A Nurse’s Perspective on Cannabis (Marijuana), Legalization, and Safety.

October 16, 2016December 21, 2017 / Carey S. Clark, PhD, RN, AHN-BC, RYT, FAAN / Leave a comment

I am a Registered Nurse with 22 years of experience, and I have had an anti-prohibition stance in regards to marijuana (cannabis) for 30 years. I was fortunate that when I moved from California to Maine 6 years ago, I was introduced to Maine’s amazing medical cannabis program. I have also been able to study and learn more about the medicinal benefits of this sacred herb through my involvement with the American Cannabis Nurses Association (I now sit on ACNA’s board of directors) and by going to cannabis clinician conferences, such as Patients Out of Time.

Cannabis is on the ballot in 9 states this November, for either legalization for adult use or medicinal consideration. As nurses, we are often concerned with safety, so the following are my thoughts on safety issues and the end of prohibition of cannabis. If you are unfamiliar with how cannabis works in the body and why it such a safe herbal medicine, I suggest you first visit my blog posting on what nurses need to know about cannabis: https://nursemanifest.com/2015/07/14/the-endocannabinoid-system-what-nurses-need-to-know-an-introduction/.

Let’s consider the following issues:

Access: The idea of increased access for adults over age 21 is compelling on many levels. As many have stated before me, all cannabis use is medicinal due to the way the herb interacts with the body’s own endocannabinoid system. (http://thejointblog.com/all-marijuana-use-is-medicinal/; https://halcyonorganics.com/all-cannabis-use-is-medical/). Patients who cannot access cannabis legally to support their healing because they did not have a documented qualifying condition may now have access to this safe effective herbal medicine. Sites like http://www.drugguardians.com are being created with impunity and are helping the population become informed by third parties, decentralizing the source of knowledge about drugs. As legal access increases, black market issues will likely dissipate which creates a safer environment for all citizens. Meanwhile, we know that in legalized states, teen cannabis use drops significantly, effectively decreasing access for younger folks, which is often a concern for those who are considering legalization or medicinal programs (http://www.usnews.com/news/articles/2014/08/07/pot-use-among-colorado-teens-appears-to-drop-after-legalization).

Quality: In Maine, our ballot calls for testing and proper labeling of cannabis products sold at both recreational stores and recreational cafes. This is a major step forward to ensuring safe use of quality cannabis products for both patients and recreational users. Many patients now are being encouraged to start low and go slow with their dosing of their medication, and proper labeling will help to ensure that people can use cannabis with comfort knowing the relative psychoactive effects increase as THC levels of the cannabis products increase. Additionally, products will be tested for pesticides and contaminants, further ensuring the medicine and products people are accessing is safe.

Smoking: I often hear that medical providers are very concerned with the idea that smoking cannabis may be harmful to the person. While there may be some minimal changes to lung structures, there is no strong correlation with COPD and lung cancer in cannabis smokers (http://www.ncbi.nlm.nih.gov/pubmed/23802821; http://www.ncbi.nlm.nih.gov/pubmed/21859273). However, there are many ways to ingest cannabis, and vaporizing cannabis is a way to inhale the medicine without having contact with some of the combustive byproducts that are related to any perceived risk of smoking cannabis. For more therapeutic effects, regular users of cannabis and those seeking its healing properties are generally encouraged to use edibles and tinctures, as they target whole body homeostasis more effectively.

OUI/ DUI: Driving under the influence of any psychoactive medication is obviously an issue. However, levels of THC in the body do not directly equate to impaired driving in the same way that alcohol does, secondary to the way THC is metabolized in the body and how it remains in the body due to it being a fat soluble substance (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3456923/). “Stoned drivers” do not pose the same risk to the public’s well-being as “drunken drivers” do; indeed “stoned” drivers tend to drive more slowly. Researchers from UCLA have called for more efforts to be made around lowering acceptable blood alcohol levels to truly curb issues around impaired driving (http://www.nytimes.com/2014/02/18/health/driving-under-the-influence-of-marijuana.html?_r=0), as being at .08 BAL leads to an eleven fold increase in the risk for being in a car accident, while driving under the influence of cannabis leads to a two-fold increase of being in an accident (texting while driving has a two fold increase and talking on the phone while driving has a 3 fold increase in risk for car accidents) (http://www.huffingtonpost.com/sam-tracy/putting-marijuana-dui-in-_b_6023136.html). Driving or operating machinery while under the influence of cannabis is unacceptable and indicates a risk, however in Colorado since legalization of recreational use of cannabis was initiated, DUI fatalities have decreased (https://www.washingtonpost.com/news/the-watch/wp/2014/08/05/since-marijuana-legalization-highway-fatalities-in-colorado-are-at-near-historic-lows/?utm_term=.64fa02a0cc5e). It should be noted that Colorado made a concerted effort to promote safer driving conditions and decreasing driving while intoxicated once they ended cannabis prohibition. all states should be making efforts to combat intoxicated and unsafe driving practices.

Children: When cannabis was made recreationally available in Colorado, it appeared that more children were being accidentally exposed to cannabis (http://www.usatoday.com/story/news/nation/2014/04/02/marijuana-pot-edibles-colorado/7154651/). I would posit however that once the plant became legal, more parents were willing to seek medical attention if their child had accidentally ingested cannabis infused edibles or other cannabis products. Additionally, the relative number of cannabis ingestion issues versus other toxic substances truly remains quite low in Colorado at 6.4% of all “poisoning” cases treated within the pediatric population (http://www.cnn.com/2016/07/27/health/colorado-marijuana-children/index.html). There has not been a single reported death from a child (or any person) ingesting cannabis (unlike other ingested toxins, such as laundry pods: http://www.cnn.com/2014/11/10/health/laundry-pod-poisonings/index.html). So while we will need to educate consumers about the risks of pediatric access and ingestion of cannabis, the risks remain relatively low. In most cases, children recover quickly from cannabis intoxication, with hospitalization for supportive care only, which generally lasts 1-2 days and generally leads to no lasting side effects (http://health.usnews.com/health-news/news/articles/2013/05/27/kids-poisoned-by-medical-marijuana-study-finds
). Both the states and the individual companies who will be selling cannabis should be responsible for educating the public around ensuring pediatric safety should a state chose to legalize. Ideally some of the tax dollars generated from cannabis sales would be geared toward education of the public on safe cannabis consumption and storage.

Teen Use: Teen cannabis use has actually declined as more states legalize or become medicinal cannabis states (https://www.washingtonpost.com/news/wonk/wp/2014/12/16/teen-marijuana-use-falls-as-more-states-legalize/). This in part may be due to tougher regulations making it harder for teens to access cannabis, and a decrease in black market availability of cannabis.

Pregnancy: Dr. Melanie Dreher, the Former Dean of Rush University school of nursing, is a nurse who researched the Ganga culture in Jamaica for over ten years, and determined that there were no adverse outcomes to the fetuses who were exposed to cannabis (https://www.youtube.com/watch?v=K9WorIM0RhA; https://www.youtube.com/watch?v=RDV5HhmP4UI). A recent study also reported that cannabis use is safe during pregnancy (though caution may still be advised)(http://www.scienceworldreport.com/articles/47194/20160910/marijuana-safe-during-pregnancy-experts-encourage.htm) and breast feeding while using cannabis also appears to have minimal risks (http://cannabisclinicians.org/breastfeeding-and-cannabis/).

Harm Reduction: Cannabis has been studied as a harm reduction tool, particularly when it comes to addiction and treating folks for pain related issues. Physicians have called for neuropathic pain to be treated with cannabis instead of opioids (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3295721/). We also know that cannabis can decrease the need for escalating doses of opioids, and assist people who are opioid dependent in either decreasing thier doses of opiates or completely overcoming their addiction (http://nationalaccesscannabis.com/press-release/opiate-study-press-release/).
For an overview of the body’s endocannabinoid system and the issue of biological harm reduction, please see here: http://harmreductionjournal.biomedcentral.com/articles/10.1186/1477-7517-2-17

Overdoses with opioids have fallen in states where medicinal and legal cannabis are available (http://www.nytimes.com/roomfordebate/2016/04/26/is-marijuana-a-gateway-drug/overdoses-fell-with-medical-marijuana-legalization; and https://www.drugabuse.gov/news-events/nida-notes/2016/05/study-links-medical-marijuana-dispensaries-to-reduced-mortality-opioid-overdose). With high rates of opioid addiction plaguing our country, it makes sense to legalize cannabis now to help address this issue.

Self-Medicating: People self-medicate with substances on a daily basis; from alcohol to caffeine to tobacco. People self-medicate with herbs as well from turmeric to Echinacea, to vitamins and natural thyroid supplements. With legalization and regulation, people have a better chance of using safe, monitored, quality herbal cannabis medicine. For most of our recorded human history, cannabis was used as a healing herb. This came to a halt when cannabis prohibition became a global stance. Additionally, legalization opens the door for more open discussions between healthcare providers and patients. Healthcare providers such as nurses and doctors must become educated around the body’s endocannabinoid system and the therapeutic use of cannabis to create homeostasis and support healing.

Pathways for New Healing Products: Currently, many new cannabis products that are available in legal states are not available to medicinal patients in states where only medicinal cannabis is legal. For instance, various teas, salves, edibles and patches that are available in Colorado, Washington, or Oregon are not yet always available for medicinal patients in other states. Once states have a legalized cannabis regulation processes in place, it may be that people can access items such as a topical sub-dermal patches to deliver cannabis medicine or specific cannabinoids. A person may be able to use a CBD (a non-psychoactive cannabinoid) only patch during the day to help with issues like, pain, anxiety, nausea, and depression, and a CBN patch (another non-psychoactive cannabinoid) at night to help with sleep. In this example, the person would have minimal if any exposure to the psychoactive effects of THC in cannabis, and yet they may experience a greater quality of life. From a justice perspective, people deserve to make choice around the medicines they would like to utilize for their own healing, particularly when the medicines are safe.

Social Justice Issues and Policing: Recently, the chiefs of police in Maine came out against the yes on 1 ballot initiative to legalize marijuana in Maine. It is interesting to me that this organization stated they are “unprepared to address legalization issues,” when certainly looking at the legalization issues in Colorado and Washington should provide plenty of data and solutions to common issues. I would posit that there would be fewer marijuana trafficking issues and convictions, and the police could turn greater attention to bigger and more harmful issues in Maine, such as the opioid crisis and OUI related to alcohol ingestion. Additionally, cannabis legalization is a step toward social justice given the illogical, irrational, and unsuccessful war on drugs (http://www.sfgate.com/opinion/article/Marijuana-legalization-a-step-toward-social-5848468.php, http://theweek.com/articles/542678/why-pot-legalization-also-fight-social-justice). Legalizing cannabis should free up our law enforcement agencies to fight crimes that cause greater damage, even as it lowers the need for them to be addressing black market cannabis issues.

I would like to close with my final thought:

All cannabis is medicinal. Our bodies have our own endocannabinoid systems; we make our own endogenous cannabinoids. However when we become deficient in these cannabinoids, we may become ill and need to seek exogenous sources of cannabinoids, or support our own bodies in creating more endocannabinoids. Cannabis is a safe effective medicine with a low rate of addiction and minimal if any withdrawal symptoms, similar to caffeine. Ingestion of cannabis itself has never lead to a death (unlike many prescription and OTC drugs, alcohol, and nicotine products), and it is time we begin to move beyond the government’s ineffective “prohibition of marijuana” stance and take steps toward effective access for all adults.

In the states where cannabis is a ballot initiative, I urge us as nurses and other healthcare providers to explore the data around cannabis as a medicine and consider our roles as advocates for patient access to the healing support this medicine can provide.

Expressing Gratitude For Our Global and Local Nursing Leaders

June 29, 2016June 29, 2016 / Carey S. Clark, PhD, RN, AHN-BC, RYT, FAAN / 1 Comment

I have been fortunate to have been supported and influenced by many of nurses’ contemporary leaders: I studied with Dr. Jean Watson prior to completing my dissertation by taking 6 units of doctoral level electives with her at UCHS. I had contacted Dr. Watson during my Masters studies, and I was amazed at how approachable she was via email. Watson’s Theory of Human Caring has influenced and directed my work in a way that is immeasurable on many levels; being with her and spending a week in sacred center, studying emerging sacred-caring science concepts brought me to a new vision of how nursing education can and should be practiced.

I also stumbled upon the work of Dr. Peggy Chinn and the nurse manifest project during my early doctoral studies, and soon found myself embraced by the NurseManifest community. I was blessed to have been part of the first Nurse Manifest research project team, and the experience of presenting our findings together was monumental in my life as an emerging nursing scholar.

While Dr. Watson and Dr. Chinn epitomize the amazing academic and scholarly accomplishments of Nurses’ Living Legends, they both also remain approachable, kind, caring, and generous. They reflect back to us a deep love for nursing, coupled with calls toward caring and a level of social justice activism that is highly needed in our process of supporting both local and global healing. There are many other nurses whom I might call “global nursing leaders” who share in this attitude, commitment, and consciousness toward change.

I am also frequently touched by the leadership capacity of my nursing students; the willingness to change their lives, spread their wings, and find ways to bring caring, holism, and healing to the “local” bedside in environments where these concepts often remain fringe in the face of allopathic approaches. The many global nursing leaders inspire nursing students, and the continuum to me is clear; students and nurses need these leaders to raise our consciousness, build our confidence, and lead us into our own leadership capacity at the local level. We need global leaders to shine a light on our professional paths and support our deepening understanding of both self as nurse and our profession’s capacity to create nursing qua nursing as the norm.

I am honored to be working with my RN-BSN students this fall in their leadership coursework. We will look at Chinn’s Peace and power work and also explore leadership through holistic concepts. We will examine burnout and how we can recover or support others in their recovery through self-care. In analyzing our workplaces, we will explore Sharon Salzberg’s (a registered nurse and globally known meditation teacher) Real happiness at work: Meditations for accomplishment, achievement, and peace as a supportive tool for self-exploration around workplace issues.

Many nursing students struggle to perceive themselves as “local nurse leaders”, and I strive to support them to tap into their own leadership capacities, to create the types of healthcare workplaces where they can thrive and support the healing of their patients through integrative modalities and caring consciousness. I do believe one way to provide this platform for students’ emerging leadership is to create a caring environment for students, to support their own healing processes, and to role model shared leadership processes and self-care-healing for, and with, students. In this way, I humbly express my deepest gratitude for those global nursing leaders who have shone their light on my own professional and healing path when it was often far from clear where I was headed.

The Prison System and Social Justice

May 3, 2016 / Carey S. Clark, PhD, RN, AHN-BC, RYT, FAAN / 2 Comments

I recently came across an article in the New Yorker entitled Madness by Eyal Press. The full article can be viewed here: http://www.newyorker.com/magazine/2016/05/02/the-torturing-of-mentally-ill-prisoners. The article looks at one Florida prison, where mentally ill patients have suffered horrible mistreatment by the prison system. Our largest provider of healthcare for the mentally ill in the United States is the prison system, and yet our leading mental health researchers and providers tend to shy away from or ignore this enormous vulnerable population.

I will warn you that you may find aspects of the Madness article disturbing, and it leads us as nurses to consider many social justice issues, including the right to adequate care, proper diagnosing, safety, and support for health and healing. As the United States has the highest incarcerated population of any country, nurses need to consider how we as a society and a culture care for and treat our very vulnerable mentally ill population. The challenges of advocating for these prisoners and one’s own potential vulnerability when working in this system are clearly highlighted in the Eyal Press article. Until we recognize the mentally ill incarcerated population as traumatized human beings in need of deep caring and support as they proceed along their own healing journey, true transformation of our systems toward ones that can offer rehabilitation and reduce recidivism may remain elusive.

I also found this article to be heart wrenching on a personal level. My brother died in prison at the age of 45, and the unit where he died is indeed either this particular unit as described in the Madness article, or one very similar to it in Florida.

My brother Bryan was a star elite athlete in his youth, holding a national age-group track record set at the Junior Olympics when he was around 15 years old. After sweeping many state championships in high school track, he received an athletic scholarship to a school in the midwest, and while he had been a “difficult hyperactive child” deeper signs of his mental illness began to emerge. He ran up huge gambling and credit care debts, and one Christmas he returned home from school having lost about 25 pounds with no good explanation for why this had occurred.

When he was about 25 years old and had finished college, Bryan had a full psychotic breakdown. He spent several months in a psychiatric facility as they strived to diagnosis and stabilize him. My brother was bipolar with schizoaffective disorder, and sometimes his life was relatively calm, like when he married his first wife and they dreamed many dreams together….other times not so much, like when in the midst of another psychotic break he held a knife to his first wife’s throat; or the time he totaled his own car using his own hands and a crowbar; or when he was found running naked on the Nike compound in Oregon.

In 2008 Bryan went off his medications for unknown reasons. He became incredibly manic, delusional, and he was certainly having hallucinations. He left his wife and young daughter and moved into a shelter setting, which he was kicked out of due to fighting with others. Simplifying the story a bit, I will just say that he was found tampering with his estranged wife’s car at her place of work and the police were called; a high speed chase ensued and my brother was charged with aggravated battery with a deadly weapon (I believe he struck one of the officers with something once his car was forced to a stop), aggravated fleeing and eluding police, and resisting an officer with violence. About two months after his arrest, upon the advice of his free public attorney, my brother took a plea deal and he was sentenced to 3 years in the Florida State Prison System. I believe his mental illness, which he had been struggling with for over 20 years, was never clearly considered in the charges or in his placement. The copy of his charges is here: https://bailbondcity.com/fldoc-inmate-CARROLL/130350 .

As sometimes happens within families of those suffering from mental illness, my brother and I had been estranged on and off for most of our adult lives. My brother would sometimes become violent, threatening, and manipulative when he was off his medication, and I desired a peaceful life for me and my young family. Our childhoods were traumatic, and while I can’t speak for my brother, my adverse childhood experiences were a “5”/ 10, which indicates trauma to the point of potentially having adverse effects on health and low stress resilience. I am certain that my brother also had a high ACES score, and that his mental health issues were compounded by our traumatic youth and family life. [If you want to learn more about how adverse childhood experiences impact one’s health, I have presentation that covers that here, slide 16 begins the information around the ACEs concepts: https://voicethread.com/myvoice/#thread/4492225/22882928/24864974 }.

Due to our previous estrangement and my own challenges with balancing caring for a newborn baby and toddler, and working as an adjunct nurse faculty for several different schools, I did not reach out to my brother prior to his incarceration or during that time, though we had been in touch on and off for the three years prior, when our mother had passed away suddenly from a massive MI. So, my father and stepmother kept me informed of Bryan’s prison life and while they did not visit him, they often scanned and forwarded his letters to me. It was clear to me that during his less than one year in prison, he declined rapidly; he claimed to be taken off all of his medications and we know he was transferred to a psychiatric unit (either the same one in this article or another one like it). In the two months prior to his death, he mentioned several times that he was dying or he was going to die, that things were very bad in prison. I encouraged my stepmother and father to reach out to him and the system, which they did not do, and I found that since I was not on Bryan’s “list” I had no rights around communication with him and within the system.

Via an email on the morning of March 28, 2009, I found out that Bryan had died in prison. The official county coroner’s autopsy stated that at the age of 45 Bryan had died of “moderate heart disease”, though it contrarily also noted no signs of stroke or MI. As his sister, I had no rights to request or pay for a second independent autopsy, and my family refused to have one performed, instead opting for an immediate cremation. Over the 7 years since his death, I know I have been suffering from complicated grief; I have felt powerless to create change in the prison system and sometimes I have felt scared to use my voice to call for change and for social justice in the way we manage the health of our growing prison population. I have felt fearful of being stigmatized and ashamed for having a relative who was incarcerated.

However, when I think of the many social justice issues the Madness article brings up, I begin to feel angry; and that anger is now motivating me to speak out and find ways to support the creation of healing within our justice systems.

I know that part of my own healing journey involves moving beyond telling my brother’s story, and beginning to move toward taking action in supporting an end to the injustices our incarcerated vulnerable populations suffer. I recently have been in connection with a beautiful resource at the Maine Prison Hospice Project (http://mainehospicecouncil.org/?q=content/hospice-corrections-partnership-maine-state-prison ), and I hope to help support their research efforts around the benefits of prisoners being of service during and after their incarceration period. I hope to someday serve as an example of how nurses on their own healing path strive to heal in conjunction with others; with those whom we serve. Imagine what we can do when we truly believe we are all on this path together, as interconnected unitary human beings; then the movement toward social justice becomes a part of our calling on this life’s journey.

The Power of Nursing

April 27, 2016April 20, 2016 / marlainesmith / 2 Comments

On January 24^th in the early morning hours my husband Brian woke me up because he said his left arm was hurting and he was nauseated. After I gave him two aspirin we rushed to the ED of our regional hospital….He had a myocardial infarction in process. The cardiac cath team was called, and an amazing interventional cardiologist performed a balloon angioplasty to open up the blocked artery. After Brian was stabilized in the CVICU he was transferred to the CV Step Down unit to wait for surgery. On January 29^th the cardiothoracic surgeon performed a CABG x 4 and Brian was discharged on February 3^rd. It was quite an ordeal. There are always lessons we learn when we are the recipients of health care.

As you can imagine this has been a life-altering event for both of us. During this critical time every person that we encountered and every circumstance that occurred, big and small, mattered to us. I can honestly say that Brian and I experienced the most excellent care that I could ever imagine, and this made a significant difference in his healing and my experience as a family member.

The nursing staff at this hospital were wonderful. We know that nurses are the heart and soul of any hospital. Every single nurse that we encountered was knowledgeable, skilled, attentive and compassionate. They were truly person and family-centered. Every one of them asked how she/he could be helpful to us. Watching the nurse caring for Brian immediately after surgery in the CVICU was amazing to me. It was like watching the conductor of a symphony. Her technological competence was incredible…she monitored everything moment by moment, while continuing to focus on Brian as a person experiencing this critical event, and on me as a wife fearful of what was happening. When I was waiting for news of Brian’s condition during surgery, several of the staff stopped in to encourage me and to give me updates if they could. This was so meaningful to me. When Brian was recovering, the CVICU staff pushed and encouraged him and did anything they could to make me comfortable. All the staff on the step-down unit exquisitely cared for Brian, supported us and made us feel “at home”. I’m so grateful to the nursing staff for creating the healing environment where this level of care happens.

We often hear about the horrors of poor nursing care, so I wanted to share this story of hope and encouragement with everyone. I am so proud to be a nurse because of the profound difference we make in the lives of people in the most vulnerable moments of their lives. Yes, our cardiologist and surgeon saved Brian’s life, but the nurses were equally biogenic (life-giving) to both of us. They preserved our dignity, prevented complications, prepared us for discharge, facilitated a smooth transition, allayed our anxieties, relieved our pain, provided comfort, lifted our spirits with laughter, gave us critical information, challenged him to do more than he thought possible, instilled hope for the future, involved us in choices, and took the time to listen to our fears and rants.

P.S. Brian is in cardiac rehab now and is recovering.

Never ever ever underestimate the power of nursing. We transform lives by healing through caring.

Celebrating recovery with Brian!

Nurses as Healers: Good Work Environments

January 25, 2016December 23, 2017 / Carey S. Clark, PhD, RN, AHN-BC, RYT, FAAN / 2 Comments

I remember when I became a new nurse 21 years ago, and a friend asked me what I did at the hospital when I worked those long 12 hour night shifts. His thoughts were that the patients were asleep, so it was probably a job where you hung out and drank coffee, occasionally checking in on a patient. I remember walking him through what I usually did on a 12 hour 7pm- 7 am night shift, including most of the tasks and requirements of the job from receiving report at the start of the shift to giving report at the end of the shift. I made sure to include that if- when I got a break, it was usually around 2am or 3am when I was finally “caught up enough” to take some 20-30 minutes to nourish and hydrate myself.

As I thought of this telling of what nurses do some 20 years later, I wondered if I included what nurses are really charged with doing, which is supporting the healing of those we care for. Did I focus on all of the tasks and duties I would complete during that 12 hour shift, or did I also include the time spent rubbing backs, holding hands, saying prayers, educating, and supporting patients and their loved ones? Did I include the story about the time I had to call a deaf woman and tell her husband had passed after she left for the evening? Or the time when the family asked me to increase the morphine drip rate because “the doctor said she would be dead before the morning and we are ready for her to be gone”? What about the man with ALS being kept alive on a ventilator and feeding tube who lay lonely in his bed, unable to verbally communicate, and went for weeks at a time without a single visitor?

I believe that as nurses we need to educate the public not just on all of the technical skills we do each day to support patients’ receiving good medical care, but also on the healing aspects of our unique work as nurses: on how we were likely “called” to be a nurse because we want to make a difference, the skills we have developed that support us in creating caring-healing environments for patients, and the rewards of being able to support others through their healing process. I think we should be making it clear to the public as well that we are committed to our own health and healing, knowing that we can’t support others through health challenges if we are not also dealing with these challenges ourselves. And as nurses, we need to support one another in our own healing process, role-modeling what self-care and stress management look like in action.

A recent study research from www.mountainmiraclesmidwifery.com/, showed that supporting nursing and creating “good nursing environments”, with adequate nurse staffing, leads to better long term patient outcomes, with fewer deaths one-month post surgery (http://mobile.reuters.com/article/idUSKCN0UZ2XL). It pays for hospitals to invest in having enough nurses, in treating those nurses well, and supporting nurses in what we have been called to do: create healing environments that support patients toward their greatest health potential. Healthcare facilities need to be moved to support nurses in managing their stress and enacting self-care in order to potentiate the healing of the patients these facilities serve. Good staffing is just the beginning of creating “good nursing environments”: nurses should be empowered to begin dialog with their employers regarding what a healthy and good work environment for nurses looks like in consideration of the healing work that nurses do.