"Not in Kansas Anymore”

National Nurses week is a time for the nurses to celebrate the profession they’ve chosen. The ANA (American Nurses Association) has taken as its theme for the 2018 celebration “Nurses inspire, innovate, influence. ” In my real nursing life, working mostly 12 hour night shifts in med-surg, orthopedics, or hospice, National Nurses Week generally meant that I would miss the daytime celebrations, appreciation lunches, and chats with the Director of Nursing. Still, sometime during that week (if scheduled that day) a cart with ice cream, sprinkles, and syrup would arrive on the unit before 8 PM. One year I was determined to cash in on the goodies at least one time in my career. I loaded up a maximal sundae and tossed it in the freezer to enjoy sometime after the first med pass. Can you guess how this story ends? My sundae and I never did cross paths again. Regardless, I’m still a believer in the importance of National Nurses Week. Every profession has to examine itself in the context of what it does, and especially in our case, who it serves.

It’s important to take time to look at what we do. After years of Nurse’s Weeks and experience, my nursing mind is convinced of this truth:


Let’s take an example of a hypothetical patient’s journey through a hospital to address a clinical issue. We’ll call her “Dorothy”. Dorothy was having a normal day, and was dusting the living room when she accidentally stepped on the cat. The tornado has started: The yowl ends in a fall and an ambulance call for what she doesn’t yet know is her broken hip. A ride with sirens and strangers brings her into the E.R. Information flies into the computers, the E.R. works quickly, dousing her pain and getting her information into the system.

She arrives on the orthopedic unit as an admission and lands, finally, in a bed, room 414. In her first quiet moment, and perhaps through a partial narcotic haze, Dorothy looks around and probably thinks something like “Gosh, Toto… I don’t think we’re in Kansas anymore.” She’s not. She’s landed in the best place to be to get the help that she needs to recover and go home again. And through the whole experience in… ‘Oz Medical Center’ - the nurse is going to be her partner and coordinate the entire journey right at Dorothy’s side, including all the professionals that will be part of the process. Let’s consider a few of the disciplines, departments, and people that are involved:
  • Medical doctor to clear her for surgery.
  • Medical imaging and radiologists to determine the damage
  • Laboratory to measure and monitor blood values and other tests
  • Surgical consult to establish the treating doctor, procedure, and O.R. scheduling
  • Physical therapists to plan post-surgical rehabilitation
  • Social workers and case managers to assess the conditions impact on the patient’s living situation
  • Administration workers will file reports and billing
Dorothy’s nurse is the one that will see and collate all the information from all the departments and people that interact with her. The nurse is the one always at her side, and the one she always returns to after visits with every other needed clinic discipline. Her nurse will coordinate the interdisciplinary effort, being Dorothy’s ‘constant clinical companion’ . Shuttling my patients to all the various services, doctors, and disciplines reminded me of what happened to Dorothy (and her pals) when they arrived in “Emerald City”. A horse driven cart took Dorothy from station to station for haircuts, clothing, measuring, beautifying, cleaning, and healing, around the inner city circle. From each place to the next, they’d move in the horse cart. Discharge planning begins on admission, and the team relies heavily on the nurse to communicate and document the patient’s progress towards that goal, and ensure that everyone who needs to be involved is informed and up to date. It would be difficult to understate the importance of the nurse's role. If any of the team or even family want to know “how Dorothy is” or “what happens next”, the nurse is the person who is usually asked. The nurse is a “horse of a different color” from the other disciplines around the clinical hub. All the other clinical services and even the doctors involved will come to you, the nurse, for information, because when it comes to your patient, you’re the one who sees it all. The patient is the center and focus, and you’re at their side from the time they land out of the twister that has changed, even for a moment, life as they know it, until the time you tell them it’s time to click their ruby heels together to get home.

The nurse is Dorothy’s voice and shepherd in a strange land.

I used to imagine that when my patients arrived, they had arrived in Oz. A strange place full of challenges, but one that would help them get to the best possible place, because for all my “Dorothy’s”, there’s no place like home.

So, for 2018’s National Nurses Week:

Inspire like a Tin man with a heart

Innovate like a Scarecrow with a brain

Influence the outcome with the fearlessness of the Lion

And you heard that straight from the horse’s mouth!

Steven BobulskySteven Bobulsky
My history is a bit unusual, but it provided a broad life experience (shorthand for “OMG how did I make it through all that?”) Teen summers walking behind a garbage truck; worked forging aluminum and titanium in to things from small widgets to Boeing 727 wings; Completed B.A., then went to M.Div. school, ordained an Orthodox priest. Pastored parishes; went on to work for EDS, and GM recruited me out of there; managed district dealers as their “factory contact” for Cadillac Motor Division; started a Computer/web service for dealers. Personal tragedies struck. A decision to pursue Nursing and passing my NCLEX (R.N.) opened up the doors in a career that I didn’t know I was looking for. All the experience a person brings with them is unique, and ALL of it can (and will be) put to use in the course of your patient care. Every good thing you go through, every difficulty you bear, knowledge from any field you’ve studied, any hobbies, talents, quirks, whatever makes one unique- will supplement and support the mind of a nurse, and the heart of your practice.
Images: ANA by ANA 2018 Nurses Week Broken hip By DocP at German Wikipedia - Self-photographed, CC BY-SA 3.0 de, https://commons.wikimedia.org/w/index.php?curid=39746622 ER scene by https://health.mil/News/Articles/2016/10/11/Air-Force-Army-team-save-lives-at-the-DoDs-only-Level-1-trauma-center?type=Articles&page=3#pagingAnchor Dorothy by https://www.flickr.com/photos/tom-margie/3088817250