Healthy work environments change—and save—lives!

I was recently traveling home to Boise, Idaho [USA], on a long flight from Florida. Throughout the trip, the flight attendants kept us entertained with their witty retorts and humorous comments. After we landed, one of them issued the usual “Welcome to Boise” and then said: “If you are in a negative relationship or working at a job you don’t enjoy, remember, life’s too short, so it may be time for a change. Take it from me, a 20-something who clearly understands the way the world works and has the infinite wisdom to advise you on these important matters.”

The comment was intended to elicit a chuckle, and I found myself grinning along with most of the other passengers. But later, as I reflected upon his remark, I realized I often meet people who don’t like what they are doing for a living. In fact, many express deep displeasure with their current work conditions, often disclosing that they can hardly wait for retirement or a new experience. Many say they are keeping their heads down, flying under the radar, doing the least amount possible, or waiting for the next best thing to come along. This, clearly, is a sad state of affairs.

I am blessed!

 This past summer, Molly Clark, BSN, RN, was
promoted to the rank of lieutenant, U.S. Navy Nurse
Corps, while serving at Guantánamo Bay, Cuba. 

I count myself among those truly fortunate individuals who genuinely enjoy their work. I’m convinced I have one of the best jobs in the world. My work as a strategic nursing adviser and consultant takes me to schools and practice settings across the country. I am blessed to meet faculty members, practice-based nurses, and other healthcare professionals, as well as students, in just about every nook and cranny of the United States. Meeting people and listening to their stories energizes me and reminds me that my work is not only important, but I am making a difference.

This was recently pointed out to me by our daughter, Molly, a lieutenant in the U.S. Navy Nurse Corps stationed in Guantánamo Bay, Cuba. [Lt. Molly Clark, BSN, RN, is the author of a 2014 RNL article in which she describes what she learned in her first job after nursing school.] Prior to her deployment to Cuba, she sailed on the USNS Comfort as part of a healthcare team on a humanitarian mission. I was praising her for the awesome work she and her team accomplish every day and how they are saving and changing lives around the world. She was pensive for a moment and then said, “Yes, the work we do is important, but your work is important, too. You’re also changing lives, only in a different way.”

I was a bit taken aback at first, then realized that perhaps she was right. When people make changes to their work environments by transforming the culture and dedicating themselves to deliver safe patient care, it’s pretty amazing. My work matters, and I am deeply affected by the people I meet on my travels.

All hands on deck: Negative work environment!

I recently facilitated, for a group of nurse executives and managers, a workshop on evidence-based strategies to foster positive, healthy work environments. Toward the end of the day, a nurse manager of a busy ED stood to address the group. She said she had been frustrated with unsupportive people who contributed to a negative work environment where teamwork and relationships were second-rate, and, as a consequence, patient care had suffered. As the leader of her department, she decided to do something about it.

She began the process by supervising—individually and deliberately—each offending nurse. Over the course of a 12-month period, 11 nurses were removed from their positions and asked to leave the organization. One by one, she replaced each negative worker with a carefully vetted nurse committed to teamwork, collegiality, and collaboration as part of a high performing team dedicated to delivering the best and safest patient care possible. Life today in that ED, she enthused, is extraordinary! While the work continues to be challenging and demanding, every day is now an energizing experience as the team works together in a highly functional, united, and mutually satisfying way.

Talk about a civility champion! Her bold declaration motivated others in the room to agree that now is the time to lead a coalition for change and mobilize teams to create and sustain healthy, positive work environments where civility flourishes and where workers band together to fulfill a collective and unequivocal commitment to safe patient care.

Wanted: More civility champions!

Road to civility

This dedication to civility—and ultimately patient care—requires principled, ethical, and authentic leadership, as well as unambiguous adherence to nursing’s responsibility to fulfill the obligations set forth in our code of ethics and other professional statements. To hold employees accountable, managers must first establish clear, specific expectations for acceptable work performance and desired behaviors. Next, managers need to discuss each employee’s commitment to fulfilling those expectations and secure his or her assurance that achievement of the desired behaviors will be supported.

It is imperative for managers to provide necessary resources for each employee to meet work-performance expectations and offer ongoing feedback regarding employee performance. Setting clear expectations coupled with quality feedback are hallmarks of holding someone accountable. Although providing constructive feedback about areas of strength and improvement isn’t foolproof, it opens the door for problem-solving and follow-up action. In many cases, giving objective, sincere feedback while expressing desire to support the employee are sufficient to change behavior. When employees meet work-performance expectations, their actions should be rewarded and celebrated.

If employees do not meet performance goals, they require additional education and training. If it is a motivation problem or refusal to comply with a performance-improvement plan, imposing a fair and appropriate consequence might be in order. This should not be viewed as a punitive measure, but an approach to encourage employees to take commitments seriously and focus on delivering safe patient care.

Remember: While managers play an important role in fostering healthy work environments, it is ultimately every one’s responsibility to model the way and be civility champions!

Editor’s note: Cindy Clark will be presenting at the Creating Healthy Work Environments conference, slated for 17-19 March 2017 at the JW Marriott in Indianapolis, Indiana, USA. The theme of the conference is “Building a Healthy Workplace: Best Practices in Clinical and Academic Settings,” and Clark’s Plenary 1 presentation is titled “Creating Healthy Work Environments: Powered by Civility, Leadership, and Ethical Practice.” The early registration deadline is 25 January. To learn more and to register.

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.

Be humble and kind

Recently, I experienced a lengthy airport delay; it would be at least an 8-hour wait for my flight home to Boise, Idaho. So, I decided to grab some lunch in an airport restaurant and finish a bit of work. I was seated near the receptionist who was engaged in conversation with my waiter. I tried not to eavesdrop, but couldn’t help overhearing their exchange.

The waiter was lamenting the lack of gratuity he received from a party of eight patrons who had required a good deal of his time and attention. He had worked very hard to make their experience a positive one, given the busyness of the airport and their rush to catch a flight, but the gratuity they gave him was only about 5 percent of the bill. Then he added, “And to top it all off, my relief is late again. He is consistently 40 minutes late for his shift. It typically wouldn’t bother me, but I have another job to get to, and when he’s late I begin to get very nervous. I need both jobs to take care of my family.”

When the receptionist suggested that the waiter share his concerns with the manager, he responded: “No way, I can’t lose this job! I just need to deal with it.” At that point, the receptionist observed: “You know what, I’ve worked here a long time and I have a very good relationship with the manager. How about I mention it to him? I won’t let him know that the matter came from you.” Showing obvious relief, the waiter responded, “How very kind of you. That would be great. Thank you.” Given his unhappy experience with the previous guests, I made sure to leave a sizable tip.

A simple act of kindness
That simple act of kindness from the receptionist touched me. I hope that reaching out and offering a thoughtful gesture or act of kindness will never go out of style. Yet, so often, we fail to pause and acknowledge others amidst the hectic, fast-paced flurry of our lives.

Listen to this YouTube video of Tim McGraw singing “Humble and kind.” and really pay attention to the lyrics and images. He reminds us, “Hold the door, say please, say thank you. Don’t steal, don’t cheat, and don’t lie. … When you get where you’re goin’, don’t forget, turn back around, help the next one in line. Always stay humble and kind.” Tim’s goal is to spread the message of kindness and inspire others to do the same.

The Clarks on graduation day.

Make it a habit and a lifestyle
Last month, our youngest daughter graduated from the University of Idaho with her undergraduate degree. Brigadier General Erik C. Peterson, a highly decorated and distinguished commander of the U.S. Army Special Operations Aviation Command, delivered the commencement address. His military awards and decorations are many and impressive, and he, too, is a graduate of the University of Idaho. As a parent of one of the graduates, I found Gen. Peterson’s speech compelling, passionate, powerful, and deeply relevant to the ideals of service, advocacy, and civility. He challenged us to share our skills, talents, energy, and gifts to benefit others and contribute to the common good. He suggested we make service a habit and a lifestyle, not just a single act, and he strongly encouraged us to “endeavor to be kind.”

Quoting Albert Schweitzer, he stated, “Constant kindness can accomplish much. As the sun makes ice melt, kindness causes misunderstanding, mistrust, and hostility to evaporate.” He further noted that, along his 30-year military journey, he has witnessed firsthand the very best and the very worst of humanity. He observed: “Nothing has had a more profound, sustained, positive impact on me than the occasional, conspicuous act of kindness of my fellow man, and the simple pleasure and reward of being able to extend the same. Kindness and civility with its inherent power are all too often overlooked. … Simple acts of kindness not only serve to counter the burdens and travails of the recipient, but are also known to improve the well-being of the giver. The impact of a [genuine act of kindness] can be profound, lasting, and positively viral.”

Pups in a truck. Four of our eight rescue pets.

This powerful, passionate, and brilliant speech touched me deeply. It was a rally cry to continue the path I am on—to be an avid advocate for civility, respect, and yes, kindness. And not only that, but to raise awareness and challenge myself and others to become “Civility Champions” dedicated to improving the lives of individuals, teams, organizations, and yes, maybe even society.

dtimiraos/iStock

Kindness is a choice
Mary Wortley Montagu reminds us, “Civility costs nothing, and buys everything.” Think about ways you touch the lives of others. Perhaps you have rescued a pet, or, as in our family’s case, multiple pets. Maybe you hold the elevator for someone dashing to catch it, or pack an extra lunch for your child to share with a less fortunate friend or classmate. Maybe when others are gossiping about someone else, you are the first to jump in and speak well of that individual. Perhaps you’ve sent a letter to a relative or former teacher letting them know the positive impact they’ve had on your life.

Compliment others. Smile and greet them. At the bank or grocery store, offer your place in line to someone with fewer items or who seems to be in a hurry—or do it just because. If you see litter, pick it up and throw it away. Bring your partner coffee in bed. Include others in conversation, especially those who tend to be shy or quiet. At the Starbucks drive-thru, pay for the order of the person behind you.

These are just a few ideas. I’m sure many of you have countless ways to say thank you or extend a kind gesture to another. As Gen. Peterson and Tim McGraw remind us, endeavor to be humble and kind. It really can make a difference in the lives of others. Maybe even our own.

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.

When people behave badly: How to recover if you're the target

For well over a decade, I have studied and contributed to the body of science on fostering civility, and creating and sustaining healthy workplaces. The utter cruelty of certain individuals never ceases to amaze me. Fortunately, the vast majority of people are respectful and civil. Yet, sadly, others treat people with disdain and contempt. I am often asked what motivates people to behave badly. It’s not a simple question to answer. Although there are reasons behind negative and harmful acts, some of which make sense, others simply fail to explain disrespectful human interaction.

For example, do you consider yourself a reasonably respectful or civil person? Most of us would say yes. If this is true for you, here’s another question: Have you ever been rude or disrespectful to someone? If you are like every other human being, the answer to the second question is also yes. So then the question becomes, why would an otherwise civil or respectful person behave rudely or badly?

Stressed out

Very often, the answer is, “Because I’m stressed out.” I agree; heightened levels of stress brought on by any number of life’s demands often account for much incivility. Stress may be caused by the challenges of managing the myriad roles and responsibilities associated with family, work, and life in general. Being overworked, underpaid, and sometimes unappreciated also may contribute to increased stress. While not acceptable, responding rudely in highly stressful situations is more easily understood than other forms of incivility.

–  People Images

In the workplace, incivility can add tension to an already highly stressed environment, and its potential impact cannot be overestimated. Being treated badly or in an uncivil manner, particularly over time, can have devastating results. In a practice-based discipline, such as nursing, this is especially troubling, because incivility can weaken confidence and moral courage, impair clinical judgment and reasoning, create vulnerability and self-doubt, and cause anxiety, resentment, and anger. Ultimately, it can negatively impact patient care.

Stress is not the only contributor to incivility. I’m reminded of a story told to me by a nursing instructor in her mid-50s. She was so excited because she had finally, after much soul-searching and research, decided to pursue a doctoral degree. She could hardly wait to share her excitement and ideas with her program director. When she had an opportunity to meet with the director and disclose her scholarly intentions, the director laughed and said: ‘‘Are you kidding, at your age? You can’t be serious. By the time you finish your degree, you’ll be ready to retire. We prefer to invest in younger faculty.”

The exchange left the instructor feeling demoralized and diminished, and she decided to forgo pursuing the doctoral degree. Whether the director’s comments were intentionally or unintentionally delivered, the result was the same. A talented and energetic faculty member was left to feel devalued and unimportant.

Rank rankism

This example illustrates the negative impact that low emotional intelligence, ineffective communication skills, and an attitude of superiority—a sense of power over—can have. The instructor in this story is the target of rankism, a term coined by Robert W. Fuller, PhD, former president of Oberlin University. In his book, Somebodies and Nobodies: Overcoming the Abuse of Rank, Fuller tells us that "rankism" lies at the heart of discriminatory behavior, is evident in nearly every institution in society, and occurs when people abuse their power to demean and disadvantage those they outrank.

Intended or not, disrespectful and rude behavior toward others may indicate prejudice and rise to the level of discrimination—in some cases, outright abuse. The antidote to rankism is to foster work environments based on human dignity for all. It is abuse of power and rank—not power and rank per se—that damages relationships and puts people at a disadvantage.

Those who are targets of rankism and other forms of incivility often describe their experiences in vividly emotional ways. Many are still negatively impacted by their uncivil experiences, even when the encounters occurred years before. Some people describe intense psychological symptoms, such as feeling traumatized, helpless, and powerless. Many feel caught in a no-win situation, with little possibility of successful resolution. The lingering effects of incivility can cause serious and sometimes lasting psychological and physiological effects.

Although each of us deserves to be treated with dignity and respect, people report varying degrees of discomfort when addressing conflict and incivility. For further discussion of this topic, read my two-part series on conflict negotiation.

If you have been the target of repeated incivility or bullying, attending to your physical, emotional, and spiritual health is a critical first step. It may be necessary to see your healthcare provider or seek counsel from a mental health expert. Getting yourself physically and emotionally prepared to deal with the problem will require you to be in a healthy state. When reporting a problem, it’s important to follow confidential policies, procedures, and guidelines (assuming they exist). In any case, inform your employer or supervisor about the problem, and request institutional support. Be sure that human resource and employee-assistance program personnel have your best interest in mind and are poised to assist you in following healthy workplace policies and procedures.

10 tips for recovery

For anyone who experiences incivility, either inside or outside the workplace, it is imperative to reverse the negative effects it can have on his or her physical, emotional, and spiritual well-being. If you have been the target of bad behavior, here are 10 tips for successful recovery.

1. Share your story with a good friend, family member, mentor, counselor, or member of the clergy. Avoid sharing your experience with co-workers. Instead, seek support from those who can offer a more objective perspective, such as an ombudsperson, conflict negotiator, or civility coach. Relating the experience and sharing it with others can provide healing. However, avoid dwelling on it too long. Tell your story, validate that it occurred, and make a plan to move forward.

2. Journal about your experience. For many people, writing their story and reflecting on it can be therapeutic and may help provide insight.

3. Engage in activities you enjoy, and don’t retreat from relationships that matter to you. Continue to make time for exercise, friends, family, pets, and social activities.

4. Enjoy a massage, meditation, yoga, deep breathing exercises, and other relaxation techniques.

5. Get plenty of sleep, stay hydrated, and eat a well-balanced diet.

6. Get (or stay) involved by helping a friend, neighbor, or co-worker. Volunteer in the community, or champion one of your favorite causes.

7. Focus on building resiliency. No one size fits all, so find the plan that works for you. Surround yourself with positive people and with those who bring you joy.

8. Try to find meaning in stressful or traumatic events and experiences, and incorporate this meaning into moving forward.

9. Recognize what makes you uniquely strong, and own it! Don’t let others define you. Memorize and practice reciting a positive script, such as: “I am poised, balanced, and in control of my life. I am talented, courageous, and confident in my ability to succeed.”

10. Remember, symptoms of distress can last from a few days to many months, and recovery takes time and progresses at varying paces and degrees. If symptoms are persistent, you may need to talk with an expert. Don’t hesitate to reach out for support if you need it.

References:

Clark, C.M. (2008). Student perspectives on incivility in nursing education: An application of the concept of rankism. Nursing Outlook, 56(1), 4-8.

Fuller, R.W. (2003). Somebodies and nobodies: Overcoming the abuse of rank. British Columbia, Canada: New Society Publishers.

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.

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.

mumininan/iStock

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.

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.