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.

I Wasn’t Ready on Day One

My first job was at a boat dock working at the diner when I was 15. I wasn’t ready on my first day and all I needed to do was take orders and deliver people their food. I haven’t been ready on day one for any job since, but I have at least had the skills and knowledge I needed to figure it out.

In college, I learned how to do my research and find the information I needed. I learned to think critically, make reasoned decisions, and plan. The result was I have been successful in every job I’ve had, which isn’t to say there weren’t some bumps in the road. I left active duty and stepped into a full professor and department chair position and moved to an Associate Dean and then Executive Associate Dean position. In my career and in all the positions I held, I’ve hired hundreds of people.

When hiring there are four critical things to consider.
1. What position am I asking the person to fill and how much experience is needed?
2. What are the critical skills and does the person have them?
3. What training and mentoring do I have in place for the person?
4. What do I need to do to make them feel valued and respected from day one?

I’ve never hired anyone that knew it all on day one and didn’t need a little help. Not the new graduate nurse or the experienced physician or the supervisor. Almost everyone required six months of training or mentorship to be a productive member of the team. The more we did to train and mentor the better teammate the person made and the more functional the team as a whole. I used to say of new nurses that universities taught them to think like professionals, but my job was to make them proficient, underwrite their early mistakes, push them beyond their comfort level until they didn’t need me. It was my job to make them feel welcome and valued.

Don’t hire a new graduate with a Bachelors degree for a job that requires a doctoral degree. It won’t be the employee’s fault when they are unable to meet the expectations. Likewise, don’t hire new RN for a job that needs a person with extensive experience. When I was a Chief of Staff my Assistant Secretary started too many days with, “[Profanity], get you [more profanity] in here. Who wrote this [even more profanity].” It was always about a speech he was supposed to give that was written by a junior staffer. After a few incidences, I refused to say who wrote as the result would be a crying junior staffer in my office or a very angry one. Either way it was better to not tell him. Finally, one day I had my husband who has two PhDs write a speech for him to make a point. When I gave it to him without telling him who wrote it he replied, “Now this is what I need, who wrote this?” I took the opportunity to explain if you want someone to write like a person with a doctoral degree you should hire one. Shortly thereafter we hired a speechwriter with a graduate degree.

None of us are ready on day one. The problem is we often forget what it was like to be the new graduate or the new person. I keep a paper that a professor gave back to me bleeding red in my Ph.D. program and before I grade papers I review it. It reminds me what it was like when I was learning. We should all walk onto a nursing floor without saying anything, and take the time to remember what it was like that first day and week and month. Do you remember the day you first felt confident? Do you remember when the fear went away or the first time you ever ask yourself why you ever thought a specific procedure was difficult?

We all have a responsibility to the new graduate. We can’t make them ready on day one to handle a full caseload, but we can give them all the tools they need to be successful. We should never stop trying to make sure they are as cable as possible, but nothing teaches you to draw blood like doing it a hundred times, nothing teaches the best dressing like seeing hundreds of wounds, and nothing replaces experience. I was new once and I’ve never forgotten.

A Hearing without Truth

Whoever is careless with the truth in small matters cannot be trusted with important matters. – Albert Einstein

I was able to watch part of the Kavanaugh hearing today. It was all I could do not to cry for our country. We have lost the ability to have a civil discussion partially because those we elected to represent us care more about themselves than the truth and the victims of sexual assault.

Sexual assault is not about sex. Let me repeat this. Sexual assault is not about sex. It is about violence, power, and control of the other person. Today, the 21 people who hold this nomination in their hands were exhibiting verbal violence, abusive power, and control over the other person. The only thing missing was the attempt at sex to disguise it.

I believed Dr. Ford and at times felt sorry for Judge Kavanaugh though I did not believe him. No rational person would believe his statement about his drinking and his yearbook even if one believed the rest of what he said. The Senate could take some lessons from nursing. Even if you think a patient is a horrible human being, a murder, a rapist, or name your evil, treat the person with respect and dignity. Provide compassionate care and the best possible treatment. If you cannot treat the other person with respect and compassion then request to be replaced in the provision of their care. It is a simple rule. Do the best you can do it all the time. Treat all patients as you would want your mother or father treated.

The next thing we teach is that to provide the best care we must work together as a team. High functioning teams build on the strengths of each team member and show respect to all. If we start yelling at each other or treating each other with disrespect then the patient will be the one that suffers the most.  More importantly, when we are focused on ourselves we forget the patient.

I was embarrassed for our country. This does not represent the best in our country. How hard is it to focus on finding the truth and for each American to care more about the truth than political affiliation? The only person that seemed to handle themselves with dignity was Dr. Ford. Everyone else needs to be sent back to kindergarten to learn how to behave. The truth matters and if we cease to care about the truth we are lost.

Man tends by nature toward the truth. He is obliged to honor and bear witness to it: “It is in accordance with their dignity that all men, because they are persons . . . are both impelled by their nature and bound by a moral obligation to seek the truth, especially religious truth. They are also bound to adhere to the truth once they come to know it and direct their whole lives in accordance with the demands of truth. CCC 2467

Labor Day

Labor Day honors the American labor movement which focused on a just society including social equality and good citizenship. We celebrate the contributions workers have made to the well-being of our country. Is there any better way to do that than to support the labor unions that helped create our prosperity? Among other things, we can thank unions for weekends, the end of child labor, and fairer and more equal wages.

I have never belonged to a union nor do I generally think they are necessary for professionals. However, there are times when we require assistance to use our skill for the benefit of others. For example, staffing minimums have a significant impact on the quality of care provided to patients. If nurses could negotiate evidence-based staffing ratios, they would. Progress has required the work of labor unions and professional organizations to push legislation making it a reality in sixteen states.

I am grateful for all labor unions have done in my life. My mother was a teamster, and my father was a member of the Atomic Trades Labor Council. I remember strikes and picket lines, but I also remember being firmly middle class, having good health insurance, and parents that worked 40 hour weeks. I support all those that belong to unions and look forward to a just society where they are no longer necessary for equality and a living wage.

If you hire a union worker, there is no doubt the works are paid a living wage. If you don’t then it is a good practice to ask what the workers are paid. If it isn’t a living wage keep looking.

Academic Pet Peeve: What’s yours?

Pet peeve of the day: careerism.

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

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

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

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

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


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

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

End of rant.


Moving In

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

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

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

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

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

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

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

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

Rural and First Generation Students

There are many government definitions that are used to describe rural vs. urban areas. Tennessee, for example, has five clear urban centers (red), but in 70 of Tennessee’s 95 counties over 50% of the population is in a rural area. An easier way to see it is to look at a color-coded map with green being the most rural and red being urban. It is clear that much of the state is rural. That means many of the state’s college students come from rural areas.

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In addition to students from rural areas, 25% of students come from low-income and are first-generation college students. What does it mean to be a first-generation college student that is also from a rural area? As I sat in a session on teaching and learning, I could not help but identify with what I was hearing. It wasn’t until I was in graduate school that I had someone that could routinely answer questions about college issues including study habits, hints on writing, the importance of office hours, and even scholarships. It was also the first time I wasn’t working full-time and going to school so it was probably the combination of the two that made graduate school exciting.

First generation students frequently do not have parents that can explain to them what it is like in a classroom. They may not understand that the money the student must borrow to attend college is worth it if they have a better life growing forward. The data is clear that career options are better, they start off better, and they make more money across their lifespan. If you borrow the price of an expensive car to pay for an education it doesn’t start depreciating the day you drive it off the lot.

The day is gone when the goal of the English and science departments is to weed out students and reduce the numbers. Most faculty now consider it their responsibility to help all students to succeed and recognize their role in lifting students out of poverty through education. Most universities now have early alert programs in place for faculty to notify advisors when students start missing classes or don’t do well on assignments. It is these programs that help with student success.

Yet, what surprised me the most was that those students who get involved early in clubs, Greek life, athletics, or other extracurricular activities are the ones least likely to drop out. It left me with this question, what about the students that must spend much of their free time working? How do they engage with the campus community? What can we do to keep them in school?

What I don’t know sometimes surprises me and every once and a while my own biases shock me. Maybe I had to work so many hours as an undergraduate that I’ve held on to that envy all of these years, but kudos to the fraternities, sororities, athletics, intramural sports, cultural centers, and faith-based groups on campus that reach out and get students involved. Kudos to all of those who made sure a friend graduated. Kudos to every professor that offered a little extra help.

“Teaching, like any truly human activity, emerges from one’s inwardness, 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. The entanglements I experience in the classroom are often no more or less than the convolutions of my inner life. Viewed from this angle, teaching holds a mirror to the soul.” – Parker J. Palmer, The Courage to Teach

Finding Clarke in All Places

When I went to Clarke University to teach nursing I felt I found my soul. I was able to let go and be the person I imagined I was born to be and not the one forged by 20 years of federal rules and regulations. As I taught nursing I learned how to be a better nurse. When I left the spiritual safety of a Catholic university I feared I would regress or in some way have my faith diminished by not being constantly in the presence of those dedicated to freedom, education, charity, and justice. What I didn’t know is that everywhere I go they are present.

Today I went to the Catholic Worker House to help prepare food. It wasn’t the organized preparation we had in St. Louis for the St. Patrick’s meals, but rather the Zen method of taking whatever has been donated and turning it into a tasty and nutritious meal to take downtown to distribute in the park.

One of my tasks was to find the scissors and in the process found Sr. Mary Dennis. She quickly introduced herself and told me she was from Iowa. As soon as I said I had taught at Clarke she beamed and announced she was a Clarke graduate and a Presentation Sister from Dubuque. We talked about our love for the place and what it means to us and promised to talk more over coffee.

I came home to Knoxville, but Clarke and especially the Sisters that helped me with the transition to higher education continue to touch my life and faith. In every city I’ve lived in since I left Clarke I have run into a Clarke graduate and without exception, the one thing they have in common is their love for the place and the life-changing impact.

catholic-worker-logo-1I feel blessed that God sent a Clarkie to Knoxville to live in the Catholic Worker house, care for those that live there, and provide hope to those that are homeless in Knoxville.
Sr. Mary Dennis and the people of the Catholic Worker reminded me that it is my job to carry with me everything I learned from the BVMs. There will always be reminders along the way that we are a community of love and part of sharing that love is recognizing the dignity of every human being. It is the education we have and share with others that helps us develop our gifts and share them. I learned to be free. I will always be free.

When Feminism Meets Southern Lady

It has been a month since I returned home to Tennessee and I quickly remembered what it means to be a Tennessean and why I loved being a Volunteer. People say good morning and actually, mean it. I still remember the psychology professor from New York that told us how it freaked her out when she first came here. In Tennessee, people make eye contact just because it is considered polite to make eye contact when you say hello and to acknowledge even a stranger when you pass them. And, it isn’t uncommon to have a 10-minute conversation in the grocery store with a total stranger. Men still hold the door and will hold it while you climb the steps as if they have all the time in the world. Plumbers, electricians, and all the workers that have been so helpful with the old home I bought quickly treat me with greater caution when I give them the “my daddy taught me…” when it comes to home repairs. The look on their faces say, she may have lost part of the accent, but she didn’t forget how to fix things.

I love being a powerful woman, but I also love wielding the Southern lady.

I learned how much the South has changed. There was a time when a new woman in a university or corporate gym may have been considered a spouse. Yesterday, an older gentleman in the gym assumed I was in a leadership position. I’m sure part of it was the dress I was wearing that clearly gave me away, but still, I remember a time when people would see me in uniform and ask me if I was a stewardess instead of recognizing me as an officer.

I was dressed for success, but a Southern man didn’t assume whose wife I might be and that is progress.

It is nice to see that the Southern ladies have made great progress in the advocacy of women’s rights and equality. After all, a true Southern lady does not stay long in the company of those that cannot respect her. I am grateful to all the female academics, graduate students, and professional women that have worked so hard for equality. I have seen these women every day and they are doing the things that impressed me as a student so many years ago. They take their mission seriously and they take it to the streets. Almost everyone I happen to have met at the university has told me about their work with the homeless, or in an underserved clinic, or with children who were born into poverty, or their mission trips to serve the poor and spread the Word. Yes, it means something to be a Volunteer and that calling to step up lives here.

This leads me to my thought of the day. We can be polite to others and accept the intention of good manners with graciousness. The woman behind the counter that calls me dear is not being disrespectful nor is the plumber that does the same if their intent is to be polite. Communication is not only the words we choose to use, but the tone with which we use them, and the body language when we are talking. Holding a door doesn’t say I am less than a man. In fact, it is meant to show respect even if in doing so it acknowledges a role that is often linked to gender or age.

I’m glad to be home and happy that I am being reminded on a daily basis that there is much to love about the South. It is nice to slow down and remember that I should never be too busy to greet a stranger with kindness and get to know them. I am a feminist, a Christian, and a Southern lady and I love it that in Tennessee I can be all of those things!

Full Circle, Returning Home

Today I came full circle to where my career began. Anyone who has known me any length of time has heard me tell how influential the faculty was in my professional development. They formed my view of how a professional should dress, behave, and handle all manner of clinical issues.

Like all first days, most of it was spent taking care of paperwork, connecting to systems, and being introduced to my new colleagues. I also had the pleasure of meeting students that were either visiting from or getting ready to go abroad to experience healthcare in a different system. Day one and I remembered what this place meant to me. It changes lives and gives students a new view of the world.

After a walk around campus and a trip down to Gus’s for a veggie sub, I took some time to look out the window at the hill to Ayers Hall. As a student, I climbed that hill more times than I can count and there was a time I knew exactly how many steps there were up to the hill. Now I look at it across the treetops with an overwhelming sense of gratitude to all the faculty that guided me and for all those that welcomed me home. I can only pray that I will live up to the standard they set all those years ago.

When I got home from my first day a letter was waiting congratulating me on my tenure being approved by the Board of Trustees. I’m home.


How many times did I climb that hill for classes and now I see it from my office.

Zen and a New Semester of Nursing

IMG_2195Tomorrow is Saturday and I need to finish painting the hall and then I need to get my syllabus revised and my class online. Tonight I only plan to sit. I need to clear my mind of the all the perfects I’m always seeking.

There was a time when I wanted the perfect briefcase or backpack whichever had all of the things I thought would help to organize my coming and going from work. Then I wanted the perfect purse. It had to be the right size so I didn’t try and put the kitchen sink in it and have pockets so I could find the important things among all the junk. There are many other perfect things I looked for wallets, ladders, gardening carts, and notebooks to mention a few. In reality what I’m looking for is something that brings a little order to my life. The search continues.

The theme of order consumes me at the beginning of each semester and it shows in predictable ways. There is almost always, depending on the time of year, either a gardening project or a painting project the week before classes begin that must be finished. One doesn’t need to look very deep to figure out the psychological roots of the behavior. It is all about order and progress. Whether it is gardening or painting there is a clear beginning and end. I can see the beauty that is added to my environment and it calms me. I pick up the brush and my focus is on a straight line, even color, making every stroke the same. The concentration blocks out all other thoughts. I’m present with the brush, the paint, and the straight lines. Nothing else. I begin my semester with a small accomplishment and a calm and centered mind.

Tomorrow I will take this sense of calmness and order and put it into a syllabus knowing that while I will never create the perfect syllabus for my course I will try to make the lines straight for the students, eliminate the junk, add beauty to the content in a way that engages their minds and spirits, and attempt to make all of the pieces blend together so that the individual strokes are invisible. I hope they will use it to create their ideal of a perfect knowledge toolbox. But tonight I sit.

“I forsake all that thing that I can think, and choose to my love that which I cannot think.” – Johnston, The Cloud of Unknowing

Sitting in the darkness I am able to let go of all the junk. My life is clear and calm when I sit and the desire is extinguished. There is no perfection and no frustration. Though I do not know God’s will, I do know that I am to serve, forgive, and be compassionate to others. I am formed moment by moment with each stroke of the brush. If I sit long enough with enough calmness maybe one day all of the brushstrokes that have formed me will be invisible. Tonight I sit so tomorrow I can serve.

Word and Speech

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

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

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

Seeking Truth

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

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

Increasing Hope by Keeping Silent

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

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

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


Good Nursing is Prudence

The intellect and not our will must guide our decisions. Yet, it is often our will that gets in the way of sound reasoning. Don’t we all want what we want? Would we not prefer to get our way? I know I would and at times my own will has gotten in the way of hearing what others had to say.

When I joined the U.S. Public Health Service (USPHS) I wanted to work with the poor and underserved. I had a mental image of what that meant. Simply, it was those in poverty or homeless. It had never occurred to me to consider those in prison or detained by immigration as poor or underserved. Nor did I ever consider the disproportionate impact that disasters have on those that are poor or homeless.

Late in my career, I accepted a job with the Administration for Children and Families (ACF) working for Daniel Schneider, who is now the Executive Director of the American Conservative Union and CPAC. I was fascinated by what he described to me. He wanted an office that would address the human services needs of people impacted by disaster and especially those that were poor or marginalized. He wanted the office and programs to be built on the principles of self-determination, self-sufficiency, federalism, flexibility and speed, and support to states. Of equal importance, he wanted a close working relationship with faith-based organizations. I was free to develop it as I saw fit so long as I understood that I was fully responsible for any success or failure. It was an opportunity to combine my work in disaster management and at the same time return to working with the poor and the underserved. I was all in and then I had my first meeting with faith-based groups that worked in disasters – ouch!

The first meeting was eye-opening. It was clear that people were angry and especially the person from the United Methodist Committee on Relief. There was bad blood and before I would ever be able to make progress fences needed to be mended. Fortunately, I didn’t have to do it alone. Two amazing organizations stepped forward and offered to help. The first was Catholic Charities, USA that filled me in on what had transpired following Hurricane Katrina. While I had worked in the Office of the Assistant Secretary for Preparedness and Response since 2001 I had no interaction with the human services programs. The second organization was the American Red Cross who suggested I let them host meetings on neutral grounds. I was grateful and realized that I needed to do a lot of listening.

While I listened I also knew that good policy had to be evidence-based or adapted from a policy that has historically been effective. It could not be based on emotion or lack intellectual reasoning. I understood that there had been hurt feelings and a lack of listening in the past, but I would not ignore that there were successful programs that could serve as models. While the population served was different the goals and objectives were the same. We needed to get to mutually agreeable principles and we needed to use evidence-based policy.

The stakeholder meetings revealed that health care was largely excluded from the services offered by Voluntary Organizations Active in Disasters (VOADS) and case managers rarely had health care experience. I wanted the case managers to be nurses, but the VOADS and my contracted faith-based organization wanted them to be lay people. We compromised and had a combination of case managers we trained and nurse case managers. When all the research was completed and the program pilot tested it turned out that what was primarily needed was the lay case manager with nurse case managers to be available for people with complicated medical needs and for consultation. Because I first listened and because we were all willing to follow the evidence we ended up with a program that we could all support. You can learn more about the ACF Disaster Case Management program at: https://www.acf.hhs.gov/ohsepr/response-recovery/disaster-case-management .

I considered the development of the Disaster Case Management program a great professional accomplishment. I had an amazing team, exceptional partners, and political appointees that trusted us to do our jobs and have the best interest of the country in mind. There was mutual respect. However, the sense of professional accomplishment paled in comparison to the change in my spiritual life.

When I was in Baton Rogue with Catholic Charities, USA I was asked to stay with them at the retreat center. They gave me free access to the grounds and the chapel and said I could use it anytime. I hadn’t been to a church of any kind since my twenties and so I was amused. Then I listened as CCUSA had to remind the Catholic sisters that they couldn’t give away all of the food. I watched as CCUSA personnel and volunteers worked with compassion and patience and with their dedication exemplified what it means to serve. I, on the other hand, could only see a mission to be accomplished and my cadre of young officers as tools to accomplish it. While CCUSA saw the humanity in everyone I wasn’t even seeing it in my own people. By the time I left something had changed. I was no longer listening with my ears, but with my heart. The VOADS and the faith-based organizations had a different perspective than the government. It wasn’t about sitreps, or numbers proving the success, but rather compassionate care provided to people that were suffering.  I woke up one day shortly after our time in Baton Rogue and announced I intended to retire. Not long after the project was completed I was working for a small Catholic university where I found what I sought and though I left the university after three years what I found and what they nurtured has never left me.

Following the evidence resulted in a policy that ensured better services to the poor and underserved impacted by a disaster. Letting the spirit transform the knowledge into an accomplishment for good put the program in hands that are filled with compassion. By being open to what was good and just rather than tactically efficient government and faith-based organizations were able to bring the best of what each has to offer to serve those in need.

I am forever grateful to Dan for the opportunity, to the administration at the time for prioritizing the poor, and to Brent whose faith I am sure crafted the principles on which the program was built and through which I found my faith. The experience showed me what I lacked as a human being, what I no longer wanted to be, and a path to a more compassionate existence.

Prudence is the birth mother of all virtue.


Caring for the Homeless, Summer Externships, and Nurse Mentors

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

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

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

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

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

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

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

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