The American Association of Neurosurgical Nurses (AANN) was founded in 1968. The organization was formed by a committee from the American Association of Neurological Surgeons composed of both nurses and physicians. In 2008, the AANN, by then renamed the American Association of Neuroscience Nurses, celebrated 40 years as an organization. In preparation for this celebration, a board-appointed task force conducted videotaped interviews with as many of the past presidents of the association as possible to obtain and to document their historical perspectives. The purpose of this manuscript was to report the lessons learned from the interviews of the 17 past presidents videotaped in this exploratory descriptive study.

The nurses who began AANN were diligent in recording their history. There are unpublished 10-, 15-, and 20-year histories of the organization along with multiple photographic records through the years. These materials are all archived at the center for historical inquiry at the University of Virginia. Articles have appeared about the beginning of the organization (Marshall, 1978) and the aspects of the historical development of neuroscience nursing in general (Hartshorn, 1986). A booklet was published to celebrate the 30th anniversary of the organization, but as it approached its 40th anniversary, at least three of the authors of that particular document were deceased (Blank-Reid et al., 1998). Therefore, it was decided, with the support of the AANN, to conduct this exploratory descriptive study of the history of AANN. The purpose was to give voice to the past presidents of the organization and to preserve their stories.

Methods

In this exploratory descriptive study of the history of AANN, past presidents of the organization who were attending annual meetings were invited to participate in videotaped interviews. An administrative assistant viewed the list of attendees and identified the past presidents, who were invited to individual interviews. The videotaped interviews took place at the annual meetings over three consecutive years (2005 through 2007). Each individual interview lasted from 30 to 45 minutes. Funding was supplied by the AANN.

Two of the researchers viewed each of the taped interviews and compiled a DVD for the 40th anniversary celebration in 2008. Usable interviews were then transcribed by one of the researchers and a research assistant. Two researchers read each of the transcripts repeatedly and using content analysis independently identified recurring themes. Consensus of themes and codes were developed and used to identify examples of the resulting lessons learned.

Sample

All of the past presidents who consented to be interviewed were Caucasian women. Three of those interviewed had been president during the first decade of the existence of AANN, two during the second decade, and six respectively during the third and fourth decades.

Findings

There were four main lessons learned from these dynamic individuals who consented to be videotaped and share their experiences as past presidents of AANN. These included the following: (1) there are many paths to neuroscience nursing, (2) you have to have passion and commitment, (3) mentors are very important, and (4) it is essential to keep learning.

Lesson 1: Multiple Pathways to Neuroscience Nursing

Early in the interviews, it quickly became obvious that one of the most important lessons was there were many different pathways these individuals took into nursing in the first instance and then into neuroscience nursing. Most those interviewed spoke of a direct pathway into nursing. Many spoke of always wanting to be a nurse. Some knew why they wanted to go into nursing from an early age, and some spoke of vague feeling of just always knowing that they were going to be a nurse.

I wanted to become a nurse since probably (the age of) 4, my grandmother made me a nursing outfit which I wore constantly and also, it was something that I always wanted to do and something I always thought I would be good at, I have no idea why because I never even did anything in nursing until I became a senior graduating from High School and thought maybe I should volunteer to see if I liked it or not which I did.

There were some individuals for whom the pathway into nursing followed an indirect course. In fact, some began their career journey with the initial intent to not be a nurse.

I was never going to be a nurse. I was the child of two physician parents and I was always going to be a physician. There was no decision about what I was going to be in life. My big decision was what kind of physician I was going to be. I grew up with it. It was part of our household[horizontal ellipsis]

Many of the past presidents spoke of a different pathway, not only into nursing but also into neuroscience nursing in particular. Some knew from an early age that they wanted to be not only a nurse but clearly a neuroscience nurse.

The reason I became a nurse was because when I was about 13 or 14 (years of age) my mother became ill and developed cancer that spread to the spinal cord. And there wasn't much in the way of hospice or home care and that kind of stuff back then and being the eldest child in the family I was the one who was designated, so to speak, to care for her. And I was quite frustrated by what I didn't know, thinking there might be things I could do for her if I only had a little bit of knowledge to help me understand the kinds of things she was going through, particularly from a spinal cord perspective because as the disease progressed she became essentially paraplegic and that was also something that, at that young age, I didn't understand. So I decided I really wanted to get into nursing to learn much more about disease processes, and be able to help people in a much more efficient way.

For some, exposure to neuroscience patients while in nursing school led them into the specialty of neuroscience nursing.

I did my undergraduate baccalaureate training at the University of California San Francisco and as a nursing student just virtually, accidentally did rotations in neurological and neurosurgical nursing units and was intrigued by neurosurgical patients.

Others spoke of different pathways into neuroscience nursing. For some, their first interview or job just happened to be on a neuroscience unit. Some entered the job market during lean times, and the only position available was on a neuroscience unit.

I had applied for a position as a staff nurse at a very large institution, Montefiore Medical Centre in the Bronx. And they asked me what kind of a nurse I wanted to be. So I wasn't aware of all these sub-specialties, well, I guess I wanted to work, maybe cardiac and they told me there were no positions there. And there were no positions in surgery, that time obviously there were no nursing shortages in 1979. I said: "What do you have available?" She said: "You know, we have this exciting position that available and it's in neurology." I'm thinking to myself, out of all the specialties that I've just named off that wasn't one of them, but I needed a job and so I took it. And it proved to be one of the most wonderful experiences. I still remembered my very first patient that I took care of on my very first day and my preceptor. Then I stayed there for 15 years.

Two subthemes emerged from lesson one, multiple pathways into nursing and neuroscience nursing. The first subtheme was that of family influences. Many spoke of how their family influences led them to either a direct or an indirect pathway into nursing. Many spoke of their mothers, grandmothers, and cousins who were nurses before them and inspired them to enter the profession. Some of the family influences were positive.

I chose nursing as a career because it's basically something I've always wanted to do my entire life, since I was little. I wanted to be a nurse.[horizontal ellipsis] I always wanted to do it, my grandmother had been a nurse and I used to love to hear her talk about stories about nursing in New York City before the depression.

Some of the family influences were negative or ambivalent at best. There was evidence of some resentment, particularly for those who were making career choices "in the 1950s and 1960s and the decision at that point for women was teaching or nursing."

We would be in a group with other women and I could hear my mother say I wished my daughters would be a nurse. We said we wouldn't be a nurse for anything and because it was resentment, you know, retaliation. You want me to do this-well I'm not going to.

Patients and their families were a constant presence that came up in the interviews no matter where the past presidents were along their pathway. Thus, a second subtheme emerged, that of the importance of neuroscience patients and their families. For some, it was neuroscience patients in general that led them to neuroscience nursing.

I rather thought through the kind of patients I had enjoyed working with and that seemed to be neuro. So I requested I be placed with students on a neuro unit and subsequent to that made the decision that yes, neuro was the area that I wanted to specialize in. And so that began my neuroscience nursing career, if you will.

Many recalled specific patients, the patient with a spinal cord injury, brain tumor, or stroke. Others talked of the families of their patients and doing things like attending the funerals of patients that died. Several vividly remembered their first patient with a neurological condition that they provided nursing care for.

New Year's eve 1977 I was pulled up to the neuro ICU for the 3 to 11 shift. Now, when I was pulled up to the neuro ICU, I walked in, there was one patient, a 4 bed unit, one patient who was a C4 quadriplegic with third degree burns, on the ventilator, in a halo [vest][horizontal ellipsis]

Lesson 2: Passion and Commitment

All the past presidents spoke about their love of neuroscience nursing.

Plus you know what, I love neuroscience nursing and I love AANN. It is wonderful, the intangibles about what we have in AANN are just absolutely powerful. The spirit of the meeting, I have heard so many new nurses, not new nurses but nurses that have been to other conferences say-people here are so friendly, there is a friendliness here. I feel so welcome when I come to this meeting, that I don't experience when I go to other meetings for the first time, or second time, or the third time. And that I think says something about who we are, about our culture is within AANN.

Sometimes, a past president began in another specialty and found a path later into neuroscience nursing but still demonstrated a high level of commitment.

That is how I literally backed into it, have loved it ever since. Went off the graduate school, did all my graduate work with neuroscience conditions, passed my certification exam and have been certified ever since. And been working as clinical specialist and faculty.

Many of the past presidents went straight into neuroscience nursing and loved it. Almost all of those interviewed spoke of their passion and commitment to AANN.

I really do truly believe that work for this association I would, you know obviously some of this came from my own perseverance, but because of the nurturing environment, the networking environment, the collegiality, encouragement from people all over United States. It was just an experience that I always tried to get other people involved in. Because once you catch the fever which I think there is a fever with any association. I think there is a sense of not only collegiality and professionalism. I think there is a sense of warmth that you may not necessarily find in other specialty organizations. So that's how I got into neuroscience nursing and have never ever regretted.

The passion and the commitment were often exemplified by their long history of service to the organization. With the exception of the early presidents, all of those who came later in the history of the organization spoke of working their way up within the organization, such as starting with the local chapter of AANN serving as officers, even founding the local chapter, and then moving on to the national level. Others spoke of years of serving on various committees, in board of director positions, and culminating with running for president.

After a year or two off of the board decided I'd like to try to run for president. Think it was because of the commitment to the association and to neuroscience patients and wanting to be a part of implementing change and progress and so ran for president around 1989.

The second president of the organization summed up the intertwining themes of passion and commitment.

He said to me "you are a neuroscience Diva, a Diva." So they wrote up business cards and gave me, with a brain on it[horizontal ellipsis] and they just love it, just love it. And so teasingly I say I am a neuroscience Diva.

Lesson 3: Mentorship

All of the past presidents spoke about the importance of both receiving and giving mentorship. Those who were president of the organization during the late 1960s and early 1970s spoke about having physicians are mentors.

I went to the surgeons, and I asked them for their by-laws because I didn't know where to start. I had never done this, never been a leader in an organization, I was in my early 20s you know. So I went to the surgeons, I got their by-laws.

Those who were president during the later decades of the organization began to speak of having nurses are mentors.

I did, I had a head nurse in the unit there and a couple of the senior staff nurses were instrumental in training me in the clinical practice and actually second head nurse who was instrumental in getting me involved in AANN as a new nurse.

Many of the presidents recalled the first annual meeting of AANN that they attended and being inspired specifically by the neuroscience nurses they met there.

My first annual meeting and it was in Colorado, Denver, Colorado. And I had joined the association at that point, I believe that was in 1981. I was so overwhelmed by watching my fellow colleagues, nurse colleagues, whether they were staff nurses or clinic nurse (practitioners wasn't really big back then). You know get to a podium and present something, you know what I considered at the time highly technical and highly scientific information. And my first impression was how do I, how do I get to be at that level? I mean, this is a great goal.

The presidents also spoke of the importance being a mentor.

My decision to run for office was an opportunity for me to give back what I felt was given to me from the association. I wanted to be able to mentor people.

Lesson 4: Continuing Education

The presidents in the first decade spoke mostly of learning from the physicians.

The doctors too, as far as neuro was concerned, I went to all the doctor's conferences and their grand rounds. I went to everything because I was one step ahead in the book with the kids I was teaching. So I went to everything and they were wonderful. I wrote a big fat manual for orientation for the nursing students and they edited it for me and helped me with it because this is how I learn. I wrote, this is how we do things, the tests that people had and whatever went on and how we did it and a glossary, a dictionary type of thing with terms we used. I mean, anisocoria, you know. That type of thing, so I wrote this whole thing and the physicians edited it and they helped me with it.

The organization learned about the needs of members and produced the materials nurses needed to provide expert care to their neuroscience patients.

Neuro ICU is not the only place to gain experience in neuroscience nursing, neuro rehab is not the only place, but they can really learn, so stick with it. Read and study, core curriculum, textbooks, you know, big books, the journal [Journal of Neuroscience Nursing] articles every time it comes out, will really help in learning that material. And you start with basics, start with anatomy and physiology and neuro assessment that sort of thing and then you move from there.

I have yet to spend a day when I did not learn something new about neuroscience nursing.

Most of those who were president in the later two decades spoke of learning to run a national organization.

You don't go in as president, you leave[horizontal ellipsis] knowing how to be president.

Discussion

There were clearly many paths into nursing in the first instance and then into neuroscience nursing for these women. Many wanted to be a nurse from an early age. For others, at the beginning, they did not even know they were going to be a nurse let alone a neuroscience nurse. Their families provided important positive and negative influences as did neuroscience patients and their families.

The passion and the commitment of this group of women came through as they all spoke of their love of neuroscience nursing, the patients, and the organization. They were a select group who had given years of volunteer service to the organization at the local and national level. These themes were intertwined and at times not distinguishable from each other.

An interesting historical perspective that became evident within the theme of the importance of mentors was that those who were president of the organization during the late 1960s and early 1970s spoke about having almost exclusively physicians as mentors. The physicians were heads of their departments, bosses at work, and in more than one instance someone who invited nursing input by asking them to join rounds or meetings about patients. Those who were president during the later decades of the organization not only talked about physician mentors but also began to speak of having other nurses as mentors. These mentors included people they worked with such as their head nurses, the clinical educators, and the clinical specialists at their institutions. Many recalled the first annual meeting of AANN that they attended and being inspired specifically by the neuroscience nurses they met there. The mentorship the various presidents received, whether from physicians or fellow nurses, was instrumental in their decision not only to become a neuroscience nurse but also, often, to run for president of the organization. Their desire to become mentors was a way of "giving back" what they felt they had gotten from the organization and the larger neuroscience nursing profession.

An undercurrent in all the interviews was learning and continuing to learn. They learned about the specialty and about running organizations and managing people. An interesting historical theme that evolved was where the nurses got their information. The early presidents spoke of having to learn from experience or to go over to the medical school to get the level of knowledge they needed to care for neuroscience patients. The later presidents felt that one of the successes of AANN was that the organization eventually produced the needed educational materials the nurses needed to provide expert care to neuroscience patients.

Articulating the lessons learned from the past presidents of this organization is important for several reasons. It gives voice to these dynamic leaders and preserves the collective memory of this subspecialty organization as it looks ahead for where it is going next in an ever changing society.

References