When Chicken Soup isn't Enough

When Chicken Soup isn't Enough: Stories of Nurses Standing Up for Themselves, Their Patients, and Their Profession

Copyright Date: 2010
Edition: 1
Published by: Cornell University Press
Pages: 272
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  • Book Info
    When Chicken Soup isn't Enough
    Book Description:

    The reassuring bromides of "chicken soup for the soul" provide little solace for nurses-and the people they serve-in real-life hospitals, nursing homes, schools of nursing, and other settings. In the minefield of modern health care, there are myriad obstacles to quality patient care-including work overload, inadequate funds for nursing education and research, and poor communication between and within the professions, to name only a few. The seventy RNs whose stories are collected here by the award-winning journalist Suzanne Gordon know that effective advocacy isn't easy. It takes nurses willing to stand up for themselves, their coworkers, their patients, and the public.

    When Chicken Soup Isn't Enough brings together compelling personal narratives from a wide range of nurses from across the globe. The assembled profiles in professional courage provide new insight into the daily challenges that RNs face in North America and abroad-and how they overcome them with skill, ingenuity, persistence, and individual and collective advocacy at work and in the community. In this collection, we meet RNs working at the bedside, providing home care, managing hospital departments, teaching and doing research, lobbying for quality patient care, and campaigning for health care reform.

    Their stories are funny, sad, deeply moving, inspiring, and always revealing of the different ways that nurses make their voices heard in the service of their profession. The risks and rewards, joys and sorrows, of nursing have rarely been captured in such vivid first-person accounts. Gordon and the authors of the essays contained in this book have much to say about the strengths and shortcomings of health care today-and the role that nurses play as irreplaceable agents of change.

    eISBN: 978-0-8014-5864-4
    Subjects: Health Sciences

Table of Contents

  1. Front Matter
    (pp. i-iv)
  2. Table of Contents
    (pp. v-viii)
  3. Acknowledgments
    (pp. ix-x)
  4. Introduction
    (pp. xi-xviii)

    Iʹve been thinking about putting this book together for several years. During two decades of writing about nursing, Iʹve read many inspirational books, articles, and essays that offer up the literary equivalent of comfort food for RNs. The authors invariably mean to be helpful to the nursing profession by lifting the spirits of its practitioners at a time when so many are feeling tired, stressed out, dispirited, or unappreciated. The problem is, in this heavily sentimental genre, the real-world context of long hours, increased patient loads, and chronic understaffing quickly fades into the background. In the foreground we see traditional...

  5. Part 1 Set Up to Lose, but Playing to Win

    • [Part 1 Introduction]
      (pp. 1-2)

      For more than two de cades, Iʹve had a front-row seat on nursesʹ socialization in self-denial. Whether in nursing school or on the job, nurses are taught how to care for and be concerned about patients. They are constantly enjoined to advocate for patients. What they are not encouraged to do is to advocate for, or even acknowledge, their own needs either as human beings or as professionals. Sometimes I think nurses are taught that altruism means they have no needs at all.

      I watched this play out in the early 1990s when I was writing about nursing at the...

    • A Covert Operation
      (pp. 3-5)
      Kathleen Bartholomew

      I was a brand new manager with absolutely no experience, but I knew intuitively that to run the fifty-seven bed orthopedic and spine units effectively, I would have to cultivate a relationship with their physicians. The orthopedic physicians met every Friday morning at seven for rounds where two physicians would present their most difficult cases. While the first and second physicians were switching out x-rays, I asked if I could talk to the doctors to establish a definite time and place for weekly communication. Thereafter, every week at “half-time” (i.e., halfway through rounds), I would get five precious minutes to...

    • Saving Patients from Dr. Death
      (pp. 6-8)
      Toni Hoffman

      I first met the surgeon who came to be known as ʺDr. Deathʺ when he was hired to work in our small rural hospital, Bundaberg Base Hospital, in Southeast Queensland in 2003, where I was nurse unit manager in the intensive care unit. Dr. Jayant Patel, whoʹs been implicated in eighty-seven patient deaths and was hired as a general surgeon, came to us from the United States. No one had ever really checked up on him—and no one had ever bothered even to Google him. That would have saved a lot of lives and a lot of anguish.


    • A Lesson for the Principal
      (pp. 9-9)
      Kathy Hubka

      School nurses take care of kids with increasingly serious health issues. Kids with asthma, diabetes, and epilepsy. To do our jobs, we give out meds. People know pills go down peopleʹs throats, but they are often unaware of the other orifices through which medications are delivered. That was certainly the case with a principal in one of the schools I coordinated in Wichita, Kansas.

      Because I was a coordinator of school nurses for the school system, principals would give me a heads up if they were planning to cut staff. So I wasnʹt surprised to get a call from a...

    • The Delicate Discharge
      (pp. 10-13)
      Ruth Johnson

      As Robert Frost once observed, home is the place where, when you have to go there, they have to take you in. Mr. Smithʹs ʺmedical homeʺ is our emergency room, where he gets dropped off every few months by the police or the EMTs, depending on whether he has attacked someone or has been attacked. He usually comes in screaming and cursing at everyone in sight. Once here, he tells us all about his powerful suicidal urges and how his prescription medications ran out and he has been forced to resort to a combination of street drugs again. He hasnʹt...

    • No Patience for Poison
      (pp. 14-15)
      Brenda Carle

      My fingers gently lift my patientʹs swollen eyelids to look into his eyes as he is recovering from coronary artery bypass surgery. I move the small light to assess pupil reaction. As I explain the reasons for my neurological assessment to my nonresponding patient, Iʹm asking myself, ʺWhy is he not waking up? Surgery was two days ago!ʺ

      I smile at his wife who anxiously watches me as I confirm his stable cardiac rhythm, monitor his blood pressure, and ensure the vasoactive medications that are dripping into his central line catheter have not leaked into the skin.

      Itʹs the moment...

    • Mr. CEO, Will You Marry Me?
      (pp. 16-18)
      Candice Owley

      For many years, as president of the Wisconsin Federation of Nurses and Health Professionals, I have negotiated collective bargaining contracts for registered nurses. In the vast majority of cases, the bargaining team is predominantly female and the employerʹs team is overwhelmingly male. This gender disparity has led to many interesting conversations filled with stereo types of women and nurses. For example, because so many nurses are women, they donʹt need a raise because they arenʹt the major breadwinners in the family. Or how about this one: Nurses/women should always have back-up babysitters handy so that they can work forced overtime...

    • Intolerable Behavior
      (pp. 19-20)
      Eleanor Geldard

      I was the unit manager of a multidisciplinary intensive care unit at a private hospital in South Africa. One day, the twelve-bed ICU was full, and it happened to be visiting hours. One of the patients—a multiple gunshot victim—was on a ventilator and, although awake, was quite ill and unstable. His principal doctor, a trauma surgeon, had seen the patient early in the morning and had written numerous orders for the patient. The nurse looking after the patient was a black woman who took immense pride in her work and always gave her patients comprehensive and empathetic care....

    • One Is One Too Many
      (pp. 21-23)
      Thomas Smith

      As chief nursing officer (CNO) in a hospital, it is my job to preserve the integrity of my organizationʹs community of nurses—a community that provides the foundation of our ability to serve patients and the wider community. Sometimes doing this is one of the most significant challenges for a CNO.

      This was a challenge I constantly faced in the 1990s when consultants were pouring through health care organizations undergoing financial difficulties. One of these firms landed in the hospital whose nursing department I led at the time. The hospital was in deep financial trouble, and the consultants had dozens...

    • A Comfortable Cover Up
      (pp. 24-27)
      Jenny Kendall

      Who cares how someone is dressed while in hospital? I do. If people were dressed in the streets as they are in hospital they would be charged with indecent exposure.

      After having spent over three decades in the operating theaters at Wellington Hospital as a second-level nurse, my concern about this issue is long-standing. No one was prepared to listen. That changed in August 2007.

      Working as a nurse in New Zealand, I had been observing unease and discomfort of patients of all ages, especially among Maori and Pacific Island people coming to operating theater for surgery. Theyʹd been given...

    • Stacking the Cards in Our Favor
      (pp. 28-30)
      Ro Licata

      Between 1998 and 2000 I was president of the nurses union—the Syndicat des Infirmieres et Infirmiers du Centre Universitaire de Sante McGill (SIICUSM)—at the Royal Victoria Hospital in Montreal, which is part of the of the McGill University Health Centre (MUHC). During this period, the union Executive and the Federation of Quebec nurses was active in addressing the problem of workplace violence. A 1995 survey conducted by the Federation of Quebec nurses (FIIQ) showed that 68 percent of respondents suffered physical assault, including being bitten, punched, or stabbed with a sharp object by patients, their family, or other...

  6. Part 2 We Donʹt Have to Eat Our Young

    • [Part 2 Introduction]
      (pp. 31-32)

      Talk to any group of RNs, almost anywhere in the world, and you will eventually hear someone announce that ″nurses eat their young.″ Aside from assertions that nursing is the ″caring profession,″ this has become one of the profession’s mantras. ″We’re our own worst enemies,″ they say. (This is in contrast to doctors, by the way, who they argue always support and stick up for one another).

      To cite one example, I was just talking with a woman in her midfifties who had recently become a nurse. She’d left an important job—in which she’d had a lot of authority—...

    • Mentor Unto Others . . .
      (pp. 33-35)
      Clola Robinson-Blake

      I’ve always hated starting a new job, especially the orientations, as a result of some not-so-pleasant experiences in the past. It didnʹt take me long to discover that my orientation for a new job on an oncology unit in a prominent hospital was going to be no different than the others. The orientation was all about business and the speed at which I was able to produce. But produce what? Better patient care? I wish.

      The usual length of this orientation was six weeks and though that may sound like a long time, it flew by quickly. Throughout the entire...

    • A Dose of Diplomacy
      (pp. 36-37)
      Donna Schroeder

      One busy day I was in charge of the medical intensive care unit. The unit is composed of sixteen beds, and acuity is often very high. Since we were down two nurses, the assignments were particularly challenging or even dangerous. Many of our patients were on ventilators and required a least one vocative infusion to support their blood pressure. Normally, such fragile patients would require their own nurse or at least be paired with another patient not as acutely ill. On this day, we were not able to accommodate this practice.

      Over the course of the morning I overheard several...

    • Standing Up for What You Donʹt Know
      (pp. 38-40)
      Judy Schaefer

      I could have lost my job. I remember vividly, still, after more than thirty years. A scared new graduate nurse in a university teaching hospital, and I stood up for my patients, my profession, and myself. I was thrilled to have this job and would never have suspected that this risky situation would arise, especially around the joy and happy background music of the holidays.

      I was a graduate nurse in my first job, and it was my first holiday on the medical-surgical ward. I was learning and struggling to keep up, as was one of my classmates. Nurses were...

    • Broken Bones and Ice Cream
      (pp. 41-44)
      Edie Brous

      Emergency department (ED) nurses become toughened after time. The relentless exposure to human tragedy would take its toll if we did not develop defenses. We learn to cope with an endless parade of suffering humanity. We develop thicker skins through use of gallows humor and even pride ourselves on our emotional calluses. We believe nothing surprises us. We can handle anything thrown at us. We believe we have seen it all. You cannot startle or shock us (or so we think). We are ED nurses. We are strong. Hear us roar.

      With calm professionalism, we tend to patients with gunshot...

    • Treating Transition Shock
      (pp. 45-49)
      Judy Boychuk Duchscher

      ʺJudy, just get your degree—you can ʹmake a differenceʹ laterʺ was the unexpected mantra that echoed from a surprising number of my nursing colleagues as I embarked on what would be a six-year commitment to my doctoral studies in nursing. In 1996, I had entered my Master of Nursing program, curious about findings that suggested new nurses leave their basic nursing program with the ability to apply an analytical approach to their practice as nurses but within months of being introduced into the ʺrealʺ world, they become prescriptive ʺdoers.ʺ As I engaged in my own graduate research, I discovered...

    • The Empty-Hands Round
      (pp. 50-54)
      Amaia Sáenz de Ormijana

      I was called in for a four-month job as a staff nurse at a medical ward in an acute care hospital in the Basque Country, Spain, where I live. The ward for thirty-two patients was divided into sixteen double rooms. There were two nurses and two assistants on the unit on every shift. Both nurses and assistants followed the same shift-rotation, so they usually worked with the same people on each shift.

      Each nurse, along with the assistant, was in charge of sixteen patients, one of them holding responsibility for the care of patients in rooms 1 through 8 and...

  7. Part 3 Excuse Me, Doctor, Youʹre Wrong

    • [Part 3 Introduction]
      (pp. 55-56)

      Weʹve heard the unfortunate stories of how nurses can abuse or mistreat other nurses. Some argue they do this because theyʹve been so badly treated by doctors. Horizontal violence is the logical consequence of vertical violence, the argument goes. Whatever the reason for the parlous state of nurse– nurse relationships, itʹs clear that the state of nurse–doctor relationships needs a lot of improvement. When I first went into hospitals to observe nurses, I was impressed—depressed is perhaps a better word—by the way doctors treated nurses as well as by the way so many nurses adapted to—rather...

    • Eye/I Advocacy
      (pp. 57-58)
      Jane Black

      Nurses who work in the emergency department interact with the EDʹs own doctors day in and day out. You come to know and trust these doctors, become familiar with their habits, and learn how best to approach each when issues come up with written orders. Working with ED doctors is also great because you donʹt have to call them up—they are right there! If you need an order or want to discuss a patientʹs care with them, it is an easy task; no calling the paging service, no waiting for a reply, no putting up with annoyed doctors whom...

    • As If the Patient Can Hear You
      (pp. 59-60)
      Clarke Doty

      Because nurses refer to themselves as ʺpatient advocates,ʺ it may seem like weʹre born knowing how to advocate. Thatʹs hardly the case. In fact, I can remember the first time I felt a strong sense of duty to defend my patient, the first time I felt—and acted—like a patient advocate.

      I was a nursing student in one of my earliest medical-surgical clinical practicums. I was working in a small hospital, caring for an elder ly patient whoʹd had a stroke. She couldnʹt speak and one side of her body was paralyzed, but her eyes were open and she...

    • Donʹt Just Add Nurses and Stir
      (pp. 61-63)
      Janet Rankin

      In the fall of 2008, the Canadian federal government mandated that all schools of nursing and medicine across Canada establish curricula activities to bring nursing and medical students together during their education. The government did this because of concerns about teamwork—or the lack of it—and safe patient care.

      As representative of the faculty of nursing in my university, I volunteered to talk with the faculty of medicine to plan strategies to deal with this new mandate. I met with the person from the faculty of medicine who was responsible for moving this initiative forward. We sat down and...

    • Gloves Off
      (pp. 64-65)
      Nancy Marie Valentine

      As a new chief nurse leader in a busy city hospital, I took time to break into the inner-city culture. The cadre of nurses I was working with could, on one hand, be as kind as any I had ever encountered. As I witnessed their care, they could literally bring tears to my eyes. On the other hand, they could be tough as nails because they had seen it all.

      One day, I knew I had started to gain their trust when the ʺtake no prisonersʺ head nurse of the surgical intensive care unit, Mary, called my office for an...

    • The Overlooked Symptom
      (pp. 66-67)
      Jo Stecher

      I came to work that morning and had two patients in our transplant intensive care unit. One was a twenty-two-year-old man who had received a liver transplant about forty-eight hours earlier. When I was doing my morning head-to-toe check, I found that he was very sleepy, his eyes were closed, he was jaundiced, and he wouldnʹt respond when I talked to him. When he did try to talk to me, he mumbled incomprehensibly.

      I knew these symptoms were a problem. As an experienced transplant nurse, I knew that when you give somebody a liver and it works, theyʹre not jaundiced...

    • Hope in the Midst of Tragedy
      (pp. 68-70)
      Connie Barden

      Years ago, before there was so much awareness about organ donation, the identification of patients as organ donors was much less automatic than it is today. Nurses were somewhat aware of the criteria used to identify an organ donor, but the systems in place to facilitate organ donation were more cumbersome and time consuming. At the same time, the need for donors was great, as it remains today.

      I will never forget the experience of caring for a young man and his wife from Oklahoma who arrived in our intensive care unit. The couple had been on a cruise—celebrating...

    • The Advantages of Age
      (pp. 71-73)
      Marion Phipps

      After forty years of being a nurse, my hair is white and my weight more than it should be. I sometimes wonder if this is due to the nature of the work of nursing, ge ne tics, or, in the case of my weight, a too great love of food. On occasion, I find using my age and experience to be a useful tool to promote an aspect of patient care that I feel is important.

      After working as a staff nurse for five years on a busy neurology unit I returned to graduate school. I have been a clinical...

    • An Expiration Date for Indignancy
      (pp. 74-75)
      Madeline Spiers

      I was talking with nurses at the Irish Nurses Organization headquarters in Dublin some years ago. They were attending an overseas nurses section, meeting mostly Filipino nurses. During coffee, Mary, a Filipino nurse with extensive experience nursing abroad, started chatting with me about working and living in Ireland. Here is one story she shared.

      I work in the voluntary sector in an intellectual disability unit since I have come to Ireland. While I have a solid grasp of the English language now, it is often the cultural undercurrents that I do not understand. Some months ago I was caring for...

    • What Hospice Is For
      (pp. 76-78)
      Jean Chaisson

      She was petite and forthright. ʺDo you think that I really need a nurse? I have been so fortunate in my life; isnʹt there a young mother without family to help her who needs your assistance more than I? Isnʹt there some poor young woman in Roxbury whoʹs just had a baby and has no family that you could help instead?ʺ Alice asked me.

      I already knew Alice from a distance, having grown up in the same community. A tireless supporter of educational initiatives for inner-city children, low-income housing, and the League of Women Voters, she had spent de cades...

    • A Real Pain
      (pp. 79-80)
      Paola Scamperle

      As a neurosurgical nurse I’ve got plenty to do, including helping patients with some of the things some doctors donʹt do well—one of which is effectively managing patientsʹ pain. Let me give you an example. I recently took care of a patient whose surgeon insisted that he didnʹt need much nursing care. The patient had been operated on for a herniated disc and had only been out of surgery for one day. Interestingly, the patient himself was a senior physician, a gastroenterologist whoʹd come to our hospital and unit because of the spine surgeonʹs reputation.

      As soon as I...

  8. Part 4 Not Part of the Job Description

    • [Part 4 Introduction]
      (pp. 81-82)

      One of the enduring legacies of nursingʹs religious origins is the notion that nurses should be saintly creatures, always quick to sacrifice themselves for their patients. Of course, we should expect nurses to put aside their own personal needs when theyʹre tending to a patient or during a crisis. (When a patient is in cardiac arrest, no nurse in the world leaves for a lunch break.) For the RN saint or angel, the expectation of self-sacrifice has no limits. Indeed, sometimes this self-sacrificing version of ʺprofessionalismʺ demands that nurses efface themselves entirely.

      Iʹve heard RN academics or managers tell students...

    • Iʹll Call in Sick If I Have To
      (pp. 83-83)
      Barbara Egger

      I was working in a long-term care facility when, one Saturday on the three-to-eleven shift, I walked in to discover I had three patients who had orders to use a Merry Walker (a safety device that reduces the risk of patientsʹ falling and also protects nurses). Unfortunately, there were only two devices on the unit. I called the nursing office, explained the situation to my supervisor, and pleaded with her to find me another walker before someone fell and got hurt. She called me back, explaining that they were kept in a locked storage building out back. Then she told...

    • Doing the Heavy Lifting
      (pp. 84-86)
      Martha Baker

      For way too long, hospitals have been asleep at the wheel when it comes to the kinds of musculoskeletal injuries that nurses suffer from and that jeopardize patient care. At Jackson Memorial Hospital and Health System in Miami, Florida, we decided to wake up our administrators by fighting for a safe lift program at the hospital as well as in the Florida state legislature.

      Thereʹs a growing body of evidence that documents the problem of lifting in hospitals and other health care settings—much of it by Dr. Audrey Nelson, at the Veterans Administration in Tampa, Florida. This startling data...

    • Attacked by a Patient, Abandoned by My Hospital
      (pp. 87-91)
      Charlene L. Richardson

      In March 2003, I was working in the emergency room at Beverly Hospital, in Beverly, Massachusetts, when I was attacked by a patient. I was trying to discharge the patient, who had been in the ER all day. Although we were having difficulty getting him a ride, I am still not sure why he became so agitated. But suddenly, he brutally and viciously attacked me.

      I was on the phone trying to get him a ride, and as I was hanging up, he lunged forward and grabbed me between the legs. Then, still hanging on to me, he stood up....

    • The Samurai Sword
      (pp. 92-94)
      Anne Duffy

      As the leader of a union that represents ten thousand home care nurses in the United Kingdom, my job is to make sure that our nurses are safe. They work in inner cities, as well as in other dangerous and remote areas. When they knock on the door of a patientʹs home, they never know whom or what theyʹre going to find behind that door. Some of our nurses have experienced terrible verbal and physical abuse. So weʹre constantly surveying our members to get data on the problem of violence in the workplace—which in this case is the patientʹs...

    • Only When Itʹs Safe
      (pp. 95-96)
      Bernie Gerard

      It was a typical Saturday morning at my hospital. In other words, busy as hell. It was also my third week of orientation at my new job. I had been an RN for only eight months. I was working in a major trauma and surgical intensive care unit (STICU) at the University of Medicine and Dentistry in New Jersey, and boy, did I understand that I wasnʹt ready to fly on my own.

      The call came in at 7:30 a.m., one half-hour into the shift: “Send Gerard to the coronary care unit.” I could not believe what I was hearing....

    • The Red Shirts Are Coming
      (pp. 97-98)
      Mary Crabtree Tonges

      As a chief nurse executive, I occasionally find myself standing up for nurses by stealth. For example, I was working for a large organization that had just undergone a work and job redesign initiative, popular in the late 1980s through the early 1990s, in which nursing assistants (NAs) learned to draw blood, take electrocardiograms (EKGs), and perform other skills that do not require licensure. They could function as multiskilled workers, Clinical Services Technicians (CSTs). This change made phlebotomy and EKG more readily available on the unit and decreased potential stand-by time for unlicensed clinical staff waiting for further direction from...

    • Not Saints or Sisters
      (pp. 99-104)
      Belinda Morieson

      Iʹve been a nurse for almost forty years and have watched nursing in Australia evolve from the English tradition with its background of church and army, when nurses wore veils and were called ʺsister.ʺ They went ʺonʺ and ʺoff dutyʺ and were infused with a sense of obligation and the need to always act with decorum. Unquestioning obedience was expected, as were poor pay and working conditions.

      In the late 1970s I was working full time in Melbourne, raising three children, and enrolled part time in a university arts degree program. Like so many other nurses, I understood the rules...

  9. Part 5 When One Advocate Can Make a Difference

    • [Part 5 Introduction]
      (pp. 105-106)

      In nursing school and on the job, nurses are expected to be, and think of themselves as, patient advocates. But what does advocacy really involve? The word itself comes from the Latin verb vocare—which means ʺto call.ʺ In this case, however, it doesnʹt refer to a vocational calling (as in nursing or the priesthood). As Websterʹs defines the term, an advocate is ʺone who pleads in a court of law, who defends a cause by argument.ʺ To defend patients today, RN advocacy almost always requires some sort of public calling out of those in power.

      Nurses take great pride...

    • Putting Lymphedema on the Map
      (pp. 107-111)
      Saskia R. J. Thiadens

      It was 1983. I was running a postoperative care facility in San Francisco for patients to recuperate after cosmetic and reconstructive postcancer surgery. On this day, I picked up a patient from the University of California, San Francisco recovery room. She had undergone breast reconstruction following breast cancer surgery. I noted her huge swollen arm and became alarmed, thinking that it could be an allergic reaction. I called her surgeon immediately and remember that he was annoyed with me for calling him about this, intimating that I was stupid.

      ʺAt least, tell me what it is and how to treat...

    • An Inconvenient Nurse
      (pp. 112-114)
      Faith Henson

      I became a nurse at the age of fifty-five, fulfilling a lifelong dream. I accepted a job in a local hospital, full of idealism, commitment, and a love of nursing. At that time I would never have envisioned the path that lay ahead, the obstacles I would have to overcome, or the positive changes in my commitment to nursing and personal strength.

      Since then, over the past ten years, I have managed to get myself fired for being a vocal patient advocate, a union organizer, and a whistleblower. As is often true, each time it was a blessing in disguise,...

    • A Safe Delivery from Domestic Abuse
      (pp. 115-117)
      Kristin Stevens

      As a nurse midwife, I do more than deliver babies. I provide womenʹs health care from menstruation through menopause; I follow women during pregnancy, helping them to prepare for the healthiest baby and best birth experience possible; and I follow women after they give birth to help them in their efforts to be healthy and prepared to meet the needs of their children. Thatʹs how I got to know Elena. She was in her early thirties, had two young children, and had recently delivered another. I had attended her during her last birth, and when she came to the hospital...

    • To Do the Unthinkable
      (pp. 118-120)
      Barry L. Adams

      By 1996, the year my ʺtroubleʺ started, the myriad reports that confirmed the extent of medical errors occurring in U.S. hospitals that were killing and injuring unsuspecting patients had yet to be written. The public, myself included, was not aware that there was, yet again, a looming shortage of registered nurses and the potential threat it posed to their health and safety. The nascent body of research that would eventually demonstrate consistently that RNs are critical to positive patient outcomes, including survival, could not yet be referred to as a ʺpreponderance of scientific evidence.ʺ However, four years of actually practicing...

    • The Only Nurse for Miles Around
      (pp. 121-124)
      Dagbjört Bjarnadóttir

      I became a nurse in 1982 and spent my first years working in psychiatric wards, ʺregularʺ wards, and operating rooms. Eight years after my graduation, I was hired as a nurse at a health care clinic in central Iceland near Lake Mývatn, which is known for its exceptional natural beauty. The rural village I worked in had five hundred residents, who were mostly farmers. When I took the job, I was recently divorced and was alone with my school-age son. When I moved here, where I still work, I was the only health professional in the area. The health care...

    • More Than Boo-boos and Band-Aids
      (pp. 125-128)
      Judy Stewart

      When, after years as a pediatric critical care nurse, I became a school nurse in western Nebraska, I set out to transform the perception of the school nurse from one who puts Band-Aids on boo boos to one who plays a vital role in improving childrenʹs learning through health. I began with the idea that the school was my professional practice setting, all of the students and faculty were my client base, and the students, faculty, and families had the potential to be my ʺcaptive audienceʺ during their public education experience. I also wanted to deal more assertively with the...

    • First Responders in the AIDS Epidemic
      (pp. 129-132)
      Richard S. Ferri

      I do remember her office was hot, and wondering what the hell I was about to get myself into. It was before the days of mandatory air conditioning in hospitals and political correctness outside of them. Sweat was pouring down my back since I was obeying the new and insane rule that demanded nurse educators wear their lab coats at all times. I suppose the lab coat was the hospitalʹs way of getting back at us for ditching the damn nursing cap.

      It was 1984, and I was melting away in the outer office of the associate director of nursing...

  10. Part 6 Choking on Sugar and Spice:: Challenging Nursesʹ Public Image

    • [Part 6 Introduction]
      (pp. 133-134)

      Almost every RN Iʹve ever met has been concerned about the public image of nursing. Whether theyʹre a nurse academic, a toplevel administrator, a bedside RN, or an advanced practice nurse, most feel that non-nurses donʹt really understand what they do. When I give workshops or lectures, I always ask the audience two questions: (1) ʺHow many of you think the public trusts nurses?ʺ I could be in Chicago or Copenhagen, Toronto or Sydney, but every time, almost every hand in the room goes up. Then I ask the follow-up question: ʺHow many of you think the public understands what...

    • Silenced during the SARS Epidemic
      (pp. 135-137)
      Doris Grinspun

      Lights, camera, action!

      Twelve nurses sat in two rows facing the journalists and politicians who had crowded into the Ontario governmentʹs media studio at Queenʹs Park in Toronto, Canada. When they were introduced by Adeline Falk-Rafael, the president of the Registered Nursesʹ Association of Ontario (RNAO), each nurse put on a surgical mask that had the word ignored, silenced, or muzzled written across it in black magic marker. For the next few minutes, the only sound in the room was the frantic clicking of camera shutters.

      After months of having their voices ignored and discounted, nurses had found a dramatic...

    • In the Halls of Academe
      (pp. 138-140)
      Claire M. Fagin

      When youʹve been in nursing for as long as I have—over sixty years—the times youʹve had to stand up for the profession are too numerous to count. Recall the adage: If I only had a penny for every . . . Rather than collecting pennies, Iʹve collected a lot of lessons. Over time, I have distilled them into three major themes: (1) Alliances are essential, including getting support from those outside the profession; (2) You should always put the needs of patients in the forefront; and (3) At times, you should be prepared to play hardball and not...

    • R-E-S-P-E-C-T
      (pp. 141-144)
      Lisa Fitzpatrick

      Every three years in the state of Victoria, the Australian Nursing Federation (ANF) (Victorian Branch [VB])—the union that represents approximately 49,000 nurses of whom 28,000 are employed in 110 Victorian State government–run health facilities (a mixture of hospitals, nursing homes, and community health centers)—has to negotiate a legally binding enterprise agreement that determines the entire terms and conditions of employment for the next three years. It also sets the agenda for other nurses and midwives employed in other sectors throughout Victoria. The agreement is negotiated with representatives of the health facilities and the Victorian State government. Iʹm...

    • Real Nurses Donʹt Wear Wings
      (pp. 145-148)
      Victoria L. Rich

      Throughout my career, I have always been concerned with the issue of nursing image. How we, as nurses, appear to others, I am convinced, is a reflection about how we feel about ourselves and how we judge our own importance. Since bedside nurses abandoned the white cap and starched white uniforms, however, nursesʹ image in the workplace has gone from rigidly circumscribed to pretty much anything goes. When, before 2005, I walked around the hospital Iʹm privileged to lead, the Hospital of the University of Pennsylvania (HUP), I saw nurses in white coats, nurses in tailored, one-color scrubs, nurses in...

    • The Lady with a Loud Voice
      (pp. 149-152)
      Jeanne Bryner

      In the pantheon of nursing, ʺthe lady with a lampʺ—the fabled Florence Nightingale—looms large as a teller of tales about the lives and work of nurses more than a century ago. In the new millennium, the voices of rank-and-file RNs are often lost in mass media coverage that downplays or ignores the role of nondoctors in health care systems.

      In 2004, I tried to remedy this problem by publishing Tenderly Lift Me: Nurses Honored, Celebrated, and Remembered. The book includes poems by me and first-person accounts by nurses that try to alleviate some of the prevailing ignorance and...

    • Taking on the Terminator
      (pp. 153-156)
      Vicki Bermudez

      In 2004, nurses in California started rallying, carrying signs against Governor Arnold Schwarzenegger when he tried to derail a bill guaranteeing patients safe nurse-to-patient ratios. Nurses in California were getting press coverage throughout the country. Some nurses felt that we might not look ʺproperʺ or ʺprofessionalʺ in the eyes of the public. I was then working as the California Nurses Association (CNA) regulatory policy specialist. As I was having coffee with a nurse executive with whom I had worked during the legislative session, she asked me point blank whether what we were doing helped nursingʹs public image.

      It was pretty...

    • Defending the Nursing Profession over Dinner
      (pp. 157-158)
      Elizabeth Kozub

      The table was lush with food: the caramelized carrots, candied yams, green bean casserole, and, of course, the fifteen-pound turkey, elegantly basted and cooked to perfection. We gathered around the table to celebrate Thanksgiving with some of our closest friends and coworkers, none of them nurses. The conversation flowed from one topic to another, eventually leading to gossip that a colleague, not present at the dinner, had a ʺnatural childbirth.ʺ I asked, ʺReally, so there was nobody assisting in the childbirth?ʺ One person at the table, often known for his boisterous opinions, exclaimed, ʺIt was just a midwife, or something...

    • Remaking the Power Nurse
      (pp. 159-161)
      Pierre-André Wagner

      She darts through the air, her red hair flying. She wears a tight green shirt, a blue mini skirt, and red boots and carries a thermometer. She looks like Supermanʹs twin sister. She is the Power Nurse. In 2001, she became a symbol of the emancipation of nurses in Switzerland. Her story, the story of her impossible mission, begins in 2001. But let us begin, well, at the beginning.

      The year 2001 was also when the Swiss Nurses Association (SNA) hired me as its lawyer. I had passed the bar exam in my home province of Berne fourteen years before...

    • Health Policy from Nursesʹ Point of View
      (pp. 162-165)
      Yuko Kanamori

      My background is a little unorthodox. I am from Japan, where I went to nursing school and got my RN license. Soon after I graduated, I moved to the United States and went to college in Georgia to study sociology. Living in Georgia was, not surprisingly, totally different from living in Japan. When I got there, I thought Iʹd study nursing again. But then I wondered how I could care for patients in a foreign culture without understanding that culture. Moreover, I found out I didnʹt need to go nursing school again to be an RN in the United States...

    • Maybe We Should Be Bragging
      (pp. 166-168)
      Guðrún Aðalsteinsdóttir

      Five of my friends—three RNs, one LPN, and one laboratory technician—and I were playing bridge at my house in Reykjavik, Iceland, recently. Iʹd been looking forward to the evening. But somehow I just couldnʹt concentrate. I wanted to talk about what had happened to me that day—I had saved a patient during a potentially fatal emergency—but as a nurse, Iʹd been socialized not to talk about the good things I have done at work. These experiences are supposed to be just another part of the workday, and to say ʺI just saved a human lifeʺ might...

    • Finessing the Chairman of the Board
      (pp. 169-172)
      Carol Blount

      I was seventy-four when this happened and had been practicing nursing for fifty-two years. For many of those years, I did not talk to non-nurses about nursing work. I, like many other nurses of my era, was taught not to brag about our work. By the time I reached my early seventies, however, I had read many books and had enough experience, and Iʹd decided it was time to change—time to speak out.

      My chance to do that came at a Christmas party given by my financial adviser in December 2005. I stood with a group of businessmen dressed...

    • Called to Duty at 30,000 Feet
      (pp. 173-176)
      Ann Converso

      I worked as an RN for more than thirty years, before retiring this year from the Veterans Affairs Western New York Health Care System in Buffalo, New York, where I was a medical-surgical and intravenous (IV) therapy nurse. I now serve as president of my national union, the United American Nurses, AFL-CIO (UAN). In our union, we often use the slogan: ʺEvery patient deserves a registered nurse.ʺ By that we mean, every patient and family should have an RN available to make critical assessments, observe changes in condition, and advocate for the needs of the patient. Lives are at risk...

  11. Part 7 Applied Research

    • [Part 7 Introduction]
      (pp. 177-178)

      Iʹll never forget the first story I did on nursing research. I pitched the piece to a health science editor at the Boston Globe. ʺThis would make a great story,ʺ I said. ʺIt really highlights the value of nursing research.ʺ

      Her response was: ʺNursing what?ʺ

      Like so many members of the public, this journalism expert had no idea that nurses do research. She was equally surprised to discover that nurses play a major role in conducting, implementing, and monitoring medical research. I was a lot like her when I first started writing about nursing. Programmed by shows like Marcus Welby,...

    • Nurse PI on a Clinical Trial
      (pp. 179-181)
      Kathleen Dracup

      Many of the problems patients have today can be addressed and answered only by teams of clinicians. No one discipline can solve the complex problems of very sick patients. This is as true in the research setting as it is in the clinical setting. A clinical problem is always multidimensional, and every discipline brings a special expertise and way of looking at the problem. For example, if a patient is on medication, itʹs helpful to have a pharmacist involved in the research. Patients have limitations in functional status, so we need physical therapists. Patients often have dietary issues, so itʹs...

    • The Need for Nurse Evaluators
      (pp. 182-183)
      Teresa Moreno-Casbas

      As chief of nursing research at the national level in Spain, I struggled long and hard to get nursing research funded. Finally, because we refused to give up and maneuvered behind the scenes, we have had some success.

      Hereʹs what we were up against.

      To get a research project funded in Spain, a proposal has to go through the Spanish equivalent of the U.S. National Institutes of Health (NIH), the Instituto de Salud Carlos Tercero, and be evaluated by a panel of evaluators. Unfortunately, until 2004, the people who were chosen to be evaluators on the instituteʹs initial evaluation panels...

    • Research and Nursing-Home Reform
      (pp. 184-186)
      Charlene Harrington

      For over thirty years, Iʹve been researching and writing about the nursing home industry and working for improvements in the quality of nursing home care. Itʹs been a long journey that began in 1975, when Jerry Brown was governor of California. I had just received my a PhD in sociology and higher education from the University of California, Berkeley. With that and my nursing background, I got a job working for the California Department of Health Services and was later placed in charge of the agency that regulated all health care facilities.

      That was my introduction to the nursing home...

    • How Nurses Make It Work
      (pp. 187-190)
      Kathryn Lothschuetz Montgomery

      In the late 1980s, when I was chief nursing officer at a research hospital, an exciting research study for the treatment of cancer was being studied in a phase 1 human clinical trial. Researchers were studying the impact of a biological modifier as a potential cancer treatment. The major focus of phase 1 clinical trials is to determine toxicity and efficacy. In this phase 1 clinical trial, lymphocytes—cells from patientsʹ blood—were withdrawn and treated so when they were reinfused, the treated lymphocytes in combination with specialized drugs would act to destroy the cancer cells. The intervention had had...

    • Teamwork through Research
      (pp. 191-194)
      Lena Sharp

      Before 2005, oncology patients in Stockholm received their care at two different university hospitals—one in the north and one in the south part of the city. All that changed when the two hospitals merged into one—the Karolinska University Hospital. Mergers are always tough, and this one was no exception. Despite being in different parts of a very large city, the two radiotherapy (RT) units were supposed to function as one. How could we do this, staff wondered—particularly when no one was happy about the merger?

      Although we knew that the merger could eliminate long wait times for...

    • Keep Asking Questions
      (pp. 195-198)
      Sean Clarke

      In my career as a researcher and professor, I try to teach my students, as well as suggest to my peers and the public, that we always need to keep an open mind and to look beyond the surface when thinking about health care and nursing. This is particularly true when there are inconsistencies in the information weʹre seeing, and especially when the questions being asked are unpopular and risky. Today, one often hears experts argue that some risk factor or variable is or is not important for patients, that a way of educating nurses or organizing nursing services is...

    • No More Martys
      (pp. 199-201)
      Jane Lipscomb

      Early in 2006, Jonathan Rosenblum, a community organizer with the Service Employees International Union (SEIU) Local 1199 Northwest in Seattle, Washington, contacted me about the issue of violence in the workplace. He was familiar with research that the University of Mary land Work and Health Research Center had done with the New York State Public Employee Federation (PEF) around the safety hazards to New York State community mental health workers. He requested our assistance with a similar situation in Washington State. During a subsequent call, we learned of the tragic death of a SEIU Local 1199 Northwest member, Marty Smith,...

    • Taking On Conventional Wisdom
      (pp. 202-206)
      Thóra B. Hafsteinsdóttir

      Being a nurse researcher isnʹt always easy. One of the things we do is evaluate the effectiveness of contemporary practice and treatments. If our results demonstrate that current approaches arenʹt effective, some people—like the bedside nurses who have mastered a particular technique or treatment or other professionals who are working with nurses—may be unhappy with our results and arenʹt shy about conveying their displeasure.

      Thatʹs just what happened when I, as a stroke researcher in the Netherlands, was asked to evaluate what is known as neurodevelopmental treatment (NDT), a rehabilitation approach for stroke patients that had just been...

  12. Part 8 Sticking Together

    • [Part 8 Introduction]
      (pp. 207-208)

      Despite the inspiring stories of individual patient advocacy told in section 5, there are times when one person acting alone canʹt make enough of a difference. To advocate successfully, there are times when RNs must also act together—a reality of the workplace world that not enough nursing schools seem to explain to their students prior to graduation. I find that nurses are repeatedly exhorted to be individual patient advocates but that the concept of collective advocacy is poorly developed. This failure to explain, or sometimes even acknowledge, the limits of individual advocacy can lead nurses to become demoralized. Determined...

    • Winning Recognition of Nursing Expertise
      (pp. 209-212)
      Edie Brous

      Traditionally, nurses have been considered simply physician extenders. It was assumed that doctors were the only health care providers with sufficient expertise and knowledge to ʺcaptain the ship.ʺ All other providers were secondary and subservient to the physician. Consequently, in a negligence or malpractice lawsuit, physicians were considered the obvious persons to serve as expert witnesses.

      Physician expert witnesses testified in all health care cases, regardless of the provider being sued. If a nurse was sued, it was a physician who would be considered the expert. It was the physician who would translate nursing practice for a lay jury. It...

    • A Union Just for Nurses
      (pp. 213-216)
      Massimo Ribetto

      It was the summer of 2000. I had been working as a nurse for just three months, at the regional hospital in Bolzano, Italy, when, for the first time, I took part in a meeting called by unions that represented nurses along with many other workers. (In Italy, large industrial unions—allied with political parties—represent multiple categories of workers. Traditionally nurses were not in unions of nurses—or even unions of other health care workers—but were in politically allied unions with journalists, steelworkers, or actors.) Faced with the lack of nursing personnel—what politicians were referring to as...

    • We Rained on Their Parade
      (pp. 217-219)
      Judy Sheridan-Gonzalez

      In 1987, when changes in financing resulted in increased patient visits in our large Bronx, New York, teaching hospital, our nursesʹ union contract was reopened. At the time, registered nurses were grossly underpaid across the United States: starting salaries had just crept up to the level of sanitation workers; longevity pay, however, was either nonexistent or capped out at a few hundred dollars annually. Nurses with twenty-five years of experience received little more than a certificate.

      Our large teaching hospital in New York City employed many single-parent nurses, forced to work second jobs to pay their rent or mortgage. Facing...

    • Protesting on the Red Carpet
      (pp. 220-224)
      Kelly DiGiacomo

      When I became a nurse in 1995, it was at the height of the hospital restructuring of that era. I worked in California for a large health care organization in postpartum, newborn nurseries, pediatrics, and then telemetry. At this time nurses were constantly being threatened with layoffs and downsizing. I was so worried about losing my job in the mother-baby unit that I left the main hospital and took a job in our pediatric clinic because, at the time, layoffs were not threatened there. Many nurses were so nervous about the layoffs that they either left the hospital, like me,...

    • Saving the Carney
      (pp. 225-226)
      Penny Connolly

      For over thirty years, Iʹve worked as a nurse at Carney Hospital—a community hospital owned by the Caritas Christi Health Care system—in Dorchester, Massachusetts. The Carney provides critical services to a diverse community, including many patients with little or no income.

      In October 2007, the Caritas system announced that they were going to close the hospital for financial reasons. The Massachusetts Nurses Association (MNA) asked the nurses who live in the area to meet to see what we could do to save the Carney. We spoke with the neighborhood health associations, clinics, and neighborhood groups. The consensus was...

  13. Part 9 Still Fighting

    • [Part 9 Introduction]
      (pp. 227-228)

      Some people didnʹt want me to include this section in this book. These are stories of defeats or of constant battling, not of victories. They are stories that highlight frustration, not success. In these stories, nurses fi ght to move the proverbial two steps forward only to be catapulted three steps back. In the typically sweet, sappy, and widely advertised motivational books that target nurses, ʺhappy endingsʺ are de rigueur.

      Unfortunately, as nurses know better than most of us, real life (and death) tends to be messier than that. Indeed, as we have seen recently, many of the victories nurses...

    • The Male Midwife
      (pp. 229-232)
      Gregg Trueman

      About twenty years ago I was a twenty-eight-year-old nursing student starting his second career in a Catholic, hospital-based school of nursing program. Learning the medicine every nurse needs to know was a joyful and rigorous academic undertaking. I delighted in my growing understanding of the human body and the human condition, studying the nature of suffering, and learning how to nurse the experience of birth and death. This was to become my lifeʹs work, and I was hooked from the very beginning.

      The problem was, just as I was entering nursing, women were beginning to assert themselves in the Second...

    • Fighting for Our Vets
      (pp. 233-234)
      Edmond OʹLeary

      Between 1974 and 1986 I served in the U.S. Air Force Nurse Corps. I had the honor and privilege of serving with the men and women who made sacrifices to make our country great. After returning from the service, I began a long career as a nurse in the U.S. Department of Veterans Affairs (VA) where I have cared for prisoners of war (POWs) from Vietnam, Korea, and World War II. I met several distinguished members of the armed forces, such as General James Doolittle, Chappie James, and nurses from the Bataan Death March. I was on the team that...

    • We Are the Experts
      (pp. 235-237)
      Karen Higgins

      Iʹve been a nurse for thirty-four years, and for a lot of those years nursing administration took care of us and made sure things were going well so that all I had to do was go in and take care of patients. But during the 1990s, things changed, and nurses like myself felt that nursing administration wasnʹt supporting bedside RNs but had become a part of the high-level hospital management team representing the financial and survival imperatives of hospitals. For the first time, I was convinced that if anyone was going to ensure patients were safe, it would have to...

    • A Collective Voice
      (pp. 238-239)
      Diane Sosne

      My maternal grandmother was a survivor of New York Cityʹs historic Triangle Shirtwaist Fire in which 146 factory workers, mostly young immigrant women, died in the fire or jumped to their deaths. This tragedy spurred legislation for improved factory safety standards and the growth of the International Ladiesʹ Garment Workersʹ Union.

      When choosing my career path, little did I know how my grandmotherʹs history would affect me. Thirty-eight years ago, I became a registered nurse. In nursing school I was taught that the basis for good patient care was nursing care plans. As a psychiatric nurse I dutifully wrote lots...

    • We Will Not Be Silenced
      (pp. 240-245)
      Carol Youngson

      The saga began in 1993 and led to the longest medical inquest in Canadian history. I was then the nurse in charge of the Pediatric Cardiac Operating Room at the Health Sciences Center in Winnipeg, Manitoba, a position I had held for several years. In June, our cardiac surgeon, Dr. Kim Duncan, left to practice in the United States. In mid-February 1994, Dr. Jonah Odim arrived to take his place. The Pediatric Cardiac team, including myself, was pleased we had been able to attract a physician with such shining credentials: Ivy League education, years of specialty training, and, perhaps most...

    • Standing By One Patient
      (pp. 246-250)
      Faith Simon

      One of the things I do as a nurse practitioner practicing pediatric and adolescent medicine in a rural health clinic in northern California—in a county with the fishing and logging industry in decline and thus a lot of poor people—is try to get people appropriate health care. This isnʹt always easy and demands persistence, patience, and sticking with the patient no matter what.

      About a year ago, a sixteen-year-old whom Iʹd known for about eight years came into the office complaining that he didnʹt feel well. He hadn’t felt well in a long time, he told me. And...

  14. Back Matter
    (pp. 251-251)