The Nursing Manifesto: Aligning action toward living nursing as caring science and wholeness

November 30, 2014December 2, 2014 / Carey S. Clark, PhD, RN, AHN-BC, RYT, FAAN / 2 Comments

“Organizations are not changing because people in organizations are not changing” (Cowling, Chinn, & Hagedorn, 2000).

The Nursing Manifesto provides us within the profession a beacon of light and hope toward creating change; it provides a map of sorts leading toward the manifestation of Nursing Qua Nursing. It calls for us to grow, change, and evolve into our professional caring autonomy.

My doctoral dissertation looked at Nursing’s Living Legend, Dr. Jean Watson’s Theory of Human Caring and how it could be explicated through relating it to other areas of academic disciplines: chaos theory, partnership theory, and transpersonal psychology were all used to support the concepts in Watson’s theory. My overall conclusion after many pages of theoretical writing was that nurses need to be on a journey of self-care and reflection in order to enact the human caring experience that Watson calls for.

“We believe that our journeys to enact this manifesto will certainly require a reuniting of the inner and outer life, accepting our wholeness and owning our freedom – a wholeness and freedom that will strengthen our outer capacity to love and serve” (Cowling, Chinn, & Hagedorn, 2000).

How can one love and serve in their capacity as a nurse? Several years after completing my dissertation, I was given the opportunity to develop an RN-BSN curriculum from a caring- holistic-integral science perspective at the University of Maine at Augusta. The recently accredited program emphasizes self-care and reflection, while students also have the opportunity to explore holistic modalities for use on their own healing paths and to share with others as well. The creation of this curriculum was an act of love and it continues to be a path of service toward the nurses we care for in our program.

For several years, I had a dream of bringing Jean to our students and faculty. Eventually we were able to partner with our local hospital Maine General Medical Center and bring Jean not only to our students, but to nurses and nursing students from around the state of Maine. After a year of planning by a committee of 10 empowered nurses, we were able to bring over 400 nurses together to spend a day with Jean, learning about her theory.

The Augusta, Maine civic center was transformed by the planning committee nurses to be a healing space; special lighting was used, break time music was geared toward songs that support healing, plants were brought in, and intentions were set by the planning committee for healing space and caring science to emerge. The lunch meal and morning and afternoon fruit offerings were also geared toward support the health of the participants.

Dr. Watson spoke for many hours throughout the day about her transpersonal caring healing moment, the challenges we as nurses face in the current medical-cure based healthcare system, and the 10 Caritas Processes that support the nurse in creating the caring moment. Participants were encouraged to ask questions and share their own experiences with caring and healing. The whole day aligned with the Nurse Manifesto process, in that Dr. Watson focused on Nursing Qua Nursing and how we can move toward a caring science reality of nursing: “It is our firm conviction that there is a body of knowledge that is specific, if not unique, to nursing’s concerns and interests. We think that this knowledge is grounded in appreciation of wholeness, concern for human well being, and ways in which we accommodate healing through the art and science of nursing” (Cowling, Chinn, & Hagedorn, 2000).

Additionally she spoke extensively about the broken healthcare system, which has morphed into an illness system, or as the nurse manifesto noted, “general subjugation of spiritual consciousness to the economics of health care” and “the long-standing ideology (acquired consciousness) of nurses being subservient to other interests, and not encouraged to be deeply committed to their own healing work” (Cowling, Chinn, & Hagedorn, 2000).

Of great importance throughout the day was the emphasis on Watson’s first caritas process ™: Embrace altruistic values and Practice loving kindness with self and others. The other 9 caritas process revolve around the nurse’s efforts toward enacting the first caritas process, which begins with the nurse learning to care for themselves through self care, or acting in love towards oneself.

Students provided us with feedback after the event, and they stated that the most profound experiences were being able to meet Dr. Jean Watson, and also experiencing the transpersonal caring moment through a listening experience. During this experience, the participants first centered themselves in order to speak or listen from the heart; and then in pairs, they had the opportunity to practice being present and listening without saying a word, as well as reversing the experience and speaking for several minutes from the heart. The students found this to be profound and they realized what it means to be truly present with another person in a caring- heart centered experience. Many nurses do not have the skills or experience in this area, so this is something we must continue to foster in our nursing curricula and healthcare settings. My hope is that the nurses who experienced this event will have experienced some change within themselves that will help foster the change needed in the healthcare system. Love, serve, remember….

I am grateful to also have had media coverage of the event. Media coverage for nurses is of great importance, moving us out of the shadows and away from the invisible nature of our work. The front page of the Kennebec Journal on November 17 read, “Love is What Heals” and included a picture of Dr. Watson at the podium. Additionally, the event was covered by the local TV station, and that can be viewed here: http://www.foxbangor.com/news/local-news/6994-doctor-redefines-practice-of-nursing.html This media coverage is important, because as we know nurses tend to be invisible in the media, our presence often over-ridden by the medical-cure based system. We need to continue to find ways to shine our own unique light of love and healing.

Reference:

Cowling, W. R., Chinn, P. L., & Hagedorn, S. (2000, April 30, 2009). A Nursing Manifesto: A Call to Conscience and Action. Retrieved from http://www.nursemanifest.com/manifesto_num.htm

Composing a Life Work: Why Creativity Matters in Nursing

October 31, 2014October 31, 2014 / Carey S. Clark, PhD, RN, AHN-BC, RYT, FAAN / 2 Comments

The following is a guest blog by Jennifer (Jen) Reich PhD, MA, RN, NC-BC Nurse Coach, Poet, Storyteller.

Once upon a time, I wrote a story called The Healer (2011). The premise of the story is a little boy from a difficult upbringing who encounters a magical being on his way to collect sea glass. He is collecting the glass to make a mosaic for his mother. With the help of his friend, he collects enough to make one for his school as well. He grows up to be an artist, creating mosaics for his community, nursing homes, and hospitals. When he is an old man, he meets his magical friend once more. She tells him he has been a great healer and will be welcomed into her tribe. At first he doesn’t understand. She explains that since he has followed his passion and created his mosaics with love, his art has brought great healing. Love, she tells him, is always healing.

I have written poetry and stories for as long as I can remember. Often I think in poetry, and it has always been a way to help me process information and feelings, to find my voice. I started playing the trombone in elementary school and music became another outlet for me. However, it wasn’t until I began working as a psychiatric tech in nursing school that I discovered how powerful the arts were to help those suffering give voice to their experience. I also realized how important poetry and writing were for me to give voice to my own experience as student nurse and tech.

As a new nurse, I learned from mentors that though a cure is not always possible, there is always potential for healing (Dossey, 2013). Most nurses have experienced the death of a patient or client and know it is part of their work. So how do nurses cope with these sorrows? Some use self-reflection and self-care strategies while others may engage in self-negating behaviors as a way to manage their stress and pain. Sometimes, it’s a little of both. The Nurse Manifest Document Introduction (1a, 2009) states: “We call forth the written and spoken voice of nursing to be claimed and reclaimed. We seek to inspire the fullest expression of the heart of nursing through individual and collective acts. We believe there are profound possibilities in claiming our individual and professional sovereignty.” As caring professionals, nurses need to have creative outlets not only to cope and de-stress, but perhaps most importantly, to find our individual and collective voice.

Very recently, we saw an excellent example of nurses claiming their voices. It began with an instance of nurse blaming in the Dallas nurses who contracted Ebola. In the case of both nurses, before the whole story was out, fault was transferred to them (Goodwin, 2014). However, colleagues in nursing would not allow this to go unnoticed and without consequence. Nurses from organizations such as National Nurses United, stood together collectively to voice their opposition and support their sisters in nursing. Petitions were generated and spread through media outlets. Individual nurses shared their personal and professional experiences through stories shared on blogs and Facebook and Twitter feeds across the Internet. These stories went beyond the nursing community and to the public where the compassion and professionalism of nurses could be seen and heard.

Despite this inspiring display of community and support, we still hear old adages such as “Nurses Eat their Young,” or concerns that nurses are the worst when it comes to taking care of themselves. Remember in The Healer story the boy learned that engaging in his work with great love and passion brought healing to others. When we don’t take time to care for our mind, body and spirit we deny ourselves the balance and harmony we seek for our students or those in our care. Creativity is a path to touching and bringing forth the inner knowing and wisdom to what we best need to reignite our passion. For example, when I do creative self-care workshops, participants will often tell me they haven’t painted, written stories or poems, or danced since before they were in nursing school, or even as far back as childhood. Having this creative release often gives them the courage to voice what has been long held within. There is very little teaching involved on my part, they already know how to be creative. My role is to provide encouragement and help them surrender to the creative process without judgment and/or critique.

There are journals dedicated to evidence-based research on the healing effects of the creative arts in patient/client populations. Music and arts-based therapists do amazing work with arts-based interventions in individuals, groups, and communities. However, there is limited research on why creativity is necessary for the wellbeing of nurses and healthcare professionals. Further, we often don’t often reflect on how the creative arts enhance our nursing practice. One example I share is from a hospice patient I met years ago. He had been a sax player and jazz musician. We spent a little time before each assessment chatting about jazz. I was able to have a volunteer get him a CD player to listen to his music. There was a reciprocal healing process as our connection through music contributed to a sense of greater well-being on both of our parts. In addition, it opened up space for me to understand his concerns and care needs.

When we are engaged in the creative process, we are fully present. This, in turn, teaches us presence. We are so longing for presence in this world. Though more and more coffee shops pop up, most of them have a drive-thru with lines wrapping around the building. We have bigger banks and lenders, and more often than not, we aren’t able to talk to a real person. We cannot explain to an automated system that the reason we missed a bill payment for example, is that we were caring for a sick parent or child. We need creative soul-utions, not just automated systems in our daily lives, and we need these in nursing and healthcare.

I had the privilege of interviewing 13 experienced RN’s on the concept of ‘story’ as part of my dissertation work. When I sent out my recruitment flyer, I received responses immediately and could not interview everyone interested. I realized from this experience that nurses want to be heard! We need to create more spaces to share our stories, to make art together, write poems, listen to music, to dance. Whether our nursing work is on the front lines in direct care, or as teachers, coaches and/or advocates, we must reignite our love for our calling and create individually and collectively a new paradigm for healing. For though there is no cure for all of the problems facing our healthcare system and the world, when we give voice to our life and work though creativity, healing is always possible~

References

Cowling, W. R., Chinn, P. L., & Hagedorn, S,. (2000). A Nursing Manifesto: A Call to Conscience and Action. Retrieved: https://nursemanifest.com/a-nursing-manifesto-a-call-to-conscience-and-action/manifesto-with-markers-for-citation/

Dossey, B.M. (2013) In B.M. Dossey & L. Keegan (Eds.) C. Barrere & M. Blaszko Helming (Assc Eds.) Holistic nursing: A handbook for practice (6^th ed) (pp. 247 – 260). Burlington, MA: Jones and Bartlett Publishers

Goodwin, W. (October 24, 2014). Was CDC Too Quick To Blame Dallas Nurses In Care Of Ebola Patient? National Public Radio (NPR) Retrieved: http://www.npr.org/2014/10/24/358574357/was-cdc-too-quick-to-blame-dallas-nurses-in-care-of-ebola-patient

Reich, J. (2011). The Healer. Retrieved: http://poetry-not-poverty.blogspot.com/2011/11/november-story-healer.html

Jennifer Reich PhD, MA, RN, NC-BC is a nurse coach, poet, and storyteller. She received her PhD in Nursing from The University of Arizona in 2011 and is adjunct faculty in the College of Nursing. In addition to nursing, her background also includes degrees in Exercise Science:(Gerontology Specialization) and English/Theatre (minor) and training and practice in Mindfulness Based Stress Reduction, Reiki, Health Appraisal and Meditation. She has incorporated these diverse experiences to design wellness programs and teach self-care strategies to nurses and caregivers throughout the country.

You can find Jen @ https://www.facebook.com/Jenreichpoetry and www.poetry-not-poverty.blogspot.com. Jen wishes to thank Jackie Levin RN, MS, AHN-BC, CHTP for her review of the blog.

The Light and Dark of Nursing: Our Shadow, Part II

September 8, 2014 / Carey S. Clark, PhD, RN, AHN-BC, RYT, FAAN / Leave a comment

I have heard from many folks that they enjoyed the Part I of this blog series, which looked at some of our deep, and most scary, shadow issues in nursing; namely how a serial killer nurse can work in a healthcare system for years before being brought to justice and how the system failed to protect patients.

While this was likely one of our most extreme cases of complex shadow issues (there are a few more serial killer nurses out there, though thankfully they are low in number) and certainly many healthcare systems and administrations are in need of reform, there are also some very serious “everyday” shadow issues that nursing needs to shine the light upon in order to transform the profession. As we shine the light on our dark side, our shadows, we can begin to move out of denial of our professional issues; hence we can also begin to look for creative solutions and transformational change opportunities.

We experience challenges with the transformation of nursing practice: why is it taking us so long to take back our practices; to be able to practice nursing as a caring, compassionate, and healing art; to practice nursing qua nursing; why does it feel like we are stuck in a dark night of the soul in nursing?. We, as a professional group, have yet to really look at our own shadow projections. Theoretically, it could be that once we recognize our own shadow, the hard work is done; then we can observe, acknowledge, witness, accept and integrate these issues. This would mean less doing and fixing for our profession; we could practice presence and being with where we are at right now during these challenging times, as we look toward where we would like to be and discover how we might get there.

Below are some shadows in the profession that may be worth examining, recognizing, and witnessing. Growing awareness, being with, and bringing our collective nursing consciousness toward recognition can help move us out of states of professional oppression. Please feel free to consider and share any nursing and healthcare shadows you experience in your workplace as well!

Cognitive stacking shadow: Boynton and Hall (2012) wrote an informative post about how complex and demanding nurses’ work is from the viewpoint of our complex duties and decision making processes. Nurse Overload: The Risks to Employees and Patients .

This is worth a read to get the basics around how our workplace environments overload us with information, data, and distractions at the risk of our own and our patients’ health and safety issues. The problem here is that while systems know that this sort of overload leads to job dissatisfaction, loss of nurses, and risks to patient safety, systems and nurses seem to be doing little to no research on how to change these issues. This is costly on many levels, and perhaps nurses need to also look into how we can create new workplace environments that support our own and our patients’ well being. Cognitive stacking leads to overload and initiates the stress response, which is our next shadow to shine some light upon.

Stress response shadow: Nurses are stressed out: we work in stressful environments and we often tend to put others’ needs in front of our own, somehow failing to recognize that a) our stress has a direct impact on the stress and healing capacity of those we care for, b) we can’t keep giving without taking time to recharge, rejuvenate, and care for ourselves and c) stress is impacting our own health and well being (Clark, 2014).

The stress shows up in obvious patterns that nurses have created. I have been asked many times why so many nurses are obese. Is this a shadow issue for us as nurses, the ones who know the damage obesity causes in our bodies? Despite knowing the health issues associated with obesity, up to 54% of nurses are overweight or obese (Miller, Alpert, & Cross, 2008). Most nurses in this particular study were not motivated to make changes in their lifestyle, despite knowing the health risks of obesity.

Students often tell me they are overweight because they don’t have the time to exercise, prepare meals, eat right, sleep well, drink water, etc. Somehow the healthcare system (12 hour shifts? lack of access to healthy foods? high cortisol levels related to stress?) creates a stressful environment for us, and somehow we fail to recognize the impact this stress has on our bodies, and that we need to manage this stress or suffer the consequences. The average nurse gets only about 6 hours of sleep before any given shift, and this has great impacts on health as well as ability to function as strong clinical decision maker hour after hour (Clark, 2014). This medscape article clearly delineates the issues we face around sleep and the impact it has upon us:A Wake up call for nurses: Sleep Loss, Safety, and Health.

Stress contributes as well to many of other shadow issues: lateral violence, the nursing shortage, and our own poor health states. Letvak, Ruhm, & Lane, (2011) found that nurses will work when they are sick, and unfortunately we have higher rates of eating poorly, smoking cigarettes, abusing drugs and alcohol… and we can tend to overwork or engage in workaholic type activities (Burke, 2000).

Time and again, I hear tales from ASN through PhD prepared nurses about how they suffered PTSD from the nursing school experience, and we know that PTSD is a hazard of being a nurse: up to 14% of all nurses meet the criteria for PTSD, while as many as 25%-33% of nurses in the critical care and emergency settings screened positive for symptoms of PTSD (Mealer et al, 2007; Laposa, Alden, & Fullerton, 2003).

We know about these issues and yet both nursing academia and the systems in which we work tend to turn a blind eye toward the reality of the nursing profession’s risks and deep challenges toward health and managing our professional stress. Every healthcare facility and every school that educates nurses should be striving to shine the light on these shadow issues, and look toward finding ways to help support the health and stress management capacity of nurses. This becomes an ethical issue when we consider how the stress of the nurse can impact the stress and healing process of patients; the nurse in stress response adds to the stress of the patient’s environments, potentially right down to the neurological stress response of the patient (Clark, 2014).

Shadow Side of Caring: Most nurses likely became nurses because they care about others, they want to support healing, and they want to make a difference in others’ lives. Unfortunately, nursing school in general does not prepare new graduate nurses for the challenge of creating caring-healing environments in the face of stressful workplace demands (Clark, 2014). Every nurse educator should be concerned about providing students the tools needed to manage stress in order that they make sound clinical decisions and maintain patient safety; and also that they might fulfill their life’s calling toward caring. This is an ethical obligation, and yet our academic environments tend to be initiation grounds for living through stress while students are not adapting adequate tools to manage stress.

There is also a lingering professional shadow that creating caring-healing environments takes time, we can’t possibly have time to care for and be with patients, when we have too much to do, too many demands, too many distractions, too much cognitive stacking, too little support, too few nurses, too much stress, etc. When we buy into the truth of this idea, there may no longer be a motivation to attempt to truly care for the patient. Additionally, many healthcare facilities, including magnet facilities, and systems may claim to support nurses in caring, and yet the reality of the workplace remains unchanged, even when changes have been claimed by administration. We may call this lack of support to realize our deepest call toward caring a form of oppression by the system (Clark, 2002, 2010). A concern I have is that oppression of nurses goes unrecognized by the profession in general, and as the largest number of healthcare providers, we seem to remain in the shadow of our own power, failing to recognize how we might begin to negotiate what is nurses do in systems and how we do it (Clark, 2002; 2010).

Shadow of Oppression

Oppression of the nursing profession may likely for many nurses have it’s shadow base in academia (Pope, 2008). As Pope (p. 21) so clearly defined oppression:

“Freire defined oppression as the imposition of one person’s (or group’s) choice upon another in order to transform an individual’s consciousness to bring it in line with the oppressor’s. Prescription of thoughts, values, and behaviors are the basic elements of oppression (Freire, 1970; Rather, 1994). A behavior that is symptomatic of oppression is horizontal violence. It is the exercise of power against people in the same oppressed group. It is overt and covert non-physical hostility, such as criticism, sabotage, undermining, infighting, scapegoating and bickering (Hamlin, 2000; Duffy, 1995)”. For many of us, these experiences of oppressive behaviors and horizontal violence began in nursing school, propelled by both faculty and students alike. Yet, most of us remain unaware that what we are experiencing, the bullying, the anger, the backstabbing, are clearly symptoms of oppression. Hence the cycles continue until we take the brave steps toward shining the light on these issues.

Pope (2008) goes on to illuminate how in the shadow of oppression, the oppressed become the oppressors; she suggested it is only through a recognition of the world of oppression, reflecting and acknowledging the reality of our socio-cultrual and political worlds, that we can begin to take action against the oppressive elements of reality and also recognize our own role in our own oppression.

The problem is that failing to address this in academia, we send nurses out into the workplace who have come to either deny oppression or conversely accept it as the norm; we may have new and seasoned nurses who lack the capacity to reflect upon these issues and their origin, rather generally accepting them “as the way things are”. As Marks (2013) found in her work with nurses at a Magnet hospital, while the nurses felt empowered with their work with patients, they knew they were experiencing a lack of empowerment within the healthcare system, but they were not aware of this as a form oppression.

Conclusion

This blog is simply the tip of the iceberg; the challenge remains for us in nursing to begin to examine our shadow issues, to be open and reflective toward our own roles in oppression, despite the discomfort this brings. We need to have scholars, researchers, theorists, and bedside nurses reflecting upon oppression. How did oppression in nursing begin, how has it evolved over the years, what are our next steps toward freedom through integrating the shadow? Are we ready to free ourselves from this oppression, choosing to not be like the oppressors, and transforming the oppressive nursing professional role toward one of nursing qua nursing: namely caring, holism, and healing?

References:

Boyton, B. & Hall, D. (2012). Nurse overload: The risks to employee and patients. Retrieved from http://www.confidentvoices.com/2012/10/23/nurse-overload-the-risks-to-employee-and-patient/

Burke, R. (2000). Workaholism in organizations: Psychological and physical well-being consequences. Stress and Health, 16(1), 11-16.

Clark, C. S. (2002). The nursing shortage as a community transformational opportunity. Advances in Nursing Science, 25(1), 18-31.

Clark, C.S. (2010). The nursing shortage as a community transformational opportunity: An update. Advances in Nursing Science, 33(10), 35-52.

Clark, C.S. (2014). Stress, psychoneuroimmunology, and self-care: What every nurse needs to know. Journal of Nursing and Care, 3, 146.

Laposa, J. M., Alden, L. E., & Fullerton, L. M. (2003). Work stress and post-traumatic stress disorder in ED nurses/personnel. Journal of Emergency Nursing, 29(1), 23-28.

Letvak, S., Ruhm, C. & Lane, S. (2011). The impact of nurses’ health on productivity and quality of care. Journal of Nursing Administration, 41(4), 162-7.

Marks, L.W. (2013). The emancipatory praxis of integral nursing: The impact of human caring theory guided practice upon nursing qua nursing in an American Nurses Credentialing Center Magnet Re-designated healthcare system. Retrieved from http://media.proquest.com/media/pq/classic/doc/3073838521/fmt/ai/rep/NPDF?_s=HaGBMdTxvziM7lbtbb%2FHTWouZWo%3D

Mealer, M., et al. (2007). Increased prevalence of post-traumatic stress disorder symptoms in critical care nurses. American Journal of Respiratory and Critical Care Medicine, 175(7), 685-7.

Miller, S.K., Alpert, P.T., & Cross, C.L.. (2008). Overweight and obesity in nurses, advanced practice nurses, and nurse educators. Journal of the American Academy of Nursing Practice, 20(5), 259-65.

Pope, B. D. (2008). Transforming oppression in nursing education: Towards a liberation pedagogy. Retrieved from http://libres.uncg.edu/ir/uncg/f/umi-uncg-1639.pdf
8.

The Light and The Dark of Nursing: Our Shadow, Part I

August 13, 2014 / Carey S. Clark, PhD, RN, AHN-BC, RYT, FAAN / 2 Comments

I love nursing and I love being a nurse. That is what makes this post so challenging to write, admitting that the profession where my heart sings, where I have grown and evolved over the last twenty years, has a dark side. But if we take the advice of Jung, we come to realize, perhaps, that the shadow, the dark parts that we may try to hide or deny, needs to be acknowledged and integrated. We can learn to be loving and kind toward that which was previously denied or rejected. By shining a light on the dark places, we can invite those hidden areas to come out fully, to open up to our secrets and our darkness. While we usually think of shadow work as an individual challenge, the profession of nursing could grow and evolve from examining our shadow, from shining a light upon our darker sides.

The Shadow: Nursing in the Media

I recently read the book “The Good Nurse”by Charles Graeber. I remember listening to NPR and hearing about the book when it was released and being very upset that a book about a nurse serial killer was given such a title. To listen to what I heard on the radio in April 2013, visit this link:

The Good Nurse, NPR

It took me a year to work up to the challenge of reading the book, as I was so upset about the title alone, let alone the interview. Who was this outside journalist who came to investigate these horrendous acts, surely he did not understand nursing if he named the book in this manner. My own anger at the title of the book and the horrific situation should have been clue to me right there that I had something to face here, at least according to shadow theory. Still, I thought a book called the Good Nurse should be all about the good nursing does, not about this outlier who murdered perhaps dozens of patients. Why not call this book, “The Worst Nurse EVER”? or “The Abhorrent Nurse?”

What I didn’t realize at the time was that this book has an important message to deliver, an important message not just about Charlie Cullen, the RN who killed many, many patients, but about the whole healthcare system, about the dark side of medicine for money and the need to protect hospitals’ revenue stream dominating over the need for patient safety. I finally purchased the book and settled into reading it over spring break 2014. About half way through reading the book, I contacted the author, Charles Graeber through email and began a dialogue about the book and his choice of the title. And I was surprised to find that Graeber was beyond generous in his responses to me, helping me to shine the light, expanding it further into this dark tale.

The story is about flaws in our reporting systems, about flaws in how nurses respond, report, react to concerns for patient safety, and about flaws in quality assurance. The book is about a call for justice, for action to be taken against the healthcare systems and the specific individuals who perpetuated Cullen’s killing spree by failing to act. There is no statute of limitations with murder charges, and healthcare administrators who knowingly supported the continuing practice of a murdering nurse may perhaps be found liable on some level for the many murders that occurred after knowledge of, or even suspicions of. multiple murders were not adequately addressed. You can read my full review of the book here:

http://www.amazon.com/review/R38G2SH63CBCVG/ref=cm_cr_pr_perm?ie=UTF8&ASIN=B004QX078C

Although we can clearly see Cullen carried a deep shadow with him into nursing, that he suffered from some sort of mental illness to have had these deep killing compulsions, that he was a manipulator or sorts who could put up a front as a hard working hero nurse, we have the obligation to also see what worked in the system, and identify the shadows that need to be addressed.

What worked, where was the light? The hero-nurse who helped to indict Cullen, the investigators who did not give up or turn a blind eye, and the penal system were the lights in this issue.This book itself also becomes a beacon to shed some light on the issue.

What did the light reveal about this looming shadow in nursing, what can we learn from this media portrayal of a nurse carrying a gigantic shadow? Perhaps we can consider if academia may have some issues with screening students; that some nurses may consider a nurse who works a lot/takes the hard patients/ and makes the coffee to be a “good” nurse; that QA/QI/surveillance issues around safety as related to nursing practice and competence is apparent; that nurses may have not been empowered to take action when their suspicions arose; and that systems failed in protecting patients through monitoring and reporting.

By increasing our awareness of shadow, dark side incidents such as this obvious one, we can begin to create change and perhaps prevent future devastation. While this is an extreme example of a shadow in our beloved profession, the next entry or Part II will examine some less extreme shadow issues and Part III will focus on actions we can all take to shine the light into darkness and further support our autonomy and evolution as a caring- healing profession.

Dreaming in nursing

April 28, 2013 / Carey S. Clark, PhD, RN, AHN-BC, RYT, FAAN / 3 Comments

I woke up at 0430 this morning with my heart pounding. Occasionally this happens, I have a “nightmare” about nursing.

In this particular dream, I was working a night shift and at the end of the shift I was chatting with the nurses. I was getting ready for report, and I couldn’t remember seeing any of my patients; no names, no faces, no recollection at all. I began to feel anxious and I asked one of my fellow nurses, “Gee I hope I finished my charting” and she replied, “No I don’t think you closed out your charts.”

In a panic I ran to the charts. Of course in the dream they were not electronic, they were huge paper charts, perhaps as big as they could be about 6 inches thick, with hand written notes. I was trying to decipher the handwriting and figure out what was going on with a particular patient. As I read through the chart I realized I had not assessed this patient. I must have slept through entire shift. How could that be? Clearly from the diagnosis this patient would have needed pain medication, turning, toileting, and so on. Who was caring for this patient? I had nothing to chart and I realized that I would, at this last hour, have to go and check on all of my patients, assess them, check their meds, and then chart. My 5-year-old daughter arrived in the dream and wanted to play and I had to tell her no.

Somehow, I woke up and had to convince myself it was just a dream, nobody was harmed, I was safe in my bed. For the record, I haven’t work the floor since the late 1990’s, though I worked as a hospice nurse and taught clinical in the hospital until 2005. Around that time, I finished my PhD, and began to focus on just honing my skills as an educator while I had two babies and raised them into young children.

I have this type of dream several times a year. I suppose I could do a dream analysis, look for the Jungian archetypes, or focus on my own life-anxiety and how it is related to my work. But I am really wondering about here is the dreams that nurses have: the good, the bad, the sleep time dreams, and the awakened dreams.

What is it that our hearts desire in our practice? What are we “dreaming of” in nursing practice and education… and how do we get there? Do we find reward in a broken healthcare system and as the largest providers of healthcare in the nation, how do we take back our practices of caring and compassion? How do we partner with others to create change? How can we use the Nurse Manifesto created by Peggy Chinn, Richard Cowling, and Sue Hagedorn to our benefit?

I would love to hear nurses’ stories about what they desire. I myself wrote a story about what nurses experiencing versus what we desire and you can read about that here: https://nursemanifest.com/research_reports/2002_study/nurse65x89.htm

This story was recently published in Creative Nursing journal. I am also presenting this story and supporting nurses in creating a personal plan of action at the American Holistic Nurses Association Annual Conference in Virginia Beach, VA this June. I hope to see you there!