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As it happens: RBC Symposium Day 3_ Wednesday, June 21 June 21, 2017

Posted by mariemanthey in Creative Health Care Management, Inspiration, Leadership, Professional Practice, Values.
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This is the busiest day of the CHCM International Relationship-Based Care Symposium, so to keep the posts from getting too long, will be sharing snippets & segments!

Launched by the wonderful Keynote by Lois Swope on compassionate care; with an all-attendee mid-day session on relationship-building in Indian Health from Phoenix Indian Medical Center; and concluding with a Poster Session; the day also included two breakout sessions with 5 choices each of those sessions! (Please join me in thanking the CHCM staff, they’ve been working extremely hard to bring this all together!)

As it happens: RBC Symposium Day 1 June 19, 2017

Posted by mariemanthey in Creative Health Care Management, Inspiration, Leadership, Manthey Life Mosaic, Professional Practice, Values.
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Today is the pre-conference afternoon of the 2017 International Relationship-Based Care Symposium, here in Minneapolis at the Hilton Minneapolis!

Here are links to the handout materials available at this time:

Gratitude_Human_Connection

DeepenFacilitationCapacity

It’s been great already to have a brunch at my home – to which I invited international guests, several local nursing leaders and CHCM consultants. Conversations ranged over various topics including comparisons between people’s situations in different countries.

The conference itself is a very enthusiastic experience! I have been constantly in motion and it’s wonderful. Everyone is very happy to be here and many are saying ‘this is exactly what we need at our hospital!’

This afternoon I was able to be a surprise guest at the Daisy Foundation session. I spoke about the the impact of Florence Marie Fisher coloring in my coloring book, and also what a wonderful thing it was for me to be able to nominate her for the DAISY award. In closing I brought in Florence Nightingale as well.

I enjoy talking about the power of nursing: as I experienced in my lifetime the impact of my nurse when I was five years old.  I like to make it clear that the work that I’ve been involved in leading is directly the result of Florence Marie Fisher coloring in my coloring book.

I don’t think that that concept can possibly be emphasized too strongly: the power of good nursing care!

Much more to come, looking forward to sharing it with all of you!

 

 

Blast from the Past: Feisty Former Chicagoan (1978) May 13, 2017

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Primary Nursing: Hospitals bring back Florence Nightingale

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This article was one of the first in mainstream media about Primary Nursing, Marie Manthey .. and Florence Nightingale!

The picture on page 1 is so wonderful, isn’t it?

Here are some excerpts from the article, which you can see directly via the links at the top of this post.

“We’re not just dealing with inert lumps of flesh that hurt” Davis says. “We’re dealing with people’s emotional well-being, too. And that’s what makes nursing exciting again.”

Chicago Tribune: Sunday, February 2, 1978

by Joan Zyda

Sometime after World War II, the American registered nurse was forced into being less like Florence Nightingale and more like a factory foreman.

The shortage of nurses resulted in assembly-line nursing, which brought with it an assortment of nameless, often uncaring persons who trained for brief periods before being turned loose on patients. They were practical nurses, vocational nurses, technicians, orderlies, nurse’s aides, and nursing assistants.

If you’ve been in a hospital in the lst three decades, you have seen this production line in action. Somebody took your temperature, somebody else gave you a bath, somebody else took your blod pressure, somebody else brought in your food tray, somebody else …

Conducting this “orchestra” was, and still is, the chief duty of the registered nurse in most hospitals. Despite years of learning to care for sick people, she ends up in a supervisory job that takes her out of the mainstream of patient care. If she sees patients at all, it’s only briefly when she gives them a shot or a pill, or if there’s a “problem.”

“The patients are completely perplexed and often get irritable or depressed by this fragmented and impersonal care; it frights and frustrates the doctors; the morale of nurses sinks to an incredible low, resulting in a high turnover rate and absenteeism; and it has caused a decline in patient care at many hospitals,” says Dr. William Shaffrrath, diretor of the National Joint Practice Commission in Chicago.

The commission was set up in 1972 by the American Medical Association and the American Nurses Association to solve the growing dissatisfaction with hospital nursing care.

Teh solution, with which the commission has been shaking the pillars of medicine, is to put the registered nurse back at the patient’s bedside, where she can use her training. Some hospitals have already done this, including Rush-Presbyterian-St. Luke’s Medical Center, University of Chicago Hospitals, Good Samaritan Hospital in Downers Grove, and Evanston Hospital.

“Most nurses we talked to are frustrated. They don’t want to be supervisors,” Schaffrath says. “They prefer hands-on nursing in the Florence Nightingale tradition. They want to walk cot to cot, tending to and cheering on the patients.”

Schaffrath credits Marie Manthey, 42, a fiesty former Chicagoan and now vice president of patient services at Yale-New Haven Hospital in Connecticut, for blowing the whistle on nursing. She has advocated for the “return to the bedside” alternative in articles in several prominent medical journals.

As a registered nurse for 22 years, Manthey has had an inside look at the failings of her profession.

“Registered nurses have become faceless people, and it’s the system’s fault,” she says. “Nursing has become extremely production-oriented with very little concern for human needs. Most nurses are embarrassed about that. They say, almost apologetically, ‘Well, I’m just a staff nurse,’ which equates to, ‘I’m just a housewife.’

“But if nurses got their identity back,” Manthey says, “they’d be a proud people again. Then they’d be saying, ‘Hey, wait a minute. I am a staff nurse. I am an important person.”

“Nurses are supposed to be in the thick of things,” Manthey says firmly.

Manthey has coined her remedy, “Primary Nursing” a system whose main goal is just that — to get the nurse to provide total nursing care to a patient during their hospitalization. That means the same nurse does all the work for a patient from admission to discharge.

“The Nurse and the Patient get to know each other,” Manthey says.

With Primary Nursing, the nurse takes over many tasks she used to assign her aides.. because they’re all relevant to patient care.”

/ end content on front page of article, clip 1of2

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For further content from this article, see clipping number 2, and/or let us know if you’d like us to post further excerpts here.

Isn’t it amazing to look back and remember the days when Nursing was at that factory-process level??

Symposium Update! Urgency Building for this Exciting Event! May 8, 2017

Posted by mariemanthey in Academia, Creative Health Care Management, Leadership, Professional Practice, Values.
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CHCM’s International Relationship-Based Care Symposium

From Silos to Synergy: Showcasing Fierce Commitment to Extraordinary Care

June 19 – June 23, 2017

Minneapolis, MN

While people will be attending this event from around the country and around the world – some of you will be able to attend any/all days without traveling at all. CHCM Symposiums are sited in vibrant health-care communities, in order for those particular communities to have the special privilege of attending events within the comforts of home.

This post is especially for those of you who have that privilege this year!

The Relationship-Based Care Symposium is a magnificent program and since you live here, the options for
attending provide a wide range of choices. You really don’t want to miss this opportunity.  This is the first time we are offering the symposium locally to the Twin Cities community.   You can opt to attend one of the three
days…all three….or the pre- or the post- conference, or all of them.

This is a great opportunity.  Look carefully at all the speakers and you will see why you don’t want to miss this event.

Some highlights are:

* DAVID COOPERRIDER, the developer and creative thought leader of Appreciative Inquiry, a strengths-based approach to organizational change based on the best in people and their organizations
* ROGER NIERENBERG, a maestro who, with the help of a professional orchestra, provides a multi-sensory immersion experience of organizational dynamics and teaming
* ROBIN AND MEREDITH YOUNGSON, co-founders of New Zealand-based Hearts in Healthcare, which focuses on organizational strategy and movement building that’s centered on making health care more
compassionate
* THE DAISY FOUNDATION, enhancing patient care by celebrating compassionate and extraordinary nurses through meaningful recognition
* DEAN CONNIE DELANEY WILL speak on the amazing topic THE SOUL OF TECHNOLOGY!
* TEDDIE POTTER WILL FACILITATE A DIALOGUE with Robin Youngson and an interprofessional team of young clinicians on PARTNERING ACROSS GENERATIONS.

The journey forward of Primary Nursing, and it’s broader implementation as Relationship-Based Care, will be celebrated, cultivated and innovated further at this  once-in-a-lifetime event.

Symposium Registration Information

Please check out the Brochure and the website and your co-workers and professional community. To obtain the group rate please email:  rbcsymposium@metroconnections.com with the list of all attendees in your group and you will receive a registration code.

This activity is planned and implemented by the University of Minnesota, Interprofessional Continuing Education and Creative Health Care Management. In support of improving patient care, the University of Minnesota, Interprofessional Continuing Education is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC) to provide continuing education for the healthcare team.

Register for the RBC Symposium today!

Please let me know any questions you have about this exciting event. We look forward to seeing all of you there!

The Mosaic of Marie Manthey’s Life April 30, 2017

Posted by mariemanthey in Creative Health Care Management, History, Inspiration, Manthey Life Mosaic, Nursing Peer Support Network, Nursing Salons, Professional Practice, Values.
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ColoringBookCover

by Marie Manthey

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 parent’s 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 for a month, visiting twice a week, and sometimes when one or the other of them came, a very painful procedure was done involving an IM injection of their blood. As a result, I felt not only abandoned but also frightened and confused about the pain associated with their visits.

Florence Marie Fisher is the name of a nurse who cared for me. One day she sat at my bedside and colored in my coloring book. For me, that translated to ‘cared for me’ … and I decided then that I wanted my life to be about that kind of caring.

From that time on I knew I would be a nurse. I entered a hospital diploma program right after high school, and worked for the next four years as staff nurse, assistant Head Nurse, and Head Nurse. During the last of those years I started going to night classes in the community colleges .. not necessarily at first to get my degree.

I was invited to enroll in the degree program at the University of Minnesota, which was one-of-a-kind at that point. After 15 months of full-time study, I received my Bachelors degree in Nursing Administration. Soon after I was recruited into the U of M’s Masters program in Nursing Administration, in what was the last of the 3-quarter Master’s degrees.

Before finishing that degree, I was recruited by Miss Julian to be an Assistant Administrator of Special Projects. This was a new position that gave me an unbelievably valuable opportunity to learn first-hand about leadership and administration. I was able to experience directly not only organizational dynamics, but was also privileged to work with a group of administrators who used Senge’s principles of a learning organization even before he’d written ‘The Fifth Discipline.’

It was during this time that I became one of two Project Directors for Project 32 (at the University of Minnesota), a pilot program to improve hospital services from an interdisciplinary/interdepartmental perspective. This project eventually morphed in to Primary Nursing, and my career became about understanding and implementing organizational changes that result in the empowerment of employees and the accompanying development of healthy workplace cultures.

Throughout the next ten years of my life in nursing administration – first at another community hospital within the Twin Cities, and then at Yale New-Haven Hospital in Connecticut – I freely helped others with Primary Nursing.. Always accepting visitors and often speaking both locally and nationally as well as publishing as time allowed.

During this period of my career, what had been a manageable, socially acceptable level of alcohol consumption escalated in to full-blown alcoholism. There was an intervention and I entered a 6-week residential treatment program on the East Coast, and have been sober ever since.

In my first year of sobriety as I was feeling my way forward, there were no positions in Nursing Administration available to me. Instead I wrote my initial book on Primary Nursing .. and returned calls to all who had ever asked me to speak, putting out the word that I was available for speaking and consulting. The result was that Creative Nursing Management, Inc. was born, now the longest-running nurse-managed health care consulting firm in the U.S.

When I finished writing Primary Nursing, the publisher asked me who I wanted to dedicate it to.. and that had to be Florence Marie Fisher, the nurse who had colored in my coloring book when I was five. We weren’t able to contact her then, and so I gave up on that idea of actually connecting with her.

My career as a successful entrepreneur has continued ever since. Running a business was not ever something I thought I would do. I didn’t see myself as a businesswoman, but rather as a professional woman. Nevertheless, through many trials and many errors, the company grew. I often say we were successful not because of my business acumen, but rather because my work was authentic and based on real-world realities and values.

In time we grew into a multi-faceted, multi-national firm called Creative Health Care Management. I sold the firm when I turned 65 (in 2000) to the employees themselves. Now in semi-retirement (still, in 2017!) I remain involved in the important work of developing nursing practice and improving patient care.. just without the stresses and challenges inherent in leading an entrepreneurial entity.

An additional aspect of my work today involves tackling the challenge of Substance-Use Disorder. A group of us concerned with the problem of shame and stigma associated with SUD formed a Peer Support Network here in Minnesota, and we are partnering with entities involved in all aspects of the situation.

Another vitally important component of my professional life today has to do with my involvement with my alma mater. After transitioning away from day-to-day involvement in the running of CHCM, I became active in the Alumni organization at the U of M School of Nursing, and also became an adjunct faculty member there. In 1999 the University of Minnesota awarded me with an honorary doctorate, which was thrilling beyond compare. Today I am also active with the Heritage Committee at the School of Nursing, and am engaged in other ways as well with the University.

I also continue to be a part of my own and others’ Nursing Salons – a safe space for nurses in all walks of the profession to share conversations and support one another.

My ongoing interest in changing the way we think about workload and resources is part of the same picture. As healthcare incorporates more and more technology, the temptation strengthens to discard the human caring aspects.

As nursing matures as a profession, I am more convinced than ever, that the choice to care – and to express care and compassion by one’s behavior – is the absolutely correct choice nurses must make in order to continue to serve society justly.

Clinical competence must be on one side of the nursing coin, and care on the other. This is the ‘Coin of the Realm’ nurses must choose if, in fact, the covenant between nursing and society is to continue to exist.

ATTENTION: Blog Revision April 19, 2017

Posted by mariemanthey in Announcements, Values.
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I want to announce a new beginning here on my blog!

In coming weeks and months you will notice a much increased level of activity here! I’m bringing my daughter, Claire Stokes,  in to the operations of the blog, in her capacity as Managing Editor (previously of Primarily Nursing Journal), in order to provide you with much greater access to my career-long body of work. We will be creating and making available written content that will be a combination of completely new writing and the best of past writing, as well as the best out there of the work of others. This will culminate into a new era here on my blog. And we want to invite you to participate more as well.

We are doing this NOW for several reasons:

  • Time is passing, and I want to provide all I can that is of use to you while I have the chance
  • Challenging times call for heightened values-based activity on all our parts, and this is my way of giving what I have to the struggle
  • My daughter has availability now that I am able to take advantage of
  • I am bursting with new ideas and content that I want to share with all of you!

I am looking forward to being more in touch with all of you throughout this process. With Claire as the logistics person, I’ll be able to respond more to your comments and your requests for content also. So feel free to let me know what’s on your mind, and your responses to what we publish here and elsewhere!

A ‘Mass Salon” event at the Texas Nurses Association meeting April 20, 2016

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Salon Resources: https://wordpress.com/page/mariesnursingsalon.wordpress.com/7

Texas has done it again.    Last Saturday I introduced Salons to the House of Delegates and for the next two hours, about 170 delegates experienced a Salon conversation at their tables.   The same format was used…check in, have a conversation, check out.   It is such a simple formula, I am always amazed at what happens at an experiential level.   After each table had ‘checked out’ we had a room-wide sharing.   And that is where the magic and/or miracle was seen.   Among the comments was amazement at how easy and conversation flowed..  “like fish moving in a school”…..  it seems organic and effortless the way the conversation moved based on the check-in.   Another comment was how easy it was despite vast age and experience differences..   “Amazingly energetic”.   “Easy to reach common ground”.   “Nursing has the same values no matter where is it practiced”.   Found the bedrock of who we are….reached common ground.   And finally as always….the word Hope came through.   This seems to be an almost universal result of a salon conversation.

The reason I was asked to do this by the TNA is they are encouraging their members to form Salons all over Texas….and the members present were encouraged to become or recruit hosts in their regions.   The TNA will provide a website to post information about all meetings, including the opportunity to RSVP right on the website.   This is a really important development and will greatly facilitate the success of this movement.

Thank You Texas….for once again Thinking Big

A Labor Day reflection: CHOICE AT WORK! September 1, 2014

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I am one of the lucky ones….I knew nearly all my life that I wanted to be a nurse. When I was 5 years old, I was hospitalized for a month. During that period I truly felt abandoned by my parents and worse yet – when they did come – a very painful procedure was performed on me each time. The only positive moment during my stay was when a nurse named Florence Marie Fisher colored in my coloring book. For reasons only known to God, that meant to me that she cared for me….in the fullest sense of that word care.
I knew from then on that being able to do that for another person was exactly what I wanted my life to be about…..and I’ve never looked back!
What made it full of wonder is that I have been able to learn so much about how to live from my work. A beautiful framework for living came through my work when I was involved in the original development of Primary Nursing. The Primary Nursing framework builds the concepts of Responsibility, Authority and Accountability (RAA) into a dynamic whole that can serve to correctly inform the proper relationship among people….the proper structure for an organization….the proper content of a job description.

When each of those three elements – Responsibility, Authority and Accountability – are viewed in their proper sequence, functionality is enhanced. When Responsibility is legitimately allocated, Authority commensurately delegated and Accountability mechanisms are designed for recognition and education (and not for punishment)….then all aspects of an activity can be optimally functional, and personal relationships can be healthy.

But the most important thing I finally learned (sometime in my mid-forties) is that these same elements are at work in my life. The moment I call my epiphany occurred with a blinding flash of insight…..during which I instantly saw that as long as I blame someone else for whatever is wrong in my life, I am not accepting responsibility for myself. I decided to learn how to change that, and I have never found it necessary to feel victimized by any person or situation or institution again.
What does all this have to do with work? I believe we all have choices every day about all aspects of our work …..and that the choices we consciously (and unconsciously)make have the power to either expand our spirit….or to destroy it. I am continually amazed at how many people tolerate working in dysfunctional systems …..or in toxic workplace cultures.  I know there are many factors operating that may reduce one’s awareness or perception of choices. Nevertheless, I have come to believe that even in the most oppressive environments…consciousness of choice instead of focus on victimization is the key to being able to grow spiritually.
Ultimately, I think the real lesson to be learned is that we have a choice to manage ourselves…..or not. Self management means being aware of the importance of healthy interpersonal relationships. Open communication (no back-biting) functional trust and mutual respect are the three key ingredients to healthy interpersonal relationships. Open communication means taking the time to learn the tactful way to talk about difficult issues with co-workers….it is a skill we can choose to learn. Trust is a choice we need to be willing to risk giving…..because withholding it breeds only more mistrust….and mutual respect requires the judgment to see everyone (at all levels of status and education) as being of equal importance to the overall workplace morale.

And I have learned that morale influences the quality of the product (nursing service) more that any other single or combination of factors. In my world that means that the morale of a nursing unit staff will have more impact on the quality of care patients receive than does any other single or combination of factors. And morale is solely determined by the way staff members treat each other in the context of workplace realities, including the reality of more work to do than time available.
These incredibly valuable lessons came to me from my work experience…..and they dovetail completely with what I have learned in recovery.
Consciousness of choice ….of how to respond to my co-workers….of how to be present in my work…. of my values of integrity and authenticity…all of these and more are the opportunities of learning and growth I have received through my work. And I know that all of this came about because Florence Marie Fisher colored in my coloring book when I was five years old. She created a caring relationship with me…..and permanently influenced my life.
She never knew that. I published a book about Primary Nursing in 1979, and dedicated it to her. The publishers tried to find her, but where unable to. Recently I came across those onion-skin copies of the publisher’s letters to a couple of State Boards of Nursing trying to find her and remembered that they were unsuccessful in locating my Florence Marie Fisher. But I thought to myself that afternoon few months ago……Google! And so I googled her and found her obituary…which also listed her survivors. I have since had the pleasure of meeting her son and grandchildren and telling them about the impact she had….not only on my life…but also on my work, which has in turn influenced the experience of nurses and patients throughout the United States and internationally. Of course they had no idea…..her simple act at work of coloring in my coloring book was a sublime act of co-creation. As nurses we can all find ways to choose to color in a coloring book. It is a choice we have to make, individually, and repeatedly. It is a choice that will not be documented….cannot be charged for….and that has a major impact on the lives of at least two people, the patients we care for and on ourselves. The choice to ‘be with’ the patient, instead of just ‘doing for’ changes the nursing experience for each individual who experiences this choice.

NURSE MANAGERS: DO YOU EVER HAVE FUN AT WORK? WHAT GIVES YOU JOY…..AT WORK? January 16, 2014

Posted by mariemanthey in Inspiration, Leadership, Professional Practice, Thought for today, Values.
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Many years ago I had a Nurse Manager (NM) role, and looking back on it I remember it as a very positive experience.    Lots of times I knew we had done a great job, and that our work was appreciated by both patients and physicians – and even our bosses.    I wonder how often today there is any recognition for excellence in nursing practice.   I don’t mean just the HCAPS scores…. I mean the real deal.

Nurse Managers attend lots of meetings, fill out lots of forms, audit lots of stuff, and spend lots of time at their desk in front of a computer.   Somehow, we have to get back to the notion that the NM is also a leader of the clinical practice of the unit.    What if a NM spent just 15 min. a day ….every day asking a nurse about a patient story in order to just recognize – or even advance through inspiration – a higher level of practice?    What if a NM made a point of finding the good stuff the staff does and bragging about it?   What can be done to improve the experience for Nurse Managers throughout the current system?

I’m really looking for some feedback from Nurse Managers about Fun and Joy….and what has worked for you to bring those experiences into your challenging role.    You deserve it.   You are the engine of the system.    Take pride in your role and its importance.

The Choice of Every Nurse Every Day…an excerpt of my introduction to this new book….. June 24, 2013

Posted by mariemanthey in Creative Health Care Management, History, Inspiration, Professional Practice, Values.
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Advancing-Professional-Nursing-Practice-Book

A painting is not created by a free floating hand making marks with oils on canvas. The hand belongs to an artist connecting with his or her mind, body, and spirit, not only to the process of creating a painting, but to those who will one day see the painting. The hands of the artist are not where the skill lies. Without the whole person showing up in the creation of the painting, there is no art; there is just painting.

The art of nursing can be thought of in much the same way. The nurse can show up as little more than a pair of hands doing tasks, but this is not nursing; this is just doing tasks.

The art of nursing (as is perhaps true of any art) is about connection. In the art of nursing, the nurse connects to the patient, and the nurse also connects to the profession of nursing. Advancing Professional Nursing Practice is about the art of both of those connections. It is a book in which the ANA standards are named and explained, connecting nurses to the practice and performance standards of their profession. It is also a book about Relationship-Based Care, which is a care delivery model that connects nurses to patients and families by removing barriers to the nurse-patient/family relationship and improving relationships throughout the organization.

I’m always happy for nurses who get to work in cultures that support healthy relationships throughout the organization, and I share the distress of those who work in environments that seem to be fueled by chaos and competition. It is the choice of the nurse, however, whether to show up in either environment as a whole person, fully invested in the care of patients and families; or simply as a technically competent task doer.

In 1966, the way I viewed nursing was changed forever by an article I read in the American Journal of Nursing. It was written by Sister Madeleine Clemence, and it was called “Existentialism: A Philosophy of Commitment.” The way I saw it, this learned nun, a woman far ahead of her time, was challenging me, a young nurse leader, to show up as a whole person in my work. Her article challenged me to change my own practice and to mentor others to do the same:

“Commitment can mean many things: a promise to keep, a sense of dedication that transcends all other considerations, an unswerving allegiance to a given point of view. In existentialism, commitment means even more: a willingness to live fully one’s own life, to make that life meaningful through acceptance of, rather than detachment from, all that it may hold of both joy and sorrow.”[1]

It was no accident that Sister Madeleine was talking about “acceptance of, rather than detachment from, all that life may hold” in the context of the nurse’s work. As a nurse herself, she could see that the work of the nurse is secular for all, but sacred for only those who commit themselves to making it so. As we go about the work of nursing, are we solving problems or are we entering into the mystery of what it means to be with a person who is suffering, vulnerable, and afraid? She quotes philosopher Gabriel Marcel, writing, “A mystery is a reality in which I find myself involved…whereas a problem is [merely] in front of me.”

It raises a provocative question for nurses: Am I involved with my patients, or are they merely in front of me?

Over a century-and-a-half ago, Florence Nightingale helped to make nursing an art through bringing compassion into her own practice and then writing about it so that others might see that when the basic relational needs of the patient are tended to, there is a healing that takes place whether cure is possible or not. She famously encouraged the soldiers of the Crimean War to write to their loved ones. She understood the simple human truth that connection is healing—connection with loved ones (be they near or far), connection with one’s own thoughts and feelings, connection with the realities of one’s current situation.

The compassionate focus on connection that Florence Nightingale brought to nursing is still there, but it has gotten lost in the shuffle over and over; throughout history every time there was a major change in the world of health care. Here is some historical background:

Prior to the Great Depression, private duty nursing was the main avenue of employment for the nation’s RNs. As the Depression eliminated this avenue for many, RNs returned to their home hospitals as temporary workers, often on a volunteer basis, sometimes working for their room and board. As such, they found themselves working in a highly regimented, task-based, time-focused system of care that was designed to control practice and teach student nurses. This eventually became the main avenue for employment of RNs and remained so until fairly recently.  This move from more autonomy for RNs to less autonomy is a pattern that has repeated itself throughout modern history.

After WWII, the proliferation of new hospital beds coupled with the baby boom (which greatly reduced the nursing workforce), resulted in team nursing, a delivery system designed to maximally utilize technical expertise and assistive support staff under the direction and supervision of an RN. Again, the focus was on assigning and supervising the performance of tasks, since the only person educated to provide a therapeutic relationship was nearly always consumed with supervision and the performance of tasks requiring a higher skill level than that of her staff.

The system upheaval that characterized the last 30 years of the twentieth century, which was driven by finance, technology, and regulation, resulted in most health care organizations dealing with higher patient acuity coupled with severe cost cutting, which again resulted in a focus on managing the tasks of care rather than managing therapeutic relationships. The resulting dehumanization within the care system drove a spiral of regulations and system constraints that further complicated (and continue to complicate) an already intensely complex adaptive system.

The age we live in is no different. As we deal with the myriad changes of health care reform, we’re seeing, once again, a return to task-based practice. This time, however, it feels different to me in various ways. I’m heartened by the numbers of organizations that are embracing Relationship-Based Care. The publication of See Me as a Person is another example – it addresses the need for nurses and other caregivers to be “in it” with their patients rather than merely ministering to their bodies. As the next major societal shift in health care advances, whatever it is, the profession of nursing must continue to define itself. Society trusts us to do so, and our covenant requires it.

Nurses must ask themselves some important questions: What exactly is it that must always be present in order for nursing to really be nursing? What is the actual core of nursing? What strengthens that core? And what must be present in order for that core to even exist? In short, what is the nursing imperative?

I would ask you to mount your own inquiry, and come up with your own answers. Here are mine:

The nursing imperative is a two sided coin. On one side there is the imperative to be clinically competent in both technical skills and clinical judgment. The other side is the willingness to step into being with the human being for whom the nurse is caring. In health care, people experience vulnerability at every level of their being: mental, emotional, physical, and spiritual. The privilege of nursing is having the knowledge and skill, the position and relationship, to interact with a vulnerable human being in a way that alleviates pain and increases mental, emotional, physical, and spiritual comfort. This is the privilege of nursing—the being with a vulnerable human being. If this privilege is ignored or overlooked, nursing isn’t happening. No matter what is happening in a care environment, authentic human connection with the vulnerable human beings in our care can and must happen. That, to my mind, is the nursing imperative.

It’s clear that half of the nursing imperative is that we have a mastery of the technical aspects of nursing, but the other half of the nursing imperative—and it truly is no less than half—is staying present to the vulnerability of others. This book seeks to address the dual nature of the nurse’s work, both the instrumental and relational. If you are a nurse (or about to become one), I’d ask you to keep this dual nature in mind as you read this book.

Marie Manthey, MNA, FRCN, FAAN, PhD (hon.)

March 8, 2013


[1] Clemence, M. (1966). Existentialism: A philosophy of commitment. American Journal of Nursing, 66(3), 500-5.