Showing posts with label nursing roles. Show all posts
Showing posts with label nursing roles. Show all posts
Monday, May 02, 2022
Nurses Week: Giving Thanks
Well, this is it, folks. This is the week that's set aside for nurses to be praised, thanked and stroked. Gratitude goes a long way in this world, so this is a week when clear and heartfelt gratitude for nurses can be found in many places, both expected and unexpected.
Monday, January 03, 2022
The Nurse, the Martyr, and the Oxygen Mask
Over the years, I’ve known a plethora nurses. I’ve
known new nurses, seasoned nurses, frightened nurses, burned-out nurses, and
nurses who were so jaded they couldn’t even see their patients if they were
right in front of their noses. I’ve known nurses who clocked out at the end of
their shift and never looked back, and I’ve known others who consistently
clocked out two hours late and then were up all night hoping their patients
were OK. It takes all kinds, and some suffer unnecessarily more than others.
Monday, May 11, 2020
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.
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| Photo by Anna Shvets from Pexels.com |
Tuesday, August 29, 2017
"The Nurse's Story" by Carol Gino
Please enjoy this republication of a previously published review of The Nurse's Story by my beloved colleague, Carol Gino.
Monday, April 03, 2017
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?
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?
Monday, September 03, 2012
Nursing: More Than Meets The Eye
Many of my online endeavors put me in contact with a growing number of nurses, and what strikes me most is that nurses are an incredibly diverse, passionate, talented and interesting group of people. I'm honored to be a nurse, and find the profession simply blossoming with richness and diversity.
Tuesday, May 15, 2012
Nursing: Trouble in Paradise?
Despite the consistently wonderful press about the trust that Americans place in the nursing profession, not to mention the heady days of new nurses being assured a plethora of jobs upon graduation, the nursing zeitgeist seems just a little diminished and subdued these days. At least for now, many new grads are hard pressed to find work and there is little to cheer about when it comes to nurses' economic standing.
Tuesday, March 20, 2012
Nurses Need Support
The more nurses I talk to, whether in my clinical nursing work or as a coach for nurses, it's increasingly obvious to me that nurses simply need support. While "Nurses Day" and the accompanying flowers, buttons and pens may be nice gestures, Nurses Day and other such celebrations would mean a whole lot more if meaningful support---not platitudes---were offered to nurses who so desperately need it.
Tuesday, March 13, 2012
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.
Tuesday, January 31, 2012
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.
Wednesday, January 11, 2012
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.
"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.
--------------
"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.
Monday, January 02, 2012
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?
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?
Saturday, March 21, 2009
Letting Go
Just yesterday, I went to the office of the visiting nurse/hospice agency that I work for as a per diem nurse, and I tendered my resignation.
With my public health nurse position consuming 30 hours of every week (and a large percentage of my cerebellar real estate), my per diem hospice position was so much background noise cluttering my mind and causing me professional anxiety. All of us who work in health care are acutely aware that maintaining a position at any facility or agency means that one has to attend trainings, keep up with changes in policies and procedures, and keep one's finger on the pulse (pardon the pun) of the organization. As a per diem nurse, this can become quite a challenge when one's life gets in the way of staying abreast.
In January of 2008, I quit my full-time case management position and entered a period of self-employment, working a number of part-time and per diem positions, consulting gigs, and online writing assignments. That professional juggling act was exciting and novel, but now that I've settled into a more or less full-time position in a demanding municipal job, keeping up with other agencies' changes and demands becomes less and less attractive and more of an emotional and mental drain.
Giving up my position of per diem hospice nurse is a mixed decision, and one that I make quite consciously. Hospice nursing is close to my heart, and is an area to which I would like to return in the future. However, as a per diem who only takes a shift from time to time, I find that making hospice visits causes me considerable anxiety and concern. When one works with the dying on a regular basis, knowing what to say and what to do becomes second nature. The symptom management, the medications, the little tricks and trade secrets all live in a Rolodex in the nurse's brain and are easily retrieved and shared. For me, those tips and secrets are not second nature, and I am loathe to deliver care that does not conform to a standard of excellence to which I hold myself wherever I work (and I recognize that this is also not in the best interest of the patients and families that I would serve).
As a public health nurse, I am no longer delivering direct care, and I do indeed sometimes miss the direct patient contact and assessment that goes hand in hand with that form of nursing. Less than a few years ago, I was a Nurse Care Manager, overseeing the coordination and care of more than 80 chronically ill patients living on Medicaid in the inner city. That work was a part of my personal and professional identity, and was also great fodder for my writing here on Digital Doorway. But my life has changed, and I have entered a period where nursing has taken on a different veneer, and instead of providing nursing care to a group of individuals, I provide the attention of a nurse to an entire municipality, its residents and its employees.
Letting go of my direct care positions is done with mixed emotions and a great sigh of relief. I have no doubt that my nursing career will take many twists and turns in the future, but for now, I am shedding what feels too burdensome, knowing that one closed door only makes room for ten more doors to open.
With my public health nurse position consuming 30 hours of every week (and a large percentage of my cerebellar real estate), my per diem hospice position was so much background noise cluttering my mind and causing me professional anxiety. All of us who work in health care are acutely aware that maintaining a position at any facility or agency means that one has to attend trainings, keep up with changes in policies and procedures, and keep one's finger on the pulse (pardon the pun) of the organization. As a per diem nurse, this can become quite a challenge when one's life gets in the way of staying abreast.
In January of 2008, I quit my full-time case management position and entered a period of self-employment, working a number of part-time and per diem positions, consulting gigs, and online writing assignments. That professional juggling act was exciting and novel, but now that I've settled into a more or less full-time position in a demanding municipal job, keeping up with other agencies' changes and demands becomes less and less attractive and more of an emotional and mental drain.
Giving up my position of per diem hospice nurse is a mixed decision, and one that I make quite consciously. Hospice nursing is close to my heart, and is an area to which I would like to return in the future. However, as a per diem who only takes a shift from time to time, I find that making hospice visits causes me considerable anxiety and concern. When one works with the dying on a regular basis, knowing what to say and what to do becomes second nature. The symptom management, the medications, the little tricks and trade secrets all live in a Rolodex in the nurse's brain and are easily retrieved and shared. For me, those tips and secrets are not second nature, and I am loathe to deliver care that does not conform to a standard of excellence to which I hold myself wherever I work (and I recognize that this is also not in the best interest of the patients and families that I would serve).
As a public health nurse, I am no longer delivering direct care, and I do indeed sometimes miss the direct patient contact and assessment that goes hand in hand with that form of nursing. Less than a few years ago, I was a Nurse Care Manager, overseeing the coordination and care of more than 80 chronically ill patients living on Medicaid in the inner city. That work was a part of my personal and professional identity, and was also great fodder for my writing here on Digital Doorway. But my life has changed, and I have entered a period where nursing has taken on a different veneer, and instead of providing nursing care to a group of individuals, I provide the attention of a nurse to an entire municipality, its residents and its employees.
Letting go of my direct care positions is done with mixed emotions and a great sigh of relief. I have no doubt that my nursing career will take many twists and turns in the future, but for now, I am shedding what feels too burdensome, knowing that one closed door only makes room for ten more doors to open.
Friday, September 12, 2008
Nurses' Voices, Nurses' Image: Nurses' Power
(Note: This is my sixth post under the auspices of the nurse blogger scholarship which I recently received from Value Care, Value Nurses.)
I have recently been re-reading From Silence to Voice: What Nurses Know and Must Communicate to the Public, by Bernice Buresh and Suzanne Gordon. What I am most struck by is that nurses still have not necessarily found their collective voice, and despite the media attention given to the global nursing shortage, I still believe that Buresh and Gordon's thesis still holds true: the public still does not fully understand what nurses do, and until that day comes, nurses' real value as clinicians will not be common knowledge.
Buresh and Gordon touch on many themes and areas of interest vis-a-vis nurses and their relation to the public, to doctors, and to one another. While I will not provide a review of the book---nor a comprehensive enumerating of its content---there are certain area which pique my interest, and I encourage curious readers to order a copy of the book and explore some of these issues for themselves.
Doctors Cure, Nurses Care
When I first heard this phrase, I was moderately disturbed by it for several reasons. Doctors, by and large, receive the lion's share of praise and gratitude when a sick patient is cured of an illness. Granted, doctors undergo a great deal of training and education in order to offer curative treatments for a variety of diseases, yet all too often, the work of nurses is grossly overlooked when it comes to successful treatment. While nurses do indeed carry out many orders originated from doctors, nurses use their own brand of critical thinking and autonomous action in order to perform specialized patient care. The public may not be aware of this fact, but many actions taken by nurses are initiated by nurses themselves, and the professional clinical assessments performed by nurses will often lead to changes in treatment and greater overall success.
Sure, nurses care, and nursing is seen by the public as a "caring" profession. However, nurses utilize scientific methods, skilled observation, and keen assessment skills to monitor patients' progress. Nurses are not just "the caring eyes and ears of doctors"---nurses are skilled professionals fully involved in patient care---and patient cures.
The Nurse as Angel, Teddy-Bear, and Child
In their book, Buresh and Gordon make one thing clear: nurses' self-presentation says a great deal to the public, and images of nurses that instill themselves in the societal zeitgeist are difficult to dispel.
Somewhere along the line, the "angels of mercy" moniker became attached to nurses as a group. Granted, in the early days of nursing, nurses' ability to act autonomously was extremely limited, and we were, by and large, the handmaidens of deified doctors. However, as much as that regrettable history has largely changed, the image of the nurse as angel unfortunately persists quite widely in our culture and websites galore promote gifts and baubles that continue to diminish nurses' professionalism. Images such as this one drive home the point: nurses are childlike individuals with starched white hats who love teddy-bears. Adding insult to injury, nurses can actually be depicted as winged angel/teddy-bears, further enforcing the infantilization (and deprofessionalization) of our profession. Would doctors allow themselves to be thus represented to the public?
Rather than being perceived as cherubic angels and childlike creatures, this writer feels that being perceived as the valuable and skilled professionals who we truly are would allow the public to have a much more accurate perception of what we do, and our importance to the care of millions.
The Clothes on Our BackNurses' uniforms have certainly changed over the years, and as scrubs have become the norm for nurses in most clinical settings, many companies have capitalized on the popularity of such utilitarian clothing. Now, designer scrubs covered with angels, teddy-bears (there they are again!), and any number of cartoon-like images adorn the hard-working bodies of nurses around the world. If nurses want to be taken seriously by the public---and by doctors and other professionals---how does the wearing of such (in my opinion) unprofessional clothing help our cause?
Picture this: a team meeting occurs midday to discuss a patient on the adult oncology floor. Present at the meeting: a medical resident, a medical student, the attending doctor, the oncologist, two unit nurses, a social worker and a respiratory therapist. Of all of the professionals in the room, who would possibly be wearing pink scrubs covered with teddy-bears and hearts, and a pin on her chest saying "Doctors Cure, Nurses Care"? And what message does this convey about the nurse's self-image and how the other professionals present in the meeting should perceive him or her?
What's in a Name?
In From Silence to Voice, Buresh and Gordon make their case that nurses being addressed by first name only is also a major image problem when it comes to the public's perception of us a collective whole.
When doctors introduce themselves to patients or other professionals, they always do so by using the title "Doctor" before their name. This practice immediately creates an impression that the doctor is a professional, that he or she has a name that should be remembered, and a hierarchy of power and authority is clearly established from the start.
Conversely, we nurses almost ubiquitously introduce ourselves by first name only, ostensibly to break down the barriers between patients and nurses, assisting the patient in overcoming fears and anxieties related to their treatment. While this tactic may have some limited benefit, Buresh and Gordon argue that "if nurses introduce themselves by their first names only, they are asking to be regarded as nonprofessionals because that is the conventional way that nonprofessionals present themselves."
The "first-name only convention", as the authors have named it, makes it significantly more difficult for individual nurses to receive recognition for their work when only their first names are known. It also creates a hierarchical structure in which the doctor stands alone as a figure of authority, towering above the patient and nurse with (patriarchal or matriarchal) power and authority.
Interestingly, many nurses will argue that introducing ourselves as "Nurse Smith" or "Nurse Cadmus" is awkward at best, but also brings to mind the infamous "Nurse Ratched" from "One Flew Over the Cuckoo's Nest". Granted, Nurse Ratched is a mythic and hated figure in the pantheon of film and modern literature, yet do we see doctors eschewing their well-earned title due to historical figures such as Dr. Kevorkian or Dr. Mengele (of Auschwitz fame)? Absolutely not. Doctors use their title so commonly and so frequently that the word "doctor" simply holds too much cultural power to be diminished by one literary (or real-life) character who used that title for ill.
As for "naming practices" between doctors and nurses themselves, further examples of an unequal playing field emerge, with nurses almost continually subjugated to a diminished status by always being addressed by first name by both patients and doctors, whereas doctors maintain their professionalism and authority through the use of their title and last name.
Taking Credit Where Credit is Due
All too often, the work of nurses is diminished by nurses themselves. When thanked for their work, nurses will frequently say, "Oh, I didn't do much. The doctors really did the hard part." Or when a nurse is asked what he or she does, the answer will often be, "I'm just a nurse." This diminution of nurses' worth does little to cement in the public's collective mind the utter importance---the crucial presence---of nurses in the healthcare system. The "just a nurse" phrase---used all too painfully often---hurts nurses' cultural standing and diminishes the profession in the public's eye.
Nurses need to stand up and take credit for the work that they do. Buresh and Gordon urge nurses to say "You're welcome" when they are thanked. "I am so glad that I could assist you in learning so much about your diabetes, Mr. Smith" or "It was my pleasure to provide your post-operative nursing care, Mrs. Jones"---these are statements that take credit for nurses' actions, acknowledge patients' gratitude, and accept responsibility for providing crucial nursing care that directly impacts patients' recovery and health.
Nurses' Agency
Buresh and Gordon recommend that nurses discover their "voice of agency". According the authors, "the voice of agency is the voice that says: 'I helped the patient to walk after surgery so that she wouldn't get blood clots in her legs' or 'I taught the patient how to take his medications so that they would be effective and produce fewer side effects.' The authors further illustrate their point by reminding us that "the voice of agency is the voice that conveys the message, 'I'm here. I am doing something important.' "
For nurses to develop their own agency---their own power---nurses must first claim and recognize the importance of what they do. As Buresh and Gordon elucidate so clearly in their book, patients do not learn self-care skills in a vacuum. Someone must teach them those skills, and it is nurses who bring their knowledge and education directly to patient care. When recovering from surgery, it isn't doctors who monitor patients every fifteen minutes, using a lifetime's worth of learning to perform important expert assessments. Nurses use a wide variety of skills---often on an autonomous basis---to provide patients with the care and attention they need for optimal health.
While nurses are indeed held in very high esteem by the general public in surveys and polls, most members of that adoring public would be hard pressed to actually describe what it is that nurses do. As Bernice Buresh and Suzanne Gordon make so abundantly clear, it is up to nurses to claim their rightful place of importance in the care provided to patients in a variety of settings. Nurses need to proudly speak of their work with a voice of agency and power, and communicate clearly---to the public, the media, their families, their friends, and their colleagues---that nursing is important, that it is meaningful, and that what nurses do contributes to successful patient care and positive outcomes. We must forgo the teddy-bears, the hearts, the flowers, the useless diminutive statements and self-deprecation, and claim our professionalism for our own.
Nursing's voice must be heard, and Buresh and Gordon feel that the time for that voice to be clearly heard is now.
I have recently been re-reading From Silence to Voice: What Nurses Know and Must Communicate to the Public, by Bernice Buresh and Suzanne Gordon. What I am most struck by is that nurses still have not necessarily found their collective voice, and despite the media attention given to the global nursing shortage, I still believe that Buresh and Gordon's thesis still holds true: the public still does not fully understand what nurses do, and until that day comes, nurses' real value as clinicians will not be common knowledge.
Buresh and Gordon touch on many themes and areas of interest vis-a-vis nurses and their relation to the public, to doctors, and to one another. While I will not provide a review of the book---nor a comprehensive enumerating of its content---there are certain area which pique my interest, and I encourage curious readers to order a copy of the book and explore some of these issues for themselves.
Doctors Cure, Nurses Care
When I first heard this phrase, I was moderately disturbed by it for several reasons. Doctors, by and large, receive the lion's share of praise and gratitude when a sick patient is cured of an illness. Granted, doctors undergo a great deal of training and education in order to offer curative treatments for a variety of diseases, yet all too often, the work of nurses is grossly overlooked when it comes to successful treatment. While nurses do indeed carry out many orders originated from doctors, nurses use their own brand of critical thinking and autonomous action in order to perform specialized patient care. The public may not be aware of this fact, but many actions taken by nurses are initiated by nurses themselves, and the professional clinical assessments performed by nurses will often lead to changes in treatment and greater overall success.
Sure, nurses care, and nursing is seen by the public as a "caring" profession. However, nurses utilize scientific methods, skilled observation, and keen assessment skills to monitor patients' progress. Nurses are not just "the caring eyes and ears of doctors"---nurses are skilled professionals fully involved in patient care---and patient cures.
The Nurse as Angel, Teddy-Bear, and Child
In their book, Buresh and Gordon make one thing clear: nurses' self-presentation says a great deal to the public, and images of nurses that instill themselves in the societal zeitgeist are difficult to dispel.
Somewhere along the line, the "angels of mercy" moniker became attached to nurses as a group. Granted, in the early days of nursing, nurses' ability to act autonomously was extremely limited, and we were, by and large, the handmaidens of deified doctors. However, as much as that regrettable history has largely changed, the image of the nurse as angel unfortunately persists quite widely in our culture and websites galore promote gifts and baubles that continue to diminish nurses' professionalism. Images such as this one drive home the point: nurses are childlike individuals with starched white hats who love teddy-bears. Adding insult to injury, nurses can actually be depicted as winged angel/teddy-bears, further enforcing the infantilization (and deprofessionalization) of our profession. Would doctors allow themselves to be thus represented to the public?
Rather than being perceived as cherubic angels and childlike creatures, this writer feels that being perceived as the valuable and skilled professionals who we truly are would allow the public to have a much more accurate perception of what we do, and our importance to the care of millions.
The Clothes on Our BackNurses' uniforms have certainly changed over the years, and as scrubs have become the norm for nurses in most clinical settings, many companies have capitalized on the popularity of such utilitarian clothing. Now, designer scrubs covered with angels, teddy-bears (there they are again!), and any number of cartoon-like images adorn the hard-working bodies of nurses around the world. If nurses want to be taken seriously by the public---and by doctors and other professionals---how does the wearing of such (in my opinion) unprofessional clothing help our cause?
Picture this: a team meeting occurs midday to discuss a patient on the adult oncology floor. Present at the meeting: a medical resident, a medical student, the attending doctor, the oncologist, two unit nurses, a social worker and a respiratory therapist. Of all of the professionals in the room, who would possibly be wearing pink scrubs covered with teddy-bears and hearts, and a pin on her chest saying "Doctors Cure, Nurses Care"? And what message does this convey about the nurse's self-image and how the other professionals present in the meeting should perceive him or her?
What's in a Name?
In From Silence to Voice, Buresh and Gordon make their case that nurses being addressed by first name only is also a major image problem when it comes to the public's perception of us a collective whole.
When doctors introduce themselves to patients or other professionals, they always do so by using the title "Doctor" before their name. This practice immediately creates an impression that the doctor is a professional, that he or she has a name that should be remembered, and a hierarchy of power and authority is clearly established from the start.
Conversely, we nurses almost ubiquitously introduce ourselves by first name only, ostensibly to break down the barriers between patients and nurses, assisting the patient in overcoming fears and anxieties related to their treatment. While this tactic may have some limited benefit, Buresh and Gordon argue that "if nurses introduce themselves by their first names only, they are asking to be regarded as nonprofessionals because that is the conventional way that nonprofessionals present themselves."
The "first-name only convention", as the authors have named it, makes it significantly more difficult for individual nurses to receive recognition for their work when only their first names are known. It also creates a hierarchical structure in which the doctor stands alone as a figure of authority, towering above the patient and nurse with (patriarchal or matriarchal) power and authority.
Interestingly, many nurses will argue that introducing ourselves as "Nurse Smith" or "Nurse Cadmus" is awkward at best, but also brings to mind the infamous "Nurse Ratched" from "One Flew Over the Cuckoo's Nest". Granted, Nurse Ratched is a mythic and hated figure in the pantheon of film and modern literature, yet do we see doctors eschewing their well-earned title due to historical figures such as Dr. Kevorkian or Dr. Mengele (of Auschwitz fame)? Absolutely not. Doctors use their title so commonly and so frequently that the word "doctor" simply holds too much cultural power to be diminished by one literary (or real-life) character who used that title for ill.
As for "naming practices" between doctors and nurses themselves, further examples of an unequal playing field emerge, with nurses almost continually subjugated to a diminished status by always being addressed by first name by both patients and doctors, whereas doctors maintain their professionalism and authority through the use of their title and last name.
Taking Credit Where Credit is Due
All too often, the work of nurses is diminished by nurses themselves. When thanked for their work, nurses will frequently say, "Oh, I didn't do much. The doctors really did the hard part." Or when a nurse is asked what he or she does, the answer will often be, "I'm just a nurse." This diminution of nurses' worth does little to cement in the public's collective mind the utter importance---the crucial presence---of nurses in the healthcare system. The "just a nurse" phrase---used all too painfully often---hurts nurses' cultural standing and diminishes the profession in the public's eye.
Nurses need to stand up and take credit for the work that they do. Buresh and Gordon urge nurses to say "You're welcome" when they are thanked. "I am so glad that I could assist you in learning so much about your diabetes, Mr. Smith" or "It was my pleasure to provide your post-operative nursing care, Mrs. Jones"---these are statements that take credit for nurses' actions, acknowledge patients' gratitude, and accept responsibility for providing crucial nursing care that directly impacts patients' recovery and health.
Nurses' Agency
Buresh and Gordon recommend that nurses discover their "voice of agency". According the authors, "the voice of agency is the voice that says: 'I helped the patient to walk after surgery so that she wouldn't get blood clots in her legs' or 'I taught the patient how to take his medications so that they would be effective and produce fewer side effects.' The authors further illustrate their point by reminding us that "the voice of agency is the voice that conveys the message, 'I'm here. I am doing something important.' "
For nurses to develop their own agency---their own power---nurses must first claim and recognize the importance of what they do. As Buresh and Gordon elucidate so clearly in their book, patients do not learn self-care skills in a vacuum. Someone must teach them those skills, and it is nurses who bring their knowledge and education directly to patient care. When recovering from surgery, it isn't doctors who monitor patients every fifteen minutes, using a lifetime's worth of learning to perform important expert assessments. Nurses use a wide variety of skills---often on an autonomous basis---to provide patients with the care and attention they need for optimal health.
While nurses are indeed held in very high esteem by the general public in surveys and polls, most members of that adoring public would be hard pressed to actually describe what it is that nurses do. As Bernice Buresh and Suzanne Gordon make so abundantly clear, it is up to nurses to claim their rightful place of importance in the care provided to patients in a variety of settings. Nurses need to proudly speak of their work with a voice of agency and power, and communicate clearly---to the public, the media, their families, their friends, and their colleagues---that nursing is important, that it is meaningful, and that what nurses do contributes to successful patient care and positive outcomes. We must forgo the teddy-bears, the hearts, the flowers, the useless diminutive statements and self-deprecation, and claim our professionalism for our own.
Nursing's voice must be heard, and Buresh and Gordon feel that the time for that voice to be clearly heard is now.
Sunday, December 30, 2007
The Countdown
The countdown continues as I face only 14 more work days before my full-time employment ends. As I connect with patients and inform them that I am leaving the practice, the reality of the change sets in. I also realize that some of my patients' lives will indeed change radically as they negotiate new clinical relationships that may or may not serve them as well as their relationship with me has done.
In terms of what I have done for patients, frequently going the extra mile---both literally and figuratively---I wonder if my going that extra mile has truly served them well. Having done so, their expectations may be that subsequent clinicians will do what I have done for them, and in this assumption they may indeed be sorely mistaken. If that is the case, did my going that extra mile only foster dependence and disempower them from a more proactive approach to their own care?
Enabling behavior among clinicians does occur, and in my (current) line of work---care coordination for the disabled and vulnerable---we are all guilty. However, if enabling does go so far as to disempower, then what has truly been served, the patient's needs or the clinician's own guilt?
For myself, this is the end of an era. It is the end of being in long-term therapeutic relationship with patients. It is the end of being a fixture in patients' lives year after year, through births, deaths, tragedies, and the inescapable comedies of error. It is the end of that feeling of responsibility of carrying the details of the care of so many on my own shoulders. I have gained much from that responsibility, and it has certainly fed my own need to be so needed. But is being so needed really all that it's cracked up to be?
As for my patients, they will survive, and they will navigate the new world without my presence however they can. Some will latch onto a new provider, some will simply fade into the healthcare woodwork. Abandonment issues will surface for some, and the more functional of these individuals will work through those issues and come out on the other side. For a few, I will just be one more well-meaning and earnest clinician who danced in their life for a while before spinning out of orbit like so many others before me.
In one exchange with a patient to whom I was breaking the news of my imminent departure, my patient said something about the fact that we had "done so much good work together" as if it was now all lost. My response was to counter that statement by framing it in the light of forward movement, of her new ability to build upon that foundation and realize more of her innate potential for self-directed advocacy. She agreed, but maintained her assertion that it was a loss of large proportions.
That day of finally closing the door on my seven-year sojourn---January 18th---is close on the horizon. What happens between now and then is only one part of the story. After that, a new chapter begins, and I will write that chapter with great interest and care. Perhaps it is already written and I only need to find it within myself.....
In terms of what I have done for patients, frequently going the extra mile---both literally and figuratively---I wonder if my going that extra mile has truly served them well. Having done so, their expectations may be that subsequent clinicians will do what I have done for them, and in this assumption they may indeed be sorely mistaken. If that is the case, did my going that extra mile only foster dependence and disempower them from a more proactive approach to their own care?
Enabling behavior among clinicians does occur, and in my (current) line of work---care coordination for the disabled and vulnerable---we are all guilty. However, if enabling does go so far as to disempower, then what has truly been served, the patient's needs or the clinician's own guilt?
For myself, this is the end of an era. It is the end of being in long-term therapeutic relationship with patients. It is the end of being a fixture in patients' lives year after year, through births, deaths, tragedies, and the inescapable comedies of error. It is the end of that feeling of responsibility of carrying the details of the care of so many on my own shoulders. I have gained much from that responsibility, and it has certainly fed my own need to be so needed. But is being so needed really all that it's cracked up to be?
As for my patients, they will survive, and they will navigate the new world without my presence however they can. Some will latch onto a new provider, some will simply fade into the healthcare woodwork. Abandonment issues will surface for some, and the more functional of these individuals will work through those issues and come out on the other side. For a few, I will just be one more well-meaning and earnest clinician who danced in their life for a while before spinning out of orbit like so many others before me.
In one exchange with a patient to whom I was breaking the news of my imminent departure, my patient said something about the fact that we had "done so much good work together" as if it was now all lost. My response was to counter that statement by framing it in the light of forward movement, of her new ability to build upon that foundation and realize more of her innate potential for self-directed advocacy. She agreed, but maintained her assertion that it was a loss of large proportions.
That day of finally closing the door on my seven-year sojourn---January 18th---is close on the horizon. What happens between now and then is only one part of the story. After that, a new chapter begins, and I will write that chapter with great interest and care. Perhaps it is already written and I only need to find it within myself.....
Monday, January 22, 2007
You're a Nurse, Right?
Yesterday morning, Mary and I drove to our favorite cafe and used bookstore in the middle of nowhere where we like to spend Sundays eating warm brown rice salad, drinking decaf, and pretending to read. The view of the icy river was lovely, and we eventually repaired to an old moldy couch in the bookstore, Tina snuggled between us (she was kicked out of the previously dog-friendly cafe).
We ran into an acquaintance who we had not seen for some time, and he regaled us with stories of his international community development work and other adventures. His stories were intriguing, plus Tina got to eat the leftover butter from his bagel. What could be better than that?
After a while, he looked at me and said, "You're a nurse, right?" I responded affirmatively, and he immediately shifted his gaze to Mary and said, "So what are you doing now?" The conversation continued vis-a-vis Mary's work for a while and then circled back to him.
Now, I'm more than happy to talk about my work, and I'm also happy to not do so, as well. It is such a big part of my life (and identity) that it's fine to leave it behind once in a while. However, after he asked me that question and did not pursue it further, I drifted off into a reverie thinking about what that lack of follow-up signified. Of course, we are all sometimes guilty of asking a question in a social situation and then failing to follow up, allowing the conversation to drift on its course, some tangents left to dangle like so many orphaned participles.
Another very possible reason for this gentleman not following up his question is that after confirming my continued nurseness, he immediately assumed that I work in a hospital. With that assumption, his mental images of "nurse"---hanging IVs, making beds, comforting the ill and dying, assisting a doctor---allowed him to have a vision of what I do every day without needing to ask further questions. The authors of From Silence to Voice would probably add that, while many nurses erroneously think that the public knows what they do without being told, many members of the public also think they know what nurses do based on media stereotypes.
Contrary to that experience, Mary and I were at our favorite tapas bar tonight for beer and snacks (and no, we don't go out to eat every day!). The bartender (who we know from her previous place of employment) said, "So, what kind of a nurse are you?" having been told by Mary that I was a nurse prior to my arrival. Question thus asked, she planted her elbows on the bar, hands under chin, and listened closely to my response, her face lighting up as she responded with her own dream of helping others by volunteering to create delicious, healthful meals for the ill or infirm.
There are several interesting points here. First, one might say that this could be an illustration of classic male and female conversational style. The man (our acquaintance) asked a question to which he received an expected answer, made some assumptions based upon his own experience, and then proceeded to the next question, ne'er looking back. The woman bartender, on the other hand, asked a question, used her body language and eye contact to express her sincere interest, and then added to my response by building upon it in relation to herself. Classic differences in communication style with which Deborah Tannen would have a field day.
Needless to say, I can imagine you need no help figuring out in which scenario I felt more "seen". While the bartender will not necessarily remember exactly what I do, she will most likely carry around a mental image of "latinos, vulnerable populations, HIV, substance abuse" as it relates to her memory of me. Whereas, aforementioned acquaintance will remember only "nurse" with either a caricature of Nurse Ratched, or perhaps a Hallmark card image of me in a white uniform and funny hat, compartmentalized in his mind. (As for the hat, I flatly eschew them, along with the white stockings and orthopedic pumps, mind you.)
But I digress. Does the public know what nurses do? Maybe they think they do. Do nurses think the public knows what they do? Perhaps nurses in hospitals, doctors' offices and schools do, but those of us in slightly alternative roles are creating the public's image of us as we go along, educating people that nurses do many things not involving a hospital. I have never been a hospital nurse. In fact, I vowed prior to graduation that I would never work as a nurse in any setting where a uniform or scrubs were required. (What a non-comformist!)
So, the next time someone says to you, "So, what do you do?", be aware of how they follow up that question. Do they put you in a mental box and carry on, or do they probe to further understand you, your work, and its place in the world? Food for thought, and for conversation.
We ran into an acquaintance who we had not seen for some time, and he regaled us with stories of his international community development work and other adventures. His stories were intriguing, plus Tina got to eat the leftover butter from his bagel. What could be better than that?
After a while, he looked at me and said, "You're a nurse, right?" I responded affirmatively, and he immediately shifted his gaze to Mary and said, "So what are you doing now?" The conversation continued vis-a-vis Mary's work for a while and then circled back to him.
Now, I'm more than happy to talk about my work, and I'm also happy to not do so, as well. It is such a big part of my life (and identity) that it's fine to leave it behind once in a while. However, after he asked me that question and did not pursue it further, I drifted off into a reverie thinking about what that lack of follow-up signified. Of course, we are all sometimes guilty of asking a question in a social situation and then failing to follow up, allowing the conversation to drift on its course, some tangents left to dangle like so many orphaned participles.
Another very possible reason for this gentleman not following up his question is that after confirming my continued nurseness, he immediately assumed that I work in a hospital. With that assumption, his mental images of "nurse"---hanging IVs, making beds, comforting the ill and dying, assisting a doctor---allowed him to have a vision of what I do every day without needing to ask further questions. The authors of From Silence to Voice would probably add that, while many nurses erroneously think that the public knows what they do without being told, many members of the public also think they know what nurses do based on media stereotypes.
Contrary to that experience, Mary and I were at our favorite tapas bar tonight for beer and snacks (and no, we don't go out to eat every day!). The bartender (who we know from her previous place of employment) said, "So, what kind of a nurse are you?" having been told by Mary that I was a nurse prior to my arrival. Question thus asked, she planted her elbows on the bar, hands under chin, and listened closely to my response, her face lighting up as she responded with her own dream of helping others by volunteering to create delicious, healthful meals for the ill or infirm.
There are several interesting points here. First, one might say that this could be an illustration of classic male and female conversational style. The man (our acquaintance) asked a question to which he received an expected answer, made some assumptions based upon his own experience, and then proceeded to the next question, ne'er looking back. The woman bartender, on the other hand, asked a question, used her body language and eye contact to express her sincere interest, and then added to my response by building upon it in relation to herself. Classic differences in communication style with which Deborah Tannen would have a field day.
Needless to say, I can imagine you need no help figuring out in which scenario I felt more "seen". While the bartender will not necessarily remember exactly what I do, she will most likely carry around a mental image of "latinos, vulnerable populations, HIV, substance abuse" as it relates to her memory of me. Whereas, aforementioned acquaintance will remember only "nurse" with either a caricature of Nurse Ratched, or perhaps a Hallmark card image of me in a white uniform and funny hat, compartmentalized in his mind. (As for the hat, I flatly eschew them, along with the white stockings and orthopedic pumps, mind you.)
But I digress. Does the public know what nurses do? Maybe they think they do. Do nurses think the public knows what they do? Perhaps nurses in hospitals, doctors' offices and schools do, but those of us in slightly alternative roles are creating the public's image of us as we go along, educating people that nurses do many things not involving a hospital. I have never been a hospital nurse. In fact, I vowed prior to graduation that I would never work as a nurse in any setting where a uniform or scrubs were required. (What a non-comformist!)
So, the next time someone says to you, "So, what do you do?", be aware of how they follow up that question. Do they put you in a mental box and carry on, or do they probe to further understand you, your work, and its place in the world? Food for thought, and for conversation.
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