Nurse of the Week Marie Manthey is a very busy 85-year-old nurse, entrepreneur, advocate, and activist in the anti-racism movement. After the American Academy of Nursing presented her with a Living Legends award in 2015 for her pioneering work in developing the Primary Nursing model, she did not retire to rest on her laurels. Manthey continues to host her Nursing Salons (regular gatherings in which nurses meet to share conversations and support), works with the company she founded and is still an active advocate for nurses suffering from substance use disorder.
Manthey is also a leader among nurses in the anti-racism movement. After the summer wave of anti-racism protests, she met with DailyNurse to talk about what it means to take action against racism, her journey as a White ally, and her latest Creative Nursing article, which takes a look at trailblazing Black nurse Frances McHie (pronounced “mic-hye”) and the struggle to overcome racism at the University of Minnesota School of Nursing.
DailyNurse: How did you first hear about Frances McHie?
Marie Manthey: “The school of nursing at University of Minnesota has long had a group of very strong volunteers who have a very extensive collection and data [on the history of the nursing school]. So this group of alumni volunteers—who care passionately and energetically about the history of the school of nursing—are responsible for managing historical documents.
And in that documentation area, we found that our first African-American student, Frances McHie, had only been admitted by demand of the legislature. (We recently celebrated the centennial of her admission, which was attended by some of her descendants).”
DN: How did you become involved in the anti-racism movement?
MM: “My awareness began when, 4 or 5 years ago, the Dean of the University of Minnesota School of Nursing, Connie Delaney—who is a phenomenally transformative leader—brought in a speaker to talk about white privilege. That was the first time I had heard that term. She also brought in a university-wide task force on diversity and equity, and I attended some of their open discussions about what is happening to African-American students in our school today.
The next step for me, was I became friends with an African-American person. Her name is Tammy, and she’s a nurse in an administrative position at a local hospital. Well, we met at a statewide leadership meeting, where we made a commitment to develop our relationship and became friends. Tammy started to come to the nursing “salons” I had formed earlier—where we would have dinner, and talk, where the question would be asked, “what’s on your mind about nursing?” and at the end of the evening we would go around and respond to the question “what’s on your mind about nursing now?” After Tammy joined us, we often found ourselves discussing issues affecting nurses of color, and Tammy went on to open a Black nursing salon. We held the first one at my house, and mine was the only white face there. That was part of my leap to a different level of understanding because I listened to what these nurses were talking about. And as I’m listening to them, I’m hearing about what systemic racism really looks like! I had not understood it before; I thought it was about the way we individually deal with racism.
[At the Black Nurses’ Salon] I began to understand what the system has done. It was a big breakthrough. I could finally see where I was in the system as a nursing leader. I could see where some of the decisions I made that involved a person of color versus a White person going for a promotion or better hours, and my decision would sometimes be ‘well, it would work out better if we give this to a White person; she’ll get along better.’ And I didn’t see that until I heard these nurses talk about what it’s like to apply for better hours or something, and despite equal education, equal experience, the white nurse will get it. Also, until now, I didn’t really understand White privilege. Now—at the age of 85—I finally get how being born white has affected everything from my thought processes to my life experiences. It’s very clear to me that action is the only solution.
Tammy and I are going to start another Salon on diversity in nursing with an equal number of nurses of color and nurses who are white. To get us talking to each other.”
DN: It’s complicated. On one hand, it’s not the job of Black people to tell Whites, “this is what you need to do to stop being racist,” but at the same time, we can only learn by communicating in an open, willing dialogue.
MM: “I had to learn how to listen without judgment. At the Black Nurses Salon, I went in ready to just accept what everyone was saying without deciding whether I agreed with everything that was being said.”
DN: One of the biggest obstacles we face is that we are living in an age of “I’m not a racist” racism.
MM: “That’s very true. I discuss that in some detail in a piece I wrote on my journey toward becoming an anti-racist. I went from proudly saying, “I’m not racist!” to actually taking on responsibility for taking steps to dismantle systemic racism and acknowledging that my people with my skin color have been building this system for 400 years At the salons, I began to accept responsibility for what happened. I didn’t ask for it or personally cause it to happen, but it was part of my culture. People of color certainly didn’t ask for it either…..and both of us have experienced the impact of systemic racism.
After taking responsibility, I began to understand that the only solution—I’m a big follower of Nelson Mandela and the idea of reconciliation; it’s a big part of my value system—is reparations. I don’t necessarily mean financial, but the way I am in my world, how I present myself, how accept what other people are saying to me.”
DN: That brings us to the Frances McHie nursing school scholarship, which is a form of reparation, right?
MM: “Yes. When the idea of a scholarship in Frances McHie’s name came up, we found a relative of hers who was a nephew and began putting some flesh on the idea. And with his help, we established the Frances McHie Scholarship for nurses of color [at the University of Minnesota School of Nursing]. That was an action step following a public apology to the McHie family. Dean Connie Delaney made a public statement reflecting that the Frances McHie scholarship was a step in reparations and in accepting the school’s responsibility for racism.”
DN: What other actions are nursing schools taking to reduce the effects of systemic racism?
MM: “Some are changing admissions criteria from a hard GPA requirement, and are taking a person’s story into account as well. I think that’s a good idea. There’s no doubt that people of color don’t have equal opportunities. I have a book that was published in 1933, [Carter G. Woodson’s] The Mis-Education of the Negro. It tells the story of how Jim Crow schools started. It says they were teaching them at a lower level, and that’s been carried on through the years.”
DN: What sorts of things can individuals do to fight racism, on an immediate level?
MM: “We can look at big-picture issues—who we elect as our representatives, our senators, etcetera, but we also have to work on a personal level. We need to make deliberate, conscious, intentional choices about the way we live our lives. What is my circle of responsibility and control, and how do I want to be in those areas? I have to look at the way I interact with my children, my friends, my family, my associates, and ask “what are the things that I can influence?” For me writing—for instance, the article [on Frances McHie] and my personal story about my journey—can help me to influence others to work toward change. I just feel that that is what I need to be doing at this point in my life. This is a personal choice we make: are we going to continue to be the way we’ve been, or are we prepared to step into an area where we can’t predict what people’s reactions will be?”
DN: Are more people sincerely examining their own views and trying to move forward?
MM: “I feel very hopeful because so many people are having these conversations. I have these conversations with a lot of my friends. A lot of [other White people] are talking to me about racism. And my company is creating a task force; we are engaged in looking at everything we do.
I’m also the chairman of the board of Directors of the Nurses Peer Review Network, which helps nurses who have been struggling with addiction and are trying to regain their licenses. I’ve been asking people, “can you help me find African-Americans or other people of color for our board?” We recently added our first Black board member, and we have two more we are considering for our [organization. And I think that I’m not the only person who is doing this. Best Buy is looking for enough people of color and women to make up 30% of their new hires. A number of companies are taking action, and I think that’s a hopeful sign.”
Marie Manthey is the author of the award-winning book, The Practice of Primary Nursing, and is a co-founder of the journal Creative Nursing. Manthey’s recent article on Frances McHie—the nurse, activist, and entrepreneur who broke the color barrier at the University of Minnesota School of Nursing—is available here.
Founded by nursing pioneer and award-winning author Marie Manthey, Creative Nursing has been a quarterly journal for health care thought leaders and innovators since 1981. The journal is edited by health care professionals who love our professions and have a vision for their future.
In 1995, when they first arrived at Vista View Elementary School in Burnsville, Minnesota, RN Barbara Wardell and CNA Donita Luth knew they would spend much of their time administering medications, treating minor injuries, and coping with childhood illnesses. However, before long they also learned that nursing grade-schoolers can be a lousy experience. “Lice happens,” says Wardell. “Anybody can get it. It does not determine if you are clean or dirty or rich or poor or anything. You get it.” At first, the school principal “had to show us what head lice looked like because neither one of us had ever seen head lice,” but after 25 years, they have become grizzled veterans in the ongoing war. “Now we have a little collection on a piece of paper in the office.”
When the new school year opens, though, Luth will have to curate the lice collection with a new partner. The 65-year-old Wardell is retiring to work full-time at the apple orchard, winery and cidery she runs with her husband. Her departure will mark the end of a generation of nursing teamwork. The RN and CNA formed a tight bond as they worked to sustain a high standard of care for their young charges. After their first year, they exchanged a “pinky swear” to stay on as a team. Wardell recalls, “We just really liked working together. If I was not in the building, I knew it was in excellent hands because I fully trust Donita to be able to do stuff or to call me if she had a question.”
As school nurses, the two knew they had to depend on each other. Wardell observes, “You have no respiratory team, you have no extra nursing staff — it’s all you, your office, your call. A kid comes in in distress, what are you going to do about it?” She adds, “If we needed to take time off, we’d cover for each other. If we had concerns, we supported each other. We became bonded — it just happened.”
Luth will miss her departing colleague, and reflects, “It’s been a good combination. We’ve made a good team.”
Nursing organizations have joined individual nurses in speaking out. American Nurses Association President Ernest J. Grant, PhD, RN, FAAN issued a moving statement, in which he remarked, “As a black man and registered nurse, I am appalled by senseless acts of violence, injustice, and systemic racism and discrimination. Even I have not been exempt from negative experiences with racism and discrimination. The Code of Ethics obligates nurses to be allies and to advocate and speak up against racism, discrimination and injustice. This is non-negotiable…. At this critical time in our nation, nurses have a responsibility to use our voices to call for change. To remain silent is to be complicit.”
“You clapped for us. We kneel for you.”
A mingling of professional training and empathy moved nurses such as Miami RN Rochelle Bradley to take a knee in remembrance of Floyd’s death. Bradley told CNN that “Kneeling here today for nine minutes and knowing that that’s how long George Floyd was on the ground with his airway compromised really bothered me as a nurse.”
For healthcare workers, the protests also reinforced their sense of unity in the era of COVID-19. In Boston, nurses who gathered to kneel in front of Brigham and Women’s Hospital carried a sign reading, “You clapped for us. We kneel for you.” One nurse interviewed, Roberta Biens, said, “I just want everybody to know they’re not alone, we’re with them and we’ll stand in front of them or behind them, wherever we need to be to support them.”
Minneapolis nurses appeared in force at the protests. One local ER nurse told the Insider, “COVID is a temporary and critical health crisis. Racism, through violence and disease, has been killing our patients since the hospital was built and will continue killing them long after COVID is gone.” And in an official statement, the Minnesota Nurses Association said, “Nurses continue to see the devastating effects of systematic racism and oppression targeting people of color in our communities. We demand justice for George Floyd and a stop to the unnecessary death of black men at the hands of those who should protect them.”
Hospitals in New York City united to stand behind the protests. The Gothamist scanned official Twitter posts and noted, “The six major hospital systems in the city–NYU Langone Health, Mount Sinai Health System, New York-Presbyterian, NYC Health + Hospitals, Northwell Health, and Montefiore Health System–have all posted publicly in support of the demonstrations…”
Weighing the Call to Civic Action Against Public Health Concerns
Medical practitioners are understandably divided about engaging in public assemblies while the coronavirus is still at large, but many believe the risk is worth taking. On June 8, World Health Organization (WHO) director-general Tedros Adhanom Ghebreyesus said, “WHO fully supports equality and the global movement against racism,” but added, “As much as possible, keep at least 1 meter from others, clean your hands, cover your cough and wear a mask if you attend a protest.”
Asked by Health.com about the danger of public protests, Natalie DiCenzo, an Ob-Gyn resident in New Jersey, responded that “the risk of remaining silent and complacent in the face of racism and police violence is also deadly. I believe that with the proper precautions, these protests can be done relatively safely when it comes to COVID-19.”
Nearly 2,000 US “public health professionals, infectious diseases professionals, and community stakeholders” also expressed direct support for the national protests in a widely circulated June 4 letter (initiated by faculty from the University of Washington School of Medicine). Following a statement that “White supremacy is a lethal public health issue that predates and contributes to COVID-19,” the letter recommended a series of safety measures to protect protestors from the virus. Among other issues it urged “that protesters not be arrested or held in confined spaces, including jails or police vans, which are some of the highest-risk areas for COVID-19 transmission, “ and that no use be made of “tear gas, smoke, or other respiratory irritants, which could increase risk for COVID-19 by making the respiratory tract more susceptible to infection…”
On Twitter, nurses participating in the protests offered their own practical suggestions. A DC pediatric nurse told attendees to bring gloves, sunglasses or goggles for eye protection, and “an extra mask. Yours will get hot and sweaty so switching it out halfway through is smart. If you have a cloth mask throw a bandana on top too…” Following participation in protests, some nurses have also taken the step of self-quarantining for two weeks.
The state of Minnesota is making headlines this December, not for its freezing temperatures or a new record snowfall, but for increasing medical cannabis access. Clinical cannabis got its start in the state when former governor Mark Dayton signed the first Minnesota medical cannabis bill into law in 2014. Many criticized the bill for being far too restrictive as it listed only 9 qualifying conditions and stipulates a lengthy patient registration process. However, as of December 3rd, 2019, the state added macular degeneration and the much more generally outlined chronic pain to the list of qualifying conditions. Minnesota can now expect to see more registered medical cannabis patients thanks to the expanded list of qualifying conditions.
Making Medical Marijuana More Accessible
Though many American states have taken steps to legalize clinical cannabis, a number of potential patients still do not have access. In most cases, state regulations prevent people with certain conditions from using medical cannabis. If the state regulatory body does not list a medical condition as qualifying, then people suffering from that condition may not use cannabis for medicinal reasons, even if a medical professional recommends it as a potential treatment. The stringent nature of qualifying condition lists make Minnesota’s addition of chronic pain as a qualifying condition a massive win for medical cannabis advocates.
Chronic pain is a very generally defined medical condition. Any number of ailments can cause it and is usually up to the patient to define. For these reasons, acquiring a recommendation for medical cannabis can be far easier than it is for other conditions. There is little doubt that Minnesota’s clinical cannabis patient registry will expand greatly in the coming months thanks to the addition of chronic pain and macular degeneration. According to the Boston Globe, “As of October, nearly 18,000 patients were certified for the state’s medical marijuana program.” That number is bound to increase as more conditions make the list.
The Future of Medical Cannabis in Minnesota
Many consider Minnesota as having one of the more severely restrictive medical cannabis programs. Though Minnesota’s list of qualifying conditions is still small, it is encouraging that the state continues to implement updates. Lawmakers must work with patients and advocates to continue to pursue the creation of a fair and easily accessible medical cannabis program. If the state continues to update its list of qualifying conditions, it can at least begin to change the narrative.
Just before a series of major climate change rallies were held in cities across the US, the journal Creative Nursing published a special issue on climate change. We spoke with special issue editor Katie Huffling, MS, RN, CNM and contributor/editorial board member Teddie Potter, PhD, RN, FAAN to learn more about climate change as a public health issue, and why so many nurses are attending these rallies and speaking out.
climate change important to the mission of the health and nursing professions?
TP: In nursing we are charged to create environments for people to be the healthiest individuals and communities that they possibly can be. Climate change threatens that. It threatens our patients and communities on multiple levels. The health impacts of climate change are severe and serious, and they’re happening right now. So that why it is important for us to address this as nurses.
longer happening in some parts of the globe, or in some
geographic areas; it’s happening everywhere. Unfortunately, it tends to have
the greatest impact on communities that are already struggling to be healthy. If
I am already challenged by being homeless, for instance, not having access to
AC or heating can lead to real [health] problems, and we see people with such
challenges often suffering worst and first from climate change.
And it’s important to point out that yes, the planet is warming but the impacts are very variable. Places that used to be cool are getting hot; some places that were usually dry are getting very wet. It’s the shift in patterns that has definite health consequences. In California, for instance, you might be more apt as a nurse to be aware of the impact of fires on the air quality affecting individuals and families and people who work outdoors.
But isn’t climate change a political issue? Why should nurses get actively involved?
TP: I hope we have made it very clear that climate change is not a political issue, any more than people having adequate food or clean air should be a political issue. It’s a health issue. And we need all people regardless of their political affiliation to be part of finding solutions and part of finding a healthier future for everyone.
KH: The Lancet has been publishing for the past few years an analysis of climate change and health and they are very clear that climate change is the biggest public health challenge that we face today. It’s a health issue, and the future of our children is at stake.
Are nurses already
seeing health issues connected to climate change?
TP: In Minnesota, we’re seeing changes in our vectors. We see more [outbreaks of] Lyme disease and West Nile disease; we see more people affected by flooding and loss of housing and livelihoods related to flooding. Farmers can’t get their crops planted on time [owing to flooding] and they can’t get their crops harvested on time, so we’re seeing impacts in that area. Health care providers need to understand that there are things we need to be considering in order to protect our patients and teach families and to ensure that if a disaster is likely, that people have a plan. For example, we need to ask “What are you going to do when category 4 and 5 hurricanes come into your area?”
KH: One thing I would add is that no matter what type of nursing you do—whatever your patient population is—there’s some way that climate change impacts that population. For example, when you have extreme weather events, and you have renal patients, are they going to be able to get dialysis? Nurses working in that area have been real leaders in working on emergency preparedness. The same goes for oncology nurses—are your patients going to be able to get their cancer treatments in a timely fashion. There are some things when you first think of them, you don’t realize how it really does span any type of patient population.
“We need to be planning for these people.”
TP: Also, there are community nurses worrying about patients who are homebound and in need of oxygen and other things that require a steady source of electricity. We need to be planning for those people. What do you do when flood waters rise, and you can’t get out of your house because you’re wheelchair-bound? And your caregiver can’t come because they’re stuck [in the flood] where they are, and you can’t even get out of bed? All of these things have to be thought about.
KH: As an example of that, here in DC it’s gotten better because the local utilities have been addressing it, but there were lots of power outages accompanying extreme weather events during the summer. And when families with children on ventilators at home don’t have electricity for a few days, they end up having to take up an ICU bed because they’re not able to be on just a general floor.
TP: As a state that has a significant rural population, [In Minnesota] we are also concerned about people working outside who harvest and pick the crops. We’re concerned about dehydration. A while ago one of our Minnesota Vikings players died from heat exposure and dehydration at the Vikings summer training camp. This is not something that we’ve had to think about in the past. Hot and humid days can impact even young people in peak condition and we are having more and more days with high heat and humidity.
Are today’s nurses
following in Florence Nightingale’s footsteps? Was she the first activist
TP: She was an activist but also a scientist. She was deeply committed to evidence-based practice and she was a brilliant statistician. She really looked at the environment as doing the healing for patients. As she said in Notes on Nursing, “medicine and surgery can remove obstructions… nature alone cures.” And she was a great believer in and taught about the importance of good food, adequate hydration, mobility, cleanly environments, and exposure to fresh air.
In the Crimean war what got her started was that they were seeing more people dying from the care they received in the hospital than from the injuries they received on the battlefield. So it was a care issue and that was what marshalled her and other women at that time to go to Turkey and set up an alternative way of caring—fresh air, clean sheets, adequate food—and people started surviving. It is deeply at the core of the nursing profession: we work with the environment to put people in a position to recover and have a quality of life. Nurses are on the move following the same principles today.
How can nurses get—and how are they getting—involved in the movement to reduce effects of climate change?
KH: I think there are a number of points of engagement. Nurses are really can-do people. When they find a problem, they want to fix it, and so when you start to learn about climate change and its effects, it is natural to immediately want to get engaged.
I think this is a great opportunity for nurses to get together—you know, strength in numbers—to elevate this issue and use our position as America’s most trusted profession to talk about it. Also, [it’s important to] meet with policy makers—whether it’s at the state, national, or local level—when you can speak with elected officials and help them to make that health and climate change connection. Because a lot of elected officials still don’t understand that it’s a health issue and if they want to protect the health of their constituents it’s an issue they need to be taking on.
And, it’s been very exciting to see so many nurses doing things like going to the different climate marches. It’s another way to show that nurses are leaders in the area around climate change. One of the things my organization (ANHE, the Alliance of Nurses for Healthy Environments) has been doing is we’ve created a nursing collaborative on climate change and health. This came out of a round-table we did at the White House during the Obama administration where we had around 20 nursing organizations and unions at this round table talking about what nurses can do about climate change and health. It was a really historic event. We were the first group of health professionals that they had reached out to at the time to do something like this.
After that, we decided we needed a strong collaborative effort, and that is how we created the Nursing Collaborative on Climate Change and Health. We have 11 organizations, and a couple more really large organizations about to sign on. Working together we show visible leadership among the nursing community as well as among policy makers.
nurses find out more about the impact of climate change?
KH: Well, at ANHE (Alliance of Nurses for Healthy Environments) we have tons of resources on the website, lots of free tools for nurses to engage. We’ve got talking points, academic databases and case studies, resources for pregnant women and children, and much more.
We’re also part of the Nurses Climate Challenge, in which ANHE’s partnered with Healthcare without Harm. Basically in the Nurses Climate Challenge we have Nurse Champions that sign up on the website. The champions then go out and educate their fellow nurses and other healthcare professionals about climate change and health. They have a really robust toolkit with PowerPoints with notes and posters they can customize if they want to make a presentation at their monthly nursing meeting. Then we track each event: if someone does a presentation, they note how many attended. The first year we had a goal of 5,000 nurses and other healthcare professionals educated, but we quickly grew past that so we decided to up our goal to 50,000 nurses educated by 2022. And we just started that a few months ago, and we’re already past 10,000. It’s exponentially growing!
“It’s an amazing opportunity to prevent disease.”
I’d like to bring in another positive note: this is also the greatest opportunity that we have to impact public health. These things that we can do to affect climate change can have a widespread positive impact on health. It’s an amazing opportunity to prevent disease. And I think that that’s another core feature of nursing practice—that we want to see our patients become healthier and to not have to be treating them for these preventable illnesses. When we address climate change we can have such a positive impact on health.
TP: I’ll just add in that the dean of the Minnesota School of Nursing has appointed me the first Director of Planetary Health for the school, so that nurses can learn to apply what we do to care for the environment so that our patients and our communities will be healthier.
Professional Practice in a Changing World: The Changing Climate
In this special issue of Creative Nursing, vol. 25-3, featured articles include “In Nightingale’s Footsteps—Individual to Global: From Nurse Coaches to Environmental and Civil Society Activists,” “Planetary Health: the Next Frontier in Nursing Education,” “Beyond the Slogans: Understanding the Ecological Consciousness of Nurses to Advance Ecological Knowledge and Practice,” and more…
This is the first time nursing contract negotiations are being
held since 2016, when Allina hospital nurses went on strike for health
insurance benefits. These current negotiations have been in talks, with
contracts set to expire May 31. But it appears that no deal will be happening
by then, and the MNA is planning to strike again.
Workers compensation claims increased by nearly 40 percent
between 2013 and 2014, up to 70 percent, and have remained at 65 percent or
higher since then. These numbers reported by the Minnesota Department of Labor
and Industry only count the most severe cases reported, including those where
nurses missed three or more days of work due to injury.
Talks for nurse protection have been gaining speed since a
2014 incident, where a patient attacked and injured four nurses with a metal
bar. Minnesota passed a law in 2015, making hospital staff training on
de-escalating and preventing violence mandatory.
Another nurse, Michelle Smith, is back to work in surgical recovery but still going through recovery from a concussion she got roughly two years ago. She similarly is pushing for more support in negotiations to prevent these incidents from happening.