Understanding My Why

(Deviant Art, 2017)

I worked as a nurse's aide through high school and college. At age sixteen I stumbled into the job after trying (and strongly disliking) the other two main options in my hometown; babysitting and bagging groceries. In college I first pursued pre-med, assuming that I would go on to be a doctor. I took classes full time and continued working in long term care. All was going well until a thirty second conversation in the course of a long term care shift derailed my plans.

As I entered a room, the nurse walked by and casually mentioned that, "I forgot to tell you. That resident is hospice now." I immediately asked what that meant, to which the nurse replied, "There is nothing more that medicine can do for her. She's going to die." 

Caring for the dying was not new to me, but the nurse's blunt manner caught me off guard. I blurted out something along the lines of, "That's horrible. So she's just going to lay there and we do nothing?"

The nurse (whose name I cannot remember) walked slowly up to me and said softly, "There's nothing that medicine can do for her. But I'm a nurse. You and I will keep her warm and clean and dry. We will turn her and make sure she isn't having pain. And when the end comes one of us will hold her hand so she isn't alone."

At that moment I fell hard and fast for nursing. To this day the nurse's words play in my head, narrating my 'why'. Nursing is about being with the patient in moments where that is the only intervention (Swanson, 1991). Nursing is independent and valuable. Nursing is the whole person and not just the diagnosis.

(Lifehack Quotes, 2017)

In my current role, I no longer practice at the bedside. Instead, I am responsible for oversight of several nursing quality indicators and have the privilege of advocating for nursing throughout the organization. This data-heavy complex position fits with my love of numbers and drive to measure the value of good nursing care (instead of the absence of bad outcomes). Those that know me best would say that I care fiercely while constantly challenging 'the way things are'. They would also say that I am not good at sitting still or making small talk. There's always room to improve, although I am pretty sure that I will never master small talk.

I am incredibly lucky to have this great opportunity at work and a strong family at home. I love the life I have. My only regret is the amount of hours I have to spend sleeping. There's so much that I don't want to miss!

My wonderful family doing what we love best...hanging out in the mountains.
Why can't we figure out how to all look at the camera at the same time?

My organization believes strongly in a 'why'-based culture. I was required to watch Simon Sinek's presentation several years ago, and I have found in practical application that communicating the 'why' works (Sinek, 2009, 28 September). Nurses are constantly being asked to incorporate new things into a day that is already brimming. Telling them to do something usually does not stick (Porter-O'Grady & Malloch, 2015). However, talking with them about the foundational 'why' and tying it to the patient almost always generates better results. Steve Jobs and Michael Jr. agree that a deeper understanding of the path gets you to a more interesting destination (Jr., 2015, September 10). Mr. Job's presentation resonated in a different way as well. His capacity to be present and contribute in a meaningful way despite his terminal illness brings me back to my personal 'why' (Jobs, 2008, 7 March).

Dr. Porter-O'Grady's presentation on leadership was new to me. Many of his insightful thoughts such as the critical need to give decision-making power back to bedside nursing reinforced my current practice. I loved that he, as a nurse executive, argued that if the Chief Nursing Officer (CNO) needed to endorse a decision made by a nurse practice council the CNO must go to the council and not the other way around. Lastly, one phrase made it to my office's inspirational thought board. According to Dr. Porter-O'Grady, there cannot be accountability without ownership (Porter-O'Grady, 2016, 23 April). As a clinical quality professional, this challenged me to re-think the way I look at nursing outcomes. Do bedside nurses have the tools and support they need to own their own work? If not, I need to do something different. In my experience with nursing today, we are a long way from that ownership. 

Dr. Porter-O'Grady's thoughts paired nicely with John Maxwell's five levels of leadership. I was relieved to see that much of Mr. Maxwell's focus was not on positional leaders. I do not currently have any direct reports, but I am expected to lead multidisciplinary teams and get systems-level results. My biggest learning was the lack of an 'official' leader title is no excuse for poor leadership skills (The John Maxwell Company, 2016)! In reviewing the American Nurses Association (ANA) leadership competencies, many apply to me and my role. I struggle with the business and financial aspects of healthcare, and must seek out opportunities to learn and grow in these areas (ANA, 2016). In general, I have many opportunities to learn and grow as a leader, and I am grateful for the many smart and articulate professionals who share their expertise. 

I became a nurse because I wanted to help, even when helping meant being with someone at the moment of their death. This is my 'why'. As a leader it is my responsibility to connect other nurses with their 'why' and leverage that power to improve patient outcomes.

Swanson's Theory of Caring outlines the importance of 'being with' patients (Swanson, 1991).

References

American Nurses Association (2016). Nursing Administration: Scope and standards of practice (2nd ed.). Silver Spring, MD: ANA. 

Deviant Art (2017). Until the very end. Retrieved from http://extraordi-mary.deviantart.com/art/DH-Until-the-Very-End-203834701

Porter-O'Grady, T. [AONE Nurse Leader]. (2016, 23 April). AONE thought leader: Tim Porter-O'Grady. [Video file]. Retrieved from https://www.youtube.com/watch?v=ytAV0jcIVPc

Porter-O’Grady, T. & Malloch, K. (2015). Quantum Leadership: Building better partnerships for sustainable health (4th ed.). Sudbury, MA: Jones & Bartlett.

Jobs, S. [Stanford]. (2008, 7 March). Steve Job's 2005 Stanford commencement address. [Video file]. Retrieved from https://www.youtube.com/watch?v=UF8uR6Z6KLc

Jr, M. [Scott Habeeb]. (2015, September 10). Michael Jr: Know your why. [Video file]. Retrieved from https://www.youtube.com/watch?v=LZe5y2D60YU

Lifehack Quotes. (2017). Florence Nightingale. Retrieved from http://quotes.lifehack.org/quote/florence-nightingale/were-there-none-who-were-discontented-with/

Sinek, S. [TEDx Talks]. (2009, 28 September). Start with why: How great leaders inspire action. [Video file]. Retrieved from https://www.youtube.com/watch?v=u4ZoJKF_VuA

Swanson, K.M. (1991).  Empirical development of a middle range theory of caring.  Nursing
Research, (40)3, 161-166.

The John Maxwell Company (2016). The five levels of leadership. Retrieved from http://www.johnmaxwell.com/blog/5-levels-of-leadership