Marie Manthey’s Nursing Salon

At last night’s (May 15) Salon, a Clinical Nurse Specialist told of an incident he was involved in yesterday, when another staff member asked him to “make them stop fighting”. The ‘them’ was a Nurse Practitioner and a Medical Resident. The ‘fight’ was a role conflict that surfaced during a patient discharge. You can guess….the resident said the practitioner was practicing medicine and the practitioner said the resident…..well, you can fill in the blanks. This ‘fight’ delayed the patient’s discharge by 5 hours!

This was one of the many experiences the 20+ guests brought to last nights discussion. And this particular incident led us into an interesting and informative discussion of role conflicts…what they mean and how to deal with them, and how to avoid them.

Two of the guests graduated just the day before our gathering and are interested in how to enter the work world in a healthy way. One guest was a nurse leader from Kenya, Africa, whose issues mirror ours in so many ways …and yet the system and the culture is so different. She spoke of the problem of nurses not being confident and many people talked about ways to acquire inner strength as a nurse.

A topic brought up almost every month is the issue of ‘entry level’ into practice….as well as new roles being created in new education programs. AD’s,BSN’s, MN, CNS, CNL, DNP, Phd,…some people’s confusion was eliminated….(others learned about new developments) and the discussion ultimately focused on the many complexities we face, and also on how do we as a profession stay united in purpose and integrated in message as we continue to evolve. As always, the contribution of individuals reflects both the uncertainty and pain of change, but also the hope and belief that whatever our preparation….our relationships with patients, with ourselves and each other is the key to honoring our covenant with society.

I encourage everyone reading this to first of all, add your 2 cents worth to the discussion. I love to read your comments and will respond. Secondly, I invite all readers to join me in a campaign to replicate these Salons. I am convinced that nurses desperately need a safe place to talk both about the issues we face in daily practice, as well as the enormous complexities of the systems we work in…..as well as the complexities of providing appropriate care in the broken health care system.

I will help anyone interested in getting one started. I have a new written description that summarizes my experience hosting one for seven years. The healing that occurs when these deep connections are made about important experiences is truly profound. And it is very easy to have a salon….just ask and I will tell you how easily it can be done.

The wonderful thing about these gatherings is that there is no agenda, no minutes and no action steps! No carry-over from one to another. Each one is a total event in itself. We just come together in a safe environment, agree to professional confidentiality….and use the ‘Socrates Cafe’ format to handle the discussion. The result is hope and healing.

My goal now is to have websites throughout the US where a nurse can go to see the Salons scheduled in his/her city/town….for the month! And can pick the one to go to based on their own schedule and the events location.

Several of us have started talking about how to do this ….and frankly, we don’t have a road-map…..but then,we didn’t have a ‘road-map’ for Primary Nursing…back in the late sixties, and look how that idea spread from one unit at the U of M to a world-wide movement! So…I know this one can too.

Last nights Salon was another wonderful experience.    We touched on a variety of subjects from unhealthy work groups -to the challenges of ethnic differences in end-of-life care-to age disparities in nursing practice and their effect on workplace dynamics.

For example, that last item….old-timers complaining that  new nurses spend too much time on the computer and not enough with patients …..and new nurses complaining about seasoned nurses being too judgmental about patient behaviors and values that are different than the nurses.   These comments yielded a rich and meaningful conversation that ended with a strong appreciation of connection between the older and younger nurses in the room.

Another rich theme of the night was how do nurses handle the stresses and strong feelings that occur on the job (ie death of a beloved patient, family disputes re. end of life that result in patient suffering, etc ) off duty?   Do our families really want to know about these issues?    Consensus was “No”….and the problem of no one to talk to about this and no time at work to process emotions was a really good and helpful conversation.

Actually for most people here, these Salons are providing this kind of an opportunity to process their work experiences in a supportive and healthy way.    The check-out always yields comments about hope for the future, pride in the profession, and  personal validation of experiences.

   There was a large group here last night….several returnees and several first-timers.   The mix of newbies and old-timers was energizing, and provided both balance and passion to the discussion.    Mid-career nurses brought workplace dysfunctionality expereriences to the discussion, while students and new grads expressed concern about being accepted as members of a nursing staff after they graduate and about being able to handle the incredible stresses and workloads required of staff nurses in today’s hospitals.   Because we were able to listen to each other intentionally…..we quickly found common ground to express ways to handle various situations within the workplace and to acknowledge the value of the wide age-distribution that exists in nursing today.

One nurse spoke with deep feeling about a terminally ill seven year old whose disfigurement in death was extremely disturbing to this nurse in her second year of practice.   Older nurses were able to help this young nurse see this experience from a perspective that was both comforting to her…..and that allowed her to see the value she brought to this patient by her compassionate presence.  It is this kind of support and perspective that is only available from seasoned nurses who have learned these things from their own experience.

It brought to my mind again the importance of using reflective practices to absorb and learn from the often incredible experiences we nurses have in this work of ours.   In the old days when student nurses lived in dorms….there were usually times and opportunities to talk about the sometimes mind-blowing sights, sounds and smells of nursing….of dealing with life and death and disfigurement.   In todays health care reality nurses often don’t have time to even talk to colleagues at work, and end up suppressing or stuffing un-processed feelings.    These Salons provide that kind of opportunity and really deserve to be replicated.   I would like to help anyone get one started….and have a written description of the way to do it I am happy to share with everyone.

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’

Yesterday I had a great experience. The Univeristy of Minnesota School of Nursing Foundation invited me to ‘do the Printy lecture’, a funded annual event for the past 15 years. My talk was titled “Back to the Future”……and the auditorium was nearly full…..over 100 nurses and a few visitors. The talk went well and the questions afterwards were good. What was especially rewarding for me was the cross section of my life represented there….from nurses I taught, to nurses I worked with, to nurses with whom at some time or another I plotted and planned and schemed with to improve patient care.

I just love being where I am. Semi retired…..meaning time to do things I couldn’t do when I was running CHCM. Acknowledging my 50th year in the profession….and feeling good, really good about that. Loving history and having an opportunity to work on nursing history for the School of Nursing. Having access to information and the latest thinking about the future of health care…..both the good and the bad of it. Being able to reflect on the past and project into the future. And being able to think about what it all means and to share those thoughts with others. It just doesn’t get much better than that…..except to also be attached to a progressive School of Nursing that I believe is reigniting the Spirit of Inquiry and Research through a transformation process that is improving the culture of the school for both students and faculty.