Of Poems, Hearts, and Hands

hand.
hand. (Photo credit: bambola_world)

Last week in my narrative medicine course I had two local authors come to class to read some of their writing and lead class discussions. The first guest speaker was Suzanne Edison, a poet and psychotherapist. She also leads Seattle-area workshops
on therapeutic poetry writing with parents of children with chronic illness, as well as with adolescents with chronic illness—at Seattle Children’s Hospital
and at Odessa Brown Children’s Clinic. Suzanne read poems from her two poetry chapbooks Tattooed With Flowers (2009) and What Cannot Be Swallowed (2012).  In our first class session this quarter we had done a close reading of her powerful poem “Teeter Totter.” Students had questions about some of the metaphors and lines in her poem, so last week they were able to ask Suzanne about them directly. (“Teeter Totter” also appeared in Ars Medica, Fall 2009).

Suzanne led the class in a poetry-writing session that she has developed. First, she asked students to write about a time they had an interpersonal conflict of some sort. Then they went through their prose piece and circled four to five words that stood out to them. Suzanne had them do some other tasks in order to come up with an expanded list of words (a dozen or so). Finally, Suzanne asked them to write a poem (in any form) using all of their words. Several students wanted to share part of or the entire poem they had written, and one student commented on how powerful it was to ‘get it out there.’ Students pointed out that reliving the stressful, difficult interpersonal interactions through the poetry exercise brought on stress responses (sweaty palms or changes in heartbeat and breathing), but that writing the actual poem gave them some distance from it and left them feeling more peaceful. Suzanne explained that the poem is a way to create a container for these powerful memories and emotions. One student wrote of this
as “framing the event in the bubble of a poem.”

I prefaced this poetry-writing exercise by letting the students know that what
they wrote was for their eyes only—that I would not ask them to turn in this
writing to me. Suzanne and I had incorporated the same writing exercise last
fall in my undergraduate community health course, when I did ask students to turn in their poems to me. I got feedback from some students that they found this to be intrusive into their personal lives when they didn’t really know me. Duly noted, and very true since it was a class of 150 students (vs. 40 students in the narrative medicine course). So this time around I set the parameters upfront that they wouldn’t have to share their poems with me. Instead, the first writing prompt I gave them for in-class writing was to share a fragment of their poem, or a key word, and to reflect on what surprised them most about what came out of the poetry exercise. This seemed to work out much better. It probably also helped that this class is specifically on narrative medicine, and students expect to do more creative and personal writing in it than they typically do in a more traditional nursing course.

The second guest author was Mary Oak, author of Heart’s Oratorio: One Woman’s Journey Through Love, Death and Modern Medicine (Goldenstone Press, 2013). (see my previous post/book review “Heart’s Oratorio” from 3-24-13). She read passages from her book and answered student questions. As one of the selections she read was about her stay in the ICU and how disorienting it was, students had questions for her about this. They also asked her what motivated her to write the book and about her development as a writer. Since Mary writes about her genetic heart condition and is a mother, students also asked what the ramifications are for her children, and what that feels like now that’s she’s lived through serious cardiac complications. Much of Mary’s book is set in Seattle and she mentions specific hospitals (Northwest Hospital and University
of Washington Medical Center) and some medical personnel by name. This led to an interesting class discussion on the ethics and legalities of nonfiction medical-related writing. Several students mentioned recent ‘compliance trainings’ they’ve had to go through in their jobs as RNs in Seattle-area hospitals, where the message was that ‘they could never ever write about their work in any context whatsoever!’ They were concerned since they were asked to write about their work for class assignments (like for my course). We reviewed the basic parameters on this for academic writing: 1) no patient identifiers such as name, age, super-rare medical condition, etc.; and, 2) no specific names of providers, hospitals, clinics, care facilities—although I acknowledged this can lead to strange permutations, such as “a large Level-I Trauma Center in the Seattle area” (there is only one Level-1 trauma center in Washington State—in fact within a four state radius—and that would be Harborview Medical Center). And then I briefly discussed various legal and ethical parameters as designated by specific journals, differentiating what I was asking them to write about versus writing for publication. I got on my soapbox briefly to rant about how hospital administrators try hard to intimidate nurses (and others even lower in the food-chain) into not writing about their work—but the intimidation is real and nurses can and do lose their jobs over this stuff—and it is easy for me to rant from the relative security of my tenured academic soapbox.

Back off my soapbox, Mary read them a lovely poem by a nurse poet friend of hers, Lise Kunkel, who works in hospice nursing in New York State. The poem had to do with her hands while caring for a hospice patient. So for my last writing prompt I had students think of a significant patient-nurse interaction they had had and to write it from the perspective of their hands: Tell the story your hands could tell. Since I was really stuck back on my soapbox and hadn’t thought through the specific writing prompts I wanted to use for that class session, this one was completely made-up on the spot. I had no idea what students would do with it until I read through their writing this week.

Wow—just wow! That prompt worked, as nurses most definitely identify and
communicate with their hands. Some students wrote from the perspective of their hands: the punishing abuse from the frequent application of hand sanitizer; the uncertainty of where to place their hands during certain patient-nurse or healthcare team interactions; the patient assessment of skin warmth or clamminess or bulges where there shouldn’t be bulges—and, as one student stated, providing “a loving touch, not a medical touch.”

Addendum: I received an e-mail from hospice nurse Lise Kunkel with a link to one of her published poems, “Reading Aloud to Dad (for Jiggs)” in Oncology Times, 3-10-09, vol 31(5),p. 34. She also told me the name of the poem that Mary Oak read to my class last week: “The Hands of a Hospice Nurse.” She uses some of her poems in trainings she does for hospice volunteers through the Care for the Dying Cooperative in NY State. Lucky volunteers and lucky patients….

Quick Toes in Stinky Shoes

The Old Running Shoes
The Old Running Shoes (Photo credit: Mike Spray)

Way to go to Heather Boyle, RN who just had her wonderful Narrative Matters essay included in the latest edition of the health policy journal Health Affairs. Her essay is entitled “As Sports Fees Rise, A Young Athlete Learns That If You Can’t Pay, You Can’t Play.” Heather is a nurse at the Center for Change, an inpatient treatment center for adolescents with eating disorders in Orem, Utah. I had the pleasure of teaching Heather for two of her nursing courses at the University of Washington, where she graduated in 2012.

As she mentions in her essay, Heather grew up in rural Washington State, near the Olympic rainforest. She took up running in elementary school by helping her family members deliver newspapers. A star high-school runner, Heather encountered financial barriers to participation in her school’s track team. Heather advocates for elimination of the “pay for play” rules in order to increase access to school sports. For my health policy course, Heather wrote a health policy essay/personal narrative on school sports, using the format of Narrative Matters. She now has her essay published, plus there is a link to her reading her essay. “Quick Toes in Stinky Shoes” was her original title for the essay, and in the published piece the editors retained it as a subheading. Heather I am so proud of you!

Nurse Ratched’s Backstory

This week the assignment I gave students in my narrative medicine course was to apply the close reading drill they’re learning to a ‘read’ of a feature length movie. I gave students a choice of six movies around the theme of caregiving: The Diving Bell and the Butterfly, The Doctor, The English Patient, Midnight Cowboy, Rain Man, and One Flew Over the Cuckoo’s Nest. Besides doing a ‘close read’ of the movie of their choice, I asked them to reflect on the following questions: 1) What is the nature of caregiving as portrayed in the movie? 2) In the film, who is being cared for and who is doing the caring? (I should note that this narrative medicine course is a hybrid, with a mixture of in-class and online/distance learning. Last week and this week were both distance learning.) Not surprisingly, many students chose to watch and write about One Flew Over the Cuckoo’s Nest (1975) with the unforgettably villainous Nurse Ratched (Mildred) played to perfection by Louise Fletcher.

As I recently re-watched this movie, it struck me how good a nurse Mildred could have been. She is smart, sensitive, and perceptive, and could have used these attributes to be a strong therapeutic psychiatric nurse; instead, she used them to be a manipulative, destructive nurse. I kept asking myself: what went wrong with Nurse Ratched?

With all due respect to Ken Kesey who wrote the novel that the movie is based on, I offer my version of Nurse Ratched’s backstory. Perhaps it can be instructional on ways not to be a good nurse—or on good reasons for someone not to be allowed become (or continue to be) a nurse.

Backstory: Mildred Ratched grew up in rural Oregon, the first of seven children in a devout Catholic family. Her mother was a stay-at-home mom and her father was a logger. They all lived in a doublewide trailer. Her father was a heavy drinker and he regularly beat his wife. Mildred’s self-appointed (or assigned) role in the family quickly was established as caretaker and protector of her younger siblings. Her mother was timid, withdrawn, and depressed, to the point that she spent days and weeks in bed. Mildred’s father loved to shout out at the dinner table that women were only good for baby-making and housekeeping and were stupid. Mildred was a smart, precocious young girl who learned to read at age four, and then went on to excel in school. Her mother encouraged Mildred to get out of Oregon—to become either a stewardess or a nurse so she wouldn’t get stuck in a loveless marriage as she had. Her mother most strongly encouraged Mildred to become a nurse because that’s what she’d wanted to be, and nursing had the whole saintly, angelic, Catholic connotations. But Mildred dreamt of being the first in her family to finish college. What she really wanted was to become a lawyer (wouldn’t she have been an excellent lawyer with that poker face, intelligence, and ruthlessness? Perhaps she wouldn’t have been strangled by McMurphy—Jack Nicholson—and lost her voice if she’d become a lawyer).

Mildred was a freshman in high school when her father fell out of a tree at work and was paralyzed. He wasn’t eligible for L& I or other disability benefits because the hospital ED physicians established that he was legally intoxicated at the time of his fall. Mildred was forced to drop out of school to care for her father as well as all her siblings. She also started waitressing at a nearby diner. Her father died a year after his accident and then Mildred went to a nursing diploma program through the local Catholic hospital. In her last year of the nursing program she met her first boyfriend, a trucker, who found nurses sexy. Mildred got pregnant right away and immediately married. Her new husband openly cheated on her from the very beginning of their marriage. He also physically abused her. Her son was stillborn and her husband left her the following week.

Meanwhile her mother was showing signs of dementia, so Mildred moved back home to care for her mother and her siblings who were still at home. She had been working as a labor and delivery nurse, but after her own baby died she couldn’t face working in that setting, so she took a graveyard shift at the nearby state psychiatric hospital. Flash-forward twenty years and Mildred has worked her way up the ranks at the psych hospital and is now head nurse (“Big Nurse”). She still lives with her ailing mother, cares for her at night, and works days at the psych hospital. She never dated again after her husband left her. She goes to church by herself, has no hobbies, and has only a few female church friends (stuttering patient Billy Bibbit’s mother). Her only source of enjoyment in life comes from the thrill of being in charge, in power at the psych hospital.

Nurse Ratched would have rocked as a good nurse. My only hope is that the sweet young junior nurse shown shadowing Nurse Ratched in the movie (the one who goes into hysterics when she discovers Billy’s bloody body in the psychiatrist’s office) doesn’t become another Nurse Ratched.

On a related note, here are my all-time favorite movies with memorable nurses as major characters: 1) Magnolia (1999) with an amazingly good male hospice nurse, Phil Parma, played by Philip Seymour Hoffman; 2) One Flew Over the Cuckoo’s Nest (enough said about it above)…. and 3)????? I guess that’s it for movies with memorable nurses, at least for me. I do like the character of Abby in many of the ER TV series—as well as the Mississippi nurse practitioner in the “Middle of Nowhere” episode in season five (although it over emphasizes all the negative stereotypes of Southerners). Nurse Jackie is just too soap-operaish and silly for my taste. Come on Hollywood! Give us some more good and realistically portrayed nurses in movies! Maybe I need to start writing screenplays, but I envision myself as Barton Fink with writer’s block, stuck in a flaming hot hotel room somewhere…. Being stuck in the godforsaken Reno airport with a delayed flight home is nightmare enough (where this post was written). Especially since I got stopped by security and interrogated as to whether I’m any relation to naughty former Nevada Senator Ensign (the answer, thankfully, is no). Sometimes life is stranger than fiction—or movies.

Close Reading Drill Simplified

This past week in the Narrative Medicine course I am teaching, I introduced students to the approach to close reading (she refers to it as a drill) as taught by Dr. Rita Charon and her colleagues at Columbia  University’s Program in Narrative Medicine. I then had students apply this to do their own close reading of JD Salinger’s short story “To Esme, With Love and Squalor.”

As a way of introducing them to close reading I had them read Rita Charon’s chapter “Close Reading” in her book Narrative Medicine: Honoring the Stories of Illness (Oxford University Press, 2006). This is a weighty chapter in a weighty book and I have discovered that many of my students were simply overwhelmed by it. So here is my streamlined version of ‘doing’ a close reading drill as applied to narrative medicine. I present the elements of close reading in the order I like to do them myself because it is more the way I read and analyze what I read.

1.     Desire (Dr. Charon’s term). What appetite or emotion is satisfied by reading this? What bodily sensations do you have while reading this? What intellectual or emotional desires arise? Put more simply: what is the overall feeling you have when reading this? (A related and interesting question would be: And what does this reveal about you as the reader?)

2.     Frame. What’s included and what’s left out of this narrative? Where did this first appear—what was the intended audience of the work? For instance, Salinger’s short story first appeared in the New Yorker in 1950. What can we surmise about his intended audience?

3.     Temporal scaffolding. How is time handled in the narrative?

4.     Form. Structure, genre, narrator, use of metaphor, allusion (especially what other works are referred to either explicitly or implicitly?), and diction

5.     Plot. What happened.

Dr. Charon makes the case that learning the skills of close reading as applied to narratives, whether written or in plays, movies, etc, can help health care providers learn to be more attuned to the illness narratives of their patients. Careful reading, careful listening, it makes sense at some level and I am teaching that to my students. Salinger’s short story that I had them read and analyze through close reading is a complex but engaging piece of writing. It has enough content about the health effects of war—PTSD especially—that nurses and others in the health professions find it interesting. Salinger’s use of frame, time, diction, and metaphor are exquisite. So this short story makes for a good—but sufficiently challenging—narrative on which to practice close reading. I found that most students did well with this assignment and really dug in. Since class this past week fell on July 4th, this was an individual take-home assignment, so I have not yet had the opportunity to discuss it with them in class.

I always have these nagging questions in the back of my mind: Does close reading detract from the pleasure of reading? And by extension, does ‘close reading’ a patient’s illness narrative detract from the pleasure of the patient-provider interaction? Do we start thinking about patients less as people and more as stories to be analyzed, stories to be recorded in our heads and then later used as material for our own written stories? Does that start to distance us from our patients? Is it like walking up a familiar flight of stairs—pleasantly distracted—then thinking about walking up the stairs and by paying attention to it, tripping? If writers consciously try to pay attention to the craft of writing, does the art of their writing suffer?

I’ve been re-reading one of my favorite books, David Ulin’s The Lost Art of Reading: Why Books Matter in a Distracted Time (Sasquatch Books, 2010). He raises these questions as well—for writers and readers in general. He states, “(…) I recognize this as one of the fallacies of teaching literature in the classroom, the need to seek a reckoning with everything, to imagine a framework, a rubric, in which each little piece makes sense. (…) leaving us with scansion, annotation, all that sound and fury, a buzz of explication that obscures the elusive heartbeat of a book.”

If I used this class assignment again I would add the personal reflection writing prompt: Write about a time when you were so overwhelmed by emotions that you had difficulty communicating—or write about a time when you were caring for a patient experiencing this.

 

 

A Patient Named Noname

IMG_0787I once had a patient named Noname. She was a thin wisp of a young woman who came to the community health clinic where I worked as a nurse practitioner. This was back in the late 1990’s soon after I had moved to Seattle from the East Coast. I was still having a bit of culture shock, getting acclimated to Seattle’s rain, tree-huggers, and serial killers. When I first met Noname I was dating a man who was a tree-hugger but thankfully was not a serial killer. He was way into natural food and meditation, so I had Namaste continually playing in my head like an annoying Bee Gees song. So when I looked at the new patient name ‘Noname’ on the patient chart and entered the exam room, I greeted her as Noname, pronouncing it as if she were a cousin of Namaste. She laughed nervously and corrected me: her name was no name. As in she didn’t want to give her real name, so it was just a placeholder of sorts. It wasn’t as if she was in clinic that day for any sort of health complaint that would make her concerned for her privacy. I never did get the story of her name, of her no name.

I remembered Noname this past week as I began teaching an eight-week Narrative Medicine course at the University of Washington, Bothell. I have close to 45 wonderfully smart and creative nursing students, all in their BSN-completion program. That means they all have their RN either from diploma or community college programs and are back to take the courses necessary for their BSN. They are all working full or part-time as nurses so they have a lot of ‘real life’ experience to draw upon.For the first in-class writing prompt I used one of my favorites learned from Dr. Rita Charon and her colleagues at Columbia University’s Program in Narrative Medicine: Write the story of your name. Everyone has rich stories to tell about their names—including the patient named Noname. I find this writing prompt to be an excellent starter prompt, as well as a way of allowing people to introduce themselves in a unique way. Of course, with 45 people in class we didn’t have time for everyone to read their stories out loud, but I have had the privilege of reading all of them and it helps me to get to know the class. I pointed out that this writing prompt can even be used effectively with patients. For instance, I’ve found that it is so much better to ask a patient (with a strange to me name), “Can you tell me the story of your name?” versus the usual “What country are you from?”

After presenting them with some basics of Narrative Medicine—what it is, where it came from, Dr. Charon’s approach to close reading—we practiced close reading together using a variety of short pieces of poetry and prose and film clips. The poetry I used was from Cortney Davis (I Want to Work in a Hospital), Raymond Carver (What the Doctor Said), Rachel Haddad (Stereotactic Biopsy), and Suzanne Edison (Teeter Totter). For the film narrative/close reading I showed them clips from the movie Magnolia (1999)—specifically two clips that are available on YouTube. One clip is the regret deathbed soliloquy by Earl Partridge (played to perfection by Jason Robards), and the second clip is of the male hospice nurse (played also to perfection by Philip Seymour Hoffman) on the phone trying to track down Earl’s estranged son (played—OK—also to perfection—by Tom Cruise). I love these two clips because they portray hospice care and hospice nursing so truthfully. They lent themselves to some rich class discussion and close reading skill building.

For the last in-class close reading and writing exercise I turned to writing by one of my favorite local authors, Judith Kitchen (Distance and Direction/ Coffee House Press, 2001); Half in Shade: Family, Photography, and Fate/ Coffee House Press, 2013). I used her sample short essay F-Stop, which is surprisingly complex for such a short prose piece (available on her website). We first did a close reading of this essay. Then I showed them a photograph of a man reading to three small children around a campfire. I asked them to write the story of this photograph—to just make one up—thus pushing (or pulling?) them into the realm of fiction writing. I could tell that many of the students struggled more with this writing prompt. Some told me they had never been asked to write fiction before in nursing school. But they persevered and came up with some wonderfully rich stories.

I’ll be writing a series of posts over the next seven weeks of this Narrative
Medicine (for nursing) course. Since Narrative Medicine isn’t ‘done’ very much in nursing schools—and I think it should be—my hope is to share my experiences with others who may adapt it for their own teaching.

Celebratory American Sentence for Happy Demise of DOMA Day!

Supreme Court
Supreme Court (Photo credit: afagen)

I was discouraged after yesterday’s Supreme Court ruling effectively dismantling parts of the Voting Rights Act, thus (in my opinion) stoking racism. We didn’t need Paula Deen‘s version of twisted Southern Hospitality to remind us that racism is alive and festering in our country… Unfortunately, the Voting Rights Act is still needed in the South and elsewhere.

But today the Supreme Court majority regained some sanity by striking down part of the 1996 Defense of Marriage Act (DOMA), overturning the law that denied federal benefits to same-sex couples.

“For same-sex couples who wished to be married, the State acted to give their lawful conduct a lawful status. This status is a far-reaching legal acknowledgment of the intimate relationship between two people, a relationship deemed by the State worthy of dignity in the community equal with all other marriages. It reflects both the community’s considered perspective on the historical roots of the institution of marriage and its evolving understanding of the meaning of equality.” (page 24/ Majority Opinion)

The Supreme Court also refused to hear a case, effectively permitting same-sex marriage in California. While there is still no constitutional right to same-sex marriages, today’s Supreme Court rulings are major victories for same-sex couples and their families. So, in the words of Gail Collins: happy demise of DOMA day!

And in the words of one of my former students, Jonathan Halldorson, who e-mailed me his celebratory American Sentence (which he told me he composed while taking a short break from studying for the NCLEX exam):

No Mo’ DOMO!

No More H8 with Prop 8!

Now is time to celebrate!

Weekend Writing Retreat for Nurses/NYC

Here is a terrific writing retreat geared for nurses. I took a writing workshop this past April with Joy Jacobson and Jim Stubenrauch (at U of Iowa’s Examined Life conference) and can attest to the fact that they are wonderfully supportive teachers.

From the Center for Health, Media & Policy at Hunter College (CHMP) HealthCetera blog:
Weekend Writing Retreat for Nurses
by Jim Stubenrauch
If you’re a nurse who writes or one who wants to write, please join us for Telling Stories, Discovering Voice: A Writing Weekend for Nurses, to be held July 19-21, 2013 in New York City. This is a chance for all nurses and nursing students to strengthen and expand their capacity to write in a variety of modes and genres, including personal essays, poetry, and fiction, as well as blog posts and articles on clinical and health policy topics. We’ll write together in a safe and supportive environment, share our writing aloud, offer encouragement and constructive feedback, and discuss the role of narrative in medicine and nursing. We’ll also examine the potential for using social media as a public-health tool.

The conference will be led by CHMP poet-in-residence Joy Jacobson and senior fellow Jim Stubenrauch. This special event is co-sponsored by the Center for Health, Media & Policy at Hunter College (CHMP) and the Hunter-Bellevue School of Nursing, and is offered as part of the CHMP’s program in Narrative Writing for Health Care Professionals. Participants will receive 17 continuing education units.

We’re very excited that Karen Roush, clinical managing editor of the American Journal of Nursing and the founder of The Scholar’s Voice, will be the keynote speaker. Karen has extensive experience as a writer, teacher, and nurse and has published books, scholarly articles, personal essays, and poetry.

The price for the conference (including continental breakfast and lunch each day) is $675 + $20 registration fee until July 1; $725 + $20 fee after July 1. Groups of six or more from one institution receive a discount price of $575/person. Students receive a 20% discount. Register for the event online at https://ceweb.hunter.cuny.edu/cers/CourseBrowse.aspx. (In the “Search Courses” window at the upper left, enter course code SEMTSDV.) Or call 212 650-3850.

Want to know more? Check out these two blog posts about last summer’s workshop: in the first, attendee Patricia Wagner Dodson, BSN, RN, MA, CCRN wrote that “in this workshop community of real nurses and real writers, a consensus seemed to emerge: the stories need to be told. The workshop was the beginning of the telling.” In the second, I shared some of my own impressions of the weekend, with excerpts from pieces written during and after the workshop by two other participants, Karen Hardin, MS, RN and Amy Dixon, BSN, RN.

Approaching Death

Check out Kimberly Condon’s essay “Approaching Death” (from the anthology I Wasn’t Strong Like This When I Started Out: True Stories of Becoming a Nurse, edited by Lee Gutkind, In Fact Books 2013) reprinted today in Slate. In the Slate version the full title includes “A nurse goes from the ER to hospice, and changes the way she thinks about life and its end.”

Congratulations Kim!

Shocking News: Nurses Can (and do) Read and Write

Who would have thought the world would come to this? A world in which there are IMG_1009so many nurses who are not only reading real books, but also writing real books, or essays, or poems, or short stories—so many nurses with the audacity (and ability) to obtain writing credentials, MFAs, writing certificates, and bona fide publications in non-nursing literary magazines and anthologies for God’s sake! Shocking indeed.

That was one of the main takeaway messages I got this week from listening to a podcast interview with Lee Gutkind on RN.FM radio. Lee Gutkind is the founder and editor of the literary magazine Creative Nonfiction; he is also the editor of the recently published anthology I Wasn’t Strong Like This When I Started Out: True Stories of Becoming a Nurse, edited by Lee Gutkind (In Fact Books, 2013).

In the radio interview, Gutkind states that the anthology was something he had wanted to do for a long time. Whenever he pitched the book idea to publishers they rejected it, saying it was a bad idea because nurses don’t write and nurses don’t read. So with the support of the Jewish Healthcare Foundation he published it himself under the new imprint of the Creative Nonfiction Foundation. Gutkind admits that he was surprised by the volume of submissions to the anthology, that the submissions “were so much better than we expected,” and “how many had writing degrees, writing experiences, as well as being nurses—it was encouraging to us.”  

The book was first released in early April, quickly sold out, and is now into its third printing. (Amazon says it is out of stock/due in 1-3 months but they should have it in stock much sooner than that. Elliott Bay Book Company has the book in stock and can ship it to you. They hosted our reading of the book this week/is what photo is of). Jane Gross, in her May 20th NYT book review ‘Semi-invisible’ Sources of Strength, wrote of the anthology:

It is beautifully wrought, but more significantly a reminder that these “semi-invisible” people, as Lee Gutkind calls them in this new book, are now the “indispensable and anchoring element of our health care system.”

I would argue that nurses always have been the ‘indispensable and anchoring element in our health care system’ and that most laypersons have long recognized this fact. Perhaps what is different now is that people higher up in the rigid health care system hierarchy are being forced to recognize this. The forces contributing to this shift are fascinating and complex, but have to include the growing proportion of BSN prepared nurses in our country’s workforce. Both Jane Gross and Canadian nurse author Tilda Shalof (whose essay Ms. Gross quotes from) are dating themselves by focusing on the outdated rift between diploma/Associate’s degree (ADN) and four-year university-educated nurses in tertiary care settings. Ladies: in the U.S. that battle is over. As the authors of the Institute of Medicine’s 2010 The Future of Nursing: Leading Change, Advancing Health report states:

The formal education associated with obtaining the BSN is desirable for a variety of reasons, including ensuring that the next generation of nurses will master more than basic knowledge of patient care, providing a stronger foundation for the expansion of nursing science, and imparting the tools nurses need to be effective change agents and to adapt to evolving models of care. (p. 4-9)

Currently, 50% of the U.S. nursing workforce are BSN prepared; the Future of Nursing report has set the goal to increase that to 80% by 2020. What a BSN education includes that an ADN education does not, are grounding in liberal arts (including literature and writing), leadership development, and public health/health policy competencies (more complex systems-level thinking)—all essential ingredients for more nurses to be readers, writers, and change agents in our health care system.

Something that I found disturbing in the radio interview and discussion was how much the two nurse radio hosts stayed stuck in the tiresome tropes of  “nurses as an oppressed profession,” (and specifically that they are oppressed by physicians) and that nurses “empower patients.” “Empowering” someone else is a slippery slope ethically and even practically, and nurses are not the only members of the healthcare team to advocate for patients. As to nurses being oppressed—oppression is understood to mean the unjust or cruel exercise of power. Yes, there are still ‘unjust cultures’ within hospitals that negatively impact nurses (as in the case of Kim Hiatt here in Seattle), but to extrapolate that to the statement that all nurses are oppressed is not only incorrect, it is unhelpful. Unhelpful to the image of nursing and unhelpful to the improvement of our health care system.

 

One of the radio hosts recommended that Gutkind offer a nurse writer conference—as a way to bring nurse writers together, to foster a community of nurse writers. Gutkind replied by encouraging listeners to e-mail him if they are interested in such a conference (information@creativenonfiction.org or under ‘contact form’ at www.Leegutkind.com).

Elliott Bay Book Company ‘Becoming a Nurse’ Event/June 11th, 7pm

The following is from the Elliott Bay Book Company (Seattle) Events page for June. I believe I have Karen Maeda Allman, bookseller and director of Author Events at EBB to thank for the kind description. As a writer who uses their bookstore as a gathering space, she is referring to the fact that I am part of Waverly Fitzgerald’s monthly Shipping Group at the EBB cafe. Thank you Waverly and all my fella’ Shippers for all the support over the years!

I want to add that we may (hopefully) be joined on June 11th by Nina Gaby, psych nurse practitioner, visual artist, and writer from the Boston area. Her essay “Careening Toward Reunion” in the Becoming a Nurse anthology is quite dogeared in my personal copy. I seriously want to meet her… If you are in the Seattle area on June 11th, please come join us for some nurse power time at Elliott Bay.

JOSEPHINE ENSIGN, EDDIE LUEKEN & KARLA THELLEN

Start: 06/11/2013 7:00 pm

It’s a particular pleasure for us when writers who use our bookstore as a gathering space have new work to celebrate, as will happen a few times this spring and summer. Tonight, Josephine Ensign, who has contributed so much to our community as a nurse and teacher of the next generation of nurses, appears with colleague Eddie Lueken and Karla Thellen for a group reading from their new anthology, I Wasn’t Strong Like This When I Started Out: True Stories of Becoming a Nurse (edited by Lee Gutkind, InFact Books). Nurses are the backbone of the healthcare system and these stories reveal something of the experiences of nurses at all stages of their careers. Here is illuminating reading for those aspiring to join the profession as well as for those who benefit from their work.

I Wasn’t Strong Like This When I Started Out: True Stories of Becoming a Nurse (Paperback)

By Lee Gutkind
$15.95

ISBN-13: 9781937163129
Availability: On Our Shelves Now
Published: In Fact Books, 3/2013

Location:
The Elliott Bay Book Company
1521 Tenth Avenue
Seattle, WA 98122
United States