of our ideas was the attendance award, and he liked it. Now people get gift certificates for 3 months of perfect attendance and it is a big hit. Retention is up, we’re happier and it was good that they listened to us.

Nurses need support within the healthcare community. It's ironic that people on the outside of the health care system hold nurses in such high esteem, but nurses are still undervalued in the medical community itself and sometimes nurses don’t even value each other. I’m glad we are gravitating more and more to a more respectful relationship with each other, and I wish nursing as a whole could get there faster.

Power Strategies: Respect, Solidarity, Innovation
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Kim - My Patients are My Heroes

2006-10-30T19:12:00.000-08:00

Kim -

Audio message from Kim

As an oncology nurse, I work in an outpatient setting, where people come for chemotherapy treatments. Sometimes I care for patient over several days, so I get to know them, and we develop a relationship. Oncology nursing is filled with emotion and challenge, and I find that very satisfying.

Some situations call on my strength and persistence. One lady came in who had been diagnosed with extensive lung cancer, and I took care of her during the three days she was there for treatment."We share what we know, our expertise, and our faith and prayers, but they are the warriors." The following weekend I was working on the floor on a Saturday morning, and I saw that the woman had come to the emergency room the night before. It had been a hectic night, and there wasn’t a bed for her when she got to the floor. Arrangements hadn't moved fast enough, and she had been quite uncomfortable. Her family had to go through the night knowing she was short of breath and in pain.

I was upset about what had happened, so even though I had other patients, I spent an hour and a half getting things straightened out, making phone calls, placing her diet order, and making sure she had the pain and anxiety medicines she'd been taking at home. In the end, all her needs and those of her family were met. They felt good knowing that I understood the situation and took time to make things smoother. Their relief and the hug I got affirms the worth of the time I spent.

I have not always worked as an oncology nurse. While working with overflow patients on my floor, I got to know one of the oncology physicians. Eventually he asked me to join his practice and work for him rather than for the hospital. I agreed to do that, and fell in love with oncology nursing.

I can be a calming presence with patients when they first get their diagnosis, or even before that--which is often a crisis time. Later, I have a part in handling the whole range of their treatment, helping and comforting them through their chemotherapy, which can be unpleasant and frightening. I put patients and their families at ease by informing them about what will be happening to them, and why.

I take the extra time to communicate well with patients, families, physicians and nurses, and I take my role in educating patients and new nurses seriously as well. I thrive on that. And on the emotional level, when patients need to verbalize the fears or anger about their treatment plan, or the diagnosis itself, I am there for them. It's important to attend to the whole patient in order to give the best help.

My patients model strength and faith. I have told many of them that they are my heroes. They're battling a tough disease, and we try to arm them--with information and good care--as best we can. We share what we know, our expertise, and our faith and prayers, but they are the warriors. One patient now comes in to the hospital with a medieval sword, which he hangs on the wall during his treatment.

Power gets distorted between a patient, the family, and the doctor, and the relationship can be less than perfect. A relative of mine had leukemia and she didn't question the doctor or even try to understand what was happening to her, and what her future would be. She didn't want to upset the doctor!

It's true that some doctors are uncomfortable in situations like that, particularly when a patient is dying. They run out of information after they’ve used all their best knowledge and technique. There's nothing more they or anyone can do. The doctor may find it difficult to give the bad news.

This is when the role of the nurse is crucial. We'll say to the doctor, "Shouldn't we be getting palliative care for this patient? Isn't it time to call for a hospice consult?" And sometimes that prompts the doctor. For whatever reason, we can step up and help a doctor who is struggling to deliver bad news by being truthful and direct, in a sensitive way.

Nurses know that patients at this point are already preparing themselves for their lives to end. Very sick people often know that they're going to die. They are ready to look at their options and to make the most of the time that is left. Nurses help them cope and provide the emotional and spiritual care they need.

I think my patients believe that I truly care for them as a whole person. That they are in good hands, and that their needs will be met. I want them to know I am confident in my skills, and that I can be trusted.

Power Strategies: Pragmatism, Spirituality, Inspiration
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Gayle - A Recent Retiree Reflects

2006-10-26T20:57:00.000-07:00

Gayle -

I graduated from nursing school in 1968 and recently retired in April of 2006. I love retirement, but I also loved my career. I enjoyed the constant change of the medical field, the contact with people and the feeling of making a difference in somebody’s life, even if it was only with a small, caring gesture.

I can’t remember a time when I didn’t want to be a nurse. In high school we had to research and write about three careers. I had a horrible time with the project because I wasn’t interested in anything but nursing.

From the very beginning, nursing was everything that I wanted it to be. I’ve heard people say, “I didn’t know you had to do this kind of work.” Or, “I thought you just walked up and down the hall and patted people and gave them pills. I didn’t realize you have to give them bedpans and wash them.” Even though I didn’t know exactly what to expect, it was always what I wanted. Whether I was helping with an emergency situation or simply moving somebody from a bed to a wheelchair, I was fulfilled knowing that I was making a difference in each patient’s life.

Every day presented something new, and the anticipation I felt as I drove to work each morning was exciting. I used my commute home to mentally go down the hallway and into each room to think what I did that touched the patient or the patient’s family. I considered it a good day if I put a patient at ease, or made the patient more physically comfortable in some way. That is the most important part of nursing.

My husband and I walk the mall and I feel so good when I run into somebody I’ve cared for and they say to the person they are with, “She was my nurse. She helped me when I was feeling so bad.”

It takes a special person to be a nurse. Anybody can do the mechanics of nursing. If you take time to study and pay attention to what you’ve learned, you can do the technical aspects of the job. But in order to be a good nurse, you have to really care about people and be willing to give from the heart. I want new nurses to consider that as they face all the technological advances that have been made in nursing.

Nursing schools have changed since I received my 3-year diploma. Now the students are not expected to have as much practice with patients before they graduate. When I was in school, I worked four hours a day for an entire summer in an operating room.“I had done my job well if I put a patient at ease, or touched that person’s life in some way. That is the most important part of nursing.” I also had a rotation where I acted as the head nurse, so I had to make decisions and be in charge of an entire floor. Students out of nursing school today may only experience bedside nursing and may have only worked with two or three patients. They have a lot of book learning but don’t have the hands-on experience. I said something about not being prepared to a recent graduate, and she said, “The schools teach us what we need to know from the books and expect that during the first year in the hospital you will make us a nurse.” It’s a good thing we do mentor and precept each other and that this new nurse expected it from me, because book learning isn’t enough.

As I reflect on my career, I would advise nurses to remember why they went into nursing, and try to connect with that feeling every day. Don’t look at nursing as just a job and patients as simply having to be cared for. Find something that keeps you fresh and brings you enjoyment every day.

When I was a child, my friends and sisters would play a game by putting our hands over my mother’s eyes to let her guess whose hands were there. My mom always knew my hands. She said there was something in the feel of my hands that gave them away. We would try to trick her and put one of my hands over one eye and a friend’s hand on the other, and she could still tell which was mine. Sometimes when I touch patients they will take my hand and say, “You have such soft hands.” That always reminds me of my mother and how she would say, “There’s something about your hands. I can always tell, Gayle, that they are yours.” She would call them helping hands. It always made me feel that she thought there was something special in my hands.

Power Strategies: Inspiration, Compassion, Fun
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Mary - Now I Help Nurses

2006-10-26T20:53:00.000-07:00

Mary -

I’m a nurse recruiter. Over the years, I’ve observed the cyclical demand for nurses. When I graduated with a BSN in 1971, there were no job openings for RNs and it took me awhile to find a job. The same is true right now. New graduates are having difficulty finding jobs here in Washington. Back in 2001 nursing jobs were plentiful, but now, the opposite is true. I often get calls from experienced nurses saying their spouse is being transferred to Seattle and they are looking for a job. So, right now we’ve got incoming experienced nurses and turnover is low.

Just this past May, a major nurse recruiting organization in the state said there weren’t jobs available for 2006 graduates. There are openings in California, Arizona and Nevada, but significantly fewer in the Pacific Northwest at this time. Hype? Sure, media says there is a nurse shortage, but I don’t find that to be true in Washington. Here, we have a need for intensive care unit and operating room nurses. But students don’t fall out of nursing school with those skills.

The nurse shortage will really occur when my generation retires, which will likely begin in the next five years.“You need to have a passion … to help people cope with what’s going on in their lives. It will be so satisfying if you can help a patient relieve discomfort because you remember to raise the head of their bed. You’ll feel like a genius.” I worry about it because there aren’t enough spaces in the schools of nursing; we don’t have enough faculty to meet the demand. The teacher/student ratio in nursing school is one clinical faculty for every ten students. It’s a very expensive program compared to say a history class which can have a ratio of 500 students per one professor. Universities can’t pay nursing faculty more than they pay the history professors, and nurses don’t want to go into teaching because they would take a significant cut in pay and leave long tenured jobs.

Before people think about going to nursing school, they should research the education required for their selected area of specialization. I focus recruitment towards nurses who have a BSN or higher. My hospital seeks new graduates from educational programs that provide very specific student clinical experiences.

Graduates are shocked to learn we won’t hire from just any school. Entry requirements for nursing programs are difficult and students are just glad to be accepted. They don’t realize they may need specialized training to be prepared to work in some areas. Maybe they wanted to work in a specialty and learn at the end of their schooling that the specialty is not thoroughly covered in the curriculum. It would help if potential nursing students analyze what they want to do and made sure their educational goals match the hiring expectations of the hospitals in which they want to work.

The nursing profession needs to agree on the entry level education needed. These days you can get your master’s degree in nursing and never be a nurse a day in your life because people are recreating their careers after they’ve attained a baccalaureate degree in a different field altogether! Several colleges offer this option. A person can have a bachelor’s degree in, for example, English, and take a two year program to get a master’s in nursing. Graduates of these programs are sometimes surprised when they can’t get hired. They’ve been sold a bill of goods by the school and don’t understand why they have to go through the bachelor’s program in nursing when they already have a bachelor’s degree. But really, it’s like saying, “Why should I get a bachelor’s degree in engineering? I’ll just get my master’s and build a Space Needle.

I went into nursing because I wanted to be a pediatrician. It only took one quarter of school for me to realize I was not willing to work that hard to become a doctor. When I realized the nurse is the person who spends the time with the patient, not the doctor, I was glad I made the decision to pursue nursing. The one regret I have is not getting my BSN. My career would have been different if I had. I like what I’m doing, but I would be somewhere else if I had more education.

I don’t work with patients now that I’m in recruiting. I’m often asked if I miss the patients, and I say “no.” I’ve really traded nurses for patients. The nurses need me too. They need me to help them find the right job. During the layoffs in the 1990s, displaced nurses needed a shoulder and I could let them lean on me. I still work with people a lot and provide a needed service. It gives me a sense of being helpful, and that’s what nursing is all about.

I like to be positive and give hope to nursing students. Sometimes they’ll say, “I’m never going to get through chemistry.” And I will tell them, “You know, every nurse I’ve ever talked to said that. It’s the hardest course ever and you wonder why you have to do it. Just get it over with and then you get on to the stuff you went into nursing for.”

I also tell nurses, “Yes, I found my first year as a nurse difficult. I thought I was smart when I graduated and after five minutes on the job I realized I had a lot to learn.” It’s important they know that they are not the only nurse having those feelings. We offer a new graduate support group here. It’s very helpful. We tell the new nurses, “Follow the advice you give your patients. Take care of yourself.”

For people thinking about nursing, I say, “If you’re going into nursing because you hear there’s a shortage and it pays well, please know that’s not enough of a reason. You need to have a passion; not to cure disease, but more to help people cope with what’s going on in their lives. It will be so satisfying if you can help a patient relieve discomfort because you remember to raise the head of their bed. You’ll feel like a genius.”

Power Strategies: Compassion, Affiliation, Connection
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Rob - Making Connections

2006-10-26T20:49:00.000-07:00

Rob -

I never stop learning. I’m also great at networking. The two go hand in hand. Networking provides new resources and avenues to explore. I tend to know everything that is going on in the hospital, simply because I talk to people. I use my network to educate myself to do my job better. I thirst for knowledge, and because I’ve created a large network I always know who to call if I don’t know the right answer. Knowledge gives me the power to both influence patients and improve their outcomes.

I strive for excellence every day. I continue to read and learn about different areas of health care. When I work on the cardiac floor, I read books about cardiac care. If I work in orthopedics, then I research orthopedics.

I also make a point of sharing my knowledge. Recently I took it upon myself to help three new nurses. I made sure they got their needs met and understood the process and procedures on the hospital floor.“Saying hello to someone immediately makes you approachable.” Normally that would be someone else’s job – but I took it on because it was important to me. I wanted to both ensure the nurses would want to stay, but also to share with them everything I know to be good nurses. If students are on the floor, I let them know that I’m there for them and want to help them fit in.

I am passionate about making sure the patient and family understand the health problem at hand, what to expect and how to know if there is a complication or problem. I sit down to talk with them so I’m seeing them eye-to-eye; I don’t stand over them. I discuss their care, what they can expect the outcome to be, and I ask them what we should do for them that we aren’t currently doing. I strive to give people the knowledge and ability to understand their bodies and take care of themselves. I also try to motivate them to take care of themselves. One of the reasons I pursued a masters degree is to become a better advocate for others.

I’ve taken on some other teaching roles in my job. I am a Joint Camp instructor. In the camp I prepare hip and knee replacement patients for their surgery. I teach them about pain management, physical therapy, and discharge procedures. When they arrive at the hospital, they know exactly what to expect from their surgery.

As a Spirit at Work representative, I go to different departments and teach employees how to interact with patients, family and other staff. I teach them to introduce themselves to whomever is on the floor, whether it’s a VP, a doctor, or someone else. I encourage them to make connections.

Many people don’t realize, and I actually didn’t realize it until about five years ago, that a connection is made simply by saying “hi” to a person. People naturally like to connect, but if they don’t know how to do it, they appreciate someone who does. Saying hello to someone immediately makes you approachable. It says, “I’m open to talking with you further.” Nurses who float have the hardest time because they don’t know anyone and they want people to trust their knowledge – so they don’t want to ask for help. I make a point of walking up to them, and introducing myself. “How are you doing? What can I do for you? I’m here to help you.”

Once a nurse came up to me and asked if I remembered her. I didn’t. She told me, “You really made a difference in my shift.” She was a float and all I did was say “hi” to introduce myself and to let her know she was welcome on the floor. She said she felt that I cared about her. I let her know I was available if she had any questions or problems. She remembered, and she felt I made a difference. That touched my heart.

I befriend everyone. It’s really important to touch people, whether it’s physically, emotionally or just by conversation. It makes a difference. If we bring everyone together inside, then teamwork is stronger and there is less adversity.

The way nurses interact with people is critical to quality health care. In my hospital, the core values we seek in staff are reverence, integrity, compassion, and a commitment to daily excellence. Every day is not perfect, but the concepts need to be embodied by everyone. Everyone is engaged with patients, families, doctors and other staff. My hospital has a couple of screening tools to make sure the people we hire have the values we embrace.

Now that I have my masters, some people expect me to go into teaching. That may be something I consider for the future, but for now the challenge is being a supportive nurse. I’m very caring, sensitive and understanding. That may not be a common trait for a male, but I’ve always been this way and working with people who are the same has further developed those skills. My skills are best used in patient care, patient and staff motivation, and informal education. I enjoy being in the core of the health care system.

Power Strategies: Connection, Teaching, Learning
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Lynette - Nurses save lives. Nurses change lives. Nurses heal.

2006-10-26T20:44:00.000-07:00

Lynette -

I was excited to begin my management career in nursing but at my first management meeting I saw a different perspective from the administrative side. I was appalled because I saw supervisors denigrating their staff to other supervisors. I thought, "Why aren't you working with your staff? If they're doing something wrong, you're the problem because you haven't managed it." I didn't say anything. I just kept quiet and thought to myself "I'm going to do it differently.” I saw my role as caring for the care giver.

I began to work with my new strategy as I took over the nursery and the post partum unit. There were challenges – staff didn't have a clue how things should work. Just by default, they would take the first answer to a question written in a communication book as gospel for the new policy.
I didn't criticize and I never dictated an answer but I made it clear that we needed to come up with systems to make the right decisions and in a way that included all key players. I worked toward getting to the right answer through identifying best practices and getting cooperation.

My responsibilities increased to include Labor and Delivery. This was a challenge as a new manager as I found the nurses in labor and delivery to be very strong, opinionated, and in this particular unit, loving a crisis."We need a collaborative model, with doctors, administrators and nurses all working together. To get there, nurses have to own their power." They were excellent practitioners and did their work exceptionally well – a patient would come in, they would fly around meeting the needs of not just the mother, but also the baby on board. However, on an organizational level, they preferred crisis management; they didn't trust that I or anyone in management would represent their needs. They were used to complaining about management but when presented with the opportunity, they resisted being involved and accountable for their own empowerment.

I worked hard to help them envision on how we could manage our unit together, as a team. There were times the staff got frustrated with me because it took time to create the structure and systems to support a participatory process. I created a visual image to help them understand – "I'm like a diver under water building a foundation for the bridge. Pretty soon you'll be able to see the bridge – the results." Once the foundation was built, our systems and structure expedited change when it was needed. It took me three years to achieve full participation but it was very rewarding as they became a phenomenal empowered staff!
I later managed a Pediatric Intensive Care Unit that had a reputation of being “the worst unit of their organization”. They didn’t support their peers and they were not aligned with the organization. The staff self identified they “ate their young.” Using the same fundamentals, the unit was transformed into an organization leader and received two quality awards for their achievements. One for a culture change which included mentoring new grads into strong PICU nurses rather than eating their young. The second for facilitating a medication delivery model for all children treated within the organization.

Our nursing leadership team had the opportunity of working with a great an organizational trainer learning Continuous Quality Management. During this time, one of my peers gave me some feedback as part of an assignment – she told me I have a very strong personality. That freaked me out because coming from my background with strong religious overtones, I was “supposed to be” nice. Very nice! Because I was learning new communication techniques, I said, "I perceive you as having a strong personality too and yet that doesn’t intimidate me. Why does my strong personality bother you?" She said she'd think about it. Later she admitted to me she had been envious of me because I had so much fun with my employees. I think being nice vs. being strong is another issue nursing has struggled with.

Historically nurses have not been empowered. As a new nurse I was very naïve and didn't get that nurses weren’t empowered. For example, I saw the pediatric intensive care unit as “my unit” and I was damn proud of the care we gave. The nurses worked hard and well together in the unit, and though we had a manager, we didn't see her that much. We didn’t feel like we needed to see her because we were able to make changes we felt were necessary. One time after some remodeling, there was an open house during which all the head honchos were congratulating themselves on their unit and their accomplishments. It dawned on me that "I am just a peon; they don't see me or my peers. We're all little peons, insignificant in their big scheme of things."

I wanted nurses to be more than bodies who come in to do whatever needs to be done while the doctors run the ship and the administrators control the finances. Nurses change lives. Nurses save lives. Nurses heal people. My vision and goal became to be part of the movement to elevate nursing as a profession. Leah Curtain was a touchstone providing vision for my nursing leadership. I used another image of identifying the continuum of where nursing is and the goal of where nursing should be. My goal has been to make a difference – to personally move the nursing profession on the continuum closer to the ideal.

We need a collaborative model with doctors, administrators and nurses all working together. Nursing has so much to offer. To get there, nurses have to own their power.

I used to be uncomfortable with power or with wanting to have power. I did not want power for my own personal gain. I learned to accept my power because that's how I can be effective, help people and make the right things happen.

Once a doctor said to me, "You always win. Things go the way you want." I said, "No, our decisions are made for the right thing to happen." But inside myself I thought, "Yes, I do always win ….. because I strive for the right decision." It felt good.

Power Strategies: Collaboration, Power, Standards
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Linda - Pediatrics: Hard Work and Satisfaction

2006-10-26T20:40:00.000-07:00

Linda -

I work in pediatrics and sometimes it gets hard for me to see children whose families are torn apart because of abuse and drugs. We had a child recently, three months old, suffering the effects of methamphetamines in her environment--she could not hold still. She was thrashing around, and we had trouble holding her still so we could give her the medicine to make her feel better. The pediatrician came in and saw how we were struggling, how we had to keep trading off because she was thrashing so much. I asked the doctor if there was anything else he could do to calm her, since the medicine wasn't doing it, and he said, "Call your chaplain."

One of the student nurses and I began praying for her, and she stopped crying and began to pull at her ear, which she hadn't done before. So I called the doctor. He came back, looked in her ear, and saw that she had a terrible infection. He said she hadn't been responding to the medication because she was in so much pain. That was a hard situation, with a good outcome, but it doesn’t always go so well.

As nurses, we identify with these situations, and it can be rough. But we support each other through the bad times. And since I work half time, I have more time to be at home and to work through my emotions, which helps.

These days nurses are doing things that doctors used to do. Back in 1963 when I started, we didn't carry a stethoscope and we didn't listen to hearts, though we did take blood pressures. Now nurses are assessing patients, and at times we call the doctors to tell them what the patients need. So you can see how our profession has expanded; we have more responsibilities and we give better care.

The hospital and insurance systems are forcing efficiencies and as a result, to my mind, we release patients too soon. As it is, we're being pushed to do more and more. The paperwork is overwhelming. We're always trying to meet new government criteria and new rules, and meanwhile we're learning new information and techniques.

It seems that every time I go back to work after my four days off, I see new things that I have to learn fast to stay up to speed. Nothing stays the same. Computers are always changing; we get a new program, and we all have to learn it. That's a challenge for me.

I’m being pushed to work 12-hour shifts."I get immediate feedback every day. Someone thanks me or someone appreciates me because they were in pain and now they're not." I'm afraid it would take all the joy out of the work I’ve chosen. I love to be there when I'm fresh, but after a certain point, I lose energy. I'm 63 years old, and working extra hours is hard on my body--all the standing, walking, doing physical work. Some days we don't even get a break; we go straight through. What we do is extremely demanding at best, and nurses face burnout if they have to work at this pace for consistently longer hours.

I'm not afraid of work, and I love what I do. It fills a need I have--to be useful. I feel good about myself when I know I’m helping people. I get immediate feedback every day. Someone thanks me or someone appreciates me because they were in pain and now they're not. I see kids who are sick, but I’m not afraid because I know I can help. I comfort the parents of those kids, too, and let them know it's going to be all right.

I feel the power of knowing that what I do is what I'm supposed to be doing. Working in pediatrics is special; not everyone wants to do it, and not everyone is suited to it. In fact, some are terrified to provide pediatric care because of the emotional toll of witnessing what happens to kids.

When I come to work, I do my best for that day. I give my all every time I clock in. I don't have to be perfect, I just have to give my best. I'd tell anyone who's looking at nursing for a career: follow your heart. Do what draws you personally, not what someone else may want for you. Doing what you love is a gift.

Power strategies: Usefulness, Determination, Care
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Kathy - Death and Ethics in the ICU

2006-10-26T20:35:00.000-07:00

Kathy -

Nursing as a profession engages us not only in personal connections with people, but in using our brain power to save lives. We have an emotional calling to care for people, and we use our intellects and our analytic capabilities, as well. The two are interconnected in nursing, which is one of the things I like.

The work of nursing has always been hard, but these days expectations and responsibilities are extremely demanding. The work environment has gotten more complicated. Unfortunately, the need to be cost- effective and efficient actually defined healthcare for a time. The work culture was about serving that economic need, rather than honoring the work of caring for patients.

Now I'm sensing a growing acknowledgment that the culture of a healthcare organization has an impact on the people in it: patients, doctor, nurses, and staff, as well as on the bottom line, profitability. We know people work more efficiently when the environment is healthy, respectful, and empowering.

We're realizing that there underneath the need to be efficient, cost effective, and profitable, is the importance of giving good care to patients. Care is at the center of everything we do.

One of way to create healthy work environments is to move toward more collegial."I struggle to keep goodness in the forefront, and not allow my soul to be robbed." and collaborative relationships between nurses and physicians. Especially in academic teaching hospitals the physicians, especially residents, are there temporarily, and so they rely on nurses, who are present every hour of every day. The residents are invited guests in the nurses' environment.

Especially in the ICU, physicians depend on the expertise of the nurses to provide continuity and to be gatekeepers for the patients. Overall, I've had some excellent experiences of that. But I know that's not true in other environments, and we have a lot of work yet to do.

Part of the problem is the long history of nursing as a primarily female profession and medicine as a male profession, with all the historical implications of inequality and oppression we've moved quite a ways beyond those stereotypes, but traces remain.

For instance, sometimes we as nurses enable physicians to continue their bad behavior. Nurses make excuses for doctors, "They're stressed and busy," or "Their work is so hard." Most of the time we're oblivious to how we as nurses keep the behavior going. We're caught in the pattern, and we need more education and awareness of harmful dynamics. All of us could benefit.

Working in the ICU in a teaching hospital, I saw some painful ethical dilemmas around the issue of death. When someone is dying, they want their death to mean something. They want the process to be peaceful and honorable and appropriate. In that situation, we were constantly searching for the balance between the physicians’ need to learn, and the need of the patients to die an honorable death.

At some point, learning the technology has to give way to respect. I have attended patients who were dying, and treatments and procedures were imposed on them, even though the outcome was known. When a doctor comes in and throws technology at a dying person, he robs them of a good death. Whenever that happened, it hurt my soul.

I struggle to keep goodness in the forefront, and not allow my soul to be robbed. Watching patients endure, watching them suffer, only makes sense when I know that the patient and the family have been given an experience they can value. When that doesn't happen, we forfeit our compassion and the trust of others for the sake of technology and someone else’s learning.

As nurses we must insist on a process that results in something good for patients, even if we can't save their lives. Even when the outcome is hard or painful or tragic, we can give care, comfort and be the witness for ethical decisions. That way, when we sense something that seems disrespectful of a life or a family we can intervene and provide education, or a different suggestion. It’s those moments when we don’t intervene that accumulate and bear down on us. We get burned out and cynical. Grief accumulates. Anger grows. Fatigue takes over.

We need more recognition of how difficult the work can be. We always want a happy ending, and we don't always get that. We also need our healthcare organizations to communicate and prove that they value integrity so people will want to come to work each day instead of wanting to leave.

My hospital is successful that way, because we have a mission that people connect with and want to be part of. The mission is to serve the population that comes to us with energy and effort and cutting-edge technology no matter who they are, or from what walk of life. That means the jail patient who's incarcerated for a felony. The homeless woman on the street. The baseball player who needs surgery.

What I value--and I think most nurses value too--is a sense of meaning and purpose in what we do, and respect for the difficulty of the work and how much of our selves we invest in it. At a certain point, I decided I couldn't tolerate that loss of my soul, so I went into a research position. I didn't leave healthcare; I didn't leave the system. I found work that had a different emphasis, and that kept me in the profession.

Power Strategy: Sovereignty, Integrity, Compassion
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Ginger - Boundaries: It's all about Respect

2006-10-26T20:31:00.000-07:00

Ginger -

My earliest nurse memories are of Miss Duncan. She was the nurse when I was in the hospital at the age of three, and again when my sister was in the hospital with rheumatic fever, around the time I was ten. Miss Duncan was phenomenal to look at. She was tall and stately, with a crisp white uniform, white stockings and white shoes. And of course a nurse’s cap. Everything about her just sort of gleamed.

I also remember being ten or eleven years old and having my appendix removed. Back then, you stayed several days in the hospital for that kind of surgery. There was an African-American nurse who would come in to give me my bed bath. Like Miss Duncan, she had that crisp white uniform and these large yet gentle hands. The bath was so warm and soothing, and I remember thinking that surely it was heaven. So I think between she and Miss Duncan, the seed for my nursing career was planted.

My father worked for a pharmaceutical company. I didn’t want to do what he did, but I knew that healthcare was something interesting to me. He said, “Whatever you do, just be the best.” When I told him that I might like to be a nurse, he said, “Then get your Bachelor’s degree.” At that point, it was a fairly new concept – going to a four-year college for nursing. I ended up in the second graduating Bachelor’s class at the Medical University of South Carolina.

The path of my career has been varied and full of opportunities. Now I advise nurses in a master’s program, as well as recruit for the program.“I try to stand up for what’s right while at the same time respecting a patient’s boundaries.” It’s a good fit for me, because I’ve seen a lot of different areas of nursing, and I’ve learned my share of lessons along the way. One of the most important lessons I’ve learned is to be attentive to people and their goals and desires. I can’t just change somebody to be the way I want them to be, or the way that I think is better for them health-wise. I have to meet them where they are and walk the road with them; not just expect to take them to the end.

The first time I got this lesson was when I did a public health rotation in my undergraduate program. There was a 10-year-old boy for whom I was doing a series of home visits. He’d had his right arm amputated clear up to his shoulder because of cancer.
This boy lived with his grandmother on one of the islands in South Carolina, and the grandmother was extremely overweight and a diabetic. Her source of income was selling candy to school-aged children. I was only 20 years old and very idealistic, and I wanted this lady to lose weight and not be dependent on candy for her income. But she told me, in no uncertain terms, that was all well and good, and her weight was not the issue. Her issue, she said, was to learn how to take care of her grandson. I realized that I was imposing my values on her, and that was not really my job as a nurse.

Years later, I had another patient with whom I did home visitation. It was a woman who had no family and lived in a trailer that was just chock-full of rotten food and dead stuff. There was barely enough room in that trailer for a pathway. She had a cord of wood stacked in the living room and she’d literally pick up the wood and throw it into the woodburning stove, which wasn’t vented correctly. I kept wanting to move her to a different place because this was truly an unsafe way to live. But when I brought it up with her, she said to me, “Ginger, if you would move me to Buckingham Palace it would look like this pretty soon, because this is the way I like it.” So, obviously I still hadn’t learned my lesson. My view of the world was wholly different from hers, and I had to re-learn to respect her boundaries.

I’m definitely a patient advocate. I have absolutely stood up to the powers that be and said, “This is wrong, I cannot do that. If you want it done you have to either do it yourself or have somebody else do it.” I try to stand up for what’s right while at the same time respecting a patient’s boundaries. It’s sometimes a fine line to walk, but I think I always do what’s in the best interests of the patient.

It is my belief that nursing will advance as a profession when we have more men in the field, and more of a voice in powerful places like the legislature. Nurses tend to have sort of tunnel vision. They go to their job, do it well, go home, take care of their families and that’s their world. They don’t see their place as a profession. When we have more men and more people that have a voice, nursing will be more readily viewed as a profession.

New nurses coming into the field need to be observant and humble, not simply jump in and change things just because they can. They need to be a part of an organization and see the good and the bad and then make alliances. They are not out there all alone. They need to know that.

The experienced nurses who will be mentoring the new ones need to be patient and kind and respect their education, even if it was different than the one they received. There are still a lot of diploma nurses out there who may find it hard to relate to nurses coming out of four-year degree programs. But they should be attentive to teaching the new ones the skills that they have, and not feel threatened. I know it’s hard to take the time with somebody who’s new, but if they would try it, they’ll find it creates a nice, symbiotic relationship, and everyone moves forward.

Power Strategies: Influence, Respect, Integrity
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Kimberley - Caring for Patients and their Families

2006-10-24T18:30:00.000-07:00

Kimberley -

Both my mother and my mother-in-law were nurses, but it was my husband who actually encouraged me to make a career of it. He saw that I always stopped at accidents and was willing to help people, and he also saw that I wasn’t fulfilled in my job with a pharmaceutical company. With his insight, I decided I would go back to school, and the short period of unemployment would eventually turn into a good career for me. I’ve been a nurse for thirteen years now, and I actually enjoy coming to work.

I’ve done emergency and critical care nursing, and one of the hardest parts for me is when I lose a patient. Four years ago, I lost my 19-year-old sister in a car accident, and suddenly I had to switch to the other side of the bed. I became the family member of a patient; I was the one being pulled into the family room by the nurses who talked to us about withdrawing life support. Now I realize first hand how hard it is for them. I know the family needs to know the information, but it’s hard not to take their grief home with me and sometimes it takes a while to process.

If an 80-year-old man dies and he’s lived a great life, he’s surrounded by family members, it’s his time to go, that’s all right. The family is OK with it and the patient is OK with it. It’s the young ones you lose that become a little bit more difficult.

We help each other when a patient dies by coming together in what is called a debriefing. I was involved in a neonatal death, and a debriefing team was brought in to help us process. Things were done that probably shouldn’t have been – nothing to bring harm to the child, we just tried a lot longer than most would to try to resuscitate this neonate.“Your voice is calming. You were there. You told me exactly what was going on.” The child ended up dying, but a lot of staff kept coming to us and saying, “That was ridiculous. I don’t know why you did that. We never give those drugs in neonate. We never do that.” I felt judged and had heard enough! I wanted to say, “Okay, but you weren’t there. You didn’t have the father screaming in your head to do something. You weren’t in the room.” So the debriefing process was very helpful because the people involved knew their place. They didn’t do any Monday-morning quarterbacking. They comforted and supported us, which was so helpful.

On the other hand, there’s so much reward in this job, despite all the tough times. The other day a man came up to me at a baseball game and he said, “You’ll probably never remember, but you were the one that was over my head the whole time the doctors were taking care of me. Your voice was calming. You were there. You told me exactly what was going on.” It was really satisfying for me to hear that.

I’m very comfortable in my faith, but I’m also comfortable being with people who have different faiths or upbringings, and I’m willing to support them in whatever that may be. I’ll broach the subject, not force it on them, and listen if they want to discuss their beliefs. If not, that’s fine. I believe listening is healing. That’s all I wanted when my sister died. I didn’t want somebody to tell me that I was going be okay. I wanted somebody just to listen.

In my practice, family comes in. I’ve had family at bedside codes. I talk to them myself or I make sure somebody is talking to them and keeping them updated, especially if they don’t want to be at the bedside. I was always a caring person before, but there are times now when I can put myself in their shoes. I don’t say, “I know how you feel,” that’s belittling them. Instead I say, “You know, I lost my sister four years ago. I will not claim to know how you feel, but I know I’ve been in a place like yours. If you just need somebody to hold your hand, if you need somebody to listen to you, I’m there.”

A lot of people laugh at how many family members are at my bedside, and a lot of nurses try to push the family away. But family is important, because the patient is going to wake up to their own son’s voice, or to their own mother’s voice, and that’s part of caring for someone. I’ve sat with people who died alone, and they died alone because their family was estranged or whatever, but to me, anybody who’s at that bedside is family. Even if they’re not a blood relative, they’re family to that patient, and a lot of times that helps. It helped me when my sister died. We had thirty people in the waiting room, and all the nurses kept saying, “Wow, you guys don’t need social workers.” Everybody is going to be at different levels at different times, and everybody can comfort each other.

I learned a lot from the nurses who took care of my sister, and it changed my own practice. It’s important to be at the bedside, because that takes the stress off the family, too. I mean, are they going to remember a nurse who says, “You can’t come in,” or are they going to remember a nurse who let them be at their loved one’s side? I remember vividly the nurses who were at my sister’s bedside, and the ones I remember the most are the ones who said, “Come on in – even though there’s ten of you it’s not a problem.” They’re the ones I remember because they thought it was important. And it was.

Power Strategies: Humanity, Passion, Service
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Chad - Taking it as it Comes

2006-10-23T21:14:00.000-07:00

Chad -

I chose to be a nurse after I heard a nursing recruiter say the profession needs guys and minorities. Being Filipino and a guy, my ears perked up. I was recently graduated from culinary arts school, but looking for something more fulfilling. As I explored the possibilities further I found that nursing would be a natural fit for me because I like to work with people and make a difference. Nursing allows me use both sides of my brain at the same time, the creative and intellectual.

I’m fresh out of college, and currently working as a community health nurse for a retirement community. It has proven to be quite an undertaking for a new nurse as I am coordinating health care for residents, performing wellness checks, reassessing people who return from the hospital, and dealing with family issues, in addition to being a manager. As a new nurse I’m unsure of my skills, and being the head RN was initially daunting. I have had great support from the previous coordinator, but much of my education has been trial by fire. My multi-faceted role as counselor, psychologist, social worker and nurse makes it difficult to plan my work day. I have to take it as it comes. I’m a hands-on learner, so this induction to the nursing profession has been good.

I’m very excited about my new job. I love community health. I feel that it is the direction nursing needs to go if we are to change the health care system. While there will always be a need for acute care, we need to focus on prevention. I once heard an analogy that acute care is like coming to a river with people floating down it, and pulling the people out. Community health is going up river to see why the people are falling in. Working up river has a larger impact on the population as a whole. Community health allows me to work with people over the long term, develop therapeutic relationships, and focus on wellness.

As a new graduate I’m excited, but I’m also nervous because people now see me as a nurse. They anticipate a vast wealth of knowledge from me, yet I have had limited experience and can only offer so much. The nursing field is so broad it is impossible to know it all, but I am expected to.“Acute care is like coming to a river with people floating down it, and pulling the people out. Community health is going up river to see why the people are falling in.” In school you are taught much theory, but because of the amount of information you need to know it is only the tip of the iceberg. I don’t know how many times I heard from other nurses, “you’ll learn what you need to know on the floor.” As a new nurse, who has much expected of them, this is not the most reassuring statement, though it worked well to calm the nerves in school. The anxiety of being a new nurse aside, I take pride in the identity formed around being a nurse; being caring and nurturing, and earning patient trust. The responsibility as a nurse is humbling because people look to you and make life decisions based on your assessments.

Before I started my community health job, I went on a medical mission to the Philippines. This trip increased my excitement for the possibilities of nursing, but also showed me there is so much to do. I assisted with healthcare delivery in remote areas. We set up a total of six camps, helping an average of 1,200 people at each camp. We dealt with everything from coughs and colds to hypertension and cancer. Many of the patients had never seen a doctor or a nurse in their life and came simply to get their blood pressure taken. It was an amazing display of how much could be done with so little. It was my first time out of the country and I was taken aback by how different it was. The landscape was obviously different, and the poverty was amazing. People were surviving on so little. Being half Filipino I felt a huge responsibility to my heritage, and as a nurse I felt a huge responsibility for the health of others. I felt called to serve there.

Eventually, my goals are to have a small business in nursing, possibly adult family homes or an assisted living facility or nursing home. I feel I can do a lot for many people. I want to make an impact in my field. I saw a graph once that showed some tiny portion of health care dollars spent on primary care, a little bit more on secondary care, and about 95 percent on tertiary care. I’d like to change my focus in nursing to preventative care; to primary and secondary care – not tertiary care.

The geriatric population is growing dramatically and they will need more care and will want to know how to stay healthy. I want to work in communities to create strong education programs and keep people out of hospitals. Once I’ve accomplished that, then I’ll take on the task of changing the rest of the world.

Power Strategies: Nurture, Impact, Connection
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Alicia - 56 Days in Management

2006-10-23T21:08:00.000-07:00

Alecia -

My education began with training in laboratory technology. I decided that wasn’t for me because I didn’t have enough contact with people. My next step was to try nursing. Nursing was a better fit for me because I believe nursing is somewhat like acting, and I was always drawn to drama and people. By the time I had my bachelor’s degree I was already getting burnt out, or at least I felt that, professionally, I needed to do something more global than bedside care. My goal was to try to elevate the profession. So I went back to school and got my master’s degree. Today I work as a clinical systems educator.

But there were those 56 days in management. I wanted to make a difference in nursing and thought being a manager would be the way to accomplish my goal. I had an ideology of what a nurse leader would be. Before I was hired as a manager I visualized that everyday, as an administrator, my focus would be on the staff. I would find ways to make their lives easier so they could provide quality patient care. The nurse executive agreed with me – that should be the mission. Provide the staff with trust and support.

At the same time I was hired into a new manager position, a new director was brought in from outside of the organization. I saw this as a great opportunity. I could learn from another nurse leader who didn’t have all the history within our culture.

However, one incident changed everything. The staffing schedule left by the last nurse leader couldn’t support the demands of the department. We didn’t want to have the nurses rebid on the schedule if we could get them to work together to fix it.“As nurses we’re pretty good at picking ourselves up, dusting things off, and evaluating what we’ve learned.” So, we scheduled three forums where the staff from the department could meet to try to fix the schedule before we went to rebid. The first forum went well and the staff had great input. The second forum was scheduled for 7:30 one morning. However, at 6:45 that morning I got a page from the charge nurse on duty. Seven night shift nurses were leaving and only four day shift nurses were coming on duty because some nurses had called in sick. There were eight critical care admits they couldn’t move up to the floors because there weren’t enough nurses.

I told the charge nurse not to worry, I was already in the parking lot. By the time I got there, the assistant nurse manager was there and I assumed she was trying to work things out. But the next thing I knew she was gone – she had left to go to the rebid meeting.

The only thing I could do was to pitch in and help the nurses. There was nobody else. There was nobody to work triage, and by state law we had to have someone in that area. I wanted to support the staff through this tough time.

You would think I had made the right decision. The staff thought I did the right thing. I helped out until 9:00 when more nurses came on duty. I consider the people I led to be extremely dedicated nurses and I wanted to support them through a tough time. But management wasn’t happy with my decision. I was actually told by management that I couldn’t make the transition. They thought I should have been at the meeting to show a unified front with management.

And that’s why I only lasted 56 days in management. I felt I let the staff down when I left management, because they felt abandoned by somebody who would provide them with good, quality leadership and support. It hurt me as well, but as nurses we’re pretty good at picking ourselves up, dusting things off, and evaluating what we’ve learned.

What I learned from that experience is if you want to make a difference in nursing, sometimes you have to think outside the box. I recently had an opportunity to share what I learned with a staff nurse who was moving into a leadership role. I told her “Hold your head up high. Don’t lose touch with who you’re serving. Be able to accept the things you won’t be able to change, but take pride in the things you will be able to change. There will be many times you will probably think, ‘Why am I doing this? I’m not getting anywhere. Things that are obvious aren’t being stated.’ Just always reflect on the fact that you know why you’re there. Hold true to your beliefs and maybe you can work your way out of that thing that I couldn’t get out of. And maybe you’ll be able to make a difference.”

Once I stepped down from the management position, I was faced with the option of returning to staff nursing or finding a way to elevate nursing in a positive way. It would have been easy to go back to what I knew, but I decided to do something different that was more challenging. So I went into computers, and am now an educator on the new electronic health record system we are implementing.

It has been a challenge and quite a stretch for me. But through the challenge I’ve re-fueled myself with the strength and energy I had lost in those 56 days. I’m making a difference in the lives of nurses because they are scared and anxious about moving from a paper to an electronic system. Some are saying they will resign because they’re being forced to do this. So I meet with them and preview the programs and put a positive spin on the transition.

The staff knows me and sees me as an informal leader. They respect me and I have credibility. I tell them I wouldn’t be on this project if I didn’t feel it was going to affect us in a positive way. That it’s good not only for us, but also for the patients we serve. And my message has been successful. I’m turning their attitudes around. I feel like I’m finally making a difference in nursing.

Power strategies: Leadership, Influence, Integrity
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Kristine - Mrs. Ripley Made Us do It!

2006-10-23T19:56:00.000-07:00

Kristine -

I have many opportunities to talk with nurses. Nurses always describe themselves as caring and compassionate, but rarely do they talk about their knowledge and experience. It seems to go back to the first half of the 20th century, when women worked as teachers, secretaries or nurses. In order for respectable women to work as nurses, they had to be like nuns; virtuous. That feeling has carried over to today’s nurses. I see a need for improvement in professional role development for nurses.

I encourage nurses to celebrate the differences they make through their knowledge and good decision-making skills. Nurses prevent poor outcomes. They help people recover quickly because they prevent things from going wrong. Every patient is better off having a nurse watching out for them.

Nurses are educated, experienced, and have the acculturation to be professional, but until we act like professionals, we’ll never sit at the table where the other professionals sit. I just started an initiative to provide leadership development for staff nurses in the state of Oregon. I also regularly encourage nurse educators to incorporate leadership development into their programs.

A nurse doesn’t enter the nursing profession with the goal to be a leader. In fact, I didn’t even think of becoming a nurse. My friend wanted to be a nurse. So I took the courses she was taking. I told my friend one day that I’d been telling people I became a nurse because she wanted to be a nurse. She said, “Oh, no! That’s what my mom said I had to do!” So we’re both nurses because of Mrs. Ripley. Mrs. Ripley made us do it!

I was an Army nurse for 32 years. Military nursing is very professional and leadership is expected.“Develop confidence, take pride in your work, try something new, take charge of your work environment, take a leap of faith and control your future.” When I first joined the Reserve Unit in Ohio, I worked for a wonderful, inspiring chief nurse. I learned a lot about developing people from her. She gave me a project, let me do it, and if it was to be presented to the command staff, then I developed and delivered the presentation. I received basic guidelines for what the end product should look like, but it was up to me to determine the means to the end.

I also learned about leadership from a supervisor I had in Augsburg. He taught me how to be a head nurse. When I was new to the job I saw everything as a crisis. He helped me figure out solutions by asking questions. “What are your options?” He never told me what to do, just talked me through the thought process to arrive at solutions that might not have otherwise occurred to me.

By allowing me to make my own decisions, and supporting me in those decisions, both mentors taught me more than I would have learned if they simply told me what to do. These experiences led to my promotion to general.

I’ve experienced rich diversity in my career. Army nursing taught me there are 50 ways to do something right, because I worked with nurses from all over the world. I learned different ways to approach issues and solve problems. I mixed things up a bit to discover what worked best for me. Working in different countries and dealing with cultural differences was also interesting. For example, when I was in Bosnia we had major discussions with the medical professionals from Sweden and Norway about the use of restraints. They don’t ever use them because they think restraints are inhumane. But in the U.S., while we rarely use them, there are times we believe we need them for the safety of the patient. Who’s to say which way is correct? We’re probably all right in our own way.

My goal is to develop nurses to lead the teams taking care of patients. Teach them to make more decisions at the bedside and take responsibility for coordination and collaboration, rather than viewing their jobs as task oriented. If nurses have more leadership training, they may also develop the confidence and motivation to move to new areas of nursing. The opportunities in healthcare are infinite. Develop confidence, take pride in your work, try something new, take charge of your work environment, take a leap of faith and control your future.

Power Strategies: Influence, Diversity, Pioneer
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Dustin - Nursing wasn't my First Choice; but it was a Good Choice

2006-10-23T19:44:00.000-07:00

Dustin -

In high school I thought I was passionate about veterinarian sciences, but through my career research and by examining my priorities, I realized I wanted a guarantee of a job regardless of the field of science and there isn’t a big call for a doctor of veterinarian science to be an employee, they usually have their own businesses. I chose nursing because nurses are in high demand, the pay is decent, it is science focused and I get to work with people. I attended school under an ROTC scholarship, so I guess you could say money is important to me, too.

During my interview for the ROTC scholarship, the questioner pointed out I would be a minority in a predominately female profession. I was 18 at the time, and I jokingly said, “Wait, so you mean I have to be around a whole bunch of women?” Of course, I had no problem with this whatsoever! As it turns out, I work in the OR, or operating room, and male nurses tend to gravitate toward that area. There are also many male nurses in the military.

Because I come from a military model, I don’t experience problems with some aspects of the power differential in health care. I know there needs to be a captain of the ship, which in the OR is usually the surgeon, and then people are needed to keep the ship afloat; that would be the rest of us. In order for the communication to flow, it needs to come from the top down.

That doesn’t mean communication needs to be impersonal. People should be treated right. I’ve seen people become pompous simply because they are the captain. Their egos get in the way of good communication. I also know men take that differently than women. Men withstand a lot more. I will take someone’s aggression and simply move on. I’m also not sensitive to the way other people treat me. A woman might get teary and hurt and be more affected by it.

I am sensitive when I have to talk with families when their loved one is dying or has died. The last year I worked on the oncology floor while I was in the military was extremely hard.“Wait, so you mean I have to be around a whole bunch of women? Of course, I had no problem with this whatsoever!” Our patients would come from intensive care where they had critical procedures done to them. Their lives were sustained with breathing tubes and the family would need to decide whether or not to continue life support. Once the family decided to discontinue the breathing tube, the patient would come to my floor to be in hospice care until they died. That’s when the job became hard, because of the sadness felt by the families. When I worked on that floor, I dealt with grieving families at least once a week.

I’ve had many loved ones die in my personal life, and I think that’s why I get emotional when delivering bad news to families. I lost my mom when I was 18, so the feelings I had when my mom died come rushing back. I even cry at Disney movies. Working in the OR has made it easier easier.

Some people think working in the OR is difficult. But when the patient has the drapes on, I focus on the part of the body that is undergoing the operation. For example, if we’re working on a heart, I don’t think about the person attached to the heart, unless something bad starts to happen. Then it’s, “Oh, goodness, this is a person.” Otherwise, it’s a heart, or a vein, or an artery that I’m working on.

It’s harder to forget about the person and focus on the body part when the person’s face can’t be covered. I actually felt sick one day when we were doing a tonsillectomy on a little girl. Seeing her face during the procedure kept me very present to the “who” behind those tonsils and I wasn’t sure I would make it through the procedure.

In my OR work I deal with families differently than I did when I worked in oncology. Now I assure them as the surgery progresses and I give them peace of mind. They are always relieved when I make contact with them. They say, “Thank you so much. Just seeing you and knowing that everything’s going okay makes us feel better.”

In the long run, that’s why I’m engaged in my profession and I know nursing is a good choice for me. It feels good to help people.

Power strategies: Security, Sensitivity, Communication
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Ethlyn - It Takes a Village to Raise a Nurse

2006-10-23T19:40:00.000-07:00

Ethlyn -

My grandmother, Annie Mae Johnson., was a midwife for our community in the south, not by training, but because it had been passed down through our family. My grandmother learned to be a midwife from her mother, and her mother before her. After I saw grandmother deliver babies and assist mothers with their deliveries, I aspired to become a midwife. In my six-year-old mind I didn't understand that to become a nurse meant graduating from high school and heading off to college. She encouraged me to do all that and to continue on to nursing school. She would say, "Ethlyn, the Lord has a greater plan for you." That greater plan was to be a role model in my community.

I spent the first ten years of my life in Mississippi, in the early 60's, during the time of segregation. To me it was just my community, full of loving women and men who supported each other, supported their community, and supported their kids. When I was ten, I moved to Cleveland, Ohio, where my family knew I'd have greater opportunities. After high school, I applied and was accepted to a four-year program at Ursiline College, where I started my nursing journey.

I had an instructor at college who became a mentor to me: Ruby P. Jackson, the first and only African American instructor I ever had. The first week I had her for clinicals, I came to the pediatrics rotation not prepared."Nursing is beyond just serving at the bedside. It's serving my community as a role model." I thought because we had this bond she would let me get by, but she sent me back home on the bus, in the snow. She told me, "If I allow you to be ill-prepared today, that will be the standard you'll live by the rest of your life." Needless to say, I came very well prepared for the rest of my clinicals. She had a master's degree in nursing, and she held high standards for herself and for her students. She was also a wife and a mother, and to see an African American woman in all those roles was inspiring.

These experiences gave me hope for myself and my generation, and I want to give that hope to the generation that's following me. Nursing for me is beyond just serving at the bedside. It's serving my community as a role model. So many of the things I do are not just clinically based. They're more family based. I use my skills for the community. Because it does take a whole village.

I had obstacles along the way. In the junior year of my nursing program, I became pregnant. I might have become just another statistic, a single mom collecting welfare. But the village came to my rescue. My mother and father helped with my daughter, so I could work on the weekends as a nursing assistant. I'd have class Monday through Thursday and do my clinicals. Then I'd work Friday night and 16 hours on Saturday, and spend Sunday preparing for the next week.

Because I had a daughter, I knew I had to be a role model for her. For that reason, I named my daughter Faith, so that every day when I called her name, I would be reminded: faith is what it took for me to bloom and grow. Whatever community I'm in, it all starts with the church. That's true for most African Americans.

In Tacoma it was Saint John Baptist Church where I began working with members who started our healthcare ministry. People would come up after church services and say "I have a question about my blood pressure." Or about diabetes, or whatever they needed to know, but were reluctant to ask their doctor. I could talk with them about what they needed.

I met my husband when both of us were in the military. I served as an Army Nurse. When my husband was deployed to Iraq and Saudi Arabia, I began helping other women who were left behind when they had questions about child rearing or budgeting or illness and hospitalization.

After two years, we moved back to the south, and again we found community in our church. We began going to small churches in rural areas and giving presentations on health care. It was our way of ministering, whether to seniors, or to families with children. Those people gave back to us when I had surgery, by bringing food to the house and taking my children to appointments.

Now we're in Tacoma again. I've worked at three of the large healthcare systems. I serve as adjunct faculty at Pacific Lutheran University and part time at Tacoma Community College, so now I have all these students that have come through me as I've taught classes. Once I had to go to the emergency room on New Year's Eve night, and it looked like I wasn't going to be admitted at Tacoma General Hospital because they were full. So I spoke on the phone to the charge nurse, who immediately said, "Nurse Gibson, it's Katrina your former student. You come on." At the hospital, the doctor told me, "I don't know who you are, Ms. Gibson, but I have three registered nurses out there and they said you taught all of them, and that I need to come in here and take care of you." That's the only time I got in and out of an emergency room in less than an hour, with x-rays, blood work, everything.

In 2004, I started working in a newly created position: community outreach liaison. I'm the bridge between the community and the hospital system. Part of my job is opening opportunities for middle school and high school students to understand what it takes to prepare for a career in healthcare. I also work with senior citizens that typically, in ethnic minority communities, don't feel comfortable coming to the hospital. We have free healthcare forums in the community that target cancer prevention, diabetes, heart disease. We bring healthcare providers who look like the people in the community to deliver those messages.

I talk to my students about what makes a nurse. Nursing is a science, and we spend a lot of time on that. But it's also an art. We need to help everyone understand what is special about the art of nursing, the art of caring. When people ask me why I don't become a doctor, I say, "Because I would miss so much."

Being a nurse takes the ability to look within your heart and know that you give a part of yourself every day to help someone become a better person. If you believe that, then everything else follows. If you believe in your heart that you are making that patient in the bed a better person, you have no trouble making sure you give them the right medication and give it to them on time, and recording it correctly. Because you believe in what you do. In your heart.

Recently I cared for my mother after surgery in Cleveland, Ohio, where she and my father live. I was my mother's nurse for two weeks. We talked about my life, the things I've been doing in teaching and nursing, and then she said to me, "You are exactly like your grandmother. Your mannerisms, the way you give to people, the way you encourage your students." I liked that.

Power Strategies; Legacy, Leadership, Community
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