Marie Manthey’s Nursing Salon

The group at this Salon was another interesting mixture of different ages: from a couple of student nurses, to several new as well as senior staff nurses, Nurse Managers, an educator, a retired physician and a couple of Clinical nurse  specialists.   The discussion eventually focussed on pressures created by the health care system and the relationship issues present in current practice settings.   Systems and Relationships.     As usual, the electronic medical/health record was front and center.   Not only the usual age-related differences in use and perception….this discussion also focussed on how it is changing the thought processes nurses use.   A very experienced NICU staff nurse mentioned the reality that critical thinking also refers to decisions about what not to do, which is equally as important as the decisions about what to do.   However, the structure of the EMR  requires those decisions to be revisited in order to complete documentation.   That comment just opened the door to more discussion about the control over practice thinking that is mandated by the EMR.   An experienced Delivery Room nurse commented about the problem of trying to put in q2min. vitals during a critical episode (not having learned typing), while another commented on the ease of her system that automatically inputs physiological data from another computer system.   Both realities impact the nurses’ thinking.  And of course, this whole discussion was framed around the issue of relationships….nurse/patient, physician/nurse and nurse/nurse.    The importance of students learning while in school to manage  themselves in these highly stressful situations was made clear, while it is also clear if that skill is not learned in school, it must be learned in the workplace.   Key to healthy relationships is the ability to manage oneself. 

At the end of the evening,  comments reflected the belief that the human contact between patient and nurse is the eternal and important truth about nursing and that there is hope it will always remain at the core of our practice.

Here are a couple of follow-up emails I received. 

Marie,Thank you for allowing me to attend your last Salon with my preceptor, Michael P! I had a wonderful time. You are an excellent cook and an engaging conversationalist!

I am in the process of writing a paper about the CNS impacting organizational culture. While researching, I came across a paper written by Lorraine Hardingham, a nurse clinical ethicist, who defends her position that “as human beings, we are essentially interrelated, and therefore, both personal and professional integrity, rightly understood, is relational in nature.” It seemed to fit with that night’s themes of Systems and Relationships. I attached the article if you are interested.

You mentioned that you’d be willing to send files on how to start a Salon. I hope finish the CNS program in May and pass the certification exams. Then, I would love to start a group here in the Fargo-Moorhead area. Please send your information when it is convenient for you.

Again, thank you for a memorable time of connecting at your home.

With deep regard, Patrick S.

Again, another stimulating evening Marie. I come home all revved up and unable to sleep with thoughts racing through my brain. Thank you so much for these incredible forums! I am able to feed my body and my soul and I thank you. Deb. M

The aftermath to the Summit of Sages has been fascinating. I have been in two major discussions with nurses about social justice with almost explosive results. The first was at the Zeta Chapter of Sigma Theta Tau and the second was a week later at a Salon in my home. At the Zeta Chapter about 50 attendees heard three nurse leaders from here in the Twin Cities speak about the issue of Social Justice from the perspective of their workplace. The first person isCNO of a specialty hospital that provides coordinated care for children with severe developmental disabilities. She spoke of finding there were NO similar services available to their patients as they become adults. The whole segment of adults with developmental disabilities from childhood have no specialty in or out patient service providers. The second speaker is from a local liberal arts college with a major nursing program who spoke about a college-wide initiative to eliminate abusive or violent communications among students and faculty members. And the third CNO of a local community hospital spoke of her previous experience in the Canadian system where no one goes bankrupt or loses their home because of illness and no one dies because they can’t afford health care. She also spoke of the young adults who arrive in their ER due to a sports injury with no insurance because they are no longer on their parents plan and not yet established themselves. After these three speakers, the audience entered into a free-flowing passionate discussion about the fact that as nurses we see the effects of this crazy ‘non-system’ of health care….and yet we seldom speak about what we know. There was a strong consensus about the need for nurses to speak up about what we know and about how we think the system should change.

The second discussion was at a Salon a week later and again, the stories about what we know were overwhelming. A quick summary:

ER Nurse Manager told of 3 patients in 2 weeks who died upon arrival at the ER door, having waited too long because they didn’t have insurance. Upon arrival at the place of help, they simply gave up the struggle. She also told of a man arriving in a friend’s car with a bleeding leg. She looked at it while he was still in the car and realized it was shooting arterial blood. He waited some time for his friend because he couldn’t afford an ambulance.

A Medical ICU nurse told of excessive end-0f-life activities that have astronomical costs for elderly patients with no hope of recovery.

Another nurse told of the multiple-birth cases where 5 and 6 babies are born, most of whom cannot survive but whose care is always extremely costly.

The point that was made over and over again is that as nurses we are at the ‘point of care’ and see the effects of the current health care crises on the lives of our citizens. the discussion ended with a commitment to find ways to speak our ‘truth-to-power’

Last night we had our monthly Salon at my home. About half the group was new and the other half had been here before.   This time only one student nurse came and one fairly new graduate working as a staff nurse and 3 attendees were not nurses, one teaches at health related topics at a local college, one is a retired physician I have known for a long time and the other was a visitor from Iceland who wanted to see how a salon worked.   Most of the rest were middle-aged staff nurses and nurse managers from various hospitals around the Twin Cities.

Although many topics were raised during the initial check-in, we ended up focusing on a wide-ranging discussion related to staffing/resource issues, social justice and inequities in the health care system so often part of the every day life of a nurse.

A manager at a local ER told about three patients who died on the floor of the ER vestibule, collapsing as soon as they arrived, having stayed away from care until the last possible moment because they have no insurance.    She also told of a man who cut his leg and waited for a friend to drive him to the ER as he couldn’t afford an ambulance.    This man had an arterial bleed and had lost enormous amounts of blood before he arrived.   In this ER visits are increasing astronomically while care hours/visit are continuously reduced to increase margins.

A NICU nurse talked about the cost of caring for multiple birth babies (5 or 6) the result of infertility treatments who stay in NICU’s for months.   Often staffing throughout their life is 1:1 or 2 nurses/baby.   The last group six births resulted eventually in one baby actually living.   A nurse manager of a medical ICU talked about the hundreds of thousands of dollars spent during the last few weeks or months of care for catrosphically failing people in their nineties.

The student is now in her public health rotation and wonders why the savings created by keeping people healthy isn’t part of the economic equation.

This may sound like an overall pessimistic evening, but it was far from it.   I can’t really explain what happens at a Salon, but we seem to be able to connect with our positive values and experience strength just from knowing each others experiences and values.

I am definitely sensing from this discussion and others that have been occuring recently that the ‘Voice’ of nursing is in the process of become loud enough to be heard.   I’m not sure just how this will happen, but I sense a real strengthening of our committment to make the world a better place coupled with a awareness that we are strong and can be stronger.

I am encouraging all of us to initiate conversations about social justice in all of our professional meetings.   Specialty organizations looking for great programs for their meetings could do what the Zeta chapter of Sigma Theta Tau did here last week when three nurse leaders presented brief comments about social justice issues in their workplace.   The discussion that ensued was energizing and confidence-building.    This concept of social justice has a rippling effect that continues to strengthen with each new discussion.