Nurses have been called many things over the years, and saint, hero, angel, and savior are just several ways they’ve been described. In a misguided sense, nurses have even been unceremoniously sexualized in the form of the tired cliché of the sexy nurse Halloween costume.
Throughout the COVID-19 pandemic, it became increasingly common to see signs outside hospitals saying something akin to, “Heroes work here.” Is the hero moniker truly helpful to the cause of nursing? Does calling nurses saints, heroes, angels, and saviors help them in any way? I posit that it’s the opposite: using such terms is a dehumanizing misinterpretation of what nurses do and who they truly are.
Heroes Work Here?
Much praise was heaped upon nurses and other healthcare professionals during the worst months of the pandemic. On many a day throughout those most challenging times, people stood outside of their homes banging pots and pans at the 7 pm change of shift to express gratitude for nurses’ hard work (never mind that it’s the rare nurse who can get out of work at 7 pm to hear such a concert, but it’s the thought that counts).
Meanwhile, the “heroes work here” banners outside hospitals reiterated the claim of heroism, putting nurses and their colleagues on pedestals that might have felt just a tad uncomfortable and precarious.
So, what’s wrong with the proclamation that heroes work in a given facility? What harm does it do when we tell a nurse they’re a saint in scrubs? What does it say when we place a mantle of superhumanity on those who serve as frontline healthcare professionals, risking their lives in the process? There’s nothing inherently wrong with a sincere expression of gratitude, yet it can sometimes not sit well with those on the receiving end.
Superhumans ‘r’ Us
Angels, saints, and heroes are individuals with superhuman traits. They are people whose qualities place them above the powers of mere mortals. They leap tall buildings in a single bound, fly weightless on gossamer wings, and perform miracles and wonders before amazed groups of onlookers.
While the work of nurses may appear superhuman and saintly to the average layperson, the day-to-day slog of hanging chemo, transferring patients, changing catheters, cleaning up feces, drawing blood, and dressing wounds may not feel so heroic or superhuman to those who perform such duties.
Nurses work on the front lines amidst the muck, mire, and bodily fluids of human life and suffering. And during their work, they can be slapped, punched, kicked, spat on, cursed at, and verbally abused.
Nurses’ work can cause them to suffer compassion fatigue, burnout, addiction, depression, anxiety, post-traumatic stress, and suicidal ideation. Are these superhuman traits and reactions? I would say they’re altogether human.
While it is simply a game of semantics, the difference between hero, angel, saint, and warrior could not be starker. When we consider angels, saints, and heroes, we might be more prone to think of creatures who have fewer needs than us mortals — these creatures with special powers have more endurance and are more impervious to the slings and arrows of life. By seeing nurses as superhuman, we can dehumanize them.
Call Us Warriors
Many nurses I’ve spoken with are much more comfortable with the word warrior than the descriptors hero, angel, or saint. They feel that warrior is a more accurate description of what they do and who they are as nurses. Healthcare delivery can feel like a battle – especially during situations like the coronavirus pandemic — and pushing through the worst times in the medical trenches makes the term warrior extremely apt.
Heroes of folklore, mythology, and fantasy are mythic, larger-than-life figures who demonstrate superhuman faculties that set them apart. I would venture that few nurses feel larger than life; in fact, most nurses are arguably more fully in touch with the realities of life (and death) in ways that many members of the general public are not.
Nurses are warriors fighting for the good of the whole against disease, illness, injury, and, at times, death itself. They engage in the battle by leveraging their human knowledge, expertise, skill, and compassion acquired through years of study, hard work, suffering, and learning. See them as heroic if you must, but also see them as the righteous warriors they truly are.
Minority Nurse is thrilled to feature Keith Carlson, “Nurse Keith,” a well-known nurse career coach and podcaster of The Nurse Keith Show as a guest columnist. Check back every other Thursday for Keith’s column.
We’ve seen the statistics showing that nurses and future nurses need mental well-being more than ever.
With healthcare staffing shortages all over the country, healthcare facilities and consumers cannot afford to lose more nurses. At the root of it is that nursing is an incredibly stressful profession, with 63% of nurses reporting significant workplace stress, 70% saying they put the safety and well-being of the patient above their own, and 31% reporting a workload assignment higher than which they felt comfortable (American Nurses Association, 2021).
In addition, 29% of nurses reported feeling sad, down, or depressed for two weeks before the pandemic, with an increase to 34% during the pandemic (American Nurses Association, 2021).
So how do educators ensure future nurses don’t enter the workforce without the skills to cope with the demands of the job? Modeling support for students in nursing school is the start for future nurses to learn resilience through the challenges of school so that they can manage the stress throughout their nursing career.
Nursing school is a demanding career path and one of the most challenging programs. Students enter the field from diverse backgrounds and often with many personal struggles – from academic challenges, medical conditions, strenuous family responsibilities, mental health challenges, and even prior traumas.
In addition, many students worked through the pandemic assisting nurses who were helping to save lives while experiencing high levels of stress and depression.
When faculty understand and agree that nursing students are experiencing stress and mental health issues, this is the time to provide support and model how to endure these challenges for long-term success. To give students the instruction they need to care for patients holistically, Chamberlain University established the Chamberlain CARE® model.
Educating Students on Mental Health
My career goal has been to combat the stigma of mental illness. The Chamberlain CARE® model has further inspired me to support students through nursing school to become strong and compassionate nurses. As a faculty of mental health nursing, it is crucial to educate students on mental health because every patient and family member they meet will likely experience some form of anxiety.
When patients and families come in, they often deal with a long list of emotions – from apprehension about a diagnosis, severity of the condition, recommended treatment, long-term implications, and even future medical bills. When experiencing this anxiety, the patients and families may display uncharacteristic behaviors as they try to cope with an unpredictable and stressful situation.
It is important to remember the feelings of fear and anxiety people have when seeking healthcare services, as these can be their most vulnerable moments. As nurses, we are in hospitals routinely and become comfortable with the environment. However, we are generally not the ones dealing with an illness or injury and facing uncertainties. Therefore, all nurses must interact with patients compassionately and without judgment.
When teaching mental health, we connect the students to a true understanding of the individual in crisis to develop greater compassion and empathy. We are in a unique position because there is greater subjectivity involved. Diagnosing and treating mental illness involves creating trust with the patient so they feel comfortable disclosing their deepest thoughts, fears, and feelings.
As educators, our role is to provide delicate guidance to help connect the students’ emotions to the reality of the patient’s trauma and life horrors. Without this connection, the students will more likely display stigmatizing behavior that prevents patients from seeking and complying with treatment.
Mental illness is a critical issue, and stigma infects societal attitudes. Many need mental health services but never seek treatment due to that stigma. As a result, some patients can accept their diagnosis, while others grapple with the idea of being seen from a vulnerable and stigmatized perspective. In healthcare, everyone is perceived as caring and compassionate, but empathy toward those with mental health issues is lacking.
This prevents follow-through on appropriate treatment and services and exacerbates the mental health issues, potentially leading to further development of mental illness diagnoses. Interventions to combat stigma are critical to the stability of these individuals and society.
Everyone Has Bias
If we confront the preconceptions nursing students may have, we can help reduce the stigma toward individuals with mental illness throughout all areas of healthcare. The first point to recognize is that everyone has bias.
We all have certain beliefs about people or groups formed throughout childhood and other experiences. Some biases we have are not even rational. Some thoughts jump into our heads, but then we may even realize that we do not believe or support those thoughts. The most important part is acknowledging that we have these thoughts. Without acknowledgment, we allow our behaviors to support those biases. For example, common biases toward mental illness are that these individuals are more aggressive or do not take care of themselves. If a nurse has these thoughts about a patient and does not acknowledge them, that nurse is likely to judge and stigmatize.
Deconstructing the Stigma
Before delving into mental illness diagnoses, we have a class discussion about stigma. We discuss what it is, where it comes from, and how it impacts everyone involved. We examine cases of some of the worst traumatic experiences and how the surviving individuals will struggle for the rest of their lives no matter the other circumstances of their lives. From that understanding, we can recognize that any one of us is a moment away from the potential of a similar life-changing tragedy.
One of the key points to remember is that those without a mental illness diagnosis are not so different from those with a diagnosis. Many patients we help in an inpatient behavioral health setting have a history of trauma, hence the greater insistence on more mainstream trauma-informed care. In the current healthcare environment, it is becoming increasingly common for nurses to experience trauma through violent events and the workplace’s compounding stress.
Impactful Self-Assessment Activity
One of the other activities the class participates in is a self-assessment using the Adverse Childhood Experiences (ACEs) scale. Ten traumatic experience categories are tallied to determine an ACEs score. The range is from zero to 10 in the scoring of traumatic childhood experiences. Once the students confidentially calculate their scores, I have them anonymously enter them into a poll that presents the class scores on the screen for everyone to see.
It is an incredibly impactful experience for the students to see the scores of their classmates. Through discussion, we realize how many students in that class have experienced high levels of trauma, primarily as they reflect on the description of each question. Some realize they are not alone in their traumatic childhoods while also, at times recognizing for the first time that those experiences are not typical for a child to experience.
This has become one of the most important activities I have implemented. It causes the students to recognize that they do not even know their classmates well enough, so how would they be able to understand their patients well enough to justify judging them? As we reflect on the numbers, I emphasize to the students that none deserved any of those traumas, just as none of our patients deserve the traumas that destabilized their mental well-being.
Support is often the most critical factor in overcoming and enduring trauma, mental illness, and life challenges. Throughout the course, there is a continual emphasis on self-care and coping skills for teaching others and as a resource for themselves. We know what nursing today looks like with nurses experiencing stress and trauma. Collectively reducing stigma can strengthen the mental health support and treatment we can provide, which can also help the nursing field. With a non-judgmental approach from healthcare professionals, we can better support each other in our times of need.
The impact of self-realization that my students experience drives me to continue supporting them. And notes from students like Larry Pitts, a senior at Chamberlain’s Addison campus who is finalizing his program, are my inspiration. “In 2020, I wasn’t doing the best in school. I was careless, unfocused, and unmotivated. Once I found my motivation and started doing better in school, Professor Mayo always made it her priority to acknowledge my progress and let me know I was doing a great job! She was a haven because she welcomed everyone to discuss anything without passing any judgment. I am forever thankful for her.”
The growth of your career as a nurse can be consciously self-generated or simply a result of happenstance and a laissez-faire attitude toward professional development. Neither of these options is necessarily bad in and of themselves, but a thoughtfully sculpted career is definitely fodder for a much richer, more satisfying, and rewarding trajectory.
Whereas employment can often feel like a means to an economic end (i.e., survival), there is also the notion that work is an avenue to self-awareness, a sense of personal pride, contribution to the community and society, and a full engagement in life.
Work, Fear, and Struggle
It is true that, at specific points in life, work serves a particular purpose. But, especially at a young age, before professional training or advanced education, work is often a utilitarian exercise. Yet, at the same time, it can also feed our sense of pride and purpose—and, perhaps, aspirations for more.
Many work ethics are out there, and many of us may be familiar with the so-called “Puritan Work Ethic,” which espouses hard work and a frugal lifestyle. But, then, there are also the 21st-century pop culture notions of “The Four-Hour Work Week” and get-rich-quick plans.
Meanwhile, fears and anxieties are frequently experienced by those who grew up during the Great Depression.
Since the economic downturn of 2008, many households have struggled to survive, with breadwinners working multiple jobs in the face of a rising cost of living, frozen wages, and increased difficulty finding health insurance (the Affordable Care Act notwithstanding) or planning for retirement.
Yes, work can feel like something we need to do to survive. But we can also consider how work doesn’t just pay the bills and put food on the table but also how it feeds us on the inside.
The Continuum of Consciousness
Considering these suppositions, where do you fall on the continuum of consciousness vis-à-vis your nursing career? Are you “sculpting” a career that’s truly meant for you to embody? Or, to the contrary, are you gliding along a track that, while more or less acceptable, seems like it was created for you by those who feel they have the right to dictate your professional pathway?
Along these same lines, is your career driven by something akin to the Puritan Work Ethic, or are you driven by fear, whether it be fear of not having enough, fear of losing status, or fear of being without work?
This continuum of consciousness vis-a-vis our nursing career trajectory can frequently change, perhaps even daily. Some days, you may feel completely connected at work, aware of how you make a difference in the lives of others. On other days, work may feel like a total slog, a chore to complete as quickly as possible, with your blinders fully in place so that you go through your day without much sense of connection or purpose.
The larger arc is what we’re after, no matter what happens daily. Even though it’s no fun to survive those problematic workdays that feel like they’ll never end, if the majority of your work life is positive, growthful, and adding meaning to your life, you’re on the right track.
Sculpting A Nursing Career That Fits
When you consciously sculpt your nursing career, you are the driver, and your decisions create the path ahead of you. And if you’re not exactly sure where you’re going, don’t worry; the path can be created with each step of the journey.
Sometimes, we follow our intuition, applying for a job because “something” tells us we should give it a try. At other times, a potential position comes into our awareness, and we “know” that the position is the best step towards a future that we’re creating. Our intuition can guide us, and we can consciously seek out opportunities that we feel are the strongest choices for us at this particular time.
The main question is this: are you consciously creating your career, or is your career just happening to you? While it may be OK to coast along from time to time, a consciously created career is the most potentially satisfying.
Paying Attention to Career Arc
So, dear Reader, pay attention to the arc of your career. Have you made good choices? If not, is there a way to remedy that situation? If your current position has you feeling stuck, what can you do to get unstuck? Who can you turn to for advice or support? What action steps can you take to get back on track?
Paying conscious attention is a powerful way to feel like you’re taking the reins of your career. Others’ opinions don’t need to matter much unless you value their opinions. Do you feel like there’s something you need to do because “they” say you “should”? Well, who are “they,” and why do you need to listen to what they say.
Some people function from that above-mentioned place of fear, and others operate from a place of abundance and grace. Which lens would you prefer to look through?
Take the reins of your career path. Find your place on the continuum of consciousness. Create a career that works for you, and make your nursing career a work of art of which you’re proud.
Water and feed your nursing career with conscious creativity and attention, and it will feed you from the inside out.
Minority Nurse is thrilled to welcome Keith Carlson, “Nurse Keith,” a well-known nurse career coach and podcaster of The Nurse Keith Show as a guest columnist. Check back every other Thursday for Keith’s column.
Have you read Part 1 and Part 2 of our interview with popular nurse influencer and nursing advocate Nurse Blake? Catch up before reading Part 3.
Whether you know Nurse Blake from his Facebook videos, podcast, live shows, or cruises, he’s proven that he’s a force to be reckoned with!
Tell me a little bit about your shows. You had done some smaller ones, but how did it all progress?
It was just trying it out, honestly. I was like, “People like my videos. Maybe I’ll do a show.” I asked people, if I did a show, vote for your city. I think we had 40,000 votes. I thought, “Holy crap! People really want to see a show.” I’m like, oh my god, I’m going to put a show together. What would that even look like? And you know, people came out. First, I did five shows. Then I did 10, then we scaled up and did, like, 50, and they all sold out. I was only supposed to do 14 shows, but those all sold out, so I’m doing 50 again.
I’m lucky enough to be repped by CAA. They’re so awesome, you know? They work with me on what venues I want. I love to keep my ticket prices at a pretty good rate so even nursing students can come.
It’s a one-person show. It is just me. It’s a mix of stand-up but with skits and videos that I show that people have never seen before. I now break it up into three parts–my life growing up, nursing school, and nursing. It goes with my journey and my flow.
One of the other reasons I decided to do my show is that I was speaking at many nursing conventions at nursing conferences and hospitals. They wanted to tell me what I could or couldn’t and what I should say.
And I was like, you know what? I’m a nurse. I don’t advocate for these hospitals. I’m a nurse. I advocate for the nurses. So in my show, I say what I want to say. I feel like I could be vulnerable and share the good and bad that the nurses go through.
But at the end of the day, while it’s funny, and I poke fun at many things, I leave nurses feeling inspired, making them realize that they’re not alone.
What’s cool about my show is that I have audience members who are 18 or 19, to nurses who have been nurses for over 60 years. I have families come–different generations, where the grandma was a nurse, then the daughter, and now a grandson. I have whole units that come–groups of 30, and they make t-shirts.
Listen, no matter which age/specialty you are, we could all get in a room and laugh, right? We could all feel the sense of community and love because I know what the hard days are like. I know what it’s like to have a shitty shift, and you’re wondering, “Is nursing really for me?”
And just knowing that you’re not alone is powerful and keeps you going. So that’s what I like to show through my performances.
What have you learned from your nursing career trajectory?
I learned in just working with patients that you only live once. You can never be perfect, especially in this profession, and as a nurse, you have to do something that you really love. So, never, ever feel like you’re stuck anywhere. If you’re at a point you don’t like or dread waking up or going to that shift, switch it up.
We’re critical thinkers and innovators, so you should do that with your job and career. Mix it up. I’ve also learned to take risks and have fun, not take life so seriously, and live in the moment, you know?
After every show, when the theaters are empty and clear, I sit alone on the stage and think about everyone who came. We know our patients’ stories but often don’t know the stories of our co-workers and nurses. So, I try to get to know where nurses come from, who they are as individuals, and where they’re going because I think so many times, we look at each other like co-workers, but at the end of the day, we’re also patients in our way.
What would people be surprised to know about you?
Oh, that’s a good question. One, that my husband’s 6’7.” And that I have anxiety and depression. I take my Wellbutrin in the morning. I take my Lexapro in the evening.
Many people see me and have misconceptions about people who have a presence online. Because you only see us when we post, right? I try and get raw and real. You see that from me when I’m in my show, and I share. No one knows I’ve ever had a panic attack before unless you’ve seen my show or that I’ve had multiple panic attacks. That’s what would surprise people maybe the most.
Is there anything I haven’t talked with you about that you think is important for our nurse readers to know?
Even though I have this comedy and humor platform, I balance that out with my advocacy. I launched a petition that got over half a million signatures to have organizations like the Joint Commission help us focus on safe staffing. I advocate for healthier work environments for nurses. I know we all hear the term “Nurses eat their young,” so I came out with the campaign “Nurses Support Their Young.” So as much as I love comedy, as much as I love doing shows, I also love advocacy work.
Why do you like doing what you’re doing so much? How do you think you’re making a difference as a nurse advocate?
I felt through nursing school that to make a difference, you had to have a master’s degree, have all these fancy letters behind your name, or go back to school to get your nurse practitioner. And when I was in nursing school back in 2013, I was denied being able to donate blood because I’m gay.
So, I started a campaign called Band4Life. I decided that I would help get the FDA to end its lifetime ban on gay males from donating blood. But I also worked as a patient care tech and went through nursing school. So, I thought that the FDA wouldn’t listen to me. But I started this campaign, shook it up with the FDA, and in December 2015, they ended the lifetime ban.
And that’s when I realized the power I had just as a nursing student. So many people think, “I’m just a nurse, or I just have my RN, or I just have my bachelor’s, or whatever.” But no matter where you are within your nursing journey, you have the power to create change. So, I encourage nurses to use their voices and not be scared. Because if you see a problem, if you don’t try to change it or fix it, who is?
Be sure to catch Nurse Blake’s PTO Comedy Tour throughout the U.S. and select cities in Australia.
Findings from a new Northwestern Medicine study rebut the idea that Black individuals’ higher risk of cardiovascular disease is because of biological differences.
“The key take-home message is that racial differences in cardiovascular disease are not due to race itself, which is a social concept that is not related to biology.”
Black adults are at significantly higher risk (1.6-2.4 times) for cardiovascular disease than white adults. The new study found these large differences can be explained by differences in social determinants of health (like education or neighborhood-level poverty), clinical factors (like blood pressure) and lifestyle behaviors (like dietary quality).
“The key take-home message is that racial differences in cardiovascular disease are not due to race itself, which is a social concept that is not related to biology,” said corresponding author Dr. Nilay Shah, assistant professor of cardiology and epidemiology at Northwestern University Feinberg School of Medicine and a Northwestern Medicine physician. “Rather, these differences in cardiovascular disease can be explained by differences in social and clinical factors. Clinicians should be evaluating the social determinants that may be influencing the health of their patients.
“The data from this study starts to identify what contributes to the higher burden of heart disease experienced by Black adults, and how much each factor matters.”
Black women had a 2.4-times higher risk for cardiovascular disease compared with white women. The study found that clinical factors, neighborhood-level factors and socioeconomic factors explained the largest components of the higher risk experienced by Black women.
Black men had a 1.6-times higher risk for cardiovascular disease compared with white men. The study found that clinical factors, socioeconomic factors and lifestyle behaviors explained the largest components of the higher risk experienced by Black men.
“The findings of significantly higher risk in non-Hispanic Black adults compared with non-Hispanic white adults is not surprising—this is well-known,” said senior author Dr. Sadiya Khan, assistant professor of cardiology and epidemiology at Feinberg and a Northwestern Medicine physician. “But it was surprising that the risk for cardiovascular disease was the same once social and clinical factors were considered over time. This finding is really important to rebut that there is an unexplained or genetic reason that Black individuals have higher risk.”
The study’s findings are important because they show that disparities in heart disease experienced by Black adults could be reduced by improving preventive care of heart disease risk factors and addressing social determinants, Shah said. The data provide a guide to identify strategies that may be particularly effective at reducing the persistent differences and disparities in heart disease that exist in the U.S.
“It is important to note that clinical risk factors, lifestyle and depression are not independent of socioeconomic status and neighborhood segregation,” Khan said. “Future research needs to go upstream to target social determinants of cardiovascular health. Our study lays groundwork to help inform community-engaged interventions that ensure equal opportunities for all people to have access to high-quality foods, environments and health care.”
The study evaluated data from about 5,100 Black and white adults who participated in the CARDIA (Coronary Artery Risk Development in Young Adults) Study at four locations in the U.S. (Chicago; Minneapolis, Minn.; Oakland, Calif.; and Birmingham, Ala.). The participants enrolled around 1985 and have been followed for over 30 years. The scientists evaluated the information participants provided starting from the time of their enrollment to determine the role of social and clinical factors in the differences in cardiovascular disease experienced by Black compared with white adults over the course of 30 years of follow-up.
Other Northwestern co-authors include Norrina Allen, Dr. Donald Lloyd-Jones, Mercedes Carnethon, Kiarri Kershaw, Lucia Petito and Hongyan Ning.
Funding for the study was provided by the National Heart, Lung, and Blood Institute (NHLBI) (grant K23HL157766); the National Institutes of Health (grants P30AG059988 and P30DK092939); and the American Heart Association (grant 19TPA34890060). The CARDIA study is conducted and supported by the NHLBI in collaboration with the University of Alabama at Birmingham (grants HHSN268201800005I and HHSN268201800007I), Northwestern University (grant HHSN268201800003I), University of Minnesota (grant HHSN268201800006I) and Kaiser Foundation Research Institute (grant HHSN268201800004I).
