BethBoynton

Seems to me like you were working really hard to provide safe care and did a great job. I feel for you as well as the night nurse. If there is any way you guys can work to understand each others perspectives and cut each other some slack, I'm all for that! People sometimes blame each other and don't see how the system isn't providing enough support so that everyone can work at a reasonable pace most of the time and provide great care. Would you say there was any opportunity for you (or night nurse) to get ask for more help so that other patients weren't neglected? I hope things work out and that this conflict becomes an opportunity to learn more about your colleagues and yourself and eventually contribute to collaborative work!

What a wonderful testiment to your daughter and your family, Donna. I can imagine some trying times and yet the gifts your 'artistic' daughter has brought into the world seem immeasurable. Besides being beautifully written and heartfelt, it seems that Lauren inspired much of your work which is helping nurses with disabilities, the patients they serve, and the organizations they work for, and the nurses they work with.....OMG...pretty amazing!

Great points! You speak eloquently to the importance and erosion of provider and patient relationships. Hard to measure and essential for best outcomes. They also help us to find meaning in our work. Thank you for your insights.

Your experience is inspiring and helped me to decide to participate in Allnurses Innovators hub. Congrats and thank you, Beth!

Seriously? Everything in every way in my life? That's quite an assessment!

Great to read your post and very validating. I totally get the "Noise" factor realized later in life that as an introvert, that all the noise and interruptions were taking a toll on me, but didn't seem to bother my colleagues or at least some of them as much. When I'm writing, especially something of some depth, I sometimes find my left hand reaching up into the air as if I'm trying to prevent an interruption! :)

Great to read everyone's comments. I get the humor as well as frustrations associated with spending time and energy answering questions that are based on misinformation or misinterpretation from stuff found on line. BUT I don't think it would feel funny to a patient who is trying to have some control and learn about his or her health issues (something that we should encourage). Further, when I feel frustrated in such a situation I think it is more about me being tired or not feeling like I have enough time to teach or maybe I feel I haven't done a good job teaching (so my own ego is getting poked.) I can almost buy that placing such a sign that is private to staff is ok b/c we do need some levity. Then I think, ya know, with all of our issues with toxic cultures and behaviors and with the cutting edge that sarcasm can have, if I were the nurse leader I'd take the sign down. I might not be very popular but could deal with that!

Recently on FB there was a lively discussion about this sign that was posted in a waiting room somewhere, it read, "Don't confuse your google search with my medical degree". Some found it funny, some thought it was informational, and I thought it had an obnoxious tone! I googled the message and found all sorts of shirts and coffee mugs proclaiming the same message. There seems to be something more going on in this proclamation than simply a statement intended to inform or honor one's education. There's an underlying theme of superiority and inferiority going on here and I don't think it has anything to do with education at all! The language is polarizing and flies in the face of respectful communication and collaboration that are so necessary for safe, compassionate care and patient empowerment. I'm not against the hierarchy, but I am against power dynamics that feed our egos. Discussions about the hierarchy in healthcare can quickly turn into a power struggle. Physicians who have long been at the top of all decision-making are reluctant to share power, nurses face increased accountability in taking more power on, and patients present along the entire spectrum from wanting to be in charge to totally dependent. Although the old hierarchy makes sense sometimes, (such as during a cardiac arrest with the physician yelling out orders to the team) it has also contributed to ineffective communication and teamwork, poor conduct, and unsafe care. When the hierarchy is toxic these dangerous behaviors are all too common: Nurses who are afraid to speak up or challenge authority Physician's who don't know how or when to listen to others' expertise Patients who withhold information or concerns because they are totally dependent on medical providers. If we are going to have safe care, healthy workplaces and rewarding careers we need to ask ourselves and each other; What makes the hierarchy healthy? In my opinion we need the hierarchy for clinical decision-making and related use of expertise, but not for egos-driven goals involving power and status. I'm referring to superiority and inferiority complexes that plague doctors and nurses respectively. Those with more power in the hierarchy falsely believe that they know more about what others need and want and listening is therefore unnecessary. Those on the other end have little faith in the value of their own ideas or observations and hesitate or worse don't speak up. For the hierarchy to be healthy we need to balance it with collaborative leadership and followership. In such a system, the hierarchy is the structure and the collaboration is the process. The former requires knowledge and skills where the latter requires respectful communication and emotional intelligence. Healthcare professionals must be adept at both. Yes, physicians may lead more often than not and yes the nurses's assistant will follow more often than not, and nurses will be leading and following almost all the time, but we must all be able to do both! And with respect and grace. Collaborative leaders at all levels are confident and emotionally mature. They use their expertise and authority for optimal clinical outcomes. They are not rattled when challenged by team members and are able to consider new input. If they input shifts care decisions they are grateful and if not they explain their reasoning, making it a teachable moment. Collaborative leaders understand this dance of being in charge while listening and following as necessary and supporting others so they are able to bring their best to the table. Their egos are in tact and they are using the hierarchy with great wisdom. All the while making healthcare safer.

AllNurses Innovator Hub #1 My Writing Path from Personal Journaling to Textbook Author (or How I Got Started in Writing as a Nurse) For me, writing has always been a safe way to reflect on things that interested or challenged me. Sometimes, a process of self-discovery and other times a way to process what is or was going on in my life. I kept a journal for many years and found I enjoyed being playful with language. As a Registered Nurse, I first tried my hand at publishing in the 90s and was successful with publishing a couple of articles on the Utilization Review process, one of which was for a legal journal. I didn't do much with any professional writing until my decision to build a consulting career that focused on teaching communication and collaboration skills and used an online newsletter to build my reputation and network. In looking back, I can see how my personal and professional writing began to overlap at that time. I was recently divorced and raising my son and developing my own emotional intelligence and assertiveness skills. It soon became apparent how hard it was to practice new and healthy communication skills in work cultures that did not support them i.e. toxic cultures. I found I had lots of material to write about and great satisfaction in sharing experiences with other nurses. A community was forming and it was/is a joyful feeling to hear feedback from a nurse who might have felt isolated or had self doubts about her (or his) experiences. This inspired me to write and self-publish my first book, Confident Voices: The Nurses' Guide to Improving Communication & Creating Positive Workplaces". I was very fortunate to work with a nurse editor who joined with me for free because she believed in the work. Bonnie Kerrick, RN, BSN and I are close friends to this day. Not long after, I met a young Nurse Blogger, Brittney Wilson, aka the Nerdy Nurse. We had a wonderful connection and she helped me to switch from a monthly newsletter to my blog, ''Confident Voices in Healthcare" which I continue to publish and write for today. (And I'm always interested in Guest Bloggers who want to share expertise or ideas that in some way make healthcare safer, kinder, fairer, and more rewarding to work in.) Then in the Spring of 2012, an acquisition's editor from F.A. Davis Publishing Company contacted me to set up a video conference. Honestly, I wasn't sure what we were going to talk about, but it turned out that he was familiar with some of my work and were planning on publishing a communication textbook for nurses. I was invited to submit a proposal! Almost 3 years later, Successful Nurse Communication: Safe Care, Healthy Workplaces, & Rewarding Careers was published! What's happening for me now in the nurse-writing world is I have many cyber blogger and author friends who write about all sorts of topics interesting to nurses. We share resources, ideas, and contacts and best of all cheer each other on. I also have several invitations to write for exciting publishers like ALLNurses, KevinMD, and F.A.Davis! If you are interested in writing, I encourage you to go for it. Write about things you are inspired to study and share and keep at it! I believe that nurses have a huge potential to be positive change agents in healthcare and writing is one way of doing so!