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


For those of you in the Seattle area who are interested in narrative advocacy from a nursing perspective, save the evening of Thursday April 18th, 2013 . I’m working with Lisa Oberg and Joanne Rich of the University of Washington Health Sciences library to host a nurse writer panel discussion and reading 6-8:30 pm at Suzzallo library, in the Smith Room (photo is of the Smith Room/ free and open to the public). I’ll be there along with some other author/contributors to the anthology True Stories of Becoming a Nurse (see below for information).

The following is the press release for the book.

I Wasn’t Strong Like This When I Started Out:
True Stories of Becoming a Nurse
Edited by Lee Gutkind
Featuring new work by Theresa Brown, Tilda Shalof, and others.

As editor Lee Gutkind points out in the introduction to I Wasn’t
Strong Like This When I Started Out, “there are over 2.7 million
working RNs in the United States (not to mention our many LPNs
and LVNs), compared to about 690,000 physicians and surgeons.
There are more nurses in the United States than engineers … or
accountants and auditors … And, yet, many of us take the work
these men and women do for granted.”

This collection of true narratives captures the dynamism and
diversity of nurses, who provide the vital first line of patient care.
Here, nurses remember their first “sticks,” first births, and first
deaths, and reflect on what gets them through long demanding
shifts, and keeps them in the profession. The stories reveal many
voices from nurses at different stages of their careers: One nurse-in-training
longs to be trusted with more “important” procedures, while another questions her ability to care for nursing home residents. An efficient young emergency room nurse finds his life and career irrevocably changed by a car accident. A nurse practitioner wonders whether she has violated professional boundaries in her care for a homeless man with AIDS, and a home care case manager is the sole attendee at a funeral for one of her patients. What connects these stories is the passion and strength of the writers, who struggle against burnout and bureaucracy to serve their patients with skill, empathy, and strength.
Pub. Date: March 2013, ISBN: 978-0-393-07156-6, 5 ½ x 8 ¼, Trade Paper, 278 pages,
$15.95, Distributed by Publishers Group West

Lee Gutkind has explored the world of medicine, technology and science through writing for more than 25 years. He is the author of 15 books, including Many Sleepless Nights: The World of Organ Transplantation, and the editor of five anthologies about health and medicine, including At the End of Life: True Stories About How We Die.
In Fact Books is a new imprint founded and edited by Lee Gutkind, editor and founder of Creative Nonfiction. In Fact Books titles help create an understanding of our world through thoughtful, engaging narratives on a wide variety of topics and real-life experiences. All titles are distributed by Publishers Group West. For more information, please visit http://www.infactbooks.com.
For interview requests and other media related questions, please contact:
Hattie Fletcher at fletcher@creativenonfiction.org or (412) 688-0304.
Early Praise:

A startling collection of stories from the bedside.
—Paul Austin, author of Something for the Pain: Compassion and Burnout in the ER

The elephant in the living room of healthcare is that providers care deeply about and are affected by the people they tend. The best ones are, anyway. In I Wasn’t Strong Like this When I Started Out, nurses recall pivotal moments with patients and families that changed them from onlookers to active
participants in the art of healing. This excellent collection chronicles those experiences in funny, eloquent, and often piercing essays. It should be required reading for anyone beginning a career in healthcare—nurses and physicians alike. —Margaret Overton, MD, author of Good in a Crisis

Within these pages, we learn what it is like to protect a dying patient from a futile procedure, to smooth a newborn’s wrinkled brow for a postmortem photo, to work in a foreign country where medical equipment is improvised from household supplies. These stories teach us the essence of nursing—that even when cure is not possible, comfort is. —Catherine Musemeche, MD, surgeon and author

The nurses in this collection bear witness to life, death, suffering, joy—the many aspects of humanity itself. These are no saccharine tales of self-sacrifice, of stereotypical Florence Nightingale-like ladies with lamps. The men and women in this collection tell stories that cut to the bone, exposing their profession’s deep emotional, intellectual, physical, and spiritual trials. Yet, in those struggles emerges great beauty and human connection. This collection exposes not only the strong, beating heart of nursing, but its brain, muscle, sinew and nerve endings—alive, pulsating, raw, real.
—Sayantani DasGupta, MD, MPH, co-editor, Stories of Illness and Healing: Women Write Their Bodies

An honest and compassionate collection of life in nursing. In voices of novices and veterans in the field, it’s an intimate portrayal of how growth is a two way street. Whether listening, touching or just remembering, when you do anything you can to help your patient, your life is also shaped in the process. They are not just lessons, but gifts, that transcend any hierarchy in medicine.
—Gulchin A. Ergun, MD, Clinical Service Chief, Gastroenterology

Like most physicians, I have a long list of nurses who have mentored me, influencing my practice of medicine in the way they live their lives and care for their patients. This book is a testament to those wise nursing colleagues–and to the paths that have brought them their wisdom.
—Marion Bishop, MD, PhD, Emergency Medicine physician and essayist

With tenderness, honesty, humor, and some anger, the authors of these engaging essays draw us into the complex beauty of nursing from an exhilarating variety of perspectives. This welcome, eye-opening collection should be required reading for every medical student and apprentice hospital administrator.
—Margaret Mohrmann, MD, PhD, University of Virginia

In these powerful narratives, twenty-one nurses unfold what it means to practice their profession: what they are thinking and feeling when they care for patients and when they go home, how they came to choose this difficult and rewarding career, their satisfactions and frustrations, their triumphs and traumas. Moreover: they write exceedingly well.
—Charles Bardes, MD, author of Pale Faces: The Masks of Anemia and Essential Skills in Clinical Medicine

Poignant recollections from often ignored voices in medicine. These wonderful stories resound with truth. —Sandeep Jauhar, author of Intern: A Doctor’s Initiation

Note: My essay “Next of Kin” is included in this anthology. I am the “nurse practitioner wonders whether she has violated professional boundaries in her care for a homeless man with AIDS” included in the book blurb above.

In order to complete the sites visits and other research necessary for writing my essay, I received a 2011 Individual Artist Award from 4Culture. Therefore, this project was supported, in part, by an award from 4Culture; thank you 4Culture.4culture_color


Nurse Writers Arrive in Wiki-land

English: Manuscript handwritten by Walt Whitma...
English: Manuscript handwritten by Walt Whitman, American poet, for his poem “Broadway, 1861” (Photo credit: Wikipedia)

As I wrote in a previous blog post “Nurses and Writing: Writers and Nurses” (3-31-11) the term “physician writer” is well-known and accepted by the general public, while the term “nurse writer” is not. Physician writer has had an extensive Wikipedia entry since March 2008.

Thanks to Dr. Thomas Lawrence Long, Associate Professor-in-residence at University of Connecticut School of Nursing, there is now a Wikipedia entry for “nurse writers.” Dr. Long has a PhD in English and a master’s degree in Theology. He teaches writing at a school of nursing and maintains a nurse writing website/blog resource called NursingWriting. Here is his Wikipedia definition of nurse writer:

“Nurse writers are registered nurses (RNs) who write for general audiences in the creative genres of poetry, fiction, and drama, as well as in creative non-fiction. The published work of the nurse writer is analogous to that of the physician writer, which may or may not deal explicitly with health topics but is informed by a professional experience of human vulnerability and acute observation.”

Nice definition, with the possible exception of the RN part. (Can’t an LPN writer be called a nurse writer? Plus, the RN designation is a relatively recent invention and may not translate to all countries). He also includes a list of nurse writers, beginning with 19th century writers, ranked by date of birth. Curiously, he left out Walt Whitman and Mary Seacole, who were both born before Florence Nightingale (who he lists first.) Including a well-known male nurse/writer (Whitman) and a nurse/writer of color (Seacole) would be a good idea. So someone out there who wants to add these, please do. While they’re at it they can add Mary Jane Nealon (Beautiful Unbroken: One Nurse’s Life, Graywolf Press, 2011) to the 21st century list.

Nurse writer Theresa Brown has a recent post (on Hunter College’s Center for Health Media and Policy blog Healthcetera) “Calling all nurse writers,” in which she encourages nurses to write. As Ms. Brown points out, nurses typically spend a lot of time with patients, have many stories to tell, and have a unique perspective on health care provision.

I have had many inquiries lately from nurses seeking advice on how to develop as creative writers. Here is my (very biased) advice:

1. Read. Read widely. Read great/classic literature as well as current writing from authors in a variety of genres. Read/subscribe to literary magazines. (My current list of literary journals includes Creative Nonfiction, The Examined Life, Bellevue Literary Review, and Fourth Genre. These are all top literary journals in my writing genre of literary nonfiction/narrative medicine.)

2. Write. Write something that is creative–for your eyes only– every day. Even if it is for just five minutes in a bathroom stall at work, during a sacred bathroom break, and you have to write on a paper towel–incorporate writing into your life.

3. Find/join a writer’s group/center in your community. In Seattle I recommend Hugo House as an excellent resource for writers at all ‘levels.’

4. Join  NYU‘s Medical Humanities listserv. Even though this is ‘hosted’ by NYU’s medical school, it is interdisciplinary and their website is an excellent resource.

5. If you are an academic or have to do academic writing in your work, find a way to purge that part of your writing brain–or at least find a way to compartmentalize it. Academic writing is formulaic and anti-creative.

6. Find a way to share your writing. This could be in a supportive writing group or class, at open-mic venues in your community, by submitting to a journal, or by posting to a blog.

Moral Distress: Call for Stories

Moraldistress is the psychological disequilibrium when a person believes he or

Moral Compass
Moral Compass (Photo credit: psd)

she knows the right course of action to take but cannot carry out that action because of an obstacle, such as institutional constraints or lack of power. (source: Arizona Bioethics Network). Moral distress has been studied in nurses—mainly acute care nurses—since the 1980s. Although imperfectly defined and measured, moral distress appears to be strongly related to professional burnout and patient safety issues in a variety of health care professionals including doctors. (see NYT article “When Doctors and Nurses Can’t Do the Right Thing” Pauline Chen, 2-5-09).

A 2010 symposium focused on moral distress was held at the University of Victoria on Vancouver Island. As reported recently by Bernadette Pauly and her colleagues in the journal Healthcare Ethics Committee Forum (2012, issue 24) interventions targeting moral distress have focused on individual coping skills of nurses and other providers. (I’ve mainly seen interventions such as deep breathing, meditation and journaling.) Most research has focused on acute care nurses and has reinforced the notion of “nurse as victim” in the hierarchical hospital system. Pauly and colleagues called for greater attention to structural issues involved with moral distress, including the ethical climate of the hospital administration. In addition, they questioned the current emphasis in nursing education on teaching ethical frameworks instead of specific guidance and skills in how to navigate increasingly complex ethical terrain in everyday practice. They also recommended interprofessional education—bringing together nursing, medical and other health professions students for this sort of ethics education.

The journal Narrative Inquiry in Bioethicshas a call for stories about moral distress from nurses and other health care clinicians. It would be great to see submissions from nurses working in schools, public health, home health, community-based clinics, and occupational health sites, as well as from acute care settings. This is your chance to contribute to a forum that could contribute to some positive structural changes in our health care system—and not just more deep breathing and meditation trainings.

Here’s the information: Narrative Inquiry in Bioethics Call for Stories

Narrative Symposium: The Many Faces of Moral Distress Among Clinicians

Edited by Cynda Hylton Rushton, PhD, RN, F.A.A.N. and Renee Boss, MD, MHS

Narrative Inquiry in Bioethics will publish an issue devoted to personal stories from clinicians regarding situations that cause moral distress and how they have responded to them. Moral distress arises when professionals find that they are unable to act in accordance with their moral convictions. The focus of this inquiry is on the personal and professional short- and long-term impact of moral distress and the ways that clinicians respond to and make meaning from that distress. Appropriate contributors might include nurses, physicians, social workers, nursing assistants, clinical ethicists, occupational and physical therapists, and professionals in training. We want true, personal stories in a form that is easy to read.

In writing your story, you might want to think about:

·         Which specific clinical situations give rise to moral distress? Why?

  • How do you experience moral distress—physically, psychologically, socially or spiritually?
  • How do you deal with moral distress? In past distressing situations

o   Did you take actions that allowed you to uphold your deepest values?

o   What conditions within yourself, the people involved, and the external environment allowed you to do this?

o   How did you made sense of the situation?

  • What have been the short or long term consequences?

o   Have you ever been professionally disciplined for acting upon your moral conviction?

o   How has moral distress affected your job performance or your commitment to your job?

o   What has been left undone or been the residual impact?

o   How have your own values evolved as a result of moral distress?

  • How would you change the system (e.g., policies, hierarchies, processes) to alleviate moral distress within your position? Do you think it can be alleviated, or is it inevitable?

You do not need to address all of these questions—write on the issues that you think are most important to share with others. You do not need to be a writer, just tell your story in your own words. We plan to publish 12 stories (800 – 2000 words) on this topic. Additional stories may be published as online-only supplemental material. We also publish two to four commentary articles that discuss the stories in the journal.

If you are interested in submitting a story, we ask you first to submit a 300-word proposal—a short 
description of the story you want to tell. Please include a statement about what type of clinician you are and what kind of environment you work in (no institutional names are needed). Inquiries or proposals should be sent to the editorial office via email: narrativebioethics@gmail.com. We will give preference to story proposals received by Oct 31st. For more information about the journal Narrative Inquiry in Bioethics, the guidelines for authors, and privacy policies, visit our webpage with Johns Hopkins University Press at: http://www.press.jhu.edu/journals/narrative_inquiry_in_bioethics/guidelines.html


Who are you?

Gargoyle by Dudley Pratt on UW's Smith Hall
Image via Wikipedia

This was the greeting Dr. Joan Shaver, PhD, RN, FAAN threw Theresa Brown’s (PhD, RN) way last night when I introduced them to each other. Theresa could, of course, have asked Joan the same question, except that we had both just finished sitting through Joan’s 90 minute lecture on the future of nursing—so Theresa knew the answer. Dr. Shaver is Dean of the Arizona State College of Nursing and gave the Soule Endowed Lecture for the University of Washington School of Nursing. Her lecture, entitled “Nursing Science and Practice: Working Together to Benefit Patients and Communities” included many PowerPoint slides—along with the seemingly required two-part:title. Her talk immediately preceded the Nurses Recognition Banquet, at which Theresa Brown was the guest speaker. Theresa Brown, as most of you probably already know, is an oncology nurse, regular contributor to the NYT’s Well Blog, and author of Critical Care: A New Nurse Faces Death, Life, and Everything In Between (HarperStudio, 2010). Especially with the national attention paid to her recent NYT’s Op-ed piece, “Physician, Heel Thyself,” Theresa is a major voice for nursing in our country. Dr. Shaver had no idea who she was. To bear witness to this collision of nursing worlds was one of the most interesting things of the entire day for me. It dismays me, since it highlights just how out of touch nursing academia is with the real world of nursing—and of nursing advocacy.

Hubris was present in abundance. At the beginning of the series of talks and awards, Dr. Marla Salmon greeted the audience and began to introduce herself as “Dean of the United States.” She caught herself mid-United States and corrected it to Dean of the University of Washington School of Nursing. Dr. Shaver peppered her talk with photos of nursing leaders she has worked with—all older white women. In contrast, Theresa Brown was grounded, humble, and gracious. Dr. Shaver’s talk focused on broad-stroke theories and recommended directions for nursing research and practice: scaling up nurse-managed clinics, group vs. individual patient clinic visits, and having a community-based vs. hospital care emphasis. Theresa Brown’s talk focused on bottom up vs. top down change, and a move towards universal BSN-prepared RN’s as a way of strengthening nursing. Theresa also admonished us all to hold each other and ourselves accountable for collegiality and to stop nurse on nurse bullying—to stop perpetuating the reality behind the saying “nurses eat their young.” She ended by stating that nursing needs more of a public voice and that is the responsibility of all of us—to speak up about what nurses do.

Dr. Shaver ended her talk with a cartoon showing a seated older, grumpy-looking woman. The caption read, “The reason you can’t fool all the people all the time is because half of them are women.” Beside this caption she had added, “and many of them are nurses.” She did preface this slide by giving an apology to any male nurses in the audience, “but nursing is still mainly a female dominated profession.” As if that made it OK? The old girl’s network of nursing leadership in this country has to change. We do not need the next cohort of old girls to perpetuate the path they are on.

At the end of the Nurses Recognition Banquet last night we toasted to nurses. Cheers. Salud, dinero y amor. Bottoms up. Secretly, I toasted to bottom up change in nursing.