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.
Panel will include an interview with Theresa Brown who writes for the NYT Well Blog. Participants include Josephine Ensign, DrPH, Associate Professor, Department of Psychosocial and Community Health, whose essay Next of Kin appears in the anthology.
This project was supported, in part, by an award from 4Culture
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.
I worked at a community health clinic that was housed in an old restored firehouse with old plumbing designed for a few firefighters and not for hundreds of patients each day. We fairly regularly had “Code Brown” called over the clinic loudspeaker when the sewer system backed up into clinic areas. Sometimes they closed the clinic until it was cleared. Sometimes we worked around it. That’s community health.
I have never worked where they called “Code Pink” and I think I am glad of that. It sounds as if it should be a mammogram emergency. According to nursing leadership expert, former Dean of the Kansas School of Nursing, and current hospital mystery writer Eleanor Sullivan, Code Pink is called by a nurse in a hospital who is being bullied by physicians or others. In her letter to the NYT editor in today’s paper (Sunday May 15th), she writes, “The word is passed nurse to nurse, and colleagues gather around the beleaguered nurse. Few physicians can stand the scrutiny of neutral-faced nurses standing silent beside one of their own.” Somehow I don’t picture the nurses as neutral-faced. All four letters today in “When Doctors Humiliate Nurses” were supportive of Theresa Brown’s Op-ed article “Physician Heel Thyself.” All four letters were relatively bland, especially compared with the responses to her article found elsewhere.
Dr. Kevin Pho on his popular blog KevinMD.com, has already written two posts on Theresa Brown’s article. In his first blog post entitled “Theresa Brown unfairly blames doctors for hospital bullying” he states, “Brown has a prominent media platform in the New York Times, and, in a way, she wields it here to metaphorically bully the entire physician profession.” Many self-identified physicians who responded to Dr. Pho’s blog post were supportive of his read of Ms. Brown’s articles, although most stated they refused to (literally) read anything she writes… One person identified as “David MD” did the math, dismissed Ms. Brown as a neophyte nurse since she has a pre-existing PhD and pre-existing children, and admonished her for “extracurricular writing” that “must have violated the terms of her employment at Shadyside Hospital.” He concludes, “From the tone of her other blogs, she must be an absolute nightmare to work with.” David MD stated that he had written a letter to the editor of the NYT in protest of her article.
In his follow-up blog post, “Doctor bashing and confronting physicians in the media,” Dr. Pho admitted that Ms. Brown’s article had brought the topic of hospital bullying into the national health care conversation. He applauded her for bringing up such a difficult topic in the NYT. But he still takes issue with her method, calling it an “adversarial approach,” and alluding to it as “doctor bashing.” He even likens it to the case of the Seattle nurse Kim Hiatt being fired by Children’s Hospital for a medication error, stating that neither will solve larger systemic issues within health care. Instead, for physician bullying, he places blame on the medical education system for perpetuating the socialization of arrogance and bad manners in medical students. That line of reasoning makes no sense to me: Medical education is by and for physicians.
What I find fascinating in many of the physician blog posts and comments to Ms. Brown’s article, is the resentment that, 1) she is a nurse and she can write well, and 2) she has a national media platform through the NYT. In his second blog post on Ms. Brown’s article, Dr. Pho writes, “Brown is a former English professor, and it’s no wonder that the framing of the piece is masterful.” Some of the posts by physicians call for her hospital administration to silence her. In Ms. Brown’s recent article entitled “Nurse as Writer, Writer as Nurse” published in the Clinical Journal of Oncology Nursing (April 2011), she acknowledges that dealing with hospital management has been tricky when it comes to her writing. She never identifies the hospital where she works, although as she says it’s easy enough to figure out who her employer is. She states that when she first started writing, the hospital management wanted editorial control over everything she wrote. “Knowing this was a request they could not legally make, I said, ‘No,’ and have had to repeat this refusal more than once. It’s not always easy, and at times I wasn’t sure I was tough enough to stand up to the healthcare corporation I work for.” I do not know what sorts of blowback Ms. Brown is currently getting from her hospital administration over her NYT Op-ed article “Physician, Heel Thyself.” But if she is feeling this heat, perhaps she could call a Code Pink of the Dr. Sullivan type. I contend that she has done vastly more through her ‘popular press’ writing to effect positive change in nursing and health care than any amount of academic journal articles or IOM reports or White Papers.
For those of you in the Seattle-area, Theresa Brown will be speaking at a public event next week at the University of Washington. Sponsored by Poets and Writers and the School of Nursing, Ms. Brown will give a talk entitled “Nurse as Writer, Writer as Nurse,” UW Health Sciences, Room T-625, Thursday May 26th 10:30-12:20pm. The following is the blurb I wrote to describe the event:
Theresa Brown is an oncology nurse, author of Critical Care: A New Nurse Faces Death, Life, and Everything in Between (harperstudio, 2010), and is a regular contributor to the New York Times’ Well blog. In a recent article entitled “Nurse as Writer, Writer as Nurse” in the Clinical Journal of Oncology Nursing, Ms. Brown addresses the most common questions people ask her, such as, “What about patient confidentiality?” “Do you take notes at work?” and “How do your coworkers (and employer) feel about your writing?” A former English professor who found her true calling as a nurse, Ms. Brown will talk about her dual paths as writer and as nurse.