When Chicken Soup Isn't Enough Stories of Nurses Standing

Up for Themselves, Their Patients, and Their Profession (The

Culture and Politics of Health Care Work) 1st Edition

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 Contents

Acknowledgments ix
Introduction xi

Part 1 Set Up to Lose, but Playing to Win 1

A Covert Operation · Kathleen Bartholomew 3
Saving Patients from Dr. Death · Toni Hoffman 6
A Lesson for the Principal · Kathy Hubka 9
The Delicate Discharge · Ruth Johnson 10
No Patience for Poison · Brenda Carle 14
Mr. CEO, Will You Marry Me? · Candice Owley 16
Intolerable Behavior · Eleanor Geldard 19
One Is One Too Many · Thomas Smith 21
A Comfortable Cover Up · Jenny Kendall 24
Stacking the Cards in Our Favor · Ro Licata 28

Part 2 We Don’t Have to Eat Our Young 31

Mentor Unto Others . . . · Clola Robinson-Blake 33
A Dose of Diplomacy · Donna Schroeder 36
Standing Up for What You Don’t Know · Judy Schaefer 38
Broken Bones and Ice Cream · Edie Brous 41
Treating Transition Shock · Judy Boychuk Duchscher 45
The Empty-Hands Round · Amaia Sáenz de Ormijana 50

v
vi · Contents

Part 3 Excuse Me, Doctor, You’re Wrong 55

Eye/I Advocacy · Jane Black 57
As If the Patient Can Hear You · Clarke Doty 59
Don’t Just Add Nurses and Stir · Janet Rankin 61
Gloves Off · Nancy Marie Valentine 64
The Overlooked Symptom · Jo Stecher 66
Hope in the Midst of Tragedy · Connie Barden 68
The Advantages of Age · Marion Phipps 71
An Expiration Date for Indignancy · Madeline Spiers 74
What Hospice Is For · Jean Chaisson 76
A Real Pain · Paola Scamperle 79

Part 4 Not Part of the Job Description 81

I’ll Call in Sick If I Have To · Barbara Egger 83
Doing the Heavy Lifting · Martha Baker 84
Attacked by a Patient, Abandoned by My Hospital ·
Charlene L. Richardson 87
The Samurai Sword · Anne Duffy 92
Only When It’s Safe · Bernie Gerard 95
The Red Shirts Are Coming · Mary Crabtree Tonges 97
Not Saints or Sisters · Belinda Morieson 99

Part 5 When One Advocate Can Make a Difference 105

Putting Lymphedema on the Map · Saskia R. J. Thiadens 107
An Inconvenient Nurse · Faith Henson 112
A Safe Delivery from Domestic Abuse · Kristin Stevens 115
To Do the Unthinkable · Barry L. Adams 118
The Only Nurse for Miles Around · Dagbjört Bjarnadóttir 121
More Than Boo-boos and Band-Aids · Judy Stewart 125
First Responders in the AIDS Epidemic · Richard S. Ferri 129
 Contents · vii

Part 6 Choking on Sugar and Spice: Challenging

Nurses’ Public Image 133
Silenced during the SARS Epidemic · Doris Grinspun 135
In the Halls of Academe · Claire M. Fagin 138
R-E-S-P-E-C-T · Lisa Fitzpatrick 141
Real Nurses Don’t Wear Wings · Victoria L. Rich 145
The Lady with a Loud Voice · Jeanne Bryner 149
Taking on the Terminator · Vicki Bermudez 153
Defending the Nursing Profession over Dinner ·
Elizabeth Kozub 157
Remaking the Power Nurse · Pierre-André Wagner 159
Health Policy from Nurses’ Point of View · Yuko Kanamori 162
Maybe We Should Be Bragging · Guðrún Aðalsteinsdóttir 166
Finessing the Chairman of the Board · Carol Blount 169
Called to Duty at 30,000 Feet · Ann Converso 173

Part 7 Applied Research 177

Nurse PI on a Clinical Trial · Kathleen Dracup 179
The Need for Nurse Evaluators · Teresa Moreno-Casbas 182
Research and Nursing-Home Reform · Charlene Harrington 184
How Nurses Make It Work · Kathryn Lothschuetz Montgomery 187
Teamwork through Research · Lena Sharp 191
Keep Asking Questions · Sean Clarke 195
No More Martys · Jane Lipscomb 199
Taking On Conventional Wisdom · Thóra B. Hafsteinsdóttir 202

Part 8 Sticking Together 207

Winning Recognition of Nursing Expertise · Edie Brous 209
A Union Just for Nurses · Massimo Ribetto 213
We Rained on Their Parade · Judy Sheridan-Gonzalez 217
Protesting on the Red Carpet · Kelly DiGiacomo 220
Saving the Carney · Penny Connolly 225
viii · Contents

Part 9 Still Fighting 227

The Male Midwife · Gregg Trueman 229
Fighting for Our Vets · Edmond O’Leary 233
We Are the Experts · Karen Higgins 235
A Collective Voice · Diane Sosne 238
We Will Not Be Silenced · Carol Youngson 240
Standing By One Patient . Faith Simon 246
 Acknowledgments

I want to thank all the contributors of this book for work-

ing so diligently to describe their experiences. I give special thanks
to Janine Slome of the South African Forum for Professional Nurse
Leaders, Charlotte Thompson of the New Zealand Nurses Organiza-
tion, David Hughes of the Irish Nurses Organization, Herdis Svens-
dottir of the University of Iceland School of Nursing, Cecilia Sironi of
Varese Hospital and the University of Insubria, Italy, and Amy Garcia
at the National Association of Student Nurses (USA) for their help
connecting me with some of the contributors to this book. I also thank
Ange Romeo-Hall for her stellar editorial work. Emily Zoss also pro-
vided critical assistance in shepherding such a large group of authors.
My gratitude goes as well to Fran Benson and Sioban Nelson for their
support. Finally, I would like to express my appreciation to the amaz-
ing editorial, production, and marketing team at Cornell University
Press for giving me their encouragement when this idea was in its
gestational phase and helping bring it to fruition. Birthing a book, like
raising a child, involves a village of people, and thank you to the very
best.

ix
 Introduction

I’ve been thinking about putting this book together for

several years. During two decades of writing about nursing, I’ve read
many inspirational books, articles, and essays that offer up the liter-
ary equivalent of comfort food for RNs. The authors invariably mean
to be helpful to the nursing profession by lifting the spirits of its prac-
titioners at a time when so many are feeling tired, stressed out, dispir-
ited, or unappreciated. The problem is, in this heavily sentimental
genre, the real-world context of long hours, increased patient loads,
and chronic understaffing quickly fades into the background. In the
foreground we see traditional images of nurses as people (generally
women) who “make a difference” through their touch—always gentle—
and niceness. Rarely are their abilities or technical knowledge—
represented in a true-to-life setting—the subjects of the story.
In the media, both entertainment and news, and in the imagina-
tions of policymakers and health care administrators, nursing is like-
wise trivialized as mere hand-holding. When, in 2009, the executive
producer of the NBC show Mercy described why nurses were chosen
as the subject of this new prime-time television drama, she explained
her belief that, “by focusing on nurses, it seemed like a way to do a
more character-based show set in a hospital. Nurses don’t really solve
cases, they don’t diagnose, so the stories can be more emotionally
driven rather than science-driven.”
No wonder the public clings to this sentimentalized vision of
nurses, and texts that are produced to inspire nurses deliver up story
after saccharine story that reinforce traditional stereotypes of nurs-
ing and women’s work. Nurses are plied from every direction with a

xi
xii · Introduction

narrative that depicts them as modern angels endowed with extra-

ordinary powers of empathy and compassion— qualities that are
never depicted as the products of education or experience on the job.
In the mirror that reflects nursing back to nurses, rarely is it shown
that nursing requires more than caring, demanding technical, medi-
cal, and pharmacological—to mention only a few—mastery. Just as
these texts are soothing and reassuring, so too is the nurses’ role in
the health care system to be soothing and reassuring: nurses hold
hands, anguish over or embrace patients and their families, adminis-
ter back rubs, or conduct late-night vigils. Both they and their pa-
tients seem to be downright etherealized. Indeed, in books like
Chicken Soup for the Nurse’s Soul, the critical intervention of RNs is
often powered not by their skill but by their personal belief in ghosts,
guiding spirits, or the divine.
It is not surprising that when nurses themselves write in these
volumes, they too downplay the extent to which their professional
judgment and experience are responsible for positive outcomes. With
typical modesty, they minimize the role of RNs in the health care
team, at times portraying the nurse as doing little more than being
present. These writings thus embrace the notion that professionalism
in nursing is an advanced form of self-abnegation. In them female
nurses—and male ones, too—are all sugar and spice and everything
nice.
Also missing from these well-meaning attempts to honor and cele-
brate nurses is any mention of the obstacles that many RNs face—
and must overcome on a daily basis—as they try to do their jobs well.
In the idealized world of these comfort food volumes, there aren’t
many nurses advocating for patients in the tough, persistent, cre-
ative, and courageous manner that I’ve seen repeatedly in hospitals
throughout North America and the world. Typically, these books
refer to workplace challenges and issues but gloss right over the crucial
tools needed to deal with them: bureaucratic maneuvering, accessing
of resources, negotiating with doctors and hospital administrators,
and conflict resolution. Nor is there mention of any role for nurses in
public policy debates related to health care, or even unity and sup-
port among nurses. And what about the contributions made by nurs-
ing researchers and teachers in developing new forms of practice or
 Introduction · xiii

raising the profile of nursing in academic circles? For the nurses in

the inspirational narrative, advocacy is a matter of feeling rather than
action, having good thoughts but not taking the kinds of personal
and professional risks nurses face every day at work as well as in the
educational, social, and political arena.
So, as I read this growing body of fundamentally flawed, so-called
uplifting literature, I became more convinced that nurses and the
public are long overdue for an antidote to the platitudes that purport
to feed the nurse’s soul. There are so many better stories to tell. We
need a collection, I felt, that spotlights the real experience of nurses
and their advocacy—in the voices of RNs themselves. Most RNs are
simultaneously deeply committed caregivers and advocates willing
to stand up for their patients and profession. That’s because the best
nurses are constantly asserting themselves, in myriad ways, directly
and indirectly. They do this as individuals— on their own in conver-
sations with a doctor, a manager, another nurse who is unsupportive,
a hospital CEO, COO, or CFO, a journalist or a politician or policy-
maker, to name only a few. And they do this collectively, as members
of professional organizations and unions that are struggling to up-
hold nursing standards, improve employment conditions, and fight
for a better health care system in the United States and around the
world.
In the summer of 2008, I went to lunch with some friends who be-
came the focus group for bringing this book to life. They included a
professor of nursing, two RN union presidents from the United States,
a visiting representative of the Irish Nurses Organization, and a labor
relations researcher from Australia.
We all agreed that self-help books of the comfort food variety re-
ally aren’t helpful at all. To the extent that some nurses are still being
socialized—in school and on the job—in the old ways of deference,
docility, and self-effacement, these books reinforce outdated notions
about how nurses should think and behave. It was time, everyone
said, to counter such platitudinous and self-defeating praise for a
nursing practice shrouded in self-deprecation. Instead, why not show
how nurses break the code of silence and deference every day? Why
not spread the word about all those feisty nurses who are the real
heroines and heroes in the profession? This conversation fortified my
xiv · Introduction

commitment to produce a volume that moved beyond the inspira-

tional to the motivational.
Since that lively lunch meeting, I’ve gone looking for stories and
collected them from dozens of RNs. Nursing groups of all types have
put out the call for additional contributors, and many of their mem-
bers have responded. My goal, from the start, was to have this vol-
ume be truly ecumenical as well as international. I wanted to include
the first-person accounts of nurses from as many countries as possi-
ble. What you find here is the result: stories from nurses from the
United States, Canada, England, Australia, New Zealand, Japan, Scan-
dinavia, Iceland, Switzerland, Italy, Ireland, Spain, and more. In this
volume you will also hear from nurses in many different institutional
roles and settings: bedside nurses and their managers; chief nursing
officers; hospice, home care, and school nurses; nurse practitioners
and professors; nursing researchers; and organizational leaders. I
have divided the book into nine thematic sections, each with a brief
introduction, although many of the stories have overlapping motifs.
Because I have asked nurses in a variety of roles to recount their
experiences, there are multiple perspectives represented in these
pages. The RNs in this book don’t necessarily agree with one another.
In fact, many disagree passionately about certain issues—such as
staffing ratios or unionization for nurses. Some of the stories involve
deftly navigated challenges to conventional wisdom, small victories
over bureaucratic inertia, or individual acts of resistance to the often-
dysfunctional medical domination of our hospital system. Some con-
tributions provide inspiring examples of collective action or health
care–related political activity. Some recount how a single nurse stood
up for— or to—a patient (e.g., when faced with the threat of physical
abuse). Some stories describe complicated interactions with doctors.
Some describe tensions among working RNs or between RNs and
their managers. Some sections of the book involve people near the
top of the health care hierarchy, for example, a nurse executive help-
ing a hospital CEO and board of trustees to do the right thing for
patients and his or her profession.
Most of the stories have happy endings. The nurse was able to en-
sure quality patient care, protect herself or her patient from harm,
and successfully advocate or innovate. In some instances, at least in
 Introduction · xv

the short term, the nurse was unable to affect needed change but
struggled nonetheless. These instances of persistence and courage
also provide important lessons. All of the stories offer nurses an al-
ternative to the kind of role model presented in the comfort food
literature.
What all of these stories illustrate is the true meaning of advocacy.
Advocacy is one of the most prominent buzzwords in contemporary
nursing. In school, nurses are taught that they must be the patient’s
advocate. Nurses, as individuals, thus declare proudly that they are
patient advocates. Professionally, boards of nursing, nursing organi-
zations, and nurses’ codes of ethics proclaim that one of the major
roles of the nurse is to advocate for the patient. Like so many words
that are used almost reflexively, when nurses say they are patient
advocates, or when organizations insist that nurses must advocate
for patients, it’s not at all clear what they mean by advocacy. Over the
years, I’ve heard nurses loudly trumpet their “advocate” role and
then in the next breath tell me they couldn’t possibly buck a doctor, a
manager, an administrator, speak to a journalist or politician, go on a
march or rally, speak out on a controversial issue because their job,
promotion, relationships with a pharmaceutical company, professional
contacts, or tenure might be at risk. At the height of the restructuring
of the 1990s, I remember talking to one chief nurse in Boston about
another nurse who’d just lost her job. She was too “pro-nursing” for
her own good, he told me. You know, if you stick your neck out like
that, well, it’s not surprising it gets chopped off. He had no intention
of doing that. Of course, I thought, if more managers stuck their
necks out, maybe no one’s would get chopped off.
I often talk to nurses about telling their stories, revealing inconve-
nient truths—the kind they tell me about behind closed doors. The
kind they say are harming, sometimes even killing their patients.
When we then discuss ways to raise these issues, some are terrified.
Too terrified to even speak off the record, not for attribution, or even
on background. Unlike doctors and many others, nurses don’t leak to
the media.
Yet, these same nurses still cling to the notion that they are “patient
advocates.” So, if that is the case, what does advocacy mean? I think to
some nurses, it means that they want the best for their patients; they
xvi · Introduction

wish them well; they hope no harm will come to them. It’s a state
of mind not a state of action. But advocacy involves—no, demands—
action. The very term heralds it. To advocate comes from the Latin
word vocare—to call. According to Merriam-Webster’s dictionary, an
advocate is one who pleads a cause in a court of law or who defends,
vindicates, or espouses a cause by means of argument. Voice is a non-
negotiable prerequisite of advocacy. You cannot, after all, “call” out in
silence (unless that silence is a silent vigil). It suggests some sort of
public speech or action, and it implies the willingness to take risks.
The nurses in this book, like so many millions around the world,
have embraced the true meaning of advocacy. Their stories illustrate
what it really means to advocate. These stories also extend the mean-
ing of advocacy beyond the traditional role of patient advocate and
connect patient advocacy to the act of advocating for nurses’ own in-
dividual self-respect, well-being, and professionalism.
Whatever their position in the hierarchy or position on controver-
sial nursing and health care issues, the contributors to this book know
that they must act and advocate because platitudes are not nourish-
ment enough in our health care system today. They know that to
make hospitals and health care institutions a better place for every-
one, we need truth telling, more calls to action, and fewer celebrations
of a saccharine status quo. In other words, to really feed their souls,
nurses know that they need to fight for them.
When
Chicken Soup
Isn’t Enough