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Remembering Dr. M. Elizabeth Carnegie

Twelve nursing leaders share their personal tributes to a nursing legend who was not only a barrier-breaking educator, author and advocate for nurses of color but also a beloved colleague, mentor, inspiration and friend

Editor’s Note: The extraordinary life and career of M. Elizabeth Carnegie, DPA, RN, FAAN (April 19, 1916-February 20, 2008) was so filled with accomplishments that there is barely room to begin to list them here. To say that she was a pioneering advocate for the advancement of minority nurses—devoting her career to increasing their educational and professional opportunities, as well as their representation in the annals of nursing history—does not even scratch the surface. For a detailed summary of her life, see www.minoritynurse.com/vitalsigns/043008_1.html.

Yet behind the “official” biography—the achievements, awards and accolades—there was also a remarkable woman who personally touched and enriched the lives of countless nurses whom she worked with, taught, mentored, supported and knew. The tributes collected here showcase both aspects of this unforgettable nursing legend—the history-making side and the personal side.

MN thanks everyone who contributed their remembrances and photos of Dr. Carnegie for this article. Special thanks are due to Dr. Marie Pitts Mosley for her invaluable assistance and enthusiasm in spreading the word and encouraging so many of her colleagues to participate in this tribute.

A Pioneer for Racial Equality in Nursing

by Willie Pearl Porter, MSN, RN

It is with great pride and pleasure that I submit my personal remembrances of my dear friend and colleague, Dr. Mary Elizabeth Carnegie. I am very much a senior citizen, as I am 96 years young, [so my memories of Dr. Carnegie go back quite a long way].

In 1945, Dr. Carnegie accepted an offer to become Dean of Nursing at [historically black] Florida A & M College in Tallahassee. She was a pioneer in the nursing field and a “spitfire” of a person, who encouraged her staff to become members of the American Nurses Association. [This was during the segregation era, and the local Florida Nurses Association chapter] held its monthly meetings in Tallahassee at the white hospital. We [black nurses] were not allowed to use the elevator at the front of the hospital to get to the meetings but were forced to go to the back of the hospital and only use the service elevator. In the meeting room, the white nurses sat on one side and the black nurses sat on the other side. We sat and listened to the discussions but [were not permitted to] take part in them. At the end of the meetings, Dr. Carnegie would talk to the chapter president.

We complained about attending the meetings but were told by Dr. Carnegie that we had to attend. She said, “We are going every month and they won’t stop us.” Furthermore, she said, “[the association is] going to change.”

The ANA state meeting was being held in St. Petersburg, and the president [of the state association] invited Dr. Carnegie to attend as well as speak on the occasion. There was tremendous applause during her speech and at the end she brought the audience to their feet. The state president, by the way, was the person who was keeping us segregated. After Dr. Carnegie’s speech, the president had the greatest respect for her. For example, on one occasion the state president was very ill and Dr. Carnegie had a speaking engagement in Miami. Even though she was ill and in a wheelchair, the president attended the meeting to hear Dr. Carnegie speak. That story in itself serves to illustrate the greatness of Dr. Carnegie.

In closing, allow me to restate that Dr. Carnegie was a pioneer in the field of nursing. She opened doors for all nurses to enter. She was our leader and she will truly be missed by all.

Chi Eta Phi Remembers Dr. Mary Elizabeth Carnegie

by Lillian Stokes, PhD, RN, FAAN, National President, Chi Eta Phi Sorority, Inc.

Like many in the nursing profession, the members of Chi Eta Phi Sorority were saddened to hear of the death of Dr. Mary Elizabeth Carnegie. The memory of her leadership and numerous contributions to nursing will never be forgotten. She will be remembered not only as an educator, historian, author and editor, but also for the distinctions of her deanships, visiting professorships, presidential positions in many organizations, and special recognitions.

We in Chi Eta Phi Sorority will remember, in particular, her devotion to humankind in general and as an honorary member of our organization in particular. Her service was exemplified in direct and indirect ways. Her responses to calls to serve within the organization were always in the affirmative. Early calls for service were through Omicron Chapter in New York, the chapter that nominated her for honorary membership into the sorority. She loved this chapter and demonstrated that love through her support, work and service throughout the organization.

We will remember her engaging ability to share her knowledge and expertise when she made keynote speeches or served on panels at educational sessions. We will remember the skills we learned and the fears she dispelled when she conducted workshops on writing for publication. Even when she was not presenting, her mere presence in the audience was enough to make one feel special. . . .

She will be remembered for being a mentor. She [never hesitated to reach out to other nurses] to offer advice, coaching, teaching and support. It was not uncommon to receive a call from her when you least expected it. “Hello, this is Elizabeth. How are things going? I’ve been thinking about you.” The questions and echoes of support would go on and on.

We will remember her as a role model. She modeled leadership behaviors. She modeled professionalism. Her active involvement in multiple organizations was evidenced by serving on boards, holding leadership positions, advisory positions and more. She seldom missed professional conferences. One could always expect to see Elizabeth Carnegie at all major [nursing] events. She was present and engaged, sitting right up front, often inviting others to sit with her. She will be remembered for the warmth that radiated from her smile.

We will remember her for the initiatives she spearheaded and the opportunities she provided to support the education of nurses on all levels, through scholarships, traineeships and fellowships. . . She will be remembered for her passion for history and her keen desire to eliminate the scarcity of documented history about African American nurses in nursing textbooks. . . .

We will remember Dr. Carnegie for the excitement she generated as she shared her personal history about her [trailblazing] career. We will remember her for her contributions to individuals, groups, schools of nursing, nursing organizations and the nursing profession. Take time to read her work and learn from her pioneering spirit, her dedication and her commitment. Use these contributions as sources for mentoring. Reflect on these as examples of role modeling for your continuing development. Reflect on these as stellar examples of service. May we forever take time to reflect on her loyal and generous service to the profession. May we resolve to continue to remember her in spirit, and may the name of Mary Elizabeth Carnegie never be forgotten.

Conversations with a Genteel Lady: The Clock Strikes Seven!

by Hattie Bessent, EdD, RN, FAAN, FRCN, Director of Project LEAD and author of The Soul of Leadership: Journeys in Leadership and Achievement with Distinguished African American Nurses

Dr. M. Elizabeth Carnegie was an accomplished professional. Her life and career reflect the greatness of those we celebrate and honor during Black History Month, so it is interesting to note that she entered into rest in February. As retirees, she and I would engage in affectionate banter each day in the early morning hours, which for us began at 7 a.m. We held conversations that began with us talking not only about ourselves, but also about what we must do to support others. We knew through our own experiences that for us to succeed, we had to be connected to a network of colleagues who had the complementary skills necessary to ensure our success.

As one of the leaders featured in The Soul of Leadership, Dr. Carnegie chronicled her own journey, penned by her own hand. She wrote her own obituary in the leaves of the text, so it need not be narrated here. More importantly, she highlights her many firsts, and she acknowledges that these firsts came as a result of garnering support from others while also sharing her expertise.

I am 81 and I first met Dr. Carnegie when I was 25 years old. In knowing her, I have experienced 56 years of mentorship, colleagueship and friendship. As Dr. Carnegie shared her journey with others, including Project LEAD Fellows, she penned her ideas and created a masterful portrait of leadership with each stroke. Her warm smile was a reflection of a genteel lady who was honored to know that others wanted to hear more and more about her life and her fight for equality for black nurses throughout the world.

Tribute to Dr. M. Elizabeth Carnegie

by Georgie Conoly Labadie, EdD, RN, ANEF, Professor Emerita, University of Miami School of Nursing and Health Studies

I had heard about M. Elizabeth Carnegie years before I ever met her. My oldest sister had switched her major from music to nursing the year that Dr. Carnegie came to Florida A & M College (now University) to serve as the first dean of its School of Nursing. I was a high school student at the time and heard about her from my sister. [When it was my turn to go to nursing school], my class was the last class that Dr. Carnegie admitted to FAMU School of Nursing. By the time we arrived on campus in the fall of 1953, she had left to join the American Journal of Nursing Company to become assistant editor of the American Journal of Nursing. She left a legacy at FAMU of pride, excellence and professionalism.

Early in my career as a nurse educator I felt the gentle hand of Dr. Carnegie as she tried her best to make a writer out of me. I was not a very willing candidate, but she never gave up on me and never failed to stay in touch with me. Those twin characteristics, never giving up and always staying in touch, will be long-lasting memories for me. Her life was an example of never giving up. She kept in touch, as a collector of stories should. Every person [she knew] was part of the nursing quilt she was weaving. What a master weaver she was and what a beautiful quilt she left, encompassing many lives in many places.

Dr. Carnegie always took pride in the many accomplishments of African American nurses. Her own life story was filled with the joy of accomplishment as well as the pain of segregation, humiliation and discrimination. She lived through many changes [in the nursing profession], participated in making them happen, wrote about them and spoke about them. She was strong in her convictions and gentle in her persuasion. But make no mistake: Her gentleness was not to be confused with weakness. Her forcefulness penetrated the psyche and made you reflect on what she was requesting. And usually the request was not for her own self-aggrandizement, but rather for the community of nursing.

She was nursing and nursing became her. In other words, she challenged individuals to be the best they could be, and through those individuals, systems were changed. As an agent of change, she moved nursing leagues away from the [racially prejudiced] past with humility and determination. Her example is worth following, and in her name we all can contribute to meeting the challenge that she saw many years ago—a challenge that is still present today. She was as much a model of doing things as she was of getting things done. This was certainly evident early in her career during the eight years she spent in Florida, where she stimulated much-needed change in higher education for nurses.

Over the past four decades our paths crossed many times. I would see her at AJN headquarters in New York, at meetings of professional organizations or at events where she was the featured speaker or honored guest. It was always with a sense of pride that I kept up with where she was and what she was doing. There have been four people
in my life who instilled a love of history in me, and Dr. Elizabeth Carnegie was one of them. Her influence penetrated my teaching and presentations. It was always a joy to see her and to listen to her as she wove a magical tapestry of stories from her past, her current work and possibilities for the future, all with the aim of assuring her audience that change is not only needed but possible and necessary. She was living proof that persistence and patience were qualities worth having and honing in order to achieve the inevitable. Even in retirement she was actively engaged.

Dr. Carnegie left a very rich legacy, a legacy with multiple meanings, from which we can take what we like and what we need individually, to help sustain us now and into the future. African American nurses especially have much to be proud of and to cherish. She kept us awake and kept the vigil. Now she is gone. It is our turn, the turn of all who follow in her footsteps. All nurses can be proud that a giant lived among us and made all of us better off by having been here.

Learning from Her Life

by Pier A. Broadnax, PhD, RN, Administrator, Children’s National Medical Center; Hampton Institute (University), Class of 1984

Dr. Carnegie taught nursing research on the graduate level at Hampton Institute (now University) during the early 1980s. The class was held on Saturday mornings. Every weekend, she traveled from New York to Hampton, Va., by train to teach the course. I learned more than the research process during that semester. Dr. Carnegie intertwined her lived experiences into the course content, which made the application of research methodologies more realistic and applicable than memorizing theoretical concepts. She continuously stressed the connection between research and improving the lives of patients. She described health disparities before it was in vogue as a research topic.

More importantly for me as a graduate nursing student trying to find her professional footing, she demonstrated to me that success is not measured by your position in life or the accolades showered upon you, but by your willingness and ability to help and encourage others.

Dr. Carnegie, it was a great sacrifice for you to travel the long distance to teach us, but the impact you made upon us is immeasurable. I thank you for all that you did and the doors that you opened. I will always remember your kindness and your smile.
 

An Irreplaceable Champion

by Terry Fulmer, PhD, RN, FAAN, Erline Perkins McGriff Professor and Dean, New York University College of Nursing

I had the privilege of knowing Elizabeth Carnegie for over 20 years and it was truly a privilege for the College of Nursing at NYU to be one of the many institutions that invited her into our school to impart her wisdom and life experiences to our students, faculty and alumni. Her commitment to the advancement of black nursing is unparalleled. Her preservation of the history of African American nurses in her award-winning book The Path We Tread: Blacks in Nursing 1854-1994 should be required reading for all nursing students who need to know that there are no limits to what you can do.
NYU College of Nursing has celebrated Elizabeth as a recipient of our Estelle Osborne Award and we have listened to her incredible story as part of our “Conversations with Dr. Carnegie” series these past few years.
Elizabeth was our colleague, pioneer, ambassador, champion for the profession and a dear friend. She is missed, will always be missed and can never be replaced.

Mentoring with a Capital M

by Marie O. Pitts Mosley, EdD, RN, PNP, Nursing Historian

It is indeed an honor and a privilege to have been asked to pay tribute to my hero, my role model, my confidant, my teacher, my sponsor, my mentor, my champion, but most of all, my friend, Dr. Mary Elizabeth Carnegie.

The first time I met Dr. Carnegie, I was in open-mouthed awe of her. How could someone who was so well known and so accomplished be so unpretentious? I thought to myself, “This is a phenomenal woman.” After that, whenever I would find out that Dr. Carnegie was presenting somewhere, I made it my business to be where she was. What can I tell you, I was a Carnegie “groupie”! At her presentations, I would position myself far enough away so as to be not noticed, but close enough to hear her conversation. I would never say a word.

Then, as God would have it and as time went on, Dr. Carnegie and I ended up at the same luncheon. When the opportunity presented itself, I hurriedly put my fears aside, went up to her and introduced myself. I recall that I awkwardly gushed out my admiration of her work and that I wanted to contact her for advice. I was brimming over with so much hyperbole that I soon realized I was being foolish. I felt that I had made a fool of myself and embarrassed her. I thought she would walk away and leave me standing, but she didn’t. Dr. Carnegie took me aside, calmed me down, accepted my apology and told me, “It’s OK, you can call me later. I’m in the phone book.” On that day, our souls met and a lifelong bond was formed.

For some reason, I didn’t immediately take her up on the offer to call, but circumstances forced me to take that leap a few months later. I needed someone to edit my dissertation. My eight-year-old daughter Dashawn told me to ask Dr. Carnegie, because I had no money to pay anybody else. I made the call. During our conversation, I asked Dr. Carnegie, “What is your fee?” She never responded to my question, but just replied, “When can you get your work to me? I’m only going to be in New York for two more days.” I practically ran the 80-plus blocks to 59th Street [to drop off the manuscript].

The next morning I got a call from Dr. Carnegie. She said, “I stayed up all night reading your work. I hope you don’t mind that I made some corrections in red.” In no time, my dissertation was finished. I called her again to tell her my defense date. Dr. Carnegie was scheduled to be in Nevada that day to receive an award, but she chose to leave Nevada early to support me in defending my dissertation.

From that day on, we were practically “joined at the hip.” Whenever Dr. Carnegie came to New York, she took time out of her busy schedule to teach me [the skills that I needed to succeed in my career]—how to write, how to read, how to do research, how to market myself, and how and where to present. After all this, you would think she’d say, “I did my part, now you’re on your own.” But no--everywhere I presented in the world, she would always be there in the front row, in the center seat.

Dr. Carnegie put the capital M in mentoring. . . .

In Loving Memory of a Treasured Friend

by Margaret T. Beard, PhD, RN, (Retired) Professor of Nursing

Life is full of ups and downs and there are not many people on whom we can depend. Dr. Elizabeth Carnegie was certainly a friend to the end and a person to be depended upon.

Dr. Carnegie was an outstanding leader, an advocate for students and a trusted friend. I first met her in 1948 at the National Association of Colored Graduate Nurses (NACGN) conference, where I was invited to be the keynote speaker. Most of my time spent with Dr. Carnegie was at professional nursing meetings and conferences.

[In 1949, NACGN was absorbed into] the American Nurses Association, which accepted all nurses regardless of their race. However, membership in the ANA was state regulated [and the segregated Southern states continued to deny membership to black nurses]. At that time, I was residing in Georgia, which was the last state to accept the “colored nurses.” Therefore, I joined ANA as an individual member and once again joined forces with Dr. Carnegie to continue the struggle for nurses of color.

As editor of the journal Nursing Research, Dr. Carnegie was instrumental in publishing my third article, [written when I was working] as a staff development nurse for the Veterans Administration. In her role as [advisory board chairman] for the ANA’s Minority Fellowship Program, she helped to secure scholarships for minority nurses throughout the United States. As president of the Commission for Nurses Foundation, Dr. Carnegie awarded financial support to nurses in need, regardless of race.

I will truly miss my devoted and dedicated colleague. The path she trod was always for the betterment of others in the nursing profession.

Mary Elizabeth Carnegie, Estelle Osborne and Me

by Janice M. Gray, PhD, RN

This odyssey began when I was at the halfway point of [completing my] master’s degree in nursing administration at New York University. [Nursing trailblazer] Estelle Osborne was the instructor for one of my nursing courses. She was the only black instructor on the nursing faculty and I was the only black student in the master’s program. I had no idea that I was in the presence of a legend, even at that time. . . .

Toward the end of the spring semester, I received a telephone call from someone by the name of Elizabeth Carnegie. She was dean of the School of Nursing at Florida A & M College and she expressed an interest in having me join her faculty. I thanked her for the invitation but explained to her that since I had never taught and did not yet have my master’s degree, I felt unqualified for the position [and could not accept her offer]. I believed the matter closed and went home to Michigan for summer vacation. While there, I received another call from Elizabeth Carnegie with the same offer. Again I declined. The woman was relentless in her pursuit. It never occurred to me to ask how she had found me and why she would want to hire me--sight unseen.

About a week later, Dr. Carnegie called again, suggesting that I think it over and reconsider. This time, my mother intervened and wisely dealt with her daughter’s insecurities. She pointed out that I was being offered a significant gift, one that I had not sought—a gift I would be unwise to refuse. So when the next call came, I accepted the offer for the position on Dr. Carnegie’s faculty. . . .

“Dean Carnegie,” as she was always called by everyone, was away when I arrived [at Florida A & M]. I had no idea of the important work she was doing around the country on behalf of minority nurses. Nor did I know that she and Estelle Osborne were friends and fellow travelers for the “cause.” Also, I later learned that Dean Carnegie and I were graduates of the same nursing school: the Lincoln School for Nurses in New York. In retrospect, I wonder how I could have been so unquestioning, so uninformed and, quite frankly, so stupid.

When we finally met, Dean Carnegie, like Estelle Osborne, very quickly “took my measure,” recognizing abilities in me of which I was unaware, then immediately developing those abilities. She was a member of several faculty committees. When she had to be away, she would assign me to represent her on some committee, cheerfully brushing aside my constant protests of inadequacy. The woman inspired loyalty without ever demanding it!

Further, Dean Carnegie was politically astute and a master strategist. For example, when there was a meeting of the [Florida] State Nurses Association, she would bring along all the members of her faculty to integrate the all-white meetings. This move would provide a clear majority to advance issues she wanted resolved in her favor.

Through the years, my relationship with Dr. Carnegie became more collegial. I was always working in the health field but not always in nursing, so we were often on opposite sides of issues. However, she was always supportive, ready to provide advice and assistance, ready to befriend and ready to swell my ego by asking my opinion. And after many years, I finally learned that it was Estelle Osborne who recommended me to Dr. Carnegie and insisted that she recruit me for her faculty.

If I am judged to have been a relatively successful professional by my peers and by society, considerable credit must be given to three people: my mother, Blanche Gray; Estelle Osborne; and especially Dr. Mary Elizabeth Carnegie, who believed in me even when I didn’t believe in myself.

Dr. Carnegie’s Light Beams on Our Lives

by Alice C. Royal, RN, BS, MPH

The passing of Dr. Elizabeth Carnegie leaves with us the legacy of a person of monumental strength and wisdom, who taught students, counseled, promoted nurses into leadership roles and opened doors for nurses to walk through into the wider world of human services. Many of her former students are now professors in colleges and universities, directors of large nursing organizations and nursing leaders who have reached the highest scientific and academic standards.

Dr. Carnegie was a great humanitarian, a woman with great outreach who met the basic needs of all people through her actions of understanding those needs. Even in her retirement, when she continued to write the most comprehensive history of black nurses through the ages in the successive editions of her book The Path We Tread, Dr. Carnegie made herself available to all of us who asked for her knowledge in so many areas of the science. [She was always ready to share her know-how] and her approaches to the health services, as well as her holistic approaches to a quality life.

The dynamic seeds that Dr. Carnegie planted in [our] minds and spirits have spread far and wide in those [of us] who are emulating her and following in her footsteps. Her books leave future generations of nurses a perceptive code of action to study so that they, too, may create their paths in the profession of nursing. Dr. Carnegie’s life of tender, loving words of wisdom, along with her actions, defined the parameters of her total life’s experiences. She was our giantess in nursing who carried her own Nightingale beam of light for many others to follow. Her life has not diminished but grown in our hearts. May she now rest in a deserved peace as she joins our other [departed] nursing leaders in the gardens of our Maker.

Someone Special

by Sheila M. Haley, MSN, RN

I had the honor and pleasure of knowing Dr. Elizabeth Carnegie for several years in a professional relationship. I remember the first time I saw her: I was in attendance at the National Black Nurses Association annual conference. I heard someone say, “Hello, Dr. Carnegie,” and I immediately turned around to see the legend I had heard so much about. I stood back at a distance watching like a child in a candy store, too shy and humbled to be in her presence. I couldn’t bring myself to say anything.

My mentor was also at this conference and I told her about what I felt would be a pivotal moment in my nursing career—having an opportunity to meet this living legend I so deeply admired. My mentor laughed and said, “Dr. Carnegie is probably one of the most humble, most gentle and kindest people anyone will ever meet.” She offered to personally introduce me to her.

As promised, the next day I was introduced to Dr. Elizabeth Carnegie, one of the greatest leaders in the nursing profession, who [blazed the trail for black nurses] and opened doors that I could walk through to achieve my professional goals in nursing. I have had many trials and tribulations as I struggle to reach these goals, but I will always remember the words Dr. Carnegie said to me that day. “Life is full of struggles and barriers, but you must continue to strive for excellence--not only for you, but for others who will come behind you. This is what I have dedicated my life to,” she told me.

After that first amazing meeting, I had the pleasure to be in Dr. Carnegie’s presence several additional times. I always found her to be easy to talk to, very encouraging and a blessing to me, with that warm, loving smile that shone like a light to illuminate the path for others in this great profession we call nursing.
I am sure many will miss Dr. Elizabeth Carnegie. I can truly say the world has lost a great angel and nursing has lost a hero. Rest in peace, Dr. Carnegie, as we striving nurse scholars attempt to carry your torch and continue to tread the path for others to follow.

Mentor to the Mentors

by Yvonne Wesley, PhD, RN, FAAN, Health Consultant and Co-founder of the Leadership Institute for Black Nurses at New York University College of Nursing

Distressed by a rejection notice [for an article I had written], I called Dr. Mary Elizabeth Carnegie. Quick to give me support, she described her own experience of rejection [when she was trying to find a publisher for] her famous book, The Path We Tread. It was hard for me to believe that she had ever known rejection. But she readily explained that some of our best learning experiences come by way of rejection.

Picture this: An award-winning nurse who had won accolades from the [Sigma Theta Tau] International Honor Society of Nursing and who had been named a Fellow of the American Academy of Nursing being told that her manuscript needs significant revisions. Better yet, imagine being rejected after serving as the editor for a top-ranking nursing journal that focuses on research. [Or being] told that the book you’ve written targets a marginal audience, and the publisher refuses to take the risk. Wow, what a blow. [Yet Dr. Carnegie refused to let this stop her, and today her book is in its third edition.]

I don’t know where I’d be had Dr. Carnegie not shared her stories of triumph as well as defeat. My one-on-one conversations with “Dr. C.” transformed my thinking. Because of her guidance, I resubmitted my manuscript to a different journal and it was accepted immediately. I’m proud to say Dr. C. was my mentor.

When Stewart and Krueger described the role of a mentor more than 10 years ago,1 perhaps they [had Dr. Carnegie in mind]. Filled with wisdom yet open to new experiences, she constantly demonstrated the reciprocal role of the teaching and learning process. Her interactions were purposeful and designed to create career development relationships. Given her expertise in publishing, she stood out and became the knowledge source on nursing scholarship.

Another of the terms Stewart and Krueger used that best describes my interactions with Dr. C. is “resonance.” When Dr. Terry Fulmer, dean of the College of Nursing at NYU, called me and described her vision of a leadership institute for black nurses, I called Dr. Carnegie. Resonating beyond our previous one-on-one interactions, our relationship took on a whole new dimension as she lent her experience to help establish this new professional development opportunity for nurses.

As the field of nursing mourns the loss of Dr. C., simultaneously we celebrate the life and legacy of a brilliant trailblazer who stood up for what she believed in. I can attest to the fact that Dr. C. lives on through my life. She took me by the hand and now I reach out to others with a positive message.

Dr. Mary Elizabeth Carnegie, truly a mentor among mentors.

1. Stewart, B.M., and Krueger, L.E. (1996). “An Evolutionary Concept Analysis of Mentoring in Nursing.” Journal of Professional Nursing, Vol. 12, No. 5, pp. 311-321.