Beating the burden of burnout

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

Manuel Faba Ortega

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

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

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

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

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

A few questions to ask
For some, burnout may also occur. Burnout is a state of emotional, mental, and physical exhaustion caused by excessive and prolonged stress. When we are burned out, we feel overwhelmed, depleted, unproductive, unhappy, unappreciated, and too tired to function. To determine if you might be experiencing burnout, ask yourself a few questions:

• Do you have difficulty getting out of bed and feeling excited about your day?
• Do you become irritable or impatient with students, coworkers, or patients?
• Do you lack energy and feel disillusioned about your work?
• Are you using unhealthy coping strategies, such as spending hours watching TV or browsing the Internet, or using drugs, food, or alcohol to feel better?

If so, you may be experiencing or approaching a state of burnout.

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

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

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

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

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

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

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

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.

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.

Rewarding civility

I am so impressed with the Allegheny College Prize for Civility in Public Life. The award recognizes individuals who foster appreciation for the vital link between an engaged, active citizenry and a healthy democracy. The first Allegheny College Prize for Civility in Public Life was awarded to David Brooks and Mark Shields for their remarkable commitment to civil discourse. Despite their very different political views, these two gentlemen are consistently respectful and civil in their communications.

It’s my belief that the civility landscape can be shifted for the better by incorporating an important lesson from Parenting 101: When we catch our children doing something right, they need to be rewarded. B.F. Skinner taught us that lesson long ago when he concluded that positive reinforcement makes a difference and, if delivered in a meaningful way, will likely result in the behavior being repeated.

Using this principle as a starting point, my husband and I discussed various ways to reward nursing students for commitment to civility and professionalism. After several conversations, we decided to establish the Clark Civility Award to recognize nursing students who demonstrate sustained commitment to civility. The award is given each semester to a qualifying senior nursing student who exemplifies civility, respect, and professionalism at Boise State University School of Nursing, College of Health Sciences, and beyond.

There are several criteria for the award, including being a contributing member of student organizations and other relevant teams and committees, having a minimum GPA of 3.0, providing a record of service to the community and the profession, and demonstrating respect and civility toward classmates, faculty, nursing staff, patients, and families. Students receiving the award must also show collegiality, trustworthiness, and responsibility. Recipients may be self-nominated or nominated by someone else.

Mark McLaughlin and Yours Truly

Last week, Mark McLaughlin became the first recipient of the Clark Civility Award. He was nominated by a faculty member, who eloquently described McLaughlin’s contributions of outstanding service to the School of Nursing and the broader community, his unwavering respect toward others, and his commitment to teamwork and ethical conduct of the highest order. An excellent student who actively participates in his community, he shows great promise as a professional nurse and consistently goes the extra mile to provide exceptional patient care.

On Wednesday, 11 December 2013, McLaughlin accepted the award, presented by the dean of the College of Health Sciences, during a ceremony attended by his classmates, faculty members, and academic leaders from the School of Nursing. In addition to a monetary award, McLaughlin received a signed copy of my book and a professional plaque commemorating his achievements.

I hope others will be inspired to create similar awards or other ways to reward those who practice civility by catching them doing something right. Perhaps you will be inspired as I am by the words of two very influential women who encourage each of us to make a difference. The first quote comes from Anne Frank, who stated, “How wonderful that no one need wait a single moment to improve the world,” and the other from Helen Keller, who reminded us, “Alone we can do so little, but together we can do so much.”

Let’s all strive to make a difference in the lives of others. By doing so, we make a difference in our own. Here’s wishing you and the people you love—and those who love you back—the happiest of holidays.

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

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.

The power and rewards of assuming goodwill

Each year I make two New Year’s resolutions—one personal and one professional. This year, I have thought deeply and purposefully about the resolutions that will frame my thinking and behaviors over the next 12 months. I try to keep my resolutions simple and clear so that I don’t lose focus. They become, in effect, my annual vision statements—a one- or two-sentence “elevator speech” that I can easily recite in a short phrase. For example, this year, my personal resolution is to “assume goodwill.” This is not a new resolution for me; in fact, it is the No. 1 working norm for our school of nursing. This norm or “principle” has served me well over the years, and I know it will help me bring my “A game” to 2012 as well.

I’d like to share a story about the power and rewards of assuming goodwill. A couple of semesters ago, in one of my nursing courses, I had a student who routinely arrived late for class. This behavior was not only mildly annoying and a bit disruptive, but his late arrival was a violation of the classroom norms we had established and agreed upon the first day of class. When the student’s tardiness started to become a pattern, I decided to address the behavior. During a break, I asked him to join me for a private conversation, and he agreed.

When we were alone, I said, “I’ve noticed that you are having difficulty getting to class on timeand I’m wondering why. What’s up?” The student paused for a moment, looked at the floor, then slowly lifted his gaze to look me in the eye.

“Yes, I know. I have been making every effort to arrive on time but, you see, I am a single parent and the sole provider for my three small children. I do not have family around or anyone else to rely on for help. So, I get the children up, make breakfast, get them off to school and race to get to class on time. Please forgive me, but their mother left us a year ago, and I am still trying to get on top of things.”

You can imagine how this disclosure affected me. I was touched by the story, concluded that the student was doing his best and expressed my appreciation to him for doing so.

I started that conversation with an assumption of goodwill, and I’m glad I did, given the student’s family situation. It reinforced for me the power of giving people the benefit of the doubt and believing that each of us tries very hard to do our best under challenging circumstances. Of course, I realize that this is not always the case, but I learned long ago that assuming the best of others goes further and takes less energy than assuming the worst.

This guiding principle of assuming goodwill is a positive way of living life. Earlier this month, I presented a civility workshop to a large group of faculty members representing a variety of academic disciplines. During the workshop, I suggested that assuming goodwill is a powerful way to allay stress and to build and sustain relationships. As I was leaving, I was approached by a faculty member who teaches diesel mechanics.

“Dr. Clark, today was the second time I’ve heard you speak on civility and the power of assuming goodwill,” he said. “I have been married for 30 years and, after your first workshop, I decided to assume goodwill with my wife. I used to think she had a hidden agenda, but once I assumed goodwill, I realized she really doesn’t have a hidden agenda—just a different point of view. And sometimes, her point of view makes a heck of a lot of sense.”

Ah, so there it is again—the strength and force of assuming goodwill! So energizing, empowering, and liberating. It’s not always easy to do but, when we assume the best of others, it reframes our cognitive focus and presents an opportunity for enlightenment. Wish me well as I make a concerted effort to assume goodwill in 2012—and I wish you the same!

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.