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.

Our daughter called today

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

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

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

Alliance/iStock/Thinkstock

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

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

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

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

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

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

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

The power of mentoring: My story

Nearly three decades ago, I started my first nursing position. It was a dream job for an energetic and eager, newly minted nurse. I worked on a surgical floor where my major responsibilities included educating and preparing patients for pending procedures, and caring for them when their procedures were completed. I loved my job, my patients, my colleagues and my free time! I began my shift at 5 o’clock in the morning and ended at 1 p.m. In good weather, I rode my bicycle, because I didn’t own a car. During the harsh winters of the upper Midwest, I rode to work in a taxi driven by a trusted cabbie. My hours were awesome, especially for a young, single person who loved to recreate and be outdoors. But, as with so many times in life, change happens.

The author, circa 1980

About a year and a half into my job, the hospital hired a new director of nursing. I have to believe that her heart was in the right place and that she was doing what she thought best for the hospital and patients, but for me, her decisions would be life changing. She decided, for reasons that still perplex me, to reassign many of the nurses to various units, according to seniority and date of hire. Though I was thoroughly enjoying my role on the surgical unit and thriving, I was one of the nurses reassigned. I was moved to the evening shift on what was then known as the “terminal unit.” It was a dismal setting compared to where I had been working , because I am a “morning person,” it was a like a death sentence. But very quickly, I grew to love my teammates and our patients, and I was surprised to discover that I had a knack for being present and listening to patients’ stories.

Many patients were in the end stages of their illnesses and in various phases of the dying process. Although a highly competent nurse, I clearly needed improvement in my timeliness and efficiency. I discovered—and, of course, so did my charge nurse—that because I enjoyed engaging in prolonged conversations with patients, my task completion often fell short. My charge nurse genuinely liked me and believed I was a skilled nurse but, on many occasions, she was compelled to admonish me on my inability to complete my work on time. I realized that I needed to improve my timeliness, and I was working on it, but there were times when I still fell short of my goals. And then one night, I experienced a defining moment in my young career.

It was a busy night, late in the shift. One of my tasks was to remove the irrigation apparatus from an elderly male patient who had recently undergone surgery for a transurethral resection. This surgery required an elaborate series of bottles and tubing, including a urinary catheter inserted through the male genitalia and progressing into the bladder where fluids could be used for irrigation. The charge nurse asked me to remove the apparatus and to do it with expediency, because there was much more work to be done. I was determined to show how well I could perform the task, and to do it in a swift and efficient manner.

I walked into the patient’s room, greeted him and began to explain the procedure. He gazed at me with tired eyes and asked, “Will it hurt?” I paused, and then said gently, “Of course, I’m not a man, but when I have done this procedure for other gentlemen, they have told me it is pretty uncomfortable.” He responded, “I’m not ready yet. Can we talk for awhile?” So, I sat beside him, and we talked. He had recently lost his wife of many decades. He spoke of her that night—about their life together, their children and how aggrieved he was when his beloved wife took her final breath. We talked for about 10 minutes, and then he said he was ready. I briefly explained the procedure and went about removing the tubing and disengaging the apparatus.

I started to say good night when I noticed tiny, unshed tears in the corners of his eyes. I couldn’t just leave, so I sat with him for a few more minutes. Then, I gathered the equipment and, as I was rolling it down the hall, bolstered myself for a “talking to” by my charge nurse. Clearly, I had not performed my responsibilities in the desired time frame. Sure enough, as I walked down the hallway, she met me, politely asked me to dispose of the equipment, finish my assigned responsibilities and meet her in the conference room after completing my shift.

Believe me, I was pretty worried. I prepared myself for the possibility of that night being my last on the job. After our shift, we entered the conference room and the charge nurse gently closed the door, folded her hands, and said, “Cindy, you have missed your calling. I want you to think seriously about going back to school to become a psychiatric nurse. You have a genuine gift for being present with people and listening with real compassion and interest.” And then she sat back quietly in her chair.

Imagine my surprise. I looked at her, acknowledged her suggestion and promised her I would give it serious thought. Later, I reflected on our conversation, realized she was right and began making plans to return to school to become a psychiatric nurse. She was right—I loved my clinical career as a psychiatric nurse. I am forever grateful, and will never forget the care shown me by my charge nurse who saw something in me I did not. Rather than reprimand, discourage or suggest I find another position, she shined a light on a pathway of new discovery that launched a fabulous career in psychiatric nursing.

I learned many lessons from that experience. I learned that when we look for what’s right and good, and when we genuinely care about people, we can change their lives. In the course of my own career, I have tried to model for others the guidance my charge nurse bestowed on me more than 30 years ago. As a clinical nurse, I looked for and celebrated the strengths of my patients, and now, as a nursing professor, I try to do the same for my students. These valuable lessons have made and continue to make an impression on how I view and navigate the world.

For Reflections on Nursing Leadership  (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

Knowing better and doing better in uncertain and uncivil times

I recently completed a national study on faculty perceptions of faculty-to-faculty incivility in nursing education and was struck by the extent to which faculty perceive this to be a serious problem. It is a sad commentary on the state of affairs in our daily work lives and a phenomenon that requires attention, because lack of civility can cause stress, emotional pain, physical complaints and spiritual distress. The effects of uncivil encounters can be devastating and long-lasting.

Several faculty members wrote stories for my study about the perceived “in groups” and “out groups” of nursing faculty teams (I use the word “team” lightly.) One participant wrote: “We have a faculty member who takes pleasure in targeting new faculty by sabotaging their ability to do their job. She went so far as to completely erase the contents of an online-learning course, so the new faculty taking it over had to start from scratch. The new faculty member was very busy learning the ropes of academe and orienting to the faculty role. She was told by the seasoned faculty member that, since she [the senior faculty member] originally developed the class, she [the new faculty member] could get busy and do the same thing.”

Another participant described interactions during faculty meetings: “One of the senior faculty members routinely cuts others off or talks over the less-senior members she appears to be targeting. She is openly condescending and rude, speaks ill of other faculty members when they are not present and is openly antagonistic to the person she is targeting. At times, the environment is quite tense, yet no one confronts the behavior. At this juncture, I am still in a probationary period and fear that trying to address it could jeopardize the position that I have worked so hard to obtain.” Other participants described experiences with ageism, sexism, racism and being “treated like a second-class citizen” because their academic degrees were in a field other than nursing.

Though these stories vary in content, they possess common features. All of the uncivil encounters resulted in an affront to human dignity and an assault on the person’s intrinsic sense of self-worth. Many believed that directly addressing the situation may be the best approach, though most feared that doing so could result in retaliation, reprisal and lack of administrative support. Others felt ill-equipped to deal with incivility and requested information about specific measures to deal with the problem, including implementing clear policies and procedures, ongoing faculty development and “civility” education, and elimination of power-based hierarchies that perpetuate “in groups” and “out groups” in nursing education. Many suggested the need for taking steps to improve relationship building, including positive mentoring, faculty collaborations, celebrating faculty accomplishments and promoting faculty achievements.

As I was reading some of these faculty accounts, I was reminded of one of my favorite quotes by Maya Angelou, who writes, “We do the best we can with what we know, and when we know better, we do better.” While I appreciate Dr. Angelou’s wisdom, I wonder sometimes if it’s true. Do we really do better when we know better, or is it wishful thinking? I choose to believe it’s true because, given what we are learning about faculty incivility, we must do better.

I am constantly amazed to learn that some faculty members are unaware of how their behaviors affect others. We must make civility a priority, therefore, and raise awareness about the myriad consequences of incivility. With the current nursing faculty shortage, we can ill afford to lose qualified educators. So what shall we do?

If you are experiencing incivility, carefully consider the nature of your situation, especially if you are part of the “out group.” Power differentials can be real or perceived and, in either case, can take a devastating toll on your emotional and physical health. So, take steps to improve your self-care and engage in stress-reducing activities. Surround yourself with positive people, and bask in the light of those you love and those who love you back.

I was recently chatting with a colleague in a non-nursing academic discipline who was experiencing relentless workplace incivility. I asked him how he dealt with the negativity. He smiled and said, “I conjure up a vision of my wife and children and my beloved family dog, and I feel immediate relief.” The conversation reminded me of one way I cope with stressful work situations. I have a number of greeting cards that I have received from family and friends over the years. I keep some of my favorite cards on my desk and select certain ones to cheer me up when needed. At present, I have a delightful valentine from my husband propped up on my desk. It features two adorable yellow labs wrapped up with each other, sheer love and joy written all over their faces. As silly as it sounds, it works for me. The picture takes me to a “happy place’ where I feel safe and wanted and stress free for just a little while.

I realize that more active measures are needed, so I highly suggest and urge all nursing programs to co-create and implement behavioral norms. As Ken Blanchard reminds us, “A river without banks is a pond.” Similarly, I believe an organization without norms is a rudderless ship. Without functional norms, desired behavior is ill defined and, thus, faculty and staff are left to “make things up as they go along.”

To co-create norms, dedicate sufficient time to ask all members of the faculty (and staff) to brainstorm behaviors that lead to effective team functioning and contribute to a healthy work environment. Avoid critiquing the suggestions—let the ideas flow. Some common examples of norms include how each team member will communicate, resolve conflicts and conduct themselves in meetings. Then brainstorm behaviors that do not lead to effective team functioning.

Once the norms are determined, discuss how each team member will “live” the norms and what will happen if the norms are violated. When faculty and staff co-create norms together, they are more likely to approve of and conform to these behaviors. Once the norms are agreed upon, they become the standard for faculty and staff interactions. To keep them dynamic, they will need to be reviewed, revisited and revised on a regular basis.

Fostering civility in nursing programs, or any program for that matter, is difficult, if not impossible, to achieve in the absence of skilled, ethical leadership. Leaders who hold formal positions as well as those without a formal title or authority, but who have significant influence throughout the organization, are called upon to effect and sustain civil, respectful workplaces. In addition to taking action to raise awareness, leaders must discuss acceptable and unacceptable behaviors, as well as model and practice civil interactions. It is also important to reward civility and collegiality, thereby reinforcing efforts to build positive relationships between and among all members of the nursing education community.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

Reflections in The Cathedral of the Blue Dome

I am a firm believer in the power of reflection and introspection. Finding quiet time to think, contemplate and wonder restores the soul. For me, being outdoors and experiencing the elements brings me considerable joy.

Our family recently moved to the country, several miles outside of Boise, Idaho. Our new home is nestled within thousands of acres of public land, surrounded by several mountain ranges, inhabited by herds of deer, antelope and elk. Above all this marvelous splendor is a big, bold, wide-open sky, what my husband and I affectionately call The Cathedral of the Blue Dome.

During the recent Thanksgiving holiday, I hiked many miles along the hilly terrain that surrounds our property and took time to reflect on some of the pivotal events of my life and how they impacted my choice to become a nurse. Along my hiking journey, a story came to mind. It begins many years ago. I was 16 years old and working as a nurse’s aide in a nursing home. An elderly man whom I will call James lived in the home. I didn’t know it at the time, but James would change the course of my life.

As a younger man, he was severely injured in a construction accident, leaving him a multiple amputee and wheelchair-bound. Later, James suffered a debilitating stroke, but he fought the good fight and refused to yield to the physical limitations of his condition. I was inspired by his spirit, tenacity and determination. The highlight of my working day was spending time with him, listening to his stories as he recounted the history of his life.

Each day was a journey into the existence of a man who loved life and feared little. He taught me to believe in goodness and kindness, and he challenged me to think big, to dream in living color. He encouraged me to make a difference in the world and to leave an indelible footprint on this earth, a footprint I would be proud to leave, one of decency, compassion and integrity. James inspired me to reach higher than I ever believed I could, to soar at 60,000 feet. Most importantly, he encouraged me to become a nurse. He loved nurses, he loved the profession and I know he loved me. As an adolescent, I gave little thought to my future, but I listened to James and his deliberations about the journey of life with its many twists and turns. I took note of his insightful lessons. They mattered deeply to me.

One day, when I arrived at work, I saw the ambulance pulling away. I knew from experience that one of the residents had died, and I wondered who it could be. The night nurse met me at the door and embraced me. Hugging me tightly, she whispered softly that James had died quietly during the night. I was devastated by the news. It was a defining moment in my life, and it made a significant impact on my future career. I decided then that I would become a nurse, that I would strive to make a difference and that I would do everything I could to leave that much discussed and highly treasured indelible footprint.

Many people like James come into our lives and influence us in ways that are deeply felt and shape the person we are; indeed, the person we are becoming. Many of these people are our role models, mentors and heroes. They challenge us every day to make an important difference in the world, to set the bar high and to “pay it forward” by becoming mentors to others, inspiring them to lead mindful and purposeful lives, lives that matter.

Each day, I challenge myself to advocate for a more just and humane world, solidly embedded in the principles of social justice, veracity and equality. I believe that each of us is called upon to serve the common good and to cultivate hope, to be reflective and contemplative when making decisions, to find quiet moments to restore and rejuvenate the spirit, to promote and celebrate the lives and accomplishments of others, and to shine the spotlight brightly on those who are a voice for the marginalized and less fortunate. In the end, it is truly what really matters.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

Celebrating the pomp and circumstance of Nurses Week

This is Nurses Week and a fitting time for celebration and merriment. This week also marks a major achievement in our household. Our daughter was pinned and graduated with her BSN—an amazing event and a very proud moment for her and for us, her family.

There was a moment during our daughter’s pinning ceremony when the glory of the pomp and circumstance threatened to burst the lump in my throat; it was when the dean of her school asked all nurses in the audience to stand and be recognized. As a nurse of many years, of course, I stood to join the others, and then the dean said, referring to the new graduates, “Please welcome our newest colleagues into the illustrious profession of nursing.”

All of a sudden, I was struck by a flood of emotions. No longer were we bound only as mother and daughter. We were now colleagues in a profession I have cherished for more than three decades. It was a very special and unforgettable experience to step onto the dais to place the nursing pin on our beautiful and talented daughter. What a thrill!

This evening, students from our own school of nursing at Boise State University will be pinned, and tomorrow they will march at commencement. It is such a festive and joyous time for gathering and celebrating. Tonight, we bear witness to a new generation of nurses, and tomorrow the pageantry and grandeur of graduation under sunny skies against the backdrop of mountains, still scantily covered with snow, will provide a grand stage to showcase our brand new graduates.

As I reflect on our new graduates at Boise State, at our daughter’s school, and on graduates from around the country, I am reminded of an ancient Chinese saying that goes like this, “The creation of a thousand forests begins with a single seed.” This saying suggests to me that every person—indeed, every nurse—isgifted with the unlimited capacity to help others grow and reach their greatest potential, and thus has the unique ability and infinite capacity to make a difference.

Helping others gives our lives purpose, meaning, and importance, and defines the essence of nursing. My friend and colleague, Marty Downey, PhD, RN, AHN-BC, calls it the “butterfly effect of nursing,” meaning that one nurse begins by touching a life, and that life touches another and another and another, causing a ripple effect into the community and throughout the world.

This touching of lives involves exercising our voices and our power, both individually and collectively, as nurses, and using our unique gifts to make a significance difference in someone’s life. This is a grand plan, and one that can not be done without taking care of oneself and nurturing the spirit.

It is important to savor quiet moments and spend time with the people we love and those who love us back; to be gentle with ourselves as we provide care to others because, while we belong to a caring profession, it is also a demanding one. Our new graduates have all worked very, very hard, but, in some ways, their work has just begun. They are clearly up to the challenge, and we honor them as they continue on their paths to “creating a thousand forests.”

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

Wonder of the season

For the past few weeks, we have gathered with loved ones and friends to celebrate the blessings of the Thanksgiving and holiday season. Like most, our family has many special holiday rituals. One of our favorite rituals is assembling on Christmas Eve to read children’s books we have read as a family since the birth of our first child. We take turns reading the slightly tattered pages, worn over the years by the touch of eager and loving hands. It’s not the books so much that matter, but the sharing and remembering that bring the magic of the season alive. Caring for and about one another inspires the spirit and joy of the season.

Many of us are caretakers. In our family, caretaking comes in a variety of shades and colors. As a nurse, I am a caretaker of my patients and, as an educator, a caretaker of my students. Our middle child is completing the senior year of her nursing program, and she, too, is a caretaker.

When asked what attracted her to nursing, she responded: “I didn’t always know that I wanted to be a nurse. It wasn’t until my senior year of high school, when I took a health-care class, that I decided nursing was for me. I realized I wanted to help people, and over the course of four years in college pursuing my nursing degree, I discovered that nursing is so much more than helping people deal with their illnesses. It’s about patients putting their trust in me and sharing their fears, emotions and memories. Recently, my grandma asked me if I could picture myself pursuing any other career. I thought about it, and the answer is no. No other career would give me the opportunities and endless possibilities nursing will bring.”

Our daughter and I are not the only members of our family who are caretakers; my husband and our son are caretakers of the earth. As scientists, they strive each day to care for our natural resources—to use science to protect our land, water, and air and save our planet. Our youngest daughter is a caretaker of the earth’s furry and feathered creatures. Like the rest of our family, she is a passionate animal lover.

Many of you know that the great blue heron is the anchor of this blog. This incredible bird represents a quiet capacity to sit calmly while others lose patience. I love the great blue and, a couple days ago, was surprised with a wonderful gift. For more than a year, the wall directly opposite my desk in my new office has remained empty. I have often pondered just the right hanging for this blank and imposing wall but, because I couldn’t make a decision, it has remained bare and cheerless.

Then, on Christmas morning, I opened an expertly wrapped, large, rectangular gift. It felt like a picture frame. Oh, so curious. As I pulled away the paper and revealed the gift, imagine my delighted surprise as I gazed into the eyes of a beautiful, stately and majestic heron. This thoughtful gift from our daughters will prominently grace the wall of my office forever, reminding me to reflect calmly amidst an impatient world.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

Getting started

Greetings, everyone. I am so excited to debut “Musing of the great blue.” Like many of you, I am a nurse, parent, spouse, scholar and teacher. My husband and I are the proud parents of three terrific children, three crazy and athletic dogs, and one very fat shelter kitty, all of whom have given us unconditional love, loyalty and a reason to get up every morning. I thoroughly enjoy cardio kickboxing, hiking, biking, cooking and reading. I especially enjoy spending time with my family, friends and pets.

I have been a nurse for most of my adult life. From the early 1980s through the mid 1990s, I worked as a psychiatric nurse, specializing in adolescent violence prevention and addiction recovery. During those years, I worked with violent youth gangs, utilizing a primary prevention model to teach aggressive teens how to settle disputes with words instead of force and weapons. Our goal was to prevent minor incidents from escalating into potentially violent episodes.

My clinical-practice experience now frames my present-day program of research and supports strategies I have developed to foster civility in nursing education and practice. As a nurse educator, I have observed incivility between nursing faculty and students and have witnessed firsthand its troubling consequences. Uncivil behavior negatively impacts the learning environment and disrupts faculty-student relationships, causing turmoil and needless distress. In the practice setting, incivility is predictive of job dissatisfaction, decreased job performance, diminished employee health and increased turnover.

My consistent and comprehensive program of research has brought these issues to bear in a thoughtful, nonjudgmental manner and has stimulated national and international dialogue on these critical issues.

You may ask, Why does civility matter? In response, I invite you to read my article “Why civility matters,” recently published in Reflections on Nursing Leadership (RNL).

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.