25 January 2016

Conflict negotiation, Part 1

Twenty years ago, I read an excellent book authored by scholars from the Higher Education Research Institute (HERI, 1996) at UCLA. In describing a social change model of leadership development, they identified ability to engage in “controversy with civility” as an essential element. Conflict, they suggested, often implies competition or disagreement that involves potential aggression, and the term frequently conjures up the notion of winners and losers. Controversy, on the other hand, implies disagreement that has potential for positive outcome resulting in a solution that is beneficial to all.

For controversy with civility to occur, observed the scholars, parties to the disagreement must accept two fundamental premises: 1) Differences of viewpoint are inevitable, and 2) resolution of opposing points of view requires that both positions be aired honestly but with civility and openness. Whether one uses “conflict” or “controversy with civility” when referring to disagreement, both terms, it should be noted, describe natural and normal processes which, when managed well, can lead to creative problem solving. This is particularly true when problem solving occurs in an atmosphere of civility, collaboration, and with intent to achieve common purpose. Successful negotiation of either conflict or controversy requires listening well and setting ground rules—rules of engagement—that provide a platform for acceptable conduct and interaction.

You don’t have to be mean to be a leader!
The relevance of the HERI publication I refer to above resonates even more for me today as I consider the political rhetoric surrounding the 2016 U.S. presidential campaign. I passionately believe that positive and effective leadership only occurs in a context of civility, ethical conduct, and professionalism. Some years ago, I developed the acronym PEAK—Principled, Ethical, Authentic, and Kind—to describe that kind of leadership.

Leading with civility and kindness is not a sign of weakness, nor is it a philosophical abstraction. Rather, it is living and leading by a durable code of moral and principled behavior that is applied in everyday life. True leadership calls for strong commitment to ethical conduct and ability to empathize with others. As I reflect on some of the comments made during the current campaign season, I am reminded of a quote by Eric Hoffer, who said, “Rudeness is the weak man’s imitation of strength,” and another quote by Tennessee Williams, who quipped, “All cruel people describe themselves as paragons of frankness.”

Not all conflicts are created equal.
In my work as a consultant, mastering the skills of conflict negotiation often tops the list of skill-building requests. While many of us recognize that conflict can be a positive experience when it is addressed directly, we often avoid it, especially if a situation has evolved over time and bad feelings have built up, resulting in a breakdown of communication and damaged relationships. In some cases, individuals avoid dealing with conflict because they lack the requisite skills or are unable to create the emotional “safe space” needed for effective dialogue and conflict resolution.

Other reasons for avoiding conflict include believing that mentioning the conflict or attempting to resolve it may put one’s position or job at risk. Not all conflicts are created equal. Some may be resolved with a brief conversation that clears up misunderstandings, but others require work, energy, and willingness to revisit a painful issue. It is important, therefore, to decide which conflicts to address and which ones to let go.

Effective conflict negotiation requires that you carefully analyze your level of interest in the other party, and how important it is to you to resolve the conflict. For example, if the issue is not of high interest to you or you are not deeply vested in the other party, the effort required to resolve the conflict may not be worth it. However, if the issue is of high interest to you and you are also highly vested in your relationship with the other party, it is probably in your best interest to attempt to resolve the problem, especially if both parties care about the results. It’s important to realize that some problems or issues may never be resolved.

Ask yourself these questions.
Before engaging in conflict negotiation, ask yourself the following questions: How important is your relationship with the other person? If you are able to resolve the conflict, how much will it affect your working relationship now and in the future? If you don’t address the conflict, will it negatively affect your ability to work with this person now and in the future? How likely is it that the conflict will be resolved and the relationship improved? What are the potential costs and benefits of addressing the situation?

Once you have carefully considered these questions and have decided to address the conflict, it is important to reflect and consider how you may have contributed to the situation. Many times, people will say, “I had nothing to do with this conflict, and the other person is to blame for the problem.” In most cases, this is not a true assessment. Even when it might be true, it’s still important to consider the other person’s point of view regarding your role. Doing so will help you develop an understanding of that person’s perspective.

Higher Education Research Institute (1996). A social change model of leadership development guidebook. Version III. Los Angeles, CA: Author.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be published.

13 November 2015

Beating the burden of burnout

It’s amazing to me that, not long after the start of a new academic year, many nursing faculty members are overwhelmed by stress with some nearing a state of burnout. During a lunch break at a recent nursing conference, I chatted with nurse educators from around the country. The conversation centered on their myriad work responsibilities and heightened levels of stress. Seated around the table, they described how each minute of every day seems to be filled with an endless list of family, life, and work responsibilities. They lamented the long work hours invested in preparing for classes, grading assignments and exams, meeting with students, engaging in committee work, working on scholarly activities, providing service, teaching—both classroom and clinical—and fulfilling a number of other responsibilities.

Manuel Faba Ortega
One professor commented: “It’s only the first month of classes, and I am completely exhausted. I’m teaching two 12-hour clinical days and an extra class as an overload assignment because we have unfilled faculty positions, and there is no one else to teach the class. I’m also enrolled in a DNP program, because our university requires all faculty members to obtain a doctoral degree. We have a new director, and she has asked me to take on some of the school’s administrative responsibilities, which I have agreed to do. On top of everything, our current cohort of students is more challenging than ever, and I am completely drained.”

Too busy for self-nurturing
Concerned for her, I asked: “What are you doing for yourself? How are you nurturing your body and spirit?” She looked at me with a perplexed expression and said, “To be perfectly honest, I am doing very little, if anything, to nurture myself. I’m just too busy.”

Unfortunately, this story is not uncommon. I often ask nurses, nurse faculty members, and nursing students the same question, “What are you doing to nurture yourself?” Sadly, the vast majority of respondents say they are working so hard and moving in so many directions that self care has taken a back seat to responsibilities that often overwhelm them.

This is deeply concerning, because lack of self care takes a significant toll on personal, physical, emotional, and spiritual well-being, and it can have a potentially negative impact on our ability to care for others, including patients. The pressure created by competing demands from family, work, and life responsibilities can cause stress and maybe even burnout.

Obviously, stress will always be a part of our lives, and mild stress levels can actually give us an edge and help us mobilize for action and achievement. However, too much stress, especially if prolonged and coupled with poor coping habits, can cause physical, emotional, and spiritual fatigue as well as ill health. Common signs and symptoms of stress overload include accumulation of belly fat, interrupted sleep, fatigue, irritability and anger, and lack of interest. Mental health problems, such as increased anxiety and depression, may result, and it’s not uncommon for stomachaches, headaches, intestinal problems, and cardiac changes to manifest when stress levels are heightened and prolonged.

A few questions to ask
For some, burnout may also occur. Burnout is a state of emotional, mental, and physical exhaustion caused by excessive and prolonged stress. When we are burned out, we feel overwhelmed, depleted, unproductive, unhappy, unappreciated, and too tired to function. To determine if you might be experiencing burnout, ask yourself a few questions:
  • Do you have difficulty getting out of bed and feeling excited about your day?
  • Do you become irritable or impatient with students, coworkers, or patients?
  • Do you lack energy and feel disillusioned about your work?
  • Are you using unhealthy coping strategies, such as spending hours watching TV or browsing the Internet, or using drugs, food, or alcohol to feel better?
If so, you may be experiencing or approaching a state of burnout.

While eliminating stress is impossible, minimizing it and engaging in self-care techniques can be extremely helpful and ultimately important in achieving an overall state of wellness. So, take a minute to jot down your favorite stress busters and most effective stress-reducing techniques. Some of us benefit from physical exercise and activities, such as yoga, meditation, progressive relaxation, deep breathing, and enjoying music or the outdoors. Spending time with family, friends, and pets, eating nutritious foods, and getting enough rest also help reduce stress.

While these stress-management techniques can be helpful—and I certainly recommend them—real and lasting change comes from identifying the sources of our stress and creating an intentional plan to deal with them. It may be helpful to carry a small notebook or make a note using your smartphone to record events or situations that cause you stress. After a week or two, you will likely gain a clear picture of where your stress is coming from and how you might address it.

Putting yourself first essential
After reviewing your personal list of stressors, identify those that you can do something about and those that are out of your control. For example, you may be stressed by your work commute. Is there a way to change the method, timing, or route of your commute to reduce your stress? If so, this is something within your control. If you identify a stressor that you cannot effectively eliminate—caring for a child with a disability, for example—perhaps there are ways to reduce the stress involved. In the case of a child with a disability, are there other people or community resources available that can share your care responsibilities and thereby lessen your stress?

Regardless of the sources of your stress—whether you can change them or not change them—putting yourself first is essential. This is not a selfish endeavor. By taking care of yourself, you can better attend to the needs of others. Enter “me time” into your calendar and regard that time as important as any other work meeting or event. Resist the urge to cancel “me time,” because the healthiest way to cope with stress and burnout is to take excellent care of yourself.

Managing your time well and staying organized can also be stress-reducing. Start each day with a “to-do” list and arrange them by priority—from high to low. Consider dropping low priority tasks altogether by rescheduling them for completion sometime in the future, or better yet, when possible, delegate those tasks to someone else. Resist multitasking and the urge to immediately respond to every text or email message you receive. Prioritize the messages, and, if possible, save them to a folder to be addressed when you have more time.

“Unplug” from your phone, television, computer, and other distractions to enjoy a moment of peace and quiet. Take a deep breath, and clear your mind. When life is busy, we often get distracted and lose connection with those we care about most. Schedule a date night with your partner, enjoy lunch or a power walk with a friend, or spend time with your furry friends. Avoid negative people as much as possible, and surround yourself with those who bring fun and laughter into your life. Take time off, or schedule a mini-vacation. Whatever you decide to do to de-stress, remember, you deserve it!

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not b posted.

28 August 2015

Civility, an ethical imperative

Everyone should choose to practice civility. For nurses and the nursing profession, however, it is imperative, an ethical requirement. According to the American Nurses Association’s Code of Ethics for Nurses with Interpretive Statements (2015), all nurses regardless of setting or position have an ethical responsibility to create and sustain healthy work places and to foster an atmosphere of dignity and regard for all. The code is clear: “The nurse creates an ethical environment and culture of civility and kindness, treating colleagues, co-workers, employees, students, and others with dignity and respect. … Disregard for the effects of one’s actions on others, bullying, harassment, intimidation, manipulation, threats, or violence are always morally unacceptable behaviors” (p. 4).

Moreover, Provision 7.2 of the code states: “Academic educators must also seek to ensure that all their graduates possess the knowledge, skills, and moral dispositions that are essential to nursing” (p. 28). Therefore, it is incumbent upon nurse educators in all levels of nursing programs to model ethical conduct, professionalism, inclusion, and civility. They must take the lead in preventing and addressing acts of incivility, set the tone by incorporating civility as a shared value within their programs, and prepare students to effectively address incivility and foster safe, healthy work environments. The stakes are high. Safe patient care hinges on our ability to self-reflect and accurately assess our own behaviors, effectively manage our emotions, and communicate respectfully.

For several years, I have intentionally integrated professionalism and civility content into my courses. Students and faculty members must engage in deliberate conversation about these topics, identifying and practicing specific strategies to foster civility. One exercise I like to use is having students complete the Clark Workplace Civility Index. During this carefully arranged activity, each student assesses his or her own perceived level of civility as well as the perceived civility level of another student with whom he or she is familiar and has built an adequate level of trust. They then candidly—and privately—share their insights with one another.

The evidence-based, 20-item questionnaire is designed to assess civility, increase self-awareness, generate discussion, and identify ways to enhance individual and collective civility acumen. The index includes assessing behaviors such as treating others with respect, keeping confidences, avoiding gossip and spreading rumors, using respectful communication, taking personal responsibility, and being accountable for one’s actions.

In addition to completing the index and discussing the issues it raises, each individual makes a firm commitment—in writing—to behave in a civil, respectful, and ethical manner. After completing the index, I recently asked a group of approximately 100 nursing students the following question: “What specific individual action can you take to foster a civil, healthy work environment?” The responses were impressive and, in some cases, inspirational.

Here are the top 10 responses:
  • Always focus on the patient; this will keep us centered and respectful.
  • Listen well and welcome other points of view.
  • Offer to help and be supportive of others.
  • Assume good will and exercise patience.
  • Model professionalism, kindness, and respect.
  • Speak up, set the bar high, and be a crusader for civility.
  • Strive to be the very best person possible.
  • Value differences and avoid judgment.
  • Take good care of myself, de-stress, and live well.
  • Practice the Golden Rule; treat others the way we wish to be treated.

Engaging in reflective exercises and candid conversation about ways to foster civility are helpful strategies to prepare students—and others—to address incivility, establish and sustain healthy workplaces, foster positive interpersonal and intrapersonal relationships, and enhance ethical practices that contribute to the ongoing success of top-performing work teams and highly effective organizations. Addressing incivility can be challenging, but remaining silent not only impairs nurse performance, it ultimately jeopardizes patient care.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.

16 July 2015

The next great adventure

My next great career adventure has begun! I recently resigned my faculty position after 20 years of teaching and started working full time as a nurse consultant for ATI Nursing Education. Some say the decision to pursue the next leg of my professional journey was swift. But those in the know are keenly aware that I was methodical and purposeful, carefully and strategically considering each aspect of my career change. It was a deeply reflective experience as I sought the wise counsel of family, friends, and numerous mentors who guided me along the way.

I knew I wanted something new, fresh, and different in my work life. My love for nursing and education never wavered, but a strong and convincing force was beckoning me toward a new direction. For decades, my custom has been to strategically plot my short- and long-term goals on a timeline, to share them with my closest mentors, and to implement an action plan to achieve them. I have known for years that, someday, I would leave my faculty position to pursue my passion to become a full-time nurse consultant. This career transition required careful consideration.

I spent a good deal of time thinking about the type of organization with which I desired to be affiliated. It didn’t matter whether the organization was private or public. What mattered most was that members of the organization lived by a shared vision and mission, based on values of mutual respect, collegiality, quality, and excellence—values built on organizational trust and community responsibility. I wanted to be a member of a workplace where employees are viewed as partners, valued as assets, and generously rewarded for their individual and collective contributions to the success of the organization.

I looked for a workplace with high levels of employee satisfaction, engagement, and morale. It was also important to be affiliated with an organization on the rise, one that encourages free expression of diverse ideas, so that all voices might be heard and appreciated to inform the best decision-making processes possible. I wanted to wake up in the morning filled with feelings of excitement and joy for the work I was doing and be rewarded for a job well done. If you are not doing work you love, you might never reach your full potential. It will continue to be just a job and eventually become rote, mundane, and boring. I never really lacked a passion for teaching; it’s just that the tug of something more continued its steady pull. Thus began my odyssey to pursue one of the best jobs ever.

To begin, I set clear goals and carefully detailed what I was looking for in terms of organizational culture, work responsibilities, opportunities for personal and professional growth, ability to express my passion and ideas, membership on a high performing team, making a difference, and most of all, having fun! Once I began to deeply reflect on these and other issues, I spent countless hours talking with coaches and mentors about the best direction to pursue. I wrote down the pros and cons of leaving my current faculty position and taking on a new role in what would essentially be the grand unknown.

I focused on key elements of a healthy work environment and, taking my own advice, I assessed the relative health of my new work environment by completing the Clark Healthy Workplace Inventory. Because I am a firm believer in working for an organization that promotes wellness, as well as physical, emotional, and spiritual good health, I wanted to ensure that I was making the right decision and focusing on important issues related to healthy workplaces.

It’s easy to become content with the status quo and fall victim to the relative comfort and ease of current work conditions, especially if we are paid a fair wage and genuinely like our co-workers. Of course, there is nothing wrong with feeling content or comfortable in your job. It's just that if you yearn for more, this complacency can hold you back from achieving your grandest dreams. Remember, we spend well over 40 hours per week at our jobs, so it’s important to regularly evaluate our career goals and consider opportunities that will take our careers to a whole new level.

Whether you are curious about the health of your current workplace or seeking employment elsewhere, you might want to complete the Clark Healthy Workplace Inventory. I have said it before, and I'll say it again: “Culture trumps everything.” So if you are curious, click here to see how your place of employment stacks up.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.

20 May 2015

Uncivil semester: The nursing class that didn't seem to care!

Just before spring semester began—for many of us in the Northern Hemisphere, spring semester begins in January—I received an email message from a nursing professor (I’ll call her Beth) who expressed extreme distress stemming from a series of ongoing uncivil encounters with a class of nursing students. Attempting to resolve her problem, Beth had availed herself of several civility resources before contacting me, but, despite her efforts, had been unsuccessful in managing the disruptive and intimidating student behaviors.

Beth was very concerned about the situation, made worse by the fact that she would be teaching the same class of students during the spring semester. With permission, I share Beth’s story:

Aggressive and abusive
Fall semester was disastrous. From August into December, Beth experienced ongoing incivility in one of her nursing classes that involved multiple students. She described the students as highly stressed, aggressive, and verbally abusive. Exposure to this incivility began the first day of classes while Beth was facilitating discussion on accelerated heart rates. In the middle of Beth’s explanation, a student rudely interrupted her, stating that Beth didn’t know what she was talking about, and that the correct term was tachycardia. 

Jupiter Images/Photos.com/Thinkstock
Beth agreed with the student and attempted to explain that she, indeed, was planning to discuss the medical term. Before she could finish her response, however, the student made a sarcastic remark loud enough to be heard by the entire class. Some students responded by rolling their eyes and grimacing, and one of them glared at Beth for the remainder of the class. These and similar behaviors continued throughout the semester. Not equipped to address the situation, Beth tried to ignore it, which only made things worse.

To rectify the problem, Beth approached an experienced and tenured faculty member to seek her counsel. Sadly, the colleague acknowledged her own inexperience and lack of ability to address student incivility and offered no assistance. Consequently, the problem went unaddressed and, like pebbles rippling in a pond, continued to expand and intensify. 

Other students also became rude and disruptive, muttering under their breath during class and making disrespectful or aggressive comments to Beth and fellow students. One student openly and consistently challenged Beth during class, often snapping at her, shooting hostile glares, and vehemently arguing with her. At one point, Beth snapped back at the student and, after several unproductive back and forth exchanges, informed the student that she refused to argue with her. This interaction was followed by confrontation with another student, who accused Beth of refusing to satisfactorily answer class members' questions.

Beth began to dread going to class. Often, she lay awake at night. Unable to sleep, she worried about the hostility she would likely face the next day. Students who did not display uncivil behavior seemed to be feeling the stress as well. Again, Beth sought assistance from more experienced nurse educators, but none offered helpful advice.

Breaking point
One day, Beth’s stress level and inability to cope hit what seemed to be a breaking point, and she experienced a fairly intense hot flash during class. Some students, finding the event hilarious, responded by ridiculing and mocking her. Beth was humiliated and stunned by their insensitivity.

One student reported to Beth that class members maintained a social media site where students would criticize the class and post negative comments. She was told that some students fanned the flames of discontent, which, in turn, intensified the situation, resulting in a mob-type mentality. Although Beth tried to remain pleasant and respectful in class, her nerves were hanging by a thread, and she was relieved when the semester ended.

Her relief was short-lived. In addition to the brutally cruel student evaluations she received, it was then she learned she was scheduled to teach the same student cohort the very next semester. As I read Beth’s desperate message and plea for help, her dread was palpable.

Suggested solutions
I suggested several interventions, emphasizing the importance of role modeling and setting expectations the first day of class. I encouraged Beth to engage the students in conversation about the need for demonstrating civility and professionalism, displaying ethical behavior, and assuming the role and responsibilities of a professional nurse. 

I also suggested to Beth that she reinforce in class the various provisions contained in the American Nurses Association's Code of Ethics for Nurses (2015), in particular, Provision 1.5 which reads: “The nurse creates an ethical environment and culture of civility and kindness, treating colleagues, co-workers, employees, students, and patients with dignity and respect; any form of bullying, harassment, intimidation, manipulation, threats, or violence are always morally unacceptable and will not be tolerated,” (p. 4) and Provision 6.3 which reads: “Nurses are responsible for contributing to a moral environment that demands respectful interactions among colleagues” (p. 24).

In addition, I suggested co-creating classroom norms to foster and sustain a safe and civil learning environment. Faculty members need to take the lead in creating safe spaces for students, faculty, and other members of the learning community to express their views and beliefs without insult or other intimidation. Thus, co-creation of class norms is one of the most important activities to accomplish on the first day of class. Establishing, implementing, and reinforcing these norms are foundational to a respectful and civil teaching-learning environment and become living documents that provide a touchstone of civility and professionalism for students and faculty—a framework for working, collaborating, and learning together (Clark, 2013).

Norms need to be reviewed, revised, and reaffirmed on an ongoing basis. Once agreed upon, they can be used to remind students of their commitment to creating a safe teaching-learning environment and can set the stage for future meetings when faculty members may need to address performance or academic issues with students.

Beth’s story, Part 2.
Wearing business attire and striking a professional tone, Beth arrived early on the first day of the new semester. After welcoming the students, she started a dialogue about class expectations, using several foundational documents including the Code of Ethics for Nurses. Next, Beth facilitated co-creation of classroom norms, emphasizing the importance of following the norms and holding one another accountable for their successful implementation. After passing out index cards, she invited students to anonymously pose questions or comments to which she would promptly respond with posts on the students’ online learning platform.

Next, Beth told the class she had reviewed the course feedback she had received from the previous semester and, as a result, would be making several changes to improve the course. She told the students about her background and experience as a professional nurse and encouraged class members to ask questions and share their own experiences.

Welcome, Civility!
An interesting and wonderful thing happened after Beth shared her plans for the course: The class virtually exploded with questions, and students told stories and shared examples from their personal and professional experiences. It was an animated and interactive dialogue. Beth was “pleasantly shocked.”

Lumina Stock/iStock/Thinkstock
In the weeks that followed, Beth addressed some of the questions posed by students on the index cards, and she periodically discussed their compliance with classroom norms and progress toward becoming professional nurses. Overall, the students remained animated, interactive, and respectful. Several made supportive comments on the index cards. In fact, one student apologized for how the class had treated Beth during the previous semester.

Moral of the story 
Preparation, professional role modeling, and open, honest discussion matter and go a long way toward reducing or eliminating uncivil behavior. More importantly, they foster civility and add value to professional growth and development. Beth’s story is an epic success. We can all learn from her courageous response.

American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. Washington, DC: American Nurses Association.

Clark, C.M. (2013). Creating & sustaining civility in nursing education. Indianapolis, IN: Sigma Theta Tau International.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.

31 March 2015

Life sentence

My beautiful, intelligent, activist, mildly irreverent, and—may I add—favorite Aunt Ellen died peacefully a few weeks ago, following a valiant battle against cancer. As her loved ones gathered, we witnessed her painful, wrenching, lingering death sentence play out in sometimes despicable ways and, at other times, amazingly beautiful ways. While cancer dealt my aunt a sentence of death, it is her “life sentence” that provides the context for this post.

My aunt faced death with unwavering courage, staying strong and resolute as she waged a fearless crusade against an ugly and detestable enemy she knew, ultimately, she could never defeat. Her fervent wish was to forgo an official memorial service. Instead, she wanted to live her final weeks and days engaged in intimate dialogue about her legacy and how her time on earth made a difference in the lives of those who loved her most. Neither she—nor we—were to be denied fulfillment of that desire.

But how would we go about doing this? How would we gather memories and impressions from countless members of our large Irish Catholic family, located far and wide around the globe, that would capture in words the impact of my aunt’s life? It was my cousin—Aunt Ellen’s daughter—who came up with an incredible and meaningful way to document the impact of someone so deeply and dearly loved. Considering that time was of the essence, her idea was an incredible way to chronicle a life well lived.

No more than six words
My cousin asked each of us to consider the following question: “How could we capture the essence of Aunt Ellen’s life—her legacy—in a single “life sentence” of six words or less?" Wow, this seemed like a nearly impossible mission! To get us started, my cousin asked us to reflect on a “story” by Ernest Hemingway who wrote “For sale: Baby shoes. Never worn.” In six words, Hemingway illustrated how an entire story could be told using only a half-dozen words. Hemingway believed you don’t need a lot of words to tell a story and demonstrated that six words can be sufficient.

They say flowers are for the living. So are loving words.
Ruta Saulyte-laurinaviciene/Hemera/Thinkstock

Using Hemingway’s story as an example of brevity, my cousin asked each of us to describe the impact of my aunt’s life. How were we changed by having Aunt Ellen in our lives? What was our unique connection with her? What did we remember most about her life? Six words, just six measly words.

74 years, six words
My cousin wanted to receive our responses within three days so she could share them with her mother as she lay dying. How do you sum up an entire life of 74 years in a few words? And how do you do that for someone who is still alive, knowing that your words will be shared and discussed with that person? While no single truth or perspective can summarize an individual’s life, a collection of them, written by various people—spouse, son, daughter, grandchild, niece, nephew, brother, sister, friend, neighbor, student, and others—offers a surprisingly meaningful portrayal of a life well lived. My aunt was adamant that, when the time came, she did not want us to dwell on her death. Rather, she wanted us to remember how she lived.

My cousin collected hundreds of reflections, encapsulated in no more than six words, that described her mother’s life. We discovered, to our collective amazement, that, when taken together, these pithy phrases truly expressed the multidimensional layers of my aunt’s life, providing a beautiful and loving mosaic.

Below is a sampling of the responses my cousin received and shared with her mother, who, elated and humbled by the outpouring of love, savored our words as she took her last breath. Later, my cousin told us that her mother laughed, cried, and ultimately took her family for a walk down memory lane as she added details to the quips we provided.

And the Oscar goes to, Ellen!
Mom: The house that built me
A mosaic of love and sassiness
She’s always a woman to me
(as sung by Billy Joel)
Danced to her own drummer
Fierce champion for children and animals
Taught me to love butter again
Petite stature, giant heart, tender soul
Keep your elbows off the table
Growing old is optional
More complicated than a Rubik’s cube
A life lived in confident rebellion
Always question the status quo

Perhaps my sister summed it up best when she said our aunt was surrounded by those who loved her most, she was content in knowing she was loved completely, her life mattered, and a sacred place is held for her in heaven. Privy to our myriad warts and wrinkles, she loved us nonetheless.

One day, a phrase will be uttered, a music lyric will be heard, an old movie will be watched, a dog will leap with joy in the presence of his human, or a young woman riding freely on her horse with the wind in her hair will remind us of Aunt Ellen, and we will be filled with laughter and joy! That’s when the healing will begin and the pain will lessen.

Family and friends are our biggest supporters and our most sought-after rescue in a storm. Maybe these six words will summarize this post: Rest in peace. You’ve earned it.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.

10 February 2015

Our daughter called today

Our daughter called today. She is a somewhat newly graduated nurse, having completed her nursing degree just a little over three years ago. Since then, she has been working on a very busy oncology unit, caring for extremely ill patients with medically challenging conditions. Her recent need to share stemmed from events surrounding a young mother dying from advanced and untreatable breast cancer.

The health care team had worked tirelessly, trying to control the patient’s agonizing pain with little success. It took nearly an entire 12-hour shift for a team of oncology experts to find the right combination of pain medication and comfort measures to help the patient find relief. To make matters worse, the patient’s husband was so compromised by the experience that he suffered a cardiac event and was rushed to the emergency department. He was later admitted to the hospital for his own health issues.

Our daughter was profoundly affected by the day’s events and needed to debrief to gain a deeper understanding of what had happened and to decrease her stress level because, the very next day, during her next shift, the stress of caring for very ill patients with complex issues would begin anew. We talked for the better part of an hour, discussing effective ways of coping, managing stress, and engaging in self-care.

The conversation with my daughter took place just one day after a nurse with 43 years of experience disclosed to me that she had abruptly handed in her keys, cleared her locker, and, without giving notice, had walked off the job at the end of her shift. She had simply “had enough” of dealing with an incompetent and bullying nurse manager, who seemed to care little about the nurses under her supervision.

With tears in her eyes, this seasoned and highly experienced nurse explained that, while she enjoyed the work and caring for her patients, what she couldn’t abide was working for a manager who demeaned her and her colleagues—sometimes even the patients. Though we had just met, she poured her heart out as I offered an impartial ear. She said that she missed the work, but the stress of the job was killing her. Sadly, she is yet another casualty of workplace incivility.

A soft place to land
On the surface, these stories seem unrelated, but they are bound by a common theme: The work of nursing—regardless of the setting—can be very stressful and demanding. Each of us needs a “soft place to land” and a caring mentor with whom we can share our worries and concerns; someone with whom, when needed, we can speak the unspeakable, to help us sort things out so we can clear our heads and refresh our commitment. All of us need mentors and other caring individuals who can lend support and offer sage guidance and experience-based wisdom. Being a nurse is hard work and certainly not for the faint of heart. Nursing requires fortitude, compassion, and a commitment beyond what most people ever possess.

Think about it from the perspective of a newly graduated nurse, or even from the viewpoint of an experienced nurse, for that matter. The life of a nurse is challenging. Minute by minute, nurses deal with life and death situations that affect not only the patients they care for, but their families and loved ones and, ultimately, the nurses themselves. After talking with our daughter and the seasoned nurse who quietly walked away from a profession she loves, I came away from those conversations absolutely convinced, once again, that we must provide a nurturing place to debrief and a safe space to express the myriad emotions that nurses experience every day when caring for others. In caring for others, they often forget to care for themselves. It is important for each of us to reach out to one another and listen—I mean really listen—to the voices of our colleagues and to provide that soft place to land.

Debriefing for perspective
Sharing our nursing experiences provides a platform for collective understanding, improves problem-solving, and builds collegiality, collaboration and teamwork. Nurse managers must be especially alert to the need for debriefing members of their health care team. Often, the mood of staff members following a critical incident will indicate the need for pulling the team together to process the event. But, in my experience, debriefing and the cathartic need to share often are most effective when the nurse is out of the immediate situation and away from the stressful pace of the work environment. Once home, he or she is more mentally ready to process the day’s events.

Having a mentor or colleague to discuss feelings and concerns helps facilitate critical reflection on our nursing practice and helps nurses find continued—often, lasting—meaning in their work. So reach out to your colleagues and listen with an open heart. Maybe, just maybe, they will return the favor when you need it most.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.