Notes on Nursing

'Give me strength and wisdom, when others need my touch; 

A soothing word to speak to them, their hearts yearn so much.

Give me joy and laughter, to lift a weary soul;

Pour in me compassion, to make the broken whole.

Give me gentle, healing hands, for those placed in my care;

A blessing to those who need me, this is a Nurse's Prayer."

This is the view I want my patients to see, not the face behind the mask, the tight fitting respirator, the face shield, the gown, and the gloves. The social distancing, shielding, and mandatory mask wearing for every patient interaction is new world nursing, and it may continue for the rest of my career. As a daughter, sister, wife, and mama, I have been a caregiver for most of my life. I graduated nursing school at the age of 20 and had my first job in a hospital taking care of patients when I turned 21. Since then, I have had the pleasure of working in many different areas and with many wonderful people. Due to the COVID-19 pandemic, I have been functioning as a relief nurse in an urban community hospital, which means I am floated to where I am needed. If you are a nurse, you know that floating is a challenge. As professionals, we have the ability to specialize within the healthcare field, fine tune our nursing skills, and take pride in our experience practicing in the areas we thrive in. With 17 years working as an intensive care nurse, I transferred to post anesthesia nursing 5 years ago for a much needed reprieve from caring for patients and families in crisis. I work part-time and enjoy caring for patients having surgery. The skill set is specific, fast paced, and full of health related teaching. Most of the patients go home, and that is good to see from a personal perspective. For the past few months, my job has changed every day. I have had to adapt, remain flexible, and expect the unknown.

This week marks a celebration of nurses and nursing as May 12 is International Nurse's Day. 2020 honors 200 years of modern nursing, led by Florence Nightingale on the day of her birth. Florence Nightingale was a war nurse, a British social reformer, a writer, a teacher, and a mathematical statistician. She is the reason every prospective nurse must take statistics in college. Her work focused on the very basics of health, including sanitation, hygiene, observation, and common sense.

The World Health Organization (WHO) designated this year the 'Year of the Nurse and Midwife', highlighting the role of nurses that make up the majority (more than 50%) of the healthcare force worldwide. An initiative of the WHO is to bring adequate healthcare to humans across the globe. The organization believes that nurses are the "bridge", a crucial link between the complex healthcare systems and the people in the communities. Nurses are on the "front lines" of healthcare, and are the key factor in achieving this goal. The nursing profession has been ranked the most trusted profession for the eighteenth consecutive year as noted by the Gallup poll. Nurses continue to uphold the highest ethical standards out of a wide range of professions, including doctors, police, and teachers.

This year also marks the release of the first ever 'World Nursing Report', which provides an assessment of the 'fitness for purpose' relative to the General Programme of Work from 2019-2023 (GPW13). The leadership priorities are high, with goals to reduce global maternal mortality by 30% and reducing malaria case incidences by 50%. Gender equality, health equity, strengthened national, regional, and global capacity for epidemic prevention and protection, communicable and non-communicable disease prevention, mental health prioritization, and addressing the health impacts of climate change and its associated environmental risks are just some of the other outcomes this report hopes to achieve.

In addition to the WHO efforts, the "Nursing Now" campaign, endorsed by Kate Middleton, elevates the role of nursing in health promotion, disease prevention, and access to treatment. If you want to support this movement, you can join Nursing Now, pledge, raise awareness, and share your experiences.

As a young nurse, one of the first books I read about the profession was 'Notes on Nursing: what it is and what it is not' by Florence Nightingale. I recently re-read this book, as it had been over 10 years since I pulled it off my bookshelf. Originally published in 1860, it is amazing to me how her research on nursing remains the foundation for health care, prevention, and treatment. She stressed the power of observation, experience, non-judgment, cleanliness, hydration, nourishing foods, healing environments, and strict sanitation as the fundamentals to becoming "a good nurse." Her "notes" were meant to provide knowledge and practical advice on the very basics of how to nurse, with the belief that anyone who has ever had personal charge of the health of others, is a nurse. The details to which she describes the importance of the health of one's house to keep families healthy is still valid today. In the section titled, "Health of Houses", she states the five essential points in securing the health of one's house:

1. Pure Air. 2. Pure Water. 3. Efficient Drainage. 4. Cleanliness. 5. Light.

With regard to ventilation and light, Nightingale states, "A dark house is always an unhealthy house, always an ill-aired house, always a dirty house. People lose their health in a dark house, and if they get ill they cannot get well again in it."

In addition to these essential points, Nightingale writes about how dirty, overcrowded hospitals often meant death for patients. Her observations of sick patients led to the practice of compassionate care, acknowledging the physical, mental, emotional, and spiritual aspects that make up a whole person. Hygiene, cleanliness and sanitation were top priorities. "Every nurse ought to be careful to wash her hands very frequently during the day. If her face too, so much the better." She promoted the importance of rest and sleep, pointing out that an environment filled with unnecessary noise and too many people is not a healing environment. She addressed the unethical situations of talking loudly, having conversations over patients, and generally having disregard for one's healing process related to overstimulation of their senses and emotions, an issue still prevalant today.

As nurses, we continue to uphold these standards and carry on a legacy of nursing that is filled with other inspiring caregivers. Here are a few examples of amazing nurses in history.

Clara Barton was originally a teacher, but became an independent nurse during the Civil War. She is most famous for her relief work with an organization known as the International Red Cross. Her statue at the State House in Boston, MA was an inspiring symbol to me when I first saw it on a fifth grade field trip with my class. 

Mary Jane Seacole was a Jamaican born Creole nurse who utilized traditional African and Caribbean medicines along with modern knowledge of medicine and infection. 

Dorothea Dix a teacher and mental health advocate helped provide humane housing and treatment for people suffering with mental illness during her lifetime. 

Mary Eliza Mahoney was the first African American registered nurse in post-Civil War era U.S. who paved the way for other women of color to receive formal nursing training. She held positions of respect and leadership, joined what is now known as the American Nurses Association, and was one of the first women in Boston to register to vote in 1920.

Lillian Wald founded the first organization of "Public Health Nurses" in New York, her focus was caring for immigrants, and people who couldn't afford healthcare. 

Walt Whitman was an American poet, essayist, journalist, humanist, and volunteer nurse during the Civil War. "The Wound Dresser", one of Whitman's "Drum Taps" poems, described his service as a nurse during this time. 

I don't know what the future of my nursing career holds, but I do know that for me, nursing has always been a practice of hope, support, strengthening, caring, cheering, and empowering others to nurse themselves.

2020

~The Year of the Nurse and Midwife~

This post is dedicated to all essential workers, and to those who have taught me to nurse, and who continue to inspire me to be a nurse.