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Good Sunday Morning November 15, 2009

Posted by mariemanthey in Academia, History, Leadership, Values.
Tags: , , , , , , , ,

I had to cancel my salon last month due to a heavy travel period.  In six weeks I was in CA, MI, NY, Germany (10 days) and Ireland.  It was an interesting experience because in 90% of the work I was speaking about Primary Nursing and Leadership.  About the past and the future. About the present, and Being Present.  There is a tremendous hunger within nursing to re-member, to re-connect with the basic values of the nursing profession.  And the enormous challenge is the workload and complexity issues that nearly overwhelm nurses is some settings.

During this past year I have been seeped in history.  Both of nursing in general and in the history of the School of Nursing at the University of Minnesota where a centennial celebration took place last week. This school is the first on-going school of nursing to start in an academic institution anywhere in the world, as far as we can tell.  (Columbia TC started at a graduate level).

I have been studying the work of the instigator of this school, a physician named Richard Olding Beard. His writings clearly demonstrate why nurses need to be educated, not merely trained, as the title of one article attests: “The Educated Spirit of the Nurse”.

So last week was the culmination of a very busy two months for me and I am now getting back to semi-retirement, whatever that means.

One more thing: the Centennial Gala was the time of an announcement about the establishment of the Marie Manthey Professorship for innovative practices.  If you would like more info about supporting creativity and innovation, add a comment or just email me. I am very excited about it.  Recruitment for the position has not yet started, as fund-raising continues.


1. Connie Thach, RN - November 18, 2009


I have been gone for a long time myself, but I am so excited to hear of your successful adventures in nursing. I wanted to revisit your blog again because I wanted to share a discussion that I had on a different nursing blog. What I am about to post below is an example of the importance for your Nursing Salons. It relates to the one of the many roots of how nurses often loose their heart in nursing due to the constant pressures to be “perfect”:

An unhappy Nurse Practitioner (NP) wrote:

“Have you ever felt like this? I am having one of those weeks right now, lol. Sometimes I feel that I missed the mark by going the nursing route. I feel that as an NP I don’t have the autonomy and respect that I really want. Not only do the docs not take me seriously or trust my judgement, but the nurses don’t either. A part of me wants to go ahead and apply to med-school, but I don’t want to borrow more money! It will also take a long time to finish, and I wouldn’t be practicing as an MD until I’m over 40!”

I empathized. I must say, having attended your Salons and learning from your wisdom and being inspired by your creativity and enthusiasm has definitely made an impact on me as a professional RN to this day. I am forever thankful and hope to contribute to nursing as much as you have. Anyhow, I hope that what I wrote in response to the unhappy NP reflects the essence of what you and your Salons has embedded into me:

“Hey there, I’m sorry to hear that you are feeling down in the dumps about the nursing profession. I’m an RN aspiring to be a an NP someday and I am sad to read this message. I am not sad because of what you said, but rather how you bring attention to the reality of the challenges I know that we all face on a daily basis as healthcare providers. I am lucky so far in that I have had more positive experiences than negative ones as a critical care RN in a world-reknown teaching hospital that facilitates a culture of multidisciplinary teamwork and respect. When I was a new graduate RN, I made sure I worked for only institutions that respected and supported Nursing. However, nothing is perfect, and I too have had negative experiences and am occasionally haunted by the self-depreciative conundrums that seem to pervade many nurses. For the patient’sake, you must get yourself out of that conundrum. The pressures to validate oneself as an intelligent provider will always be there unfortunately, but the focus should be the patient. Stop thinking you should have gone to medical school as you may very well face the same disrespect and pressures as a doctor, too. (Shall I remind us all that there are also incompetent doctors?) Credentials only take you so far. The rest is how you respect and handle yourself.

First of all, may I make an assertion here that I feel that RNs in general are very self-critical. It seems to start in nursing school and then intensifies on the job as practice becomes a real-life issue between the patient and the healthcare team. The general public does not have a comprehensive understanding of the power of nursing and doctors are from an entirely different discipline that are also generally unaware of how powerful our contribution to a patient care is either. As I make it a point to tell all student nurses and nurses alike, that the life-saving and life-optimizing effect you provide to all patients under your care are often invisible and/or unacknowledged not so much because you are under-valued, but because they are acts of prevention and principle that are not easily detected or benchmarked. People recognize a doctor’s skill because he/she fixes what is visibly broken. People don’t recognize what nurses do because we keep them informed (aka worry-free) and comfortable and prevented potential harm done unto them. If you are successful in prevention, then there would be no need for attention from the patient that would illicit acknowledgement. Our impact to their care is counter-intuitive, I know. But, that’s where the art of nursing lies.

We coordinate multiple orders thrown at us for the patient so that their tests, treatments, and medications are all given in a streamlined order. Doctors and patients do not know we do this, but we do this because it’s safe for the patient. We cancel redundant and unnecessary laboratory orders for cost-effectiveness for the patient. We work around the unconducive hospital architecture just to reposition our patient or provide a bed cot for the family members. We catch sentinel events before they occur and prioritize our cares so that the patient is stable at all times. We hold their hands when they are afraid and in pain and we teach when they need to learn. RNs/NPs alike, this is what we do and know that our skills influence the totality of the patient experience. It just isn’t always acknowledged, and that’s okay because these are acts of principle. (Personally, this is where I see the beauty of what we do.) We do it because it is simply the appropriate and ethical thing to do not because we are in search of praise each time we accomplish a task for the patient. This is principle. I didn’t become a nurse to be constantly thanked. I became a nurse to keep people safe and well and that’s just what I do – what we do. Gosh, if it was not for us, can you imagine what patients would have to go through?

Can you think of a time that you caught an overlooked order and fixed it? Have you answered the pages from RNs who could not get the doctor’s attention? (As an NP, you are the nurses’ nurse, the nurses’ advocate.) Have you been able to explain a test result or drug to a family member to alleviate their concerns and fears? Even if you say no, I am sure you have because you would not have made it this far into your career to say no. Remember that and make sure that you are not discrediting yourself for all the times you have made a difference in people’s lives. Don’t forget your patients and their family. They are thankful to have your care. The other half are your coworkers so don’t let their criticism ruin your entire experience as an NP. Actually, they should be less than 50% of your experience as an NP. They should be 25%. The other quarter is you and those who love you for who you are.

Before you beat yourself up over things that are unfortunately out of your control, remember that you have gained a lot of experience as an RN as well as extensive training through NP school. If you just started out, give yourself a year to acclimate to the pressures of finally being in that autonomous role. If it is seriously problematic, consider working for a different employer that values NPs. Or, practice conflict resolution skills with those that are particularly problematic for you and do so in a professional and diplomatic manner. Prepare yourself to be logical rather than emotional by talking to trusted peers about your frustrations. (Hell, I’d even write them down!) As healthcare workers, we all work in an emotionally intensive environment. But, we are all here because we want to focus on the patient – not ourselves. Do not give into the pressures of their derogatory/antagonistic expressions and respond well to those who are willing to explain their disagreements with you. Choose your battles wisely. Learn from your mistakes and acknowledge that all healthcare providers are lifelong learners in the practice of healing. Time will give you the experience that you need to become a better practitioner. The fact may really be the institution and not so much you. There is a solution to this. Persevere and reflect on what drove you to become that smart NP. Remember this and take them with you to work everyday.

Thank you for being a nurse practitioner. Society needs NPs who can share the responsibilities with the doctors but provide care with the nursing touch. There are people out there that still appreciates you – such as I.

Chin up, keep going, and take it easy from time to time.”

2. Lilia Raposo - November 19, 2009

Dear Marie,

Always so good to hear from you!
Congratulations once again about your so meaningful round all over the places speaking as well as teaching everyone about PN and others…
Hoping to see you next March, 2010, hopefully in one of your Salons!
Let me know when it will happen close to the date and I will be there to reach you.
Missing you very much and all CHCM Staff!!!
Lilia Raposo, RN
São Paulo – SP – BRAZIL

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