Some of my friends say they always knew they wanted to be nurses. They tell stories about their childhood toy nursing play sets. They shared that they read the Cherry Ames mystery series in which Cherry progressed through almost every nursing role. Among other things, she served as a staff nurse, army nurse, chief nurse, flight nurse, veteran's nurse, private duty nurse, visiting nurse, camp nurse, and rural nurse. She was even a cruise ship nurse, boarding school nurse, department store nurse, and "island" nurse (you'll have to read it to understand that one). Her adventures impressed at least one generation of young girls with the variety of nursing specialties and opportunities. My colleagues tell me that, partly because of that, they had early aspirations to join this profession.
My male colleagues may not have had the same early calling to our work, but most tell me that their decision to pursue this career was based on a recognition that Nursing, along with its mission to serve others, presents multiple opportunities for a career filled with variety. They chose it because of these options.
Some nurses add that their own early experiences with hospitals or family health issues influenced their choice of occupation. They remember coming into contact with women (and a few men) who wore white uniforms and made lifelong impressions on their young minds.
I, on the other hand, never intended to be a nurse. Yes, I did have a white plastic "Nancy Nurse" kit, and a "Get Well, Mary Bell" doll on which to practice my caring skills. I read the Cherry Ames books, but I also read Nancy Drew and Hardy Boys mysteries. When my mother was dying, our community hospital did not allow children to visit, so I never came into contact with the nurses who might have influenced my impressionable 6-year-old self.
So, Nursing wasn't an aspiration for me. I wanted to be a writer. I planned to be a newspaper journalist, and also write books like those I loved to read. I only went to Nursing school because the lure of an all-expense paid scholarship was irresistible. I planned to get that BSN, work to earn what I needed for more tuition, and then head back to college to study journalism. How was I to know that I would fall in love with this profession, my nursing team members, and (most of all) the patients?
I was hooked within my first months as a graduate nurse, and I've loved every one of my Nursing jobs, from the hospital front line to the health care system executive suite. I admire my brilliant and caring colleagues. I'm awed by the experiences afforded by this profession. I'm always proud to say that I'm a nurse.
That's why I have trouble comprehending the rationale of individuals who seem to want to distance themselves from that title. Years ago, a hospital CEO introduced herself to me by saying, "I used to be a nurse, too." When I asked if she didn't still consider herself to be a nurse, she seemed shocked. "Oh no," she said, "I have a master's degree in hospital administration. I'm a CEO, and I dropped the RN, because, you know, the other hospital executives wouldn't respect me if they thought of me as a nurse." To this day, I wish I'd asked her this question: When did having once touched patients become something to be ashamed of?
Unfortunately, that individual has not been the only executive I've met who feels that way. While I've never heard a physician CEO state that he or she is no longer a doctor, I've encountered a number of nurses who drop their nursing credentials when they leave bedside care. I was also once told by a nonclinician hospital administrator that I would need to drop my RN credential if I wanted the "top" hospital job. "The problem you have," he said, "is the combination of being a woman and a nurse. If you were male, the RN credential is OK. If you were an MHA female, you'd have a chance. It's the combination of being female and a nurse that makes you less likely to be a leading candidate for the CEO spot."
I first heard a nurse leader openly talk about this issue in the 1980s. Dr Roxanne Spitzer was a speaker at a nurse executive meeting I attended. She discussed the reality that Nursing has been undervalued and underappreciated, partly because it has historically been viewed as a female field; partly because compassion and kindness is equated (consciously or unconsciously) with lesser business acumen; and partly because we don't take deliberate action to educate others about the intellect that accompanies the art and science of holistically caring for others.
Roxanne spoke of the nurse CEOs who wouldn't admit to their Nursing roots, and how their unspoken disclaimers and distancing from these supports the myth that nurses are merely kind "angels of mercy." She encouraged us to stop hiding our intelligence and leadership ability. From her presentation, I also took away the conviction that we need to help our own nursing colleagues understand that nurses who no longer practice in hands-on (at bedside or chairside) roles have not left Nursing. We've chosen a different Nursing specialty. Most of the readers of this journal have histories in medical-surgical, pediatric, psychiatric, emergency, perioperative, obstetrical, critical care, or other hands-on practice. You are also leaders and executives who have added the specialty of Nursing Management to your career resumes.
Nursing Management is a specialty. It requires knowledge and education in areas as diverse as finance, marketing, statistics, politics, psychology, sociology, and business. It also, when practiced well, is based on evidence that has been developed by leadership researchers from both inside and outside health care. Unlike generalist managers, nurse leaders must also stay educated in the trends and changes in clinical nursing practice. Our roles are complex, but most of us wouldn't have it any other way.
We recognize that this profession is rich with opportunities to experience multiple roles in careers that are never boring. When I was younger, I thought it wasn't realistic that Cherry Ames practiced a different kind of Nursing in every adventure. I know now that her ever-changing roles were not that far-fetched. Because I am a nurse, I've also been afforded the opportunity to be a journalist (both as a health care newspaper and journal columnist), author (management books), and editor. Nursing didn't stop me from accomplishing those early aspirations-it enabled me to pursue them.
In this edition of Nursing Administration Quarterly (NAQ), we are celebrating the variety of jobs that nurses hold. As you read it, I hope you will be even more proud of your profession, your colleagues, and yourself. Many of the individuals whose stories are shared here are not practicing in areas typically associated with Nursing. However, all of them once touched patients. All of them were educated in the holistic art and science of Nursing. All of them retain a passion for making a better and healthier world. All of them share an essence that has been historically difficult to define and verbalize. It's the essence of Nursing: a combination of education, skill, and love for individuals, communities, and the world.
As I end this unusually long editorial, Linda and I are concluding our tenure as editor-in-chief and managing editor of NAQ. I've cherished the last 7 years as editor, as well as the years before that when I served as an associate for NAQ's first editor-in-chief, Dr Barbara Brown. We're leaving the journal in capable hands, so we will all continue to enjoy the writings of our nurse leader colleagues. I'll be concentrating on my next chapter in this adventure series known as a career in Nursing. It will be challenging, interesting, and rewarding, as every chapter has been. It will never be dull, because, like you, I'll always be a nurse.
Thank you for choosing to lead,
-Kathleen D. Sanford, DBA, RN, FACHE, FAAN
Editor-in-Chief
Nursing Administration Quarterly