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This post is by CHMP’s graduate fellow, Amanda Anderson, RN.  Amanda is a practicing bedside nurse in Manhattan, and a grad student at the Hunter-Bellevue School of Nursing, where she co-directs The Nurses Writing Project. Her personal site, This Nurse Wonders, hosts her writing, and she tweets @12hourRNfile0002101523869

It’s been a strange week for nurses in the media, to say the least. We were present, but our crowning achievement – an M&M-throwing parody on SNL – isn’t exactly one for the history books. While our ability to entertain rang through the web, our titling in print stayed true to its baseline. Sure, a reporter or two mentioned going the extra mile to get our quotes, but their pavement pounding (or biking), didn’t seem to reach our far-off doors.

Or did it?

This week, I was dismayed to read not one, but three articles on a topic that is familiar to every nurse’s practice: Falls. I realize that my experience is limited to the horrible occurrence of finding a patient on a hospital floor, but I believe it’s safe to say that each nurse caring for a patient has their own version of care, and knowledge of prevention, when it comes to this topic.

My first few passes through these articles, written by a woman named Katie Hafner, proved bereft of nurse voice. Again, a huge article on a topic that is largely nurse-centric, written without a single quote from a member of our profession. In reality, our interventions to prevent and treat falls are paramount, and our profession produces scores of practice-defining research on the topic – why no word from us here?

In my frustration, I decided to reach out to the author. I asked her if she was unaware of recent nursing research related to falls? Had she missed a nurse-led initiative by the Robert Wood Johnson Foundation to implement fall-reduction protocols in hospitals, or a recent article in The American Journal of Nursing, where nurses and physical therapists discuss a mobility program, aimed at halting fall-inducing deconditioning? Did she try any of the San Francisco hospitals or care facilities that she referenced, for a quote from a clinical nurse specialist or nurse educator about their current initiatives to prevent and treat falls?  Did she know that each bedside nurse, the first line of prevention for a falling patient, could offer insight and experience into how we daily screen each of our patients for falls, as per federal requirements?

Perhaps my questions were too pointed, because she replied with prompt and wholehearted affirmation – falls could certainly not be spoken of without nurse input. So why no sourcing? She had spoken with MANY nurses, she said. Two of which – both prominent researchers on the topic – were cited in one of her pieces.

Huh?!

I went back to her pieces, scouring for the sources she spoke of. Sure enough, I found them, halfway through – Dr. Pat Quigley and Dr. Dorothy Baker. But Dr. Baker, an accomplished nurse practitioner, was just, “a research scientist” recommending chats with primary care physicians, and Dr. Quigley, a celebrated and highly credentialed nurse practitioner, clinical nurse specialist and Fellow of the American Academy of Nursing was simply, “a falls prevention expert,” advocating for the replacement of sleeping pills with warm milk.

I’ll admit to my initial oversight, but I wanted further explanation of its cause from Hafner. Why had she titled these nurses this way, stripping them of their foundational specialization? Had they asked for their otherwise prominently listed nursing credentials to be nixed for the piece? I received a fascinating and equally frustrating response: She, like any good reporter, had listed them exactly the way that they had requested.

This news is saddening to me, and surprising. Why would researchers who built their careers on a foundation of nursing experience, distance themselves from it in the media? Apparently this phenomenon isn’t rare, and brief conversations with scholarly editors and health care journalists attest to this. Joy Jacobson, former managing editor of The American Journal of Nursing, and frequent contributor, says many of her nurse sources aren’t just hard to find, they’re reluctant to speak openly for lack of support, and fear of saying something that might make them lose their funding or jobs. Others hypothesize that academic nurses want to distance themselves from a profession scarred with stereotypes and oft-poorly spoken advocates.

While we’re likely not the easiest sources to locate – a quick Google of “doctor + Manhattan + Ebola” provided far more than a search substituting nurse as provider – I think much of our media absence must be caused by our lack of knowledge on how to speak effectively for ourselves, and our lack of support in doing so. Because we are afraid or unsure of our words, we silence ourselves to the public, just like we silence ourselves at our own dinner tables – no one wants to hear of the gross things I do, anyway, we often say.

This all too familiar sentiment – one that seems to plague even those at the top of the professional ladder – must be fought with work and study. Programs exist – Diana Mason & Barbara Glickstein’s media training is nationally renowned, and the organization Working Narratives, offers multiple resources on storytelling and social change – both great places to start.

Our profession will continue to be ridiculed and misunderstood if we don’t speak up and claim it in a unified, trained voice. While Baker and Quigley requested to leave their “RNs” out of print, Kaci Hickox, regardless of the correctness of her quarantine choices, was stripped of her many professional distinctions this week, titled simply, “NURSE.” I haven’t spoken with any of these nurses, and don’t know the full story behind their titling choices or blunders. But I wonder if, in the end, they’re all the same, all falling into Jacobson’s cutting assessment of nurses as sources: “They have an unparalleled perspective on what really goes on in health care, and to survive, they feel, they have to keep it to themselves.”

This post is by CHMP’s graduate fellow,

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leslie nicollThis post is written by Leslie H. Nicoll, PhD, MBA, RN, FAAN  a passionate nurse, wife, and mother. She lives in Portland, Maine where she owns her own business, Maine Desk LLC. She is the Editor-in-Chief of CIN: Computers, Informatics, Nursing and Editor of Nurse Author & Editor. Dr. Nicoll is an advocate for the poor and vulnerable in our society and lives this mission by working 2 1/2 days per week as the Coordinator at the Portland Community Free Clinic. Dr. Nicoll was very proud to be inducted as a Fellow in the American Academy of Nursing in October 2014. 

Kaci Hickox, the nurse who was quarantined in a tent in New Jersey for four days, has become a household name—sort of. What isn’t as well publicized are her educational credentials and expertise. Nurse Hickox is presented as “just a nurse” and if one is to believe the comments written about her in public discourse (newspapers, Facebook, Twitter) she is the worst kind of nurse: selfish, narcissistic, ambitious, egotistical, and negligent. Definitely not the sort of nurse someone would want at their bedside when they are in extremis, if you are inclined to agree with the opinions that many anonymous writers have shared.

I’ll be honest, I didn’t start paying close attention to Nurse Hickox’s story until she left New Jersey and came home to Fort Kent, Maine. But once her situation became local news (I live in Portland), I couldn’t ignore it. “QUARANTINED NURSE” was the lead headline for the past week.

One thing I noticed, right off the bat, is that all stories about her gave the bare minimum of information—her name and sometimes, her age (33). That’s it. No mention of her employer, education, expertise, or experience. Reporters did talk about her boyfriend, Ted Wilbur, 39, a nursing student at the University of Maine at Fort Kent. It was surreal to feel like I knew more about Ted than I did about Kaci, who really was the person of interest at the heart of this story.

Limited info about Nurse Hickox didn’t stop the online “pitchforks and torches” crowd from attacking her, however. Think of the nastiest thing you can say about someone and multiply it by ten—that will give you a sense of the vitriol that has been posted on the websites of the Portland Press Herald and the Bangor Daily News. I ventured to a Kaci Hickox Facebook page and read more of the same, including this comment: “Bet this fanpage isn’t working out the way you expected it would, bitch!!”

Things reached a head, at least in my head, when I read a series of posts from people claiming to have contacted the Maine Board of Nursing demanding that her license be revoked and finding out that she isn’t even licensed to practice nursing in Maine! This caused even more outrage, with comments suggesting that she is not a “real RN” and that she was “practicing medicine” [sic] in Africa illegally.

So, who is Kaci Hickox, really? It turns out she is extremely well educated and well qualified for the work she is doing: BSN from the University of Texas at Arlington (2002), MPH and MSN from Johns Hopkins University (2011), a diploma in tropical nursing from the London School of Hygiene and Tropical Health, plus a two year post-graduate fellowship in applied epidemiology with the CDC. Nurse Hickox is a paid volunteer by Doctors Without Borders (Médecins Sans Frontières, MSF) and under their auspices, has traveled to work in Myanmar, Nigeria, and most recently, Sierra Leone. She has a very definite career path to work with poor and vulnerable populations throughout the world. Interestingly, she was turned down by MSF for a job in 2004 because she didn’t have enough experience. That motivated her pursue her tropical nursing diploma and dual master’s degrees, all while gaining international experience in Indonesia and other countries.

Clearly Nurse Hickox is a smart, assertive, and intelligent woman who knows how to stand up for her rights and fight for what she believes in. But the press seems determined not to show us that side of her—instead, they keep her anonymous and vague. In headlines she is often nameless, to wit:

  • Judge in Maine Eases Restrictions on Nurse (New York Times, October 31, 2014)
  • Unapologetic, Christie Frees Nurse From Ebola Quarantine (New York Times, October 27, 2014)
  • Tested Negative for Ebola, Nurse Criticizes Her Quarantine (New York Times, October 27, 2014)

In videos that I have watched of Gov. Christie (NJ) and Gov. LePage (ME) discussing the situation—Nurse Hickox is never mentioned by name but always referred to as “her” and “she.” Gov. LePage goes on to say that “that woman” has “violated every promise” and that “we can’t trust her—I don’t trust her.”* He has also warned that she might be attacked if she leaves her home, which I heard as a veiled threat and bullying tactic.

I posted a comment in response to a New York Times article on October 31 that detailed some of her education because I was tired of the lack of information about her. So many commenters were assuming that she was undeducated and unprepared for the job and that she had gone to Africa on a lark with an urge to become famous. I wanted to do my little bit to get accurate data into the public record. 

People thanked me for  my post, saying that this information had not been shared before and was not “common knowledge.” Was I truly the first person to investigate Nurse Hickox’s background (which took about two minutes of Googling)? Turns out I wasn’t—there was an article in the New York Times on October 25 with this background, but it was buried on page A24. It was a standalone piece and none of the information contained in that article has been referenced in subsequent articles written about her. I also found alumni articles from Johns Hopkins and the University of Texas at Arlington** but has this material been shared generally? Sadly the answer is no.

So, what is my takeaway on all of this? One—the world out there: the public, reporters, governors and everyone else—see “nurses” as a commodity, one in million, who do not need to be named and identified by education and experience. Knowing this, we need to be vigilant to provide names, degrees, and credentials, for both ourselves and our colleagues. Note that in this post I have explicitly used Nurse Hickox rather than “Kaci” or “Ms. Hickox.” I believe this is a small way to be respectful and also get the fact that she is a nurse right out front.

Two: nursing education is confusing. This, unfortunately is a problem we in the profession have created but for people who aren’t pursuing a degree in nursing, it can be simplified and made clear. Most everyone knows what a bachelor’s degree is, likewise a master’s or PhD. Use those terms. “Kaci Hickox has two master’s degrees from Johns Hopkins.” People will understand that Nurse Hickox must be “wicked smart” (to use a Maine term!) to have accomplished this.

Three: career options in nursing are wide and varied (good for us who are looking to do different things) but again, the public seems to equate nursing with being at the bedside in a staff nurse role. There were many opportunities in the Nurse Hickox story where misconceptions were not corrected: she has a definite career plan, she has the education and expertise to serve in complex public health situations, and she did not go to Africa on a whim.

Fourth: strong, assertive nurses (and women) are not bad people. Nurse Hickox stood up for her rights and was publicly shamed for it. This is not acceptable and we must be vocal and support our colleagues. Interestingly, Monica Lewinsky has recently come forward with a mission to stop cyberbullying and public humiliation, based on her experiences of the past 16 years.*** Cruel, heartless online posting, from people who can hide behind a screen name are abhorrent to me and unfortunately, the incidence seems to be increasing. We must do what we can to stop this practice. Getting on the right side of the Nurse Hickox story seems like a good place to start.

Fifth: modern nursing is not the profession that many envision—docile, subservient nurses dressed in white and working in the hospital. Instead, we are creative, educated, and intelligent men and women who work in settings unimagined a generation ago. Each of us has a responsibility to correct misconceptions about our profession and career and should do this at every opportunity. When asked what I do, I always say that I am a nurse first, then add, “I own my own business,” “I am the editor of a professional journal,” or “I am the coordinator at our local free clinic.”

I was heartened this morning when the headline in the Maine Sunday Telegram did identify Nurse Hickox by name. Of course, she was called “Ebola nurse” in the same headline. Sigh…one step forward, one step back.

Written by: Leslie H. Nicoll, PhD, MBA, RN, FAAN

Sources:

*Gov. LePage: http://www.pressherald.com/2014/10/31/maine-cdc-restaurant-worker-may-have-exposed-patrons-to-hepatitis-a/video/

Gov. Christie: http://nyti.ms/1u9zFAP

**http://www.uta.edu/utamagazine/archive-issues/2010-13/2012/07/passion-practicality-drive-nursing-graduate/

http://nursing.jhu.edu/news-events/news/news/ebola-hero

***http://www.cnn.com/2014/05/06/opinion/robbins-lewinsky-strength/

This post is written by Leslie H. Nicoll,