For me, summer is full of reading. I tend to save books throughout the year for the few laid back months in between the school seasons that seem to be made for relaxed reading.
I’m not a big fan of fiction books, but every once in a while I give one a try. What are you reading or planning to read that you think I should pick up, as well? I’ll be sure to share my current reads throughout the summer, too.
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In honor of nursing graduations everywhere and the thousands of people who are preparing for the NCLEX…here’s a note of encouragement for you or others. Feel free to download, print, and encourage at random intentionally.
The NCLEX is tough. And stressful. It’s a “make-it-or-break-it” kind of moment, and the past two to four years (or more!) have led to the single, stress-inducing, career-predicting test. A note of encouragement just might brighten a future nurse’s day, so be sure to include your own hand-written cheers on the inside!
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Dr. Mukherjee used the story of the Red Queen’s race from Lewis Carroll’s Through the Looking-Glass in his best-seller The Emperor of all Maladies: A Biography of Cancer. The analogy burned a place in my mind, and I have been drawn back to it several times since I finished the book.
“Well, in our country,” said Alice, still panting a little, “you’d generally get to somewhere else — if you run very fast for a long time, as we’ve been doing.”
“A slow sort of country!” said the Queen. “Now, here, you see, it takes all the running you can do, to keep in the same place. If you want to get somewhere else, you must run at least twice as fast as that!”
Oh, how true in our warp-speed society. Twice as fast is the standard, no? There is some ridiculosity in our “average” daily speed. I cannot help but laugh as I hear the Red Queen in my ear. Sometimes I am panting. Other times I smirk back and intentionally slow my pace, re-evaluating the time and distance.
What’s your pace today?
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Nurses deliver difficult news every day. Whether it’s reiterating exam results the physician explained earlier to the patient and now the family that was absent is suddenly present and the patient no longer remembers all the intricacies of the delicate conversation or simply informing a patient who has been NPO all day that, yes, another procedure was just ordered requiring NPO status for a little while longer, sharing not-so-great news is a part of work.
Nurse managers and leaders, while many still (unfortunately) wrongly think “sit behind a desk all day,” are not immune to delivering difficult news. The news simply changes. It may range from disclosing medication errors with patients, families, and internal team members to letting a team member go giving someone the opportunity to excel at another organization to telling a physician or social worker or administrator why his specific pet-project doesn’t fit into site/network/unit/daily priorities right now.
Whether in health care or not, we all must share difficult news with others at some point. It’s rarely a skill (yes, skill) we are trained to do or encouraged to refine through ongoing education and practice. Yet, when the time comes to actually deliver the news, it is easy to notice inadequacies. Here are a few things I do when sharing especially difficult information with others.
1. Prepare. This is a loaded step involving data gathering, thought refining, and word selection. Be sure to gather information you can use when sharing difficult information with others. You should cover the basics, explaining the issue as fully as possible or allowed. People typically have questions, and you need to be prepared to answer them honestly and openly with the information you’ve acquired. Separate the facts from opinions, which may be your own biased views, as well. In conjunction with having the correct information, you need to prepare your thoughts and words. If you can practice saying the news out loud, that is helpful to allow you to hear what you’re actually thinking, which often sounds very differently from what you’re meaning to say.
2. Share in person. The more sensitive the information, the more personal the conversation needs to be. An email firing someone is not appropriate. A telephone call relaying bad news, while it occurs often, is not ideal. Body language and tone relay volumes of information. If it truly is difficult news, say it to people in their presence, with eye contact.
3. Allow questions. Difficult news creates a disruptive state. Encourage questions so people can have all the information (that you’ve either already gathered or will find out if you do not know the answer). When people have their questions answered, everyone can work with the same knowledge and rumors can be laid to rest.
4. Provide feedback. If the difficult news is part of a “process,” be sure to provide regular updates to everyone involved.
Do you see a theme here with information and transparency? As with everything, these tips typically take practice. Good communication is a skill. You may have to intentionally think about these tips the first few times you share difficult news; with practice, though, these become second nature.
How do you prepare to share bad or difficult news with others?
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The most recent audio book keeping me company on my daily commute into work is Maya Angelou’s Letter to My Daughter. With 28 short chapters, you can read or listen to this inspiring book in a little less than three hours. Angelou, biological mother to one son, admits in the foreword that this book is for all women.
It’s bold, witty, sad, and encouraging. The best part, though, is that the audio book is actually read by Maya Angelou. I really enjoy hearing authors read their own works. After all, they know best exactly what it should sound like. Angelou’s booming, husky voice powerfully delivers the many stories and anecdotes.
I have always been a fan of her work but I knew very little of her back-story, her life and history. Letter to My Daughter contains much of that, including mentions of her mother – a nurse and business owner.
Overall, Letter to My Daughter is a short read (or listen). It’s easily a summer-reading-list book.
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A life I’ve never lived
To live the life I live now.
You did not know me,
But you knew everything about me.
My safety and freedom
Was your danger and enlistment.
Thank you for giving.
Thank you for serving.
I remember.
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Article: Tschannen, D. and Lee, E. (2012) The impact of nursing characteristics and the work environment on perceptions of communication. Nursing Research and Practice, E-pub February 22, 2012, 1-7. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3316962/pdf/NRP2012-401905.pdf.
Big Idea: Communication within health care is a major concern. Poor communication can lead to fatal errors. A stressful work environment may lead to break down of communication; the values of the work environment (i.e. respect, trust, etc.) likely impact communication, as well. In this cross-sectional, descriptive study, researchers analyzed 135 nurses’ individual nursing characteristics (i.e. experience, education, etc.) in relation to their self-reported perceptions of communication. The frontline nurses, both RNs and LPNs, were from four medical-surgical units at two hospitals.
Survey Says!: After many statistical tests, environmental values such as trust and respect, specific nursing unit, higher levels of nursing education, and more years of experience correlated with nurses’ increased perception of open communication among other nurses and physicians. Both the RN and the LPN groups agreed communication among nurses was more open than communication between nurses and physicians.
Quotable: “For the past three years, miscommunication has been identified as one of the most frequently identified root causes of sentinel events reported to The Joint Commission, with 82% of the sentinel events in 2010 identifying communication as the primary root cause [reference]” (p. 1).
“Understanding the environment (e.g., presence or absence of trust, respect, status equity, and time availability) is a foundational step that must occur before implementing any strategies aimed at improving communication. A failure to understand the environment may in part explain why no one strategy has been shown to consistently improve nurse-physician communication [reference]” (p. 6).
So What?: Not only does this article provide a method to measure nurses’ perceptions of open communication among units and hospitals, but it also gives practical solutions and ideas to improve open communication among the RN-LPN dyad as well as the nurse-physician dyad.
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So many of my friends have had birthdays recently. I’ve been pondering a certain thought, so I decided to turn it into a card. You can download it to print and share, as well.
Enjoy your privilege, and celebrate!
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It seems as though I have been reading and hearing about courage a lot recently. Maybe it’s my subconscious. You know, when you want to buy a new car and then you start seeing that exact car all over the place? Yep. That is happening to me now; only this time it’s about courage to fulfill a dream. It’s a rather recent dream. Nonetheless, it’s flourished rapidly from “That might be cool. Maybe someday,” to “I can totally do that. Right. Now.”
[gulp]
I had a moment this week when everything pointed in one direction. The puzzle picture became clear. It all made sense. The frayed and disarrayed threads of my past, present, and future experiences revealed a glimpse of the contralateral design. It sounds surreal, I know. I was there. It was.
Now, I need to do. That sounds much easier than the heavy reality I feel as I take small steps toward stepping out and actually doing. I am taking steps. That’s progress. I’ve learned a bit about courage; I plan to share some thoughts about that learning opportunity soon. I also hope to openly share this new-found, quickly-becoming-reality dream “soon.”
[gulp]
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The Emperor of All Maladies: A Biography of Cancer has been on my “to read” list ever since it debuted. How fortuitous the library branch closest to my work, which gave me the pleasure of reading listening to another book, just so happened to have this audio book in stock when 
I returned my previous rental. Yesss!
Written by Siddhartha Mukherjee, an oncologist, the audio book is read by Stephen Hoye. I must admit, parts of the book were difficult for me to listen to. Mr. Hoye has won numerous awards for his book readings, but I found his tone quite dry, which makes for 21 hours of not-so-easy-listening. Sections of the book that detail conversations between two people are almost unbearable as the “characters,” which are actually real people, have no distinct voices, leaving them void.
Dr. Mukherjee’s writing is powerful and academic. This is not an “easy-starter” book, and the inclusion of medical terminology, albeit explained by the author, is a lot to take in. The content of the book, though, is intriguing. Dr. Mukherjee is a beautiful historian and a master of metaphors. The chapters cover topics such as creation of clinical trials, inadvertent discovery of new pharmacologic agents, epidemiology controversies, the development of end-of-life care, cancer funding, the “cancer war” influence on AIDS research and advancement, scientists who gave their time and sometimes their literal lives to find a cause or cure for cancer, a history of diagnoses and treatments across centuries and continents, and more. Albeit not a complete history of cancer, the book covers a lot of information and story after story to help bring the content alive.
Overall, The Emperor of All Maladies: A Biography of Cancer is worth a read or a listen, especially if you are in health care. I have great respect for the men and women – both academics and non-academics – who have brought oncology care so far and continue to propel it forward. This book only solidifies that admiration.
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