I hope all of my nursing friends will take the time to complete this short survey for the Idaho State University School of Nursing.
Zen and a New Semester of Nursing
Tomorrow 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.
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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. 
We 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
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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.
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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.
The 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
