Where is Devin Nunes’ Cow When I Need It

I am a fan of social media because through it I am introduced to people and ideas that I would not otherwise encounter. It can be heartbreaking and humorous at the same time. However, there are those that have no sense of humor and sue cows. Fortunately, the vast majority of people with whom I interact are amazing and share an interest in nursing, social justice, Catholicism, disaster preparedness, or a vast number of other topics as silly as cats. Sadly, there are a few that spoil conversations. They troll topics and people and dig into their lives outside of social media. It becomes a personal attack rather than a productive or fun conversation.

I first experienced ocial media trolls at the University of Missouri – St. Louis when I publically supported a student who protested after Michael Brown was killed. I was grateful to a not-for-profit that reached out to me and advised me how to get rid of trolls and offered their help. It worked and in a few weeks, they were gone. For the most part, they were people that were angry and tinged their anger with racial comments. It was easy to dismiss them because I have zero tolerance for racism or those that infringe on the free speech of students.

A couple of weeks ago I responded to a former graduate student’s post on twitter. The post linked to a video that she implied was misleading about nurse practitioners. She was clearly annoyed as many of us are when we see such attacks on our profession. However, the post highlighted a common problem with the arguments against full practice authority for nurse practitioners. Many arguments against full practice authority are not accurate and others appear to be intentionally deceptive and/or false. For example, it is true that nurses lobby for change, but the reality is that policy is not changed because pockets are being lined. That, in my opinion, is intentionally deceptive.

Like Devin Nunes’ Cow, my sense of humor offends some. Saying that there are liars everywhere and that there is a reason that nurses are the most trusted profession and “well” physicians aren’t wasn’t well received by a group that seems to detest nurse practitioners. They found no humor in my words and instead interpreted as all physicians are liars. I never said all physicians are liars or though it.  It is a leap to draw that conclusion. I did think that the post and whoever produced it was intentionally deceptive which by definition that is a lie. This was followed by over a week of an ever-growing list of comments from people who identified as physicians that could be perceived as threatening and intimidating. One brave physician stood up to these people. She pointed out that she stayed anonymous on Twitter because she had been attacked a group before and that one physician had been the recipient of attacks merely for being married to a nurse practitioner. As I blocked an ever-growing number of them (some I’m pretty sure not real people and only troll accounts) the physician trying to be supportive would screenshot my original post and share in an attempt to defend me. It further enraged them. I’m not sure when but they then started copying places I’ve worked and spamming them. Having successfully ended such behavior before I used the tactics I was taught by the not-for-profit and I blocked more people in the last week than I have in 8 years using Twitter. I also tried to get them to stop tagging me and tried to redirect the conversation to something kinder in approach. I failed.

Nasty conversations are counterproductive. When people are only slinging insults no opinions will change. Likewise, if evidence is produced and no one is willing to accept it then there is no point in the conversation. We must present the evidence in a way that will be heard. It can’t be a gotcha or I know more than you approach. We must engage those with whom we disagree, but we can do that with respect. Equally as important is exploring our biases, letting go of misunderstandings, and not taking ourselves too seriously. 

In an era where political adds deceive us, the justice system is biased, the Church covers up abuse, and “Prince Harry” follows and then unfollows me on Twitter it is important that the health professions be trusted. People need to know that when we say something it is true and accurate. Nurse practitioners are not buying policy change. We are using the evidence to support the case for full practice authority within our scope of practice. There was a time when registered nurses could not take blood pressures because it was believed that it was practicing medicine? I cannot remember the last time a physician or even an RN took my blood pressure. It is usually a technician using an automated machine.  The scope of practice changed because we realized that it could be done by others that were clearly qualified.

I have worked with amazing physicians and as a rule think they are highly intelligent, compassionate, and talented leaders. In fact, we couldn’t train nurse practitioners without them. In my 28 year career, I have never known physicians like the ones I’ve encountered the last week on Twitter. It is harder to dismiss this group because I admire and respect physicians as a profession and it saddens me to see some so disrespectful and threatening. However, I will never stand by and let people mislead the public about my profession. If one backs down from a bully the bully wins, which is not meant to imply that all physicians are bullies, but some of the ones I encountered last week seem to meet the definition.

I want to end with a cow joke, but…

For more information on the quality of care of nurse practitioners see Quality of Nurse Practitioner Practice.


We Love Our Pets, We Are Better for It

There have been a few Priests lately on rants about people loving their pets too much and treating them like people. I think we all realize they are not people, but we love them. It seems so odd to me that anyone would think we should not love all living beings. There can never be too much love in the world. I say love your pets and provide them the best care you can. They journey through life with us and for me have made my life happier.  To those obsessed with us loving our fur babies too much I say, maybe you should focus on the starving children, the victims of abuse, racism, murder, or nuclear disarmament. There are big issues in our world. Loving our pets isn’t one of them.

This was my husband’s obituary to our cat Chaucer. Judge me if you will, but I loved him and still do. He was kinder than many of the people online.

Early this morning my cat, life witness, and buddy, Chaucer died.  He was 18.  For those 18 years, he has stood as either a silent or meowing witness to a long segment of my life river.  He was there as I studied and obtained my Ph.D. in psychology, and I am at times inclined to think he channeled a dissertation to me.  He was there when I married.  He witnessed my comings and goings from Tucson, Arizona to Batavia, New York to Phoenix, Arizona to Minneapolis, Minnesota to Vienna, Virginia to Atascadero, California to Dubuque, Iowa to San Antonio, Texas. He witnessed me starting my private practice.  He waited for me when I did a postdoc in Minneapolis.  He sat at my feet as I wrote book chapters, reviews, and articles.  He was kind enough to meow approval as I wrote, but only if he was in a good mood.  Despite it all, he never let me get a swelled head.  He slept on top of Roberta.  If I wanted something warm, I had to make do with a pillow.  He has died in San Antonio.  Before today, he had waited to move with me and Roberta to St Robert, Missouri.  It is that trip he will not make.  Instead, he waited one last time, this time a ghost, as Roberta and I dug his grave in the garden.  A statue of the Buddha will guard him from a distance.

Of course, Chaucer was no Buddhist.  Buddhism teaches the cessation of desires.  Chaucer was devoted to their satisfaction.  If feeding his desires created new ones, he was fine with that, provided Roberta and I made the right effort to satisfy them.   In many ways, he was an odd buddy for me.  For example, we could never agree on capital punishment.  I hate it.  He was all for it, and had a long, long list of crimes that he viewed as capital offenses, especially living in his space without paying rent or at least tribute.  When we lived in Arizona, I am convinced he would have attended militia meetings if I had let him.  I also suspect the absence of firearms in the house was an affront to his martial sensibilities. 

For the first 16 years of his life, he did what most mammals do.  He started thin and ran to fat.  When thin, he loved to hop up onto my shoulder.  He enjoyed perching there as if he were a parrot, and having me cruise about the house to give him an elevated view of his estate.  And he liked getting fat, even if the lard robbed him of spring in his legs.  He had a taste for expensive chevres, and ignored the Kraft that I would eat.  He had no use for beef, but was keen for Chilean sea bass at $25 a pound.  He also showed his solidarity with my father’s co-religionists by being mad for lox, though he preferred his lox with cream cheese on it.  He liked expensive ice cream as well, but only when placed on a wood to give it the flavor he liked.

Goodness is slippery.  The gods are ironists.  Against Chaucer’s loud protests, Roberta and I had him vaccinated.  At heart, he was a Christian Scientist with no use for vets or their practices.  And he was not shy about expressing it.  One vet wrote in his record, “Nasty cat.”  Chaucer didn’t care.  If a vet wanted to examine him, it was the tank first.  I see the gallows humor in it having been a fibrosarcoma that blossomed from one of Chaucer’s vaccination sites.  This cancer was a savage cannibal.  Chaucer never backed away from him.  When he was diagnosed, the vet reckoned Chaucer had 3 to 6 months to live.  Chaucer stood firm for 19 months as this cannibal tumor ate him.  Perhaps he would have died sooner if not so fierce when facing a remorseless killer.  And the vet had not understood the skill and devotion of my nurse wife.  For these 19 months, she has fed Chaucer prednisone, cleaned his wound, changed his dressing, and held him as he died.  Chaucer was never abandoned.  Roberta held him in love until the end. 

Eighteen years is a long time in any human life.  If I am lucky, I may live another 18 years myself.  Roberta almost certainly will.  Despite our good fortune, our lives will have a gap in them, even though we will carry the memory of Chaucer in us.  It’s been a long journey we all have had together before we stood together at his grave.    I thought back to how he got his name.  He was a handful of kitten.  I found him curled on a Penguin copy in my library of the Canterbury Tales.  From then on he was Chaucer, though Chaucey and Mr C would also do.  I write in his memory so that others may also remember by buddy and witness—Chaucer.   I loved and love him.    09 May 2014, San Antonio, Texas

People Like Me and Racism

I went to the Ash Wednesday service at John XXIII which is the Catholic Center on campus. It was relatively full and it was interesting to look around and see people that I recognized, but whom I didn’t know shared my faith. Likewise, I heard a student say with some surprise, “Isn’t she the Associate Dean?” There is something that feels good about knowing there are people around you that share a cultural identity. It is suddenly a more familiar and safe environment. It is that familiarity and safety that I would hope we could make more available.

I’ve spent the majority of my adult life living in diverse cities and in diverse neighborhoods. Thirteen years in the DC metro area where I was happy to live on a street that boasted at least four languages, three years in Tucson, one year in San Antonio, and four years in St. Louis though while diverse was the 6th most segregated city in the country and once I got to my neighborhood you wouldn’t have known the city wasn’t 100% white and mostly Catholic.

When I came back to Tennessee my husband ask if I was sure. I’m Catholic and I have belonged to a Zen Center for years. Tennessee is the least Catholic state in the country and the nearest Zen Center is either in Nashville or Ashville. When I went looking for “community” I did it with greater intent than I did in St. Louis. I wanted a diverse community and a diverse church. I thought the university parish would be the most diverse and the most socially active, but I was wrong. I found that Holy Ghost was the most diverse parish in the city and relatively socially active so I ended up splitting my time between the two because I want to be part of the university community but also wanted diversity. I have found that I’m no longer that comfortable when everyone is like me and I never again want to live in a segregated community.

The racism, sexism, and homophobia was part of why I wanted to leave Tennessee in the early 1990s. The racist comments on the rock, the lack of acceptance of persons who are LGBTQ, and the recent blackface incident were shocking, but what I remembered. The difference between then and now is the response from the administration. In short order after each incident, the administration had responded with disapproval. That disapproval is being followed up with action. I am pleased that they are leading by example. They have held campus discussions and now are going to require cultural competency, inclusion, and bias training for all faculty, staff, and administrators beginning with the executive administration and it is to be developed and implemented immediately. While the administration and faculty didn’t paint the rock or record themselves wearing blackface they are saying change begins with me.

How has Tennessee changed since I left in 1991? People like me have looked at ourselves and said, where did these young people learn this behavior? And the answer may not be what I did, but what I didn’t do. I have had a fair amount of cultural competency and bias training and even included it in grants and program development, but I still notice my own bias. In St. Louis our program recognized a lack of diversity and in two years we went from 7% underrepresented minorities to 29% in our doctorate program. We didn’t change a single admission criterion, but we did recognize our own bias in the selection and ranking process. It was a painful two years for some of the faculty. They felt called out, but in reality, the change wouldn’t have happened if they didn’t recognize and own the bias and then act to implement change.

There will always be those that ask why they have to go to training when they aren’t racist, didn’t paint the rock, and have never taken part in offensive behavior. My answer is because our job isn’t just to teach or do research. It is to set the example of what it means to be a professional, a good citizen, and a person that can acknowledge their own bias and work to fix it. It is because they are young and they will identify with us. Whether we know it or not they see us.

Cultural competency training is needed and it needs to be ongoing at all universities. Many, if not most, nursing programs now have cultural competency and bias training is woven throughout the curriculum because we know the impact on health outcomes. The inclusion of cultural competency training for students beginning at orientation and global citizenship as part of our new curriculum will be beneficial for the community, the individual student, and for the patients for whom our students will provide care.

I don’t know what it feels like to always be in the minority or to have been the victim of racism. I’m all too familiar with sexism, but it frequently lacks the same level of hatred and hostility associated with racism, homophobia, and Islamaphobia though is likely equally harmful. The more people like me own our part in a culture that has allowed racism to exist the sooner all will feel welcome, safe, and respected.

I’m dedicated to a more diverse and welcoming campus. I’m also old enough to know that when we are silent about the evil that is racism, sexism, homophobia, or Islamaphobia we are complicit with that evil.

I Teach Nursing, Not Political Ideology

I teach the art and the science of nursing. Nursing does not have a political ideology, so unlike what some religious leaders believe I do not teach liberal, progressive, or conservative ideology. I teach science, compassion, and the skills that help prepare students to care for all patients.

I view nursing as a calling and sharing and advancing knowledge as a responsibility. I teach nurses because I love my vocation and I want to nurture those who have a desire to care for the sick and the injured, change health policy, and improve outcomes. My philosophy of teaching is heavily influenced by three factors: 1) a career of serving the poor, the incarcerated, and those impacted by disasters, 2) the joy of being constantly surrounded by young officers with a desire to learn and grow into the future leaders of the vocation, and 3) having seen the profound impact that evidence-based policy can have on lives.

Teaching, like any truly human activity emerges from one’s inwarness, for better or worse. As I teach, I project the condition of my soul onto my students, my subject, and our way of being together. – Parker J. Palmer, The Courage to Teach

I believe a strong liberal arts education, supported by science, serves as a foundation for a well-rounded nurse. This is essential because nursing requires a broad understanding of the human condition, including cultures, religions, and history. Moreover, studying nursing is necessarily an interactive process between the instructor and the student that prepares undergraduates to be novice nurses and helps graduates students to become experts.

Imagine my surprise every time some or religious leader holds forth on how colleges and universities teach liberal ideas. I’m pretty sure the principals of chemistry, physics, engineering, mathematics…and nursing are not liberal or conservative. Even more surprising is when educated people make comments implying that education does not improve one’s life. Not only does what I teach improve the lives of the students, but it improves the lives of all those in their care. The average new BSN graduate will make between $55,000 and $65,000 as a new graduate in a job with security, retirement plan, and health insurance. Many people find that nursing has flexible hours and part-time options are available when one is raising a family or as one moves into retirement. In addition to the obvious advantage of higher income that generally comes with a college degree those with a college degree live on average 7 years longer, have better health, and engage in fewer risky behaviors.

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Of course, a college degree isn’t without a cost. When I attended the University of Tennessee other than my first and last semesters for which my parents funded I either borrowed money or earned it to pay tuition. I managed to only borrow $2000 while living at home for free most of the time. I had a full-time job(s) mostly waiting tables and went to school full-time. It did take me 6 years to graduate, but it was doable because I was essentially paying $243 plus some fees for 12+ hours of credit. The same 12+ hours now cost about $5555 plus fees today. In 1980 I was making $2 per hour plus tips so a little less than $10,000 per year. Add in gas, car maintenance, insurance, clothing, books, supplies, and other incidental expense and I could pay my tuition. However, I don’t encourage anyone to try and work that much while going to school. It was reflected in my undergraduate grades which are still embarrassing.

Today if a person made minimum wage, worked full-time, and lived at home with few expenses other than the ones I had that person would make around $15,000 per year. Tuition would be around $12,000 before books and supplies and in nursing, it isn’t unusual to pay $200-300 for a book. If one budgets $1000 per year for books the total of tuition and books is $13,000. Add to that gas, clothing, car insurance, and all the other expenses and a student going to school full-time would need to be able to live off of $3000 per year. It is not reasonable to expect a young person today to be able to work their way through college without substantial loans.

I think what struck me as most hypocritical about the comment from the religious leader was the suggestion that the students should pay just like everyone else. I’m a faithful Catholic and every year I give to my parish, Catholic Charities, the Bishops appeal (which helps fund seminaries), and various other calls for money. While some parish priests are expected to pay part or all of their education most dioceses help fund the education either wholly or in part or provide loans that the Priest can pay back after graduation, but even then those loans aren’t the full cost. Many religious orders pay the full costs. What if you did expect the young man to pay it all? If he lived at home and went to Kenrick-Glennon Seminary he would pay $26,000 per year. How is it that one would expect a young man to study for the priesthood and work full time to then take a job that with many orders requires a vow of poverty and even more parishioners expect it…of course $100,000 in student loans does almost guarantee at least tempory poverty starting out.

I’m proud of the fact that I worked my way through college and paid for most of it myself. I learned valuable lessons, but I would have preferred to have graduated with a 4.0, have had time to be socially involved on campus, and to have made friends that were not merely associated with my college job. I did work my way through college and it is exactly why I don’t want others to work more than 10 hours a week. College is a time for learning and the rest of life will be filled with work.

As a teacher, my objectives are to:

• Instill a desire for service to others
• Inspire joy in learning and facilitate life-long learning skills
• Develop students that are critical thinkers and exercise sound judgment
• Ensure students master the basics and proceed into the vocation with confidence
• Advance knowledge through service, research, and administration

If religious leaders do their jobs then they might be a little less worried about people like me teaching students the liberal way to change a dressing or start an IV.

I Wasn’t Ready on Day One

My first job was at a boat dock working at the diner when I was 15. I wasn’t ready on my first day and all I needed to do was take orders and deliver people their food. I haven’t been ready on day one for any job since, but I have at least had the skills and knowledge I needed to figure it out.

In college, I learned how to do my research and find the information I needed. I learned to think critically, make reasoned decisions, and plan. The result was I have been successful in every job I’ve had, which isn’t to say there weren’t some bumps in the road. I left active duty and stepped into a full professor and department chair position and moved to an Associate Dean and then Executive Associate Dean position. In my career and in all the positions I held, I’ve hired hundreds of people.

When hiring there are four critical things to consider.
1. What position am I asking the person to fill and how much experience is needed?
2. What are the critical skills and does the person have them?
3. What training and mentoring do I have in place for the person?
4. What do I need to do to make them feel valued and respected from day one?

I’ve never hired anyone that knew it all on day one and didn’t need a little help. Not the new graduate nurse or the experienced physician or the supervisor. Almost everyone required six months of training or mentorship to be a productive member of the team. The more we did to train and mentor the better teammate the person made and the more functional the team as a whole. I used to say of new nurses that universities taught them to think like professionals, but my job was to make them proficient, underwrite their early mistakes, push them beyond their comfort level until they didn’t need me. It was my job to make them feel welcome and valued.

Don’t hire a new graduate with a Bachelors degree for a job that requires a doctoral degree. It won’t be the employee’s fault when they are unable to meet the expectations. Likewise, don’t hire new RN for a job that needs a person with extensive experience. When I was a Chief of Staff my Assistant Secretary started too many days with, “[Profanity], get you [more profanity] in here. Who wrote this [even more profanity].” It was always about a speech he was supposed to give that was written by a junior staffer. After a few incidences, I refused to say who wrote as the result would be a crying junior staffer in my office or a very angry one. Either way it was better to not tell him. Finally, one day I had my husband who has two PhDs write a speech for him to make a point. When I gave it to him without telling him who wrote it he replied, “Now this is what I need, who wrote this?” I took the opportunity to explain if you want someone to write like a person with a doctoral degree you should hire one. Shortly thereafter we hired a speechwriter with a graduate degree.

None of us are ready on day one. The problem is we often forget what it was like to be the new graduate or the new person. I keep a paper that a professor gave back to me bleeding red in my Ph.D. program and before I grade papers I review it. It reminds me what it was like when I was learning. We should all walk onto a nursing floor without saying anything, and take the time to remember what it was like that first day and week and month. Do you remember the day you first felt confident? Do you remember when the fear went away or the first time you ever ask yourself why you ever thought a specific procedure was difficult?

We all have a responsibility to the new graduate. We can’t make them ready on day one to handle a full caseload, but we can give them all the tools they need to be successful. We should never stop trying to make sure they are as cable as possible, but nothing teaches you to draw blood like doing it a hundred times, nothing teaches the best dressing like seeing hundreds of wounds, and nothing replaces experience. I was new once and I’ve never forgotten.

A Hearing without Truth

Whoever is careless with the truth in small matters cannot be trusted with important matters. – Albert Einstein

I was able to watch part of the Kavanaugh hearing today. It was all I could do not to cry for our country. We have lost the ability to have a civil discussion partially because those we elected to represent us care more about themselves than the truth and the victims of sexual assault.

Sexual assault is not about sex. Let me repeat this. Sexual assault is not about sex. It is about violence, power, and control of the other person. Today, the 21 people who hold this nomination in their hands were exhibiting verbal violence, abusive power, and control over the other person. The only thing missing was the attempt at sex to disguise it.

I believed Dr. Ford and at times felt sorry for Judge Kavanaugh though I did not believe him. No rational person would believe his statement about his drinking and his yearbook even if one believed the rest of what he said. The Senate could take some lessons from nursing. Even if you think a patient is a horrible human being, a murder, a rapist, or name your evil, treat the person with respect and dignity. Provide compassionate care and the best possible treatment. If you cannot treat the other person with respect and compassion then request to be replaced in the provision of their care. It is a simple rule. Do the best you can do it all the time. Treat all patients as you would want your mother or father treated.

The next thing we teach is that to provide the best care we must work together as a team. High functioning teams build on the strengths of each team member and show respect to all. If we start yelling at each other or treating each other with disrespect then the patient will be the one that suffers the most.  More importantly, when we are focused on ourselves we forget the patient.

I was embarrassed for our country. This does not represent the best in our country. How hard is it to focus on finding the truth and for each American to care more about the truth than political affiliation? The only person that seemed to handle themselves with dignity was Dr. Ford. Everyone else needs to be sent back to kindergarten to learn how to behave. The truth matters and if we cease to care about the truth we are lost.

Man tends by nature toward the truth. He is obliged to honor and bear witness to it: “It is in accordance with their dignity that all men, because they are persons . . . are both impelled by their nature and bound by a moral obligation to seek the truth, especially religious truth. They are also bound to adhere to the truth once they come to know it and direct their whole lives in accordance with the demands of truth. CCC 2467

Labor Day

Labor Day honors the American labor movement which focused on a just society including social equality and good citizenship. We celebrate the contributions workers have made to the well-being of our country. Is there any better way to do that than to support the labor unions that helped create our prosperity? Among other things, we can thank unions for weekends, the end of child labor, and fairer and more equal wages.

I have never belonged to a union nor do I generally think they are necessary for professionals. However, there are times when we require assistance to use our skill for the benefit of others. For example, staffing minimums have a significant impact on the quality of care provided to patients. If nurses could negotiate evidence-based staffing ratios, they would. Progress has required the work of labor unions and professional organizations to push legislation making it a reality in sixteen states.

I am grateful for all labor unions have done in my life. My mother was a teamster, and my father was a member of the Atomic Trades Labor Council. I remember strikes and picket lines, but I also remember being firmly middle class, having good health insurance, and parents that worked 40 hour weeks. I support all those that belong to unions and look forward to a just society where they are no longer necessary for equality and a living wage.

If you hire a union worker, there is no doubt the works are paid a living wage. If you don’t then it is a good practice to ask what the workers are paid. If it isn’t a living wage keep looking.