Social justice in nursing and public health preparedness: Issue 1

I was recently asked what I mean by social justice in nursing and public health preparedness. When I think of social justice in nursing and public health preparedness I think about the concept of a strong back and a soft front which I first read about in 2010.

We need a strong back to navigate this field of investigation and to enter into deep, transformative relationships with clients…It takes a strong back to listen, become a part of the story, be expected by the client to help (yet be uncertain just how to do so), and to sincerely proceed even in the midst of not knowing—and allow your open, soft heart to work in tandem with your strong back. The strong back provides for stillness in the face of client winds that violently shake branches but do not disturb roots. — Bein, Andrew. The Zen of Helping: Spiritual Principles for Mindful and Open-Hearted Practice (p. 10-11). Wiley Publishing.

I am reminded of my work at the Administration of Children and Families focusing on Disaster Case Management for the poor and underserved. Much of the disaster services were designed for those that have much. And many of the recovery actions focused first on the wealthy, landowners, and large businesses. For example, with Katrina and New Orleans, we saw the wealthy sections rebuilt quickly and in the poor sections there were limited attempts to rebuild. The city and Corp of Engineers blocked many efforts with justifiable reasons, but the reasons always seemed to favor those with power and wealth. We also saw generational poverty when houses were handed down without legal paperwork resulting in many not being able to even prove their home was their home.

We see it even now with COVID. We only need to look at who receives vaccines first to know that all things are not equal. Some take greater risk, but many at the top of the list had no greater risk (Congress as an example). But how many high school graduates who have to go to work every day to keep the water running, the trash picked up, the grocery shelves stocked were on any of the priority lists? What about vaccines being given out at Publix? Are there any Publix stores in poor neighborhoods?

Last week I was reminded of a strong back and a soft front listening to a talk by Joanna Macy and Joan Halifax. In short, they said we also need a focus on social action, social justice, and social transformation to eliminate institutional and structural violence. Imagine if we eliminated institutional and structural violence in the way we approach policy, education, practice, and research. What if we ask:

  • How is the design and implementation of these systems keeping people from meeting their basic needs?

We know that after a disaster, or illness, the greatest needs fall in the bottom two rungs of Maslow’s hierarchy and needs and yet the majority of the resources after a disaster go to the people that have the ability to meet those needs for themselves. Thus with every disaster, those at the lower socioeconomic level, those already marginalized, those already facing discrimination have their situation exponentially exacerbated.

I don’t recall if it was Joan Halifax or Joanna Macy that ended by saying:

It is a moral imperative not to be morally disengaged.


Zen and catholicism

There is nothing like having a Priest pull up your profile and then post it saying you aren’t Catholic because you love Zen to get one thinking about books to read or reread and all the reasons I love Zen. I think Richard Rohr captures it best.

Reading List

  • McDaniel, Richard. Catholicism and Zen, 2013
  • Macinnes, Elaine. Zen Contemplation for Christians, 2003.
  • Macinnes, Elaine. The Flowing Bridge: Guidance on Beginning Zen Koans, 2007.
  • Kennedy, Robert. Zen Spirit, Christian Sprit: The Place of Zen in Christian Life, 1995.
  • Chetwynd, Tom. Zen and the Kingdom of Heaven. Boston: Wisdom Publications, 2001.
  • Eusden, John Dykstra. Zen and Christian: The Journey Between. New York: Crossroad, 1981.
  • Graham, Dom Aelred. Zen Catholicism. New York: Crossroad, 1999.
  • Hackett, David G. The Silent Dialogue. New York: Continuum, 1996.
  • Hart, Brother Patrick (ed). Thomas Merton/Monk: A Monastic Tribute. Kalamazoo, MI: Cistercian Publications, 1983.
  • Inchausti, Robert. Thomas Merton’s American Prophecy. Albany: State University of New York Press, 1988.
  • Lipski, Alexander. Thomas Merton and Asia: His Quest for Utopia. Kalamazoo: Cistercian Publications, 1983.
  • Kadowaki, JK, SJ. Zen and the Bible: A Priest’s Experience. London: Routledge and Kegan Paul, 1982.

Websites

Videos


covid-19 vaccine blessings

This week I had the pleasure to be a volunteer vaccinator. Day 1 I supervised nursing, pharmacy, and medical students who had volunteered to be vaccinators during their holiday break. Day 2 I was one of the people blessed to be giving vaccines to frontline healthcare workers. The entire event was well organized to make sure not a single vaccine went unused and that the vaccinators were not pulled from the frontline staff, but rather faculty and students. Everyone was prescreened and consented. They were then entered into medical records and the appointment for the 2nd vaccine schedule with an appointment card handed to each person. When each got to the vaccine station everything was triple checked and they were again ask about history of fainting or allergic reactions. Each vaccine was appropriately labeled and rechecked for dosage.

In my career I’ve been part of flu vaccine clinics and many emergency responses, but this felt different. This time the people I vaccinated were my friends, colleagues, and neighbors that had been risking their lives for others for the last 11 months. They were tired and stressed, but when the needle went in their arms it was as if months of fatigue and stress melted away. The expression was a cross between relief and gratitude. And yet, with each vaccine my sense of respect and love grew for them. They served knowing the risk and when they got vaccinated not one responded as if it were owed to them, but rather they were grateful. These men and women who had given their all for months were grateful to us because as one young man said to me, we were told that all of you volunteered your time to help us. I almost cried looking at what months of wearing a mask had done to the bridge of his nose and he was thanking of us. It gave new meaning to selfless.

When I became a nurse I felt that it was a calling. Most days I can’t imagine having ever done anything else, with maybe the exception of viticulture. I hope when you look at these physicians, nurses, housekeepers, and other frontline healthcare workers you see the love of God. They did their jobs when no one knew if there would be a vaccine. They did their jobs as people continued to not wear masks and acted irresponsibly. And, they did their jobs with inadequate PPE, squabbling politicians, policies made by people who knew and cared nothing about public health, deaths of coworkers, and through myriad lunatic conspiracy theories.

When I imagine the love of God the mental image will be of the masked face of a healthcare worker.


Wisdom from prudence

Prudence is my friendly road runner

Most of my friends have been introduced to Prudence. She is my favorite neighbor and stops by everyday for lunch. I give her dried meal worms and she drops empty snail shells on the porch as a thank you. During this year filled with social isolation I’ve had more conversations with her than anyone else.

Today, in addition to discussing when I thought COVID vaccines would be available to the neighborhood (she thinks it is important to keep bird lovers healthy and safe) we discussed things that make us emotional. It surprised me that seeing FedEx trucks loaded with vaccine made me cry tears of joy and filled me with pride in a country that worked so hard to create it. Prudence says that is how she feels when FedEx shows up with more meal worms. But today, I was surprised that I was moved to tears watching nurses being vaccinated. I thought of my many friends that have worked tirelessly during this pandemic while people like me were safely working from home.

There are ways that all of us who were safe at home can give back to our communities. We can help our neighborhoods plan. Sometimes it is the little things we do for each other that makes us all more prepared.

Make a Plan

  • Ask your family members to commit to getting vaccinated.
  • Ask your pastor/priest/roshi to help spread the word and provide public information.
  • Have your parish nursing community help with public messaging.
  • Talk to your neighbors when you see them outside.
  • Make sure older neighbors have a ride.
  • Keep yourself updated on local distribution plans.
  • Talk to your health care provider if you don’t know who to ask about vaccines.
  • Get your students and faculty involved.
  • Have a vaccine buddy you commit to go with to get vaccinated.
  • Commit to being responsible for getting one additional person vaccinated.

I have never been more pleased with the healthcare community for all it is doing. I hope in 6 months I will look back and say I have never been more proud of our country as all who are able chose to get vaccinated.

My conversation with Prudence ended with her suggesting a new bowl would be a great Christmas gift since I broke the one she is using. She wanted me to tell you “Vaccines Save Lives.”


Rejoice: COVID-19 vaccinations begin

The third Sunday of Advent is a day to Rejoice. This year it feels especially true as I cried watching the first trucks loaded with COIVID-19 vaccines pull away from the facility headed toward you. I was grateful for the scientist who used their intelligence to imagine new vaccines that can be produced quickly and safely. I was grateful for the FDA that insisted on following the safety procedures even in a crisis so we could all have faith the vaccines are safe. I was grateful to FedEx, UPS, and Boyles that are doing the deliveries, and for the U.S. Marshalls that are escorting them. I was grateful for all of those that have served on the committees that planned how to distribute the vaccine when it arrives in communities all across the country. And I am grateful for all of those that are working in their communities to be advocates for vaccinations.

Two days this week I am volunteering to administer COVID-19 vaccinations. It will be the first time since March that I have been inside in a room with a large group of people I don’t know except to go to the grocery store. While I have concerns about doing indoor vaccination I think it is worth the risk to keep hospitals and communities from using nurses that are caring for patients. I also believe it is a small way to give back to all of the frontline personnel that did so much for all of us during this pandemic. When this over we owe them so very much more.

The first day I’m eligible I plan to show up, roll up my sleeve, and get vaccinated. It is important for everyone to get vaccinated. We need to reach a minimum of 70% of the population vaccinated to achieve herd immunity and that means the majority of us have to play our role as good citizens. It is what Americans do. We show up when we are needed and we come together. We see the whole as more important than any one individual. And we enter each crisis as a community. I don’t want this crisis to be any different.

To me it is simple:

  • Love yourself enough to stay healthy by being vaccinated.
  • Love your community enough to reduce risk and be able to fully participate.
  • Love your country enough to help end this pandemic, end the isolation, and make it possible for everyone to get back to work, school, and church.

I miss seeing my friends and my students. I miss taking the time to talk to the people in the grocery store. I miss restaurants, concerts, plays, and travel. Most importantly, I miss a time when the daily news didn’t involve numbers of the dead, ICU availability, and new positive tests. I hope each of you will do your part and get vaccinated.

I know that many fear vaccinations and there have been things in our past that add to that fear. There are others that believe conspiracy theories, it will most likely be impossible to change their views. By their nature, conspiracy theorists are not rational. They can no more control their irrationality than a person who is afraid can control their fear. The difference is the person who is afraid may recognize the fear as not in their best interest, but the person that believes conspiracy theories will not. Therefore, it is important to walk with the people that are afraid and be their strength and comfort. We should not equate people who are afraid with those who buy into conspiracies. I hope that each of my friends who has influence and trust in their community will take the time and effort to walk with those that are afraid or lack trust. Lend them your compassion and your strength.

The light at the end of the tunnel may just be UPS and FedEx headlights. Give them a warm welcome and for the next few months pull to the side and let them through traffic.


Nurses Must Stand Together Against COVID-19 and Unjust Demands

Nurse X quit her job as a nurse in an ER. She was wearing a N95 mask in the ER lobby. A supervisor said she didn’t need it and asked her to take it off…He told her to quit. She did. Her child needs a mother. It’s only a matter of time before you see more healthcare workers making this choice if they don’t have proper PPE.

I am hearing disturbing stories of supervisors forcing nurses to remove their masks. Nurses have always been advocates for our patients. I don’t know a single nurse that is not willing to go toe to toe with a physician, administrator, or even a family member in advocating for their patients. Yet when nurses need to advocate for themselves they would rather quit than take a stand. The fear of retaliation is stronger than the fear of being unemployed. The dirty little secret of nursing is that we have a reputation for eating our young and not standing together when a colleague is targeted by a supervisor or peer.

The Largest and Least Heard Healthcare Profession

Nursing has 3.8 million women and men many of whom now fear for their lives just by going to work. While I see physicians on the news virtually every hour of the day I have rarely seen people discussing what is happening with nurses or having nurses as guest experts. People continually vote nurses the most trusted profession, but apparently, we are not respected for our expertise. The consequence is when nurses are being forced to take off their PPE (mask) by their supervisors or be fired or threatened with being reported the general public is not hearing our stories.

Many nurses feel they cannot quit their jobs so they remove the mask knowing the risk while others quit their jobs and walk away from the work they love. I have yet to hear of one nurse that refused to take off the PPE and instead told the supervisor to fire them if that is what they must do, but they will not practice in an unsafe manner.

What many people do not realize is that many hospitals have social media policies that prohibit nurses from publicly saying anything against their employer. If the nurse does not remain anonymous they can be fired. Essentially, to be a nurse one must give up their freedom of speech. They must give up the right to safety. They must be willing to risk their lives to stay employed while apparently, the employer has no obligation to provide a safe working environment.

If we have plenty of PPE as the President says almost daily, where is it. Why are nurses and physicians being forced to wear the same N95 mask for days? Is there anyone or even a single expert or one bit of evidence that says that it is safe to wear the same mask for days? We all know the answer is no there is not.

Do Not Quit

I firmly believe that nurses should not walk away from their patients and their jobs. I also believe nurses must learn how to say NO. No, I will not take off the mask I bought because you can’t seem to find them. No, I will not move to a unit when I have health and family obligations that I made known when I was hired. No, I will not wear the same mask for days because we all know that it is not safe. No, I will not be silent if my employer will not keep me safe.

What I will do is file an OSHA complaint, write my Representative, and talk to the press. I will contact a union and ask them to help us organize. I will continue to buy my own PPE and refuse to remove it. I will speak out. I will cancel my memberships to my professional organizations if they don’t start advocating for us in a way that is visible to the country.

Nurses Must Stand Together

I  suggest that we take this opportunity to come together as one strong profession and take our place as the largest healthcare profession in the county. It is time to make our voice heard and to let the country and the healthcare system know what we expect and we expect to be safe at work. It is also a good time to change our culture and trust our colleagues as much as the public trusts us. This is not a time we can afford for nurses to quit. If a nurse is told to take off PPE then absolutely ever nurse in the facility should stand together and say either that nurse is allowed to wear the PPE or we will all quit. If we speak with one strong voice the hospitals and healthcare systems will have no choice, but to step up and keep our colleagues safe.

PPE Shortage

I keep hearing that we have a shortage of PPE. We apparently had enough medical supplies including gowns and mask to send 17.8 tons to China last month to help them, but we don’t have any to keep nurses and physicians safe. We have yet to use the Defense Appropriations Act to force companies to make more PPE. And, we have safety standards that seem to be weakened by the day. We have policies that prevent many companies from selling medical supplies to the U.S. Most significantly, we have a government that is not doing enough to address the problem.

Stand up, speak out, and be heard. Caring for patients requires healthy nurses and physicians.


Let May Registered Nurse Graduates Practice Now

Each May over 100,000 nursing students graduate from programs across the country. Most of those students are now being pulled out of clinical and their classes have moved online. Some are being told their graduation may be delayed. The faculty will make every effort to deliver the content, but it will not be the same as the in-person classes. As anyone who has developed an online class knows it is an extreme amount of work that can’t be done in a few days.

Considering the current 8% nationwide vacancy rate for nurses and that the additional need over the next few months may exceed 100,000 nurses, it would help with the surge needs of hospitals to grant the May graduates their degrees now and waive the NCLEX. I know that some will think this is radical and how will we ensure quality. The truth is most students pass on the first try (88.18%) and if you add a second try (72.85) it is near 100% total pass rate. While students may go back and study more they do no more clinical. Thus the clinical skills they have at graduation are the ones they will have when they enter practice even if they take the exam a second time. If we can get the students out now, it may be a substantial help to hospitals that are likely to become quickly overburdened. Additionally, most of these nurses will be in the age group less impacted by COVID-19.

A second option would be to allow them to graduate now, practice for 6 months as an RN and at the end of that time take the NCLEX. As a faculty member, I prefer option 1 because we know that the longer the student delays the NCLEX the less likely they are to pass on the first attempt. Universities are assessed based on that pass rate and it would be unfair to penalize them, or the students, as the result of a national emergency.

I can hear the uproar now from people saying they need to be oriented, we don’t enough people now, and so on. However, much of the orientation could be condensed. Much of HIPAA is waived during a public health emergency so do they really need that training right now? Most have used the electronic medical record in school, so it could be taught very quickly. They are all required to have the necessary vaccines, CPR, and many other items just to enter their clinical practice settings. The truth is there is a lot of redundancy between what a hospital requires for the new employees and what schools require for students in clinical.

It is time for the National Council of State Boards of Nursing and all Boards of Nursing to take bold action. We should think out of the box and while we are at it break it down and throw it in the recycling bin. If we continue to practice as normal and hold tight to our policies we will do more harm than good if the worst-case scenario occurs with COVID-19. It is the time to act and let our May graduates have their degrees right now. If we wait until we are facing the worst-case scenario it will be too late. We must put the patient first.

Let May graduates practice. Let them join the fight against COVID-19.


The Ministry of Nursing in a Time of COVID-19

I woke up this morning and said a prayer for all the nurses and healthcare workers leaving the safety of their homes for hospitals and clinics around the country. Today your practice should be guided by the science and the best available evidence. When you practice know that it is also an art and for the coming months as you pass through this difficult time help to draw a beautiful picture of compassion and love for those in your care.

One of my favorite books is Spirituality in Nursing by O’Brien. It speaks to me as a nurse and my favorite passage reminds me of what it means to care for the sick. I hope you can carry it with you as you care for those with COVID-19.

I had been invited to attend an early morning church service at “Gift of Peace,” a home for persons with terminal illness operated by Mother Teresa’s Missionaries of Charity. On arrival, I settled quitely into a back corner of the small chapel. There were no pews; the sisters sit or kneel on the floor. As I began to observe the saricclad Missionaries of Charity entering the chapel I noticed, with some astonishment, that none were wearing shoes; they were all barefoot. I knew that the sisters wore sandles when they cared for patients but these had apparently been put aside as they came to kneel before their Lord. Not wanting to violate the spiritual élan of the service, I proceeded, as inconspicously as possible, to slip out of my own sandals. Somehow, becoming shoeless in church, a condition I had not experienced before, provided a powerful symbol for me. I felt that I was truly in the presence of God, of the Holy Mystery, before whose overwhelming compassion and care it seemed only right that I should present myself barefoot, in awe and reverence. Near the end of the service, as I went forward and stood before the altar in bare feet to receive the sacrement of the Eucharist, I sensed in the deep recesses of my soul that I was indeed “standing on holy ground.” That memory will, I pray serve as a poignant reminder that whenever I stand before a suffering patient, I am there also, just as surely in the presense of God, and I must take care to remove whatever unnecessary “shoes” I happen to be wearing at the time. I  need to allow the “bare feet” of my spirit to touch the “holy ground” of my caregiving, so that I shall never fail to hear God’s voice in the “burning bush” of a patient’s pain. –Sister Macrina Wiederkehr

Nursing is your ministry. Never doubt that you were called by God to care for the sick and in the coming months, you are going to see more than you imagined. If we don’t flatten the curve you may see more than it is possible to treat. You may not be able to offer a ventilator to every person that needs one. When your heart is breaking and you are exhausted slow down and take off you “shoes” and know that in the “burning bush” that is your patient God has called you to be present at that moment. It is at that moment your art and your ministry are one with your patient. You will not be able to save them all, but they will forever know that you cared.

New York is already reaching out to retired nurses and faculty to help them with surge capacity. I believe it is time for every state to do the same and make sure they have a mechanism to identify nurses that can serve.

Patron Saints of Nurses

  • St. Agatha of Sicily
  • St. Catherine of Siena
  • St. Camillus of Lellis
  • St. Elizabeth of Hungary

Nursing Schools Closing as COVID-19 Spreads

I spent the last ten years of my U.S. Public Health Service career working in public health emergency preparedness. I was fortunate to be able to help plan for some of the issues related to surge capacity for nursing in disasters and public health emergencies. In much of our planning, we made the assumption that we would be able to add nursing faculty and students to the surge efforts. We understood that schools may close but I don’t think we believed that schools and hospitals would exclude students, especially senior students, from assisting during a national crisis.

Nursing Shortage and Disaster Preparedness

Nationwide there is an 8% RN vacancy rate. The rate is even higher in many areas and especially rural and underserved communities. Added to this the average nursing students receives virtually no training in public health emergency preparedness. However, it isn’t just RNs; When we surveyed students and administrators from across the country MD, DO, and MPH students don’t feel confident to respond and the administrators were only slightly better. Screen Shot 2020-03-16 at 1.31.42 PM

(Red = not confident, Yellow = moderately confident, Green = Confident)

Healthcare students expressed dissatisfaction in their curriculum coverage related to disaster and public health emergency preparedness. Our study found similar results to others—a combination of poor curriculum coverage of disaster topics and a lack of confidence in acting on what was learned in their future positions.  This low coverage is concerning due to documented links between disaster training and willingness to respond.

MPH students reported the most coverage and NP students the least.  However, these differences did not correlate with confidence, with NP students expressing the highest confidence in their abilities to utilize their disaster knowledge. It could be because NPs already practicing as RNs.  When we interviewed 13 expert trainers we only had one that said population health was even considered in the training they provided. In short, we don’t do adequate training in school and we don’t do it in the workplace.

Bad Assumptions

Assuming that nursing faculty and students would step up has now been proven to be a bad assumption. Nursing schools across the country are moving classes online and clinical rotations are being canceled. This may cause multiple problems.

First, some states require a certain amount of clinical to be with patients rather than in simulation. Even if the schools could add more simulation they cannot do so if students are not in residence. This will lead to a reduced graduation rate in May 2020 by thousands of nurses when we are in a crisis.

Second, if nursing students are sent home then they will not be present to assist even as a volunteer with the supervision of faculty.

Compare this to England where the National Health Service is considering temporarily registering 18,000 students to provide care on a voluntary basis.

Utilization of Volunteers

Not surprisingly, nurses are the most requested health professional for most types of disasters.  A combination of modeling supported by the Agency for Healthcare Research and Quality and past experience in deployments led to estimates for the number of nurses required to respond to a disaster ranging from a low of 436 for hurricanes to a high of 507,150 for pandemic influenza (R. Lavin & R. Knouss, personal communication, September 10, 2005).  The federal, state, and local professional responders, such as USPHS officers and DMATs, could easily deploy 436 nurses, but the concern is for how long.  All of the nurses have full-time jobs elsewhere, frequently in direct patient care settings.  However, the total number of federal nurses and DMATs combined do not equal 507,150. therefore it is necessary when considering worst-case scenarios to include citizen volunteers and to enhance the existing ability to effectively and efficiently identify, credential, and utilize those volunteers. 

I’m a little concerned that we did not consider how we would allow students, especially senior students, to assist at least as a CNA during the crisis. Instead, because of the legal concerns most hospitals and schools are choosing not to have students present at all. Not only will this not aid in the response, but it is likely to delay graduations in a time of extreme need. I hope going forward we will revisit this issue and find a way around regulations that restrict licensure during public health emergencies.

 


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


Gratitude and a Little Sarcasm on Thanksgiving

When your Dean asks you to share something you’re grateful for in a meeting there is a certain amount of internal pressure to say something. Of course, request like that cause my brain to immediately become a vast wasteland of irrelevant thoughts. Worse yet ask me when I’m working on accreditation reports and massive sarcasm floats to the top.  I remained silent for fear of saying what I was thinking,  “I’m grateful CCNE only comes every 10 years.” Ah, sarcasm my defense mechanism to sharing my true feelings.

Now that I’m home and I have a solid draft of the CCNE self-study I have time to reflect on the year and be grateful. Let me begin with the things that are truly important as I get older. I’m grateful for the scientist and the pharmaceutical industry that invented and manufactured my ACE Inhibitor, Motrin, and Tums and the federal government that provides the vast majority of the money for the research that makes such miracle drugs possible. I’m also grateful for being a nurse and having the skills to monitor my own blood pressure and adjust my meds when CCNE self-study stress causes my blood pressure to rise from the combination of stress and stress eating french fries at lunch with all the associated comforting fat and salt.

I’m really, really, really grateful that I work with nurses who by their natures are nonviolent, compassionate, and don’t harm me when I make repeated request for the same data, but divided by the various different dates that don’t align for USNews & World Report, CCNE, the Tennessee Board of Nursing, and PhD self-study and all the other people that make requests and seem to have absolutely no idea how much time all the reporting eats up.  I would be more grateful if they would all learn to share and pull the data from one source and cut it whatever way they want for themselves so I could actually focus on curriculum and making things more efficient for students and faculty.

I’m grateful to have five cats. When I get home they could care less about data. They care about food, bird watching, letting me know about all the ladybugs they found in the house, and of course standing in front of the computer screen to remind me they are much more interesting than anything on the screen.

I’m grateful for amazing friends that have stuck with me throughout my life. I’m grateful my friends are so diverse and keep me grounded in the reality that what seems true to me isn’t always true to them. Long ago I forgot what it feels like to struggle financially, but some of my friends still do and they remind me to be a good friend means to share. I’m grateful to those of color who remind me that what I experience as a white woman is not what they experience and I need to work every day to check my own privilege. I’m grateful for those that are progressive and conservative because their friendship reminds me that good people see the world differently and their difference do not mean they are any less children of God or any less deserving of my love and respect. I’m grateful to those of faith for lifting me up when I struggle with my spirituality and am grateful to those that are atheist because they remind me it isn’t faith that makes one a moral person. Friends make the world a much more beautiful place and I love them all.

It should go without saying that I’m grateful for a good job that I love, a husband who is the love of my life, a family that brings joy, and all the may blessings that I probably fail to notice every day.

Happy Thanksgiving and may you be blessed with amazing food, family, friends, and gratitude. As I enjoy a good meal I pray:

This food comes from the Earth and the Sky,
It is the gift of the entire universe
and the fruit of much hard work;
I vow to live a life which is worthy to receive it.


Are Nursing Instructors Too Harsh

It has been 30 years since I began my nursing education and I laugh about what I once found stressful, but I’m never sure if I laugh because I think it is funny or out of a stress reaction. I wonder how many nurses from my era cried over care plans/maps or a thousand pages of reading assigned in one week? How many of us went to our clinical rotation after having been up most of the night preparing all the while wondering how we would ever do this for eight patients at a time.

Six months out of school everything seemed easy. I moved from wondering how I would ever do it all to why I ever thought it was hard. Therein lies the problem. I moved from a student who felt the stress to a nurse that was thinking “suck it up”. We all survived and are better prepared to care for patients as a result of those stressful and sleepless nights. But, are we?

When are we asking too much

Having worked at four universities I’ve never made it through a year without a student expressing concern about the workload and the lack of flexibility. Usually, the concern stems from an unexpected emergency, conflicting student activity, or the need to work to help pay tuition. Much of the workload cannot be helped nor can student conflicts. There is a minimal amount of content that must be taught for a student to successfully pass the NCLEX and a minimum number of clinical hours for a student to learn the necessary skills. It is a challenge for faculty and students.

When is the extra assignment too much

I think it would be good for faculty to ask what assignments are actually necessary to facilitate learning and which actually interfere with the ability to learn. If we have students spend all their time reading and doing exercises and no time remaining to reflect on the content is it as beneficial as it could be? Increasingly I believe the answer is no, but I have not found any evidence in the nursing literature to support or refute that belief. Much like the number of clinical hours and the need for content to practice safely and effectively we don’t seem to study it.

If I had an hour to solve a problem I’d spend 55 minutes thinking about the problem and 5 minutes thinking about solutions. – Albert Einstein

I have always thought it would be great to have time to sit and think about the book or the article I am reading, but even now I feel the need to push on to the next task. It is what my nursing education modeled for me?

A Chronicle article from January suggest that 5 pages were sufficient. Obviously, in nursing that is a ludicrous suggestion, but so is the belief that a student can read 500 pages in a week and have multiple assignments. I can imagine a world where we get together and coordinate reading and assignments so that it is reasonable and thus it is possible for the faculty to give more attention per assignment and the students to be able to read, think, and then apply.

What do we do when an assignment is missed

I have almost always had a statement in my syllabus that essentially says that the due date is the latest possible date due so if one is prone to illness, accidents, or the heartbreak of procrastination they need to plan ahead because late work will not be accepted. Of course, it was somewhat dishonest because I clearly intended to make exceptions for births, deaths, accidents, illness, marriages, and all manner of life events. Students are people too and life happens to them. The question is always whether to adjust the grade for the extra time that their peers didn’t get or in the case of a clinical experience whether to add extra work or a makeup day.

As I have gotten older I have mellowed. I don’t think there is any evidence that a single missed clinical day has a measurable impact on performance as a nurse. I do think that adding a makeup day or assignment unnecessarily stresses the student and the faculty member. If we can’t show that it makes a measurable difference and it clearly causes student and faculty stress then why do it?

There must be a creative way to build in a late assignment or absence without encouraging either. If you know the answer please share.


Is Anyone Called to Work in A Concentration Camp

When I was young I wanted to work with what I thought of as the poor and underserved. Over the course of my career, I’ve worked in four types of facilities: mental health facilities, homeless shelters, prisons, and detention facilities. They all share similarities.  I was excited when my first job out of college was at St. Elizabeths Hospital in Washington, DC working on a unit for those who had a mental illness and “no fixed address” which was the systems euphemism for homeless.

The unit and the hospital was largely still as Ervin Goffman described it in Asylums. While the harshest of treatments had long ago ended they were still given donated clothing or hospital purchased clothing to patients and generally not returning their clothing. The food was dismal and best. There were times when the food was so limited that patients checked out against medical advise. The conditions for staff were also not what most would expect. Nursing was chronically understaffed and depended heavily on per diem nurses. There were long periods when nurses were forced to work overtime that could be an additional shift or even an additional day or more. Anyone who thinks forcing people to work multiple shifts of overtime a week improves quality of care or compassion is delusional. I don’t know if any of us complained about or filed protest through official channels or even thought to do so. I do know that many of us donated our used clothing and brought food that we cooked and shared with patients.

I volunteered in shelters and tried to understand what could be done to change a society that allowed so many people experiencing homelessness to go without the medical, mental health, and social services care they needed. There was only one answer, we are still a puritanical society that sees the plight of those experiencing homelessness as just punishment for sloth. I suspect many believe mental illness is a myth and so when the mentally were deinstitutionalized under President Regan with the promise of outpatient care that never materialized people complained and shouted at the wind, but we still don’t have adequate outpatient care?

Mental illness is nothing to be ashamed of but stigma and bias shame us all. – Bill Clinton

After three years I ask for and received a transfer to the Federal Bureau of Prisons in Tucson, AZ leaving the care of one group of people held against their will to care for another. FCI Tucson was in many ways a model facility. It was clean, efficiently run, had fully staffed medical and dental clinics, lab, psychology, and pharmacy. The food was good and most of the staff ate the same food as the “inmates”. Those that worked in UNICOR were paid and a commissary was available to purchase things that were not provided. In fact, many of those who were there for illegal reentry into the U.S. would send some of their money home. It wasn’t what I had in mind when I thought of working with the poor and underserved, but there were many similarities to large psychiatric facilities through the prisons seemed better funded and better staffed. We seemed to treat those in prison with more respect and compassion that either those with a mental illness or those experiencing homelessness.

I was in prison and you came to visit me … I tell you the truth, whatever you did for one of the least of these brothers of mine, you did for me.”
(Matthew 25:36, 40)

It was at FCI Tucson that I began to realize that to make big changes one had to be able to change national policy. The Federal Bureau of Prisons is not luxurious, but most of their federally run facilities comply with the American Correctional Association and National Commission on Correctional Healthcare guidelines. In fact, while I was at FCI Tucson we sought and were accredited by the Joint Commission. If one wanted to be an administrator there was a training program that had to be completed and thus there were standards. Every person working there had to complete annual training and sign off confirming they knew the rules. There will always be bad actors, but they were the exception. In my time there if I ask for anyone to be sent out to the local hospital it was not debated. It happened and generally happened quickly.

In 1997, I became the Health Services Administration at the Buffalo Federal Detention Center. Medical care was run by the Division of Immigration Health Services (DIHS). Many of the people were pending deportation after serving time in prison. When I arrived the medical clinic was still under construction. I hired a physician, two nurse practitioners, an RN, an LPN, two medical records techs, a pharmacist, and a pharmacy tech. We had a dentist and a psychologist that came in on a regular basis. Additionally, we invested in telemedicine equipment which at the time was new and gave us access to other providers. Within fifteen months of opening, we were accredited by the ACA, NCCHC, and Joint Commission. In my time there we had no deaths and provided high-quality care. My biggest complaint was the inability to get patients brought to us in a timely fashion and too often being told someone had been removed from the facility when in fact they were still there.

I became the Chief of Field Operations responsible for administrative oversight of the eleven health clinics in Immigration detention facilities (not contract facilities). I visited most of them and did a thorough review of any deaths. Most of the healthcare staff were U.S. Public Health Service officers and so most were passionate about their work and caring for those in detention. There were exceptions and some people over time became judgmental about the plight of those detained, but in my worst nightmare, the worst case I reviewed, the worst thing ever reported to me doesn’t equal what is happening today with the detained children. More importantly, if any of what is happening now was reported Immigration and DIHS would have immediately sent teams to investigate.

I left DIHS in 2001 after 9/11 when to run the command center for Secretary Thompson’s at the Department of Health and Human Services. I never returned to DIHS and was grateful as I had become increasingly concerned about what I saw as a push to limit the care provided and a move to more contract facilities and more contract staff. Physicians were feeling overworked and nurses were being asked to take on more and more of the care. While I didn’t think nurses were being asked to do anything out of their scope of practice it was a constant battle to not cross that line.  I also knew I was pushing the envelope. I was told at one point, “You will do the right thing no matter the consequences.” It was not meant to be a compliment. The person was angry and my life was becoming more difficult.

In 2007, I went to work for the Administration for Children and Families (ACF) as the director of the Office of Human Services Emergency Preparedness. I worked closely with the Office of Refugee Resettlement( ORR). The reason for the visits was twofold, assess their emergency preparedness and see how they did case management. ORR was considered to have an excellent case management program that moved people from being a new refugee that didn’t speak English to being fully self-sufficient in six months. It was a huge effort that was supported by faith-based organizations. I visited a few of the facilities for unaccompanied children and I did find them depressing, but they were clean, each child had a bed with linens and blankets, age-appropriate clothing, plenty of food, medical care (which I didn’t think was at the level I would have liked), and education though it certainly was not equivalent to elementary or secondary schools in the community. There were around 40 facilities and 1600 beds. They were chronically underfunded even then. What they could do was limited by the funding. Congress and the White House knew it. In fact, the faith-based organizations that ran many of the facilities also knew about the underfunding.

This is my long way of saying I could not believe what I was hearing when the detention facilities were referred to as concentration camps and there was inadequate food, no basic sanitary supplies, inadequate medical care, and children taking care of children. The places I worked and visited were not great, but I called the people working there colleagues and friends. Would we have ever allowed this to happen? I even argued with people the term “concentration camp” was inflammatory and not helpful. When I saw the court recording, the pictures, and heard statements of lawyers I was shocked.

How could healthcare people not speak out? I hope that some of this information is getting out because they are leaking it. Yet, I don’t want to be too quick to forget what it is like to be the nurse in the facility. Each day you go in and see as many people as you can thinking if you aren’t there who will be there to provide the care. You go home and you pray for your patients. Yet the most obvious thing to do is sometimes the hardest. How do stand up to those in charge and say, not on my watch?

I’m outraged, but my outrage doesn’t change the current situation. CDR Jonathan White testified before the Energy and Commerce Committee on February 7, 2019. In his verbal responses, he was clear that people were warned about separating children and parents. He did not address all of the unaccompanied children that cross the border, but I’m sure he was equally concerned about them. Then in April 2019 before the Senate Homeland Security and Governmental Affairs, there was further testimony from CDR White and others.  He appears to care about the welfare of the children and is trying to reunify children that came with parents or family member. In fact, for over a year ago HHS officials have warned about the situation. CDR White clearly states that the problem isn’t of data exchange, but that children were separated. The ORR program was designed for the truly unaccompanied children and not for children separated by the U.S. when apprehended. You can see the disgust on CDR White’s face when he says the issue is that it happened at all. Since July 2018 HHS has been warning the administration and Congress yet there is no positive action.

The Catholic tradition teaches that human dignity can be protected and a healthy community can be achieved only if human rights are protected and responsibilities are met. Therefore, every person has a fundamental right to life and a right to those things required for human decency. Corresponding to these rights are duties and responsibilities–to one another, to our families, and to the larger society.

My question to all of those screaming about the atrocities is what have you actually done to change it? Have you actually written a letter to your representative? Have you donated money to one of the not-for-profits that provide the care at most of the facilities for unaccompanied minors? And to Congress, other than the horrific legislation offered by Senator Graham that ignores the dangers faced by the asylum seekers, Senator Cruz’s Protect Children and Families Through the Rule of Law Act which is more about removal quickly back to the danger they fled, and U.S. Senator John Cornyn (R-TX) and U.S. Representative Henry Cuellar (D-TX-28) who proposed the HUMANE Act has anyone drafted legislation that would actually address the problems in the “concentration camps”?  Is there anyone in the House or Senate that is working together to fix laws that allow this to continue?

If you really think this is inhuman, a concentration camp, and must be stopped then why not work day and night to pass legislation that will stop it? Isn’t that more productive that tweeting? I want to see a Tweet with a link to the legislative fix. I want to see posts about people volunteering with their local churches and community organizations to help support the needs of refugee families. In our parish, it took the hard work of five families to get one family to self-sufficiency. More volunteers are needed in almost every city in the country.

As for the rest of us, here is an interesting fact, anyone in the U.S., any citizen can draft legislation and a member of Congress can introduce it. I will write it if AOC will promise to introduce the legislation. I bet she even has some aides that could help. Likewise, what about all those running for President, where is your draft legislation to fix this?

We don’t need more hypocrisy. We need action that recognizes that our Puritan history must be weeded from our hearts, laws, and policies.

For I was hungry, and you gave me to eat; I was thirsty, and you gave me to drink; I was a stranger, and you took me in. (Matthew 25:35)

 


Nurses on Twitter

Whether you like it or not social influence now matters in your professional life. You can stay stuck in the past and ignore Facebook, Twitter, Instagram, LinkedIn, and ResearchGate, but you do at the risk of becoming obsolete. I recently saw a post by a philosopher who thought it was better when all of the intellectual discussion stayed within academia and peer-reviewed journals. What he didn’t realize is that elitism is no longer acceptable and is a view largely held by the privileged who never had to fight to be heard. The days of predominately white men controlling what is discussed, studied, taught, and identified as important are over.

While there are politicians that think social media has too much influence I would argue that what they may be objecting to is that we can now be heard by the masses and politician, clergy, and the famous no longer are the sole owners of the bully pulpit. The average person on the street can reach as many people as the pastor of the church. The elementary school teacher can use social media to let the entire community know there isn’t enough money to buy all of the school supplies. The healthcare community can spread the word about healthy lifestyles and policy that may adversely impact your access to care unless you act.  Who of us doesn’t get posts in our neighborhoods about break-ins and crimes so we know to be on the lookout? Each of us can call out politicians for their lies. We are able to form a community with people we would rarely if ever see and we are stronger and more equal as a result.

Social media also matters in your research influence. It is impossible to attend every conference and network with all the people you would like to meet, but almost every conference now has a #hashtag. If you look it up you can follow the tweets of the conference and network with people even when you can’t be present. It grows your network of people with whom you share a research, policy, or practice interest. When you do meet people in person they will know your name. In emergency management, we always say you don’t want people to hear your name for the first time in the middle of a disaster. As a researcher, you don’t want people to hear your name for the first time when you need their help.

The various platforms have their limitation but they each have their strengths and purposes. For example, I only used LinkedIn for professional contacts. I will accept any professional request. I use Facebook mostly for friends and people I want to stay in touch with from previous jobs and neighborhoods.  I only accept a friend request from friends, colleagues, and people I know or have met at conferences, events, or interacted with in other ways. ResearchGate is only about my academic work. Twitter is like a huge town hall or community meeting. I can connect with people that share interest across nursing, disaster research, health policy, public health, politics, faith and all manner of social activism. Each platform has a purpose and I use each in a different way. I now regularly run into people at conferences that I know through social media. That connection has improved my networking at conferences and the attendance when I’m presenting.

Understanding and maximizing tools are important. Almost all of the social media tools have limits. The limits on Twitter make management important and it also makes etiquette important. Twitter only allows individuals to follow 5000 accounts unless you have more than 5000 followers. Once you reach that number there is a metric that essentially allows one to follow 10% more people than follow them. The result is that some people reach the 5000 and then can’t follow anyone else even if it is their research partner unless they first unfollow someone.  Here are some quick tips to maintain your numbers

Follow

  • People that will follow back – the truth is if they aren’t following you back they probably think the relationship is less important than you do. A less kind view is that they only care about their own success and not about the success of anyone else.
  • Those that share an interest and will interact.
  • Those who have influence in your profession or provide information you may not otherwise see.
  • Those you may want to connect with related to work, research, and social issues.
  • The people that are trying to make the world better even if they may never follow back. Some days you need to be inspired and know there are people out there that try hard.
  • Key influencers in your area of interest.

Don’t Follow

  • Large accounts and news media. Those accounts will most likely show up in your timeline anyway. It is the Donald Trump phenomena. Unless you block him he will show up in your feed so why follow. He certainly doesn’t need the followers to be able to follow anyone he wants and unless you are famous he probably never sees your replies.
  • People who have mistaken Twitter for Tender or another dating app. If a man or woman has to tell you the are honest, or God-fearing, or loyal they probably aren’t.
  • Don’t be afraid to unfollow or block people that are rude, believe conspiracy theory over science, or generally make your blood pressure rise. I should want to convince anti-vaxxers of the error of their ways, but God either didn’t give me that level of patience or I have failed to develop it.
  • Don’t follow people or companies that follow/unfollow/follow/unfollow… It is an effort to get you to follow back or they are using it as advertising. That is different from people that follow you and accidentally hit unfollow and refollow within minutes or people that are unfollowing non-followers because of the limits.
  • Don’t feed the trolls. Block them.
  • I also block people that keep getting recommended to me by Twitter, but who clearly have no interest in collaborating or interacting. It is the only way I’ve figured out to get their names to stop popping up.

Maintain Lists

  • The accounts you don’t want to follow but want to check on a regular basis.
  • People you NEVER want to interact with because of their behavior online.
  • The hashtags that are of interest to you.
  • Researchers or leaders in your area.

My Favorite Nursing Hashtags

  • #VolForLife
  • #NurseTwitter
  • #NursingEducation
  • #NurseEd
  • #NursePractitioner
  • #NP
  • #FullPracticeAuthority
  • #CRNA
  • #NPsLead
  • NursesWhoTweet
  • #NurseLife
  • #FutureOfNursing

Nurses to Follow

I wanted to add nurses to follow, but there are so many amazing nurses involved in policy, research, practice, and social justice that I didn’t want to leave anyone out. If there is a downside to nurses on twitter is that many are not good about following back. If they don’t it is fine to unfollow and then check their pages from time to time.

I wish we were as good about making lists of people to follow as some other groups are because there is power in numbers and we are the largest healthcare profession. If we all joined together we would make nursing issues trend on a daily basis and bring our special talents to issues that matter to us. Imagine 100,000 or 500,000 nurses tweeting about immigration health in the detention facilities, or full practice authority, or NINR funding or the unacceptable infant mortality rate in the US. Imagine.

 


When You are Ready to Retire: Teach

A friend recently called for advice about making the move to academia. Many nurses and other professionals in government civil service and uniformed services have doctoral degrees in their chosen professions and of those, a significant number have worked in policy, research and development, and administration. If they entered public service right out of college they are relatively young when they reach the years of service necessary to retire. I was 48 so I had time for another 20-year career and I couldn’t think of anything I would rather do than teach.

Why Make the Move

A life of service is hard to leave. Any person that has dedicated their life and professional career to the service of the country is unlikely to be fully satisfied in corporate America or staying at home. When you chose government service you clearly do not do it for the money and that is a characteristic that is unlikely to change. You may like having money, but most likely it is not the key driver for making a decision. The retirement check gives you the freedom to follow the heart and the ability to take a salary less than what you were making in the government and still break even.

When I left active duty I applied for four jobs. Three jobs were in academia and one was with the state government. I almost immediately had three interviews and three job offers. I took the one that paid the least but was most likely to be an easier transition. As my husband told me, I was used to people “kissing my ass” and doing what I said without question and in academia neither would happen. That would turn out to be a very pleasant change. There is little that is more limiting to personal growth than blind loyalty or loyalty out of fear of position.

You may have given a lot, but a lot was given to you.  If you are retiring you have given your entire adult life to service to the country. But, your country has been giving too. My Ph.D. was fully funded, every training course I took was paid for by the government, and every effort was made to help me succeed. I may have given, but I received in equal or greater measure. When the Ph.D. program in nursing began at the Uniformed Services University one of the hopes was that after completing service to the country those they educated would then teach as a way of giving back. Never forget the country you served also served you.

There is a difference between what is taught and what one needs to succeed. Senior officers and government official hire and train hundreds if not thousands of young people fresh out of college. They have seen what makes those young people successful and what leads to difficulties in their professional lives. It is true that what is taught in college is essential knowledge and if done well gives a young person the necessary skills to adapt, but in many cases, it is the skills of listening, respect, professional presentation, and teamwork that are missing. As an officer or a senior official, you know how to blend this information into impactful lessons in a way a person who spent their life in academia will not.

I am easily able to explain to students why it is important to always be early for work and to think before you speak. I have a dozen real-life stories of things that have happened. I also have stories of people that thought they were on the right path but didn’t recognize that they had strong talent that would take them further if they had the courage to chose a different path or make a career change. One of our Presidental Management Fellows who was a nurse turned out to be the best champion of the Combined Federal Campaign our office ever had. She was missing her calling in fundraising and went on to be very successful. Not every student in nursing wants to be a nurse. It is okay to point out other paths they may take after finishing their degree. It isn’t necessary to change majors. It is fine to take a nontraditional path.

Academia needs people with well-developed leadership skills. There are things universities do well, but teaching leadership is not one of them. From day one as an officer leadership is taught and emphasized. It is not about learning to administer, which is definitely emphasized, but about leading. Don’t misunderstand, there are some amazing Deans, Provosts, and Presidents of universities, but there are even more that have little formal leadership training. What makes a great researcher isn’t always what makes a great leader.

If you work for the federal government until retirement you will have been sent to courses on strategic planning, financial management, personnel management, and leadership. You have probably managed large numbers of people, large and small budgets, grants, pilot projects, policy development and implementation, and a plethora of special projects. You have in your toolbox things the average academic does not have and in addition, you have been tested under different leaders and multiple administrations with all the political appointees they bring with them who may are may not have any knowledge of the area they oversee. Most importantly you have grown a thick skin and learned how to work fast and under pressure.

I was privileged to work with an amazing President, Provost and Graduate Dean when I first came to academia. They hired me for my leadership skills and not my academic history. The department had been without a Chair for a couple of years and the one before me had left quickly. I had looked for the job that needed my skills and was also willing to let me teach. When those three job offers came in there was no doubt which one I wanted and which was the best fit. It was the small school where I could learn academia and help them to address several years without a department chair. It was a win-win.

Transition Planning

It is a good idea to start your transition plan one to two years before you retire. Here are 10 must for your transition plan:

  1. A curriculum vitae is a must and it should look like one in academia. There are many things in government that are the same as academia, but academics will not understand government speak and if you don’t use academic terminology you will hurt yourself.
  2. If you are not publishing you need to start. I would highly recommend two to three peer-reviewed articles a year. It may seem intimidating, but it is easier than it sounds.
  3. Never turn down an invited presentation. All of the invited presentations you did now need to be on your CV. You are most likely going to have to search for them.
  4. Make sure your CV includes the number of people you supervised, budgets managed, and major accomplishments by position.
  5. You didn’t get to retirement without serving on many committees, task forces, and probably at the national level. You need them all on your CV.
  6. Start teaching by working as an adjunct instructor or lecturer. You do not need to be paid but you do need a letter of appointment. If you have ever taught a government course, precepted students, or developed training it needs to be on your CV.
  7. If you haven’t practiced clinically in a while you may want to renew that skill. Most places will want to know that you still understand the clinical setting even if they will not expect you to teach clinical courses. Volunteering is a good way to make sure you are current.
  8. Attend professional conferences where you are likely to run into academics. Use all of the skills you ever learned about networking. You need to start a new Rolodex.
  9. Start looking at university requirements for tenure and rank and make sure you are writing to those requirements.
  10. You need a good mentor for the transition and you need to reconnect with your dissertation advisor. Both can couch you on negotiating rank, salary, and start-up packages. If any university tells you that a retired Captain O-6 or senior executive service needs to start as an Assistant Professor you need to look elsewhere and this is especially true for women as it is more likely to happen to you than your male counterparts.

Teaching is a great opportunity to continue your life of service and it will remind you on a daily basis why you chose your profession all those years ago.

 


I Want to Walk in Your Shoes

I have had a long career and a wonderful life that I look back on with joy. There are a few exceptions and most of those are the times I could not find it in myself to walk in the other person’s shoes before passing judgment. I excused my behavior as putting the mission before individual needs, including family needs, when in reality it was poor communication and a lack of trust.

As both a staff member and a leader I have been a horrible judge of how much time it takes to do a task. I’m not any better with home repairs. If you ask me how long it will take to paint my home office I imagine I can do it in one day. Having painted many rooms I know I can’t do it in a single day, but none the less my mind tells me I can.

One day our office was preparing a briefing for the White House. As the Assistant Secretary and staff worked on the brief I reminded them how much time we needed to print and collate the required copies. As they passed the last possible minute we could get it printed on time and leave adequate time for them to get in the car and make the trip to the White House I was stressed. A copier doesn’t work faster because the presentation is going to the White House and neither can a person. The Assistant Secretary was so angry that it wasn’t completed when he needed it that he threw his briefcase, but that also didn’t make the copier work any faster. It is a common failing of highly motivated and highly successful people to think the world revolves around their expectations and needs. It doesn’t.

In academia, the stakes are much lower, but the passions are just as high.  How many classes can a faculty member successfully teach and how many papers can be carefully graded in a normal work week? Is it more work to grade a graduate or an undergraduate paper? How many grants can be written and how many papers published? How much time does committee work actually take? How much time does it take to grade the work of a student after a nursing clinical and how early must the faculty member be at the clinical site before the students arrive so everything is ready for a seamless day? How much time is actually spent on research with and without a graduate research assistant?  And then there is all of the unaccounted for time of mentoring, advising, writing letters for jobs for former students, and being active in professional organizations. But work isn’t all that a person must do. My experience is that everyone is working hard and maybe even too hard. It is an American characteristic.

All people have things they need and want to do that are not related to work. Each person has tasks of self-care such as dental and medical appoints. There is the task we all hate but must do such as getting vehicle inspections and anything to do with the DMV.  Moms and dads must care for sick children and even attend the extracurricular activities of those children. Who hasn’t had to be home to sign for a package or wait on the plumber? We all will eventually have to attend a funeral. These are all tasks of life and they are not optional. A well-rounded person must do these things and a productive employee should be supported when doing them. Why do we judge them?

Judgment is not new. Consider that at the time of Jesus they were writing about the Father judging no one I assume that the message is that we have done it throughout history and it has always been an undesirable behavior.

22 Moreover, the Father judges no one, but has entrusted all judgment to the Son,23 that all may honor the Son just as they honor the Father. John 5:22-23

I know my inability to see the perspective of the other did not end at the office and I doubt I’m alone. How often do we try to walk in the shoes of our spouses, parents, or children?  How often do we try to understand the store clerk whose line is slow or the driver who makes a mistake or the person that doesn’t understand stand right and walk left on the metro escalator? How often do people try to understand issues of equality without trying to justify the current norm?

Ultimately to walk in the shoes of the other person we must be willing to trust the person is working as hard as we are, cares as much as we do, and has intentions that are honorable. We must see the other person as equal and deserving of respect.

I’m finally at the point in my career and my life that I would rather trust a person than find fault. I would rather underwrite the mistakes of others than limit them and me with my judgment.

See each person for what they bring to the table and not what you would bring if you were them.

 

 

 

 

 


Do Catholic Women Want Women Deacons

When I taught at Clarke University Sr. Joan told me I should start all meetings with a prayer. I was fresh out of the 21 years of active duty where you did not pray at federal meetings. Asking me to lead a prayer before meetings caused me great anxiety. I was so bad at it that Sr. Kate gave me As We Gather, As we Part which contained 150 opening and closing prayers.  Mostly, I was bad at it because I didn’t feel I had led a life that deserved to lead a prayer, but I looked around at the Sisters and knew they had. Last night I searched the house for the book and couldn’t find it. Today I found it in my office. I should have known it was packed with office books because that is where I used it at Clarke. I knew I needed it.

The tongue of the righteous is choice silver; the mind of the wicked is of little worth. The lips of the righteous feed many, but fools die for lack of sense. Proverbs 10:21-22

Women are not fragile! I don’t know what women were like in 533 AD, but my guess is fragile was far from accurate. Today women are definitely not fragile. We fought for the right to vote and then we literally fought for the right to fight for our country. We fought for the right to work and then for equality in the workplace. Despite the obstacles, we continue to raise families and in most cases take on the majority of that task. We continue to show up even when you treat us as less than because of our gender. Fragile, those Bishops should have looked inward. I suspect their egos were what was fragile.

I’m not sure how many people are interested in the topic of women deacons. I’m not sure if Catholic women care enough to be the Dorothy Day of our time, but I do. Show up and be counted. If we do not bring equality to the church it will be diminished in our lifetime as young women walk away because they see the hypocrisy and the misogyny in the Bishops that deny history.

Let’s not be the fools that die from lack of sense. If we don’t trust that there are women chosen by God to be Deacons and stand and support them, then we are no better than the Bishops that saw women as fragile. Are you fragile or are you ready to be a suffragette?

Our problems stem from our acceptance of this filthy, rotten system. – Dorothy Day

 


Curse of a Nurse: Social Justice Nursing in the World

The curse of a nurse is an educated mind often formed by religious and social backgrounds combined with work experiences which enable us to see things from a little different perspective. Principles of religion, education, and nursing practice illuminate what is wrong in our society.

We are both blessed and cursed with what we see and experience. The day of an average nurse is full. It is full of cultural perspectives, love and hate, grief and joy, violence and compassion, and fear and bravery. Nurses see people when they are vulnerable and willing to share truths, but they also see them when in the delirium of medication or pain they reveal what they would normally never give a voice. The nurse in the clinic or at the bedside sees the end result of failed policy, bigotry, and poverty. The nurse also sees those with privilege, success, and wealth and realizes the results of disparities.

Nurses experience all we see and what we see fills our lives with wonder and a search for the truth. There are days that we are bone tired with aching feet. The best we can do is ramble on about what we have seen to supportive family and friends. There are times when the mind is too tired to resist and in those times the truth is most apparent. There are also angry and frustrating times when we can identify with the worst instincts of humanity. It is a unique perspective and empathy that drives us to work for social justice. Out of our wonder, we find joy.

Many nurses are called to address social justice in the world and see it as part of what it means to be a nurse. It is tied to our spirituality. I write from my perspective as one who embraces the curse of a nurse and strives to pursue social justice in my small piece of the world. Love my perspectives or hate them, but know I have a thick skin and think we all grow through open and honest conversation even when it is difficult.

And so the [hu]manwho philosophizes and wonders is ultimately superior to one who submits to the despairing narrowness of indifference. For the former hopes?  – Joseph Pieper



My Favorite Nurses

It is a good week to say thank you to all the nurses that helped me along the way. If I talked about one each year between now and my old age I would not be able to thank them all so today I want to start with just two, CAPT (ret) Cecelia Reid and Chris Kasper.

When I finished my MSN I had to report to duty the next morning in DC. I walked out of graduation, picked up my diploma, handed my father the keys to my apartment because he was going to meet the movers, and got in the car so that I could report at 0800 the next morning. I could not have been more excited. When I arrived a serious looking Captain in Service Dress Blues ask for my ID, slapped it down on her desk with her hand over it and ask me for my ID number. When I told her the number without a moment’s hesitation she smiled and we have been friends ever since. She was my first role model as an officer.

Cecelia recommended me for deployment on an NOAA research vessel to the South Pacific for two months that turned into three because we sustained damage going through a typhoon. She did forget to tell me that we would be going to the Aleutian Islands and into the Bering Sea first, which would have resulted in some warmer clothing. It was the greatest adventure of my young career.

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CAPT Cecelia Reid with Faye Abdellah

Cecelia was there when a patient pulled a knife on my unit and she was there when another patient was so violent that all the nurses and psychiatric nursing assistants (PNA) were wrestling on the ground with him screaming at the psychiatrist to call a code. I still remember that woman saying, “You can handle it. You can handle it.” The words I used to get her to call the code shocked me. I think it was the first time I was disrespectful to a physician or an elder, but then again we were getting our butts kicked by the patient on PCP that should have never been released from the restraints.  She was also there with a sense of humor when a psychiatrist complained to her and the Chief Medical Officer that I called her incompetent in rounds. I did not. I called her a blanking idiot. In my defense, it turned out the psychiatrist had never passed her boards and somehow in ten years the hospital had not noticed. I noticed when one of the PNAs informed me that she was removing my orders from the chart every night and returning them in the morning. Needless to say, what she did could have endangered the life of the patient. Obviously, the psychiatrist didn’t say what provoked my inappropriate comment, but when I told CAPT Reid it resulted in the discovery that the psychiatrist didn’t have a medical license.

Cecelia was supportive when I ask to transfer to the Federal Bureau of Prisons and she arranged a temporary duty assignment for me with Indian Health Service when I was working in DC. She wrote my nomination for my first early promotion. She wrote one of my reference letters to my Ph.D. program and she is still always there when I write or call. Cecelia is that nurse you want to be when you grow up. She is kind, compassionate, organized, intelligent, creative, and always looking out for her team. What I didn’t realize as a young officer was that when you were on her team it was for life. She is still the nurse I want to be.

Chris Kasper is an academic through and through. She never stops thinking about how to make nursing and healthcare better. Her life is academic research and training the next generation of nursing researchers, and now Dean. When I first met Chris she knew I was doing some work with AFRRI and ask if I would find out if they did any research with muscle. The next time I was there I ask and was introduced to a scientist that had the answer she wanted. I never imagined it would result in her being my dissertation chair, a lifelong friend and mentor, or a total change in my career path. She said noone would ever doubt I could do policy since I was a Chief of Staff, but I needed something else when I moved into academia. She knew I would.61519_155812487780481_3082463_n

Chris is one of those rare people that see through the illusions and delusions. She knew better what I needed to do to be successful than I did and guided me down the path. She is the first person I told I wanted to move to academia, after my husband. She had perfect advice and helped me with negotiations along the way. Anytime I’ve changed academic jobs my first call has been to her to ask if it was a wise move. My success in academia is largely due to her guidance and letter writing.

Chris and Cecelia couldn’t be more different in their career paths, but they had four things in common:

  1. Leading by example and with love for patients and team.
  2. Tireless dedication and service to the nation.
  3. Unequaled integrity.
  4. Fierce loyalty.

Happy Nurses’ Week to all my mentors and friends.


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?


Immigration Health: My Biggest Regret

Life has sometimes taken me on unexpected journeys. When I joined the U.S. Public Health Service (PHS) it was to work with the poor and the underserved. I had a vision of working with those that were homeless or with Indian Health Service. Fate had a different plan. The care of immigrants and children in cages reminds me that rather than making progress in the care of immigrants we have actually gotten worse.

In 1997 I accepted a job as a Health Services Administrator for an Immigration detention facility. It was a joint facility of the U.S. Marshalls service and Immigration.  From the interview on it was an adventure and a moral challenge. During the interview, one person kept asking me questions that were nonsensical to me. After what seemed like an hour, probably 30 minutes, I couldn’t take it and replied, “what the hell does that even mean?” I was sure I was done at that point, but the Immigration Officer in Charge (OIC) of the Facility stood up, pointed at me, and said, “she’s the one.” Seventeen days later I was selling our house and traveling to New York.

When I arrived I was wearing a Service Dress Blue and the OIC took one look at me, handed me a hard hat, and sent me to get jeans and boots. It was the first clue that this was going to be a challenge. The clinic wasn’t finished and it smelled of skunk. Before the building was finished a skunk got in the clinic and the workmen killed it in the bathroom. Every time it rained it smelled which foreshadowed the entire three years I worked for Immigration. It was the omen of the skunk.

It wasn’t just Immigration that was difficult. Unlike the Federal Bureau of Prisons, Immigration was disorganized and the immigrant advocacy organizations were any better. As the health services administrator, I tried to reach out to them to coordinate care for those that were released to the community, and especially those taking medications for a positive tuberculosis skin test. I’m pretty sure they thought I was the devil. It didn’t matter that I was trying to do the best I could for the person being released, they didn’t want anything to with me. I suppose they thought it would be better if there was no healthcare personnel in the facility. I never gave up trying, but I never succeeded either. When I left we were a Joint Commission accredited clinic, had a fully implemented telemedicine system in 1998, and had a fully staffed clinic with a physician, nurse practitioners, medical records, assistants, dental care, and a pharmacy. The clinic was well equipped and well staffed. Our only problem was getting patients we requested in a timely fashion.

After the successful accreditations, I was excited to accept a job in DC where I quickly became the Chief of Field Operations with oversight of all the clinics nationwide. There were only 12 Immigration detention facilities at the time, but it was an opportunity to make a difference in the lives of those seeking the promise of the USA.

Within a short time of arriving in DC we deployed to Guatemala for a mass migration of Chinese. They had boarded a death trap masquerading as a ship bound for the U.S., but when they ran into trouble the ship was pulled to port in Guatemala by the Coast Guard. With a small team of physicians, nurse practitioners, and RNs we carried all of our supplies with us including a portable x-ray machine. Excluding the x-ray maching, we were only allowed to bring 75 pounds each into the country so most of our luggage was medications and equipment.

When we arrived we were all shocked by the condition of the ship and that it held approximately 500 people. It was nasty and piled deep in garbage from the journey. I could not imagine what would drive a person to take such a risky journey on that ship? Their circumstances must have been unbearable.

We were on the ground within days of being asked to respond. I was going because I knew how to take and develop x-rays and had been working on mass migration plans with Immigration. My boss was going for the first few days and then would leave me to manage the team on the ground. What I didn’t know is that the equipment I needed to develop the x-rays wasn’t available. Instead, we traded our hats and boots to get a local man to mix the developer in a sink and develop the x-rays which we then hung on a lemon tree with clothespins to dry. They definitely did not teach me that in nursing school. We did x-rays for all 500 people on the ship.

We also did physical examins for all 500 people in what was less than ideal surroundings. To say what we had for a clinic was inadequate was an understatement. We had one room inside, but most of the care was provided outside and it was hot and humid. It didn’t take long before I was questioning Screen Shot 2019-04-09 at 9.46.59 PMthe morality of what we were doing. We could do cursory exams, but that was about it. We were able to bring one nurse that spoke the language, but the rest of us depended on interpreters. If the person was judged to be tortured or abused they could request asylum otherwise they would be put on a plane back to China where we didn’t know what would happen to them. Near the end of our time in Guatemala one young man became ill. When we took his shirt off he had what appeared to be cigarette burns all over. I do not remember the exact details which I’m sure I’m blocking, but when we pointed it out to the immigration officials they said there was nothing they could do. I do remember asking how it was missed in the physical, but I knew. Like too many providers, and with limited to no privacy they didn’t actually undress the patient.

By the time we recognized what had happened, it was too late as all the asylum claims were complete and the lawyers were gone. I reported it, but I took no for an answer when I was told there was nothing they could do. We failed the patient; a teenager. None of the medical staff knew what to else to do.

A few days later we were getting ready to board a bus to the airport with all of the immigrants. Young women were throwing themselves around our legs and begging us to help and we could do nothing. On the bus, from the coast to Guatemala City, a women saw the poverty of Guatemala and said, “These people should try to escape to China.” They had fled their country, but as bad as it was they thought it was far better than Guatemala. Is there any wonder that so many people come from that region seeking asylum?

Immigration has always detained people and they have never really shown the ability to handle the volume of people detained. However, there was a time when they were making efforts to improve the quality of healthcare, but at that time the healthcare personnel did not report to Immigration but were part of another organization. They seem to have struggled as they moved to for-profit facilities and began to contract out the healthcare.

I suspect the healthcare personnel in facilities with the children are doing their best to provide care. They are probably no better equipped than I was to address issues and are probably taking no for an answer when everything inside them is screaming to do something. They may even be questioning why they are there. Then they see the children and know someone needs to be there.

I have always believed God opens doors and so long as I walk through I will be where I’m supposed to be and all I need to do is trust and work hard. Maybe with immigration, I lost the trust and I certainly had lost my desire to pray. I had been told when I took the job that I needed to come in fully aware, but no warning was sufficient. There are patients I remember fondly and ones that made me wish I could have done more. There is only one I regret. A Chinese teenager with cigarette burns.


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.

 

 


Where is Devin Nunes’ Cow When I Need It

I am a fan of social media because through it I am introduced to people and ideas that I would not otherwise encounter. It can be heartbreaking and humorous at the same time. However, there are those that have no sense of humor and sue cows. Fortunately, the vast majority of people with whom I interact are amazing and share an interest in nursing, social justice, Catholicism, disaster preparedness, or a vast number of other topics as silly as cats. Sadly, there are a few that spoil conversations. They troll topics and people and dig into their lives outside of social media. It becomes a personal attack rather than a productive or fun conversation.

I first experienced ocial media trolls at the University of Missouri – St. Louis when I publically supported a student who protested after Michael Brown was killed. I was grateful to a not-for-profit that reached out to me and advised me how to get rid of trolls and offered their help. It worked and in a few weeks, they were gone. For the most part, they were people that were angry and tinged their anger with racial comments. It was easy to dismiss them because I have zero tolerance for racism or those that infringe on the free speech of students.

A couple of weeks ago I responded to a former graduate student’s post on twitter. The post linked to a video that she implied was misleading about nurse practitioners. She was clearly annoyed as many of us are when we see such attacks on our profession. However, the post highlighted a common problem with the arguments against full practice authority for nurse practitioners. Many arguments against full practice authority are not accurate and others appear to be intentionally deceptive and/or false. For example, it is true that nurses lobby for change, but the reality is that policy is not changed because pockets are being lined. That, in my opinion, is intentionally deceptive.

Like Devin Nunes’ Cow, my sense of humor offends some. Saying that there are liars everywhere and that there is a reason that nurses are the most trusted profession and “well” physicians aren’t wasn’t well received by a group that seems to detest nurse practitioners. They found no humor in my words and instead interpreted as all physicians are liars. I never said all physicians are liars or though it.  It is a leap to draw that conclusion. I did think that the post and whoever produced it was intentionally deceptive which by definition that is a lie. This was followed by over a week of an ever-growing list of comments from people who identified as physicians that could be perceived as threatening and intimidating. One brave physician stood up to these people. She pointed out that she stayed anonymous on Twitter because she had been attacked a group before and that one physician had been the recipient of attacks merely for being married to a nurse practitioner. As I blocked an ever-growing number of them (some I’m pretty sure not real people and only troll accounts) the physician trying to be supportive would screenshot my original post and share in an attempt to defend me. It further enraged them. I’m not sure when but they then started copying places I’ve worked and spamming them. Having successfully ended such behavior before I used the tactics I was taught by the not-for-profit and I blocked more people in the last week than I have in 8 years using Twitter. I also tried to get them to stop tagging me and tried to redirect the conversation to something kinder in approach. I failed.

Nasty conversations are counterproductive. When people are only slinging insults no opinions will change. Likewise, if evidence is produced and no one is willing to accept it then there is no point in the conversation. We must present the evidence in a way that will be heard. It can’t be a gotcha or I know more than you approach. We must engage those with whom we disagree, but we can do that with respect. Equally as important is exploring our biases, letting go of misunderstandings, and not taking ourselves too seriously. 

In an era where political adds deceive us, the justice system is biased, the Church covers up abuse, and “Prince Harry” follows and then unfollows me on Twitter it is important that the health professions be trusted. People need to know that when we say something it is true and accurate. Nurse practitioners are not buying policy change. We are using the evidence to support the case for full practice authority within our scope of practice. There was a time when registered nurses could not take blood pressures because it was believed that it was practicing medicine? I cannot remember the last time a physician or even an RN took my blood pressure. It is usually a technician using an automated machine.  The scope of practice changed because we realized that it could be done by others that were clearly qualified.

I have worked with amazing physicians and as a rule think they are highly intelligent, compassionate, and talented leaders. In fact, we couldn’t train nurse practitioners without them. In my 28 year career, I have never known physicians like the ones I’ve encountered the last week on Twitter. It is harder to dismiss this group because I admire and respect physicians as a profession and it saddens me to see some so disrespectful and threatening. However, I will never stand by and let people mislead the public about my profession. If one backs down from a bully the bully wins, which is not meant to imply that all physicians are bullies, but some of the ones I encountered last week seem to meet the definition.

I want to end with a cow joke, but…

For more information on the quality of care of nurse practitioners see Quality of Nurse Practitioner Practice.

 


We Love Our Pets, We Are Better for It

There have been a few Priests lately on rants about people loving their pets too much and treating them like people. I think we all realize they are not people, but we love them. It seems so odd to me that anyone would think we should not love all living beings. There can never be too much love in the world. I say love your pets and provide them the best care you can. They journey through life with us and for me have made my life happier.  To those obsessed with us loving our fur babies too much I say, maybe you should focus on the starving children, the victims of abuse, racism, murder, or nuclear disarmament. There are big issues in our world. Loving our pets isn’t one of them.

This was my husband’s obituary to our cat Chaucer. Judge me if you will, but I loved him and still do. He was kinder than many of the people online.

Early this morning my cat, life witness, and buddy, Chaucer died.  He was 18.  For those 18 years, he has stood as either a silent or meowing witness to a long segment of my life river.  He was there as I studied and obtained my Ph.D. in psychology, and I am at times inclined to think he channeled a dissertation to me.  He was there when I married.  He witnessed my comings and goings from Tucson, Arizona to Batavia, New York to Phoenix, Arizona to Minneapolis, Minnesota to Vienna, Virginia to Atascadero, California to Dubuque, Iowa to San Antonio, Texas. He witnessed me starting my private practice.  He waited for me when I did a postdoc in Minneapolis.  He sat at my feet as I wrote book chapters, reviews, and articles.  He was kind enough to meow approval as I wrote, but only if he was in a good mood.  Despite it all, he never let me get a swelled head.  He slept on top of Roberta.  If I wanted something warm, I had to make do with a pillow.  He has died in San Antonio.  Before today, he had waited to move with me and Roberta to St Robert, Missouri.  It is that trip he will not make.  Instead, he waited one last time, this time a ghost, as Roberta and I dug his grave in the garden.  A statue of the Buddha will guard him from a distance.

Of course, Chaucer was no Buddhist.  Buddhism teaches the cessation of desires.  Chaucer was devoted to their satisfaction.  If feeding his desires created new ones, he was fine with that, provided Roberta and I made the right effort to satisfy them.   In many ways, he was an odd buddy for me.  For example, we could never agree on capital punishment.  I hate it.  He was all for it, and had a long, long list of crimes that he viewed as capital offenses, especially living in his space without paying rent or at least tribute.  When we lived in Arizona, I am convinced he would have attended militia meetings if I had let him.  I also suspect the absence of firearms in the house was an affront to his martial sensibilities. 

For the first 16 years of his life, he did what most mammals do.  He started thin and ran to fat.  When thin, he loved to hop up onto my shoulder.  He enjoyed perching there as if he were a parrot, and having me cruise about the house to give him an elevated view of his estate.  And he liked getting fat, even if the lard robbed him of spring in his legs.  He had a taste for expensive chevres, and ignored the Kraft that I would eat.  He had no use for beef, but was keen for Chilean sea bass at $25 a pound.  He also showed his solidarity with my father’s co-religionists by being mad for lox, though he preferred his lox with cream cheese on it.  He liked expensive ice cream as well, but only when placed on a wood to give it the flavor he liked.

Goodness is slippery.  The gods are ironists.  Against Chaucer’s loud protests, Roberta and I had him vaccinated.  At heart, he was a Christian Scientist with no use for vets or their practices.  And he was not shy about expressing it.  One vet wrote in his record, “Nasty cat.”  Chaucer didn’t care.  If a vet wanted to examine him, it was the tank first.  I see the gallows humor in it having been a fibrosarcoma that blossomed from one of Chaucer’s vaccination sites.  This cancer was a savage cannibal.  Chaucer never backed away from him.  When he was diagnosed, the vet reckoned Chaucer had 3 to 6 months to live.  Chaucer stood firm for 19 months as this cannibal tumor ate him.  Perhaps he would have died sooner if not so fierce when facing a remorseless killer.  And the vet had not understood the skill and devotion of my nurse wife.  For these 19 months, she has fed Chaucer prednisone, cleaned his wound, changed his dressing, and held him as he died.  Chaucer was never abandoned.  Roberta held him in love until the end. 

Eighteen years is a long time in any human life.  If I am lucky, I may live another 18 years myself.  Roberta almost certainly will.  Despite our good fortune, our lives will have a gap in them, even though we will carry the memory of Chaucer in us.  It’s been a long journey we all have had together before we stood together at his grave.    I thought back to how he got his name.  He was a handful of kitten.  I found him curled on a Penguin copy in my library of the Canterbury Tales.  From then on he was Chaucer, though Chaucey and Mr C would also do.  I write in his memory so that others may also remember by buddy and witness—Chaucer.   I loved and love him.    09 May 2014, San Antonio, Texas


People Like Me and Racism

I went to the Ash Wednesday service at John XXIII which is the Catholic Center on campus. It was relatively full and it was interesting to look around and see people that I recognized, but whom I didn’t know shared my faith. Likewise, I heard a student say with some surprise, “Isn’t she the Associate Dean?” There is something that feels good about knowing there are people around you that share a cultural identity. It is suddenly a more familiar and safe environment. It is that familiarity and safety that I would hope we could make more available.

I’ve spent the majority of my adult life living in diverse cities and in diverse neighborhoods. Thirteen years in the DC metro area where I was happy to live on a street that boasted at least four languages, three years in Tucson, one year in San Antonio, and four years in St. Louis though while diverse was the 6th most segregated city in the country and once I got to my neighborhood you wouldn’t have known the city wasn’t 100% white and mostly Catholic.

When I came back to Tennessee my husband ask if I was sure. I’m Catholic and I have belonged to a Zen Center for years. Tennessee is the least Catholic state in the country and the nearest Zen Center is either in Nashville or Ashville. When I went looking for “community” I did it with greater intent than I did in St. Louis. I wanted a diverse community and a diverse church. I thought the university parish would be the most diverse and the most socially active, but I was wrong. I found that Holy Ghost was the most diverse parish in the city and relatively socially active so I ended up splitting my time between the two because I want to be part of the university community but also wanted diversity. I have found that I’m no longer that comfortable when everyone is like me and I never again want to live in a segregated community.

The racism, sexism, and homophobia was part of why I wanted to leave Tennessee in the early 1990s. The racist comments on the rock, the lack of acceptance of persons who are LGBTQ, and the recent blackface incident were shocking, but what I remembered. The difference between then and now is the response from the administration. In short order after each incident, the administration had responded with disapproval. That disapproval is being followed up with action. I am pleased that they are leading by example. They have held campus discussions and now are going to require cultural competency, inclusion, and bias training for all faculty, staff, and administrators beginning with the executive administration and it is to be developed and implemented immediately. While the administration and faculty didn’t paint the rock or record themselves wearing blackface they are saying change begins with me.

How has Tennessee changed since I left in 1991? People like me have looked at ourselves and said, where did these young people learn this behavior? And the answer may not be what I did, but what I didn’t do. I have had a fair amount of cultural competency and bias training and even included it in grants and program development, but I still notice my own bias. In St. Louis our program recognized a lack of diversity and in two years we went from 7% underrepresented minorities to 29% in our doctorate program. We didn’t change a single admission criterion, but we did recognize our own bias in the selection and ranking process. It was a painful two years for some of the faculty. They felt called out, but in reality, the change wouldn’t have happened if they didn’t recognize and own the bias and then act to implement change.

There will always be those that ask why they have to go to training when they aren’t racist, didn’t paint the rock, and have never taken part in offensive behavior. My answer is because our job isn’t just to teach or do research. It is to set the example of what it means to be a professional, a good citizen, and a person that can acknowledge their own bias and work to fix it. It is because they are young and they will identify with us. Whether we know it or not they see us.

Cultural competency training is needed and it needs to be ongoing at all universities. Many, if not most, nursing programs now have cultural competency and bias training is woven throughout the curriculum because we know the impact on health outcomes. The inclusion of cultural competency training for students beginning at orientation and global citizenship as part of our new curriculum will be beneficial for the community, the individual student, and for the patients for whom our students will provide care.

I don’t know what it feels like to always be in the minority or to have been the victim of racism. I’m all too familiar with sexism, but it frequently lacks the same level of hatred and hostility associated with racism, homophobia, and Islamaphobia though is likely equally harmful. The more people like me own our part in a culture that has allowed racism to exist the sooner all will feel welcome, safe, and respected.

I’m dedicated to a more diverse and welcoming campus. I’m also old enough to know that when we are silent about the evil that is racism, sexism, homophobia, or Islamaphobia we are complicit with that evil.


I Teach Nursing, Not Political Ideology

I teach the art and the science of nursing. Nursing does not have a political ideology, so unlike what some religious leaders believe I do not teach liberal, progressive, or conservative ideology. I teach science, compassion, and the skills that help prepare students to care for all patients.

I view nursing as a calling and sharing and advancing knowledge as a responsibility. I teach nurses because I love my vocation and I want to nurture those who have a desire to care for the sick and the injured, change health policy, and improve outcomes. My philosophy of teaching is heavily influenced by three factors: 1) a career of serving the poor, the incarcerated, and those impacted by disasters, 2) the joy of being constantly surrounded by young officers with a desire to learn and grow into the future leaders of the vocation, and 3) having seen the profound impact that evidence-based policy can have on lives.

Teaching, like any truly human activity emerges from one’s inwarness, for better or worse. As I teach, I project the condition of my soul onto my students, my subject, and our way of being together. – Parker J. Palmer, The Courage to Teach

I believe a strong liberal arts education, supported by science, serves as a foundation for a well-rounded nurse. This is essential because nursing requires a broad understanding of the human condition, including cultures, religions, and history. Moreover, studying nursing is necessarily an interactive process between the instructor and the student that prepares undergraduates to be novice nurses and helps graduates students to become experts.

Imagine my surprise every time some or religious leader holds forth on how colleges and universities teach liberal ideas. I’m pretty sure the principals of chemistry, physics, engineering, mathematics…and nursing are not liberal or conservative. Even more surprising is when educated people make comments implying that education does not improve one’s life. Not only does what I teach improve the lives of the students, but it improves the lives of all those in their care. The average new BSN graduate will make between $55,000 and $65,000 as a new graduate in a job with security, retirement plan, and health insurance. Many people find that nursing has flexible hours and part-time options are available when one is raising a family or as one moves into retirement. In addition to the obvious advantage of higher income that generally comes with a college degree those with a college degree live on average 7 years longer, have better health, and engage in fewer risky behaviors.

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Of course, a college degree isn’t without a cost. When I attended the University of Tennessee other than my first and last semesters for which my parents funded I either borrowed money or earned it to pay tuition. I managed to only borrow $2000 while living at home for free most of the time. I had a full-time job(s) mostly waiting tables and went to school full-time. It did take me 6 years to graduate, but it was doable because I was essentially paying $243 plus some fees for 12+ hours of credit. The same 12+ hours now cost about $5555 plus fees today. In 1980 I was making $2 per hour plus tips so a little less than $10,000 per year. Add in gas, car maintenance, insurance, clothing, books, supplies, and other incidental expense and I could pay my tuition. However, I don’t encourage anyone to try and work that much while going to school. It was reflected in my undergraduate grades which are still embarrassing.

Today if a person made minimum wage, worked full-time, and lived at home with few expenses other than the ones I had that person would make around $15,000 per year. Tuition would be around $12,000 before books and supplies and in nursing, it isn’t unusual to pay $200-300 for a book. If one budgets $1000 per year for books the total of tuition and books is $13,000. Add to that gas, clothing, car insurance, and all the other expenses and a student going to school full-time would need to be able to live off of $3000 per year. It is not reasonable to expect a young person today to be able to work their way through college without substantial loans.

I think what struck me as most hypocritical about the comment from the religious leader was the suggestion that the students should pay just like everyone else. I’m a faithful Catholic and every year I give to my parish, Catholic Charities, the Bishops appeal (which helps fund seminaries), and various other calls for money. While some parish priests are expected to pay part or all of their education most dioceses help fund the education either wholly or in part or provide loans that the Priest can pay back after graduation, but even then those loans aren’t the full cost. Many religious orders pay the full costs. What if you did expect the young man to pay it all? If he lived at home and went to Kenrick-Glennon Seminary he would pay $26,000 per year. How is it that one would expect a young man to study for the priesthood and work full time to then take a job that with many orders requires a vow of poverty and even more parishioners expect it…of course $100,000 in student loans does almost guarantee at least tempory poverty starting out.

I’m proud of the fact that I worked my way through college and paid for most of it myself. I learned valuable lessons, but I would have preferred to have graduated with a 4.0, have had time to be socially involved on campus, and to have made friends that were not merely associated with my college job. I did work my way through college and it is exactly why I don’t want others to work more than 10 hours a week. College is a time for learning and the rest of life will be filled with work.

As a teacher, my objectives are to:

• Instill a desire for service to others
• Inspire joy in learning and facilitate life-long learning skills
• Develop students that are critical thinkers and exercise sound judgment
• Ensure students master the basics and proceed into the vocation with confidence
• Advance knowledge through service, research, and administration

If religious leaders do their jobs then they might be a little less worried about people like me teaching students the liberal way to change a dressing or start an IV.