The Eric Hoffer Award

I am pleased to announce that Stories from the Tenth-Floor Clinic: A Nurse Practitioner Remembers is a 2019 Eric Hoffer Award Finalist.

Nurses Week–Here We Go Again

Here we go again. It’s Nurses Week and we are still battling a misguided perception of nurses.

This isn’t just a week to celebrate nurses for all that we do to keep patients well and safe, not only in hospital settings but on the world stage, and to remind ourselves that for 52 weeks a year we need to be vigilant and proactive to maintain our autonomy.

This time a politician shows her ignorance regarding nursing practice in hospital settings. The following is an excellent response by two nurses to the offensive comment:

Nurses aren’t sitting around playing cards, they’re working to fix global health

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Nurses aren't sitting around playing cards, they're working to fix global health

© Getty Images

Washington State Republican Sen. Maureen Walsh’s recent comment  that nurses “working at hospitals in rural regions probably play cards for a considerable amount of the day” is offensive to nurses regardless of nursing role or practice setting.

While Walsh has apologized and many nurses have expressed their disgust for her statement, voicing their disdain on social media, via emails, letters and even sending  1,700 decks of cards to Walsh, nurses can seize this moment to educate Walsh, policymakers and citizens on the role and contributions of nurses who daily care for individuals and communities worldwide to help people achieve health.

As nurses with decades of service to the profession, we know firsthand the tremendous work that our colleagues do as clinicians, researchers, educators and policy advocates. On a daily basis, we work alongside and in collaboration with very talented, educated and committed individuals who consider it an honor to serve in this capacity.

Whether in rural or urban areas, the demands associated with providing quality care require that we spend our working hours doing just that, not engaging in activities that do not lead to better outcomes for those we serve. To do otherwise would be disrespectful to the profession and would violate nursing’s contract with society.  

We do not take the distinction of being the most trusted profession lightly. For 17 consecutive years Gallup poll results revealed that more than four in five Americans, or 84 percent, rated nurses’ honesty and ethical standards as very high or high compared to 20 other professions.

Yet, the misrepresentation of nurses is not new.

For years the profession has worked to elevate the image of nursing and reverse the stereotypical images depicted in the media. Sandy Summers and Harry Jacobs Summers, authors of the 2009 Saving Lives: What the Media’s Portrayal of Nurses Puts Us all at Risk  provide examples of  the dangers of inaccurate portrayal of nurses.

As a profession, nurses have made progress highlighting the tremendous role nurses play in caring for those need of health care services. This month, Oprah magazine featured  five nurses who “just might save the world”.

Globally, nurses such as Dr. Sheila Tlou, a former UNAIDS Director for Eastern and Southern Africa and former Minister of Health in Botswana, raise awareness of the critical role nurses play in health policy. Tlou used her expertise as a nurse to develop and lead a nurse-driven intervention to decrease the maternal mortality rate due to HIV/AIDs in the region from 38 percent in 2004 to 9 percent in 2008. These interventions reduced  mother to child transmission of HIV from 40 percent to less than 4 percent within four years.

Members of the British monarchy have recognized the contributions of nurses in protecting human health and wellness. The Duchess of Cambridge, Kate Middleton, helped launch the campaign Nursing Now. The campaign is based on the triple impact report identifying the need to develop  the profession of nursing in order  improve health, promote gender equality and support economic growth.

Nursing Now, recently launched in the U.S., is committed to elevating the status of nursing globally and helping people understand how important it is to have the expertise of nurses in their communities and in positions of decision making on health care initiatives.

It is time to erase the inaccuracies and re-examine the prevalent image of nurses in this country. The opportunity to elevate the conversation extends beyond our elected officials. Everyone could benefit from knowing our commitment to advancing a nation’s health.  

This is not a game to us.

Janice Phillips, RN PhD, is an associate professor at Rush University College of Nursing and the Director of Nursing Research and Health Equity at the Rush University.  Medical Center. Colleen Chierici BSN, RN is the president of the nursing staff at Rush Oak Park Hospital and working towards her doctorate in Family Nurse Practice.  Both are Public Voices fellows through The OpEd Project. 

A Long Overdue Thank You

I had finally decided to clean out my office closet. I started with the stuffed cardboard Unknownfile box. The first thing I reached for was a frayed manila envelope. The stack of typed pages spilled out onto the floor. After I read the first two sheets—an early attempt at documenting my nursing life—I knew I was doomed to sit on that floor by the open closet door until I had scrutinized every page. One story especially held a surprise.

In the early 70s, after my husband completed his degree at the University of Chicago, we moved to the far south suburbs where housing costs fit our tight budget. My first job was at a community hospital. Soon after I started, I found out that my salary was the same as a new graduate nurse who had never even done a simple urinary catherization. I, on the other hand, was an experienced ICU nurse. I wrote a letter of complaint and while the Director of Nursing of the hospital commiserated with me, I wasn’t offered a raise. I quit.

I decided to apply for a job at a close-by nursing home in spite of the fact that I thought I was overqualified and working at a nursing home felt demeaning to my young arrogant self. I eventually learned differently.

I wrote about this experience in my memoir:

 

. . .I had worked in a nursing home—a well-run home

with low staff turnover—for a short period of time, but long enough

to savor the slow pace after being an intensive-care nurse for years

before. The residents bestowed many hugs and an occasional slobbery

kiss as I passed out medications on the evening shift.

I had forgotten that experience the day my academic advisor and

I talked about a master’s thesis. In 1979, like most of my classmates, I

wanted to study women—women of child-bearing age. Why did she

think she had to ask me again: “What group do you REALLY enjoy

caring for?” That’s when I remembered the hugs in the nursing home.

At the end of the version of the story about working in a nursing home that had sat in the manila envelope for over 15 years, there was an added comment about Eva Harrison that I hadn’t remembered writing.

Eva Harrison, the nursing home DON, had offered me a salary higher than the one I received from the hospital. She ran a warm and caring facility, valuing her staff and residents alike. I know she felt sad when I left after only six months but a new clinic opened. At the time, I believed that this new job was more prestigious than that of pill pusher in a nursing home.

What I had written was that I wished I had gone back to tell Eva Harrison that my time at her nursing home had so influenced me that when I graduated as a nurse practitioner a few years later, I had declared geriatrics my specialty. Working in a nursing home, Eva Harrison’s nursing home, set me on a career path that would both challenge and reward me.

Thanks, Eva.

Barriers to Advanced Practice Registered Nurses

In the April 2019 AARP Bulletin there is an article discussing the restrictive laws in North Carolina that control Advanced Practice Registered Nurses.*

North Carolina is where I now live. While I no longer practice as a nurse practitioner, I’m always on the lookout for the latest restrictions or advances in APRN practice. And I am saddened with this particular write-up. Why? Because the story shows that the years of research proving that APRN’s give the same level of safe, quality care as physicians in similar settings is totally disregarded. Therefore, limiting the use of APRN’s has caused the following:

Many rural North Carolina counties face severe provider shortages. Three have no primary care doctors, 26 counties have no OB-GYN, and 32 are without a psychiatrist, . . . .

North Carolina:

  • Ranked 35th for overall health care
  • Ranked 41st for infant mortality
  • 56% of low-income children don’t have a doctor

(Michelle Crouch, Bridging the Health Care Gap, AARP Bulletin/Real Possibilities, April 2019. p 44.

In 2017, a bill to expand APRNs practice was defeated. Both the NC Medical Society and the NC Academy of Family Physicians opposed this bill, in spite of the fact that “moving restrictions on APRNs could save the state $400 million to $4.3 billion in health care costs annually” and, could increase the number of APRNs to correct the health care shortage.

I have almost 40 years’ experience in watching the struggle to limit APRNs practice. I know many physicians who work alongside nurse practitioners, nurse midwives, and mental health nurses who promote their role in keeping our communities healthy. From my viewpoint, it’s the efforts of organized medicine that disregards putting patients first and values only its own economic growth.

A new bill to remove barriers to APRN practices is expected to be introduced this year. I will be following this closely. It is my dream that in the near future, all states will give APRN’s full practice authority.

See how APRN practice varies from state to state.

*Advanced Practice Registered Nurse

  • Certified Nurse Practitioners
  • Certified Nurse Midwives
  • Certified Nurse Anesthetists
  • Clinical Nurse Specialists

The Dreaded Question

I have become much better when I meet someone new at acknowledging that I am a writer and have published a book. After I give them the elevator speech describing the book, they usually ask, “How long did it take you to write?”

I have spent more time answering this question than telling them what the book is about. I feel the need to justify why it took seven years to finish.

A new acquaintance asked just yesterday, “So, how long did it take for you to write the book?” As usual, I spent many minutes with my in-depth explanation. I droned on as if giving a lecture that I had given many times before and had to reluctantly deliver it again. Why?

Then that afternoon, after I read Marlene Adelstein, The Dreaded Question, I knew why. My book writing journey doesn’t follow Marlene’s exactly but her story does help to clarify that my first book, Stories from the Tenth-Floor Clinic, has been growing inside of me for years. Years! My previous writing was mostly in preparation for this book. Like Marlene, I recognize that I have had subconscious motivations for finishing this book all along. I am still processing the reasons, which I will share in another post.

I hope you enjoy Marlene’s fine story and her lovely writing as much as I did.

Bloom

by Marlene Adelstein 

Now that my debut novel, Sophie Last Seen, has just been published and I’ve started doing readings and interviews to promote it, I’m hoping my least favorite question won’t pop up. But inevitably, it does. How long did it take you to write? It’s often the first question out of people’s mouths. Why the length of time it takes to complete a book is of such interest, I’m not sure. Maybe people secretly want to hear it took a long time so they can feel better about their own slow writing. Or perhaps they want to hear it didn’t take very long at all, and they’ll think, That sounds easy, I can do that!

The fact is, when I started writing this book the World Trade Center had just toppled. And it was only a little more than a year ago that I got a…

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COLD CLINICAL FACTS

This seems like a good time to revisit an earlier post as I start on my second book, which will be about various home visits I have made over the years. It originally appeared on April 7, 2013.

Recording sad, depressing, and unpleasant experiences is challenging. They are often the stories we nurses would rather block from memory. I empathize with nurses who choose not to write while, at the same time, I encourage them to do so. Motivation varies from writer to writer, and composing my stories grants me an absolution of sorts. Revealing my reactions to clinical situations will be challenging. But then who said writing is easy?

Nursing Stories

revising & revising

Four women in my Wednesday evening non-fiction workshop graciously agreed to be my beta-readers and look over my manuscript during a two week break, following suggestions outlined by our leader, Carol Henderson. What Carol stressed, among other things, was not to get bogged down with spelling and formatting but look for flow, bumps and where you fall asleep. How does the narrator come across? Make a note where things are not clear.

The four women are talented writers. Their stories deep, interesting and well told. I consider myself lucky to have willing and skilled readers. Their feedback, positive and negative, can only improve my book. They have heard my stories, isolated, standing alone, without any connection to what had happened before or followed next. Now for the first time they would have the whole picture of my creation.

Stein On Writing Stein On Writing

The “corrected” manuscripts (Sol Stein, Stein on Writing,

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Spotlight: Marianna Crane

There would be no Stories from the Tenth-Floor Clinic if it were not for my job as coordinator of the Senior Clinic at EFHC some 30 years. On Wednesday February 20th, I am speaking to the nurses at Erie Family Health Centers.

I thought it fitting to reblog the Spotlight Marianna Crane that first appeared in the EFHC Donor Newsletter on September 3, 2017.

More details about this visit to the windy (and snowy) city in my next post.

Nursing Stories

This appeared in the September 2017 Erie Family Health Center Donor Newsletter

Anniversary Spotlight: Marianna Crane

Over thirty years ago Dr. Sally Lundeen, a nurse and Erie Family Health Center’s first Executive Director, spearheaded a project that would provide care for the underserved elderly right where they lived. The Senior Clinic* opened on the 10th floor of an apartment building on 838 N. Noble, then managed by the Chicago Housing Authority specifically for low-income elderly residents. Marianna Crane was one of the first nurses to join Dr. Lundeen in this endeavor. She had recently left the VA Hospital, disappointed that, due to a lack of funding, she wasn’t able to provide the specialty care she knew that the elderly there needed.

Crane was at the forefront of a shift in health care, one of the first gerontological nurse practitioners at a time when geriatrics was barely beginning to be considered…

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Nursing Truths for a New Era: Author Interview with Marianna Crane

A serendipitous meeting with Michele Berger reminded me of the long road I traveled conceptualizing, creating, and finally completing my book. Many folks that I met along the way inspired and supported my efforts. Most I never had the chance to thank. Fortunately, now I can tell Michele that her creativity workshop and follow-up coaching encouraged me to stay on track.

Thank you, Michele.

Below is Michele Berger’s recent post spotlighting me and my book.

The Practice of Creativity

Happy new year, everyone! It feels especially poignant to begin the first post of the year with a special Author Q&A. More than a decade ago, before I formally began my coaching practice, I taught creativity workshops at UNC-Chapel Hill’s The Friday Center. They had a thriving adult enrichment program. My classes were popular and I met and coached people from all backgrounds. It is always a delight to run into people many years later and hear about their creative adventures.

Two months ago at the North Carolina Writers’ Conference, out the corner of my I saw a distinguished-looking woman. Her face looked familiar, but I only caught a glimpse before moving on to my next panel. To my great delight and surprise, this same woman came up to me at the reception. We immediately recognized each other. She had taken one of my classes at the Friday Center and…

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The Building as Character

 

Countdown to Publication Date: One Week

I have three readings scheduled at local books stores in the next few weeks. I will send out an e-vite tomorrow. It’s both a stressful and exciting time. I have to remind myself to “have fun.”

The latest review of my book: Chicago Writers Association, Windy City Reviews:

Stories From The Tenth Floor Clinic. Marianna Crane. Berkeley, CA: She Writes Press, November 6, 2018, Trade Paperback and E-book, 212 pages. 

Reviewed by Deb Lecos. 

Marianna Crane has written an important memoir detailing the complex needs of an aging population and how a humane society should shift its thinking about what is “conscious-care” when people reach a certain level of fragility. The reader journeys along with Marianna while her beliefs change as a nurse practitioner, running a senior clinic within a Chicago-based, subsidized-housing building. 

As a nurse practitioner specializing in gerontology at the Veteran’s Administration, Marianna is governed by strict parameters. When a job change takes her to a senior clinic within a CHA building, she faces an environment quite different from where she trained, and is forced to adapt so she can help those under her care. Many of her patients are alone, disconnected from family, and easy prey for those intent on stealing their meager incomes. Continuing to live independently can be difficult when a patient’s health moves swiftly downhill and there are no friends or relatives to assist in decision-making. Residents of the building have come to rely on the clinic and its support staff to ensure they have social interaction, food in the refrigerator, and a fan when the heat becomes dangerously high. 

After work, Marianna’s home life is fraught with similar issues, as a complicated relationship with her mother has reached an unsustainable level of dysfunction. Her mother has become increasingly combative, and her disinclination to engage therapeutically requires Marianna to devise a solution that is respectful to her husband and two teenage children, while ensuring her mother has a safe place to land. Utilizing the new approach that she’s been reluctantly taking with her patients affords Marianna necessary skills to handle this emotionally-challenging situation. 

With chapters unfolding in story form, the reader glimpses the lives of vulnerable people. We learn what happens when the frail are shuttled into the corners of society without enough support. Filling that gap in care are Mattie and Mary, who work under the direction of Ms. Crane and are devoted to building humane over-sight relationships with the residents. Mattie and Mary compel Marianna to redefine her role in the clinic community by introducing her to Angelika, a woman choosing to die in her apartment instead of going to a hospital. Angelika has refused a diagnosis of the ailment ending her life. After losing the battle of Angelika’s resistance to leave her home, Marianna allows herself to adjust to the 

needs of those she is intent on helping. She comes to understand that sometimes care means respecting the wishes of a dying woman and not requiring her to take a final breath in the hospital, even if doing so breaks a dozen rules in the process. 

The stories Ms. Crane starkly and, at times, graphically illustrates occurred in the 1980’s. Similar events are continuing to unfold today in subsidized housing and homes all across the country. Difficulties the aging and poor experience in navigating ill-health and death within a system built for the well-off and healthy have worsened in the time since the author encountered these experiences. The VA, health clinics, and senior care programs are still underfunded and mismanaged, exacerbating the condition of buildings and staffing needs. 

There are no concrete solutions to the problems we face in determining how to care for a growing low-income, aging population. It is my fervent wish as a reader of this memoir that we do so with an ability to change our thinking, much as Marianna Crane convinced herself to do. Convenient, easily-enacted answers to the complex struggles of the elderly, many of whom are not connected to functional families, will not be successful. As Marianna came to her own epiphanies on how to be of assistance, so must our national community. This is a relational issue and it deserves a relationally-creative response, one that is centered on humane and caring treatment for all ill, infirmed, and end-stage-aged people.