About Lisa Sundean, RN, MSN, MHA, PhD Candidate

PhD Candidate, Jonas Scholar University of Connecticut School of Nursing Statewide Director Connecticut Nursing Collaborative-Action Coalition Connecticut Nursing Collaborative-Action Coalition

Inspiration in Unlikely Places


IMG_1565Hiking uphill along a strenuous stretch of mountain trail in Vermont, I happened along an older woman hiking downhill. I estimated her to be in her early 80s. My first thought was, “Oh my goodness. I need to help this woman. This is far too strenuous for her. She might fall, get lost or dehydrated.” But I quickly realized she was moving perfectly fine, steady and balanced with 2 hiking sticks, sturdy shoes, a backpack (perhaps with water, a snack, and a phone), a hat, and sunscreen visible on her nose. I didn’t have hiking sticks, a snack or a hat. She had a smile on her face. She greeted me with cheer and moved along with the gait of a nimble mountain goat. And that’s when it hit me.

Why did I assume she needed my help? Why did I assume she lacked the ability and fortitude for the hike? Why did I immediately see myself as her protector? In fact, I am always inspired by older people who are active, agile, and adventurous. I want to be that person in my later years. And yet, I imagined her as feeble, incapable, in need of my help and protection. I based my assessment on the assumption that she was weak. And in that assumption, I never considered her strengths.

As nurses, are we programmed to see problems or opportunities? Do we assume weakness in  our patients, our colleagues, our students? Does caring mean we place ourselves in a privileged position over others? If so, what is lost by this weakness-based approach? Better put, what could be gained by a strengths-based approach?  Consider approaching patients, colleagues, students with the assumption that they bring strengths to every situation. Instead of uncovering problems to solve, we can assess circumstances, identify strengths, and collaboratively define opportunities to optimize those strengths rather than focus on weaknesses. Rather than feeling disabled, dis-empowered or disrespected, our patients, our colleagues, our students, even we, feel strengthened, empowered, energized, and respected. This is not a call to ignore problems and certainly not a call to ignore emergency situations that need immediate intervention. It is a difference in approach between “What is the problem and how can we fix it?” to “What is this circumstance, what is going well, and how can we do more of it to restore balance?”

Perhaps this is a trivial nuance in thinking but plenty of positive psychology and brain science literature point to the power of positivity and strengths-based approaches to situations. It so occurred that I began drafting this blog post just as Adeline Falk-Rafael’s post, Peace as a Prerequisite for Health, appeared on the NurseManifest blog site. I cannot help but draw connections to the deep reflections in her bittersweet post. While reflecting on recent outbreaks of violence and civil unrest, she calls attention to courage and peace, social justice and equity as positive antidotes to violence and antecedents for health. Her photo choice: Lesha Evans, a Black female nurse confronting law enforcement in poised courage beautifully illustrates the power of positivity in creating peace and health. She chose to emphasize a strengths-based approach.

I am inspired by Lesha Evans. I am inspired by the vitality of the woman I passed along the trail. I admire their strength, their passion, and their commitment to living fully in peace and positive strength. I have to admit, even as I recognized the strength of the woman on the trail, I made a mental note to keep an eye out for her on my way back down…just in case… Once again, she showed me that strength and courage win. I never saw her again…she was well along her way to greener pastures by the time I completed my descent. I owe a debt of gratitude to this woman on the trail for giving me the opportunity to engage in critical reflection and to find professional inspiration in an unlikely place. I really do want to be that woman hiking the trail like a nimble mountain goat when I am in my 80s and I hope the younger whippersnapper who passes me thinks, “Wow! I want to be like her one day!”

 

A special note of gratitude goes to Peggy Chinn for her words of wisdom and encouragement in the development of this post.

 

 

 

The ROI of Reflection


Research, write, revise, rinse, repeat. Meet, plan, do, re-do, rinse, repeat. Heavy patient loads, high acuity, diminishing resources, rinse, repeat. Hurry, hurry, hurry, rinse, repeat. Sound familiar? Is your head spinning? For many of us, it is a constant state of being – the whirlwind of life. We get caught up in it and often, it is a necessary adjustment to make. But what if we stopped briefly, for an intentional moment or two? What if we stopped to take in the beauty of life around us, the big picture, a few cleansing breaths? What is the return on investment (ROI) of reflection or contemplation?

Of course reflective and contemplative practices are not new. Most societies have reflectionpracticed different formal and informal forms of reflection and contemplation for centuries. The best examples are the spiritual and prayerful practices of the world’s religions. More attention is being given today to all forms of reflection and contemplative practices as credible and evidence-based ways to reduce anxiety, PTSD, depression, and aggression to name only a few. Similarly, reflective practices can increase feelings of well-being and focus. The benefits of practices like mindfulness based stress reduction are becoming widely known and practiced, for example.

But what if you are already happy, content, focused, and have no pathological mental health concerns? Can you still benefit from reflective practices? At this point, refer back to the opening scenarios – the ones that left your head spinning. Happy and mentally intact, we all feel the crush of stress from time to time. Writer’s block? Stressful. Compassion fatigue? Stressful. High patient loads? Stressful. Deadlines? Stressful. Negative feedback? Stressful. High stakes presentations? Stressful. Proposals? Stressful. The list goes on… At the risk of sounding like a 1960’s television advertisement, I propose an intentional reflective practice to keep the stress at bay and guarantee a positive return on investment.

A quick peruse of the academic databases support the ROI of reflection, and while I could take a very academic approach to this blog post, I will leave that to those who are doing the research. This is purely anecdotal and I stand by the guarantee. The pathway to an intentional reflective practice occurs in many forms: formal prayer, physical activity, cooking, meditation, playing with children, connecting with loved ones, gardening, listening to music, giving to those in need, etc. Cultivating a daily practice of intentional reflection takes time and commitment (a few minutes will work; a few hours is a luxury). The goal is to empty the mind of constant chatter, connect to the breath, connect to the wonder of all things greater than self, connect to the positive, and connect to the belief that all is well.

For me, as my colleagues well know, the ROI of reflection comes in the form of daily walks in nature. It is where I find solitude, wholeness, hope, and beauty. It is where I find the ‘crystal moments’ – those moments of pure connection and energy. In the whirlwind of a very busy life, the ROI of reflection manifests as stress reduction, clear insights, moments of peace, feelings of well-being, hope, mental fortitude, and improved long-term productivity. Moments taken to contemplate and reflect – the return is well worth the investment. Of course, some stressors require direct action and cannot fully be controlled or alleviated without coordinated and persistent effort. However, an intentional reflective practice can help manage stressors and enhance the ability to craft feasible solutions and outcomes. Breathing in and breathing out. The ROI of reflection – guaranteed.

References

Farb, N., Daubenmier, J., Price, C. J., Gard, T., Kerr, C., Dunn, B. D., . . . Mehling, W. E. (2015). Interoception, contemplative practice, and health. Frontiers in Psychology, 9(6). doi: 10.3389/fpsyg.2015.00763

Keltner, D., & Haidt, J. (2003). Approaching awe, a moral, spiritual, and aesthetic emotion. Cognition and Emotion, 17(2), 297-314. doi:10.1080/02699930302297

Polusny, M. A., Erbes, C. R., Thuras, P., Moran, A., Lamberty, G. J., Collins, R. C., . . . Lim, K. O. (2015). Mindfulness-based stress reduction for posttraumatic stress disorder among veterans: A randomized clinical trial. JAMA: Journal of the American Medical Association, 314(5), 456-465. doi:10.1001/jama.2015.8361

Ray, M. A., Turkel, M. C., & Cohn, J. (2011). Relational caring complexity: The study of caring and complexity in health care hospital organizations. In A. W. Davidson, M. A. Ray, M. C. Turkel, A. W. Davidson, M. A. Ray, & M. C. Turkel (Eds.), Nursing, caring, and complexity science: For human–environment well-being. (pp. 95-117). New York, NY, US: Springer Publishing Co.

Wayment, H. A., Wiist, B., Sullivan, B. M., & Warren, M. A. (2011). Doing and being: Mindfulness, health, and quiet ego characteristics among Buddhist practitioners. Journal of Happiness Studies, 12(4), 575-589. doi:10.1007/s10902-010-9218-6

A License to Hide?


When I graduated with my BSN many years ago, I was filled with pride; pride for having completed a rigorous course of study and pride for having passed the most anxiety-producing exam I had ever taken – the NCLEX. I remember my professors saying that myRN professional signature should always include my licensed title and degree; RN, BSN. RN – the holy grail of credentials for those who take the challenge of nursing education and dare to confront the NCLEX. They said all other denominations of nursing come after the RN. So, I became Lisa J. Sundean, RN, BSN and now I am Lisa J. Sundean, RN, MSN, MHA and soon-to-be Lisa J. Sundean, RN, PhD. Aside from my name, what is the constant in this lineage of credentialing ancestry? You got it – RN. Registered Nurse. Hello, I am Lisa and I am a Registered Nurse. In that you can trust according to annual public polls. RN is the only designation that allows me to practice as a nurse. No other credential allows me to practice legally except the RN license.

According to the American Nurses Credentialing Center (ANCC), the proper way to display licensure and credentials is by highest degree earned followed by licensure, state designations, awards/honors, and others (ANCC, 2013). So apparently, I need to tweak the order of my signature. I will consider it. But note, RN is still clearly in the signature. Some would argue that APRN can substitute for RN, but not according to ANCC. I’m not going to argue that point. I will leave that for the APRNs. What matters is that RN is displayed somewhere in the alphabet soup of acronyms.

Several years ago, I was volunteering for a local hospital fundraising organization. While recruiting sponsors for the flagship fundraising event as co-president of the organization, I was signing letters directed toward potential sponsors and donors. Of course, my signature was Lisa J. Sundean, RN, BSN (I didn’t have the MSN, MHA yet). The hired event planner took issue with my credentials saying it would be confusing for sponsors and donors. Naturally, I argued with him and I kept the signature intact. I argued that if people knew a nurse was asking for support they would feel more confident about giving. Revenue for that event increased by more than 100% over the prior year (yes, you read correctly!). Okay, maybe my signature was not the only reason, but nurses do have credibility. For sponsors and donors, knowing a nurse was leading the fundraising effort probably helped.

Not so many years ago, I was finishing my Master’s degree program. The capstone project had me combing through hospital websites and board directories looking for RNs serving on hospital boards. I’d heard of certain hospitals that had RNs on their boards but I was challenged to locate them in the board directories. I was perplexed that very few hospitals listed nurses on boards with their RN titles. The reasons for this are complicated, but in talking about it with a particular hospital CEO and RN, I was told that as nurses move up the career ladder to more senior level executive positions, they sometime drop the RN title because it can become an impediment to further career advancement. Pause. Think about that for a moment. The very licensing credentialing that allows nurses to practice, to deliver educated care to people in need, to advocate as educated and licensed professionals becomes an impediment to personal/professional development…(sigh).

Recently I have noticed that some nurses from academia and other work settings have retired the RN title in favor of using state designations and certifications. It may be obvious to those of us who are familiar with the constellation of initials that these people are, in fact, RNs with superlative credentials. However, the general population, who apparently trust nurses inherently, have no idea how to decode these initials. They wonder, “Is this person a nurse, a professional bill collector, a doctor of neuroscience, a professional health director, or a certified entrepreneur of noetic perspectives?” In all of the high level credentialing that nurses accumulate, the only letters that really stand out to the general population are RN – Registered Nurse.

At a time when nursing is entering its “golden age” as Donna Shalala declared so emphatically in 2010 at the release of the Institute of Medicine report, The Future of Nursing; Leading Change, Advancing Health (Robert Wood Johnson Foundation, 2015), some nurses choose to hide their licensing credential. At a time when we need nurse representation and participation at so many levels for healthcare transformation, some choose to stow the RN away. It is concerning that some feel the need to hide their professional identity to advance and have influence in leadership positions.

Now is the time to display the RN prominently along with other credentials. How else can we take credit for nurses’ roles in health, healthcare, and social justice? The public trusts us. Do we trust in the power of the RN? Let’s commit to leadership influence using the licensing credential that we worked so hard for; the licensing credential that we must hold to advance our nursing education, to provide bedside care, to be recognized as nurse leaders. The RN is not a license to hide. The RN credential is one to display proudly and be empowered by. If career advancement is at risk by our credentials, perhaps the alternative approach is to advocate for all that the RN stands for.

2016 is just days away. Now is nursing’s time. Be an RN. Happy New Year to all my colleagues.

 

References

American Nurses Credentialing Center. (2013). How to display your credentials. Retrieved from http://www.nursecredentialing.org/DisplayCredentials-Brochure.pdf

Robert Wood Johnson Foundation. (2015). Campaign for Action Five-Year Celebration Video. Retrieved from https://www.youtube.com/watch?v=SLM5zC7zmF4&feature=youtu.be

Response to White Coat Ceremonies for Nurses


Welcome to Lisa Sundean, who is joining our team of bloggers!  

Lisa Sundean

Lisa Sundean

WCCs originated in 1993 by the Arnold P. Gold Foundation. The purpose of the WCC is to symbolize the transition into the medical practice and to remind medical students of their promise to scientific, compassionate medical care. Since 1993, several other health professions have adopted the WCC as a professional milestone and transition for students. More recently, nursing schools have begun to adopt WCCs, endorsed and supported by AACN in partnership with The Arnold P. Gold Foundation (The Arnold P. Gold Foundation, 2013).

On the surface, the symbolism of the WCC for health professionals is honorable. However, one must question the utility and deeper meaning of the WCC for nurses. First, the WCC originated for the medical profession. Are nurses still so enamored by medicine that we cannot embrace our own professional symbolism and rituals? Second, nurses understand the struggle of the profession to rise up from more than a century of medical oppression and yet, we are willing to don the white coat of physicians as a symbol of achievement and transition in the nursing profession. Are we not cloaking our students in the very cloth of oppression we seek to emancipate from? Finally, as we face the critical need to transform healthcare, we fully understand the importance of interdisciplinary and interprofessional collaboration. Such collaboration capitalizes on the unique synergies of knowledge, skills, and expertise of various disciplines and professions. Is the WCC contrary to such collaboration? Does the WCC unconsciously invoke nurses to become more like physicians rather than the unique profession it seeks to become; a profession with a unique knowledge base, a unique skill set, a unique expertise, a unique contribution to health and healthcare, and a unique set of professional traditions?

The WCC is a new tradition for the medical profession. It is fair to respect the symbolism of the ceremony for physicians. However, adoption of the WCC for nurses is questionable. Nursing scholars encourage us to find our professional voice and establish our professional uniqueness (Kagan, Smith & Chinn, 2014). The quest for that uniqueness is a road paved with rigor, creativity, dedication, and commitment to the metaparadigm of nursing. With all due respect to The Arnold P. Gold Foundation, nurses, we can do better than allow ourselves to be seduced by a medical tradition to symbolize our unique profession and identity.

References

Kagan, P. N., Smith, M. C. & Chinn, P. L. (2014). Philosophies and practices of emancipatory nursing: Social justice as praxis. New York, NY: Routledge.

The American Association of Colleges of Nursing. (July 2015). Gold Foundation and AACN to fund 60 nursing schools for 2015 white coat ceremonies. Retrieved from http://ymlp.com/zwDmlO

The Arnold P. Gold Foundation. (2013). White coat ceremony. Retrieved from http://humanism-in-medicine.org/programs/rituals/white-coat-ceremony/