I promptly lost my first Medicare card. When I opened the envelope and saw the red, white and blue border, I was reminded of the elderly I cared for over twenty years ago when I was a gerontological nurse practitioner. I ran a not-for-profit clinic in a converted one-bedroom apartment on the tenth floor of a senior citizen highrise in Chicago. How many times had I asked to see someone’s Medicare card? Most of my patients were poor, illiterate and had multiple health problems. So when I first looked at my card, I could only remember loneliness, despair and disability. This couldn’t be happening to me. And, poof, the card was gone.
Slowly other patients strolled into my memory. Mildred, blind and lived alone, always asked me to put her kitchen cabinets back in order after her daughter visited. Margie, ninety-something with an Irish brogue, came down to the clinic…
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
BY COLLEEN CHIERICI AND JANICE PHILLIPS, OPINION CONTRIBUTORS — 04/28/19 02:00 PM EDT 165
THE VIEWS EXPRESSED BY CONTRIBUTORS ARE THEIR OWN AND NOT THE VIEW OF THE HILL
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.
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.
I had finally decided to clean out my office closet. I started with the stuffed cardboard file 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.
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, . . . .
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.
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.
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…
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?
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
The “corrected” manuscripts (Sol Stein, Stein on Writing,
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.
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…
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.
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…
“Home is a shelter from storms—all sorts of storms.”
—William J. Bennett
As a family nurse practitioner, I read Marianna Crane’s memoir with great interest and she did not disappoint. Her description of ministering to the frail elderly population was realistic and graphic. I’m thrilled to feature Marianna in this guest post about Stories From the Tenth Floor Clinic which will be published on November 6, 2018.
As I wrote my book: Stories from the Tenth-Floor Clinic: A Nurse Practitioner Remembers, I recognized that the Chicago Housing Authority building was very much a central character.The clinic I ran, originally a one-bedroom apartment, was located in the middle of the long hallway facing two elevators. Our door was always open. Anyone could come in—our scheduled patients, or walk-ins who lived in the building or those from the surrounding neighborhood. Lucky for us, being on the tenth floor discouraged the drug addicts.
The twenty-story building rose above the surrounding multifamily homes. Chicago winds blew the debris of the dirty city along the wide expanse leading up to the entrance. The scent of ammonia unsuccessfully covered the sour odor that filled the lobby. Two elevators that carried the residents to their apartments frequently broke down. However, the view from the twentieth floor community room presented a view of the Chicago skyline that rivaled the luxury condos on Lake Shore Drive.
The CHA building offered subsidized apartments, mostly one-bedroom, to needy seniors and the handicapped. The few two-bedroom units had a long waiting list. The majority of the residents were of Eastern European descent, with a scattering of Hispanics and blacks. Each floor had a personality of its own.
Charlie Sparks and LeRoy Turner lived next door to one another on the 17thfloor. Both supported the prostitutes who prowled the building. Charlie was younger than the cut off age of 65. He had special permission to live in the building because he took care of his bedridden mother. I often wondered how Charlie’s mom, whose hospital bed sat in the center of the living room, dealt with Charlie’s dalliances.
LeRoy Turner was often drunk. He worked on his car that was permanently parked in the lot behind the building. He muttered a good morningwhenever I passed him but nothing more.
It was Molly Flanagan who told me about both men and their habits. Molly was a little bit of a woman in her nineties with no medical problems. She enjoyed visiting the clinic to gossip. One morning, Molly stopped by the clinic to tell me in her Irish brogue how she wielded her broom in the air, and chased the two prostitutes down the stairs.
“You’re fearless,” I said. But I warned her that one day one of the woman might knock her down with her own broom.
A formally homeless woman, who collected garbage, moved into an apartment on the twelfth floor. Soon afterwards, the stench from her place seeped down the hall and into the exit staircase. Whatever possessed the management to move a second homeless person, this time a man who also was a hoarder, onto the same floor? The stench only got worse until the Hazmat team appeared in bright yellow uniforms, hoods, gloves, and heavy shoes to evict the man, and decontaminate his place. The woman, watching his eviction, began to clean out her rooms with the help of her sister.
Each floor exposed the ethnicity of its occupants by the cooking aromas in the hallways: greens, ham hocks, kielbasa, sauerkraut, and spaghetti sauce.
Unwanted odors appeared in various locations. The elevators reeked of urine and beer, especially on Friday, payday, or when once-a-month social security checks came in the mail. The heavy scent of cigars and cigarettes lingered in the back of the building, especially in warm weather as the smokers scattered butts and used matches around the two battered picnic tables.
Individual apartments didn’t have thermostats. The heat would often become oppressive in both summer and winter. In winter, one could open the casement windows but in the summer, the apartments became ovens. Since older persons aren’t sensitive to high temperatures, they were at danger of suffering heat stroke, and sometimes they died.
When I came to work in the mornings, I often had to walk up to the tenth floor because the elevators weren’t working. I climbed the stairs slowly, stopping to rest often. The exercise was good, I reasoned. I could tell which floor I was on by the hand written number on the inside of the door. Or by the smells that seeped under the doorsill. I would arrive early, lock the clinic door behind me, heat up a pot of coffee, and sit in one of the mismatched chairs in the waiting room. Enjoying the silence and watching the sun rise above the Chicago skyline, I wondered who would walk through the clinic door that day.
Running a clinic for seniors requires a lot more than simply providing medical care. In Stories from the Tenth-Floor Clinic, Marianna Crane chases out scam artists and abusive adult children, plans a funeral, signs her own name to social security checks, and butts heads with her staff—two spirited older women who are more well-intentioned than professional—even as she deals with a difficult situation at home, where the tempestuous relationship with her own mother is deteriorating further than ever before. Eventually, however, Crane maneuvers her mother out of her household and into an apartment of her own—but only after a power struggle and no small amount of guilt—and she finally begins to learn from her older staff and her patients how to juggle traditional health care with unconventional actions to meet the complex needs of a frail and underserved elderly population.
About the Author:
Marianna Crane became one of the first gerontological nurse practitioners in the early 1980s. A nurse for over forty years she has worked in hospitals, clinics, home care, and hospice settings.She writes to educate the public about what nurses really do. Her work has appeared in The New York Times, The Eno River Literary Journal,Examined Life Journal, Hospital Drive, Stories That Need to be Told: A Tulip Tree Anthology, and Pulse: Voices from the Heart of Medicine.
She lives with her husband in Raleigh, North Carolina.
Her book: Stories from the Tenth-Floor Clinic: A Nurse Remembers will be published November 6.