I was doing my annual “Managing Holiday Stress” lecture on a cold December evening one week in the Hospital Auditorium.  This lecture has been traditionally part of our Behavioral Health Departments’ Holiday gift to the hospital and the community.  As a Clinical Nurse Specialist, I regularly presented on Wellness for the general public.  One never knows what one will “get” at these lectures.  I had spent a fair amount of time preparing for the talk. The audience turn out was dismal.  Or so I thought.

I turned my back from the large empty auditorium to collect my things and leave.  When I turned back again to the seating, I was surprised to see one woman, a senior citizen, sitting alone in the middle of the large room.  “Oh my,” she said in an embarrassed tone.  “No one else is coming. Well, I won’t take your time.”  She began to gather her things to leave.  I thanked her for coming and sat down near her.  I asked, “Why did you come here tonight?.”  “I love these lectures,” she replied.  “I don’t go out at night except to come to these talks.  I don’t really have a reason to go out at night anymore.  I don’t understand why more people aren’t here.  I knew it would be interesting.”

“Well, how do you spend the Holidays?”  I inquired, hoping that I could help to make her venture out in the cold worthwhile.  “I don’t do Christmas, you know.  I don’t have the money for gifts in boxes.  Today everyone has everything anyway.”  I agreed and asked if she’d like to do next year’s talk with me.  She smiled and we laughed.
“I’ve had to ‘downsize’ (her word) and don’t have room for lots of stuff anymore,” she said.  “I’ve been able to give away a lot this season!”  She sparkled as she said this.

I commented that giving is part of the Holiday spirit.  “Yes,” she replied.  “That’s mentioned in Eastern religions, isn’t it?”

“Oh yes,” she replied.

“Oh yes,” I answered.  “And in the prayer of St. Francis: It is in giving that we receive.”

“Oh, that is right, isn’t it?” was her cheerful reply.  “Well,” she went on, “Don’t you think we should practice that part of Christmas every day?”  I smiled and nodded.

I was wondering how she coped with the holidays, so I asked, “What do you do?”

She held her head humbly.  “I don’t do Christmas.  Instead, I go to the soup kitchens downtown and feed the homeless.  I really enjoy that.  Thanksgiving is my favorite.  I have so much to be thankful for in my life.  I’ve always had food and shelter.”  I asked about family and friends, in concern for her loneliness (I was thinking about inviting her to a potluck I was to attend later in the evening).

“I have no family, but I have a few friends.  Therefore, I don’t like a lot of those family things.  I’m not comfortable.  All that food is more than I like and more than I need, as well.”  She continued, “Sometimes those gatherings can be like ‘false tinsel’, just like the emphasis on presents that cost money.  I see how that makes people crazy.  I work weekends in a gift shop and watch people suffer over the perfect gift.” She hesitated. “I think the whole gift thing can be kind of fake sometimes. You know, people with possessions are possessed.”  I nodded and asked permission to quote her.  We laughed again. “You are so kind,” she said.  “Well, you know I’ve done all that Christmas gift stuff in the past. I have grey hair now,” (as though that would excuse her from the season’s stress).  Her snow white hair seemed to glow as she giggled and combed it with her fingers.

I did go to Christmas in the Prado in Balboa Park.  It was wonderful!  The park was filled with children, music and beautiful sights.  You really should go next year!   I assured her that I would.

I told her that I thought she had the spirit of the season, and that her giving and acknowledgment of others was what Christmas was about.  She became coy, bowed her head and repeated, “You are kind.”

“You know, I think you really do ‘Do Christmas,” I insisted.  To my surprise, this wise woman quietly replied, “You really think I’m OK?”

I assured her that she was.

I asked her name.  She replied, “Mary.”

I told her she had given me a gift.

I turned back to the stage to once again collect my things.  When I turned back Mary was no longer in the auditorium. I said, “good bye” … to myself.


(click here to see source document)

Background: Research has documented an association between Magnet hospitals and better outcomes for nurses and patients. However, little longitudinal evidence exists to support a causal link between Magnet recognition and outcomes.

Objective: To compare changes over time in surgical patient outcomes, nurse-reported quality, and nurse outcomes in a sample of hospitals that attained Magnet recognition between 1999 and 2007 with hospitals that remained non-Magnet.

Research Design: Retrospective, 2-stage panel design using 4 secondary data sources.

Subjects: One hundred thirty-six Pennsylvania hospitals (11 emerging Magnets and 125 non-Magnets).

Measures: American Nurses Credentialing Center Magnet recognition; risk-adjusted rates of surgical 30-day mortality and failure-to-rescue, nurse-reported quality measures, and nurse outcomes; the Practice Environment Scale of the Nursing Work Index.

Methods: Fixed-effects difference models were used to compare changes in outcomes between emerging Magnet hospitals and hospitals that remained non-Magnet.

Results: Emerging Magnet hospitals demonstrated markedly greater improvements in their work environments than other hospitals. On average, the changes in 30-day surgical mortality and failure-to-rescue rates over the study period were more pronounced in emerging Magnet hospitals than in non-Magnet hospitals, by 2.4 fewer deaths per 1000 patients (P<0.01) and 6.1 fewer deaths per 1000 patients (P=0.02), respectively. Similar differences in the changes for emerging Magnet hospitals and non-Magnet hospitals were observed in nurse-reported quality of care and nurse outcomes.

Conclusions: In general, Magnet recognition is associated with significant improvements over time in the quality of the work environment, and in patient and nurse outcomes that exceed those of non-Magnet hospitals.


Kutney-Lee, Ann PhD, RN; Stimpfel, Amy Witkoski PhD, RN; Sloane, Douglas M. PhD; Cimiotti, Jeannie P. PhD, RN; Quinn, Lisa W. PhD, RN; Aiken, Linda H. PhD, RN

2015 is the 100th anniversary of Florence Nightingale’s Death.   And May 12th is typically thought of as Florence’s Birthday.  So pause for a moment and reflect on our profession and the legacy we offer to our communities.  We are clearly a profession worth celebrating.

For entertainment, here are some of Florence’s pledges.  The original and a more contemporary version:

Original “Florence Nightingale Pledge”

  • I solemnly pledge myself before God and in the presence of this assembly to pass my life in purity and to practice my profession faithfully.
  • I shall abstain from whatever is deleterious and mischievous, and shall not take or knowingly administer any harmful drug.
  • I shall do all in my power to maintain and elevate the standard of my profession and will hold in confidence all personal matters committed to my keeping and all family affairs coming to my knowledge in the practice of my calling.
  • I shall be loyal to my work and devoted towards the welfare of those committed to my care.

Interestingly, the pledge was not written by Florence Nightingale. The pledge was actually written by a committee at the Farrand Training School for Nurses in Detroit, Michigan, in 1893. The committee was chaired by Lystra Gretter

“Practical Nurse Pledge”, a modern version based on the “Nightingale Pledge”

Before God and those assembled here, I solemnly pledge:

  • To adhere to the code of ethics of the nursing profession
  • To co-operate faithfully with the other members of the nursing team and to carryout [sic] faithfully and to the best of my ability the instructions of the physician or the nurse who may be assigned to supervise my work
  • I will not do anything evil or malicious and I will not knowingly give any harmful drug or assist in malpractice
  • I will not reveal any confidential information that may come to my knowledge in the course of my work
  • And I pledge myself to do all in my power to raise the standards and prestige of the practical nursing
  • May my life be devoted to service and to the high ideals of the nursing profession

However a favorite comes from “the truth about nursing” and is quite inspirational:

As I care for you, it is my job to protect you from all harm. That means any harm from your illness or its symptoms, from outside forces including the care environment, and from other people if necessary, even those involved with your health care or health financing. As an autonomous health professional who reports only to senior nurses, it is my job to defend you from poor or misguided health care from any source. I am your advocate. I vow to do my best to protect you as if you are a member of my family.

So go forth and celebrate choosing profession that makes the world better. – Jim Kane



It was another Saturday night in the intermediate step-down unit where I had been working as a registered nurse for a little over a year.  I suctioned Harry and decided to bathe him because it was already 4 AM, and I thought I’d have him “fluffed and buffed” by the change of shift.

Harry and I spent many Saturday nights together.  We had CNN on and the lights dimmed while I chattered to this 69-year-old man who was far away from home.  He and his wife Claire had been driving through Pittsburgh in their Winnebago, fulfilling a dream to travel throughout the United States.

On a cool March morning, Harry and Claire stopped to “gas up” the Winnebago and have breakfast before moving on to Washington, D. C. to see the cherry blossoms in bloom.  As the two began to drive out of the gas station, Harry clutched his chest and, putting the Winnebago in park, lost consciousness.

Alone in a strange city without family or friends, Claire called 911, described their situation, and waited for help.  The paramedics arrived, stabilized Harry, and sent them to Allegheny General Hospital.  After an unsuccessful angioplasty of his coronary blood vessels, Harry was sent to the OR for emergent coronary bypass surgery.  Harry never regained consciousness.  He was put on a ventilator and his electrolytes were unstable.  The calendar changed.  Harry’s mediastinal wounds had healed, and Claire continued to sit faithfully by his side day after day, but Harry was still asleep after sixty-one days.

I bathed Harry as I continued my one-sided conversation with him about my diabetic dog.  I washed his arm and carefully in between each and every finger, because nurses often forget those parts, and then I respectfully asked Harry to hold his arm up so that I could wash under it, though I knew he couldn’t hear me.  This evening was different for Harry and me though.  This time when I asked him to hold up his arm, I could feel his arm straighten and stiffen.  I let go of his wrist and his arm stayed in the air!

With tears in my eyes, I asked Harry if he could hear me, but his eyes remained shut and his facial expression was unchanged.  I then asked him to squeeze my hand and he did.  By the end of the week Harry was awake and following commands. Eleven weeks after surgery, Harry’s tracheostomy tube had been capped and he began to whisper.

Harry asked where he was, and where was Claire, his wife and best friend for 37 years.  We had been chatting for an hour when he looked at me with the deepest blue eyes I have ever seen in a man his age, and asked me how my dog was.  Stories about my diabetic dog, Marti’s little girl, Dr. Rich’s fishing trip, and details about a surprise spring snow began pouring from his lips.  I’ve had patients tell me stories that they had remembered hearing while asleep, but never did a patient remember so many different stories in so much detail.  After 77 days, Harry and Claire walked out of the hospital together to go home to Oregon to recuperate.

Nine years have passed since I met Harry, and I continue to talk to my patients about the weather, world issues, their family, and what has been happening on my favorite television shows, even though my patients may be unconscious or unable to clearly understand the words that I babble.

I know that my patients can hear me speak hopeful words.  They can feel me touch them with caring hands, and they know, for that moment, that I am caring only about them while I wait for them to wake from a sleep that cannot always end with a stretch and a yawn.

Karen A. Tarolli, RN, BSN

Allegheny General Hospital, Pittsburgh, PA

Mrs. Dundee was a 50-year-old woman with end-stage lung cancer, which had metastasized to her brain and bones.  She was from out-of-state, but she and her husband had done their homework and selected our university teaching hospital and our doctors.  I’d spoken to Mr. Dundee twice while Mrs. D was semiconscious, and had established some rapport.

Family and friends from all over were gathering to say goodbye to the patient, including her daughter who was eight months pregnant.  The room was often filled with laughter and tears, and many loving stories of good times in the past.

I visited one day, and was surprised to see the patient out of bed.   I greeted Mrs. Dundee, she began talking softly, her voice barely audible.  Her friends began interpreting her statements to me, explaining that Mrs. D was meaning this or that, and that she was confused. I continued to focus on the patient, and encouraged Mrs. Dundee to speak.  I also encouraged the family to listen to her.

Mrs. Dundee then told us an amazing story of sitting alone in her motor home soon after being diagnosed with cancer.  She described crying her heart out, overcome with fear about what the future might bring.  After a while she began talking to God, and soon felt a warm breeze move over her, followed by being completely filled with peace, a feeling which remained with her ever since.  She said, “Everything will be okay, I’m in God’s hands.  I’m so lucky to have my husband, I’m so lucky to have my family, I’m so lucky to have my friends,” and she went on and on, listing people she cared about.

She relaxed as she spoke, and her voice became stronger and clearer as we listened.  A sense of awe descended in the room.  When she became silent, I acknowledged the beautiful gift she’d given us.  One of her friends offered to write the story down and share it with family and friends who had not been present

I believe it took a nurse to recognize the potential in this situation.  This was a sacred moment in Mrs. D’s life.  She was displaying more energy and alertness than she had in several days.  She had something to say.  I modeled patience, presence and active listening for the friends and family gathered, and this empowered her to bring forth her story.  Once her story was received, its value became clear to all of us. Her daughter would write down her mother’s words for those not present, including the unborn grandchild.  Mrs. Dundee’s’ story would live on.

Ramita Bonadonna, RN, MSN 

Charleston, South Carolina



Jill Bormann

Among the dearest and most inspirational people I know is Dr. Jill Bormann, RN, CNS, FAAN.

Jill was a partner in delivering Eknath’s eight point program.   This program inspired Jill to devote her career to caring and quantifying the effects of the use of a mantram (like mantra) on wellness of Nurses, veterans, and people with numerous health problems.  She has received the highest accolades for her work including being inducted in the prestigious Fellowship of the American Academy of Nursing.  Below you will find a few of the citations with my annotations from her massive dossier.  They are worth your perusal.



easwaranEkanth Easwaran

My journey was catapulted during the peak of the AIDS epidemic while performing my role as a Psychiatric Clinical Nurse Specialist in an urban medical center in San Diego.  In addition to the countless individuals who touched me and I touched during my clinical work, I witnessed many friends dealing with the ravages of this catastrophic illness.  Part of my healing occurred while practicing and delivering a program of Meditation, mantra and life management based on the work of Ekanth Easwaran’s eight point program

The program is powerful and elegant in its simplicity, however simultaneously challenging and transformative. I recommend it highly for everyone at any point in your journey.





  • This is the 60 Minutes interview with the nurses who cared for the gentleman who passed from Ebola.  This is a truly inspiration piece about the power of our work.
  •  Leeza Gibbon recently the winner of Celebrity Apprentice held herself in a place of highest integrity throughout the TV program.  No small accomplishment in my opinion.  She inspired me by her passion for individuals with Alzheimer’s through the Leeza’s Care Connection foundation.   Her lovely jewelry supports her mission.

 Dr. JoNeil Smith

joneil_smithOne of my true best friends Dr. JoNeil Smith’s doctoral dissertation studied the incidence and predictors of bullying in Surgical Suites.  Her dissertation is fascinating and compelling as it tells the story that bullying is alive and flourishing behind the doors of our ORs.

Florence Nightingale

florence“Were there none who were discontented with what they have, the world would never reach anything better.”
“I attribute my success to this- I never gave or took any excuse.”
“The object and color in the materials around us actually have a physical effect on us, on how we feel.”
“How very little can be done under the spirit of fear.”


Love Dogs and Cats interacting

As an experienced critical care turned cardiac rehab nurse I worked with a couple who remain vivid in my memory.  They taught me about love, courage, and generosity of spirit.

John had a heart attack at the age of 52.  His risk factors were positive for cholesterol, high blood pressure, and family history.  After reviewing his chart, I went to the bedside for our first visit.  We began to talk about his symptoms, how he was feeling at the moment and what he thought the impact would be upon his life.  While we were talking, visiting hours began.  A very attractive man, a few years older than myself came into the room.  He introduced himself as Greg and sat down at the bedside.  John and I chatted for a few minutes more and agreed to meet the next afternoon to discuss discharge plans and risk factor modification.  I suggested that it would be helpful if a family member could be there to hear the information as well.

When I entered the room the next afternoon at our scheduled time, Greg again was sitting at the bedside.  We talked for a few minutes and I asked John if any family members would be joining us.  He glanced at the younger man sitting beside him, looked up at me and said, “Greg is my family.”

“Okay,” I replied, being perky in that annoying, young know-it-all fashion.  “He can’t possibly be your son, you’re much too young.  Is he your brother?”

John looked seriously at me, probably astounded at my naïveté, and said, “Greg is my lover.  We’ve been together for 10 years.”

I was taken aback…I grew up in the Southern United States where homosexuality is still today not widely accepted and had not been introduced to an openly gay person until college.  I had, as far as I knew no gay friends and would not have been much more surprised had John claimed to be a Martian!  I did manage to pull my foot out of my mouth and begin the first of our discussions about cardiac anatomy, physiology, and risk factors.

In the late seventies, MI patients were routinely kept in the hospital for ten days or so.  As the days passed, John, Greg, and I spoke frequently.  We discussed risk factor modification, exercise, diet, medications, cardiac signs and symptoms.  I encouraged them to participate in the hospital’s cardiac rehabilitation program.  We got to know one another and I saw the deep care and concern that they had for one another, the gentleness that they expressed in little ways as a couple.  I was moved and enlarged as a person by observing how they interacted.  They were like any loving, committed heterosexual couple with whom I worked.

As the discharge day approached, I found myself avoiding one topic that routinely was discussed with cardiac patients.  Usually, I had no difficulty talking to patients about sexual activity.  I had discussed sex with men older that my father and twenty-something, single and married people, but never with anyone who was gay.

One afternoon, when I came into the room, John looked at me, smiled, and reached for Greg’s hand.  He took a deep breath and said, “I know this is probably uncomfortable for you, but we need to talk about sex.  What can’t we do, what can we do, and when?”

I was simultaneously, touched by their courage in pursuing the information they needed and embarrassed by my discomfort.  Their concern for my feelings should have been unnecessary.  They put me at ease with their openness and empathy.  We discussed their usual sexual practices and although I had no readily available resource materials to help, we spoke of general principles.  I promised to investigate further and get additional information.  We were able to find appropriate advice to share with them and clarify their questions.  Whenever I got tongue-tied at not knowing exactly how to discuss something, John or Greg would help me.

John was discharged in good condition with a good prognosis.  He attended our cardiac rehabilitation program for a few months and I was able to see his physical condition improve steadily.  Psychologically, John moved through the same adjustments as anyone with a major illness.  But he spoke often to me of how Greg’s support was helping him through the emotional ups and downs of recovery.  John returned to work and, the last I knew, was living well with his disease under control in the same loving, committed relationship.

I don’t believe that I was prejudiced against gays in 1978, but they were outside my conscious experience, different…unknown.  It was in a time before AIDS, when being gay was less dangerous than today.  John and Greg gave me a tremendous gift, to see individuals who were different from myself and ask, “Are these good people?  Do they care for one another and for others?  Do they harm anyone unnecessarily?”

I have met many, many people since who are “different” in one way or another, as we all are.  We are all part of the tapestry of humankind, rich with color and texture.  Although my mother, who is also a nurse, tried to explain it with words as we grew up, it was demonstrated fully by two wonderful men who hugged me one afternoon and said, “It wasn’t so hard, was it?  Thanks!”  I hugged them back and replied, “Thank YOU.”

Donna Nolten RN
Santa Cruz CA

– excerpted from Touched By a Nurse©

It was around 5:00 p.m. on a Friday afternoon when I “should” have been going home when I got a call to see a patient in the neurological intensive care unit.  As a psychiatric liaison nurse, I am called to see “problem patients” who have emotional as well as physical problems.  Sometimes, it is not the patient who has the problem, but the staff.  It was not unusual for me to get frantic consultations on a Friday afternoon, so I cancelled my evening plans and walked up a flight of stairs to the Neuro ICU.  When I entered the unit, I hear a female voice groaning and distinctly saying, “I can’t believe it.  They say that they love you and they shoot you in the head.”  Hearing someone speaking other than the staff is a strange experience in the Neuro ICU since most of the patients who enter here have a brain injury or are paralyzed, making talking impossible.  Therefore, I was curious as to who was speaking and why.

The nursing staff saw me enter the unit and motion me to a secluded corner.  The nurse asks me to see Chrissy “over there in the corner; the one who is talking”.  She continues to tell me Chrissy’s history of what brought her to the hospital.  Chrissy is a 21-year-old woman who works as a waitress and was shot in the left side of her brain by her ex-boyfriend.  Her ex-boyfriend shot Chrissy and then shot himself.  He died on top of her and when she awoke, she had to crawl out from under him and walk to the neighbor’s trailer for help.  The nursing staff’s dilemma was that Chrissy kept repeating the story over and over again.  Chrissy was unaware that she was saying the same thing again and again and again.  What I noticed almost immediately was that most of the nursing staff in this unit were young, (in their mid twenties) and unmarried themselves.  Hearing Chrissy reveal how her boyfriend professed his love and then shot her was too much for the staff to bear.  In the meantime, Chrissy is having difficulty believing this horrible incident has happened to her.

When I approached Chrissy, I was struck with how small she was.  Her head was all wrapped in a large white bandage, her dark brown eyes were filled with sadness and disbelief.  I asked her how she was doing today. Her voice was shrill and defensive as she spoke, “How would you be feeling if your boyfriend shot you in the head?”  All I could think to say was, “I would be sad and scared if something like that happened to me.”  She immediately calmed and said, “Yeah… I can’t believe he did it.  He told me that he loved me and then he shoots me in the head.  You’re not supposed to do that to someone you love.  Are you?”  I asked her if she could remember what had happened that night and she told me the story.  I sat there a long time that night listening to her repeat her story until she fell asleep.  The nursing staff were so relieved to have another person (me) talking to her so they would not have to listen to the terrible details of betrayal from someone whom you have loved.

With Chrissy’s particular gun shot wound to the left temporal lobe, she was unbelievably alert and could recall the events leading up to her hospitalization.  She knew who she was, how old she was, what year it was, and that she was in the hospital.  However, she could not remember that it had been three days since the shooting and that she kept repeating herself to the nursing staff, telling them the same story over and over and over.  Her repetition of the story was wearing the staff’s defenses down; they wondered privately if the same thing could happen to them.  At the time that I saw Chrissy, she was not depressed; she was in a state of shock and suffered from delirium from the swelling in the brain caused by the gunshot wound.  Both the staff and Chrissy needed me to talk and listen to Chrissy as she retold her story in an effort to resolve her trauma.

I worked with Chrissy throughout her hospitalization and afterwards when she went home to live with her parents.  Chrissy met with me on a weekly basis for three months in an effort to restore her life.  During the first month after discharge from the hospital, Chrissy looked at me and said, “You know, what happened to me was the pits.  I still can’t believe it. But, you know, I don’t think that I would ever be able to go on if you hadn’t been there for me.  I know that I don’t always say much and that I repeat myself over and over, but I got to do it over and over right now.  None of my friends and my parents  want to hear it any more.  I think that it scares people too much.”  I thought to myself that she indeed needs to continue to talk about her trauma and how perceptive she had become.  Chrissy did recover significantly from her gunshot wound.  She went to a local community college and took accounting courses.  Math was never her best subject; however, since the shooting, she was able to better grasp the concepts.

Jane Bryant (Neese), RN, MS, CS
Charleston, SC