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


Why Nursing Care Plans Refuse to Die

Social Security: Public Health nursing made av...
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Today I was simultaneously searching for appropriate guidelines for case study presentations for nursing students working in public health settings, and wondering where nursing care plans came from. The two seemingly disparate threads of inquiry converged in a stranger than fiction way.

The earliest origins of the nursing care plan seem to be attributed to Ellen L. Buell, a public health nurse and nursing instructor at Syracuse University, NY in the 1930s and 40’s. In 1930 in the American Journal of Nursing, she published an article: “The Case Study: As a Method of Teaching Students and Graduates the Principles of Public Health Nursing.” She presented the public health case study as a way of teaching comprehensive and systematic thinking and care planning to new nurses. It was based on home nursing, so included all the family members, their health status, socioeconomic status, housing conditions, and nationality/citizenship status. Some of the nursing diagnoses she uses are shyness and temper tantrums (for the children). Recommended nursing interventions include more fresh air and play out of doors. Her public health nursing case study approach then led to a codification of nursing theory, nursing process, nursing diagnoses and the nursing care plan. The development of all of these occurred within baccalaureate nursing programs. Nursing care plans originally were considered ‘higher thinking’ and planning possible by BSN prepared nurses, and were also meant to guide delegation of nursing duties to the ‘lesser’ diploma-trained and LPNs.

Nursing care plans took on a life of their own in the 1960s and 70s in the US, and then spread virally to other parts of the planet. They became an established requirement within BSN programs, as a way of indoctrinating nursing students into thinking like a nurse. Nursing care plans were a way of differentiating nursing practice from medical practice. All of the current nursing faculty in our country had to do 6-page nursing care plans in nursing school—it is an unquestioned part of becoming a nurse, so it is continued.

What is amazing is the lack of any evidence to support the usefulness of nursing care plans, either to teach nursing students systematic thinking, or to improve patient outcomes. And nursing care plans are not required for hospitals or long-term care facilities by the Joint Commission for certification. Interdisciplinary care planning and coordination is a Joint Commission requirement, but not nursing care plans. Nursing is the only health care discipline to continue to insist on having its own separate care plans.

Most nursing students abhor nursing care plans and find them simply busy work. Most real nurses out there practicing in hospitals and long-term care facilities find them tedious, and say they detract from and don’t aid good patient care. The advent of EMRs and electronic checklist nursing care plans have streamlined the process to some degree. Luckily, public health nurses—who started this whole crazy nursing care plan idea in the first place—don’t do nursing care plans.

Most useful relatively recent article I found on this topic was: Interdisciplinary Care Planning and the Written Care Plan in Nursing Homes: A Critical Review, by Mary Ellen Dellefield, The Gerontologist, 2006, 44(1): 128-133.