What Is Your Nursing "North Star"?

Many nurses often refer to the profession of nursing as a "calling". Being a nurse can become and intrinsic part of our personal identity, and reporting for work can end up meaning much more to us than just a paycheck.

There are also nurses who approach their work like any other employed person, with no acknowledgment that there is anything more to be gained than a means to a financial end by fulfilling the tasks required of our position. There is no judgment of this approach to professional nursing, but this apparent dichotomy is worthy of our exploration.

The Profound Meaning of Nurses' Week During a Pandemic: Nurses Show Up

Nurses' Week is upon us, and May 12th, 2020 is the 200th anniversary of the birth of the Florence Nightingale, the veritable progenitor of the modern profession of nursing. Meanwhile, we also find ourselves in the middle of the International Year of the Nurse and Midwife as declared late in 2019 by the World Health Organization (WHO), the healthcare arm of the United Nations. Add to this the impact of the COVID-19 pandemic, and we have a recipe for a very profound moment when it comes to nurses and the nursing profession in this global context.

Photo by Anna Shvets from Pexels.com

The "Nursing Class Hero"

This post was originally published on June 24th, 2013. It has been slightly edited and updated for your edification and enjoyment. 

Fans of the late John Lennon might bristle at my adulteration of the title of a famous song by the iconic musician and peace activist, but a "nursing class hero" is certainly something to be.

Explaining What Nurses Do

This post about what nurses do and how nursing is perceived by the general public was originally posted in 2012. It's been updated and republished for your enjoyment and edification. 

When I tell people that I'm a nurse, they will often innocently ask, "So, how many hours do you work at the hospital?" While such questions are well-meaning, they belie the fact that so many people make wild assumptions about nurses and nursing, and most everyone has little idea what nurses actually do. I've expounded on this topic before, and will no doubt do so again.

If we're put in boxes by others, do we also unthinkingly put ourselves in boxes, as well?

Nurse Change Agents Can Mix It Up

Nurses, when you're at work, do you feel like there are things that need to change? Are there processes, policies, or nursing procedures that everyone follows but seem woefully inefficient or old school? Are people at work stuck doing things the same old way just because no one has taken the initiative to pivot and alter the pattern? That can be frustrating, especially if you're a natural born nurse change agent.

Book Review: "Celebrate Nursing" by Renee Thompson and Joanne Turka

Renee Thompson, DNP, RN, CMSRN is a renowned nurse speaker, author, consultant and Doctor of Nursing Practice (DNP). Her work in the arena of understanding and preventing nurse bullying is profoundly informative and powerful. Renee has appeared on RNFMRadio numerous times, and she brings a level of emotional intelligence and intellectual prowess that is a true gift to nurses throughout the world. This is a review of her new book, co-written with Joanne Turka, MSN, RN-BC, CCRN.

Nurses As Connective Tissue

Last night on RN.FM Radio, we were graced with three guests, including the editor and two contributing authors from a new book, "I Wasn't Strong Like This When I Started Out: True Stories of Becoming A Nurse". It was a fascinating and inspiring conversation, to say the least.

A Nurse Mensch Is Something to Be

According to the annual poll by Gallup, nurses are the most trusted professionals in the United States, and those of us who love nurses understand why. We're the backbone of the healthcare system, and we interface with consumers more than any other members of the healthcare team. But when it comes to being the best we can be, the notion of being a "nurse mensch" is one worth exploring.

Book Review: "The Real Healthcare Reform"

Note: As with all of my book reviews here on Digital Doorway, I received no payment for this review other than a copy of the book from the authors in order to expedite the review process. 

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According to Linda Leekley, BS, RN and Stacey Turnure, RN--the authors of "The Real Healthcare Reform: How Embracing Civility Can Beat Back Burnout and Revive Your Healthcare Career"-- incivility "infects" healthcare workplaces in epidemic proportions. Based on that premise, the authors maintain that it is through embracing civility that true healthcare reform will take place.

Book Review: "The Craft of Compassion at the Bedside of the Ill"

Disclaimer: As always, I received no payment for this book review, only a copy of the book from the author in order to facilitate the writing of this post.

"The Craft of Compassion at the Bedside of the Ill" is a poetic and moving discourse on compassion by nurse, author and medicine man Michael Ortiz Hill. In this stirring book, Mr. Hill presents his view of compassion as a craft that can be learned, honed and developed, a notion that many in the nursing and medical fields would be wise to heed.

Nursing, NPR, and Where to Go From Here

Nurses and nursing are consistently in the news these days, and with issues surrounding health care continuing to come to a boil in the U.S. and elsewhere, we can expect more stories that include nurses to bubble to the top.

Self Compassion and Empathy

Last night on RN.FM Radio, nurse and well-known author Carol Gino spoke eloquently about the need for nurses to develop self compassion before they can truly experience empathy for their patients. She was so right.

Happy Patients vs Healthy Patients

Recently, I published a blog post entitled "The Disneyfication of Nursing" wherein I examined the relatively new practice of "scripting" nurse-patient interactions, demanding that nurses communicate with patients in a specific manner.

The reality is that hospitals now want to provide care with an eye towards positive scores on patient satisfaction surveys upon which Medicare will soon begin basing some of their payments. While this is an understandable---yet short-sighted--reaction on the part of facilities that receive payments from Medicare, it is clear that there is a slippery slope that may very well backfire when it comes to achieving desired patient outcomes.

The Disneyfication of Nursing?

A recent article on Boston.com describes efforts by hospitals to offer specialized training to nurses in customer service and courtesy. According to some reports, many hospitals are hiring outside consultants in order to boost customer satisfaction surveys in response to Medicare's new ruling that they will begin basing a small percentage of payments to hospitals in accordance with facilities' "patient experience" scores.

Gender, Healthcare and Communication

Last night on RN.FM Radio during a discussion with Beth Boynton, the nurse author of "Confident Voices: The Nurses' Guide to Improving Communication and Creating Positive Workplaces", we touched on the subject of gender and its effects on communication. Countless books on communication between the sexes have been written---the ones most readily coming to mind being those by Deborah Tannen, including "You Just Don't Understand" and "That's Not What I Meant"---and I am keen to point out that there is currently no book on the market of which I am aware that specifically discusses the gender aspects of communication within healthcare.

Internet Radio for Nurses Takes Off!

Our newly birthed internet radio station for nurses---RN.FM Radio---is maturing into a reliable weekly source of inspiration, encouragement, interviews and nursing news that many nurses are flocking to every Monday evening at 9pm EST. 

Book Review: "Confident Voices" by Beth Boynton

A note to the reader: As always, I have received no remuneration for posting this book review. As a point of disclosure, I did, however, receive a free copy of the book from the author in order to facilitate the review process.

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"Confident Voices: The Nurse's Guide to Improving Communication and Creating Positive Workplaces", was published in 2009 by Beth Boynton, RN, MS and edited by Bonnie Kerrick, RN, BSN.

Summary

In Confident Voices, Boynton strives to give nurses the understanding and skills to navigate the workplace in a way that fosters improved communication, healthier workplaces and a more supportive and safe environment for them and their colleagues. Boynton achieves her goal, and delivers information that is useful, well-organized, easy to digest, and potentially possible to put into practice immediately.

The book walks the reader through three distinct sections covering various topics of interest to the nurse who wishes to work in an environment that supports positive relationships and respectful communication.

Part I addresses workplace dynamics, and identifies the characteristics of toxic workplaces, and delves into theories that explain human behavior, especially in the context of the workplace. Organizational culture is explained and dissected, and workplace violence---be it physical, verbal or emotional---is also addressed.

Part II is focused on "building assertiveness and respectful listening skills" and explores "strategies for creating organizational cultures where effective communication and respectful relationships can thrive".

Part III integrates the theories, insights and skills covered in Parts I and II in the context of nurses' experiences which were gleaned from interviews with nurses in the field. Common toxic behaviors are described and various revisions of the encounters in question are offered as examples of improved communication and healthier outcomes for all involved.

Discussion

Toxicity in the workplace is an important subject rarely given its due, and Boynton succeeds in communicating her mission clearly in this very useful book. We all know that the health care system is suffering from various forms of overload and dysfunction, and the result for nurses is that we often feel powerless in the face of old patriarchal systems of organization, entrenched methods of communication, and hierarchical relationships that apparently strip us of our power and leave us literally speechless in the face of workplace violence, bullying, top-down management, and organizational failure.

Boynton gives nurses concrete examples of common situations wherein nurses can practice their assertiveness and respectful communication skills. She also provides practical tools for nurses within a theoretical framework that takes into consideration the characteristics of toxic workplaces, the ways in which workplace violence impacts nurses, and how effective communication can cut through the static to a place of greater clarity, personal empowerment, and professional satisfaction.

In a future edition of "Confident Voices",  I would like to see the author make use of a more diverse selection of real-life scenarios in order to address potential gender and power issues that her examples fail to take into consideration.

Suggestions

The nurse interviews used in the book to illustrate Boynton's thesis all feature female nurses who are interacting with male physicians in the hospital setting. While this gender dynamic may be common (and may be a deeply and culturally embedded knee-jerk reaction when we think of "nurse and doctor") there are now a plethora of female physicians working alongside male nurses, and male nurses working alongside male physicians.

Additionally, it would be interesting to explore workplace dynamics when we consider male and female nurses working together, as well as combinations of male nurses alongside male nurses, and female nurses collaborating with female doctors. It could also be enlightening to explore the dynamics of workplace violence, bullying and communication when considering comparisons between male and female supervisors and administrators, and the ways in which gender differences impact communication in health care. Several books have been written about the effects of feminism on the nursing profession, most notably "Daring to Care: American Nursing and Second-Wave Feminism" by Susan Gelfand Malka. Perhaps an exploration combining the effects of feminism on nursing and changes in communication would be an interesting follow up to "Confident Voices".

Within "Confident Voices", Boynton also does not address cultural, ethnic and racial differences in communication that could greatly impact nurses and those who work in health care institutions. Asians, Native Americans, Hispanics and other groups may have cultural practices and norms vis-a-vis communication that differ widely from white American culture. From eye contact to body language, communication in the workplace also needs to take these differences into consideration.

My Recommendation

Overall, I would highly recommend "Confident Voices" to any nurse who wishes to improve his or her own communication skills, share those skills with colleagues, and attempt to understand organizational culture with an eye towards creating positive workplaces for all concerned.

On the Radio

Beth Boynton will be appearing as a guest on RN.FM Radio: Nursing Unleashed on March 12th, 2012 at 9pm EST. Please tune in and you will be able to call into the show and ask Beth questions about her work as a nurse, writer, and workplace communication expert.

What We Leave at the Door

As nurses, when we are preparing to walk into an exam room, a hospital room, or a patient's home, we bring with us a veritable toolbox of skills, ranging from biopsychosocial analysis to keen physical assessment skills. We are trained to look at the whole patient, the family system, and the multifaceted aspects of patients' lives.

However, we can also walk through that door with judgments, suspicions, preconceived beliefs, fears, projections, and a host of other "baggage" that may or may not serve the therapeutic relationship---nor our patient's chances of healing.

In my own work, I have witnessed patients and their families engaged in drug addiction, prostitution, child neglect, elder abuse, financial exploitation, and numerous other social conditions or actions that could often make my skin crawl. I also witnessed patients simply making poor choices, living in squalid conditions, refusing treatment, and otherwise choosing chaos over order, illness over health, and hell over healing.

When possible and necessary, I would intervene, and sometimes that meant calling the police or the local protective service organization. Sometimes it meant just listening and trying to get to the root of the behavior. At others, it was a call to a therapist, a psychiatrist, or a drug counselor.

No matter the situation, we health care providers bring to the situation our own life experiences, our own traumas, and a unique personal history. In this line of work, transference and projection are not just quaint vocabulary terms memorized during a requisite Psych 101 class, and if you're a nurse and you can't tell me what projection and transference are, then it's time to do some brushing up. (Perhaps that Psych 101 textbook is still in your garage somewhere.)

No matter where you are in the course of your career, you are subject to the same psychological forces as a novice nurse, and at times it is exactly our experience as seasoned nurses that can harm us the most. Cynicism, jadedness, and a sense of "I've seen it all before" can actually get in the way of our seeing the patient for who they are in the first place, so looking beyond our experience with fresh eyes and an open heart can work wonders for actually "seeing" the patient or situation in front of our very noses.

Before you walk in that door, think about what it is that you bring to the therapeutic relationship and the situaton at hand. What is the baggage that might get in the way? What are the stresses and worries from outside of work that need to be set aside? And once you're in that room, keep a sharp eye out for those projections, that sneaky transference, and the judgments that undermine your ability to be objective and most clinically effective.

And remember to ask yourself: What am I bringing to this encounter? What are the skills that I most need to activate at this time? And what do I need to leave outside that door?