Marie Manthey’s Nursing Salon

I had a most thrilling experience today … 

Some of you may remember that I dedicated my book, The Practice of Primary Nursing to a nurse named Florence Marie Fischer. Sometimes when I speak, I tell my own story about how I became a nurse… and I always mention Florence Marie Fisher. I became ill at the age of 5 and was hospitalized for a month at St. Joseph’s Hospital in Chicago. It was a traumatic experience in a couple of ways. First of all, my parents didn’t know how to prepare me, since they had never been hospitalized themselves. So they just said I was going to a large building. They left me there and visited occasionally. However, when one or the other came, a very painful procedure was done involving an intramuscular injection of their blood (horribly painful), so I felt not only abandoned but also frightened and confused by the pain associated with their visit.

Florence Marie Fisher is the name of a nurse who cared for me. She would sit by my bedside and color in my coloring book. For some reason, that translated to me to mean she ‘cared for me’. I decided right then that I wanted my life to be about that kind of caring, and from then on, I knew I would be a nurse. As a kid I often got doctor/nurse kits for Christmas, and I always threw away the doctor stuff. Only being a nurse was of any interest to me.

Forty years later I wrote the book on Primary Nursing. When I finished, the publisher asked me who I wanted to dedicate it to, and after a few minutes of thought I said Florence Marie Fisher. Although we had never communicated in any way after I left the hospital, I never forgot her name. And so the book was dedicated to her.

The publisher thought it would be really cool to find her, so they contacted the Illinois State Board of Nursing, whose records indicated she had moved to Indiana and that her last name was Ambrose. They then wrote to the Indiana Board to locate her, but there was no response to their request, and the search had come to an end.

It was earlier just today, when my search resumed. I was going through my papers in preparation for turning them over to the University of Minnesota Library Archives. I found copies of the publisher’s letters to the state boards and got to thinking about a way to search for Florence Marie Fischer that wasn’t available almost thirty years ago… the Internet.

Now for the thrilling part. I didn’t find her, but I found her son… and I just finished talking to him. As I was explaining my connection to his mother, I got choked up several times just realizing I was actually talking to Florence Marie Fisher’s son! He was just as thrilled to hear from me, as he had no idea of his mother’s impact on me. Out of nowhere he gets this call about the influence his mom had on me. She died in 1989, so I guess I was just meant to find him now…. not back in 1979 when I was writing my book.

He knew nothing of me, my work, or his mother’s connection to that work. It is a straight line for me. And as I told him about my work, the book dedicated to his Mom… the impact on nursing and patient care this work has had… he got just as choked up as I was.

The connection we had was extraordinary. I never thought I would find her, and I guess technically I didn’t, but talking to her son felt very close. And being able to tell her son about the tremendous impact she had on me was one of the high points of my life!

I am sending him one of the few remaining first edition hard copies of The Practice of Primary Nursing and the second edition, which is also dedicated to Florence Marie Fischer.

Staff nurses and nurse managers tell me they really like Crucial Conversations as a guide in managing morale problems. Here’s the deal: morale problems are always caused by problems in interpersonal relations among the staff. This book gives very specific and useful advice about how to talk about important issues/behaviors that are a problem among co-workers. Everyone has to handle these issues for themselves. It usually doesn’t work to expect the nurse manager to step in and solve problems at the staff nurse level. The more each individual develops the skill of managing their own relationships successfully, the healthier a unit’s morale will be. The manager’s job is to help the staff develop the skill to talk about difficult situations skillfully, so that a solution can be reached that doesn’t make the situation worse. 

So…if there are managers out there who haven’t found the book yet, I suggest you get it. Add it to the unit library and use it to provide guidance and support to the staff to manage their own relations successfully.

Add your stories about handling difficult situations to the blog.You never know when your experience will be a ‘teachable moment’ for someone else struggling with a similar problem.

Latest news indicates the shortage produced by baby boomer retirements will only be in the neighborhood of 350,000, rather than the 700,000 originally projected. Great news! But the shortage is still a huge problem.

Besides losing the experience, skill and wisdom gained over years of clinical experience, I worry that we also might lose some of our history. One of my personal delights at this point in my career (50 years this year!) is being involved in ‘heritage-work’. If you have artifacts, pictures, etc. of nursing decades ago, see if your local school of nursing has an interest in preserving items of historical value.

An advantage to having 50 years of experience is the personal knowledge of how it was to compare to how it is and the ability to creatively think about how it can be. One of the realities that sometimes clouds the incredible upward trajectory of nursing is the way changes in the workplace can negatively impact nursing’s contribution to the health of society. This kind of thinking, remembering and projecting is an important contribution senior nurses can make as they prepare to retire. Also, retirement itself is being re-considered as we speak. Clinical support for student nurses is just one of the ways being implemented now to ‘pass on’ the experience and wisdom acquired in years of practice.

Another need is to pass on the underlying values of the nursing profession. We who know need to teach the value-foundations of the nursing profession to the new crop coming in. Our covenant with society is profound. Our opportunity to make a difference in the lives of human beings is the constant that occurs in busy ICU’s, ambulatory surgical suites, in nursing homes, on peds units, in doctor’s offices…..in every setting every day we have an opportunity to make a difference in the lives of the people we contact. What a privilege! Those of us who learned that in years of practice need to take responsibility for ‘passing it on’ to the younger generation of nurses.

I invite veteran nurses to share stories of the ‘good old days’ that might help young nurses connect with our heritage. Do you know someone who made a difference in the life of an iron-lung patient? How did nurses care for people with TB, knowing they might become infected? Did you care for patients recovering from cataract surgery, on bed rest with sandbags holding their head steady for 10 days? Where did YOU make a difference?

Send us your stories about handling difficult situations. You never know when your experience will be a ‘teachable moment’ for someone else struggling with a similar problem.

What is Wrong with this Picture?

Several times a week, in hospitals all over, system or another breaks down…requiring a staff nurse to ‘fix’ the problem so a ‘patient won’t suffer’ from the breakdown. Maybe it’s pharmacy sending the wrong drug….or not sending it on time….or a late tray that never arrives for a hungry patient….or the transporter arriving without a wheelchair to take a patient for a test…..you know the situations.

Time after time, nurses stop what they are doing to ‘fix’ the problem. Eventually their frustration mounts to the point they tell their nurse manager that something needs to be done.

What would Nightingale do?

She would assess the pockets of power, align herself with strong allies, and convince people that a solution to the problem will be found. She had an extraordinary knack for letting some things go until they had to be fixed. I’m reminded of the story that when she arrived in Crimea the British Military Surgeons refused to let her enter the hospital. They did not want to deal with a ‘do-gooder’…and a lady at that. The fact that she arrived with a ship fully loaded with medical supplies, dressings, bedding, food, clothing, etc. gave her the leverage she needed. She responded to their refusal to let her enter the hospital by refusing to allow the ship to be unloaded. For some days it sat in the harbor with desperately needed medicine, equipment and supplies….until they changed their mind and invited her and her nurses to come work in the hospital. It seems clear to me that during those days the ship was in the harbor, there were patients who ’suffered’ because they didn’t have the food and medicine on the ship.

The lesson I take from this is that the strategy of letting a failing system fail might be better than the situation by situation ‘fixes’ nurses engage in, which takes them away from the patient.   Strategy is important. Over the next few weeks, I’ll share some examples of potential strategies I’ve either seen work….or would like to see someone try. Meanwhile, please share strategies you’ve used or heard of to get failing hospital systems to work better.