Reflections on a Nursing Journey

The gift of the nursing profession, and it is a gift, has brought me to faraway places But the less tangible places that I, as a nurse, have traveled, places where there are no postcards or passports, have been the real adventures of my nursing career.
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Senior woman discussing prescription medicine with nurse in clinic
Senior woman discussing prescription medicine with nurse in clinic

This week we celebrate and reflect on the hard work and compassion of nurses around the world. From Boston to rural Malawi, nurses act as tireless patient advocates, delivering care to some of the most marginalized populations. I feel incredibly fortunate to be a member of this unyielding group. Last week I had the honor of speaking at the Northeastern University School of Nursing's convocation and pinning ceremony and delivering the commencement address at Resurrection University. Both events were for the classes of graduating nursing students, from new nurses receiving their bachelors degree to longtime nurses returning for their masters and doctorates. It was a wonderful opportunity to reflect on the power of nursing and how it has, personally, shaped my life. I share my thoughts with you to highlight my lessons learned, the work of the inspirational nurses who have led the way and most importantly in honor of the patients and families who have taught me about this wonderful journey we all travel together.

To the Class of 2013, I am very honored to be here today. This is an extraordinary day, one where you gather with your family, friends, faculty and staff to celebrate, give thanks and to rejoice in your accomplishments. We all get by with the help of many, and in the words of our first lady Michelle Obama, "When you've worked hard, and done well, and walked through that doorway of opportunity, you do not slam it shut behind you. You reach back, and you give other folks the same chances that helped you succeed." It is your turn now to join our nursing community and to take your rightful place and help other future nurses others along the way.

Twenty five years ago I graduated from the School of Nursing at Northeastern University. Twenty five years, a quarter of a century, and what a journey it has been. Twenty five years as a nurse, and I have worked at so many different places: hospitals, community centers, academic medical centers, community based organizations, prisons, rural villages and urban slums. Now I work as a Nurse Practitioner at Massachusetts General Hospital (MGH) in the infectious diseases unit where I have worked for the past 16 years, I am on faculty at the MGH Institute of Health Professions and I spend the vast majority of my time as the Chief Nursing Officer at Partners in Health (PIH). Partners In Health is an international non-governmental organization that works in 10 countries globally and provides health care to over 3 million of the poorest people in the world.

The gift of the nursing profession, and it is a gift, has brought me to faraway places such as the Navajo Nation, South Africa, Botswana, Thailand, Haiti, Rwanda, Malawi, Lesotho and many places in between. The geographic landscape has been amazing, the sunsets in Malawi, the beauty of the rivers of Lesotho, the hills of Rwanda, the desert of New Mexico and the mountains of Haiti have all influenced me and how I see the world. But the less tangible places that I, as a nurse, have traveled, places where there are no postcards or passports, have been the real adventures of my nursing career.

I grew up in rural Maine, where everyone looked like me, everyone lived in similar houses, and everyone pretty much had the same opportunities and same life. Being allowed to meet, talk with, care for, laugh with and be present with people different from me has been one of the most rewarding parts of my life. You grow when you are not in your comfort zone; often it is in those uncomfortable or difficult spaces where we truly see ourselves. This is the life and people that sometimes exists in the shadows. It is easy to ignore the shadows, easy to not see the disparities, inequities and the overt world of the haves and the have-nots, whether in Boston or Haiti. It can be ugly; it can be hard to not be in the majority, to be the different one. Some of you know these challenges all too well.

Gaining access to someone's intimate world is an enormous responsibility and privilege. As nurses we interact and intersect with people at their most vulnerable times, times of pain, birth, death, sadness, grief and suffering. This is a sacred place -- we cannot forget that. It is easy to get caught up in the day to day, to see nursing sometimes as a job, paycheck, series of tasks, and, yes, there are tasks that are part of nursing care. But -- nursing is not a series of tasks, we assess our patients and community, follow a process of inquiry, apply critical decision making and intervene as necessary, evaluate and start over again. That is critical. Evidence-based practice is what distinguishes us as a profession, as a discipline. The part of nursing practice that is less well defined, less visible potentially and less able to be quantified is how we react to one another based on our shared humanity.

Carl Wilkens , a human rights and anti-genocide activist who was one of the only Americans who stayed during the 1994 genocide in Rwanda describes it as "the other." He talks about how we relate to each other and that tragic violence can only be possible when we can no longer see ourselves in that person. When we can successfully distance ourselves from the other human beings, see the differences rather than the commonalities, that is when the light goes out on shared humanness. The genocide is an extreme example, much more common is when we consider others so different from us, so undeserving of our attention, effort, money or care that we don't feel obligated or responsible for one another. We don't step up or intervene, or advocate for people who don't look like us, talk like us, worship like or live like us. It is "their "problem not ours. Nurses are consistently number one in polls of the most trusted profession, this trust placed in us by society should not be wasted or squandered. Bearing witness to the shadows is hard, bearing witness to inequities in the world is hard. Life is not always glamorous as a nurse; it can be exhausting, thankless, stressful, frustrating and sad. It takes courage to be a nurse, not necessarily the courage we hear about on the news or in award ceremonies, this is best said by Mary Anne Radmacher when she said "Courage does not always roar. Sometimes courage is the quiet voice at the end of the day saying, 'I will try again tomorrow.'"

Do I expect nurses to be better people, to be more sensitive to other's needs, to hold ourselves to a different standard and to be the voice for the marginalized and those on the fringes of society, those in the shadows? I do.

We are all so lucky. We have received an amazing education at the bachelors, masters or doctoral level in nursing at world class educational institutions. We trained at some of the world's best hospitals and had opportunities that are not available to many in the world today. Tom Brokaw said, "Your certification is in your degree. You may think of it as the ticket to the good life. Let me ask you to think of an alternative. Think of it as your ticket to change the world". You are receiving your ticket, how are you going to live your nursing journey, how will you change the world?

I have a small group of family and friends that I email when I travel. This is my community who I let down my guard with and talk honestly and openly with about my challenges. When I was in Haiti in late February I emailed to my group, "I worry about how we will get this all done. There is so much to do, how will we be able to handle the rainy season and the surge in Cholera cases, will we be able to treat the many women showing up with breast cancer who want and deserve a shot at cure or palliation to stop the pain." I went on to talk about my fears and frustrations with the opening of our new teaching hospital in Mirebalais; a hope for the country of Haiti.

As always, my supportive community sent words of encouragement -- my daughter told me she loved me and filled me in on life in Boston, my nursing friends gave concrete suggestions and ideas, my dad sent his usual humor filled email to make me laugh out loud and my dear mother sent one short line. "Sheila, all will be okay because strong women and nurses are there -- I love you, Mom" She was a very wise woman who left us too soon, and I miss dearly.

All was okay, we opened the outpatient clinic at the hospital a few weeks later and, although there are still challenges, it is amazing to see the hospital bustling and alive. All will continue be okay because we are strong women and men, because we will step up, we will see all people, not as the other, but as part of our human race. We will use evidence-based practice to provide excellent clinical care, we will use our leadership and our voices to demand healthcare as a human right regardless of where you were born, how much money you have, what color you are or what gender you are. We will treat people with dignity, respect and compassion. We will work in the shadows and bring in the light. And in the words of my mother -- All will be okay -- because the nurses are here. Congratulations to all of you.

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