In the Year of the Nurse and Midwife, one of the underlying themes is that of nurse leadership—and the nurse leaders of today and tomorrow have a wide range of inspiring role models! Below are profiles of six outstanding nurse leaders as described by Marion E. Broome and Elaine Sorensen Marshall in their new text Transformational Leadership in Nursing, 3rd Edition.
The story of modern Western nursing began with little-noted but great leaders, and it traditionally starts with Florence Nightingale, but the 20th century has also provided us with a wealth of transformational nurse leaders. Six trailblazers include…
Isabel Hampton Robb
Isabel Hampton led nurse training at Johns Hopkins in
Baltimore and was the first president of what became the American Nurses
Association. “Her vision of nursing … required a transformation of … accepted
norms. [Her work] demonstrated her ability to effectively lead change and
inspire others toward her cause” (Keeling et al., 2018).
Mary Adelaide Nutting
Mary Adelaide Nutting was Hampton’s student at Johns Hopkins
and was among the first visionaries to foresee academic nursing education,
rather than apprentice nurse training solely in hospitals. She led efforts to
develop the first university nursing programs at the Teachers College of
Columbia University and to secure funding for such programs (Gosline, 2004).
Lavinia Lloyd Dock
Lavinia Lloyd Dock was a strong woman who was involved in
many “firsts” that influenced the profession for years. She firmly believed in
self-governance for nurses and called for them to unite and stand together to
achieve professional status. She was among the founders of the Society for
Superintendents of Training Schools for Nurses, which later became the National
League for Nursing (2019), and an author of one of the first textbooks for
nurses and history of nursing. She encouraged nurses and all women to become
educated, to engage in social issues, and to expand their views internationally
(Lewenson, 1996). She was known as a “militant suffragist” and champion for a
broad range of social reforms, always fighting valiantly for nurses’ right to
self-governance and for women’s right to vote.
Lillian Wald, who modeled the notion of independent practice
a century before it became a regulatory issue, founded the first independent
public health nursing practice at Henry Street in New York. She not only
devoted her life to caring for the poor people of the Henry Street tenements
but also was the first to offer clinical experience in public health to nursing
students. She worked for the rights of immigrants, for women’s right to vote,
for ethnic minorities, and for the establishment of the federal Children’s
Bureau (Brown, 2014).
Mary Elizabeth Carnegie
Mary Elizabeth Carnegie established one of the first
baccalaureate programs in nursing in 1943 at Virginia’s Hampton University
(American Association for the History of Nursing, 2018). She became the first
African American nurse to be elected to a board of directors of a state nurses
association (Florida). She was on the editorial staff of the American Journal
of Nursing, was senior editor of Nursing Outlook, and the first editor of
Nursing Research. Carnegie was a president of the American Academy of Nursing
and was awarded eight honorary doctorates over the course of her career. Her
legacy of leadership included making the contributions of African American
nurses visible in the professional literature.
Ildaura Murillo-Rohde was a Panamanian American nurse,
academic, and organizational administrator. She came to the United States in
1945 and studied at Columbia University. She was the first Hispanic nurse
awarded a PhD from New York University. Her specialty was psychiatric–mental
health nursing, and she was an outstanding advocate for mental health needs of
Hispanics. Murillo-Rohde was an associate dean at the University of Washington
and the first Hispanic dean at New York University. She founded the National
Association of Spanish-Speaking Spanish-Surnamed Nurses in 1975 and served as
its first president. She was named a living legend in the American Academy of
Nursing (National Association of Hispanic Nurses, 2019).
Today’s healthcare leaders inherit courage, vision, and grit
that must not be disregarded. We stand on the shoulders of valiant nursing
leaders of the past who left a foundation that cries for study of its meaning
and legacy for leadership today. They were visionary champions for causes that
were only dreams in their time but today are essential. They dared to think
beyond the habits and traditions of the time. These leaders were truly
transformational. You are among the pioneer leaders to move healthcare forward
to better serve society.
Association for the History of Nursing. (2018). Mary Elizabeth Carnegie DPA,
RN, FAAN (1916–2008). Mullica Hill, NJ: Author. Retrieved from https://www.aahn.org/carnegie.
The role of nursing has evolved from its early days of taking orders from doctors and working primarily in hospitals to, today, having a leading role in directing patient care and working in an array of non-hospital settings. As we celebrate 2020 International Year of the Nurse and Midwife and National Nurses Week from May 6-12, this is a good time to recognize the ever-evolving role of nursing and the vast opportunities to serve, particularly as we face unprecedented challenges brought by COVID-19.
In just a matter of weeks, health care has gone from status quo to redesigning care delivery in nontraditional ways. Telehealth is the new normal, yet only 55 percent of hospitals fully or partially implemented telehealth systems as recently as 2014. Nurses and care teams are quickly finding new ways of meeting patient needs; developing strategies never even conceptualized before this pandemic. They’re doing this with limited supplies and in some parts of the country, without adequate personal protective equipment; having to make hard decisions such as which patients will get access to lifesaving ventilators. All while feeling the pressure of this ultimate question: how do you provide care to patients and families for a disease that has no cure, while still caring for those who can no longer visit the doctor’s office?
This pandemic has demanded expedited creative thinking, flexibility and innovation from all of us in health care, nurses included.
At my organization, there are many ways nurses have shown adaptability and creativity through this crisis. One of these includes a companion program to provide a safe way for patients with COVID-19 to say their last goodbyes to family members. Within 48 hours, Virginia Mason nurses created a protocol for family members to visit their loved ones one last time. Amid so many heartbreaking stories of people passing away alone from COVID-19, nurses took control and made a solution to a devastating reality for so many families.
Nursing teams are also leading infection prevention work among team members, including monitoring employee health and keeping our hospital’s workforce safe. Early on, nurses helped design a drive-through testing station for one of our medical centers, including templates for screening protocols and overall work to build the necessary record-keeping and team communication for such a process.
None of these activities was part of their regular duties prior to COVID-19 and that’s the beauty of this profession— nurses have an incredible ability to adapt to challenging situations even when they are dealing with the unknown.
As we look to a future past this pandemic, there are impacts of which we don’t quite yet know the ramifications. Before COVID-19, nursing was already facing a staffing shortage, and now that reality becomes even more threatened. Other areas and the full impact on the profession remains to be seen.
However, in all the fear and unknown, this pandemic allows us to see the unique attributes of nursing more clearly, and all of the opportunities within — to lead in health care, care for patients and make a difference in our communities. The opportunities within nursing are limitless, and without nurses, we could not provide the necessary lifesaving, compassionate care that so many in our country need now and in the future.
Ventilators are in short supply for COVID-19
patients, but nurse leaders need a safe way to vent, too.
Continually fighting COVID-19 at work and home is creating unsustainable levels of stress for nurse leaders. Providing a safe place for them to debrief and process their feelings (to vent their frustrations and conflicting emotions) can help them persevere through this ongoing crisis.
Leaders expect to be lonely when making tough choices, but that has never been more true than for nurse leaders during the COVID-19 crisis. Our courageous nurse leaders are in the unenviable position of having to implement previously unthinkable policies and compromises that make them and their bedside nurses feel extremely exposed and vulnerable. These difficult decisions are born out of necessity — like having to use the same mask all day or substituting garbage bags for non-existent protective gowns. But the moral distress these ad-hoc, but unavoidable, measures create is sapping the strength and emotional reserves of even the most confident and committed professional caregivers.
For nurses, there is no escaping the mental strain of COVID-19. Severe stressors surround nurse leaders and their teams, both professionally and personally. When they’re at work, they feel guilty for not helping at home. When they’re at home (however briefly), they feel like they should be at work. And having to decontaminate their clothes and their bodies upon arriving home is exhausting after working yet another 12- to 16-hour day — only to have to distance themselves from their family members once they get inside. Some worry what would happen if, heaven forbid, both they and their spouse were to contract and succumb to COVID-19 leaving their children parentless.
Many nurse leaders are around COVID-19 patients all day every day. The fear of being exposed and not being careful enough at work never leaves their minds. They must be healthy for their families, they must remain resilient for their patients, and they must stay strong for their teams. This relentless mantra repeats itself every day.
Nurses need to talk about what they are seeing and have a safe place to vent. Some of them are the only ones who can hold the hands of patients when they take their last breath. Others are having to facilitate FaceTime calls with family members so patients can give their final good-byes. No one should die alone. But COVID-19 is making this a common occurrence. The effects are dramatic and traumatic on nurses and nurse leaders who confront heart-wrenching moments like these all too often. Creating a safe space for nurse leaders to regularly talk about their COVID-19 experiences can help them clear their mental cache.
With this goal in mind, Lori Gunther and Melissa Gell, partners and co-owners at Synova Associates, are offering crisis debriefings on Facebook for nurse leaders who need to vent. They have invited me to co-facilitate these meetings with them from a clinician’s perspective. We’re calling the group Nurse Leaders One to remind nurse leaders that we are in this together and that they are not alone. Nurse Leaders One is here to help nurse leaders get the confidential emotional support they need to get throughout the COVID-19 crisis. Our daily crisis debriefings last for just 45 minutes to an hour. We meet in the evening, Monday through Saturday. And only 10-15 people participate in each group so everyone can participate.
We are enlisting other facilitators and nurse
executives to help so we can make more of these groups available. Hosting these
groups is important work because, when we take better care of our nurse
leaders, they can take better care of their nurses and patients.
I have never been more proud to be a nurse than I am at this moment. Ironically, we are celebrating The Year of the Nurse in 2020. And, true to form, the nursing community is rallying like never before in the fight against COVID-19. It’s heartwarming to see the recognition nurses are receiving in the media for their dedicated, often heroic service. The voluntary surge in staffing—from even retired nurses—brings tears to my eyes. But if we want to see this level of commitment continue, we’ve got to provide our nurse leaders with the emotional support they need now and throughout this crisis.
We know better than to think sheer willpower will be enough to see us through. We know better, so we’ve got to do better. Please let me know if you are interested in helping us offer more Facebook groups through Nurse Leader One. Contact me on LinkedIn at https://www.linkedin.com/in/armstronglori.
A midwife–especially a Black midwife–can tilt the balance between life and death for African American infants and their mothers. Regardless of income and education level, childbirth for Black women is more dangerous than it is for White women. Even Serena Williams had a dangerous close call during her pregnancy, after doctors failed to heed her request for a CT scan and blood thinner medicine. Despite her history of blot clots, it was posited that “Williams’ pain medication must be making her confused.”
The Centers for Disease Control reports
that African American mothers die at three to four times the rate of White
women, and the mortality rate of Black infants is higher than that of any other
ethnic group in the US. Why? As AmericanProgress.org states in a 2019
policy blueprint, “Racism is part and parcel of being black in the United
States, and it compromises the health of African American women and their
infants… Put simply, structural racism compromises health.” According to Dr
David Williams, a pioneer in measuring the effects of racism on health, “We now
know that discrimination is linked to higher blood pressure, to high levels of
inflammation, to low infant birth weight…”
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One action that promises to change these dire
statistics is expansion of the midwifery movement, especially within the
African American community. Angela
Doyinsola Aina, interim director of the Black
Mamas Matter Alliance (BMMA) recently told an American Public Health
Association (APHA) conference, “We have to go beyond just talking about giving
people, especially low-income people, access to care…. We also need to ask
whether that care is high quality and culturally relevant.”
Where do Black midwives come into the picture? ProPublica
notes in a report
on how increasing the role of midwifery in the US could reduce maternal
complications and mother/infant mortality rates, “Many… [US] states
characterized by poor health outcomes and hostility to midwives also have large black populations, raising
the possibility that greater use of midwives could reduce racial disparities in
maternity care.” And Lamaze.org
suggests, “When Black families are cared for by Black health professionals,
like midwives, they are better heard, seen, respected, understood, and get
their needs met, which relates directly to health outcomes.”
One of the women at the forefront of the Black Midwives
movement is Jennie Joseph, founder of the Birth
Place in Winter Garden, FL. Joseph’s work as a provider of perinatal
services to underserved and uninsured women of color has already brought about
positive change in the CDC numbers. Trained in the UK, where half of all babies
are delivered by midwives, Jennie Joseph arrived in the US to find that in the
most affluent country in the world, owing to concerted opposition from doctors
and hospitals, midwives attend only 10% of all births. She also found that the
US has a much higher incidence of maternal and infant mortality
rates—particularly among minorities and the disenfranchised—than in countries
such as Canada, Sweden, and the UK, where midwives attend the majority of
Joseph’s “open access” clinic at the Birth Place provides pre-natal
and post-partum care for women regardless of their ability to pay and focuses
on minority and underserved women in the area. As Miriam Zoila Perez marveled
in the New
York Times, the Birth Place manages to beat the dire maternity figures for
women of color: “When you look into her statistics, you find something quite
rare: Almost all of her patients give birth to healthy, full-term babies… maybe
not surprising until you learn that the majority of them are low-income
African-Americans, Haitians and Latinas….”
Expanding the Midwives’ Movement
Another pioneering Black midwife is Shafia Monroe, who has long been one of
the major forces behind the Black midwives’ movement. Founder of the
International Center for Traditional Childbearing (which was re-formed in 2018
as the National Association to Advance Black Birth) and winner of a Lifetime
Achievement Award from the Human Rights in Childbirth Foundation, Monroe
started working with mothers and infants as a nurse’s aide in the postpartum
ward at Boston City Hospital at the age of 17. It was in 1991, when she
encountered difficulties in finding a midwife of color for her own pregnancy, that
Monroe founded her influential International Center for Traditional
Childbearing. Under the auspices of the ICTC, she became a pioneering figure in
the cause of Black midwifery. Monroe has worked tirelessly to reduce
mortalities linked to pregnancy and to increase the number of Black midwives
and doulas. To women who are interested in becoming midwives, Moore urges, “Join
an organization! There’s MANA (Midwives Alliance
of North America), ICTC, ACNM (American College of Nurse Midwives);
there’s so many organizations. Look into organizations that are familiar with
black reproductive issues, and our history.”
As the co-director of Black Mamas Matter Alliance (BMMA), Elizabeth Dawes Gay, says, “If even one more person just says they want to take up the cause, they want to become a doula, they want to become a midwife, they want to start an organization—to me that’s a success.”
A History of Midwifery in the United States: the Midwife Said Fear Not
Written by two prominent leaders in the field of midwifery, this book spans the historical evolution of midwives as respected, autonomous health care workers, and discusses the strengths, weaknesses, threats, and opportunities for midwifery in the US. Featuring a range of photos and illustrations, and engaging stories filled with cultural and spiritual content, this book is a must-have resource on the history of midwifery and women.
As I said in my previous blog entitled “The Joy of Working with Pediatric and Neonatal Nurses,” when I took care of critically ill newborn infants and children, young adults for about 30 years, I relied on the nurses I had the privilege of working with in the infant special care unit, the pediatric floor, the emergency department, and in the intensive care unit. These nurses are truly on the front lines and are first responders for these patients and their families, just as paramedics, EMTs, and battlefield paramedics are on the front lines!
Wherever I was, including when we were transporting these infants and children, I listened critically and thoughtfully to everything they told me about the patients we cared for. When they were worried and concerned, it was important that I also worried. I can literally give you hundreds of anecdotes of clinical situations, including instances in the delivery room with newly born critically ill infants when the nurse and I worked together to stabilize the baby with clinical issues ranging from being born at 24 weeks gestation with respiratory distress to a term newborn with undiagnosed probable Down syndrome.
In the ED, we had a well tanned 19-year-old male who presented in cardiac arrest one winter evening and a young girl with fever and purpuric lesions who presented in shock with meningococcemia.
On the pediatric floor, the nurse called me when her infant patient was having apneic episodes with oxygen desaturation with an RSV infection.
In the intensive care unit, there was a young girl with malignant cerebral edema after head trauma. Her nurse and I stayed by her bedside all day and night as we needed to manage her increased intracranial pressure. Thanks to our team, she survived and is now living a normal life.
In each of these clinical situations, I relied on the nurses I worked with who were almost literally on the front lines! I also worked with my wife, Sally, at Children’s Memorial Hospital, when I was a senior resident in 1979 when I covered our patients on our service. She worked on the front lines with a number of critically ill children and came up with some instrumental clinical observations and interventions that helped us in the care of these patients. She and her colleagues in the infusion area at what is now Ann and Robert H. Lurie Children’s Hospital of Chicago are on the front lines caring for children with cancer, inflammatory bowel disease, rheumatoid arthritis, systemic lupus erythematosus, and numerous other chronic illnesses. They do clinical assessments in addition to providing intravenous access for chemotherapy, infusion of biologics, and enzyme infusions for these sometimes critically ill patients. They work with nurse practitioners to care for these children.
I hope everyone has a sense for what these nurses do on the front lines and how instrumental they are in the care of these children and their families.
Early in 2019, the World Health Organization (WHO) announced that 2020 would be the Year of the Nurse and Midwife. WHO is planning lots of programming and reporting around the year to celebrate nurses and support the profession. Here are six reasons why 2020 is the perfect time for the Year of the Nurse.
1. It’s the 200th anniversary of Florence Nightingale.
Florence Nightingale was born on May 12, 1820,
making 2020 the 200th year anniversary of her birth. The “Lady with the Lamp”
became the founder of modern nursing and the first woman to receive the Order
of Merit. During the Crimean War, Nightingale was put in charge of nursing
British and allied soldiers in Turkey. Her time in the wards, especially her
night rounds, earned her the nickname “Lady with the Lamp” and helped her begin
to formalize nursing education. She went on to found the first scientifically
based nursing school—the Nightingale School of Nursing at St. Thomas’ Hospital
in London—in 1860. She also helped institute training for midwives and nurses
working in workhouse infirmaries. Nightingale continues to inspire nurses all
over the world with her legacy of dedication and innovation. While
International Nurses Day commemorates her birthday every year on May 12, the
2020 celebrations will take place year-round and further champion nurses’ work.
2.It’s the release of the first State of the World’s Nursing Report.
In conjunction with the Year of the Nurse, WHO will be releasing its first-ever wh prior to the 73rd World Health Assembly in May 2020. According to WHO, “The report will describe the nursing workforce in WHO Member States, providing an assessment of ‘fitness for purpose’ relative to GPW13 targets.” GPW13 refers to the Thirteenth General Programme of Work 2019−2023, which lays out WHO’s leadership priorities in five-year blocks. Some of WHO’s 2023 goals include reducing the global maternal mortality ratio by 30% and reducing malaria case incidences by 50%. WHO will also be a partner on the State of the World’s Midwifery 2020 Report, which will be launched around the same time as the State of the World’s Nursing Report.
3. It’s the culmination of the Nursing Now campaign.
The three-year Nursing Now global campaign launched in 2018 and will wrap up at the end of 2020. Nursing Now is a collaboration between the World Health Organization and the International Council of Nurses and is championed by Kate Middleton, Duchess of Cambridge. Nursing Now focuses on five core areas: ensuring that nurses and midwives have a more prominent voice in health policy-making; encouraging greater investment in the nursing workforce; recruiting more nurses into leadership positions; conducting research that helps determine where nurses can have the greatest impact; and sharing of best nursing practices. Nurses can support Nursing Now by signing its support pledge, sharing about the campaign on social media, hosting events, sharing their experiences with other nurses, and organizing to advocate for the nursing profession. You can also start or join a Nursing Now group in your local or regional area. There are currently groups in more than 100 countries worldwide.
4.Nurses make up a majority of the worldwide healthcare force.
While doctors get much of the attention, especially in Western nations, nurses and midwives make up more than 50% of the health workforce in many countries. Nurses armed with clinical supplies are usually the front line of care and, in some cases, may be the only provider in the area, especially in developing countries. They make a difference not just in individual patients’ lives but also in the community as a whole. Due to their sheer numbers and the locations where they often work, nurses are vital players in improving public health outcomes around the world.
5.Nurses are a huge part of the health care worker shortfall.
Due to the major role they play in the worldwide healthcare workforce, nurses and midwives also make up a significant part of the nursing shortage–more than 50% of the shortfall in the global health workforce to 2030. Looking at just the U.S., the Bureau of Labor Statistics (BLS) predicts that employment of registered nurses is projected to grow 12% from 2018 to 2028, much faster than the average for all occupations. BLS also predicts that the U.S. will need an additional 200,000+ nurses per year from now until 2026, adding up to more than one million additional nurses. And that’s just one country that already had a health care infrastructure that’s significantly more developed than some others.
6. Supporting nurses boosts economic growth and gender equality.
As part of Nursing Now and its other efforts to support nurses, WHO often speaks of the “Triple Impact” that comes from giving nurses what they need: better health, stronger economies, and greater gender equality. While the first outcome is more obvious, the second ones are equally important. While men can and do become nurses, worldwide the vast majority of nurses are women. Becoming a nurse opens up opportunities for women, giving them the chance to receive formal education, enroll in training programs, secure a license, and finally get a job and its accompanying income. This improves overall economic growth and also increases gender equality in the workforce.
Nurses should already be
proud of themselves when they don
their scrubs for a shift, but in 2020, they’ll do so with the extra
confidence of knowing that it’s the Year of the Nurse and that organizations
all over the world are supporting their profession.
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