In recognition of National Nurses Week, four nurse leaders reflect on what has influenced them as nurses.
2020 is designated as the Year of the Nurse and of the Midwife by the World Health Organization. Unfortunately, it's also been the year of the coronavirus pandemic. And so, as it came time for me to write my annual article to commemorate National Nurses Week, I felt a little strange. I admit, I have always been a bit of a Nurses Week curmudgeon. The 'I Heart Nurses' coffee mugs and trinkets always seemed a little superficial and too light and fluffy to celebrate the truly spectacular things nurses do each and every day. This year, with nurses on the frontlines of the battle against COVID-19, it seems inappropriate to casually salute nurses with a Happy Nurses Week!
However, as I thought about it, though the Year of the Nurse and of the Midwife and Nurses Week 2020 are taking place during a more somber than expected time, this year really has shown the public nurses' capabilities.
For the past 18 years, the public has ranked nurses as the No. 1 profession when it comes to honesty and ethics in Gallup's annual poll, so nurses have held the public's respect for almost two decades. But this year, nurses have gone above and beyond what the public imagines they do. They have had to change the way they function on a daily basis.
"As a bedside ICU nurse, when you add personal protective equipment [PPE], your whole routine changes. It's hot. It's hard to talk. Your glasses fog up when you have a mask on. You're motioning to others outside the room in a kind of horrible game of charades [to get] what you need. You have to cluster your care. You worry about every step you take and everything you touch inside and outside the room, and you wash your hands till they're raw," Megan Brunson, RN, MSN, CCRN-CSC, CNL, American Association of Critical-Care Nurses' president and night shift supervisor for the cardiovascular ICU at Medical City Dallas, told me during a recent interview.
In some cases, nurses have found themselves at risk of infection as they faced shortages of necessary PPE. Some have even lost their lives as a result of COVID-19.
Yet, nurses have consistently cared for frightened and severely ill patients. Each day they go into work, they go in with the intent of giving patients the best care they can in order for them to recover from the virus (and other illness and diseases). When patients pass away despite nurses' best efforts, they must process a tsunami of emotions, including sadness and grief.
The COVID-19 pandemic is something no one imagined going through. Even though it is exhausting and leaving nurses raw as they go through it, I hope that someday they will be able to look back and find a way this experience changed them as nurses, and that it will be positive.
With that in mind, this Nurses Week, I chose to share stories from four nurses who reflect on the experiences that have shaped them during their nursing careers.
And by the way, I am not going to say, "Happy Nurses Week." Instead, I am telling nurses:
- You are strong.
- You are amazing.
- You are indispensable.
- You are role models.
- Thank you!
Compassionate care for patients with HIV
The pivotal career moment for Adele A. Webb, PhD, RN, FNAP, FAAN, Executive Dean of Healthcare Initiatives at Strategic Education, Inc., with main hubs located in Herndon, Virginia; and Minneapolis, was when she was a pediatric nurse. A young child with HIV was admitted to the pediatric emergency department where she worked. The child's mother was HIV positive as well. It was around 1990, so healthcare workers were aware of how HIV was transmitted. Still, what Webb witnessed was shocking—the majority of her colleagues refused to care for the patient or touch them when they went in the room.
"One other colleague and I provided all their care. The child didn't live for long and it was at that point that I thought, 'There is really something wrong with the fact that we have this amount of fear in our profession," she recalls. "I don't know if it was because we were in middle class suburbia and they thought this could never happen around there. But the reactions were stunning to me because we had taken care of plenty of patients with [diseases] that were contagious and put us at risk. But I think it was the fact that to people with HIV/AIDS, it was a death sentence and people became afraid for their lives. To have such a visceral reaction and actually say, 'I'll quit before I'll provide care.' I'd never seen anything like that before."
It was at that point Webb's entire career changed. She began learning everything she could about HIV, and she changed jobs in order to work in an area where there were a high number of HIV patients.
"I became involved with the World Health Organization by reaching out and saying, 'I'm willing to go.' I was actually deployed, and I've worked in over 50 countries educating nurses and other kinds of providers, like health workers, about how to care for people with HIV," she says. "And it became my life's mission. I wanted to make sure that people that needed the care could get it."
Webb says she felt a responsibility to HIV patients.
"… [P]eople need help and that's why I'm in nursing. I want to help people," she says.
Webb's international work also gave her a new perspective.
"What you learn about when you work internationally, is that there are some problems that are insurmountable and how lucky we are [here]. That's a message I continue to carry back to my colleagues," she says.
She says it also helped her to develop "stamina."
"I'm a stick-to-the-[finish type of person]. I started this, I'm going to do it because it needs to be done, in spite of the fact that a lot of people didn't want me to do it," she says.
In addition, she says her work with HIV patients gave her a high level of compassion.
"These aren't just people that you see for an hour and a half in the emergency room. You see how families are being devastated and so it gives you a higher level of compassion and understanding," she says.
'Nursing is not a profession. It's a way of life.'
Through his career experiences, Dan Andrews, MBA, BSN, RN, CEN, Director of Operations at CHI Saint Joseph Health in Nicholasville, Kentucky, has developed the motto: "Be safe, be nice, and be prepared."
"This job is tough. It's physically and emotionally demanding [at times] but it also can be so rewarding. If you live by those three tenets, you will make it rewarding. I wouldn't change my career path for anything," he says.
One experience that helped him develop this three-pronged philosophy took place in his hometown in Michigan. In addition to working as a nurse, he was also a volunteer firefighter. During his volunteer shift, there was a house fire where one child died, and another was burned and taken to a hospital.
Fast forward to Andrews' 11 a.m. nursing shift in the emergency room the next day.
"My first patient of the day was the child who was burned in a house fire. He had received some second-degree burns to his hand and needed some [debridement]. His parents had taken him to another hospital immediately after the situation, but they weren't happy there, so they came to our hospital," he says. "By God's grace, I was given the opportunity to take care of this little one. Just knowing the story, having been at the fire the night before and working hard to try to save his brother, just allowed me to really connect and bond with the family."
That experience helped Andrews develop his perspective about the nursing profession.
"It taught me that nursing is not a profession. It's a way of life. Being a nurse is really at your core. Nursing doesn't just happen within the walls of a hospital or a facility. I've been blessed throughout my career to work on an ambulance. I've worked on a helicopter, I've been in the military, and [I] worked in hospice going into other people's homes to help in end-of-life situations. It really just opened my eyes to the fact that, again, nursing is a way of life. We can't just compartmentalize it. It's who you are," he says.
Andrews says he advocates for preparing patients and families for whatever the next step may be.
"I've had an opportunity to take care of a lot of sick people from trauma situations, medical situations. One of the things I always say to folks, especially newer nurses, is that there comes a time when you stop taking care of the patient and start focusing on the family to prepare them more for what's coming next. So, when there's not much more we can do for the patients, let's take care of the family because they're the ones that will be left behind. Preparation and education are a few of the things I try to stress to newer folks that I'm able to mentor along the way."
In addition to a nurse being changed by their experiences, they also have the opportunity to change the lives of their patients and families.
"I think I was able to see that some of the things that we do, in fact, change people. Although she never said it, I feel like because I was honest and sincere and could share some of my feelings with the mom (of the boy who was burned), she was able to heal a little bit by knowing that even though she had suffered a loss, she felt that we truly cared for her child who was still alive. He could have been just another patient, but because of the connection we had [our interaction] was really a lot more sincere," Andrews says. "The golden rule is still be nice to others and treat them how you want to be treated. That makes all the difference in a bad situation."
Caring for and assessing patients' well-being
Before Iain Holmes, DNP, RN, NEA-BC, Associate Chief Nurse at Albany Stratton VA Medical Center in Albany, New York, became a nurse in 2011, he worked in horse racing, which interestingly, may have helped him develop attributes that transferred nicely to his new career as an RN.
"I think taking care of racehorses was a great steppingstone to being able to take care of the people of my community," he says. "[When you are running] a premier racing stable … you check legs every day, you want your whole group to feel well, and now I analyze and assess well-being."
Holmes transition from racing to nursing took place after he began volunteering at a hospital.
"I was working with racehorses and started volunteering at the hospital because while racing is a lot of fun … you go from race meet to race meet. Upon volunteering, I realized that I really enjoyed interacting with patients and making patients feel better and the pathophysiology of disease and the pharmacology of medicine," he says.
Holmes recalls how an interaction with a patient helped him develop a core value of his nursing career.
As a novice nurse in the ED, he took care of a college student whose parents were out of town.
"I remember how we couldn't quite tell what was wrong with her and she was feeling quite unwell," Holmes says. "I left my shift and I kind of went on my way."
Three years later, he needed a rental car while his car was in the shop.
"The person who was renting me the car realized that I was the nurse that took care of her. She told me that she was incredibly scared, and the care I provided to her was wonderful, and I was the shining light in a scary moment, so to speak. What stuck with me is that as a nurse, and as a person, I have a profound ability to determine how people feel in all sorts of situations. That is something that I work on every day. I want people to know that I truly care," he says.
In addition to taking pride in the care they provide, nurses can cultivate caring through active listening and addressing people's needs, he says.
"In every interaction I'm doing, I am trying to ensure those goals are being met. Are we making this person feel better by knowing that they're cared for and addressing their needs? Do they feel scared? Do they feel that they don't have answers to questions because they feel that people aren't listening to them? And then you go with what you've uncovered," he says.
Holmes says he advocates for developing emotional intelligence as a strength and putting others first.
"It comes back to being more than just someone who delivers medicines and treatments. [You want to be] someone who really cares for the well-being of that community and make others feel like an appreciated member of the community, whether they're a patient or an associate."
Being a patient advocate
Terry McDonnell, ARNP, MSN, DNP, Chief Nurse Executive and Vice President of Clinical Operations and Facilities at Seattle Cancer Care Alliance was influenced by both her experiences as a family member and as a nurse. Nursing is her second career and she came to it after a series of family illnesses.
First, when her son was eight, he was diagnosed with a severe form of group A strep bacterial pneumonia. He spent 25 days at the hospital, was in and out of the ICU, had multiple major surgeries, and chest tubes. McDonnell was dedicated to advocating for her son and spent as much time at the bedside as possible, picking up medical lingo and concepts along the way.
McDonnell got to know her son's primary nurse quite well, and over the course of his ICU stay, the nurse asked McDonnell, " 'Have you ever thought about going into nursing?' And I looked at her like she had 15 heads and I said, no, I never have. She said, 'You should really think about it."
Then, McDonnell's father experienced interstitial pneumonitis and was admitted to the ICU at Massachusetts General Hospital for a prolonged hospital stay before he succumbed to the disease.
Once again, McDonnell took on the role of bedside patient advocate for her father. Impressed by her healthcare knowledge, her father's primary nurse in the medical ICU suggested she considering going into nursing.
"My father passed away on his 57th birthday, and I said to my husband, 'You know, I only need to be hit in the head so many times until I get it.' That was the end of October. By January, I was back in school doing prerequisites and, by September, I'd fully matriculated into the Mass General direct entry program," she says.
Just as nurses influenced her life, McDonnell would go on to influence her patients as well.
"I had gotten to know this wonderful, wonderful patient. Just a dear, darling elderly gentleman, newly diagnosed lung cancer. And my first day off orientation he threw a massive PE and literally died in my arms. The thing is that will shake you to your core, but also you are struck, as a nurse, by the honor and the privilege that we have of being with our patients through the good, the bad, the scary, and sometimes when they leave this earth. I will never forget the look of trust on his face as he left this world. His family wasn't there. It was myself and my colleagues that were there with him," she recounts. "That's one of those moments that really formed who you become. I don't think I've ever forgotten the respect and the privilege that we all carry as nurses being on this journey with our patients."
McDonnell says she's learned there is a story behind everything.
"There's always a story. Nothing is ever as it seems. One of my instructors early on in nursing school counseled us to always look for the story. And [by doing that] you learn to pause," she says. "You're always observing. You're always learning. There's always new information."
"The one thing I've learned that I've carried forward and how I've shaped my leadership is no matter who you're with, whether it's a patient, whether it's a colleague, whether it's a student, whether it's an observer, you always have something to learn. And you always want to treat someone the way you want your family treated."
Jennifer Thew, RN, is the senior nursing editor at HealthLeaders.
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