Linda - Not a "Bleeding Heart Nurse"

Linda -







I’ve never done the same job twice, ever. It wasn’t by design, I just didn’t have a plan. When I was getting my nursing degree, my fellow students and I used to say that we would never go back to school again once we graduated. We all thought that by the time we reached our fifties, we’d be working as the nursing director in some nice, quiet little two-hundred bed hospital, and people would think we were wise and benevolent and that’s how we’d end our careers. But I realized in my early years of working that I could end up fifty years old and one of those poor, broken down night-shift house supervisors too. And I observed that all of what I called the “interesting jobs” went to people with more education. So it came to me in a blinding flash of the obvious that I would have to go to graduate school after all! It was a very pragmatic thing for me to do, because at the time the government was encouraging nurses to get advanced degrees by paying for their education and even giving them a stipend. And sure enough, once I had my degree, doors started opening up for me.

Throughout my career, I’ve consistently had a hand in the directional decisions of the organizations for which I’ve worked, at least where it affects patients and nurses. For example, twice in my career I have successfully argued against management attempting to save money by not paying nurses who worked in the ambulatory clinics as much as the ones who worked in the hospital. In both cases, I felt I made a fairly assertive, eloquent argument and I won against more powerful figures by pointing out that reducing the individual to the hours they worked totally ignored the basic qualifications that they were asking people to bring to the work – a certain level of education, critical thinking skills, independent decision making – and if they didn’t bring that, then you didn’t need a nurse to do that work.

One thing that I have never been, though, is a so-called “bleeding heart nurse.” The bleeding heart nurse believes everything revolves around nursing and that nurses are always the smartest and best. Of course the work we do is important, but not necessarily more so than that of a pharmacist, or physical therapist or physician. It’s different work and it takes different education.“You can’t help but learn, which is good for the mind as well as the soul.” But it’s harder to articulate its value, because for example with a pharmacist, there’s a tangible thing that he or she gives you – your medication. The care you receive from a nurse is not as tangible or quantifiable. Part of the problem is the inability to adequately describe that care, and why it is unique to nursing. And yet, it’s only a portion of what nurses do. People don’t understand all the critical decision-making that goes on every minute a nurse is working with a patient or thinking about a patient, all the things they’re sorting in their minds that they don’t write down and tell everyone about.

Many women my age went into nursing because our career options were limited to one of three areas – secretarial, teaching, or nursing. Of course, the women’s lib movement changed all of that, but it took a while for young women to break through that kind of thinking and realize they had more choices. But I have never regretted going into nursing. It’s been a great career, and I would still encourage people to go into it because if you’re halfway interested in the profession, it’s extremely meaningful. You make such a difference in people’s lives. You’re invited into the most intimate times of their lives – births, deaths, serious illness, bad news, disabilities, and they let you help them. From a pragmatic standpoint it’s actually a fairly decent wage. You can work anywhere in the world. If you had a hundred people in a room, you might find at least fifty of them were nurses. They might not be working as nurses but it’s somewhere in their background. So everywhere you go, you touch people who are nurses even if you don’t know it.

What I like most about nursing is that you’re always learning. You can’t help but learn, which is good for the mind as well as the soul. When I was in school, I didn’t especially like the OB-GYN part, but I did love births. I can still remember the first birth I ever saw. It was at an inner-city hospital where almost all the patients were young, unmarried African-American women. A young woman gave birth to twins, and for me it was so wonderful and emotional to witness these two beautiful black babies being born. I’ll never forget that. It was so exciting and I just wished that everybody could have experienced it. I’ve seen lots of other births since then and it’s always exciting, but I will never forget that first set of twins I helped welcome into the world.

Of course, the healthcare world aside from nursing is also a work world. One of the things I’ve noticed about other fields compared to healthcare is that healthcare is populated by all kinds of extremely well-educated and diverse people. You work with engineers, accountants, architects and psychologists. It’s a very rich world in that way. That became clear to me when I met a new human resource professional who was brought into a hospital where I worked. He came out of manufacturing, and one day he said to me, “Wow. Healthcare is so different. You know, in manufacturing if you have ten people in the whole organization with Bachelors degrees, you’re blessed. Everybody else is a good worker and they’re on the line doing whatever the work is.” He was just impressed with how educated the healthcare workforce is. And it was affirming because that’s one thing I have always liked about my career – meeting interesting people who know lots of things I don’t know, and learning from them. The intellectual stimulation – nothing else matches that for me.

Power Strategies: Mastery, Influence, Adventure
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Al - A Better Team Member

Al -







I was born and raised in the Philippines, and while in high school I began to think about going abroad to work in the medical field. I didn’t want to be a physician because it required too many years of schooling with no guarantee that it would lead to a job in another country. Nursing, on the other hand, sounded like a better fit for me. I learned as a child the value of caring for people. As the youngest of the siblings in my family I was always the recipient of very tender loving care. In the Philippines, family is very solid and mine is a very close extended family, so I grew up able to appreciate others caring for me. I guess I wanted to return that same kind of caring. At the same time, I wanted be able to work abroad for a better future educationally and financially.

It looked like the profession belonged to the female gender. My class at the university had initially eighteen male nursing students, but only four of us were able to graduate. I was elected the president of the nursing class for two years in a row, and when I graduated from that university, I became the alumni president. It was very fulfilling to have that kind of recognition from my fellow classmates, especially since so many of them were women.

My experience going through a program dominated by females made me more confident that I’d be able to interact with nurses of either gender more professionally. It gave me a broad understanding of how people react to one another. If I had entered a male-dominated profession I may have built a relationship with my colleagues through “male bonding.” Instead, I understand the personality differences between the genders better, and how those differences affect behavior. It makes me a better team member, I believe.

As the years progressed, I have become very comfortable and satisfied with my career choice.“I grew up able to appreciate others caring for me. I guess I wanted to return that same kind of caring to others.” My impressions of nursing changed dramatically when I came to the United States. In the Philippines, nurses follow the doctors’ orders and do not ever question them. Here nurses are more empowered to share their opinions and observations and patient care is better here because there are more professionals lending their expertise.

Those entering the field should get as much experience as they can in different areas. They shouldn’t settle too quickly on one specialty so you can get a good feel for what you would like the best by trying them all. Additionally, exposure to only one area can lead to burnout. I have personally experienced burnout after a certain number of years.

Burnout can jeopardize the quality of care that you give to patients. When it happened to me I had to take action to be fair to myself, my co-workers and to the recipients of my care. What I did at that time was to cut back gradually on my work hours. I’m now a per diem nurse, but not too many people can afford to reduce their hours like that. I was able to do it because of the income from a business that I started years ago, which is an elder care facility.

My wife and I opened the facility when we were ready to begin a family, so that she could quit her nursing job. For me, caring for the elderly comes naturally, because it is what we do back home. Families stay together, and the young care for the old. It was natural for me to take that kind of caring and turn it into a successful family business. I feel fortunate to have both that and my regular job, which is with the open heart surgery team at the hospital.

The tradition in my family of caring for each other is partially cultural, and I’m grateful that it helped lead me to this profession. There’s an automatic desire within me to do this, because I was immersed in an atmosphere of caring which began from inside our family circle. But I don’t see it as a gift or a calling; it is just part of my life – it’s who I am – someone who cares about other people.

Power Strategies: Ethics, Achievement, Adventure
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Pam - Love and Pride

Pam -







As a nursing student, I discovered I had the ability to really look into people’s eyes and connect with them. It’s a gift, but I didn’t necessarily understand its implications at the time. Then, about fifteen years ago when I was working in a geriatric unit, I discovered that I could see the youth in an older person’s eyes. Even though they were decades older than I was, I could relate to them on some level. I could see the life inside their old, frail bodies. And I could see what they still wanted – the yearning, the passion for life – even though they were on their deathbeds. I saw them for who they really were, and it moved me.

Since seventeen, when I entered nursing school in Australia, I have loved the connections I made with people. My impressions of nursing have changed over time. Today, there’s just so much technology. Sometimes it feels like a barrier to what we do best. When I first started, everything was handwritten – the charts, the notes. Today we check off boxes, so it’s not as personal. Even though in some respects technology has given us more time, it has also taken more time away from what is, for me, the heart of nursing: the time you spend with a patient, one-on-one, helping them to heal.

In terms of day-to-day work, nursing is always hard. There’s so much to do. Apart from the workload, it’s also difficult when a patient dies. However spiritual or religious anyone may be, it’s just a moving, emotional experience. From racing someone with an ectopic pregnancy from the ER to surgery and hoping that you don’t lose her, to someone who’s had cancer for a long time and is withering away and everybody knows the end is near – it’s one of the toughest parts of the job.

I clearly remember a gentleman who was told by the surgeon that he had forty-three days to live. So he got one of those tiny little notebooks and kept track of every single day. His wife stopped coming to visit because they had come to the agreement that she didn’t need to be there for those forty-three days. The hospital staff became his family, and would you believe that man actually died on the forty-third day? Just to walk with him on that path was an incredible experience. How he could direct his life like that made such an impact on me.
“It’s funny because my hands are so old and dry looking, but as a nurse I cherish the wisdom of those hands.” He had pancreatic cancer, so he was in quite a bit of pain and I remember just trying to help him get through those days – not to convince him that he could go on longer, just being with him. There came a point where he saw things in the corners of the room – almost like angels were there – and he would speak to them. He would say, “No. No. Forty-three. No. Sixteen? Hmm. No. Forty-three.” This man had been an accountant, so I felt it was like the numbers coming back to him, and the angels were perhaps trying to negotiate a bit. But he was so set in his ways and would just sit there so seriously, yet talking to something in the corner of the room that nobody else could see. I felt honored to be a part of that, to be present and to witness it, but I didn’t ever think about changing his mind.

Although my eyes have played a big role in my nursing style, my hands have also always been healing for people. In fact, for many years I have been using therapeutic touch as part of my work. If I touch someone they’ll often say to me, “Your hands are warm, they’re soft; I feel the caring coming through in them.” It’s funny because my hands are so old and dry looking, but as a nurse I cherish the wisdom of those hands. And touch is really powerful medicine.

These days, my career path has a new direction because I have chosen to go back to school to become a nurse practitioner. Some people think they’re the new breed of nurse, but that’s not really the case. Nurse practitioners have been around for at least a quarter of a century. What’s changing is that they are starting to have their own practices. Some say nurse practitioners are actually competition for family practice physicians these days. But are we really competition, or are we the mid-level providers? I think that’s all sorting itself out right now.

Now more than ever I’m excited about being a nurse, although, there has never been a time when I have felt like leaving the profession. My love for nursing is too strong. And I am proud to be nurse. If I can educate someone or help them move along in a more positive direction on their path, I take a lot of pride in that.

Power Strategies:
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Barbara - The Original Healers

Barbara -







I always wanted to be a nurse; I never wanted to be anything else. I filled my high school curriculum with science so I could go to nursing school. But my mother insisted I go to university, so after completing a three-year nursing program, I went through a baccalaureate program specifically for nurses. I wound up getting a degree in history. Two years later, I got my master’s degree, and eventually sought a doctorate in healthcare administration and women’s studies.

I chose women’s studies because historically there has been a lot of male/female tension between doctors and nurses. Until very recently, physicians have been predominantly male while nurses historically have been and continue to be about 97% female. Although the gender demographics in medicine is changing, there’s been this on-going tension around collaboration that some people would like to continue to attribute to doctors being mostly male and nurses mostly female. I was of the belief that it couldn’t be just a male/female thing; that there had to be more to the tension than gender.

I did a lot of work on the history and evolution of nursing in the United States throughout its 100-plus year history. I wanted to be able to rethink the relationship between physicians and nurses and account for the communication challenges, status differences, and the perception that being a doctor is more important than being a nurse, or that nurses are subservient to doctors. I wanted to explain it in a way that was different than simply saying, doctors are boys, nurses are girls.

My research showed that women were the original healers during ancient times, but that during the course of our history men usurped their roles. I learned traditionally men had access to formal education that women didn’t have. Things have changed over time. For example, hospitals in the US were traditionally run by women – mostly nuns – until the 1940’s. Around the late 1940’s and early 50’s, following World War II, men returned to the workforce and took over hospital administration roles. It was a job opportunity for them, and it was lucrative to run hospitals.

Prior to that, women were very much at the forefront in hospital administration and the application of science to care - Florence Nightingale’s work is a strong and popular example. Women had played a leadership role for which they obviously didn’t get much credit. Today, many people think hospitals have always been run by men, but because of my doctoral research I know that is not the case.

Getting a PhD in this area has helped me to see the leadership world through a different set of lenses. It gives me the ability to interact and communicate more effectively with my colleagues, most of whom are men.“The work that nurses do is not more or less valuable than what the physician does – it’s just a different contribution.” I’m a chief nurse now, and although the nurses I supervise are mostly women, the heads of the organizations I deal with are mostly male. We probably have the same goals and objectives, but we have different ways of getting there and we figure out a mutually agreeable way to arrive. It is safe to say physicians categorically and clearly want to do the right thing by the patient. They want to give the best care and to be good at what they do. Most physicians recognize that nurses have the exact same goals. They just haven’t always appreciated us as a partner in healthcare. The work that nurses do is not more or less valuable than what the physician does – it’s just a different contribution.

Nurses’ work has been described as being “invisible.” People don’t see it, not in the way they do a physician’s work. If you can’t see it, you can’t count it. It’s hard to quantify. And if you can’t quantify it, you can’t attach a cost to it. And if you can’t attach a cost to it, you don’t necessarily want to pay for it. So in the end, you don’t understand its value.

It has only been in the last 20 years or so that nurses have come to understand this and have begun the effort to quantify their work in order to demonstrate its value. If you ask people what they think about the work of nurses, those who can best respond are the ones who’ve had experience with nursing care. Either they or a loved one has been very sick, and they’ve seen what nurses can do to take care of that person. But if you haven’t experienced nursing care personally, it’s hard for most people to understand.

I’m really passionate about the value that nurses bring to the care of patients. I think that physicians are very good at diagnosing and treating, but it’s really nurses who shepherd the patient through the journey, particularly those patients who have an acute situation or a chronic illness. For most people, significant health issues are not something they have to confront. But for those who do, it’s a hard journey and it requires WORD WAS UNINTELLIGLBE support. And that, I think, is what nurses do.

Power Strategies: Knowledge, Leadership, Unity
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Marta - A Basic Human Right

Marta -







My first degree was not in nursing at all; it was a liberal arts degree. We studied many subjects at Hampshire College, humanities and arts, social science, communications and cognitive science, and natural science. By the time I’d graduated I had focused in on photography and sociology, a humanities and arts and social science mix, and I used that education to go into photojournalism. Originally, I became a photojournalist because I wanted to do something that I felt was socially responsible. My assignments took me to Africa a couple of times, and while there I witnessed humanitarian work and non-governmental organizations in action. I especially gained a lot of appreciation for the health care areas of this kind of work.

As I got more into my job as a photojournalist, I began to feel like I wasn’t making as direct an impact as I really wanted to. And when I came face-to-face with health care workers in developing countries, working in crisis situations, it made me realize that what they were doing was very direct, patient-centered, and human-rights oriented. The idea of it appealed to me, and I began to consider nursing as a career option. It was a journey I was destined to take.

Back home, I found out from a friend about master’s entry programs into nursing, and felt like that type of nursing program would be perfect for me. I applied to three, and was accepted by the college of my choice. Currently, I’m in the middle of my master’s program. It can be very challenging at times, especially since unlike many nurses who get their master’s degree, I don’t have experience out in the field yet. I’m just at the beginning of my career, and everything is very new.

I have discovered nursing is very scientific and very much about critical thinking. For me, it’s about accumulating a lot of tools for a toolbox and then using the tools appropriately. The most difficult part of my learning curve is not only accumulating this toolbox, but also realizing I have to know which tool to use when.

When I finish nursing school, I anticipate staying in the area for a few years to get some experience. But I know my long-standing interest in human rights will take me right into international health and work abroad. For me to use my skills, especially in Africa, would be ideal. I have a lot of personal ties to Africa from my previous visits, and it feels like the right thing to do. Becoming a nurse and developing that part of my career has been richly rewarding because it feels like a calling.

The feeling comes from deep within me. It’s the most natural thing, and it is really satisfying to finally be on this path. I’m so excited to get out there and start working with people in a nursing role.“When I think about nursing in Africa, I think of helping to provide a basic human right.” Initially, and still, when I first became attracted to nursing, I was thinking of it in an international service context. It was powerful for me to recognize that I may be able to help somebody achieve better health, and that would, in turn, enable them to affect development by being an involved mother or an active community member. When I think about nursing in Africa, I think of helping to provide a basic human right.

I am just astounded by how difficult this career is. I mean, not that I thought it would be easy, but coming into it – it’s incredible. The more I get into it, the more respect I have for nurses. Sometimes it’s admittedly a bit intimidating to talk to a nurse who has come from a more traditional route in their education. Unlike me, they have gone through a longer, more step-wise approach to learning their job. It’s easy to think someone like that, who has that type of education and years of experience, would not appreciate the way that I’ve become a nurse. But the truth is, we can all learn from each other. Discovering the personal story behind each nurse’s background, and what she went through in her educational journey, is valuable information. Just knowing their stories makes me feel more comfortable. In turn, more experienced nurses need to understand that the field is growing and changing, and people are coming into it through different channels. Today, there are lots of ways to enter the nursing field.

I’m excited to have a life-long career in nursing. It is a wonderful profession. You gain a lot of really powerful knowledge. Knowing about health is applicable anywhere and to anybody. You can travel internationally, or take advantage of opportunities in your own backyard. For me, the minute I entered my nursing program I had this feeling of, “Oh, this is what I should be doing.”

Power Strategies: Service, Vision, Commitment
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Carolyn - Making a Difference in a Different Way

Carolyn -







I came to nursing as a second career. For years I worked in the field of business accounting. It was something I fell into, but it left me professionally unfulfilled. I felt called to nursing, and specifically to emergency room care. I wanted to impact the lives of those who need care in a hurry, and that’s why the ER caught my attention.

I was drawn initially to the diverse nature of the patient population in emergency work. A nurse doesn’t care what the patient's background is or how much money they make. We don’t care what they did to land in the ER. We’re just there to take care of that person and we’re going to give them the best care we can.

Knowing that I make a difference – that’s what keeps me in my field. Nurses know we have an impact on people's lives; there’s no doubt about it. That's why nursing fulfills me in a way that accounting never could.

In a health care facility, the nurses work closely with physicians and other interdisciplinary folks--that's essential, but the nurse is the one who actually manages the hands-on, every day care. Maybe we should be called Care Managers because we manage all aspects of what happens in the patient’s room, including the patient.

I’m a toucher. I reach out and comfort patients by touching their hands or their forehead. It's how I extend my respect and humanity. When patients are lying on the gurney, they’re at their most vulnerable state, and they're frightened. Sometimes they can’t talk, but they can see you and feel you. Sometimes all they need is eye-to-eye contact and a touch that shows someone is there for them.

Although I loved the work, I got burned out on emergency care. After a few years of full-time work, I felt myself “hitting the wall.” I had high expectations for myself and felt the need to pick up any unfinished work, which, when coupled with an understaffed ER, led to my exhaustion. My cup was empty.

Yet, if there’s no one else to do the work, there’s no other option except to do it yourself. You don’t abandon your patient.“I’m a toucher. I know how to comfort a patient by touching their hands or their forehead. It's how I extend my respect and my humanity.” We have technicians, but patients need a nurse with critical thinking skills, experience, and expertise to care for them when they're ill. Right now our patient population is getting sicker and sicker. It's frightening. Because they have no insurance, patients either use the emergency room for primary care which bogs down the system or others wait until they’re terribly sick and then they need emergency department.

The irony of the health care system is that nurses drain themselves in order to give the best possible care to their patients. A nurse's needs as a human being always come second. We don’t do a good job of taking care of ourselves as care providers.

When it got to a point where I was just too tired to keep giving, I stepped away from bedside nursing. But I found a way that I could still provide care and at the same time keep my own cup filled: working in education and prevention where I can make an exponential difference in the number of cases seen at the emergency room…alcohol abuse education.

Working in the trauma bay, I'd seen people with serious injuries, people with disabilities, families torn by injuries, most of them due to alcohol-related car crashes. At my present job, I work to reduce alcohol use among adolescents. I’m nursing and tending to people’s needs outside of the hospital but in the community, helping lay the groundwork for healthy lives. I no longer feel drained and discouraged. I'm keeping myself healthy and doing work I know helps save lives.

Power strategies: Responsibility, Making a Difference, Community
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Debi - Lessons from Frank

Debi -







It was my mother who really inspired me to be a nurse, and not just because of her white dress and cap. She would discuss her day with us when we’d be sitting around the dinner table, telling us all the different things she had experienced. As she described her patients and the different situations she faced, she used those stories as lessons for my siblings and me: this particular person got shot because he was in the wrong place at the wrong time. They were cautionary tales. But I was always more interested in where the bullet went, how deep it went, and how it was removed.

So when I first got into nursing, my mom was the image I had in my mind. But things were different back in her day. At that time, nurses followed whatever the doctors said, no questions asked. They just went along with it. Today we have changed so much. Nurses are now thinking machines. We’re not just listening employees anymore. We go to school. We analyze things. We work together as teams. And we work together with doctors as partners. Nursing also used to be a profession that only females chose. But today, males and females are getting into it, and both of them are using the opportunity to its fullest.

I was very fortunate to have a fantastic mentor when I started nursing. She was always there to answer questions for me and help me through things. And she chose to tell me, “Never leave here without learning something each day.” At first, I didn’t truly understand what she meant by that. I just thought she meant as long as I was a newbie, I should be learning something every day. But she actually meant that for the rest of my career. And she was right. There is so much out there to learn and every time you think that is all, there’s something else coming around the corner.

Today’s graduates – I’m not sure if they’re seeing the real world versus seeing it on paper. On paper it looks like it follows a pattern, but nursing really doesn’t. You have to be flexible. You may start off in one direction but head off in another, all before you can take a coffee break. I see the challenge these new nurses face trying to grasp all of the information being thrown at them. That’s why mentors are so important.

I think new nurses create other problems for themselves by wanting to specialize too soon. They want to do pediatrics, for example, and they think that’s what nursing is. But that’s just one small piece of it.“it’s OK to push the limit, to make a decision for myself … do whatever it takes to promote healing” When I hear them complaining that they have to float, I always tell them to look at it as a learning experience. Who knows, maybe after they get up there on that new floor, they may actually like it. But I tell them now is not a time to settle. Now is a time to explore and find out what’s out there. I am in orthopedics now, but it’s not a specialty I would have chosen. I was never attracted to orthopedics, actually, I learned I actually liked it while I was being a float. I can do all the other areas of nursing, but orthopedics is where my heart is.

One of the biggest lessons I learned early on in my career was that it’s OK to push the limit, to make a decision for myself. This lesson didn’t come from my mom or my mentor, but from a man named Frank. I was a new RN and new to the floor and he was a patient that I could hear crying at night. One night he was crying out pretty loudly. He wasn’t my patient, so I went to his nurse and asked what was the matter. His nurse said, “He’s dying in his room, so we pulled the curtain around him.” So I asked, “Can’t we go in and do something?” And she said, “No, there’s nothing else to do for him. The family elected to let him go.”

I went into his room anyway because his crying really got to me. He held onto my hand and looked at me and said, “I just don’t want to go alone.” In that moment, my work got pushed behind and I spent his final hours with him holding his hand until he finally closed his eyes and settled down. I didn’t care if I had to stay three hours, or through the next day, as long as Frank was comfortable. That is why I went into nursing in the first place, to care for people. So I think that was the best thing I’ve ever done in nursing – to hold Frank’s hand when he needed me to do so. He died the following morning and I stayed with him the whole time. I felt like I had done my job that night. I couldn’t prevent him from dying, but I could help him emotionally by holding his hand.

The other nurse didn’t resent me for what I did. In fact, she was grateful. She was a senior nurse and didn’t have the time to do what I did. But I have to say that if the same situation occurred to me today, I would still make time for the patient.

I’ll always remember Frank. He’s my guide that makes me stop sometimes and think, “Hey, wait a minute. Remember the patient.” We have to help the patient all the way around. We can’t just take care of the pain, or the wound, or the illness. We have to help every single part, including the emotions. To me that plays a big role, because if a patient cannot handle what’s going on emotionally, he’s not going to heal. I need to do whatever it takes to promote healing. If that means staying late to hold someone’s hand like Frank’s so he could die well, well then that’s exactly what I will do.

Power Strategies:
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Norma - These are the Things I've Learned

Norma -







I have a nursing degree and an education degree. Most of my career has been in education and administration. I regret I haven’t had more direct bedside experience. As a director and an educator, I’m considered a “white coat.” According to nurses, white coats don’t do real jobs, they do education. There’s a certain lack of respect because I haven’t been in the trenches.

I’m slowly moving my career into coaching, particularly with nurses. Coaching can be a real blessing to the health care field. Health care organizations are hiring coaches and organizational development specialists to teach their people to work together. Health care workers provide so much care and support for their patients, but health care hasn’t historically been a work environment that fosters care and support of its workers. Because the system is broken, it is wonderful organizations are finally seeing the contributions coaches can make toward fixing the problem.

Most of the nurses I work with don’t feel respected. The disrespect comes mostly from other nurses and I grieve about that. Its sad nurses would have such low regard for each other.“I’d like to see nurses develop the capacity to feel secure in each other’s capacity – to enjoy and acknowledge each other’s successes.” They should be there to lift each other up. Nurses alienate each other. I see the numbers that say a million nurses are needed and I see how we’re robbing developing countries to fill the nursing needs here, yet we don’t do things to make sure nursing has a good reputation. I’m often asked if I would recommend nursing as a career choice. I do on some levels, but I’m also very guarded about my recommendation because I know the strength new nurses will need in order to survive.

There’s a gap in the health care system. Nurses have abilities and knowledge and courage to provide quality care for patients. But health care organizations don’t tap into all the skills nurses possess, so the power rests elsewhere. Nurses aren’t recognized for what they can bring to the table, and it becomes apparent as early as nursing school. Not everybody who enters nursing school has the feeling of being powerless from the beginning. It happens somewhere in the nursing education process.

I would like to see the nursing profession become whole. By whole I mean healthy and secure in itself, where every nurse recognizes their gifts, strengths and wisdom. They bring strength to their organization and a strong, caring and wise voice. It will take education to bring power to nurses and the education needs to be in school or after school, over the long term, either one nurse at a time, or with a group moving forward together. The change that needs to happen is at the pith, the core the foundation of the way a nurse views herself and his or her own power and contribution.

It’s also something that can come from the top down. I know a phenomenal nurse manager who took the time to learn as much as possible about organizational development, and then shared her knowledge with her staff. She had a very high-functioning team. She was successful because she encouraged everyone who worked with her to be successful. She wanted her staff to be knowledgeable, because the more they knew the better care they gave to the patients and to each other. So many nurses think, “If I acknowledge you are doing well, I’m taking something away from myself. I can’t enjoy your success because your success may make me less than you.” I’d like to see nurses develop the capacity to feel secure in each other’s capacity – to enjoy and acknowledge each other’s successes. Once that starts happening, nursing can become whole and nurses can bring heart back into their environment and their profession.

Power Strategies: Respect, Power, Calm
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Gretchen - Profound Healing: Answering the Call

Gretchen -






What does it mean to be a nurse? I no longer work as a nurse in the traditional sense, but feel I do more nursing now than I’ve done in some previous conventional settings. I operate at the root of nursing, which is nurturing–I’m helping people with profound life changes. To me, that is the essence of nursing.

After working for a number of years as a nurse, while I was in the midst of graduate school, I was invited to apply to the first nurse practitioner program in the State of Washington. It was a brand new field then, and the focus was on nurses getting training to provide primary care.“I’m helping people with profound life changes. To me that is the essence of nursing.” Darrington, a small rural community in the North Cascades, was the site of the first pilot FNP program in Washington. Another nurse and I were selected as the first two trainees. The training was seven weeks and very intense followed by years of on-going Cont. Ed and lots of “on the job training!” After helping the Darrington FNP clinic get started I returned to the UW to complete my masters in the nurse practitioner program and then was on faculty for seven years, working mostly with students in rural areas.

In the early 70’s prior to entering the nurse practitioner program, I had an epiphany that came to me in a dream while on a trip to Europe. I had a wonderful meditation that gave me the sense that I needed to one day create an educational, recreational and therapeutic community. At the time I didn’t know what that meant. I envisioned some sort of wellness center, but I wasn’t sure. I started getting my masters in social work because I thought I could combine that with being a public health nurse to have more skills for whatever this calling was. Even though I had received this calling, I was not ready to do anything about it at the time it came to me.

After teaching at the UW for seven years, I got exhausted and depressed. There was a lot of pressure to do high-level research and publish as well as teach. I loved the teaching, but the rest was more difficult. I felt out of balance because I was putting my work above everything else in my life, not taking care of myself and getting depleted at many levels—and I was in an environment where working intensely long hours was the norm.

I began feeling I didn’t belong in that setting. I went on a research expedition to Nepal with hopes of pleasing the tenure committee. I realized while on that trek I wasn’t willing to put myself in a position of potential harm to meet the requirements of the university. It was a wake-up call. I resigned when I returned from Nepal.

The next couple of years were spent healing myself and focusing on the question, “What is my life all about?” It was a dark time—I was in an uncertain place. Sure, there were lots of things I could do with my nurse and nurse practitioner skills, but I wanted to know what my calling was. What is my passion? Who am I and what is uniquely mine to do in the world?

I went on a retreat and became aware that I was being called to revisit the dream I had while in Europe. I surrendered to divine sources, trusting there is a guidance we all get if only we’re willing to listen. Sometimes you have to be broken before you can be renewed and ready for a new path. Hopefully it doesn’t go that far for most people, but it did for me. I finally found a way to listen for guidance in my meditation, and then take action to follow my calling, noting the signs that showed me the way.

The culmination of my quest was Harmony Hill. In the beginning, Harmony Hill was the vision from my earlier dream, an educational, recreational, and therapeutic community. It became a retreat for people seeking wellness in their lives.

A major turning point occurred in the early 1990s when I discovered the internationally acclaimed Commonweal Institute Cancer Help Program when viewing Bill Moyer’s PBS documentary, Healing and the Mind. As soon as I saw the program I was intrigued with the prospect of helping people with cancer learn coping tools to get through their journey. I participated in Commonweal’s first training for other centers, and soon after that Harmony Hill offered our first five-day residential cancer program. We’ve now provided more than 80 cancer retreat programs serving over 800 people since 1994. Each retreat is quite magnificent.

The cancer program lets me use my nursing perspective and all the self-care knowledge I built while trying to heal myself. Stress management is the bottom line, as is diet and exercise. However, a person doesn’t have to have cancer to come to Harmony Hill. We also offer space for group retreats, and provide wellness classes for those interested. For example, some of our weekend retreats are labyrinth workshops, which provide spiritual renewal. We also offer a lot of yoga classes. Business groups have an opportunity to listen to their own calling and connect deeply with their mission in ways that aren’t possible in the thick of things.

Because of my background, I encourage Harmony Hill to provide renewal resources for health professionals. A group of volunteers who are nurses, physicians, and other health providers serve as “house moms” for the cancer programs. That group has become support for each other, and is now developing burnout prevention programs for people in the helping fields.

Harmony Hill isn’t conventional in its approach, and for a long time it was considered “out there.” Even though we didn’t change, times have, and we’re now considered “leading edge” with our body-mind-spirit integration focus, as alternative and holistic health approaches demonstrate their value and are embraced more and more by the mainstream.

I’m fortunate for the opportunity to follow my calling. Because of past experience, I’m committed to living life fully and joyfully, and continuing to listen for my next direction. I’m passionate about reaching out to others and helping them in whatever way I can. I want to provide people with tools to take good care of themselves, their families, and the people they work with. I want to help them move toward wholeness.

Power Strategies: Nurture, Leadership, Wellness, Healing
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Angela - Putting Patients First

Angela -







I’m really excited about my new role – I’m a charge nurse, and I really like that a lot. Problem solving and helping other people figure out how they can do their job better are things I enjoy. There are a lot of younger nurses on this floor, who maybe only have a couple of years’ experience, and it’s really hard for them sometimes to start off on med/surg, because the patients can be very demanding. Things don’t always go smoothly.

We recently had a patient - a lady in her 90’s. Mentally she was still quite sharp, but she was legally blind. I was the charge nurse on the day this lady was supposed to be discharged. Transportation arrangements had been made for her, but she got tired of waiting and decided she was just going to walk home. Here she is, legally blind and attempting to walk home.“We can’t always fix the physical things. But we can help lift people’s spirits.” We had to call security to return her to the hospital and keep her there until she could be discharged into someone’s care. Meanwhile, I discovered the nurse who was handling the discharge hadn’t filled out any of the paperwork. Additionally, when I told her what was going on with the patient, she said she needed to take a break. I was incredulous! It seemed like this nurse was putting her needs over those of her patient. Ultimately, I ended up going downstairs myself and going over the discharge instructions with the lady, and then helped get her into a cab.

I’ve been a charge nurse for just a short while, and in retrospect, I should have denied the nurse right there in that moment and told her it was not the time to take a break, and that she had to take care of her patient. But at the time I was just more frustrated than anything and I was focused on ensuring the lady’s safety and getting her discharged. But the episode kind of got to me. For me, the patient always comes first.

I’m passionate about the chance I have to make people feel better. We can’t always fix the physical things. But we can help lift people’s spirits. Nobody likes to be in the hospital, so you might as well try to make people happy while they are there. Or at least just make it tolerable for them.

When I first started in this career, I thought it was going to be mostly about stitches and medicine. I’ve found it’s more intellectual than I anticipated. Yes, there is still quite a lot of physical work, of course, like medications and dressing changes. But, at least on this floor, it’s more about supporting your patients and trying to make their lives better for them.

Still, there are days when I count down the hours to the end of my shift. Everybody has those. But in general, I feel like I’m making a difference, not just for my patients but for the staff too. I try to bring listening skills and a compassionate method sort things out to meet most of everybody’s needs. I know you can’t please everybody all the time, but I try to do my best to meet people halfway. Sometimes I get positive feedback like, “I love having you as charge nurse.” That’s my reward.

Power Strategies: Achievement, Responsibility, Compassion
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Amy - Genuine Care

Amy -







Perhaps my grandmother is the reason I went into the home health care field. She had nurses come to care for her in her home, and I remember as a young girl being in awe of them. I think I was admiring the compassion that they had for her, as well as the knowledge they seemed to have. They knew exactly how to treat the different ailments from which she suffered. But I also admired that these nurses recognized the importance of family. They always encouraged us kids to play around Grandma, and they never scolded us for anything. My grandmother passed away when I was thirteen, but I never forgot those nurses who had cared for her up to the end of her life.

Now I am one of those nurses. I feel like I am trying to convey to my patients and their families the same thing that I saw take place when my grandmother was ill. I want them to feel very comfortable around me, and able to ask me anything. I want them to feel comfortable with the care that I'm giving, and to realize that I know what I'm doing.

With home care, it's easy to develop a really close relationship with patients because it’s just them and their families. In a hospital or nursing home setting, it's harder for that kind of trust to form, because you're not with those patients all the time.“I don’t believe it takes a special kind of person to do home health care. I think anybody can do it if they really have the heart for it.” In my job, I am fortunate to have the time to build relationships, and often my patients let me know what a difference I have made in their lives. For instance, I had a client for about a year who was a paraplegic. He had wounds that I treated, and when they were finally healed, it was really sad for both of us because it meant I wouldn’t be coming out there anymore. To this day, we still keep in touch. He will send me birthday and holiday cards, and sometimes he calls me. He expressed his appreciation and let me know that I had done a good job. It’s not unusual for me to develop those kinds of close bonds with my clients.

I don’t believe it takes a special kind of person to do home health care. I think anybody can do it if they really have the heart for it. You have to care what the client feels like. You have to ask them, “How's your day going?” And you have to care about their answer. You have to be patient. You must be able to adapt well to their personality or to their surroundings. I have met other home health care workers who say they don’t want to go back into so-and-so's home because it's a mess, or they don't want to deal with so-and-so because they got yelled at last week. I’m not like that at all. Sure, I might have a couple of difficult patients, but after I've known them for a couple of months, we develop a relationship. They might have a bad day and yell at me, but I forgive them for it, and we act like nothing ever happened ...the same thing you do with your spouse and kids.

My style of nursing has always been one of genuine caring. Not just for the patient, but for his or her entire family. My first year out of nursing school I worked in a nursing home, and on the very first shift I worked by myself I had a patient who passed away. It was very shocking for me. I left the room to call the family and found when I returned that the aides had wrapped a towel very tightly around this lady’s neck. They said it was to prevent the neck from breaking when the funeral home people picked up the body. I was horrified, though, because the towel looked like a noose, and I knew the family was coming to see their loved one for the last time. I didn’t want them to see her like that, so I told the aides to remove the towel. For them it was no big deal, because they did this all the time. But for me it was unacceptable for this family to have to see that, and in the end I prevailed. The experience instilled in me a strong desire to care not only for the patients, but to extend my caring all the way to their families as well.

I am happy where I'm at right now in my career, and have no desire to go for any bigger title. Home care is the right fit for me, and I would be content to stay in this field until I retire. If you’re considering going into this profession, know that it's probably going to be the hardest job you’ll ever have. There are going to be times when you're going to feel very unappreciated. You’re going to work very hard and feel like you’re getting nothing in return. But for every one bad experience you have with a patient or a family member or a doctor, there will probably be five good experiences. So just bide your time with the bad stuff, because the good stuff is there, too. It’s been my experience that if you don't have the heart for nursing, you'll give it up pretty quick, because it's a tough field to stay in. Those of us who have the heart, we know we're there to help people. And we know that if a patient is really demanding, it’s probably because they need attention and they're not getting it. The nurses that care – we realize that. And we give them the attention they need.

Power Strategies: Pragmatism, Empathy, Wisdom
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Mike - An Outstretchd Hand

Mike -







When I first began working as a nurse, I had a lot of doubts and anxiety. I questioned whether or not I could really do it. The responsibility of having a people’s lives basically in my hands nearly paralyzed me with fear.

Now that I’ve gained some experience, however, I’ve also gained more confidence. I have faced the worst thing that can happen to a nurse, which is when somebody dies on your watch.
“When a new nurse reaches out his or her hand to you, all you have to do is reach yours back..” In this case, I was transferring a man from his wheelchair and he collapsed in my arms. It was a dramatic situation, and rather surreal because I had been working as an LPN for a couple of years but had never even seen a dead body before. For a moment I just froze, and then suddenly everything kicked into action. I called for help and an RN responded, I was just so grateful that she was there. She took control of the situation until the physician’s assistant arrived and was encouraging me throughout the whole ordeal.

Once you get through the sequence of a full code, your confidence builds and things just kind of progress naturally. Afterwards, she continued to support me, which was really great because this man had been involved in a car accident and I ended up having to talk to the police medical examiner. This nurse told me, “Everything’s going to be OK. Don’t worry about things. Just think back and make sure your charting’s good.” It was really nice to feel like somebody was on my side.

I’m much more confident today, but there are still times when I feel like I don’t know everything. It’s a healthy fear of the unknown, though. That’s what drives me to keep learning. Even on my off days, I’ll pick up a nursing book and read. You can never know enough.

One thing I want to guard against is becoming desensitized. I have to constantly re-examine myself, check my sincerity, and check in with myself that I truly care about the person lying in that hospital bed. I remind myself that the person has a family that cares about them. I have to care about them, and it has to go beyond the paycheck, I want to care, and I think all nurses should want to care. If you get to the point where you don’t care anymore, I think it’s time to reassess your job because it really affects how successful you are as a nurse.

When I’m having a hard day and I feel myself shutting down, I try to take a moment out for myself. If I have a patient who is lashing out at me, I don’t take it personally, even though sometimes it’s difficult not to. Just because you don’t like somebody doesn’t mean you can’t respect them or give them their dignity. That’s the hard part for people in the medical field, as well as for police officers and firefighters. It just doesn’t matter who you’re dealing with; you have to always remember it’s still a human life.

You have to inspire yourself sometimes. I’ve got a family at home with kids. I’d much rather be with them than in the hospital sometimes, but that’s what inspires me. If it was me lying in that bed, I would sure want somebody who was dedicated and really focused on what they need to do to care for me. There have been times when I have gone back, after punching out for the day, and just sat and talked to some patients – mostly homeless men. The experience I want them to have is the feeling that somebody actually gives a damn. They’re not just a room number.

I’ve been an RN for a little less than a year, and I have just begun precepting – that is, mentoring new nurses. When I orient someone, I emphasize the importance of being positive. The people in the bed really need that, but your co-workers certainly need it too. I want to help others become the most well-rounded nurses they can be, do things in moderation, be diligent and focused, but not too focused, because you can lose the caring aspects of your personality. And what I mean by moderation is to study hard and give the job everything you’ve got, but remember, you have a life out there, beyond people who are sick or dying.

Nurses who have been around for a while need to remember what it was like for them when they first got on the floor. They should remember how scared they were because, let’s face it, everyone is scared at the beginning. I bless that RN who supported me when that man collapsed and died in my arms – she is the shining example of how mentorship can be such a positive influence. And it doesn’t take much effort. When a new nurse reaches out his or her hand to you, all you have to do is reach yours back.

Power Strategies: Boundaries, Tenacity, Mastery
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Janice - A Nurse Forever

Janice -







It bothers me when people ask, "What did you do when you were still a nurse?" In my opinion once you become a nurse, you're a nurse forever … until the day you die.

It takes a lot of giving to be a nurse. Most people could not do the kinds of things that nurses do unless they really cared for others. We deal with the most awful kinds of situations and the worst physically circumstances that can happen to people. We do it because we care and there's nobody else who can stomach it.

My career has actually included very little bedside nursing. I’ve provided patient education, nursing education and clinical work. In the last couple of years I have found that the people providing bedside care don’t seem to be as attuned to the basic kind of care that I remember learning as a beginning nursing student. There's so much more documentation demanded from nurses these days. Some things have become easier because of computers, but on the other hand, so much more is demanded. It’s partly because hospitals are trying to shield themselves from anything that could go wrong. Our litigious society makes it hard for people to care and to give in a way that is totally unconditional because they have to worry about consequences.

I’m concerned about the quality of care in the future as our population ages. A lot of RN's just are not doing the kind of care in nursing homes that we need, I think it's a financial problem.
“by giving up the white uniform and cap, we’ve given up some of our symbolism that helps to identify us and empower us.” Nursing homes are hiring aides at lower costs, but they’ve had just a few months of education. Their preparation cannot match that of an RN going in and doing a head-to-toe evaluation of a patient. I'm a little worried about all 75 million of us baby boomers who are going to need end-of-life care in the next 20 years. How will we provide care for this many people with any kind of real quality? I sometimes joke that every family should raise one or two nurses, for their own self-interest!

Recently, I went back to nursing school for my 35th class reunion. The planners staged a “fashion show”. We saw nursing uniforms dating back in the 1890's through the present time. It was fun, but it also made think. I’m not saying we should wear caps again or even nylons, but by giving up the white uniform and cap, we’ve given up some of our symbolism that helps to identify us and empower us. Now patients sometimes say, "I don't know how to tell a nurse from an aide because everybody wears scrubs.”

Although it’s been many years since I’ve worked in a hospital setting, I can still remember the most difficult situation I ever had to face. I was working in the ICU and a woman came in who had suffered a botched abortion. She actually had to go into isolation because she was highly infected. You’d walk in the room and the odor was just awful. I would go in and she would say, “I don't know how you can stand to come in here, because I can barely stand to be in this room with myself." But she and I were not very far apart in age, and somehow we just connected psychologically. Ultimately, though, she ended up dying from the abortion. That made a huge impression on me. I just felt so awful at how she suffered.

On the other end of the spectrum, I had an extremely uplifting experience working with a mother who suffered from postpartum depression. When her second child was born, she was able to get effective treatment and did not have to suffer like she did the first time. She was able to go home and care for her two boys, and was just a healthy and wonderful person.

Those two very different patient outcomes really underscore how nursing can affect your psyche and your emotions. Anyone going into the profession should have good friends who will love and support them, whether those friends are nurses themselves or not. They should be involved with some sort of a support network, so that they don't feel like they're out there working by themselves. It’s important to have somebody to connect with.

Power Strategies: Connection, intimacy, Compassion
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Jackie - The Ministry of Healing

Jackie -







I started my career in the Army Nurse Corps and went to Vietnam after a year stateside. There I was – so young, bright-eyed and fairly naïve – being sent into a war zone. I’m sure my naiveté kept me in some ways safe, because there were things I just didn’t know. Some of the inherent dangers of the situation just didn’t occur to me at the time.

My military occupational specialty, or MOS, was pediatrics. The children we cared for were Vietnamese. We treated everything – war wounds, burns, amputations. That was primarily what I did over there. Of course, I also had to help with the triage of soldiers. It was twelve-hour days, and very demanding work. But I enjoyed it.

It would not be the last time I would work overseas as a nurse. After completing my tour in Vietnam, I returned to the States and worked for over a decade in nursing jobs. At a certain point, I began to desire change again.
“…nurses really have to be aware of their bodies, hearts and minds, and take care of those things when they need a break.”> There was this sense of, what am I going to do with my life? Graduate school was one option, but at that time an American organization was heavily recruiting for nurses to go to Saudi Arabia. A year earlier, if you had asked me to find Saudi Arabia on the map, I would have had to really look hard. But I thought, Wow. This sounds like something I might be interested in doing. I applied for the program and was accepted. And the newborn nursery manager position opened up shortly after I got over there, so I ended up doing that for two years.

It was another incredible experience. So many times we as Americans go to a foreign country and expect their people to adapt to us. I don’t have that philosophy. I went over as a guest in their country, played by their rules, and did just fine. Women are treated very differently in that society but it wasn’t a problem for me. I didn’t feel like I had to prove that the American Way is the best way. I just enjoyed seeing what I could see of the country despite the restrictions placed on me. And I met the man who would eventually become my husband while I was over there, so it was a very significant time in my life.

One thing that really brings joy to my heart these days is my involvement with parish nursing, which is an approach to health care that involves the whole person – body, mind and spirit. The focus is on wellness and disease prevention. Parish nurses do a lot of educating, such as holding blood pressure clinics or classes on various health issues. But there is not a clear-cut path for what you have to do. I’ll sit and pray with people, or I’ll visit them in the hospital if I’m asked to do that. I’ve done home communion. These are all lay ministry activities that you don’t have to be a parish nurse to do, but it does roll into it very nicely. It was through my church community that I first heard about parish nursing, and my interest led me to take a class in it. My regular, full-time job doesn’t leave much time for such volunteer work, but I look forward to being able to devote more time to it in retirement.

Spirituality in whatever form can be very healing for nurses, particularly when they experience the death of a patient. As the manager of an inpatient pediatrics unit that included cancer patients, I once planned a memorial service for my staff because we lost seven kids in one year. That was a lot because it is a small unit, and it was hard on everyone. The social worker and I planned an opportunity for the staff to come together, to talk and share stories about these kids. And it was incredible, just a wonderful time of laughing, and crying, and letting go. Not a religious event, but a spiritual one. That ministry of healing is what I feel called to do, and in this case it was ministering to my staff. I would love to be able to do more of it.

There are so many different ways to be a nurse. Most people go into nursing for the same reasons – helping others, compassion, and healing. You have to love it, because otherwise it’s just too hard. And the inpatient setting is really draining – physically, emotionally, and spiritually. It takes its toll. So nurses really have to be aware of their bodies, hearts and minds, and take care of those things when they need a break.

My experiences being a nurse in other countries have taught me resilience and flexibility. I know that life can be lot tougher in other places than it is here. My career began in a war zone, helping children to heal. People ask if it was tough for me to see some of the things I did. Of course it was, but at the same time my own youth kept me unaware of how tough it really was.

Nursing is an incredible profession. For people that are going into it, the opportunities are wide open. I’m now a clinical manager for consulting nurses in a large HMO. Nursing is definitely going to change a lot in the next few years, but opportunities will only continue to expand. It’s a great place to be.

Power Strategies: Spirituality, Community, Healing
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Paul - Putting Patients at Ease

Paul -







My dad inspired me to become a nurse. He was a nurse anesthetist in the Navy. He was very good at his job and received many awards for his achievements. He sounded so knowledgeable when he talked about what he did. It made me want to do the same thing. What I admired most was his dedication and attention to detail. He took the time to really know his patients and cater to all their needs. If he was working with young children, he would put bubblegum smell inside their mask. He took special care to make his patients feel at ease.

My father was a nurturer, so naturally he passed that on to me. I have three girls and I’m affectionate and nurturing with all of them. I want to model the way they should be with their children. I learned by Dad’s examples. I always go the extra mile for my family and my patients. If patients have questions, I take the time to explain things to them, even if the surgeon and everyone on the other side are saying, “Come on Paul, let’s go.” It’s important for the patients to feel comfortable.

Like Dad, I was a Navy nurse for seven years. After I got out of the Navy, I quit nursing for a year-and-a-half and worked as a pharmaceutical representative. I didn’t like the business aspect of that job and I missed the patients. So I returned to med/surg nursing and then transferred to surgery and have been there ever since.

When I wasn’t nursing, I missed the patients’ appreciation for the assistance I gave them. My reward is doing something that helps them get better. Family members are appreciative and I receive many thank you letters.“Nursing isn’t all medications and dressing changes; it’s also getting to know the patient and I find people fascinating.” I enjoy talking with the patients. I like the med/surg floor because many of those people are older and they have incredible stories to tell. I met guys who are World War II veterans and they told the most interesting tales. Nursing isn’t all medications and dressing changes; it’s also getting to know the patient and I find people fascinating. The more they tell me about themselves, the more familiar they feel with me. That closeness is good for the well-being of the patient and it makes me feel good too. It makes me want to come back the next day and learn more about the person.

Nursing has evolved over the 20 years I’ve been in the profession. Nurses are recognized as professionals now. We have learned to balance both of our roles; the nurturing role and the patient advocacy role. To advocate for my patient, I need to be able to communicate on a professional level with the surgeon and the anesthesiologist and anyone else involved.

For a long time I found it difficult to assert myself to advocate for my patients. Because I come from a military background, I was used to a rank structure. My mother was also a powerful figure in my life because my father was often away on ships. If a female had power over me, it was hard to express myself and be assertive with her. It has taken some time, but I challenge myself to practice speaking up and I’ve become much better at it. The current female department head I work for is easy to talk with, so that has helped raise my confidence. I’m finding it easier to assert myself with surgeons and other health care workers as well.

My future vision includes getting my master’s degree. I’m leaning toward business administration because I would like to be in management. I’ve been in patient care for almost 20 years and I’m ready to take my career to the next level, but slowly. Right now I’m a charge nurse but I see myself being a Chief of Nursing. No matter what my title, my commitment will always be to do all I can for the patients. That way my career will continue to be rewarding and give me a feeling of accomplishment.

Power Strategies: Nurture, Communication, Intimacy
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Leoni - Holistic Nursing Renewed my Passion

Leoni -







I went into nursing because I wanted to a midwife, so I started out being a childbirth educator. I received my nursing degree and became involved in home births. Then I found myself in the hospital pushing people through - I became disillusioned with my job. I didn’t feel the system provided much support for people birthing their babies, and I strongly considered leaving nursing.

When I was about ready to move on to something different, I discovered the concept of holistic nursing. I attended a holistic nursing workshop and found myself sitting with a hundred other nurses who shared similar visions as mine. Up to that point, I had lived a holistic lifestyle, but my lifestyle and my job were separate and the way I worked did not connect with the way I lived.

Suddenly, I saw a new way of nursing. Holistic nursing gave me an identity shift that renewed my passion for nursing. On the outside it didn’t look like I’d changed. I would still go to the hospital and take care of women in labor. The shift was inside of me and changed the way I perceived myself and what I was doing. I always believed that working with women in labor was valuable and it was something that was deeply part of who I was. But after what I call my “midlife crisis” and my quest towards holism, I was not embarrassed to be a nurse. Instead, I started honoring what I did.

In the early 1990s when I found the concept of holistic nursing, the American Holistic Nurses Association was gaining momentum. I took a very comprehensive certification course in holistic nursing.“The more present you are, the more you’re able to have your own heart open, the better you’re able to connect with your patient.” It was a very personal journey and I devoted a lot of time and energy for the three years it took me to complete. Once I graduated from the certification course, I submitted a portfolio to the AHNA to become a certified holistic nurse. About the time I was ready to apply to the AHNA for my certification, everybody was saying by the year 2000 all nurses would have to have a bachelor’s degree. At that point, the AHNA made it a requirement that as of the year 2000 you could no longer become a certified holistic nurse unless you had your bachelors.

Of course, all the associate degree nurses, including myself, were rushing to finish their certifications by the year 2000 so they could be grandfathered in. I wanted badly to be certified as a holistic nurse. I wanted it on my name badge. But I didn’t agree with the AHNA’s requirement. I was uncomfortable with it because it was becoming obvious the bachelor’s degree requirement for RNs was not going to happen. It also made me uncomfortable when I thought about an associate degree nurse walking up to me and asking me to talk about my holistic certification, and I would have to say, “You can’t be this anymore.” The third issue was ny belief that holism is inclusive and holistic. It’s saying that inherently, nurses are holistic, and so are the heart and the spirit of what we do. To me the organization that represented the concept of holistic nursing was saying, “You can’t be a holistic nurse unless you have your bachelors.” That struck me as the height of hypocrisy.

I had everything completed and ready to submit in December of 1999. Instead of submitting my portfolio, I wrote them a letter and said, “You’re wrong. I don’t agree with this policy. It strikes me as the height of hypocrisy that you’re talking about holism but you’re going to be exclusionary. I don’t buy it and I don’t want your certification. I’m a holistic nurse, period.” I felt I needed to stick to my principles, and to do this day I don’t have any regrets.

I see a lot of people who choose to get into nursing because they open the newspaper and see 20 want ads for nurses at $30.00 an hour. They know they can go anywhere and have a job and they have a perception that it’s a job that won’t be outsourced. But I also see those people burning out much faster. People really need to find something inside of them that gives them passion for what they do, instead of training for a job simply because it provides money and security. The nice thing about nursing is there are 1,001 different ways you can be a nurses, both with different work environments and different focuses. So somewhere you have to find the piece that is your passion; your dharma. I just precepted a PLU student and it was quite frustrating because she was just putting in the time. I don’t think birth was necessarily her thing. She was technically good, but she was disengaged from the patients. When it was her time to comfort, connect and calm a patient, she just wouldn’t do it. I tried to coach her but I don’t think I ever got through to her. It was disheartening.

Being present is the heart of nursing and the presence needs to be a reflection of whatever the patient and his or her circle of people needs. For some patients it might be the 3 C’s; comfort, care and calm. For someone else it might be giving information. For another patient it might be creating a safe place for them to be scared in. It’s being present for whatever is right in front of you.

There is a myth that by being present or opening your heart your energy is going to get sucked out of you. Part of what I teach in my workshops is the way energy and information moves in a circle. The more present you are, the more you’re able to have your own heart open, the better you’re able to connect with your patient. And the great news is it’s also the best way to walk out the door at the end of the day with your batteries full. It’s the opposite of the myth. Not being present and having our hearts closed costs us as individuals.

I’m a different nurse everyday, based on the connection I make with each individual patient. But at the end of every day, even if I’m on my feet for 12 hours and I’m physically tired, my heart and my spirit feel great. When someone asks me what I do, their eyes light up when I tell them, because my eyes light up when I talk about it. They didn’t used to. But now I’ve found a richness and honor in all I do.

Power Strategies: Passion, Presence, Dignity
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Sally - Hold Each Other Accountable

Sally -







When I was three I wanted to be either a nurse or an Indian maiden. I’m not Native American, so I became a nurse. Now, however, I jokingly tell myself I’m in the Indian maiden stage of my life. I say that because I am more adventurous and not fearful of the future. I’m able to lead in uncharted territory. I have a vision, but I’m also open to new ideas and experiences. So, in a way, I’m realizing both of my dreams.

I believe people must be genetically wired to be nurses. Did you know there are almost three million nurses in the United States? I find I bump into other nurses and I just know, “That’s a nurse.” Nurses nearly sparkle and seem to have an aura about them and it helps us to be drawn to each other. I connect with nurses all the time in places that are not medically oriented. It’s not like I can look at an entire room and say, ‘There’s one.” But many times there has been an immediate bonding that happens during casual conversation when I encounter another nurse. I think it’s almost spiritual – like we’re drawn to each other.

I, like many other nurses, have been told, “You should have been a doctor.” What people don’t understand is I chose nursing for a reason. Nurses tend to look at the world in a more holistic manner. We have a rich history of being able to provide care in a broad context. We do that by taking the time to understand the patients and the world they live in … who their families are. Nurses have this intuitive sense that there is more to a person than just the heart rhythm on the monitor. Nursing is bigger than medicine. That’s not to say physicians don’t care, because they do. But nurses look at the whole pie; the bio, social, psycho and spiritual.

Often nurses will say, “Well, I’m just a nurse.” I wonder why they would belittle their role in the health care partnership. I have never been inclined to minimize my contribution and I don’t think nurses should try to make their profession feel less than somebody else’s.“Nursing is bigger than medicine.” Nursing is the most trusted profession. It has been the most trusted for as long as trusted professions have been surveyed, except for after 9/11. That one year firefighters and police officers came out number one and nurses were number 2. But now nurses have returned to the top spot. So why, if the public thinks so highly of you, would you think so little of what we do?

Not only do nurses belittle their profession, sometimes they just won’t be there for each other. When a nurse is reaching burn out, or is in over his or her head, usually many nurses will rally and provide support to that individual. But there are other times when no help is available and you’re there alone. Maybe the nurses have their reasons for not being supportive, but I always feel two or three together can handle a lot more than one.

In addition to supporting each other, nurses need to hold each other accountable. I mean sometimes something doesn’t go well or somebody says something inappropriate or something doesn’t get done that needs to get done. We really need to step up to each other and make sure things get corrected. So many nurses write problems up and hand them to administration to fix rather than deal directly with each other. Educationally we need to help people be more comfortable with communication. Teach nurses to say, “You know, when I came on duty yesterday I noticed this didn’t get done. Can you help me understand why this didn’t happen?”

The irony is nurses listen to patients all the time. Why can’t they listen to their colleagues? Maybe the “offender” forgot or had some other crisis they didn’t think to mention to you. Maybe they didn’t know the duty was suppose to be done because nobody ever told them. There could be a million reasons. But there needs to be an opportunity to have that dialogue instead of just running it over to somebody else to fix.

Accountability is something I’ve been very interested in recently. The Institute for Healthcare Improvement has a 100,000 lives initiative. It was spun out of a book called To Err is Human which said that 98,000 people die annually in American hospitals because of medical mistakes. So this group has come together to set a target for saving 100,000 lives by putting into place certain practices that are proven to save lives. I was struck when I reviewed the practices because many of them are simply basic, good nursing care. They just had the celebration for over 122,000 lives that were saved.

What mystifies me is, it took a campaign in 2005-2006 to get people’s attention? I think the accountability piece is missing because of a fear of conflict. People don’t like to confront each other. Nurses aren’t trained to have good, confrontational conversation without sounding negative. I don’t know why some nurses may not confront. Maybe they are burned out, or maybe they are just mentally ticking off the tasks and not putting together the whole story. They aren’t realizing why this task is so important in relationship to the whole picture for the patient. So maybe a task gets missed because of a lack of critical thinking. It’s wonderful this has become a focus, but it’s something we should have been paying attention to all along.

I recently left my job as a nurse administrator to complete my doctorate degree. As I journeyed into nursing my dad pointed out there will always be people who are sick. You will always have a job. As I enter new, uncharted territory in my career, I know nursing will continue to provide exciting adventures for me.

Power Strategies: Accountability, Adventure, Communication
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Tracy - A Witness to Injustice

Tracy -







When I tell people I work in a burn center, most of them cringe and say, “I could never do that.” But really, it just takes an ability to see past all the bad things. These people come to us in such bad shape, but we can get them to a point where they’re better. A lot of other units have these ups and downs, in which people are sick, then get better, and then get sicker again; but in the burn unit, we mostly start at the worst moment and move up from there.

It takes a toll. We have a high turnover rate because it takes such a physical and emotional toll. A lot of people get depleted quite quickly, because they don’t realize how much it’s going to take out of them and they don’t last very long. One day I was taking it hard and I asked myself, “Why am I still doing this?” I think I’m one of those people who are just cut out for this kind of nursing and I don’t think I’ll ever go anywhere else. I don’t see myself ever wanting to do anything different – maybe something in addition to it, but not ever giving up my burn unit, as I call it.

The ultimate motivation for me to continue what I’m doing is passion for what I do - I love my job. Speeding one patient’s recovery is enough motivation to keep me going for months, because it is so rewarding to see somebody go from such a low point to full recovery.

Our patients’ circumstances can be so terrible, it’s hard to hear. Sometimes these are criminal assault cases and high profile so I won’t say too much. One patient who was already in a wheelchair had been assaulted. He was with us for over 10 months and we learned he had always taken great pride in his appearance. So in the process of trying to save his life and heal his skin, we also wanted to give him a body image that would help him maintain his appearance and standard of living.

After three and a half months, we had gotten to a point where he was ready go to a rehabilitation facility.“I’m an educator … I’m a counselor … I’m a friend … I’m an advocate … I’m a coordinator of care. But I also serve as a witness to the terrible injustice that is sometimes done to people.” His skin was healed and he was doing well. But then he choked on some food, contracted aspirational pneumonia and began a downward spiral in his recovery. At that point, the burn care was really minimal because skin-wise he was nearly healed. But he was so sick he almost died. We had never cared for somebody so close to dying. And now, against the odds, he has again made a full recovery. He says, being that close to death – twice – and making it through has made him feel like there is a purpose for him in this world, but sometimes he doesn’t know how the purpose could be worth it.

My experience with that patient made me more aware of the different roles I play as a nurse. I’m an educator, educating people on what has happened to them and what is going to happen. I’m a counselor. I’m a friend. I’m an advocate. I’m a coordinator of care. But I also serve as a witness to the terrible injustice that is sometimes done to people.

It feels soul-robbing at some times. But the same situation can give you hope about the nature of humankind and our survivability in the worst of circumstances. It also just reminds you of your complete mortality because we have all these things, like hot water and fire, that are meant for so much good and yet they can cause so much suffering to innocent people. When you’ve seen some of the things I’ve seen, you’ll never look at a fireplace the same way again.

Those of us who are caring for patients need to broaden our perspective. Meet with the administrators who make the decisions affecting patient care, and our ability to deliver that care and tell them how it is. They need to hear from us so they know what our patients need. Nurses should be out in the community as well, educating, sharing knowledge and explaining what people need to do to remain healthy. Until it personally affects them, most people aren’t aware of what it’s like being in the healthcare system. I think nurses could change that.

I’m strongly committed to maintaining an impervious standard of exceptional care for patients. Sometimes, I see people who are willing to let go of our standard because of financial pressures or because they are physically, mentally and emotionally exhausted. We need to be there for each other, I don’t ever want to quit on that. That’s always number one with me.

Power Strategies: Humanity, Achievement, Dedication
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Thom - Come Back Home

Thom -







Most people assume that bringing men into the nursing profession will help raise not only the standard, but the pay as well. It’s actually a false assumption. Men are just looking to have the same rights that women do in the profession – the scheduling issues, the training opportunities, the advancement. There is still this pervasive attitude that only men have power, and that women should remain subservient in health care. But let’s take a broad look at the global issue. We have more women in the advanced practice roles, and in the administrative roles. While they’re making their own career choices and advancing, they are helping us, the men, further our own personal beliefs that we can care; its okay for a man to cry, it’s okay if we only want certain shifts to take care of our children, just as women do.

In dealing with that, the women unconsciously mentor us in return. While they’re trying to push us forward, we want to stay within our own comfort zone. When we’re ready, we’ll step forward. But as much as we would like to move forward, we don’t have the opportunities women do. It seems much harder for men to get into the advanced practice roles. You hear things like, “Well, you’ll always need a female chaperone,” or, “That’s not a specialty that men really should get into.” So it becomes a gender issue instead of a nursing issue.

When I was a nursing student, I had faculty who were very supportive of me. They would place me in opportunities where I could excel.”“Human first. Nursing later.” One instructor said to me, “I can put you in any environment, and you can figure it out on your own. At the time, I was just trying to pass the class, frankly. But then, when it was all over and done with, the same instructor came back to me and said, “You will be a great nurse. You may not be the best test-taker, but you will be a nurse that people will remember.”

I know that I am the face of the American nurse, and as an instructor myself now, I’m going to change the global perspective of “nurse.” Nursing is not about the technical skills. It’s about how you nurse. You take the perspective of the person for whom you are caring. Having been a nurse who has experienced good and bad outcomes, sometimes it’s not what you do with your hands, but what you do in the silence of your delivery. Are you just standing there listening? Are you offering that touch? It could be that simple foot rub that relieves pain for someone without you ever saying a word. You’ve done something human. “Human nursing” is so far behind. We have so many obstacles against us; the resources, the staffing, the money, the availability of things. Why take the human factor out of it? This is a human being. They have their own special needs. Against your own grain, you do what you need to do to take care of them, because it’s about them.

To me, it doesn’t matter if you’re an associate degree nurse, a baccalaureate-prepared nurse, or a master’s-prepared nurse. I lump everybody together in the same category. No matter how many credentials you have, you’re still a nurse. You just have more refined skills. I’m fond of saying, “Come back home…you’re a nurse.”

In today’s healthcare, it’s hard to beat the system. But it makes a difference if you keep that human factor in there. Once as a traveling nurse, I was in a 90-day assignment that I couldn’t wait to finish. As I was nursing in the hallway with no resources, I was given this listless child who was about to go. So I first just comforted this child, and did what I had to do as a human being. I even told everyone around, “I’m going to be very busy right now. If you have something else, I will get to you, but let me work with this child first.” And then I brought that child back to life who was actually very badly dehydrated and running a fever. That child had pneumonia but the mother, a non-English speaker, didn’t know how to communicate. So in the emergency room, the triage nurse had gotten frustrated with her and thought, “Well, it’s just another childhood sickness.” Based on that wrong assumption the child waited too long, and basically needed fluid volume resuscitation very quickly. When I heard his first cry come back, it confirmed to me that I was human enough to make that difference, and I could nurse later. Human first, nursing later. And everybody around me was crying and saying, “I’ve not ever known another nurse who would do that in this place.” That was my qualifier that no matter how horrible a place was going to be for the remainder of my time there, the community would know that a good nurse had stepped in.

My validation for my whole nursing career was when I was standing at Ground Zero on 9/11 and looking at what I was supposed to do, either as a nurse or a human being. And I said, “I don’t have to be a nurse here. I can be a human being.” I chose to not do the nursing sector on that day. I actually volunteered giving foot massages, working in the chow line, and just listening to people and letting them know it was okay. It’s a day I want to remember for the rest of my life. Most people want to forget bad things, but this is something I want to remember. And I share the experience with my students, or, as I call them, my little chickadees. I tell them there comes a point where you need to leave the textbook behind. They need that real-world experience sometimes, in a good storytelling way, so they can learn from it.

Power Strategies: Connection, Influence, Power
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