Rending My Nursing Heart

 

Even now, says the LORD,
return to me with your whole heart,
with fasting, and weeping, and mourning;
Rend your hearts, not your garments,
and return to the LORD, your God. JL 2: 12-13

Lent begins with a reminder to rend my heart.  As I looked into the courtyard outside my office I thought it is a lot like my heart. The mess of fall leaves has not been cleaned up and with all the rain they are now a mushy mess. Daffodils and the tulip tree are in full bloom heralding the coming spring and the hope of green grass, sunny skies, and warmer weather. Yet it is impossible to enjoy the beauty of spring without cleaning up the mess of fall.

Recently, I have had two college students to contact me. Neither are current students of mine, but both wanted advice. Their requests were simple enough to answer, but in both cases I found myself thinking what they really needed was someone that could be silent and listen. It is easy to listen quietly, but it is much harder to shut down the inner speech while listening that is screaming at me that we must change our culture in nursing education.

I knew both students had the answers and what they wanted was confirmation. Largely, they wanted someone to say it was okay to challenge a faculty member. As I listened it was hard to stay true to my belief that one should always first refer the students back to faculty to work out their issues. It is good practice for professional life. It builds professional negotiation skills and it builds honest working relationships. That is what I did after listening long enough for them to find their courage.

My question to my nursing friends is why does it happen so often? Why do students fear us? We should be the model of kindness and compassion to them, but instead, it sometimes feels more like we are the inquisitors. We blindly and harshly apply rules to students. Rules that can profoundly impact their academic success. Of equal concern is that when we show them such harshness we are modeling the behavior we claim to detest.

We absolutely should challenge students intellectually and ask them to dig deeper into issues. We should ask them to think out of the box and explore options that will require hard work. But we should also make sure they know that it is always safe to challenge us. I worry that the problem is we are not comfortable being challenged. Personally, I would much rather deal with the person that challenges me to my face than the one that walks away without speaking their mind only to then complain to anyone who will listen. I wish teaching inner courage was an expectation in every class.

Maybe my heart feels like a fall mess because I haven’t done enough to change the status quo. I know I want a better environment for the young nurses we are teaching, but I need to dig deep to find what it takes to change the culture that sees conflict as win-lose rather than an opportunity to understand divergent perspectives and grow.

Relational trust is built on movements of the human heart such as empathy, commitment, compassion, patience, and the capacity to forgive… If we embrace diversity, we find ourselves on the doorstep of our next fear: fear of of the conflict that will ensue when divergent truths meet. Because academic culture knows only one form of conflict, the win-lose form called competition, we fear the live encounter as a contest from which one party emerges victorious while the other leaves defeated and ashamed. To evade public engagement over our dangerous differences, we privatize them, only to find them growing larger and more divisive.  — Parker J. Palmer


The Teaching of Cats and Academia

Tonight when we sat I closed the door behind me. As I sat comfortably the bell chimed, my mind quieted, and then there was a cat shrieking outside the door and the bap, bap, bap of his paw on the door asking to be included.  Cats don’t like to be excluded any more than people. Crockett’s (the cat) view was I could never hope to be holy without recognizing the importance of community and family which necessarily requires open doors and open hearts.

I loved being an officer in the U.S. Public Health Service. Teams became families and together we always knew the mission was bigger than any one individual or even group of individuals. We knew that each member was of equal value and together we succeeded or failed. While we had ranks we didn’t treat them as exclusive clubs. We knew that whether we were responding to a disaster, or an epidemic, or working in a prision we depended on each other.

When we staffed national security special events to provide emergency care we knew the risk was small, but the worst case scenario would require us all to have complete faith and trust in the other. There was one deployment where we were asked to do a task that had some significant danger and rather than one or two of us going we all went. Teams stick together. We worked together, we celebrated together, and we grieved together.

I miss that comradery in academia. There is too much us and them. There are those that are paid a small amount to teach a class here and there, those that have annual contracts and are not eligible for tenure, and those that sit at the top in the tenure track. Then there is the staff that makes all other work possible, those with head or dean in their title that keep the ship functioning and are often resented for their efforts, the upper levels with Provost in their title that have to make hard decisions that will impact the future of the university, and the people at the very top who have to keep everyone else happy while playing the necessary political game and are held responsible when anything goes wrong on campus.

Above all, love each other deeply, because love covers over a multitude of sins. Offer hospitality to one another without grumbling. – Peter 4:8-9

When I first retired to move to academia I started at a small Catholic university that believed in the equality of all faculty. Everyone with a terminal degree was eligible for tenure. The faculty cared so much about the staff that they voted to forgo pay raises so the staff would all have a livable wage. They also had a common dining room for students and faculty and everyone socialized there. It was so egalitarian that all faculty were expected to use their first name and know all students by their first name. I see that as an ideal environment for creativity, innovation, and forming young adults.

I’ve always been somewhat uncomfortable with exclusion which may be why that small, egalitarian university was so comfortable to me. I love faculty social events but am uncomfortable when those in staff positions are excluded. I wish I had the skill to create the collegiality and egalitarian nature of that small university. I wish I had in my soul the vision of Mary Frances Clarke, BVM and that special style of leadership.

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When you look into the abyss the abyss looks back

I often think of the song All Are Welcome and I suspect everyone has a song that lifts their heart and reminds them how important it is to be inclusive. Crockett wants to know what song is in your heart?


How Do You Feel About Evaluations?

I have copies of every evaluation I ever had as an officer and none as an academic. I took them seriously. I set goals and worked hard, too hard, to excel. It wasn’t enough just to do my job, or be above average I wanted to walk on water. Then one day I realized I can’t work harder and I have never been told anything I didn’t already know either good or bad.

My first duty station as a nurse was at St. Elizabeths Hospital in Washington, DC. The first day my supervisor ask me for my ID, slapped it on her desk face down with her hand over it and ask me for my ID number. Fortunately, the one thing I don’t forget is numbers. It is stored in the part of my brain that has my first home phone number, my credit card number, and all sorts of other numbers I no longer need. We were immediately on the same page.

I worked 30 days before asking for a day off. As a person who has now supervised for 25 years, I don’t know how that is allowed to happen, but when the Chief Nurse found out she immediately sent me home. When I returned I went back to showing up early, staying late, and never taking leave. By the time I had reached 3 years of active duty I had maxed out the amount of leave I could carry over and started losing leave every year.

I carried the same drive into my off duty time volunteering at shelters, working on special projects, and being involved in my professional organizations. My evaluations reflected my efforts and so did the three below the zone/exceptional capability promotions to LT, CDR, and CAPT. Then one day I met a man that didn’t give me an evaluation that said I walked on water. It was an above average evaluation, but not perfect. When I quested it he replied, “I’ve evaluated people that won Nobel Prizes and they didn’t get perfect evaluations. When you get one let’s talk.” He was smiling and so did I. I realized that I was now competing in a different league. I was fine with it but realized that a Chief of Staff will never get a Nobel Prize and so the evaluation really didn’t matter.  My motivation needed to be intrinsic. I had to stop competing.

I’ve never had a bad or even average evaluations so why do I hate them? I think they are anxiety producing. I would have worked hard with or without evaluations. I worked hard because I cared for my patients and loved my country. I volunteered because I wanted my community to be for others what it was for me. I didn’t need a piece of paper to tell me what was a good or bad performance. I knew when I succeeded and when I screwed up. Yet for about a month a year, I had to spend time documenting what I had done all year. It took time away from my patients and job. It also made me obsess about what else I could have done. It felt like shameless self-promotion and the harshest examination of conscience every. It didn’t make me a better nurse. It just made me obsess. The only thing worse was evaluating others.

I’ve evaluated some amazing people and few that fell short of expectations and a few others that were not good people. I had one person threaten violence with a knife for waking him up when the person should have been caring for patients, another that was ordering supplies and then selling them, and another that didn’t know the liver from the spleen. I’ve also had people that changed national policy and made the world better for all of us.

When I do evaluations I’m still a good officer. I will follow orders, but I no longer pretend that I agree with the process or think it makes the organization or the employee better. I think they are harmful to moral. That is not to say I don’t think employees need feedback. We all do. If someone needs feedback I will give it to them at the time it will be helpful, not a year later. I think praise should be offered freely and correction only when it is something the person doesn’t recognize. If a nurse made a medication error and reported it I don’t need to call that person in and lecture them on the error. I need to make the necessary reports, but in most cases, the person is already chastising themselves. When we made a huge mistake on a grant award the Secretary didn’t call us all in or write it on an evaluation. We were all horrified by the error and he knew it and worked with us to fix it.

I could tell you horror stories of good, excellent, and exceptional evaluation that people grieved because the comments weren’t glowing enough or there was one area for improvement. As much as I have tried to make them useful most people come into my office looking nervous and I know that I am about to give them something that may make them feel valued, but may also make them question their worth.

Is there evidence that evaluations improve outcomes? The growing body of literature is that they do not. According to Ryan Williams, “There is compelling new research that shows performance reviews actually don’t improve performance, and may actually cause a decline in performance.” Knowing that, why do we continue to do them? When I ask I almost always get the same answer about the need to document poor performance. Rephrased that says we do harm to the majority who do a job so we can fire the few that do bad jobs. That just seems wrong.

I’m willing to admit the staff member that threatened violence with a knife when I was still in my twenties may have forever skewed how I feel about evaluations and negative feedback. It could also be twenty-five years of supervising brought me to the realization that most people don’t need a supervisor. They need to be trusted to do a good job. It is simply not true that the only one that cares about success, outcomes, and the mission is the person in the administration. Maybe we would be better off to have quarterly meetings to discuss as a team what we are doing well, what we could do better, and what we should stop doing because it is ineffective. It seems more collaborative than one person evaluating many others.


Students Should Begin Practice Understanding Diversity and Inclusivity

When I left Tennessee to start my career as a new nurse practitioner I thought I was leaving behind racism and sexism. Silly me. While it is less prevalent in some parts of the country it is ever present and I was unprepared.

I arrived at St. Elizabeths hospital the day after graduation to begin work. I had spent two summers working there while I was finishing my Master’s degree so I knew it was in Anacostia, a predominately black neighboorhood and in an area with a significant drug issue. It was where I wanted to be and what I wanted to do. There was little I did not love about being at St. Elizabeths. The neighboorhood was made up of the large, old houses that were suffering some deterioration but still beautiful. Across the street was a Chinese restaurant and down the block was a Popeye’s, which became an addiction I only recently broke.  The campus was 396 acres and 101 buildings many of which were still beautiful and others that were more deteriorated than some of the houses. There were trees from countries around the world and beautiful flower gardens. The room of Esra Pound was even still maintained. Screen Shot 2019-04-08 at 11.52.06 PM.png

I was assigned to a unit that cared for those that were homeless and had a mental illness. I learned more working at St. Elizabeths than any other period in my life. Part of what I learned was my ignorance of people that didn’t look like me, didn’t sound like me, or for that matter were not from Tennessee. I left a community that was predominately white and middle class and moved into an apartment complex that had a great deal of diversity and took a job where I was in the minority.

It is now common to hear about cultural sensitivity or cultural competency, but it wasn’t in 1991. Because I was too young and ignorant to be embarrassed about what I didn’t know I was comfortable with what I now know as white privilege. The day I arrived the unit coordinator announced he was going on vacation and I was in charge. I had completed an entry level MSN. It was the first week of my first job and I was in charge. About a week after I started work one of the Psychiatric Nursing Assistants ask me something that made her realize I was actually a new nurse and from that day forward everything changed. A more senior nurse stepped in and did what I should have done and spoke to the Chief Nurse. She should have been in charge all along. Looking back I had an MSN, new LTJG bars, and I was white. Rather than holding it against me, I was treated like a new nurse and I absorbed all everyone had to teach me from my supervisory medical officer to the psychiatric nursing assistant. 

At some point, my mother asked me one too many times about the color of the person’s skin I was telling her about. I could feel the slow burn as I lost my cool and told her that unless I tell her otherwise she should assume that everyone I knew was black, all my coworkers and all my friends. Of course, at that time it was fairly accurate but why was it always an issue? Why was it always a detail she wanted? Until the day she died, she never asked again. When I left St. Elizabeths to work in a Federal prison one of the interview questions was how my family would feel about me working in a prison. I said not as bad as they did about me working in DC. It was sadly true. My mother never appreciated me telling her that I was truly part of the team when I walked down the street in DC and someone yelled my name from an ally which may not be the best thing to tell a mother.

I have been fortunate to spend the majority of my adult life living and working in very diverse environments. When I retired from the U.S. Public Health Service and moved to Iowa I was surprised that the majority of the faculty and students were white. In my professional life that was a first for me. One person in the city told me they used to be a Catholic town, but now they are only 80% Catholic. I think it was the first time that I truly realized how different life is when there is limited diversity. I wish I had the words to describe it, but it is a feeling that is hard to explain.

I was only in Iowa for three years before moving first to San Antonio and then to St. Louis. It was in St. Louis that the difference between diversity and inclusion was glaring. The university had demographics similar to the community at the undergraduate level, but yet there were significant issues. While we had 20-30% underrepresented minorities at the undergraduate level we did not at the graduate level and it was not because there was a lack of qualified students? The college had recognized the problem and instituted holistic admission and still no change. It wasn’t until we blinded the admissions that we went from 7% to 29% in one year. Fortunately, we had a dean that was supportive of the effort and stood with me when some faculty said we were implying they were racist. We had a positive outcome, but it was evidence that implicit bias existed in the admission process. Where was it unrecognized? My guess is that there hiring and promotion suffered the same bias.

Diversity doesn’t mean inclusion as was the case in St. Louis. I look back and wonder when it was that I found my voice and my courage to stand up. It wasn’t at St. Elizabeths where I dare say I didn’t recognize my white privilege. It certainly wasn’t when I was told I couldn’t hire any more Hispanics for the Cuban Mafia. I think it was when I was told that I couldn’t promote a black officer and if I did “when she fails and they all do I will hold you personally responsible.” That was the day I ordered my boss out of my office and said I will take that responsibility and hired the officer. I was grateful when I was transferred a few weeks later because I knew that there would be hell to pay.

I still would not say I’m culturally competent and I certainly can’t understand what it must be like to be the officer that was expected to fail. But I do realize that it isn’t enough to count numbers, 7 – 29% and call that success. It isn’t enough to hire the person and not report the blatant discrimination. It isn’t enough to increase the diversity of students and do nothing to address the bias in teaching evaluations or to even use them knowing the bias exists and it will harm professors of color and women. It isn’t enough and so we should make it part of the curriculum to include content on diversity and inclusivity. Students should not have to learn how to address racism on the job or that diversity doesn’t mean inclusivity. We can’t continue to send students out unprepared to address real-world issues.

 

 


Teaching Undergraduates is a Privilege

It is the time of year when we will soon be sending undergraduates out into the world to be Registered Nurses. They will be caring for our friends, neighbors, and one day each of us. Most are young, enthusiastic, and ready to provide excellent nursing care to the sick and the dying. They will work to prevent illness, educate new moms on how to care for their babies and provide comfort to those that are grieving. And they will do so much more.

It is the undergraduate that comes in believing anything the professor tells them and leaves with the ability to call the same professor on a mistake, a misquote, or for being a little too arrogant. The undergraduate will be your biggest fan as the years pass, but may not recognize how much you offered them at the time of graduation. They are also the ones that will call you years later to say thank you, or ask for advice, or tell you of their successes. It is the undergraduate that fills your heart with pride.

I think it is an honor and a privilege to teach undergraduates. These young people are entrusted to us by their parents. They trust us to guide and care for them in additions to teaching them. While we see undergraduates as student nurses it is those students that make each of us a little more thoughtful and a lot more humble.

I’m always a little surprised when I hear of faculty that don’t want to teach undergraduates. I know they are more work than graduates students and the courses take up more time on campus, but without undergraduates, we have no graduate programs. It is the undergraduates that keep programs financially viable and if we treat them like the young professionals they will be they will remember us when it is time to return to graduate school. It may be the professor they gave the hardest time that is the one they want to guide their dissertation.

It is also undergraduates that fine-tune one’s teaching skills.  It takes practice to make the complex understandable, to keep the attention of 80 or 100 students, and to know when they are prepared and not. The big lectures, the small clinical, and the remediation are all skills learned and perfected with the undergraduates and what makes graduates seem easier. The main reason I don’t understand why one wouldn’t want to teach undergraduates is that it is in their classes that it is possible to identify future superstars and recruit your next graduate assistant or the student that will carry on your work and take it to the next level.

It is exciting to see student nurses when they first arrive,  but I attend graduation whenever possible because it is even better to see their goals achieved. The happiness on the face of the graduates is a close second only to the look of overwhelming love I can see on the faces of their parents. It is a reminder that what we do for them brings joy.  They then spread that joy to their patients in small ways every day. Life is better when we share the joy.

 

 


Student-Athletes are Students

Yesterday I went to see my Volunteers play football. It began with a tailgate with alumni and hearing about the growth in enrollment and research funding at the university. As the players ran through the T I was proud to be part of the Volunteer tradition. Screen Shot 2018-09-23 at 12.50.40 PM

I left after half-time because I thought it was only going to get worse. No, not the level of play of my team, but the behavior of the fans. The stadium staff had to be called to get a young man out of the seat of a woman which was rude, but a minor issue of poor manors. I decided to leave because the young man sitting across the aisle from my husband had an anger control issue and as did the man behind me that was screaming at the top of his lungs using enough profanities that a sailor would have been embarrassed. It didn’t help that he spewed his spit all over me as he frothed at the mouth.

I bought season tickets because I love football and I love and support my school. What the hate-filled men forget is that those young men on the field are students first and athletes second. They are there to play a team sport and the reason team sports are important is that they teach young people how to work together. They learn we are stronger together and by recognizing the strengths and weaknesses of our teammates we can compensate for them. They learn we perform better when we stay focused and don’t get rattled by mistakes. When we work through tough times, help our teammates, and underwrite their mistakes we grow as human beings. It is the job of the coach to make sure that the players learn these lessons. It doesn’t help when even the coach gets a technical foul. That is the wrong lesson. If football makes you so angry you aren’t having fun then maybe you should watch golf or synchronized swimming.

When we go to the game to cheer on our team and our school we should remember the motto of the torchbearer “One that beareth a torch shadoweth oneself to give light to others.” As the alumni, we need to do a little more to live that motto. Let’s give the players a little light as they learn to play together so that they play better in life after graduation.IMG_2591

 


Academic Pet Peeve: What’s yours?

Pet peeve of the day: careerism.

My career has been a great pleasure. I loved being a U.S. Public Health Service (USPHS) officer and I now love being an academic. The worlds have commonalities that drew me to them. They are filled with people that are dedicated to service and to making the world more beautiful. At their worst, there are too many careerists that never consider how their secrecy robs the public of knowledge.

I became a USPHS officer because I wanted to work with the poor and the underserved, but was too fearful of being poor to be a missionary or join the Peace Corps. I became an academic because I wanted to create new knowledge and share it to improve health care and quality of life.

Throughout my career, I have grown increasingly intolerant of those that take a taxpayer-paid salary or taxpayer-funded research grants and then refuse to openly share their work. Over and over I have seen people recreate the wheel because others didn’t know it existed or didn’t respect the person that created it and thus felt it necessary to recreate the work and again at taxpayer expense.

Today I heard an expert on nuclear preparedness communication hold forth on the need to, “make research accessible”. He went on to say that research cannot just be in the peer-reviewed literature. This would have had more integrity if he and most of his panelist had not prefaced their presentations by insisting that there be no photography or recording of their presentations as some of their work is copyrighted.

Hypocrisy: the practice of claiming to have moral standards or beliefs to which one’s own behavior does not conform; pretense.

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Nuclear preparedness research on how to best communicate with the public is critical to preparedness, but for it to be truly effective it must be put into practice not just at the higher levels of government, but it must get down to the workers, to the mom at home with children, or to the average nurse. As the speakers stated the average teacher or clinician doesn’t read the peer-reviewed literature. How will research get down to the bedside if researchers don’t freely and openly share their work? How will we be prepared for a nuclear event if those doing the research and government officials will not share?

If you really care about improving healthcare, making us more prepared, or creating new knowledge consider the impact on lives when careerism rules public good. We can’t let advancing a career trump the public good.

End of rant.

 


Moving In

This morning as I was going to Mass I passed a mom hugging her son and crying as the father stood by stoically. The son kept reassuring her he would see her soon. It was clearly a struggle to let him go. She had done her job and now she was sending this young adult off to find his way in the world. He will face new challenges and if he embraces the challenges he will grow into a productive member of society that can give others what his parents have given to him.

I love move-in days because it is a hopeful time of the year for students, parents, and faculty. Parents are sending us their greatest accomplishments in life and trusting us to help them transition into adulthood. We will help them build on the foundation their parents gave them. It is our responsibility to help students seek the truth, but not to define that truth for them.

As an instructor of nurses, both novice and experts, it is my responsibility to introduce students to the art and the science of nursing at multiple levels. It is also my responsibility to foster in nurses a sense of duty to those we care for that must sometimes outweigh self-interest. As with any art, nursing requires a passion for the vocation because without passion the skills and knowledge alone will not sustain one when there are too many patients, too few nurses, or not enough resources. Likewise, with students, it is the passion for nursing that will sustain them when there are too many pages to read, too many papers to write, and not enough time to memorize every possible medication.

As a teacher, I strive to recognize students that are having difficulties and help them to find a path to success. I have found in my career that it is those that came to me with the greatest difficulties, that when nurtured, became the most loyal and productive. I know from my own experience that early failures are not always a predictor of future success and thus it is important to look past grades alone and assess work habits, drive, and determination. The student is responsible for embracing his or her vocation, striving to learn, exploring personal motivations, and seeking guidance and assistance when needed.

We began Mass in the presence of new students and their parents singing “All Are Welcome“. It is never more meaningful than the beginning of the academic year.

Built of hopes and dreams and visions… All are welcome, all are welcome, all are welcome in this place.

The students enter with hopes and dreams for the future. Some will cling to what their parents taught them and some will choose another path. I hope that in all I do I encourage students to seek the truth through academic endeavors. I always remind myself that students see me in all I do and all I say. Let us all embrace our status as role models and know that parents are looking at us to be the role models in their absence.

It is time once again to help students fill their intellectual toolboxes, but it isn’t our job to ask them to throw out the gifts their parents gave them.


Word and Speech

The insatiable commotion of idle talk is all too common in nursing and indeed most workplaces. We should ask ourselves why we do this thing we all hate? In my experience the greater the turmoil in a workplace the greater the idle talk. As the idle talk increases the sense of hopelessness also increases.

While I was working as the Chief of Staff for the Acting Assistant Secretary for Preparedness and Response most of my days began in the same way. A loud New York voice yelled out of one office and across the lobby to my office with a few expletives attached and a demand to get in there. It was usually the same issue. A young staffer assigned to write a speech, brief, or put together a presentation had not done it at the expected level. Of course, the level expected was that of an experienced writer, policy analyst, or researcher and not a green staffer fresh out of college.

The first few times I was beckoned I responded by giving the requested information on who had done the work. The result would be a devasted young person that had their confidence shaken and the same thing would repeat the next day. I caught on quickly and would reply I would handle it, but no longer would say who did the writing or completed the assigned task. After a few months, even I was frustrated with the all too frequent morning dance around unsatisfactory work. One evening I took the assignment home with all the necessary policies and research. I gave it to my husband who had dual Ph.D.s in philosophy and psychology and ask him to write the requested speech.

Seeking Truth

People need to hear the truth, but to hear it one must be open to listening. When the speech was reviewed it was exactly what he been wanting. My reply was  “if you want work that looks like it is done by a Ph.D. you need to hire a Ph.D.!”  A few months later we had a professional speechwriter.

Most of us believe we want the truth, but the truth isn’t always easy to hear and is frequently even harder to relay. When someone does tell us the truth we should be both grateful and take action. It is through the action that we show our respect for the person that bravely spoke the truth.

Increasing Hope by Keeping Silent

Morning silence and lack of daily criticism built hope and a better climate followed. The fear that had resided in so many young people was gone and as result, they could explore their potential and grow into highly productive professionals and a cohesive team. Most of us don’t make a sudden radical change. shutterstock_711523417We tweak our behaviors and our performance because it is hard to put away our fears. Only when we are able to wrestle those fears can we be truly just in our dealings with others because we forget about self-protection and can focus on the good of those for whom we have responsibility.

It is not necessary to be friends with professional colleagues, but it is important to treat them as one would a friend. We are more likely to accept the flaws of a friend while approaching them with greater compassion and truthfulness. We are more likely to listen openly to friends. And, we are less likely to engage in idle talk about friends. What if we treated all colleagues, students, and patients as we would a friend?

The friend who can be silent with us in a moment of despair or confusion, who can stay with us in an hour of grief and bereavement, who can tolerate not knowing… not healing, not curing… that is a friend who cares. — Henri Nouwen

 


Caring for the Homeless, Summer Externships, and Nurse Mentors

The summer of 1990 was my second summer in the Junior Commissioned Officer Student Training and Externship Program (COSTEP) of the United States Public Health Service (USPHS). I knew what I would be doing and where I would be going, unlike my first year which was filled with surprises and challenges that started with a tire that was destroyed by something sharp in the street and cost me $70 of the $200 I had to last me for my first 45 days in DC.

In 1989 I was in the second year of a non-nurse Master’s program when someone came to class and handed out applications for the COSTEP program. It was a competitive program and I thought I had little chance of being selected but it paid approximately $1800 per month for the summer. When a call came asking me if I was interested in being a COSTEP I immediately said yes to which the Commander on the other end of the line ask me if I wanted to know where the job was located. I replied that would be nice. A few months later I was off to St. Elizabeths Hospital in Washington, DC for the first of four times moving to DC as a USPHS officer.

A few days after July 4, 1990, Mitch Snyder, the founder of the Center for Creative Nonviolence (CCNV) and the best known homeless advocate in the Nation committed suicide. My goal after graduating had been to work in healthcare for the homeless. I had visited CCNV and they had taken the time to discuss the healthcare needs of their residents with me and my fellow students. I would remember the discussion and the funeral as I worked on my theses that year.

My master’s thesis was on health care beliefs and self-care practices of homeless men, my volunteer work had been with those that are homeless, and I worked on a unit that treated those that were mentally ill and homeless. I saw Mitch Snyder as an icon of compassion and action. It wasn’t until many years later that I considered the aspect of his life that involved policy and the role that the failure of Initiative 17 may have had in his loss of hope and sadness over his relationship.

418902_3189361892271_666383875_nThe nurse manager on my unit suggested I attend the funeral. I was sad and in awe of this man that was what I wanted to be.  The city had turned out and Rev. Jessie Jackson officiated and then lead a procession through DC. The list of celebrities present was long and people like Phillip Berrigan were being asked for comments. He had referred to Mitch Snyder as a “true shepherd”. That is high praise coming from anyone, but a special honor coming from Phillip Berrigan. As I stood behind a gaggle of the press I wondered how much the world lost that day.

The nurses that supervise students during summer externships should always recognize that the students are there to learn. The goal is not to use them as nursing assistants, but rather to help form them as future nurses, professionals, and engaged members of society. My nurse manager did not have to send me to the funeral. She recognized my passion as a nurse, nurtured the passion, and helped to ensure that I chose a career that focused caring for the poor and underserved.

I returned to St. Elizabeths Hospital as a Nurse Practitioner and a USPHS office for three years after graduation. I continued to volunteer in shelters and work with the homeless until 1999. The nurse manager that sent me to the funeral probably had no idea the impact her decision would have on my future choices, my continued desire to work with the poor and underserved, or my view that nurses must be engaged community members. If you think your summer externs forget you they do not. You forever influence their career choices and how they engage with students in the future. Those summer externs are your legacy.

I believe God has a path for me. He’s always had a path for me, and I’ve always been in the right place at the right time – not because of my efforts, but because of my preparation and because of the guides that I have, the mentors that I have, the spiritual walkers that I’ve had all my life. — Judith Jamison


Growing as a Nursing Professor & Administrator in 2018

I love New Year’s resolutions and letting go of the past. Resolutions are a bet with myself that I can make a difference. Starting around Christmas I begin to think about my resolution. This year is different because I have reached a point in life that I realize that my purpose may not be to make the change, but rather educate the one that will be the change. My concern is that I won’t recognize the gifts the person has and know how to nurture their calling. How did my teachers see in me what I couldn’t see in myself in my early twenties?

Nineteen years ago I spent the holidays working a mass migration in Guatemala. It was one of the saddest and most memorable moments in my career as a US Public Health Service nurse and one of the moments that I recognized how much I owed to my nursing professors. They taught us to adapt and use the knowledge and resources we had to provide the best possible care.

They taught us things I thought I didn’t need to know and would never use and of course did need to know and did use. They knew what we didn’t, life is not predictable and if you have a strong foundation you will be able to adapt to any situation.902683_10200964806901714_356566915_o

The beauty of the deer in the field as the fog began to rise was almost enough to momentarily forget that if I turned around there were 500 people that had been rescued from a ship that was helping them flee China for the freedom and promise the United States. The promise engraved on the Statue of Liberty, “Give me your tired, your poor, your huddled masses yearning to breathe free” had beckoned to them. I still wonder what it must be like to desire freedom and not have it. What must it be like to get on a ship that isn’t seaworthy and risk one’s life for freedom only to have it cut short in Guatemala? 

The feeling of helplessness as we told them they were being returned to China and having young women fall to the floor and cling to our legs asking for us to help them is life-changing. Never again were my views on immigration the same. Never again could I see that promise on the Statue of Liberty as anything other than an oath.

The trip from the air base where they were detained to the airport opened my eyes to the poverty all around. As we were on the bus the women were staring out the window and one commented that “these people should escape to China”. The poverty in Guatemala was so shocking to the Chinese women that they couldn’t imagine why anyone would stay.

Some people come to the U.S. for freedom, others to escape war and torture, and some to escape devastating poverty. All hope for a better life. All seek the promise we offer. This year I hope we live up to that promise and give the Dreamers a path to citizenship. I hope we find a way to open our borders rather than closing them. I pray for all those men and women I could not help and hope that in my lifetime we will recognize that when we turn away the poor, the hungry, the huddled masses yearning to be free we fail to recognize their humanity and we fail in our oath to the world.

In many of my experiences as a nurse, I wanted to reach out and thank those that prepared me. There were so many lessons that were both formal and informal. Lessons that taught me what was excellent work for one may be inadequate for another because they had different abilities, which was especially important as a supervisor of young officers. Or, the unspoken lesson that presentation and professionalism matters. Probably most important was to do with a smile what you know you are going to have to do anyway.

This year my resolution is to take the best of all the professors that taught me and use it to be the best possible professor and administrator. I want to reflect on the influence of others in my life and my successes and use them as a guide in my daily life and interactions with students and faculty. I want to be the example that I had. Each day I hope to reflect on my journey to grow as a nurse, a professor, and an administrator.

Mind

My door is open to any student that wants to learn more than what can be offered in the classroom. Every Wednesday I’m in town we will have coffee and discussion of nurses that have changed their communities, the profession, or inspired others to make the world a better place.

Body

We ask so much of our students we need to be healthy to give them our best. This year I intend to give up the things that raise my stress level or cause me to be sedentary or distracted. When I’m stressed, distracted, or moving too slow I’m not available to others. First on this list is to stop reading tweets from @realDonaldTrump. Life is just too short for that much dishonesty and nastiness. Meat isn’t something I need and I feel better when I don’t eat it. No animal needs to die for me to eat. Television is a time pump and mind-numbing (Lady Vols Basketball being an exception). If the television is on I need to be cleaning, exercising, or otherwise engaged in something that involves moving. Motion is lotion and especially as I get older.

Spirit

Let faith guide my career and my decisions. This may be in the tradition of Thomas Aquinas – faith, hope, love, prudent, just, brave, and temperate. Or, it may be through the acknowledgment that all the wrong karmas made by me were created from beginningless attachment, aversion, and delusion. Born of the body, mouth, and mind. I now repent all of them wholeheartedly.

It is the supreme art of the teacher to awaken joy in creative expression and knowledge. — Albert Einstein


Nurses Most Ethical

Nurses have been named the most honest and ethical profession for the 16th straight year. A close second was military officers. Are military nurses especially trusted for their honesty and ethical standards? My guess is they are because they exemplify the best of both nursing and service to the country. Near the bottom of the list are members of Congress and at their lowest level since the poll began is clergy.

I think other professions could learn a lot from nursing about what it means to be honest and ethical. For most of us honest and ethical behavior is easy. It is something we teach and build into both education and practice, but mostly it is an expectation of all nurses. If we make a mistake, such as a drug error, we do not punish the mistake, but instead, we make being honest about the mistake an expectation. We then search for the cause of the mistake and we work to correct it. Dishonest is never acceptable. We embrace our humanity and our failings and when we realize a colleague erred we help them to do better in the future and we make every effort to try and help anyone that may have suffered as a result.

Nursing teaches us that everyone will make mistakes, but we are not defined by those mistakes. Our patients will eat too much and harm their health. They will drink too much, or exercise too soon after an injury, or do something dangerous, or any number of things humans do that harm their health or the health of a family member. Which among us doesn’t have a story we tell and laugh about that relates some serious failure in judgment? It isn’t our job to judge, but to help in recovery, educate on how to be healthier or safer, and treat each individual with evidence-based and compassionate care.

What could Congress and clergy learn from us? Start with self-determination. People have a right to determine their own health, faith, and path. When a patient, a parishioner, or a citizen tells you what they want it is our job to respect their choice. If they don’t want a procedure even though it might help them to be healthier we must respect their decision. Congress could learn that the truth is always best even when it isn’t what people want to hear. Don’t spin it. We don’t tell patients that cancer will make them healthier, wealthier, or happier. We don’t give a treatment we know will not make them better, but will likely make them worse and may in fact seriously harm not only them but their family and friends. We don’t refuse to provide care because someone with more money or more power doesn’t want us to do it.

Likewise, if we harm someone we don’t deny it. We make every effort to correct any harm we caused even if it means that we will get sued or have a negative mark on our records. If we are about to do something that will cause discomfort we talk the patient through it and we try to offer as much support as possible. We never take joy in any pain a treatment causes others and we would never tolerate a nurse that intentionally makes a treatment more painful. I’ve never known a nurse that does not consider patient advocacy more important than protecting a peer that made an error. And, we ensure in every state there is a system for anyone to file a complaint or voice a concern and we ensure that it will be taken seriously and the action taken as a result will be public.

My suggestions to Congress and clergy is to follow these easy rules:

  • Self-determination is more important than your personal wishes.
  • Tell the truth. People know when you are lying and unfortunately, once you are dishonest most people lose all faith in you and what you represent.
  • All people deserve equal respect and dignity. In case your don’t remember what his means here are some definitions.
    • Definition of equal. 1 a (1): of the same measure, quantity, amount, or number as another. (2): identical in mathematical value or logical denotation: equivalent. b: like in quality, nature, or status. c: like for each member of a group, class, or society.
    • Definition of dignity 1. the quality or state of being worthy, honored, or esteemed.
  • Admit your mistakes and work to rectify them.
  • Transparent and translucent are not the same thing.

It is not our job to force our ethics on others, but to show them our honesty and ethics through our behavior.

 


RN-BSN: The next step in nursing education

It has been fifty years since the American Nurses Association (ANA) first advocated for baccalaureate degree be the minimum degree for entry into practice as a registered nurse. Only one state ever required a BSN as entry into practice and it only lasted a few years before they reversed course.  Today 55% of nurses earn a BSN and many more return to continue their education from the ADN to the BSN.

Today Alicia Hutchings joined me to discuss reasons to continue one’s educations and specifically discussed the program she will be leading starting in January, 2018.


PhD or DNP

Welcome to the first podcast of My Nursing Education. In these podcasts, we will explore the path to becoming a registered nurse and advancing one’s career to become a researcher, academic, nurse practitioner,  and always a leader.

Today, I have two guests with me. Kathryn Records is the PhD Director at UMSL College of Nursing and conducts intervention research to improve the health of women and their newborns. Most of her research focuses on the health of women prior to and during pregnancy and considers how experiences such as abuse, obesity, and depression affect outcomes for the woman and her child at birth and across the first year of life. Her research has significantly advanced the science of maternal-newborn/infant health outcomes during pregnancy and postpartum. The clinical relevance of her work is exemplified by her development of a postpartum depression curriculum that has been implemented in two Southwestern sites serving primarily Spanish-speaking Latinas for the past eight years.

Also joining me is Laura Kinsting. Laura joined the UMSL College of Nursing in 2016 as the MSN/DNP Program Director. She has been a practicing pediatric emergency department advanced practice registered nurse (APRN) in St. Louis for over 25 years and a pediatric nurse for over 30 years. In addition to teaching, she continues to practice in the Mercy Children’s Hospital-St. Louis emergency department. In 2015, she was the Director of the Institute for Emergency Nurses Advanced Practice (Emergency Nurses Association). Currently, she is the President of the St. Louis Chapter of Pediatric Nurse Practitioners, an active member of the St. Louis Chapter of the Emergency Nurses Association, and an active member of the St. Louis Nurses in Advanced Practice group.

I hope you enjoy the podcast.


A Path to Diversity

I spent most of my career taking diversity for granted. Having entered my career at St. Elizabeths Hospital in Washington, DC my first supervisor was an African American female. When I returned to St. Elizabeths as a new nurse practitioner my medical director and the supervisory physician was an African American male and in fact, most of my colleagues and those that helped me transition into practice were African American. When I left St. Elizabeths and moved to Tucson, AZ my supervisor was Indian American and my most of my colleagues were Mexican and Phillapino Americans. I had no idea at the time how the diversity I experienced in my early career formed and broadened my perspective. Nor did it ever occur to me that the people with whom I worked would be anything other than close friends.

It wasn’t until I was in my mid-career that first experienced being pressured to make a choice based on race. I was not asked to hire a less qualified person that was a minority. I was asked not to hire the more qualified person who happened to be an African American female. I was told, “When she fails, and she will because they all do I will hold you personally responsible.” I hired her anyway and she went on to be highly successful. I thought it was an isolated incident, but I never forgot it.

Diversity is a blessing

Diversity is in harmony with justice, grace, and peace. Diversity should be defended as it is representative of the dignity that belongs to each person. It is the uniqueness of each individual – ethnicity, religion, political views, nationality, sexual orientation, physical and mental abilities, age, vocation, and thought – added together that makes a strong and more perfect society. The source of diversity and thus the strength of the society doesn’t come from a state mandate but is the creation of God. If an organization lacks diversity, the diversity created by God, then we are going against the natural order and in so doing are weakening ourselves and our society.

I find myself disturbed by the lack of diversity in academia. Maybe it is the places I’ve been or the limited number of people with whom I’ve interacted, or maybe it is an issue in nursing departments. However, the more I read the literature the more I realize that perceptions are sometimes reality. A quick review of a post by Donna Nelson makes clear that there is a lack of diversity in academia and especially in the sciences. Thomas Pfau implies that while we in academia obsess about academic freedom we are a little less concerned about freedom of speech and certainly diversity of perspective.

What is diversity

Diversity refers to all the ways in which people differ and the effect of those differences on our thinking and behavior. This includes socioeconomic status, race, ethnicity, language, gender, religion, and age. A core element of diversity is inclusion, which calls for creating a climate where all individuals are actively engaged, feel safe, and are welcomed. – American Association of Colleges of Nursing

It is not necessary to commit to a substantive definition of diversity and make explicit the normative grounds on which such a definition rests. Diversity is about more than being of different races, ethnicities, or genders or quantifying this many of X and that many of Y. In fact, by adhering to such a definition and quantification one may be missing the attitude of respect that diversity helps to achieve. It may be sufficient to know which affinity group you identify as being important in defining diversity? How would the diversity help you to achieve a more perfect organization or society?

  • Race
  • Ethnicity
  • Gender
  • Sexual Orientation
  • Socioeconomic Status
  • Nationality
  • Political views
  • Generation
  • Genetic characteristics
  • Abilities (mental, physical, emotional)
  • Religion
  • Marital status
  • Work experience

It is not sufficient to tolerate others or the practices of others. Diversity is an attitude of respect that must include a  conscious effort to:

  • Understand and appreciate the interdependence of humanity, cultures, and the natural environment.
  • Practice mutual respect for qualities and experiences that are different from our own.
  • Understand that diversity includes not only ways of being but also ways of knowing;
  • Recognize that personal, cultural and institutionalized discrimination creates and sustains privileges for some while creating and sustaining disadvantages for others;
  • Build alliances across differences so that we can work together to eradicate all forms of discrimination. (QCC)

Reading these it is clear that if we practiced this level of respect and did make a conscious effort toward diversity we would be stronger as individuals, organizations, and as a society.

What is getting in the way of diversity

The easy answer is our fear of change, but that is too easy. I believe that the first and primary issue is that we have done a poor job of explaining the benefits and blessings of diversity. We have not made clear the positive impacts on thought, creativity, peace, and justice.

Question: Why did the universe or God put this person in my path? What am I to learn from them and what have I got to offer in return?

The second barrier is the bias in the way we view those that check different affinity groups from the majority. We all have biases, but not everyone lets bias adversely impact decisions. If I am willing to recognize and own my biases it is easier to break down barriers and not let them obstruct desirable and just action.

Question: What biases do I have and how are they impacting my interactions with others? Do my biases prevent me from treating another human being with full dignity and respect?

The third barrier is privilege. Those of us that grew up in the majority have trouble seeing ourselves as part of the problem. We view the world through a lens that has largely lacked discrimination. It is true that women face discrimination when competing with men, but white women are certainly advantaged over African American and Hispanic women. It is also true that some white males have been disadvantaged when competing for jobs as a result of a desire for diversity. However, it is the exception and not the rule. We could walk through every group in this same manner – older/younger, rich/poor, Christian/Muslim, and on and on. The result would be the same. Some groups are now and have historically been privileged and continue to benefit from those privileges which they did not earn, but were given.

Question: What privileges do I have?  How have those privileges made my life easier? Have my privileges resulted in someone else being made worse off?

The final barrier is lack of moral courage. How many of us have seen a more qualified person passed over for the less qualified? There is always a rationale that is offered and too many that are willing to accept the rationale as a reasonable explanation even when knowing that explanation violates our values.

We can and must remain connected to our fundamental values such as respect for human diversity and the need to create and sustain inclusive environments. Those of us who are associated with or work for organizations that have made their diversity and inclusion values public and even published them have an additional responsibility — to call on the leaders of those organizations to reaffirm those values. As Mahatma Gandhi said:

Your beliefs become your thoughts

Your thoughts become your words

Your words become your actions

Your actions become your habits

Your habits become your values

Your values become your destiny.

Five Actions for Diversity officers and Social Justice Advocates – Johnnetta Cole

Question: What are my values? Am I willing to show moral courage and call on my leaders to reaffirm the values of diversity?

Don’t be timid

It takes moral courage and effort to make diversity a priority. If one is to move an organization the first thing to do is acknowledge that people will be uncomfortable and accept that it is necessary for change. There will be no room to be timid.

For the Spirit God gave us does not make us timid, but gives us power, love and self-discipline. (Timothy 1:7)


Some Advice for the Journey – Teachers Care

When I was studying to be a nurse I sometimes thought that teachers either did not care or did not understand. It was not until I was out of college for a few years that I realized they all cared. They cared so deeply that they were willing to come back semester after semester knowing that the new group of students would have similar complaints to the last group. The complaints are frequently about not being able to find the exact answer in the textbook, having to read too much, having too much work, or not finding the presentations exciting though I’m quite unsure how any of us ever thought a professor was going to make the Kreb’s Cycle exciting.

Looking back, I’m fairly certain that there were times when I was ready to give up that the person that cared most about my success was my teacher.  Some care because they see in you what you cannot see in yourself. Others care because they know if they can only get you over this hump you will be fine. Then there are those that care because if you fail they consider it their failure. Whatever the reason, looking back I never had a teacher that did not care about my success.

Caring does not mean that a professor will turn a blind eye to cheating, or pass you when you fail or stop pushing you just because you cry. As faculty members, we are not always good at letting a student know how much we care about them as individuals and as future nurses. As teachers and students, we can do more to understand each other.

HINT: Crying doesn’t work on other women. We all know what the tears mean. You are mad as hell and can’t say out loud what you are thinking so those words stream down your face.

Teaching feels like a gift from heaven. I cherish the opportunity to share my life and knowledge with others and am forever grateful when they share theirs with me. Each day I have wonderful opportunities to interact with future nurses and seasoned professionals. Sometimes I remember the rules I set for myself and other times I fail. Most days it is a mix of success and failure, but there is never a day I do not care.

Here are a few of my ground rules. I hope one day to master them.

1. Take the time to listen with your heart wide open.

Sometimes we are in a hurry and do not feel we have the time to sit and listen to the same story we have heard every semester. We too easily forget that the story is not new to us, but it is new to this impressionable young person that desperately wants to be a nurse. When a student asks to talk to us we should make the time and we should always encourage students to ask. Will it be the end of the world if we are late to a faculty meeting or another curriculum revision workgroup?

2. It is not necessary to offer advice

When I ask you to listen to me
and you start giving me advice,
you have not done what I asked.

When I ask you to listen to me
and you begin to tell me why
I shouldn’t feel that way,
you are trampling on my feelings.

When I ask you to listen to me
and you feel you have to do something
to solve my problem,
you have failed me,
strange as that may seem.

Listen! All I ask is that you listen.
Don’t talk or do – just hear me.

Advice is cheap; 20 cents will get
you both Dear Abby and Billy Graham
in the same newspaper.
And I can do for myself; I am not helpless.
Maybe discouraged and faltering,
but not helpless.

When you do something for me that I can
and need to do for myself,
you contribute to my fear and
inadequacy.

But when you accept as a simple fact
that I feel what I feel,
no matter how irrational,
then I can stop trying to convince
you and get about this business
of understanding what’s behind
this irrational feeling.

And when that’s clear, the answers are
obvious and I don’t need advice.
Irrational feelings make sense when
we understand what’s behind them.

Perhaps that’s why prayer works, sometimes,
for some people – because God is mute,
and he doesn’t give advice or try
to fix things.
God just listens and lets you work
it out for yourself.

So please listen, and just hear me.
And if you want to talk, wait a minute
for your turn – and I will listen to you.

–Author Unknown

3. It is never necessary to criticize another person to help the one in front of you

Anyone that has taught for any period of time has heard a student tell a horror story of a bad lecture, unclear assignment, or poor classroom management. It should never be the case that one teacher says something bad about another teacher to a student. It is much better to try and get the student to speak directly to the teacher. If that does not work then it is better to go yourself. You will build trust and respect. You might even help avoid a bigger issue down the road.

4. Teaching well must be a priority.

The purpose of the university is primarily creating prepared minds. Our research and service help enhance the education, but teaching is is why most universities exist. Just as strong teaching can enhance one’s research abilities, research provides fresh ideas for the classroom. All faculty must learn to balance the priorities, but students should never be shortchanged because of one’s research or service. Students must remain the center of the university.

5. Southern hospitality helps create a positive environment.

Teachers and students are both human beings. When they are upset or stressed they need to feel welcome in your office. That is often as easy as a cup of coffee, a cookie, or a candy jar. Keep your door open and keep the coffee, cookies, and candy flowing.

Therefore encourage one another and build up one another, just as you also are doing. (1 Thes 5:11)