Through the Wormhole: The Lady with the Lamp

Sandi Elmer

Okay, you're not going to believe this. I recently had the most remarkable experience of my life! I spent an entire day with...wait for it...Florence Nightingale! Yes I know, pretty far-fetched you might say, but really, it happened! You know, Florence was quite the innovator, downright brilliant, determined, persevering, and well, somehow she was able to master time travel! She said something about wormholes, quantum physics, special relativity---truthfully, she lost me at quantum physics. Why she chose me to visit, I'm not completely sure. Maybe it's because I've been a nurse for so very long, seen so many changes, and, well, I'm disillusioned with nursing as a profession, and healthcare in general, and....my life right now. Pretty much burned out actually, spiritually, physically, emotionally, and ya, so, she showed up at my door! I'm not going to spend tons of time trying to convince you, so just let me tell you about our visit. When she left that day, I felt a little less disillusioned, less burned out, and actually quite energized to move forward again, instead of going around in circles, digging that rut ever deeper. I wish this for you, too, my nurse friend! Let's get started!

After the initial shock of it all, and the introductions, we got right down to business! She wanted to know all about what the nursing profession looks like now, in 2021. Wow, where do you start with that? Let me summarize it for you, otherwise, we'll be here forever! As you may have guessed, I started with the recent pandemic. Florence was empathetic, and could definitely relate to how quickly a disease can advance. She was, however, surprised that our government and our healthcare systems were not completely prepared. I recounted how quickly covid consumed our medical resources. I related how healthcare workers on the frontlines worked long, long hours, without adequate breaks or nutrition, and sometimes without adequate PPE to deliver care safely. Often nurses feared contracting the infection themselves and bringing it home to loved ones, leading to anxiety and depression along with physical exhaustion.

Florence picked up on my frustration and anger immediately. She reminded me of a quote from her writings which read, "I never gave, or took an excuse." We as a nation, and as healthcare professionals, have no excuse for our ill-preparedness, and we must not let it happen again! Florence then asked me, "So what do you do now; what's the solution?" I hesitated, and she said that right now, our governmental agencies and healthcare leaders should be gathering data from the pandemic in order to do an analysis of what we need to improve, how we can improve our clinical processes, what we can do to ensure adequate staffing and resources, along with many other aspects of pandemic preparedness. She pointed out that we should be surveying our frontline healthcare workers and really listening to their input. I agreed that we've learned some difficult lessons, and hopefully we won't let history repeat itself. I congratulated her on being such an amazing statistician and repeated her quote, "to understand God's thoughts, we must study statistics." I also stated that this pandemic wasn't all negative. It's always beneficial to reflect on mistakes made but I can't forget the awesome, amazing work done throughout the pandemic on the part of governmental public health agencies, healthcare systems, and healthcare personnel. She was pretty blown away by the speed at which we obtained a vaccine and the smooth vaccination process.

Continuing with our discussion, I wanted to give Florence a clear picture of what the typical nurse looks like today! I told her that often a nurse has a spouse, or a partner, and many commitments other than his or her nursing career. She was astounded at this! Florence was single all her life, and apparently had been asked to marry more than once, but declined as she wanted to devote her life to nursing. "How do you do it?", she asked. I gave her some examples from my own life, telling her that I really never mastered the "work-life balance" thing. I mentioned that hospitals and other healthcare systems had come up with the idea of 12-hour shifts, but those would often turn into 13 or 14 hours, and extra days off would be spent recuperating from the long shifts! I've noticed that employers are now advertising "work-life balance" for the job they are posting, and some employers offer "mom shifts" for mothers who want to see their kids off to school in the morning. I told Florence that there is a projected nursing shortage, and she said that she thinks employers should do their best to create a work environment that will attract and keep nurses. I gave her a high five on that point, and she laughed at the weird gesture of high five! I also admitted that much of the work-life balance issue had to be the responsibility of the individual nurse. Nurses tend to be people-pleasers and we need to learn to say "no" to extra shifts and responsibilities. Florence chimed in with her quote, "The martyr sacrifices themselves entirely in vain. Or rather not in vain for they make the selfish more selfish, the lazy more lazy, the narrow, narrower." Florence also admitted that she was not very good at "self-care" and this might have contributed to her long illness after the Crimean War. I thanked her for her transparency and told her I thought nurses were becoming more aware of taking care of self, but we have a long way to go.

We couldn't end our discussion without talking about inadequate staffing. I related how nurses work long hours, often without getting an adequate meal break, which leads to irritability and exhaustion. There's no time to socialize with coworkers, or even to ask for an opinion. The nurse can feel isolated and alone in a sea of coworkers. It's frustrating to not be able to spend adequate time with a patient, to hold a hand, or give information to decrease anxiety about an upcoming procedure or diagnosis. Not being able to spend adequate time leads to not being able to make good observations and assessments, which directly correlates with patient outcomes. Again, Florence asked, "So what's the solution?" I think I knew she'd ask that. I gave her a few of my thoughts. The solution is most certainly multifaceted. Nurse retention is a major factor in adequate staffing. Employers need to collect data from nurses regarding what would encourage them to stay at a job. I'm thinking nurses want reasonable hours, professional development with training on and off-site, good pay, adequate break time, paid time off, respect, the ability to share ideas and concerns, and tuition reimbursement. An on-call pool of nurses to fill in when someone calls off would be wonderful. Of course, this is expensive, but in the long run, isn't it more expensive to hire and train new nurses? I mentioned shared governance to her and she thought this was a wonderful idea. Unfortunately, shared governance won't work if time isn't allotted by administration to develop it. Again, this is expensive. Also, both leadership and staff need to buy in. Finally, our voices need to be heard in local, state, and national government. Florence said she couldn't get the government to read what she wrote, so she starting using colorful pictures of her data and analysis. I made a mental note of that! I mentioned that it seemed like I was awfully negative, and Florence gave me another quote from her writings. "Were there none who were discontented with what they have, the world would never reach anything better."

When it was time for Florence to leave that day, she asked me if I could possibly do her a favor. "Of course, what is it?", I asked. "Well, I think in your time the expression is "set the record straight." Could you set the record straight that I did not die of syphilis? I died of old age!" I grinned, and said, "I'm on it!"

By now you've surmised that the above story is a fantasy. Florence Nightingale did not appear to me. However, she does continue to appear to us all in her writings. I feel like I know her after studying her biography, and who knows, maybe someday ...

References/Resources

35 Famous Nursing Quotes by Florence Nightingale: https://www.mothernurselove.com/35-famous-nursing-quotes-by-florence-nightingale/

https://www.famousscientists.org

Florence Nightingale actual cause of death: https://blog.oup.com/2015/08/florence-nightingale-syphilis-death/

Death of Miss Florence Nightingale: https://www.theguardian.com/century/1910-1919/Story/0,,126410,00.html#:~:text=We greatly regret to announce,of death was heart failure

What Florence Nightingale can teach nonprofits about telling better stories (through pictures): http://www.tricycleusa.co/blog-1/2017/6/30/florence-nightingale-nonprofit-data-visualization