Changing Nurse Stereotypes Through Creative Control

At a restaurant, I demurely settled onto a chair pulled out by my escort. Glancing at the menu,  I wonder out loud what the night’s special might be. In a gesture meant to display his bravado, my date raises his finger to signal the server, shouting, “Nurse!”

Another relationship bites the dust.

If Kafka Wrote About a Nurse by jparadisi

If Kafka Wrote About a Nurse by jparadisi

The public’s image of nurses hasn’t changed for decades. Every Halloween, sexy nurse costumes appear out of nowhere, as if summoned by call lights. On TV shows, doctors do hands-on patient care while nurses find the necessary supplies STAT! from wherever TV hospitals store their supplies.

The media represents nurses as one of five basic archetypes. Oncology nurses, in particular, tend to get lumped into the nurse saint group, perhaps because of the longstanding relationships we tend to develop with our patients. It’s a difficult persona to uphold during long, short-staffed shifts.

Additional images are created from combinations of the basic five, which are:

  • Nurse bitch
  • Nurse saint
  • Smart-ass nurse
  • Nurse/mother substitute
  • Sexy nurse

Why do derivative portrayals persist?

Because screenplay writers do not write from a nurse’s perspective.They write about nurses from their own point of view, limiting the possible creation of new characters. These portrayals of nurses are weak because depth of knowledge, intuition, internal dialogue, and a range of personalities cannot be grasped through observation without familiarity. Writing workshop instructors will tell you: Authenticity only occurs when a writer has a clear understanding of her topic.

For instance, in his deeply moving novel, Cutting for Stone, Abraham Verghese creates a complex tapestry of personality for his character, the surgeon Thomas Stone. However, in his portrayal of Sister Mary Joseph Praise, the mother of Stone’s twin sons, Verghese resorts to a clichéd saintly-sexy-mother nurse composite who dies early in the story, saving him from further character development.

I’m going to go out on a limb and suggest Verghese is more familiar with the personality traits of surgeons (he’s an MD) than of nurses. He writes a stronger character when he’s familiar with his character’s point of view.

With this in mind, I believe nurses will not be authentically represented in the media until we raise book writers, novelists, and screenplay writers, or TV and filmmakers, from within our ranks. The media’s portrayal of nurses will change when nurses take creative control of it.

What might occur if grants were available to nurses desiring to make film documentaries, write books, or create paintings from our point of view? What if hospitals allowed, and encouraged, creative sabbaticals for nurses to pursue such projects, as do many other industries? Would the public perception of nursing change? Would nurses’ perception of themselves change? Would patient care and delivery of service also benefit from nurse empowerment through creative control?

Nurses: Telling Our Stories Can Help Others

In art school, I once presented a painting entitled, “Recuerdo (I Remember)” for class critique. The painting was inspired by my experiences as a pediatric intensive care nurse.

The image sparked an enthusiastic discussion among fellow students, during which I answered many questions about the role of nurses. One classmate told the story of her baby’s stillbirth decades earlier. She thanked me for the sensitive rendition, allowing her to share her story.

The instructor said, “You’ve got something here.”

Recuerdo (I Remember) by jparadisi

Recuerdo (I Remember) by jparadisi

Recuerdo appeared in the college’s continuing education catalog the following spring. I was pleased with the painting’s reception, but I realize it could as easily have had the opposite effect: bringing a classmate to tears. Nurses’ stories are proverbial double-edged swords. When wielded thoughtfully, they heal. Even so, they can easily cut someone else to the bone.

I am aware of the power of story when practicing oncology nursing. I was occasionally a patient at the infusion clinic where I now work. My coworkers view the story I bring from the experience favorably. That I can teach tying scarves into attractive head coverings for chemo-induced alopecia is a plus. However, through trial and error, I have gained judiciousness about telling patients I am a cancer survivor.

Here are some self-imposed rules I follow about story telling in the patient care setting:

  • Know your patient’s prognosis. It’s one thing to tell a newly diagnosed stage 1 breast cancer patient that you are a survivor, and that her hair will grow back. It’s something else entirely to say the same thing to a woman with metastatic disease. Tailor the story to the patient’s needs.
  • Talk about cancer treatment in universal terms. Some cancers do not have the same level of news exposure and financial support as breast cancer. Cancer patients should not feel they have a less “special” kind of cancer.
  • If you are not ready to answer questions about your experience, don’t bring it up. It’s natural for patients in similar circumstances to ask what treatment options you chose. If we’re talking about breast cancer, they may ask if you had a mastectomy. If so, one or two? They may ask about sexuality, too. You might be judged for your answers. You have to stay therapeutic anyway.
  • Allow patients to have their own experiences. Cancer treatment is not one size fits all. Do not assume that a patient shares your concerns. Exchanging information is often best done through asking questions rather than offering opinions. Let the patient direct the conversation.
  • Know when to let go. Being a cancer survivor does not make me the world’s best oncology nurse. The experience is simply a tool at my disposal. What’s best for most patients is a team of expert, compassionate caregivers bringing their unique experiences to the conversation.

Have you had a health condition that impacts your approach to nursing — or a coworker who has? What advice would you share?

Ah Yes! Back in The Studio

I write so much about nursing and art that I sometimes forget I’m a painter. Low census yesterday meant I had a free day in the studio, with this result. I love the flexible hours of nursing!

Untitled (Woman Holding Baby Doll) oil on wood by jparadisi 2013

Untitled (Woman Holding Baby Doll) oil on wood by jparadisi 2013

Commitment Makes You an Artist or A Nurse

That I am an artist was never questioned by anyone other than myself. It took time for me to believe in myself as an artist, because I felt I would know when I became one. Some artists laugh at such thoughts:

In artistic work one needs nothing so much as conscience; it is the sole standard. — Ranier Marie Rilke

Self-Portrait. Pencil on paper by jparadisi

Self-Portrait. Pencil on paper by jparadisi

How do I know I’m an artist?
The same way I know I am a nurse: Not because I am paid for my work, but because of my commitment to nursing. Commitment manifests itself as time set aside for continuing education, and time to practice skills. It’s not enough to want to do something. You need time to practice skills, whether it be starting IVs, or developing a series of paintings for exhibition. You commit to nursing through education, taking boards, and continuing education. You have to commit to creativity, too.

Begin with one hour a week, every week. It needn’t be the same day or time each week, although a set schedule may make it easier, childcare and weird nursing work schedules may necessitate flexibility. Protect this hour as if it were a difficult-to-reschedule dental appointment.

What will you do with this hour each week? You will have a creative date with yourself. For now, don’t invite a friend. Free yourself completely of taking care of other people. You need to hear your voice to find your creativity. You may already know what you’ll do with the time: write a poem or short story or resume piano, dancing, or voice lessons. If you’re drawing a blank about what to do, here are a few suggestions:

  • Wander the aisles of an art supply or craft store. Give yourself $10-$20 to spend on pens, paper, stamps, inkpads, dried flowers — whatever. Need ideas? Check out MarthaStewart.com, or Pinterest.
  • Wander the aisles of an office supply or dollar store with $10-$20. Buy felt pens, stickers, glitter, glue sticks, and an inexpensive scrapbook. Tear pictures from old magazines of everything catching your eye. Paste them into the scrapbook using a glue stick. Decorate the pages with your glitter, stickers, and felt pens.
  • Buy a cheap rectangular or square flower vase made of clear glass. Fill it three-quarters full with small glass beads. You can use small, polished stones instead, but they tend to scratch the implements. Use it to hold pens on your home or work desk.
  • Go for a walk with your camera. Take snapshots of anything that attracts your attention. Take lots of pictures without over-thinking the process. You’re practicing how to “see.”

The important thing is to make a habit of allowing yourself at least an hour a week to explore and develop your creativity. What ideas can you add to this list?

Maintaining Curiosity in Nursing Practice

Insight is the unanticipated gift of creativity. It struck like lightning during a shift in the oncology infusion clinic.

A colleague asked, “Where does IV iron come from?”

Baby Doll in Conical Bowl by jparadisi

Baby Doll in Conical Bowl by jparadisi

I’ve infused the stuff into patients for years, but never wondered how the iron was obtained. From iron ore? By soaking rusty nails in water? It seemed unlikely it’s derived from blood products, as it’s often prescribed for bloodless surgery patients. However, what most impressed me was the curiosity that stimulated the question in the first place. It demonstrates thinking outside of the box, and beyond a task-driven mentality. Curiosity prevented her from mindlessly hooking an IV drip to a patient. She sought understanding.

Insight struck: curiosity is a foundation of creativity.

The questions “What, how, and why?” gave birth to science and art. They inspired Leonardo da Vinci to dream of contraptions which later became the basis of modern aviation. Artists ask themselves these questions standing before a blank canvas, a lump of clay, or the ingredients for tonight’s dinner.

My father, sitting at the head of our dinner table, told me many times, in his Italian accent (English was his second language), “Sweetheart, never stop devil-upping your coo-ree-os-ity.” I understood he meant: “Never stop developing your curiosity.” It remains excellent advice.

Maintaining curiosity in nursing compels you to create individualized methods for patients to organize and remember their home meds. Curiosity fuels your medication information searches and the creativity involved in formatting to educate people of various backgrounds: patients, their families, students, or coworkers. You create presentations that work best for any occasion: handouts, graphs, pie charts, or PowerPoint.

Curiosity leads you to use creativity in your nursing care plans:

Imagining what losing your hair feels like, you cheer up a chemo patient by helping her collect pictures from magazines of hairstyles — short, medium, and long — so she can visualize her new hair when it grows back. Maybe she’ll try a vivid new color too.

Wondering how to entice a patient to eat more, you explore recipes for textures and flavors of food that will appeal to him.

Why is the easiest question of all to answer: “Because I care.”

Nurses are creative in ways we care for patients. We don’t simply “push a button.” Neither do we stop developing our curiosity. This is the art of nursing.

By the way, IV iron solutions are man-made.

Learn to Say No

Developing creativity requires personal time. You’ve heard it before: Learn to say no.

I was a new-ish nurse working night shifts on a busy hospital unit. Our census exploded,

The Bride by jparadisiWhat are you married to?

The Bride by jparadisi
What are you married to?

and every evening the nurse manager called all off-duty staff begging until someone accepted the overtime shift. It is difficult to refuse extra shifts when it’s your manager asking. This went on for what seemed an inordinate amount of time. Answering machines were new back then, and I resisted owning one.

One afternoon, my daughter raced to the ringing phone, picking up the call before I could. I overheard my manager asking, “Hello, is your mommy there?” As I reached for the receiver, my daughter blurted out, “You’re not going to make my mommy go to work again, are you?” Embarrassed, I grabbed the phone. On the other end, the manager apologized: “I’m sorry, I guess I’ve been calling too often. Enjoy the evening with your daughter.”

The next day, I bought an answering machine, and learned to screen calls.

Not long afterwards, something unexpected happened: The manager took her overtime-paid hours to administration, along with the record of increased census. They discovered they’d save money by hiring another FTE. The overtime calls became occasional.

Moral of the story: it’s not my personal responsibility to fix my unit’s staffing problem. I’m not advocating nurses refuse shifts during staffing crunches. In nursing, being a team player is essential. However, I found that if I work more than two overtime shifts a pay period, I get a diminishing return on the extra income because of taxes where I live. Therefore, my flexible boundary is to limit overtime to two shifts a pay period. I learned to say, “No,” to more than that.

Recognizing which problems are yours to solve, and which are the responsibility of others is the key to learning to say “no,” to coworkers, patients, children, spouses, boyfriends, girlfriends, parents, soccer moms, whomever.

Write this down and tape it to your bathroom mirror:

I am responsible for my own stuff, and that is enough.”

The caveat to this affirmation is:

If you step in it, you’re going to have to clean your shoes.”

Remember:

▪ Avoid drama.

▪ Evaluate commitments carefully.

▪ Protect your personal time.

Our ability to say no is strongly connected to the important relationships in our lives. Nurses in particular are conditioned to believe that saying “No” in order to make time for ourselves is selfish. Add the nurturing nature of a nurse to this training, and saying “No” becomes nearly impossible.

You cannot grow creatively without time to yourself. Recognizing what stuff is yours, and what belongs to others is the first step towards self-care and personal growth.

Do you think nurses have more difficulty saying “No” than other professionals? Do you think this problem is gender related? What experiences have helped you learn to say no?

Are You Circling The Drain? Self-Diagnosing A Creativity Resuscitation

Voiceless mixed media on vellum by jparadisi

Voiceless mixed media on vellum by jparadisi

Productivity and creativity are not the same thing. Neither are they mutually exclusive, but they are not the same thing. I didn’t always know this.

Like most nurses, I have always been productive. Whether making things with my hands, painting the dining room, running 10Ks, growing my own vegetables, or hand-making pasta, I often sat down for dinner around 9:00 p.m. It wasn’t until a breast cancer diagnosis flattened me on a couch that I realized the artist inside of me was starving.

In retrospect, there were early symptoms before the differential diagnosis that a creative resuscitation was necessary. Do you have any of these symptoms?

  • You think, “I can do better than that,” when watching friends or colleagues succeed in a creative endeavor. Maybe you can. The question is, why don’t you?
  • You daydream about what your life would be like if you didn’t have commitments to a job, spouse, children, etc.
  • You use the universal sign of creative strangulation: When you talk, you tend to place one hand at your throat, with the thumb and index finger forming a V around it. What words and ideas are you choking back with that hand?
  • You use the universal sign of carrying the weight of the world on your shoulders: When you talk, you place one hand on the back of your neck. What burdens weigh heavily on that spot? Can you set any down?
  • You feel vaguely unfulfilled despite your accomplishments.
  • You hang out on the periphery of creative people. You have an inexplicable desire to help them succeed, but don’t believe you possess their level of talent.
  • You’re bored despite high productivity.
  • You fear releasing your creativity will destroy life as you know it. You believe you cannot be fulfilled creatively and hold a job or have a family. Or be a nurse.
  • You knew what you wanted to be when you were a child, and it is not what you are doing as an adult.

Nurses recognize when productivity is mistaken for quality in health care. We sometimes fail to make a similar assessment about ourselves.

Do you suffer from any of these symptoms? Can you add to the list?

 

 

Finding Self-Expression in A Profession of Permission

Nursing is a profession of permission.

I had this epiphany when a patient asked me, “Can I have a couple Tylenol for my

Twenty-One by jparadisi

Twenty-One by jparadisi 2007
Inspired by the paintings of the Chauvet Cave.

headache?” The automated medication dispensing cabinet with a drawer full of Tylenol was in plain sight, but I could not give the pills, because I did not have a doctor’s order. I called her doctor and received the order (permission) to administer it.

Anyone can walk into any drugstore in America, purchase a bottle of the stuff, and eat it at will, but in my nursing role, I cannot administer medication without an order (permission). However, there is a reason for obtaining an order first. If this patient has liver disease or allergies, and I am unaware, calling her doctor for something as simple as Tylenol may prevent a medication error; the safety net of redundancy.

On a bad day, this lack of autonomy is tiresome.

Another example is staff meetings. Someone once told me, “For God so loved the world that He did not send a committee.” I did not fully appreciate the meaning of this statement before working in healthcare. Gathering consensus among nurses is like watching a freighter turned slowly by tugboats in a narrow harbor. It seems to take forever. In my opinion, I have the answer to the problem the nurses are discussing. It’s simple and cost effective, but no, everyone needs to give his or her input and sign off on it first. By the time the change occurs, I’ve mentally moved on.

Even using the bathroom during a shift requires asking another nurse to watch your patients while you’re off the floor. Nurses ask permission to use the restroom.

Nursing is a team activity. It’s the nature of our work. As individuals, we bring our unique experiences and voices to this work. Finding a place for self-expression is vital to our humanity — the wellspring of compassion.

Where do we find creativity in a job requiring permission to use the bathroom or eat lunch — after a 12-hour shift of caring for the sick on sore feet? For many of us, home life is just as demanding — shuttling children to soccer practice and music lessons, grocery shopping, making meals, paying bills, and finishing housework. Make time for a little exercise, and you fall asleep exhausted as soon as your head hits the pillow. The next day it starts over.

“Creativity?” I hear you say. “Yeah, right after I figure out how to sustain life on Mars.”

Consider this: Self-expression is so essential that 30,000 years ago, prehistoric humans drew pictures on cave walls to tell their stories. Their daily activities revolved around survival. Food was hunted and gathered. Marauding tribes threatened to take away what small comforts they possessed. Still, they made art.

So, forget Mars and ask yourself: Where can I find self-expression in nursing?

 

 

 

Random Thoughts: I’m An Artist

Three Horses by jparadisi

As much as I love making images of my heart’s desire as an artist, there’s something to be said for developing the ability to create an image on demand. It’s a little like working with a limited palette: it forces me to look at the available options, then push myself to create something I might not have imagined without the limitations/expectations. It reminds me of when I was in kindergarten and the other kids would line up at my easel with their sheets of paper and ask me to draw horses for them. It didn’t make me feel less of an artist, it told me I am an artist.

New Post for TheONC: Can Looking at Art Make You Well?

This week I ask Can Looking at Art Make You Well? in my post of the same title

Girl With Pearl Earring, after Vermeer. watercolor by jparadisi 2012

for TheONC.

I asked the question after re-reading a 1995 essay written by Lawrence Weschler for The New Yorker titled Vermeer in BosniaIn his essay, Weschler interviews Antonio Casse, then the president of the Yugoslav War Crimes Tribunal, during the trial of Dusko Tadic for crimes against humanity.

Weschler asks Judge Casse how he maintained his sanity while listening day after day to grizzly accounts of torture, rape, and murder. Casse’s answer:

“Ah, you see, as often as possible I make my way over to the Mauritshuis museum, in the center of town [in the Hague], so as to spend a little time with the Vermeers.

As do most nurses, I spend my workdays witnessing life and death among patients. At home, the evening news is full of world conflict and disaster. Can merely looking at art calm us and increase our resiliency from burnout, as Judge Casse asserted?

The Oncology Nurse Community (TheONC.org) is a new online social forum for oncology nurses and cancer care teams where they can leverage their collective knowledge, nurture professional growth and emotionally support each other in a secure environment, as registration is required.

Moderated by oncology nurses and key opinion leaders, TheONC features discussions and commentary covering key issues ranging from symptom management and palliative care to managing ethnic and cultural diversity.

Other resources in the community include:

▪                A Library of resources including patient education materials and presentations by community members

▪                Clinic Close-Up, where members can view video-based interviews with experts from large group practices, private practices, and academia covering a variety of topics

▪                News items relevant to clinical practice

▪                An interactive Quiz feature where nurses can test their diagnostic knowledge on a regular basis

▪                A Calendar of national and regional events and meetings specific for oncology nurses and cancer support team members

If you are a member of an oncology nurse or member of a cancer support team, Like TheONC on Facebook, and follow us on Twitter @The_ONC.