While there is much that I love about nursing and about being a nurse, there are times when it bores me to tears, times when I feel I have been dropped down a rabbit hole time warp, times when I despair for its future. My current list includes:
When the Cult of Florence Nightingale is invoked as the one and only true vision of modern nursing;
When busy (and boring) Powerpoint slides are used as props to make any and all (mostly vacuous) statements;
When nurse academic-types staunchly defend an old, tired, narrow-minded, biomedical model of ‘nursing research’ as the one and only true version of research;
When older, privileged white women (who seemingly are blithely unaware of their privilege) are nursing’s chosen leaders and spokespersons.
There are effective antidotes to this despair and I will share my list in a follow-up post.
Stories beget stories, so be careful of the ones you tell—or listen to or share.
This past week I was a participant in the StoryCenter‘s webinar “Defining Compassion in Nursing” based on the Nurstory digital storytelling project founded by Dr. Sue Hagedorn from the University of Colorado School of Nursing. I was intrigued by the title of the webinar as well as by the opportunity to learn how digital storytelling is being used in nursing education and advocacy.
Digital storytelling (DS) refers to short video segments (typically 3-5 minutes in length) personal narratives that incorporate digital images, music, and voice-over narration by the person making the video. They are typically created within a workshop-based process that includes a Story Circle to share, critique, and refine stories-in-progress. Developed in the early 1990s by media/theater artists Dana Atchley and Joe Lambert and promoted through their StoryCenter (formerly the Center for Digital Storytelling), DS has been used for public health research, training, and policy campaigns (such as the powerful Silence Speaks global women’s health/human rights campaign); community building (such as the now archived BBC Capture Wales program); literacy programs; and reflective practice with health science students. DS is increasingly used as an innovative community-based participatory method that is especially effective at informing program planners and policy makers about the lived experiences of marginalized people.
Besides the fact that not all stories can or should be told in a nice, neat, linear 3-5 minute format, there are numerous ethical issues to consider. A brief overview of some of the ethical issues with DS is included on the StoryCenter website under “Ethical Practice in Digital Storytelling.” And, with their permission, here is an excellent overview by Kelsen Caldwell (formerly in the University of Washington School of Medicine, Health Sciences Service Learning and Advocacy group) of ethical considerations of storytelling in health advocacy work with communities: “The Ethics of Storytelling.”
I have worked with groups of people experiencing homelessness, as well as with health science students working on community-based service-learning projects that include homeless people, and have helped them to make some of their own DS videos. I completed a participatory digital storytelling video workshop in August, 2015 with a group of homeless youth through the Zine Project Seattle (sadly, no longer in existence). With their permission I share links to two of their videos here: “Harm Reduction is Good” and “Tug of War.”
I have concerns about how empathy and compassion are defined by nursing and how we as nurse educators have our own unpacked, unexamined, uncritically looked at stories of what nursing should and should not be. Who gets to decide what is a “proper” nurse story of compassion? Shouldn’t it more properly be Nurstories instead of the singular Nurstory? That said, after viewing all of the DS videos on the Nurstory website, I am struck by how powerful and even subversive several of them are. Rawaih Faltatah’s “Circle of Care” is an ode to her older sister, a nurse, and the effects of her caring and compassion on her own life and choice of a career in nursing. A more difficult to watch and listen to, yet subversive and important DS video is “Invisible Touch” by Kate Clayton-Jones.
One of my first patients was a suffragette poet. She was 102 in 1981 when I cared for her in a Presbyterian nursing home in my hometown of Richmond, Virginia. I was a recent Harvard Divinity School drop-out working full-time as a nursing assistant, wrestling with the decision of whether or not I wanted to be a nurse. I was—and still am—a feminist. I was not sure I could be both a feminist and a nurse. Nursing seemed anti-feminist, steeped in the traditional subservient roles to which women were relegated.
I’ll call her Lillian because in my memory she stands out as steely kind and sharply intelligent as I imagine Lillian Wald, the founder of public health nursing, to have been. As a young woman “my” Lillian had met and worked with Susan B. Anthony. “My” Lillian had marched in suffragette demonstrations in Washington, DC and had written suffragette tracts and poetry and lobbied hard for passage of the Nineteenth Amendment in 1920 that finally granted women full voting rights. She never married and spent the rest of her life as a Presbyterian missionary in various African countries. Being a missionary was one of the few acceptable roles for single women at that time, along with nursing and teaching. (The drawing below is from my paternal grandmother’s 1919 college journal showing the “choices” she was considering for her life—ranging from Old Maid to Bride.)
In my research this past week I ran into an article written in 1904 in Seattle by a man named Honor L. Wilhelm. In between his serialized stories of his honeymoon to Victoria, BC, and guest articles on Native Americans, he wrote a piece titled “The Girl Alone” that made my feminist blood boil. He stated, “Motherhood is the acme of womanhood. The girl alone is a sinful, selfish, miserable, abhorred, ugly, wretched, hideous creature, whom to know is to shun and to meet is to pass by. She is an outcaste and a social parasite.” (p. 74, The Coast: Volumes 7-10, 1904)
The elderly suffragette poet I was fortunate to have had in my young adult life helped convince me that in becoming a nurse I did not have to trade in my feminist ideals and identity. I mainly worked evening shift at the nursing home. Late at night, once I had completed all my work, I sat beside her bed while she told me stories of her life and read drafts of poems she was working on. She gave me a hand-written poem which I treasure—a talisman of feminism.
A year later when I went back to school for my bachelor’s degree in nursing, I had no feminist nurse professors or role models. The sole feminist nursing student I knew dropped out of school in disgust after our first semester. I wish I had known about the work of feminist nurse Peggy Chinn and her colleagues who had just started Cassandra: Radical Feminist Nurses Network. Dr. Chinn’s work continues, including through her NurseManifest Nursing Activism Project. And the next generation of feminist nurse activists have started the Radical Nurses group.
March on. We still have so much work to do to help make our world a safer, healthier, more equitable place for all.
Someone asked me recently at a public forum if empathy has been diminishing among nurses (and nursing students). Excellent question. In my answer, I pointed out that empathy is being sorely tried and spread quite thin in our country currently. That goes for everyone, including nurses and physicians, and students and teachers. And writers.
The question was in response to my reading of excerpts of my essay “Walk in My Shoes” included in my recently published book Soul Stories: Voices from the Margins(San Fransisco: The University of California Medical Humanities Press, 2018). In “Walk in My Shoes” I explore empathy, including if it is always a good thing. Empathy is “feeling with” as opposed to the more distancing “feeling for” of sympathy.
We all tend to be more empathetic to people who are similar to us. Climbing the socioeconomic ladder can diminish our empathy for people less well off than ourselves. It becomes easier to blame the poor and the homeless for their situations. Experiencing our own significant traumas can make us more empathetic to people who have experienced similar traumas—but only if we have had the resources to heal sufficiently.
In The Empathy Exams, Leslie Jamison describes empathy as “a penetration, a kind of travel. It suggests you enter another person’s pain as you’d enter another country, through immigration and customs, border crossing by way of query: What grows where you are? What are the laws? What animals graze here?” p. 6
I like this description because it includes the cognitive dissonance, the discomforting disorientation—and humility—that come with travel and with empathy as travel. It also highlights the healthy curiosity required of successful travel, successful empathy. Empathy takes work to gain and to maintain.
Empathy cannot be taught but it can be modeled and it can be nurtured.
What is a nurse? What images of nursing do you have? What images of nursing are portrayed in the media? What images of nursing do we want in the future?
These are just some of the many questions that can—and should—be asked about the profession of nursing. No matter where in the world you happen to be living, a healthy and positive image of nursing matters. Nurses constitute the largest segment of the healthcare workforce worldwide. Valuing the vital work they do—and can do when given the chance—is important for individual and population health.
Do we really want to stay stuck with the image of nursing portrayed by the lady with the (Victorian) lamp, Florence Nightingale? Do we want to stay stuck even further back in time to the monastic orders who provided nursing care? Do we want to stay stuck in the limiting hospital-based image of nursing portrayed our slightly more evolved TV soap operas (from General Hospital) of E.R. and Grey’s Anatomy or even Nurse Jackie?
In reviewing my own—literal—images of nursing that I have collected over the years, it struck me how few I have of hospital nursing. To be precise, I only have one photograph I took of a hospital nurse and that was quite by accident. I was taking a photograph of a shiny-surfaced piece of hospital artwork and a nurse happened to be walking past behind me. In contrast, I have numerous photographs I have taken of nurses providing foot care and health education in homeless shelters, tent encampments, and even under bridges. Intrepid, empathic, fearless nurses. They are my image of what nursing is and what nursing can become. They are from many parts of the world. Here they are and I hope they give you hope for the future of not just nursing. And check out the Nursing Now program, in collaboration with the World Health Organization and the International Council of Nurses, which aims to raise the status and profile (and image I suppose) of nursing.
Today, on this 100th anniversary of the armistice that ended the long bloody battle of World War I, I am reminded of the odd, and to me, unfortunate, relationship between war and nursing. Since I currently live in the land of Florence Nightingale, the lasting legacies of war nursing surround me.
From the Crimean War during Nightingale’s time, through the two World Wars, and on to the more recent wars in Afghanistan and Iraq, modern nursing developed alongside modern warfare. Of course, many medical advances have come from battlefield medicine. But nursing as an entire discipline (and only more recently a profession) in Britain came directly from wartime nursing practice. The legacies of this include a rigid, hierarchical, old-fashioned, and sexist nurse practice structure that is almost exclusively hospital based. The old-fashioned and sexist parts are how I view it, especially given the fact that British hospitals still have “ward sisters” and “hospital matrons.” And, nurse practitioners exist here in name only—they are not allowed to perform any of the expanded scope of nursing practice that we are able to do in the US. (Happy National Nurse Practitioners Week to all of you nurse practitioner colleagues back home. I have loved being a nurse practitioner now for a total of thirty-two years.)
How—and why—has American nursing developed in a different direction from that of British nursing? While I do not pretend to be an expert on the history of nursing, I imagine that the comparatively youthful cheekiness of early American nurse pioneers has something to do with our country’s diverging development of modern nursing. The American nurse pioneers like Dorothea Dix (mental health reformer/Superintendent of Women Nurses for the Union Army—if not a nurse herself she was certainly influential on nursing) and especially Lillian Wald, of Henry Street Settlement in New York City and founder of public/community health nursing.
Public/community health nursing does not and never has existed in Britain. Since public health/community health nursing and the expanded primary care role of nurse practitioner were what inspired me to even consider nursing in the first place—and are what continue to inspire me–I have come to realize that I would not be a nurse if I had been born in Britain or in any of the many countries which are former colonies of the British Empire (including Australia, New Zealand, and Canada.) Yet (and this is a big plus), the UK and these three countries/former British colonies all have some form of national health care. And, for the most part (Scotland where I am living is an exception), they all manage to have healthier populations overall for much less healthcare spending.
The photograph in this post is one I took in the Te Papa Museum, Wellington, New Zealand in 2016. It was part of an exhibition on WWI nursing and WWI’s effects on New Zealand in general. It was appalling to realize that entire populations of “fighting age” men (including Maori men) of New Zealand villages were killed in the war. WWI commemorative statues, along with the ubiquitous red poppies, abound throughout the tiny nation of New Zealand.
There is a time and place for silence, but only when it is freely chosen, not imposed. But now is not the time for silence. Now is the time to step us, speak out, and, at least in the United States, to vote. It is time to remember that progress on human rights and social justice issues in our world is not a given. That basic respect for girls and women is not a given. That universal abhorrence of gender-based violence is not a given. We all have to work for it—even when (and especially when)—our lives are turned upside down.
Nurses are the most trusted professionals in both the U.S. and the U.K. (although tellingly, nursing was only added as a legitimate profession to these polls in the U.K. two years ago). As nurses, we have always prided ourselves on being truthful, for speaking out and advocating for our individual patients or communities. But for various reasons (including a lack of contemporary role models or inclusion in nursing curricula), nurses have not be so good at political advocacy and activism.
Historically, nursing does have some amazing examples of nurses who bucked the status quo, spoke truth to power—who were radical nurses. Florence Nightingale in the U.K.—and especially her work after the Crimean War in bringing nurses to work in poor/workhouses in England. And in the U.S., my favorite historical role model is Lillian Wald in New York City. Lillian Wald founded the Henry Street Settlement in the poorest section of New York City, and she founded public health nursing. Public, community, population health nursing is what drew me to nursing in the first place and it continues to be my passion. Public health nursing work is always political work.
In the U.K. in the 1980s there was the short-lived but influential Radical Nurses Group (RNG). Some of their archived material was the subject of a (again, short-lived) blog, “The Radical Nurses Archive” written by a former NHS nurse using the lovely pseudonym, The Grumbling Appendix (with another blog on nursing and politics in the U.K. that ended in 2015). Where have the radical nurses in the U.K. gone? I am currently on a quest to find them.
Back in the U.S. we have the NurseManifest website and resources on nursing and activism co-founded by Sue Hagedorn, Peggy Chinn, and Richard Cowling. Beginning in the summer of 2018, they have added the Nursing Activism Project with a growing list of historical and contemporary nurse activists “Inspirations for Activism.” In addition, they have a dynamic list of resources for nurse activism.
No excuses. All you nurses out there in the world: Get informed. Get inspired. Get active.
I include a recent interview I had with my colleague here at Edinburgh Napier University School of Nursing and Social Care, Dr. Peter Hillen, on nursing and activism.