Glenna - Teamwork in the OR

Glenna -







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

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

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

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

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

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

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

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

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

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

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

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

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

Dawn -







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

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

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

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

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

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

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

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

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

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

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

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

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

Gail -







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

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

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

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

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

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

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

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

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

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

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

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

Mandy -







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

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

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

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

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

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

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

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

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

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

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

Cathy -







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

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

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

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

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

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

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

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

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

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

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

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

Elizabeth -







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

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

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

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

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

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

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

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

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

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

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

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

Kim -

Audio message from Kim






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

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

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

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

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

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

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

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

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

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

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

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

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

Gayle -







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

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

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

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

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

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

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

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

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

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

Mary -







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

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

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

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

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

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

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

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

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

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

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

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

Rob -







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

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

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

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

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

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

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

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

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

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

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

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

Lynette -







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

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

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

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

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

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

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

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

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

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

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

Linda -







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

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

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

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

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

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

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

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

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

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

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

Kathy -







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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

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

Ginger -







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

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

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

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

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

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

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

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

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

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

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

Kimberley -







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

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

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

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

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

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

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

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

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

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

Chad -







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

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

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

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

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

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

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

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

Alecia -







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

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

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

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

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

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

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

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

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

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

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

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

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

Kristine -







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

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

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

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

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

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

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

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

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

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

Dustin -







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

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

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

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

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

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

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

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

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

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


Power strategies: Security, Sensitivity, Communication
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