A Call to Peace and Nursing

DSC00821Today, 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.

 

Note:

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.

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No Time to Be Silent: On Radical Nursing

P1020860There 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.

 

Reflections on the Poor Laws

P1020893.JPGWater of Leith, Edinburgh, bench beside Saint Bernard’s well with a statue of Hygieia, goddess of health

The largely impenetrable layers of history and how we humans are so prone to repeat past mistakes.

That is what occurs to me today as I walk these ancient paths and sit beside an ancient, pagan well of healing—mineral waters—overlaid, of course, by Christian (Saint Bernard) and ancient Greek (Hygieia) symbols. After a morning of reading ancient British Poor Laws—weeks of researching them and tracing their repercussions today, not only in the U.K. but also in the U.S. and in Seattle/Washington State. The worthy and unworthy poor. The deserving and underserving poor. The impotent poor. Paupers. Vagrants. Ruffians. Charity and its attendant ills. Solidarity and its limitations.

Beige mud puddles surround me here as I sit on this bench, barely staying dry underneath my umbrella. What sort of stone is all this beige-ness? (note: ancient sandstone, over 300 million years old.) The entire city of Edinburgh is composed of beige stone. And what minerals are in this water? (note: Sulphur, magnesium, and iron it seems.)

A soft purple Scottish thistle—late blooming ones in the midst of a large patch of blackened, dried up plants with thistle heads. There seems to be a prickly and a not so prickly version of thistles here. Why is the thistle the national flower of Scotland? (note: no one seems to know although there is a story about it that involves Norwegian invaders by sea who stepped on the thistles and alerted the Scots to their presence.)

Why aren’t nurses taught more about the history of social welfare and of the legacies of ancient pauper laws? Are they taught that at all here in Scotland or elsewhere in the U.K.? How much of it are even social workers taught either here in the U.K. or back home in the U.S.? It seems so important and puts many things in perspective, especially in terms of addressing the current thorny question, “What to do about the homeless?” And my own ongoing work in the vicinity of that question. I almost feel cheated in not having known about it much earlier in my life and my career as a nurse.

The deep layers of the histories of places and peoples are important to acknowledge, to know, at least at some more than superficial level. Is this something that can only be appreciated as one ages and takes on a proper sense of time?

A beechnut exploded, scattered on the ground along the river walk path wending its way beneath an old tree. They look like flowers but are hard. I try to press one between these pages and it breaks through the paper. Only the seeds remain.

 

Trauma Mastery

IMG_0253Note: This is an excerpt from my essay “The Body Remembers” in my book Soul Stories: Voices from the Margins (San Francisco: University of California Medical Humanities Press, 2018).

Early in my career as a nurse, I worked for a year in a “safe house” emergency shelter for women who were escaping intimate partner violence. Before my work there, I did not understand the concept of trauma mastery and how this plays out in the lives of women caught up in the cycle of abuse. I sided with the common misperception that the reason so many women return to their abusive partners is because the women are psychologically damaged and weak.

I learned that there is the not-insignificant role of addiction to the thrill of trauma and danger—to the effects of the very activating yet numbing fight-or-flight neurochemicals—which can bring at least temporary relief to the bouts of fatiguing depression that often accompany trauma. And there are also unconscious attempts to return to the previous trauma to “get it right this time”—to do what we wish we could have done the first time, to master our trauma.

Seattle social worker Laura van Dernoot Lipsky points out that these unconscious attempts to master our traumas often backfire and simply reinforce our old traumas. She says that many of us in health care and other helping professions are often using our work as a form of trauma mastery, and that by doing so, we may set expectations for ourselves and others that are “untenable and destructive.” (1) She advocates ongoing efforts aimed at self-discovery and self-empathy, and points to the many positive examples of “people who have been effective in repairing the world while still in the process of repairing their own hearts.” (2) Eve Ensler, with the combination of personal work and “world repair” work that she describes in her powerful book In the Body of the World, is one of my favorite examples of this sort of balanced approach. (3)

 

Sources:

1 and 2, Laura van Dernoot Lipsky with Connie Burk, Trauma Stewardship: An Everyday Guide to Caring for Self While Caring for Others (San Francisco: Berrett-Koehler Publishers, 2009), page 159.

3, Eve Ensler, In the Body of the World (New York: Metropolitan Books, 2013).

 

Dear Flo: What Nurses Week Means to Me

IMG_4737Happy National Nurses Week to all you dedicated, compassionate, hard-working nurses out there! While you’re enjoying your free cinnamon bun and coffee, I hope you will pause to reflect on your work and on what truly fuels your continued passion for nursing (or where the heck that passion has gotten to if you have lost it).

And if you have time to read more than patients’ chart notes or community outreach notes, I hope you will pick up and read a “real” book written by nurse authors. We may be a small group compared with the vast number of physician authors, but we are growing in strength. I am proud to be a nurse and I am proud to be a nurse author in the company of some amazing, inspiring people.

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As far as living nurses go, there are many who inspire, innovate, and influence me. One of these is Ruth Watson Lubic, the nurse-midwife, MacArthur “genius” award winner, and founder of the Family Health and Birth Center, located in one of the poorest neighborhoods in Washington, DC. She walks the talk of what nursing can and should do well, to “treat everyone like a human being,” to create a community-based health center where “everyone who walks in that door feels love.” Plus, she has combined direct nursing service with upstream policy work as succinctly depicted in this brief video. (And she is a way cool elder who has her own Hip Hop Saves Lives song and video!)

The American Nurses Association Ethics and Human Rights Statement of 2017 states that “Nursing is committed to both the welfare of the sick, injured, and vulnerable in society and to social justice.” It goes on to proclaim that “Nurses must always stress human rights protections with particular attention to preserving the human rights of vulnerable groups, such as the poor, the homeless, the elderly, the mentally ill, prisoners, refugees, women, children, and socially stigmatized groups.”

I am a proud nurse educator and (most days) count among my blessings, the opportunity to work with the amazing, smart, creative, and compassionate future nurses. Like the students yesterday at the Nurses Week event at Shoreline Community College. And like these University of Washington School of Nursing students at our Doorway Project pop-up community cafe who spent a sunny Sunday afternoon washing the feet of homeless young people. Dear Florence Nightingale, happy birthday and happy Nurses Week! As Florence Nightingale nurse scholar Tony Paterniti, PhD, RN states, Nightingale wasn’t only the lady with the lamp, she was also a “woman with a mission.” (Check out Dr. Paterniti’s fascinating digital archive collection on Florence Nightingale through Texas Woman’s University.)

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Global to Local: The Doorway Project

IMG_3706Dream big. Take calculated risks. Be innovative and creative. Work collaboratively. Be open to learn from other countries and other communities and support the global to local connections. Dare to be labeled woo-woo. Remember nurse power!

Those are the lessons I have been learning—or relearning lately as I help launch the Doorway Project, a campus-community interprofessional innovative collaborative project aimed at reducing if not ending youth homelessness in the University District of Seattle. It is a form of public scholarship and includes creative data-gathering and design modalities including participatory community mapping, photo voice, and participatory digital storytelling videos. It’s final product will be a youth-centric human/community designed community cafe modeled after the amazing Merge Cafe in Auckland, New Zealand. It is ambitious and audacious and it just might work.

We have our kick-off and first pop-up community cafe and community participatory design activities this Sunday, December 3rd, noon-4pm at the lovely community center University Heights in the U District of Seattle. Here is an edited down 4-minute version of a longer interview I did today with our local U District public radio station KUOW 94.9 FM. Many thanks to them and especially to Producer Andy Hurst whose mother happens to be a nurse.

On (Homeless) Self Promotion

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Happy 1st birthday to my medical memoir, Catching Homelessness: A Nurse’s Story of Falling Through the Safety Net. There is this upcoming sale of the e-book for all you e-bookish fans.  It has been a fascinating and fun year and it has taken me places I never expected to go.