Nurses’ Day Eve

May 5, 2014 / Carey S. Clark, PhD, RN, AHN-BC, RYT, FAAN / 1 Comment

It is the eve of our special day

Can we honor nurses’ caring in a new found way?

Can we as a profession unite?

Centering and shining our healing light.

It’s our own day emerging from here, nurses’ day eve

Supporting one another, let’s believe:

That all nurses can earn a superior pay

That love and caring will rule the day

That hope and healing reign supreme

That we soon shall realize Nightingale’s dream

That we shine the light in any places remaining dark

That each nurse may leave her or his healing mark

That nursing education moves fully toward caring science

That we remain cohesive and united, growing our reliance

Yes, the field of nursing is moving out of oppression

Journeying forward to our own art, science, and caring expression.

With great thanks to the many nurses actively striving to create transformative change, innovations, and holistic-caring practices; keep striving, keep healing, and share your love and light!

When nurses have a bad day

May 2, 2014 / Carey S. Clark, PhD, RN, AHN-BC, RYT, FAAN / 3 Comments

I had a mostly wonderful experience today. I used to teach medical surgical nursing with nursing students and today I was afforded the experience of observing and “evaluating” a nurse educator on a medical surgical floor. I think I was more excited to be there on the floor then anybody else; I still love the bedside, though my academic endeavors have taken me away from that experience.

I found myself more co-teaching with the instructor (as you know if you are experienced teacher, it is pretty difficult to sit back and simply observe) and getting to know the patients better while the students and instructor were scanning meds. This afforded me the opportunity to act as a role model for the students and help them to get to know their patients better, but the students were nervous about doing injections and having me along as a second observer may have increased their anxiety a bit. Speaking with the patients and really connecting with them made me long for that experience I realized I had been missing, the transpersonal caring space.

The rose colored glasses were soon to be abruptly removed.

We had gowned and gloved up to go into an MRSA patient’s room. A woman (wearing no identification, no lab coat, and none of the required PPE) admonished us after we knocked and stated we had medications for the patient. She angrily and abruptly came to the door and shut it in our faces, stating she had to talk privately with the patient, that she was arranging discharge. I could hear her abrupt and angry tone with the patient and after a few minutes she swung open the door to leave.

The instructor I was with said in a very friendly and positive tone, “Oh did you know this is an isolation room?”. And the reply of the discharge nurse was, “I didn’t touch a single thing in this room and I certainly know what precautions are”. She maintained her angry and abrupt tone and without washing hands she left the MRSA contaminated room and headed off to the next patient.

The instructor and I were both taken aback and after finishing the work with the patient and student, I asked her what she thought of the situation, should she perhaps “report” the discharge nurse to the manager. The greatest concern of course was patient safety; and the nurse’s failure to take proper PPE precautions was of concern to me as she was now potentially putting more patients at risk for contracting MRSA. This is how MRSA usually spreads in hospitals, from healthcare workers who fail to take the proper precautions of using PPE and washing hands.

My secondary concern was that this nurse’s palpable anger was being directed wherever she went: toward patients, students, instructors, other nurses. Her anger and stress were creating an environment of stress activation for others and we know that stress leads to a hindered immune system response and impacts one’s ability to heal. The nurse was, all by herself, impacting others in a negative way and she seemed either unknowing or uncaring about the impact of her actions.

The instructor and I agreed the incident should be reported and later when we saw the nurse manager, we made our concerns known. But as an instructor this can create a bit of a tenuous situation; we absolutely must act as the patient advocate, but we are not employees of the hospital, and if the complaint is followed through properly, the discharge nurse will indeed know who made the complaint. As the instructor relayed the incident to the nurse manager, she mentioned several times, “maybe the discharge nurse was just having a bad day…”.

And this is what I am left struggling with, because the discharge nurse was definitely having a bad day…or week… or month… or maybe even life. I am even now struggling with finding my compassion for this nurse who I intuitively sense as being in stress mode and likely burned out. The safety risks she was willing to take for having a bad day are in my mind inexcusable, and yet how do I find ways to let go of my anger about the situation (which would also impact my immune system!) and move toward a place of caring and compassion for this person? I suppose if I was there for longer then this one time of a few hours, I could devise ways to care for her myself better, to eventually ask if she was having a bad day, and to let her know I would like to support her. Or perhaps I could just create a “vibration” of love and caring around her, letting my heart’s electromagnetic field reach out to her unspoken pain and anger.

As we head into Nurses’ Week 2014, I would love to see nurses banded together in practicing self-care and caring for and loving one another. I want to see us also create room for supportive, loving, and constructive conversations for those nurses who are seemingly continually difficult and angry, whose bad day after bad day turns into a life driven by unresolved anger, compassion fatigue, and stress. We all deserve love and care, and if you find you cannot have overt conversations with the tried, angry, and frustrated or with difficult colleagues, patients, or family members, then I would suggest taking this action on internally, and seeing if things change over time.

For instance we know that HeartMath(TM) is used in many hospitals to assist providers in creating caring- healing presence. This is all about a process of tuning into your heart space, and hospitals have used it to help support staff in creating patient-centered healing experiences. However, one can also simply imagine coming into a full heart space, and imagine oneself as overflowing with love for this person who is clearly suffering. Sometime it helps me to picture the person as an infant, or a young child, in need of love and I send that love out with an intention for healing. I am not perfect at, but when I catch myself thinking negatively about someone, I strive to turn that feeling around. I then often include them in my loving-kindness prayers for well being and healing.

As we enter nurses’ week, let’s follow our caring-healing guiding nurse theorists, like Jean Watson and Savina Schoenhofer, and see that our work as nurses extends towards creating caring-healing environments. To celebrate this special week, let’s strive to remember that we can care for love all we come into contact with.

What are nurses saying?

December 19, 2013 / Carey S. Clark, PhD, RN, AHN-BC, RYT, FAAN / 6 Comments

I have been intrigued lately with what nurses are saying in public arenas and how it reflects our practices. Many nurses blog or journal about their work, and while some of it serves to accurately portray the workplace issues we face, some of it may also be damaging to our profession and our image, serving to keep us stuck and in need of emancipation versus moving us toward freedom and autonomy as a profession.

Take the following blog post, created by a nurse known only as Brownie3, which seems at first glance to portray some of the issues we face as nursing. http://brownie83.hubpages.com/hub/10-Things-Nurses-Dont-Want-You-to-Know

Despite it’s title of “10 Things Nurses Don’t Want You to Know”, the blog reflects a keen desire to begin to inform and partner with patients, creating a venue for discussing with the public what nurses do. Why is it that we would perhaps not want our patients to know our profession and our challenges better? In many ways the blog clearly reflects the face of modern nurse as somewhat distanced and harried, un-empowered, and it provides background for why we must act in a reductionistic manner with our patients; we simply have too many demands, too much stress to “perform”, and legal constraints, such as on the use of patient names. The issues with pain medication and the nurse’s desire for the patient’s to be “sincere” in their needs reads very judgmental. However, my greatest concern is that the blog fails to portray what I believe we charged with as nurses: to provide caring, non-judgmental, presence at the bedside that supports the patient’s healing journey. There is no inkling of the idea that the nurse is there to share the journey and no clue to the idea that nurses are guided in their decisions by nursing theory and evidence based practices. Of course, as one of my colleagues pointed out, this is just one person’s experience, but when the statements are broadly placed to all of nursing, it becomes a concern for all of us professionally.

The next entry I looked at this week was from an intensive care nurse who wrote the blog as a fairly new graduate nurse. Diary of an Intensive Care Nurse begins to reflect the many troublesome issues nurses face in providing care in the highly technological world of the ICU: http://nypost.com/2012/12/09/diary-of-an-intensive-care-nurse/

While Nurse McConnell makes a clear portrayal of the issues in ICU around the country, there is something lacking here. One thing missing is the use of evidence to back up some of these statements; for instance there is some great evidence out there about what harm the ICU does, but it is not included here and in some ways the personal experience, while very valuable, could be better validated with use of data. Also, there is a lack of a solution; while the nurse calls for change in ICU settings, what and how that change might be is unclear. Again, there is plenty of evidence to suggest earlier palliative care and use of hospice at end of life greatly change end of life outcomes, and many more patients are opting for these services. My thought is that perhaps the writer is not yet keenly aware that these options exist and we should be striving toward greater use of these options for all people, or incorporating some of these more holistic and caring approaches into ICU type care.

While we want all nurses to have a voice, we also need to support one another in developing the best ways to express our concerns for the profession, and our plans for creating change. One thing I think is for certain: as nurses, we all should ideally support greater levels of education for our nurses, so that every nurses understands how evidence and theory drive practice, they each grasp the ethical implications of their practices, and they all can be supported in meeting their true call to nursing. The greatest joy in our profession is in the supporting of each patient’s healing capacity across the lifespan and through the death experience.

On the nurse manifest project and creating change

June 7, 2013December 9, 2013 / Carey S. Clark, PhD, RN, AHN-BC, RYT, FAAN / 4 Comments

I had the pleasure yesterday of presenting the NURSE #65X89 story to holistic nurses at the American Holistic Nurses Association.

We started the workshop with a brief grounding and centering exercise and moved on toward my reading the story. Then the participants had an opportunity to dialogue about the story and its meaning, and we then beagn some goal setting around creating the future of holistic nursing, one that exemplifies the values of the Nurse Manifesto, and also supports the vision of how nurse Jane in the story lives holistic nursing. For some participants, very concrete goals that were measurable emerged; for others what may have emerged was the need to do self care and find ways to let things go so that they can begin to realize holism and healing for themselves. As I have blogged about previously, it is a must that we have our own self-care in place if we are going to be able to create change in systems and the science of psychoneuroimmunology supports this need.

Meanwhile, the idea arose for us to perhaps collect more nurses’ stories, to do another round of Rogerian Narrative Inquiry Analysis on the stories of nurses, but I wonder about what differences may have emerged over the last 11 years. I suppose my concern is that the stories will continue to be reflective of the struggles of nurses and nursing toward emancipation, and I wonder if the new patterns emerging would be any different then the patterns we identified those years ago? Or perhaps the story of nursing is declining even further, and maybe I need to realize that perhaps this part of the chaotic change process, part of the bifurcation where a new pattern may emerge.

My intention from here is to stay in touch with these amazing holistic nurses, create ways to continue to communicate about their goals, use social media to stay connected, to share our light as we head back toward the institutions where darkness may seem to still rule and oppress our desires for healing and holism.

However, I wouldn’t be doing this work if I didn’t believe that a shift is possible, that light shall reign supremer, that healing is emerging… and so let’s all shift together.