September is Pediatric Cancer Awareness month; we encourage everyone to “Go Gold” with the goal to shed some light, and increase awareness, for those affected by this terrible disease. Here are some facts about pediatric cancer: according to the American Childhood Cancer Organization (2019), each year there is an estimated 15,780 children aged 0-19 diagnosed with cancer in the U.S; approximately 1:285 children will be diagnosed before their 20thbirthday… that’s a pretty scary statistic. It becomes even scarier when you receive that diagnosis for your own child.
I’ve worked as a staff nurse and nurse leader in Pediatric Oncology, and although kids are surprisingly (and extraordinarily) resilient, sadly some do not survive, even with the best doctors, and most up-to-date protocols… but we never stop fighting, and we never, ever give up! And the kids and their parents…well, they become superheroes and fight like champions against this heartless, evil “villain” living inside them.
Taylor Swift performed her song Ronan on the Stand Up For Cancer fundraiser event several years ago; she wrote the song in memory of a 4 year-old boy (Ronan) who passed away from cancer after reading a blog written by the boy’s mother, Maya Thompson. The following is a link to her performance:
American Childhood Cancer Organization. (2019). About ACCO. Retrieved from https://acco.org
Swift, T. (2012). Ronan. Retrieved from https://youtu.be/tvN7BOAQn9I
Many organizations are focusing on implementing a zero-tolerance policy for bullying behavior that has historically been done at the staff nurse level. New nurses enter the workforce, eager to begin their professional journey, and then are faced with the harsh reality that “nurses eat their young”. They are met with criticism and intolerance; sometimes even cruelty. We have all gone through it at varying degrees; most of us developed a “thicker skin” until we proved ourselves to be competent, and were gradually accepted into the team. It is not an easy process and some nurses don’t even last a year; they decide that this was not what they signed-up for, and opt to transfer to another unit, another organization, or even decide to leave nursing altogether.
When bullying or incivility is tolerated in the work environment, job satisfaction and retention are affected (Lachman, 2014). Smart organizations are proactively focusing on retention, and are inviting staff nurses to become part of the solution through peer mentoring and retention committees. But what if the bullying is being done from above, at the administrative level? Nurse leaders are not all created equal. There are many levels to leadership roles, from a Manager or Supervisor, to Chief Nursing Officer, or Vice President of an organization. To presume that hospital administrators and nurse leaders are above bullying behavior is a great falsehood; it happens all the time in competitive organizations. I’ve witnessed it firsthand, and it left quite an impression; it makes one question the integrity of the entire organization. While some leaders “talk the talk” about transformational leadership and anti-bullying initiatives, they do not always “walk the walk” when it comes to their own behavior to other managers and leaders. The environment can become hostile, and many mid-manager level leaders are unable to speak-up for themselves out of fear of making a mistake, and concern over job security. While nurse leaders must try to follow the vision and goals of the organization to implement changes that ensure patient safety and improve outcomes, they still face obstacles on a day-to-day basis that can be challenging to overcome. The most justifiable and well-intentioned suggestions can fall on deaf ears from the powers that be when one is working in an environment that doesn’t foster collaborative change. Even very experienced leaders can feel pressured by upper administration to perform tasks that are above and beyond realistic expectations, often without help or support.
When someone from administration decides that the organization wants to “go in a different direction”, no one’s job is safe. The Union does not protect managers, and leadership jobs can be filled quickly, with enthusiastic candidates looking for a new opportunity and career advancement. In fact, other leaders from within the organization can often begin to sense when a colleague is being left out from the “inner circle” and start to distance themselves from you in fear of being connected to the outcast. You begin to wonder when and how you will be “let go”, or asked to resign with reputation intact, so it is easier to find another job, as if it was your idea to leave instead of being fired. Sometimes, a small severance package may be offered to make the dismissal somehow less offensive.
If bullying is being tolerated at the administrative level, what options do we have? Casale (2017) states that if incivility is not being addressed in the workplace at the highest level, it projects a general acceptance of bad behavior that provides the bully with a degree of power and control. For change to occur, administrators need to model, and commit to, a culture of respect and civility to ensure a healthy work environment (Casale, 2017).
When I was young, I remember that my Dad used to joke every time we passed a cemetery, “ya know,people are dyin’ to get in there” … he thought it was so funny, and we would give him a courtesy half-laugh over the predictable double entendre. I realize that cemeteries may seem like a morbid subject to some, but I find them so interesting. I’m drawn to the history and the peaceful solemnness of the permanent resting place of so many; it is sacred ground. Every grave holds a story, and I think about the people who have walked this Earth, lived a life, and are now memorialized six feet underground by a tombstone, marking the ultimate ending to their story; the inevitable great escape to the unknown. Who were they; what did they do with the time that they were given; did they have a life well-lived; how did they die; how will they be remembered? I think about these things. That “dash” between your years from birth to death represents a lifetime; “only those who loved them know what that little line is worth” (Ellis, 1996).
Gravestones are an everlasting memorial to a life lost, but they tell very little about the person… some show a long life, and tragically, some are quite short. The picture below shows actual gravestones in the cemetery where my Dad, grandparents, and other family members, rest:
One can only guess that these modest memorials are due to the immodest cost of a burial and gravestone… or, perhaps, those who buried them cared little about a name, or some dates… they chose to remember them simply. We will never know, and perhaps that is the way it was intended.
Do you believe in ghosts? As nurses we often witness the passing of a life; ask any nurse who works in an ICU or Oncology unit whether they have seen, or felt, something unusual, like a “presence” on their unit, and I would guess that many will say that they have. When I worked in pediatric oncology, one nurse told me that after a young boy passed away, his young cousin told his mom not to worry, she saw her cousin walking away, holding his father’s hand (his father had passed away a few years prior). Some may find it hard to comprehend such stories, but I find it comforting to think that we will be reunited with loved ones when we pass.
I reconnected with an old friend recently, and as we were catching-up on this crazy thing called life, he gently reminded me that we all have stories. While some stories are harder to tell than others, most of us are fortunate enough to have a surplus of great memories that we carry as a reminder of who we are, and where we’ve been.
“Owning our story can be hard, but not nearly as difficult as spending our lives running from it. Embracing our vulnerabilities is risky, but not nearly as dangerous as giving up on love and belonging and joy—the experiences that make us the most vulnerable. Only when we are brave enough to explore the darkness will we discover the infinite power of our light.” (Brené Brown)
Being brave can mean different things to each of us… it all depends on your ability to face your fears. Overcoming such an intense emotion isn’t easy; in fact, it can make us extremely uncomfortable, and is often the result of an act of love or necessity. My challenges with trying to be brave have changed as I have gotten older. As a child, being brave meant getting a “shot” from the doctor; as a teenager, it meant trying to overcome self-esteem issues; as an adult, it has been more about being honest when the truth was hard to hear; it was letting go after losing trust; it was starting over as a single mom. Being brave is stepping-up to a new challenge and trying again (and again) after failure. It is saying “yes” when every fiber of your being is feeling afraid and anxious and wants to (safely and comfortably) say “no”. Being brave is facing your fears and fighting a battle that you know you may not win, but will never give up trying.
Hope is exciting; it makes you feel that anything is possible. It is powerful and profound. The feeling of having hope can make even the tiniest spark of light seem like a sunrise in the making. Hope can make one walk a little lighter and feel a little happier. It can make you forget everything bad and painful, even if only for a short time. It is wise to be cautious with expectations, but I have found that even the slightest chance of something awesome happening, can make all the difference in the world between giving up or getting up.
This is not a political post; rather, it is quite personal to me, as I can’t help but deeply relate to the slogan, “nevertheless, she persisted“, which became popular in 2017 after Mitch McConnell condescendingly uttered it while trying to silence Senator Elizabeth Warren during the U.S. Senate vote to confirm (recently fired/resigned) Jeff Sessions as Attorney General. He did not know at the time that those words would resonate with so many women; me included… and yes, I bought the T-shirt. If you have been following my blog, you know that I was recently diagnosed with a rare spinal cord condition called Arachnoiditis. It is something that I had never heard of (even as a nurse), but it has come to be my fate after complications from my last spinal fusion in 2016. I am presently coming to terms with trying to advocate for my own healthcare needs and navigate through hours of online research to educate myself and practice patient-centered care; this time with me starring in the role of impatient “patient”.
I consider myself a (mostly) private, independent person, but I must confess that I feel so helpless… it is scary to consider how this diagnosis will affect my future, both personally and professionally. This little blog that began as a way to express myself during a time of loss, continued on with my writing from a personal perspective about my love of Nursing, has now entered into a new challenging phase of my life. Please bear with me as I stumble through this unknown territory, one day at a time.
Change can be hard; we become comfortable with habit and familiarity. The longer you stay in one place, the harder it is to leave. I feel strongly that in order to grow, one must be open to, and adapt to, the challenges of change. I (especially) advocate for trying new things in one’s career, such as earning professional certifications, or going back to school to pursue a higher degree. I have written many letters of recommendation endorsing fellow nurse friends and colleagues whom I truly believed had the potential for great things in the field of nursing for other positions, promotions, or awards… even if that meant that they would be leaving my own unit/organization for bigger and better opportunities. I applaud them for being brave to try something new. As a nurse leader, it is my responsibility to raise others “up”, and I am proud to do so, just as it was done for me by my mentor, Nicole; she taught me many things about leadership and change, and led by example. Nicole also re-introduced me to the rare genius and leadership lessons from Abraham Lincoln in Lincoln on Leadership (Phillips, 1992).
“I have simply tried to do what seemed best each day, as each day came.” –Lincoln
Some of Lincoln’s greatest quotes have held the test of time and have proven to be especially true and powerful in our current political climate.
“A house divided cannot stand“- Lincoln
Yes, change can be difficult, but believe in yourself and your ability to overcome obstacles and take control of your future. Confidence comes from stepping out of your comfort zone and expanding one’s experience, expertise, and perspective in other areas. In my 30-year nursing career I have worked in many sub-specialty areas in the world of Pediatrics. I was never afraid of change; it actually sustained my love of nursing. I was challenged with each and every opportunity. These different experiences have proven to be invaluable to a nursing career well-lived and loved; I wish the same for you!
Phillips, D.T. (1992). Lincoln on leadership: executive strategies for tough times. New York: Warner Books