Showing gratitude. What a gift!

During one of my recent traveling adventures, I was browsing a bookstore in the Minneapolis airport. As I approached the checkout stand to make my purchase, I was pleased to see a generous stack of P.M. Forni’s book Choosing Civility (2002) piled high and prominently displayed right next to the cash register. I was delighted to see that the topic of civility is one that still resonates with readers. It is my hope that the concept will continue to be a focus of attention, not only in nursing and health care, but in American society and beyond.

One of my favorite quotes by Forni is, “When we are on the receiving end of an act of civility, we feel validated, valued, and it gives our life meaning.” If you prefer a more colloquial version of this observation, you may enjoy a quote from Mark Twain who quipped, “I can live for two months on a good compliment.” Whichever quote strikes you most, each author makes a similar and compelling point—that we feel valued when we are recognized and appreciated by others.

Reflect for a moment on a recent or past experience when you felt affirmed and validated. Perhaps the affirmation came from a co-worker, student, family member, supervisor, or friend. As you contemplate the affirmation, consider the thoughts and feelings associated with the experience. My hunch is that they are enjoyable and pleasant. That’s because affirmations and words of encouragement add meaning to our lives and can lift us up during challenging times. They are like a port in the storm or a buoy on the choppy ocean. They situate us in the sweet spot of contentment. Unfortunately, when the opposite happens and we are treated rudely with disdain or disrespect, we feel dismissed, diminished, unimportant, and insignificant.

iStock/Thinkstock

During one of my recent workshops, a nurse in the audience commented that the effects of incivility last far longer than the two months of gratification cited by Mark Twain. The nurse observed that the impact of incivility can be crippling, while a genuine affirmation penetrates like a warm, welcoming, soothing salve.

A few months ago, just before our youngest daughter left to study at a university in England, we were visiting one evening—simple family talk, really—when she gazed at me for a moment, and declared, “You know what, Mama? You have always been a good mama, but I want you to know that I think you are also a very impressive woman.” Wow! What an unexpected and always-to-be cherished affirmation. Since her departure for Europe, I have reflected on that sweet, yet powerful pronouncement, and it lifts my spirits every time.

Like me, you have received affirmations that you treasure and hold onto tightly. But I wonder how many of us have to ponder a while to recall a time when we felt affirmed and validated. It’s perplexing that, while we know how great a positive comment feels, we are slow to affirm others—even those in our closest circle for whom we care the most. For whatever reason—busyness, stress, lack of face-to-face connection, or believing that a real “thank you” costs money—we often miss opportunities to affirm others. I would like to suggest several ways to acknowledge and express gratitude that cost very little, yet render high-impact results.

Smiling and greeting others by name can go a long way in helping colleagues and students feel welcome and significant. Make a point to say ”Good morning,” or extend a similar greeting as you go about your day. As Lady Mary Wortley Montagu reminds us, “Civility costs nothing, and buys everything.” Say “Thank you” often, and offer praise in front of others. Be specific with your praise. It’s good to praise, even when you express it in general terms, but it’s better to be specific, and it’s best to extend praise beyond the confines of the current setting.

Suppose you are a nurse working on an oncology unit. You have just put in a very long day attending to very ill patients, many of whom suffer from terminal conditions and are receiving palliative and end-of-life care. You are an attentive and compassionate nurse, but clearly exhausted and ready to go home. Just as you are leaving the unit, your charge nurse approaches you and says, “Great job today! I really appreciate you.” Obviously, this comment feels good—in fact, it might feel very good.

Now, what if your charge nurse is a bit more specific with her feedback and addresses you by saying, “Chris, I am so impressed with the care you provided today. I especially appreciate how you collaborated with Dr. Bailey to find the right combination of medications to relieve Mrs. Jones’ pain. Her family is deeply grateful, and because of you, she is going to have a restful night. Thank you for being such a great nurse. You are a valued member of the team.” Wow, what an incredible message! It’s specific, unambiguous, and, clearly, your charge nurse is appreciative and observant. You will likely remember this personal affirmation for a long time.

What if we take this expression of gratitude one step further and elevate the message beyond the work setting? In his book, Creating Magic: 10 Common Sense Leadership Strategies from a Life at Disney, Lee Cockerell (2008), former executive vice president of operations at Walt Disney World Resort, suggests sending a note of recognition to a family member. For example, in the above situation, the charge nurse might take a few minutes to mail a handwritten thank-you note to your family member or significant other that reads something like this: “Dear Terry, I want to take a moment to let you know how much we appreciate Chris. She is a caring, talented, and gifted nurse who takes great pride in the care she provides for every one of her patients. She is a joy to work with, and I can’t begin to fully explain how much she means to our team, and most especially to our patients and their families. Thank you for sharing her with us. She is a very special person.”

Now that is a powerful message! It’s a low-cost reward with high-impact results. And it takes only a few minutes of time and the price of a postage stamp. There are many other creative ways to say thank you. We can treat a colleague to lunch, leave a note of appreciation on their car or in a public place; give them a lottery or movie ticket or a gift card to their favorite coffee shop.

Shortly after delivering a plenary address at a nursing conference where we discussed the power of acknowledging others, I was approached by a nurse who shared a personal experience. She said, “I have worked in the neonatal intensive care unit for 16 years. Every day, I come to work, caring for very sick babies and tending to families terrified of losing their greatest treasure. Many of our babies don’t make it, and the toll it takes on the people in their lives is nearly unbearable. 

“So, a few years ago, I started a support group. It is a safe space for loved ones to share thoughts and feelings and, in many cases, to express the pain of their devastating loss. I facilitate the group on my own time, but it is worth every minute. While my teammates appreciate what the group means to families, for years it went largely unnoticed by my manager and others throughout the hospital. But, of course, I wasn’t doing it for the recognition.

“And then one day, a colleague showed me a brief write-up in the hospital newsletter. On the front page of the newsletter was a short paragraph describing the support group and the positive impact it was making on the families of our babies. One of the families had sent a letter to the CEO expressing their gratitude for the support group. I had no idea, but there it was in black and white on the front page of the newsletter! My name was even mentioned! I decided right then and there, I can do this another 16 years!”

Let this holiday season begin a long tradition of inspiring others by affirming their value and giving them the glorious gift of gratitude.

Reference:

Cockerell, L. (2008). Creating Magic: 10 Common Sense Leadership Strategies from a Life at Disney, New York, NY: Double Day Publishing Group.

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.

It was the nurses!

Last month, I had the privilege and high honor of delivering the endnote address to hundreds of neonatal nurses who attended the 30th Annual Educational Conference of the National Association of Neonatal Nurses (NANN). Asked to speak on the topic of civility and healthy workplaces, my presentation was titled “Igniting the power and passion of civility in nursing: Creating healthy workplaces.”

My objectives were to emphasize the imperative of fostering civility in nursing and provide several evidence-based, ready-to-use strategies for creating and sustaining healthy workplaces. The organizers of the conference asked that I deliver a message of optimism and highlight positive aspects of transforming practice environments, a request that fit easily and comfortably with my views on the topic. Clearly, the dedicated, hardworking nurses in attendance wished to end the conference and return to their busy, high-stress working places refreshed and invigorated by a message of hope and inspiration. I was determined to do just that, because they deserved my best.

What the organizers didn’t know—and what I chose not to disclose until the day of the event—is that, just over 30 years ago, I was the mother of a high-risk infant, a baby who spent nearly two months in a neonatal intensive care unit. Conceived during a northern Illinois winter, known for its frigid, tundra-like conditions, my firstborn child was due to be delivered in early August, associated in our hemisphere with sunny summer days. Who knew, instead, he would enter the world in the spring, almost 10 weeks before his due date?

Eric’s story is one I had never shared outside our family and close circle of friends, and, as I prepared for the NANN conference, I wondered if the moment had finally arrived to share a small piece of Eric’s early beginnings. There would likely never be a more fitting audience than this group of exceptional neonatal nurses, so, with Eric’s permission, I closed my endnote address by sharing this story. After all, had it not been for the unwavering, exceptional care provided by the entire NICU team, especially the nurses, Eric might not be with us today. One of NANN’s core values is advocating for quality patient and family care. Eric's neonatal nursing team took this value very seriously and lived it—every minute of every day.

I was young and inexperienced. I read just about everything I could on the topic of pregnancy, and talked with my mother and grandmother frequently about my pregnancy and pending delivery. Like most young mothers, I was thrilled and a bit fearful—all at the same time. Most of my pregnancy progressed normally, but long before the due date, I began to feel sluggish and nauseated. I became quite edematous and easily fatigued. I kept thinking something was wrong, so I visited my physician, who assured me I was fine. Somehow, I knew that wasn’t true, but I forced my worries to the back of my mind and allowed myself to think only about delivering a healthy child. In my way of thinking, if I thought it, it would happen.

When it became evident Eric would be coming much too early, I was rushed—following a flurry of examinations and ER visits—to a nearby medical center that boasted an excellent neonatal intensive care center. I remember arriving terrified. Immediately, I was swarmed by members of the medical team, all of them trying to determine the best course of action. Tests were run, examinations completed, and consultations made, all in a hurried attempt to save Eric’s life. Specialists agreed that the only chance Eric had of surviving was to prepare me for vaginal delivery.

Tests had determined that Eric suffered from a rare condition that included an in utero bowel perforation, an enlarged liver, and gross abdominal ascites, so we knew going into the delivery room that the odds for his survival were poor. The delivery room was packed with nurses, physicians, medical students, respiratory therapists, and just about anyone else who might be needed to save our baby’s life. The delivery itself was excruciating, and the level of infection I incurred post-delivery kept me hospitalized for nearly two weeks. But the real story is about Eric. A tiny, vulnerable infant, his Apgar score was 1, but only because he had a weak and thready pulse.

Eric then—a tiny, vulnerable infant with a weak and thready pulse.

He was rushed to the OR, where surgeons fought to save his life, conducting a procedure so revolutionary it had only been performed twice before. Chances of Eric’s survival were grim, particularly when, six days later, his bowel reperforated in another area of the colon. Over the course of the next 10 weeks, I experienced a roller coaster of emotions—fear, hope, worry, and yes, a love so deep it is unexplainable—all juxtaposed, layer upon layer. Through it all, the nurses—yes, those glorious, wonderful, highly skilled nurses—took care of every one of us, not just Eric, while our devoted family and friends stood vigil, hoping and praying for Eric’s health and recovery.

It was the nurses who, day in and day out, held my hand, accepted my tears, and encouraged me to never give up hope. It was the nurses who loved my son nearly as much as I did and inspired me with stories of other babies who had graduated from the NICU and were living healthy lives. It was the nurses who gave me hope, who never grew tired of my need to talk, who found a way to help me through every second, minute, and hour of each challenging and exhausting day. And finally, it was the nurses who helped me prepare for that most glorious of days—taking our son home. I have never forgotten, nor will I ever forget, the kindness, caring, and dedication shown to our son, our entire family, and me. Because of the nurses, our son is alive today and leading an incredible life. Though he has some physical limitations and lasting deficits, none of them has affected Eric’s beautiful and brilliant mind. He has earned a master’s degree in civil engineering and works as a professional environmental engineer. He is funny, witty, highly intelligent, and an incredible role model, not only for his two younger sisters but for all who have the privilege of knowing him.

Eric today—an environmental engineer with a
master's degree in civil engineering.

I told this story to the audience of neonatal nurses at the NANN conference for the sole purpose of expressing my deepest gratitude for the tireless and important work they do every day. I shared the photos included in this blog to illustrate the incredible life that Eric now leads largely because of their efforts. I also shared with them a note, written in Eric’s voice, that we gave to his nurses the day we finally left the NICU. It’s funny, but I still have the original note. Why, you might ask. It's because Eric’s thoughtful, unselfish nurses made a copy of the note for their notebook and returned the original to me, knowing that someday we would probably wish to have it in its original form. They were right. The note has been tucked away in Eric’s baby book for more than 30 years. It reads:

My dearest friends,

Almost 10 weeks have passed since I entered the world. I leave you all today with great admiration and gratitude. In the first two months of my life, my parents and I have come to understand and realize the fragility and sacredness of life. From your hands and hearts came the loving and professional care which has enabled me to leave here with the potential for a very long and eventful life. The greatest gift we can ever give another is the gift of ourselves. You have given of yourselves over and over, and goodness knows, how much I have appreciated that most precious gift. Thank you so much for your knowledgeable assistance and prayers; and thank you for loving me as much as you have. Perhaps someday we'll meet again and I can do something wonderful for all of you. We will keep you posted on my progress, and I promise to stop by and visit whenever I am in town. May God bless you all, and may your remarkable work continue to benefit all of the little children who pass through this center. You are and always will be so dear and wonderful to me.

Thank you again,

Eric

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.

Hardwired for the 'soft skill' of civility

For nearly 15 years of my recent adult life, I spent three to four evenings a week learning and practicing self-defense and cardio kickboxing in a traditional karate dojo under the tutelage of Sensei Pon Inthatarath, world-champion martial artist and self-defense practitioner. The dojo became my second home. The lessons I learned then and since have shaped my life in myriad ways beyond the scent of sweat and the smack of leather.

More than three years ago, I blogged about some of the important life lessons learned from my dojo experiences, such as how to survey my surroundings, how fitness extends well beyond physical capacity, and being alert for risky encounters. Sensei reinforced discipline, hard work, and training. We ran, punched, kicked, and performed countless plyometric and boxing drills—and then did it all over again. The countless hours of training taught me confidence, courage, and the importance of standing strong on the side of right. The seemingly endless drills and relentless training improved my ability to respond to challenges, learn from my mistakes, and be a model of courage and integrity.

Like muscle memory honed in the dojo, responding
effectively to disrespectful behavior is a skill that
can be learned.

Much of what we practiced, studied, and ultimately learned was a result of “muscle memory”—teaching our physical bodies to repeat movements and techniques over and over until they became routine and eventually stored in our grey matter, to be retrieved when needed. Our muscles grow accustomed to certain types of movement, and the more often an activity is rehearsed and reinforced, the more likely it is to be performed without putting much thought into it. For example, one of the lessons I learned from the dojo is to scan a room upon entering, locate the exits, and sit with a view of the door. The muscle memory of this lesson has resulted in rote, unconscious behavior on my part. It’s automatic, reflexive, and involuntary. Because we learned the skill, practiced it over and over again, and received ongoing and constructive feedback from our teacher, it became second nature.

To me, muscle memory is akin to deliberate repetitive practice (DRP), a process for learning and mastering psychomotor skills by progressing through three primary phases: 1) understanding the skill and learning how to perform it accurately, 2) refining the skill until it becomes more consistent, and 3) practicing the skill until it is automatic and the learner does not need to consciously think about each step. Oermann noted that, to master skills, learners need op­portunities to practice them repetitively and receive feedback to guide their per­formance. Without deliberate repetitive practice, many skills may decay or be lost altogether.

Consider just about any type of nursing skill, such as ausculating lung sounds, taking a blood pressure reading, or deescalating a client living with bipolar disorder who is experiencing a rapid cycling phase of their condition. None of these skills are mastered overnight. In fact, many need to be practiced and practiced and practiced some more. The same is true for engaging in meaningful dialogue and using effective communication skills. We don’t wake up one morning fully proficient at addressing challenging encounters. Learning and becoming communication-competent and conflict-capable take time, training, experience, practice, and feedback. And guess what—no encounter is the same, so the skills we develop and practice are a continuous work in progress and must be rehearsed until we become comfortable and composed in similar situations.

Just like muscle memory honed in the dojo and use of DRP in nursing programs, learning, practicing, and retaining skills to effectively address uncivil or disrespectful behavior are essential skill sets. One evidence-based technique used to address incivility is cognitive rehearsal (CR). Similar to DRP, CR typically consists of three parts: 1) learning and instruction, 2) rehearsing specific phrases to use during uncivil encounters, and 3) practice sessions to reinforce instruction and rehearsal.

Various frameworks are used to structure a ‘civility conversation” using CR, but, for years, I have used the TeamSTEPPS approach with my nursing students to prepare them for addressing potential uncivil interactions and, more importantly, to act as role models for civility and decorum. TeamSTEPPS is a communication system that provides a powerful evidence-based framework to improve patient safety between and among health care professionals in practice settings. The model my students prefer most is CUS. An acronym for concerned, uncomfortable, and safety, CUS is a communication structure used to assist with conflict negotiation.

When a health care professional uses CUS, it issues an alert that a patient-safety problem has been identified. For example, if a nurse encounters an uncivil experience, they may respond in the following way: “I am Concerned about the tone of this interaction. I am Uncomfortable, because the stress resulting from this exchange could impact the Safety of our patients. Please address me in a respectful way.” There are several other acceptable models for teaching and learning effective communication skills and becoming conflict-capable. However, the essential ingredient is to use a CR (or DRP) framework where skills are learned, practiced, and reinforced until responses become second nature.

Another key component is to have learners “make it their own.” In other words, we can provide a script, but it should only be used to guide the development of a learner’s own, personal response. For example, in an upcoming article by Martha Griffin, PhD, RN, CS, and me —pending publication in Journal of Continuing Education in Nursing (JCEN)— we provide scripted responses to nine common uncivil encounters that include nonverbal behaviors such as eye rolling, deep sighing, and arm crossing. For example, our suggested response to eye rolling is to politely address the individual in this way: “I sense from your facial expression that there may be something you wish to say to me. It’s OK to speak to me directly.” We offer this and other responses as starting points for practicing a retort until the words flow and become natural and spontaneous. I encourage my students to practice these and other related responses in front of a mirror until they feel prepared and ready to use them when needed.

Our pending JCEN article builds on the early work of Griffin, who used CR as a shield for lateral violence and details the use of CR as an effective intervention against incivility and bullying behaviors. We firmly believe, and remain steadfastly convinced, that CR as a strategy for addressing incivility and bully-like behaviors in nursing is a valuable tool. Being well prepared, speaking with confidence, and using respectful expressions to address incivility can empower nurses to break the silence of incivility and oppression.

So, whether you are refining your boxing skills, sharpening your auscultation ability, or polishing your communication capacity, using a framework for deliberate, repetitive practice or cognitive rehearsal is highly recommended—because it works!

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.

Landed that faculty interview? 20 questions YOU should ask!

I recently received the following message from a colleague starting a new teaching position: Today was the first day of my new faculty position at Acme College [not the real name], and it was awesome! I can tell already that it will be a great place to work, teach, and learn. Everyone is very supportive and respectful. I even have a mentor who will be working with me over the course of the next few years. My new director is amazing and has eagerly invited feedback and ideas. I feel motivated and inspired to do my best work. I feel thrilled and privileged to be a member of such a forward-thinking team.

Contrast that positive and optimistic message with this one: I will be leaving my faculty position as soon as I can. I can’t stand the pressure anymore. I am spending money I don’t have to consult a health coach to assist me in dealing with my negative work situation. The effects of a hostile workplace are taking their toll. I am having difficulty sleeping, concentrating, and focusing. I’m distracted and preoccupied with worry about my work situation and, perhaps more importantly, how the fallout might negatively impact my students and co-workers. I feel like I am running for my professional life.

The above examples are representative and vary by degree with nursing faculty around the country. What accounts for these discrepancies? Although reasons for these contrasting experiences differ—budget constraints and increasing job competition from clinical sites, to name two—in many cases, ineffective leadership is a decisive factor. For better or worse, leaders make a significant impact on the workplace by setting the environmental tone and tenor of the milieu. It is often said that people don’t leave companies; they leave managers and leaders. If this is true, leadership matters if nursing education is to successfully recruit and retain qualified faculty members who, in turn, will prepare the nurse workforce of tomorrow.

When they ask if YOU have any questions, say yes!

— Digital Vision/Thinkstock

Ethical, effective, and supportive leadership styles are essential to fostering healthy workplaces and creating engaged learning environments where everyone thrives. A supportive work environment improves mental and physical health, decreases emotional exhaustion, increases organizational commitment, lowers absenteeism, and reinforces faculty members’ intent to stay. Certainly, it is everyone’s responsibility at all levels of an organization to positively impact the work culture. Leaders, however, play a crucial role in this process by defining the future, aligning people with a compelling vision, and inspiring action to achieve sustained and long-term cultural change. The heavy lifting of leadership requires vision, effective and continual communication, willingness to engage in and successfully negotiate conflict, and openness to other points of view.

One of my foundational beliefs about workplaces is that culture trumps everything. In other words, if the workplace is unhealthy, toxic, or uncivil, it will be challenging to retain faculty members. Given the current and projected nursing faculty shortage, we cannot afford to lose even one qualified nurse educator. Low faculty salaries, an aging workforce, dissatisfaction with the educator role, pressure to acquire research funding in an era of dwindling resources, and stress from rapid and sustained change are just a few of the stressors that affect nurse educators.

We must do better. As nursing programs place a cap on admissions and, as a result, turn away large numbers of qualified applicants—some of whom might choose to become nurse educators—lack of qualified faculty will result in insufficient numbers of registered nurses to provide patient care. Unfortunately, an uncivil or toxic work environment adds to the dreary list of reasons for faculty exodus. Without question, this is avoidable. The goal for all members of the academic workplace is to reap the benefits of a healthy, respectful work environment. What are the elements of a healthy, respectful workplace?

According to the Chronicle of Higher Education, 12 key features are associated with excellent academic workplaces: collaborative governance, confidence in senior leadership, respectful supervisor or departmental chair relationships, active professional and career-development programs, healthy teaching environments, clarity regarding tenure and promotion processes, fair compensation and benefits, job satisfaction, respect and appreciation, diversity, workplace security, and an emphasis on work-life balance. These features are consistent with the six standards identified by the American Association of Critical-Care Nurses for establishing and sustaining healthy work environments: skilled communication, true collaboration, effective decision-making, appropriate staffing, meaningful recognition, and authentic leadership.

I suggest the addition of three related elements: 1) establishing and living a shared statement of organizational vision, values, and team norms, 2) creating and sustaining a high level of civility, and 3) emphasizing leadership, both formal and informal, throughout all levels of the organization. At a time of unprecedented change and technological and cultural transformation, academic institutions are increasingly being called upon to create cultures of collegiality, collaboration, and civility.

It is vital, therefore, to ask timely, relevant, and important questions about the workplace culture. I contend that employment decisions should not be made lightly because a nurse educator spends an average of 50 hours or more per week fulfilling faculty responsibilities. Moreover, it is concerning that very few faculty members ask key questions about their prospective employment.

For example, over the course of my academic career, while serving as a member of interview teams charged with hiring new and potential faculty members, I have been amazed that applicants, when asked if they have questions, often say no. To me, this is an incredibly lost opportunity. Remember, you—the interviewee—are interviewing the organization as much as the organization is interviewing you. So, be sure to come to interviews equipped with essential questions that help lead to informed decision-making about whether or not to accept a faculty position.

To get you started, here are 20 questions to consider asking when applying for a faculty position. (To evaluate your current workplace, you may also want to ask these questions of yourself.) Each question calls for an explanation, so, for each one, be sure to ask the person or persons interviewing you to provide an example or two.

1. How does your school live out its organizational vision, mission, shared values, and norms?
2. How would you describe the level of trust between leaders and those they are assigned to lead?
3. How do faculty members, staff members, and students describe the culture and character of your school?
4. What policies has your school established to address incivility and promote civility?
5. What values are fundamental and important to the school? How are they expressed?
6. What are the best features of working at this school? How are they being celebrated? What are some of the most common complaints? How are they being addressed?
7. How are the school’s organizational culture and faculty satisfaction assessed? Are they assessed on a regular basis? Where might I find the assessment results and measures taken to improve the workplace culture?
8. How would you describe faculty and student engagement and overall morale?
9. What are the school's vision and strategic goals for the future? How do faculty members participate in these initiatives?
10. Describe the leader’s leadership style and specific attributes. How does his or her leadership style and attributes influence the workplace culture?
11. Tell me how faculty contributions are recognized and rewarded.
12. Describe how faculty members—and others in your organization—know what is expected of them and how people are held accountable for results.
13. Describe how new faculty members are mentored upon hire and throughout their tenure.
14. What is your process for shared governance and participative decision-making?
15. Tell me about the school’s strategic approach to developing and sustaining a healthy workplace.
16. How is faculty performance assessed? What resources are available for faculty support and development?
17. Would you recommend this organization to your best friend or a family member as a good place to work?
18. On a scale from 1 to 10—10 being the most fantastic, amazing, and inspiring workplace—what score would the collective faculty assign to this school?
19. If this organization could be summed up in one or two words, what would they be?
20. All things considered, is this is a great place to work?

If you believe, as I do, that culture trumps everything, take a proactive approach and be ready to ask some key questions that will help you make a well-informed and responsible decision about your next faculty position. By doing so, you will be sending messages to colleagues much like the one I received and quoted at the top of this post.

If you are currently in a position where answers to these questions fail to measure up to your desired expectations, perhaps it is time to be an agent for change in your organization or to carefully consider your next move. Either way, take care of yourself. The profession needs you and can’t afford to lose you!

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.

Planting seeds of kindness

It’s a stunningly gorgeous morning in the high desert of Boise, Idaho, USA. I just returned from an early morning hike with three of our energetic and high-spirited rescue dogs. They run with abandon and enthusiasm to greet the morning, leaping with the utter joy of being alive! I share their exuberance as I listen to the meadowlarks fill the morning air with their catchy and melodious song.

When we arrive at the top of the knoll where we turn to go home, we pause for many moments to take in the panoramic view of mountain ranges that encircle our home. None of the mountains bears even a remnant of the snows that fell and blanketed them earlier this spring. Instead, they stand bare and tall against the blue sky, beckoning elk and other wild critters that inhabit the region, as well as hikers.

The view from our front yard.

When we return from our hike, I attend to the usual morning chores before starting a day of writing, tending the garden, looking after pets, and watering flowers. There’s a particular little flower patch that I planted shortly after last month’s commencement. I dug the patch myself. I could’ve asked my husband to assist me, but digging the small plot was a chore I relished and wanted to do. So one day, I tilled the soil, enriched it with nutrients, and lovingly planted seeds given to me by one of my nursing students. The package of seeds was tucked inside a lovely card in which she thanked me for inspiring her. It included this entry: “Dear Dr. Clark, plant these seeds and watch them bloom, as so many students have bloomed under your guidance.”

I was deeply touched by the sentiment. Today, as seedlings poke through the earth and reach for the sky, I am humbled by the influence we have on the lives of our students. As faculty members, we are and always will be one of their most formidable and influential role models. Therefore, we must always be cognizant of the way we speak and act. The importance of modeling the way cannot be overestimated. Students are watching our every move. It’s a daunting thought, as well as a wonderful opportunity.

"Dear Dr. Clark, plant these seeds and watch them bloom ..." 

— SachmaDeluxe/iStock/Thinkstock

As nurse educators around the globe, we have an important responsibility to prepare and mobilize our nations’ nursing workforces. This is no easy task, and we must not take our students’ professional role development lightly. One of the most important nursing roles is that of a “civilist."

What is a civilist, you may ask? Contending that being civil takes self-discipline, practice, and commitment, Kenneth Maxey (2011) coined the term civilist (p. 10) to describe the attributes and habits of a civil person. I couldn’t agree more! It is incumbent upon nurse educators and academic nurse leaders to intentionally grow the next generation of civilists—nurses well-prepared to create positive change and promote a safe, healthy workplace.

While it is important to establish civility as an organizing value in any organization, it is equally important for each individual to self-reflect and take an accurate inventory of one’s own behavior. Each of us needs to evaluate our interactions and display behaviors that support the dignity of others. It is tempting to return incivility for incivility, to respond in a ‘tit for tat’ manner. Instead, we must be prepared and practiced in the art of addressing uncivil behavior. For example, a demeaning comment or sarcastic remark could be responded to in this way: “I learn best from individuals who address me with respect and value me as a member of the team. Is there a way we can structure this type of interaction?”

I realize that creating a totally civil society is a utopian ideal. Yet, devoting time and attention to being a civilist can make a significant difference. Crafting a personal civility credo, along with developing—and living out—a list of life principles and daily habits, is a good starting point. For instance, my personal civility credo is “to lead the coalition for change by raising awareness, amplifying the civility conversation, and inspiring civil action.” Some of my life principles include living with purpose and meaning, leading an examined life, assuming goodwill, and nurturing my body, mind, and spirit. These life principles are made operational by practicing daily habits, such as smiling and greeting others by name, expressing and living in gratitude, and striving to make a positive difference in the lives of others.

I encourage you to take the time to consider principles and daily habits that shape your life. Writing a personal life statement provides clarity and insight, and helps strengthen your commitment. Putting pen to paper or keyboarding your ideas into a thoughtfully composed statement helps solidify your plan. Share the plan with a family member, friend, or trusted colleague, if you wish. When we share ourselves with others, it strengthens our commitment and resolve.

So, go forth, plant seeds of civility and kindness, and watch them bloom!

Reference:

Maxey, K. (2011). Civil business: Civil practice in Corporations and society. Denver, CO: Colorado Writing Services.

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.

Savor those Golden Moments!

A couple weeks ago, we celebrated our senior nursing students at Boise State University with a lovely and memorable pinning ceremony. I had the special and distinct honor of delivering the keynote address to the graduating senior class and their assembled family and friends. In honor of nursing graduates across the globe, I’d like to share excerpts from my speech.

It began like this: “Good evening family, friends, faculty, staff, and distinguished guests—and, to our newly graduated and esteemed colleagues, welcome to the profession!

“What a wonderful, incredible time for the profession of nursing. Virtual medicine, genetic engineering, informatics, telemedicine, genomics, and other scientific and technological advances in health care are strands in the fabric of our daily working lives. Unquestionably, science combined with empirical evidence gained through careful research provide the gold standard for safe, quality, patient-centered care. However, seeking and discovering the delicate balance between the science and the art of nursing—and appreciating both—form the basis for professional practice. One without the other is an incomplete application of our craft. I’d like to illustrate this point with a lesson from my own nursing practice.

Stuff of nightmares
“As many of you know, before I started teaching at Boise State, I worked for more than a dozen years as a psychiatric nurse. I was a member of a crew of mental health workers who treated adolescents suffering from a variety of conditions and disorders. Many of our patients were violent, adjudicated youth with long histories of severe substance abuse and criminal activity. Others had been abandoned, rejected, and abused—often forgotten and left to fend for themselves. And the offenses some had committed were so grave they were the “stuff” of which nightmares are made. Our work was challenging and often tested our resolve. But, through it all, the team members had each other. We were young, determined, and unshakable in our belief that we could make a difference.

“I remember clearly one notable event. After a particularly challenging day, we were definitely looking forward to going home, but Dr. M, the psychiatrist on our team, suggested we meet for a few minutes before leaving. Dr. M is a brilliant, gifted physician. She is also a child of Austrian immigrants who survived the horrors of internment in a Nazi Germany concentration camp. Her life experiences and sharply honed psychiatric skills helped us become better clinicians and, I believe, better people.

Golden Moment
“As we gathered for a meeting none of us really wanted to attend, we had no idea the spontaneously called encounter would be a game changer. After we had assembled, Dr. M looked around the room at each of us and then said, “This is our Golden Moment.” To clarify, she added, ‘This unique intersection of our lives, this amazing coming together, is a gift to be cherished. It is not a single moment, or even a single day. Instead, our Golden Moment is an accumulation of the days, months, and years we have worked, sweated together, and supported one another to make a difference in the lives of the kids entrusted to our care.’

Savor those Golden Moments. 

Photo: Lorenzo Rossi/Hemera/Thinkstock

“A Golden Moment is the expressed joy and satisfaction of being part of a team engaged in very difficult but rewarding work. I remember a very personal lesson I learned from Dr. M. We were co-therapists for an adolescent group-therapy session that met twice a week. The kids in our group were members of a special ‘club,’ if you will. Teens who lived life on the edges of polite society, many had made their living on the streets, marketing drugs and selling themselves for shelter, food, and any number of reasons. One day, an adolescent I’ll call Ty began to share with the group his story, one of prolonged abuse and neglect. Often beaten, he would be locked in a closet for days at a time, without food or water, with only a bucket for relief.

“As he told his sad tale, I found myself deeply affected and unable to hold back the tears that stung the corners of my eyes. I had been schooled in the fine art of not showing emotion. I was embarrassed by my vulnerability because, according to theory, showing emotion was nontherapeutic and could be potentially harmful to the often-fragile, patient-nurse relationship. When the session was over, Dr. M met with me—she could see my embarrassment—and said, ‘Never, ever, be ashamed of feeling your feelings. Much of what you are learning, and so much of what I still have to teach you, cannot be learned in a textbook. Being present and ‘real’ and connecting with patients on a deeply personal and human level is often the most effective tool in our toolbox.’

“Our Golden Moment together spanned years, and it taught me lessons that have shaped and continue to shape my worldview and interactions with others. These lessons include: 1) Each person shall be afforded human dignity and treated with common decency. 2) There, but for the grace of the divine, go I. And 3), ultimately, it’s the three R’s that matter most in life—relationships, relationships, and relationships.

Use all of self
“The moral of the story is: Embrace the importance of the use of “self” in the art and practice of nursing—and use every part of your self to promote health, alleviate suffering, and prevent illness.

“Using all of self involves using our nimble and capable feet to walk in the shoes of others, understand their paths, and appreciate their journeys without bias and prejudice. It means using our strong backs and shoulders to lift up and advocate for the less fortunate, the vulnerable, and the underserved. It means using our sturdy arms to embrace those who need us most—the homeless, the mentally ill, and the neglected. It means using our skilled and gifted hands to examine, massage, palpate, and touch the lives of the newly born, the children, the aging, and the dying.

“We need to use our bright minds to critically think about and consider the holistic aspects of the human condition—that special quality that sets nursing practice apart and makes our profession unique from other health care disciplines.

“We must open our hearts and be compassionate; live by the principles of non-malfeasance, social justice, and caring. And, perhaps, most of all, we must share our human spirit and cultivate hope where hope sometimes seems impossible.

“Like technology and machines that require proper maintenance, so too, must we take excellent care of ourselves. We must find time to restore, relax, and be contemplative—to enjoy quiet moments and be with the people we love and those who love us back. So, be good to yourselves as you provide for others. While we belong to a noble profession, it is also a very demanding one.

Positioned to lead
“This graduating class is well-positioned to lead the way and advance our nation’s health. Your steadfast and resolute commitment to just causes, your keen and collective intelligence, and your deep allegiance to being fearless on the side of right will take you far and set you apart from the ordinary and the mundane, if you speak with voices of measured reason and mutual respect.

“But remember, in this fast-paced, moving world, we almost never accomplish anything worthwhile solely on our own. Witness the people in this room tonight and others who have helped you along your nursing education pathway, those who have been by your side every step of the way on your journey toward even greater accomplishments and achieving your own Golden Moments. Your family, friends, neighbors, loved ones—and yes, even your faculty—have joined you on this journey, and we are all very, very proud of you.

“So, appreciate and cherish the gifts you’ve been given, and never waste them. Use them to make a difference in the lives of those in your care today and in the years to come. Never waiver in fulfilling obligations to your patients and their families. Be an advocate for a more humane and just society. Champion a world of caring and compassion; show up, make a difference, and pledge commitment to service. Be reflective and thoughtful when making decisions. You are the promise of our profession, and, tonight, we pass the torch to you, our graduates, for you are well-positioned and well-prepared to boldly and confidently lead our profession into the next generation of nursing excellence.

“So, as an uncertain world rushes on, savor those rare and quiet moments. Be gentle with yourselves as you provide care to others. You have all worked very, very hard, but, in some ways, your work has barely begun. You are clearly up to the challenge, and we honor you as you continue on your path to nursing excellence—both as scientist and artist.

“I’d like to close by reciting a few selected lines of prudent wisdom from Oh, the Places You’ll Go!, written by Dr. Seuss one year before his death at the age of 87.”

     Congratulations!

     Today is your day. You’re off to Great Places.

     You’re off and away!

     You have brains in your head.

     You have feet in your shoes.

     You can steer yourself any direction you choose!

     Oh, the places you’ll go! There is fun to be done.

     There are points to be scored.

     There are games to be won!

     And the magical things you can do with that ball,

     Will make you the winningest winner of all!

     Oh, the places you’ll go!

“So, colleagues, enjoy the ride. On behalf of all of us gathered with you tonight, congratulations on a job well done, stay in touch, and thanks for the memories.”

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.

Surviving and thriving in a stressful workplace

As I travel about the country, I am often asked about strategies to persevere in a less-than-ideal workplace and, in some cases, survive a toxic work environment. Some individuals, compelled to stay in a workplace that lacks civility and esprit de corps, report feeling “stuck.” Others describe being place-bound—either by choice or circumstance—for a variety of reasons. Some, close to retirement, want to finish out their tenure with benefits intact. Others, with small children, are reluctant to make moves that require a change of school or neighborhood. Still others may be place-bound because of a spouse’s employment; and then there are those who love where they live and have no desire to relocate.

Reasons for staying in a less-than-desirable situation vary, and, if you find yourself in that position, you need to consider strategies that will help you cope—maybe even thrive. My most important piece of advice is to be a change agent, and take a leadership role in transforming the culture of your organization. I refer you to Chapter 11 of my book Creating & Sustaining Civility in Nursing Education for a comprehensive, evidence-based pathway to foster organizational change.

When you can't stop the world and get off, hang on for dear life and enjoy the ride! Yours Truly on a zip line in Costa Rica.

If you have made efforts to transform your workplace, and your attempts have failed or fallen short, you may be looking for ways to survive a stressful work environment. The following strategies are based on the assumption that your efforts have produced minimal or marginal results. So, if you are working in a situation that is undesirable but you are unwilling to leave, perhaps for one of the reasons mentioned above, consider these strategies:

1. Live your best life! Enjoy your personal life, and surround yourself with people you love and those who love you back. Develop a circle of support with colleagues and friends to share ideas and ways to bring joy to your workplace. Connect, encourage one another, and spend quality time engaged in positive activities.

2. Expand your professional network outside your workplace. Volunteer for exciting projects, new initiatives, or assignments associated with professional organizations. Associate with people who respect you and build your confidence. Join a “think tank,” and be part of something bigger than yourself.

3. Post positive quotes and inspirational messages around your workspace. Use them to inspire and remind you of family and friends who think you’re a rock star!

4. Always do your best. Stay professional, and behave civilly and with integrity. Despite how you might be treated, always take the high road. Imagine that your interactions are being filmed and may be uploaded on YouTube later that day. How do you want to appear in your video? With poise and aplomb? Or showing disrespectful exchanges and making negative comments?

5. Do small deeds of kindness. There will always be some people we get along with better than others but, in the long run, showing kindness can go a long way toward keeping work relationships civil. Just taking the time to thank someone and acknowledge their work can improve morale. Acknowledge your colleagues’ achievements and contributions.

6. Avoid “water-cooler gossip.” Have a verbal strategy at the ready when gossip occurs. For example, if someone is gossiping about Sam, another colleague, you might say, “That’s not my experience with Sam; perhaps this information was taken out of context. I suggest you talk directly with Sam.”

7. Take good care of yourself. Make your physical and mental health a priority. Exercise, enjoy the outdoors, dance, read, hang out with your pets, or start a new hobby. Take breaks during your workday; go for a walk, stretch and deep breathe, or find another work venue. Perhaps there is a coffee shop nearby where you can set up your laptop and work while enjoying your favorite beverage and snack. Better yet, consider working from home at least one day per week.

8. Maintain a healthy distance from colleagues who bring you down. Consider communicating by telephone or email. Perhaps you can meet by conference call or through an online meeting site. At the same time, hang on tight to your principles, core values, and keep doing the daily habits that amplify their meaning.

9. Employ technology to assist you. To help good practices become habit, use an app to set reminders to get up, take a short walk, talk to coworkers—and breathe.

10. Keep a gratitude journal. Focusing on gratitude and appreciation for the people and things around us decreases stress and puts life into perspective. Devote a few minutes each day to reflect on the blessings in your life. Jot down your thoughts in a journal; if you wish, share them with a trusted friend or family member. Expressing gratitude may be one of the most effective strategies there is for achieving and maintaining emotional health and leading a contented life.

11. Talk with someone. When stress or worries start to build, talk with a trusted friend or counseling professional. You may also consider speaking with a representative of your employee assistance program. If you perceive your situation as serious, you may also wish to consult with a representative of the human resources department in your organization.

12. Be strategic. If you are considering leaving the organization, make a plan and don’t act irrationally—or too soon. Communicate your plan to one or more trusted mentors. Share it with your family or friends, and vet your plan using a decision-making model.

While we may be deeply passionate about our work and professional life—I certainly am—it's important that we always remember that work is what we do; it does not completely define our personhood and who we are. I am buoyed by the words of an amazing mentor who reminded me and the rest of our mental-health crew that, ultimately, it’s the 3Rs in life that really matter: relationships, relationships, relationships. Words to live by. Now, go out and live your best life!

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

The power and promise of storytelling

Once upon a time, there was a college professor who loved stories. She loved listening to them; retelling them; creating, writing, and sharing them. As a young child, riveted by some of the world’s best storytellers (her family and friends), she quickly learned that a powerful, absorbing story can mobilize action, influence thinking, stir emotions, and sometimes move us to tears. And that every now and then, a gripping story can teach us lessons that change our lives. That college professor is me! I grew up witnessing and embracing the magical power of a compelling story.

Stories not only illuminate a topic, but tell us something about the storyteller, too. Telling a simple, powerful, relevant story breathes life and relevance into even the most uninteresting topics. Stories help make the forgettable and unexciting memorable and significant. The ancient art of storytelling grabs us and refuses to let go. The lessons learned and the morals taught provide fodder for reflection, self-discovery, and inspiration.

Devonyu/iStock/Thinkstock

When we share our stories, we provide context for understanding and sorting out our experiences. Here’s a story that was recently passed along to me by a recently graduated nurse. [I’ll call her Holly, not her real name]. Holly was 23 years old when she had her first month of orientation on an oncology unit and was inexperienced in end-of-life care. Here’s her story.

During my nursing education, I had never experienced the death of a patient. As a brand-new nurse, that changed dramatically. It didn't take long for me to realize that death on an oncology unit is a common occurrence.

I struggled to deal with the range of emotions that quickly became part of my day-to-day working life. One extremely busy night, several very ill patients required complex procedures while they and their families also needed emotional and spiritual comfort and support. Learning my new role while simultaneously administering holistic care to clearly compromised patients, I felt torn in so many directions. I struggled to do my best, and, since every member of the health care team was stretched to the max, was determined to function as independently as possible.

One of my patients, Mr. Brown (not his real name), was in especially critical condition and had a DNR/DNI order. I had been checking him constantly throughout the night and, during a final round, found him surrounded by family and taking his last breath. After checking Mr. Brown’s heart rate and confirming he was deceased, I reported his passing to the physician, who then came and pronounced him dead.

Since Mr. Brown was my patient, it was my responsibility to provide postmortem care. After giving the family time at the bedside, I found myself alone in the room with the deceased and quickly realized I had no idea what to do. I had not been introduced to this type of care during my nursing program, nor had I received postmortem training during orientation. Despite the busyness of the night, I knew I needed help. I explained the situation to my charge nurse, who was immediately supportive and guided me gently through the process. Being a new nurse can be challenging, but knowing when to ask for help and having a collegial and responsive team make all the difference in the world.

Sharing our stories with others helps us deconstruct and interpret new experiences. Stories help us organize our thoughts, make sense of events, and assist us in making decisions and determining courses of action.

What do we learn from Holly’s story? First, reach out to others, and don't be afraid to ask for help. Ultimately, our patients’ safety and care depend on it. Second, the impact of a traumatic experience is eased when we share our thoughts and feelings with trusted and more experienced colleagues. Third, seasoned nurses have the capacity to model caring and supportive behaviors for less experienced colleagues. By serving as a positive role model and sharing knowledge, experience, and wisdom, experienced nurses guide the professional development of those with less experience. Positive role models are generous, competent, and focused on collegiality and collaboration. Nurses at all levels of experience need to encourage initiative and curiosity, foster desire to learn, and promote willingness to seek guidance.

Storytelling is an incredibly powerful tool for opening the nooks and crannies of our minds and makes room for fresh ideas and points of view to take up residence. Stories have the potential to ignite our senses and fill our grey matter with creative ideas and new ways of knowing. So, boldly share your stories and experiences with others, and use those stories as catalysts to create personal, professional, and transformational change. The results might just change the world.

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.