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.

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!

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.