Shocking News: Nurses Can (and do) Read and Write

Who would have thought the world would come to this? A world in which there are so many nurses who are not only reading real books, but also writing real books, or essays, or poems, or short stories—so many nurses with the audacity (and ability) to obtain writing credentials, MFAs, writing certificates, and bona fide publications in non-nursing literary magazines and anthologies for God’s sake! Shocking indeed.

That was one of the main takeaway messages I got this week from listening to a podcast interview with Lee Gutkind on RN.FM radio. Lee Gutkind is the founder and editor of the literary magazine Creative Nonfiction; he is also the editor of the recently published anthology I Wasn’t Strong Like This When I Started Out: True Stories of Becoming a Nurse, edited by Lee Gutkind (In Fact Books, 2013).

In the radio interview, Gutkind states that the anthology was something he had wanted to do for a long time. Whenever he pitched the book idea to publishers they rejected it, saying it was a bad idea because nurses don’t write and nurses don’t read. So with the support of the Jewish Healthcare Foundation he published it himself under the new imprint of the Creative Nonfiction Foundation. Gutkind admits that he was surprised by the volume of submissions to the anthology, that the submissions “were so much better than we expected,” and “how many had writing degrees, writing experiences, as well as being nurses—it was encouraging to us.”  

The book was first released in early April, quickly sold out, and is now into its third printing. (Amazon says it is out of stock/due in 1-3 months but they should have it in stock much sooner than that. Elliott Bay Book Company has the book in stock and can ship it to you. They hosted our reading of the book this week/is what photo is of). Jane Gross, in her May 20th NYT book review ‘Semi-invisible’ Sources of Strength, wrote of the anthology:

It is beautifully wrought, but more significantly a reminder that these “semi-invisible” people, as Lee Gutkind calls them in this new book, are now the “indispensable and anchoring element of our health care system.”

I would argue that nurses always have been the ‘indispensable and anchoring element in our health care system’ and that most laypersons have long recognized this fact. Perhaps what is different now is that people higher up in the rigid health care system hierarchy are being forced to recognize this. The forces contributing to this shift are fascinating and complex, but have to include the growing proportion of BSN prepared nurses in our country’s workforce. Both Jane Gross and Canadian nurse author Tilda Shalof (whose essay Ms. Gross quotes from) are dating themselves by focusing on the outdated rift between diploma/Associate’s degree (ADN) and four-year university-educated nurses in tertiary care settings. Ladies: in the U.S. that battle is over. As the authors of the Institute of Medicine’s 2010 The Future of Nursing: Leading Change, Advancing Health report states:

The formal education associated with obtaining the BSN is desirable for a variety of reasons, including ensuring that the next generation of nurses will master more than basic knowledge of patient care, providing a stronger foundation for the expansion of nursing science, and imparting the tools nurses need to be effective change agents and to adapt to evolving models of care. (p. 4-9)

Currently, 50% of the U.S. nursing workforce are BSN prepared; the Future of Nursing report has set the goal to increase that to 80% by 2020. What a BSN education includes that an ADN education does not, are grounding in liberal arts (including literature and writing), leadership development, and public health/health policy competencies (more complex systems-level thinking)—all essential ingredients for more nurses to be readers, writers, and change agents in our health care system.

Something that I found disturbing in the radio interview and discussion was how much the two nurse radio hosts stayed stuck in the tiresome tropes of  “nurses as an oppressed profession,” (and specifically that they are oppressed by physicians) and that nurses “empower patients.” “Empowering” someone else is a slippery slope ethically and even practically, and nurses are not the only members of the healthcare team to advocate for patients. As to nurses being oppressed—oppression is understood to mean the unjust or cruel exercise of power. Yes, there are still ‘unjust cultures’ within hospitals that negatively impact nurses (as in the case of Kim Hiatt here in Seattle), but to extrapolate that to the statement that all nurses are oppressed is not only incorrect, it is unhelpful. Unhelpful to the image of nursing and unhelpful to the improvement of our health care system.

 

One of the radio hosts recommended that Gutkind offer a nurse writer conference—as a way to bring nurse writers together, to foster a community of nurse writers. Gutkind replied by encouraging listeners to e-mail him if they are interested in such a conference (information@creativenonfiction.org or under ‘contact form’ at www.Leegutkind.com).

Elliott Bay Book Company ‘Becoming a Nurse’ Event/June 11th, 7pm

The following is from the Elliott Bay Book Company (Seattle) Events page for June. I believe I have Karen Maeda Allman, bookseller and director of Author Events at EBB to thank for the kind description. As a writer who uses their bookstore as a gathering space, she is referring to the fact that I am part of Waverly Fitzgerald’s monthly Shipping Group at the EBB cafe. Thank you Waverly and all my fella’ Shippers for all the support over the years!

I want to add that we may (hopefully) be joined on June 11th by Nina Gaby, psych nurse practitioner, visual artist, and writer from the Boston area. Her essay “Careening Toward Reunion” in the Becoming a Nurse anthology is quite dogeared in my personal copy. I seriously want to meet her… If you are in the Seattle area on June 11th, please come join us for some nurse power time at Elliott Bay.

JOSEPHINE ENSIGN, EDDIE LUEKEN & KARLA THELLEN

Start: 06/11/2013 7:00 pm

It’s a particular pleasure for us when writers who use our bookstore as a gathering space have new work to celebrate, as will happen a few times this spring and summer. Tonight, Josephine Ensign, who has contributed so much to our community as a nurse and teacher of the next generation of nurses, appears with colleague Eddie Lueken and Karla Thellen for a group reading from their new anthology, I Wasn’t Strong Like This When I Started Out: True Stories of Becoming a Nurse (edited by Lee Gutkind, InFact Books). Nurses are the backbone of the healthcare system and these stories reveal something of the experiences of nurses at all stages of their careers. Here is illuminating reading for those aspiring to join the profession as well as for those who benefit from their work.

I Wasn’t Strong Like This When I Started Out: True Stories of Becoming a Nurse (Paperback)

By Lee Gutkind

$15.95

ISBN-13: 9781937163129
Availability: On Our Shelves Now
Published: In Fact Books, 3/2013

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Location:

The Elliott Bay Book Company

1521 Tenth Avenue

Seattle, WA 98122

United States

Becoming a Nurse: The Events

This week Jane Gross in the NYT wrote a nice review of the new book I Wasn’t Strong Like This When I Started Out: True Stories of Becoming a Nurse, edited by Lee Gutkind (In Fact Books, 2013). The title of the book review is  ‘Semi-invisible’ Sources of Strength, referring to the fact that nurses are often the un-sung, un-heard, un-seen cast members in the grand drama that is modern medicine. Semi-invisible sources of strength: I suppose then that nurses are to health care what the backbone is to the human body? Lumpy and bumpy, semi-visible through the skin, at times painful? OK, I’ll stop with the analogy.

In the days following the NYT book review, True Stories of Becoming a Nurse quickly became one of their top sellers. In the past day it has been in the top 20 on Amazon. Fascinating to see the book filed under “healing,” “spirituality,” and “personal transformation,” as if it belongs in Whole Foods next to the crystals and incense and socks made of recycled bamboo. Thanks Jane Gross for writing the review and thanks NYT for including it. That Ms. Gross focused her review on the old old and seriously tiresome rift between diploma-trained and university-educated nurses in tertiary care settings is unfortunate—but understandable given that she was writing the review as a testament to her diploma-trained RN mother. I get it; I’ll move on to more important topics.

Our University of Washington (with support from 4Culture)-sponsored Becoming a Nurse book launch on April 18^th at Suzzallo Library in Seattle was a great success. We had a total of five nurse author panelists who read from their anthology essays. Many, many thanks to the four panelists (Kim Condon, Eddie Leuken, Lori Mulvihill, and Karla Theilen) who paid their own way out here to attend the event. I only had to ride my bike two miles in the rain to get to the event—several of the other panelists flew in from across the country). Many, many thanks as well to the mighty team of UW Health Science librarians (Tania Bardyn, Lisa Oberg, Joanne Rich, and Janet Schnall) for organizing, hosting, and recording the event. The video recording of the readings is here . Note that the audio quality is much better than the video but you can see our general shapes as we read!. You can’t see the wonderful audience but they packed the room—standing room only. Thanks all you supportive audience members!

In case you missed the UW Suzzallo Library Becoming a Nurse event, we will have another Becoming a Nurse reading next month (Tuesday June 11^th, 7pm) at Elliott Bay Book Company in Seattle. I will be reading along with Eddie Leuken and Karla Theilen). All three of us will read excerpts from our anthology essays, as well as new work.

This Friday (May 24^th) at 6:30pm I’ll be reading at the Northwest Folk Life Festival in Seattle as part of the 2013 Jack Straw Writers Program. (6:30-7:30pm SIFF Cinema/Narrative Stage). Kathleen Flenniken, poet laureate of Washington State will be the host/KUOW sponsors the event. I’ll be reading from new work from my collection of poetry and prose I’m working on called Soul Stories: the stories feet can tell about the journey of homelessness. In the essay I’ll read I ask myself (and partially answer) the questions: why am I drawn to the suffering of others? Why have I spent the past thirty years working as a nurse with homeless and marginalized people? Wouldn’t I be happier if I was drawn to work as a shoe buyer for Saks Fifth Avenue? Questions I am sure many nurses and others in helping professions ask themselves.

 ___________________________________________________

The following is the press release for the book.

I Wasn’t Strong Like This When I Started Out: True Stories of Becoming a Nurse
Edited by Lee Gutkind
Featuring new work by Theresa Brown, Tilda Shalof, and others.

 

As editor Lee Gutkind points out in the introduction to I Wasn’t Strong Like This When I Started Out, “there are over 2.7 million working RNs in the United States (not to mention our many LPNs and LVNs), compared to about 690,000 physicians and surgeons. There are more nurses in the United States than engineers … or accountants and auditors … And, yet, many of us take the work these men and women do for granted.”

 

This collection of true narratives captures the dynamism and diversity of nurses, who provide the vital first line of patient care. Here, nurses remember their first “sticks,” first births, and first deaths, and reflect on what gets them through long demanding shifts, and keeps them in the profession. The stories reveal many voices from nurses at different stages of their careers: One nurse-in-training longs to be trusted with more “important” procedures, while another questions her ability to care for nursing home residents. An efficient young emergency room nurse finds his life and career irrevocably changed by a car accident. A nurse practitioner wonders whether she has violated professional boundaries in her care for a homeless man with AIDS, and a home care case manager is the sole attendee at a funeral for one of her patients. What connects these stories is the passion and strength of the writers, who struggle against burnout and bureaucracy to serve their patients with skill, empathy, and strength.
Pub. Date: March 2013, ISBN: 978-0-393-07156-6, 5 ½ x 8 ¼, Trade Paper, 278 pages,
$15.95, Distributed by Publishers Group West

 

Lee Gutkind has explored the world of medicine, technology and science through writing for more than 25 years. He is the author of 15 books, including Many Sleepless Nights: The World of Organ Transplantation, and the editor of five anthologies about health and medicine, including At the End of Life: True Stories About How We Die.

In Fact Books is a new imprint founded and edited by Lee Gutkind, editor and founder of Creative Nonfiction. In Fact Books titles help create an understanding of our world through thoughtful, engaging narratives on a wide variety of topics and real-life experiences. All titles are distributed by Publishers Group West. For more information, please visit http://www.infactbooks.com.
For interview requests and other media related questions, please contact:
Hattie Fletcher at fletcher@creativenonfiction.org or (412) 688-0304.

 

Southern Sin

I am immersed in the land of the Delta Blues, soaking up the stale fried grease smells (they really do deep fry everything—peanuts, pies, pickles, pork rind), humidity, wafts of tobacco smoke, waves of whisky breath, and the amazing deep Southern drawls. Here in Tupelo and Oxford Mississippi I have been contemplating Southern Sin in all its permutations. On the plane ride from Seattle I read through the newest edition of Creative Nonfiction’s special edition, Southern Sin. Not surprisingly, many of the essays deal with sex. It probably isn’t a surprise that the Bible Belt of Mississippi has the highest per capita number of Christian churches (mostly Southern Baptist), and also has the highest per capita number of sexually transmitted infections of any state in the U.S. It is no surprise that Mississippi is the fattest state. It did surprise me that Mississippi has our country’s highest casino market, concentrated along the Mississippi River. Life expectancies are the worst in Mississippi. But something that has really struck me while here is how worn out and unhealthy the poorer white women look. Many of these women I’ve encountered have been working in gas stations or in diner-type places—low-wage service jobs—so I assume they do not have much education. For me they are now the ‘face’ to the dry statistics showing the stark decline in life expectancy for white Southern women without a high school education. Recent studies show that for this group of women life expectancy has fallen by five years since 1990. Nationally, life expectancy for white women without a high school education was 73.5 years, vs. a life expectancy of 83.9 years for white women with a college degree. Researchers are mostly perplexed by the life expectancy declines for disadvantaged white women, but guess that higher stress levels, smoking, obesity, and misuse of alcohol and prescription pain medications are contributors.

Sources:

Life Expectancy Shrinks for Least-educated Whites in U.S., NYT, Sept 20, 2012/ Sabrina Tavernise.

One Nation, Seven Sins. Las Vegas Sun, March 26, 2009/Abigail Goldman.

 

Fat Phobia

Obesity Campaign Poster (Photo credit: Pressbound)

Maybe it is the fact that swimsuit and shorts season is fast
approaching for many of us in the non-tropical parts of North America. Or maybe it’s just that I’m facing yet another round of reading and grading nursing student papers, many of which are by students who remain fervent in their anti-obesity zeal. But there seems to be a lot of recent news articles about obesity, and about the effects of our national obsession with weight control and with our deeply entrenched fat phobia.

Upfront, I’ll admit it. I have a fat phobia. I already knew this. I was noticing how many times I included weight in my physical descriptions of people in my own writing or in my conversations with my husband. But my fat phobia seems to be a fact and not just a hunch. I just took the Fat Phobia Scale from the Rudd Center for Food Policy and Obesity at Yale University. I scored at the highest possible level of fat phobia. Although I am currently and have been for most all of my adult life, of normal weight, I was anorexic for a few years as a teenager, followed by a rebound into the overweight category for a while as a young adult. I know first-hand what it feels like to be both under and overweight, what it feels like to be in those different bodies of sorts—how people interact with you differently because of your weight. I am well aware of how stress and poverty and genetics are more powerfully connected with obesity than are the commonly perceived individual character flaws of gluttony and laziness. I am also aware of the recent research on the “obesity paradox” indicating that obesity may not be as bad for a person’s overall health as we have been taught to believe. (see NYT article Obesity Paradox: Thinner May Mean Sicker, by Harriet Brown, 9-17-12). I encourage my students to confront their own biases that can negatively affect their patient care—all the ‘isms’ we traditionally try to address, such as racism, classism, heterosexism, etc. But ‘fatism’ still seems to be not only tolerated but actively encouraged within our nursing educational system. I’ve been part of that and will try to mend my ways.

Two recent NYT articles spurred my interest in this topic. One by Tara Parker-Pope, entitled Overweight Patients Face Bias (4-29-13) reports on a study at Johns Hopkins indicating that physicians showed less warmth and compassion with patients who were overweight. The second NYT article (by Jan Hoffman, 5-1-13) entitled When the Doctor is Overweight, reports that patients are less likely to trust doctors who are overweight. Studies indicate that nurses are twice as likely as physicians to be obese (and depressed), even after controlling for income and education levels (see references below). For hospital nurses obesity is often linked with job stress and sleep cycle disruptions. I imagine that the same sort of ‘fatism’ bias negatively affects patient care by nurses.

References:

Olivia Katrandjian/ABC News, Study Finds 55 Percent of Nurses are Overweight or Obese, 1-3-12.

Carolyne Krupa/American Medical News, Doctors Follow Own Advice for Healthy Living, 10-24-12.

Praire Lights

A week or so ago I returned to Iowa City to attend this year’s Examined Life narrative medicine conference at the University of Iowa Carver College of Medicine. I was there two years ago for the same conference and at that time I kept asking myself why Iowa was such a center for creative writing in our country. I think I concluded that it had to do with the fact that there’s nothing else to do in Iowa City except drink, write, and watch the corn grow. I’m sure there’s more to it than that, but I have yet to discover it. Two years ago when I first visited the town, I wasn’t much impressed by the indie bookstore in town, Prairie Lights. I was being a Seattle big city snob. This time I spent more time in Prairie Lights and it began to grow on me. I adored having my soy latte served in grandmother’s flowered china alongside water served in a canning jar. The bookstore has a small-town friendly vibe and the staff people are helpful and enthusiastic about all things literary. They helped me track down, buy, and read Granta’s Summer 2012 edition “Medicine,” which features Chris Adrian’s excellent short story “Grand Rounds.” Out of the sixteen authors included, only three identify as working in health care—and all three of them are male physicians. But OK, who’s counting (except me). The likes of Alice Munro are included.

I was trying to make sense of Chris Adrian’s sort of Grand Rounds keynote speech that I had just sat through at the conference. The official title of his talk was “Uselessness.”  The proposed objective of his talk was: “Participants will reflect, perhaps usefully, on their own anxieties about uselessness as artists, medical providers, humanists, and scholars.” It was a bit of a rambling speech that he read off of an ipad mini from behind a podium to a packed medical school auditorium. I tried to listen to his talk, but was often distracted by the sound of my seatmate—a NYC female physician dressed head to toe in animal print and clutching her animal print covered ipad—snoring loudly, her head falling with a thunk onto my shoulder. Discourses on existential crises will forever be labeled in my mind under the category “fake dead animals.”

There’s a point to this somewhere. To this blog post. To Chris Adrian’s University of Iowa keynote Grand Rounds speech. To the primal animal snores of my med school auditorium seatmate. To the coffee grounds left in the bottom of my Prairie Lights soy latte… Ah yes, it is that I refuse to think this is useless.

Death, taxes, and childbirth!

Cover of Gone with the Wind

“There’s never any convenient time for any of them.” Thus said Scarlett O’Hara in Margaret Mitchell‘s Gone with the Wind.

I have no advice to offer on either taxes or childbirth, although I have experienced both in my life. But I do have advice on death, specifically on the importance of having Living Wills/Advance Directives. I’ve written many blog posts related to this topic, about my frustrating encounters with the healthcare system misplacing/not honoring my elderly father’s Advance Directives.

“April 16 is National Healthcare Decisions Day, and I hope that you will take this time to discuss and document your healthcare wishes.  We all need to be prepared in the event of a health crisis, and having the talk is easier than most people think, but many of us need a little inspiration or a reminder to do it.  I hope that this message and National Healthcare Decisions Day are all you need for inspiration.  Please check out the short, but fantastic video at www.nhdd.org and then mark your calendar for April 16 to have the talk with your loved ones.  There are all sorts of free resources–including free advance directive forms for each of the 50 states–on the NHDD website: http://www.nhdd.org. Additionally, please help me spread the word with Twitter, Facebook, and LinkedIn. Advance care planning is something we ALL should do and encourage others to do, regardless of age or current health.  Discussing your wishes can be one of the most important gifts you ever give your loved ones.” (from Nathan Kottkamp, Chair of the National Healthcare Decisions Day initiative.”

Related to this topic, and especially relevant to nurses, is the excellent American Journal of Nursing short essay by Doug Olsen, “Issues Raised by Media Coverage of a Nurse Declining to do CPR.”In his essay, Olsen points out the ethical issues related to media people who sensationalized the case of the ‘nurse’ in a California assisted living facility who refused to do CPR on an elderly woman resident. But he also points out the willful lack of education of the general public (by the healthcare system) about the dangers of and limits to CPR, especially in elderly patients. This is something nurses and other healthcare professionals need to do a better job with.

So listen to Scarlett: do your taxes, attend to whatever childbirths you may encounter, and talk with your loved ones about their end of life wishes.