Why I am smiling

On 10 June 2016, my PhD was conferred! I am officially Tiffany M. Montgomery, PhD, RNC-OB, C-EFM, so you can now call me Dr. Tiffany Montgomery! The journey was long and very difficult at times, but I made it. I have a ton of respect for those who came before me, and I promise to make myself available—whenever possible—to mentor those coming behind me.

I love sharing with others all the things I wish someone had shared with me. It’s one of the reasons I’m grateful for the opportunity to write for Reflections on Nursing Leadership (RNL). This blog, “Taking hold of my dreams,” is the perfect platform to share some of that wisdom. As Mr. Mattson, the editor of RNL, and I agreed when I began posting entries in June 2011—my first post was titled “I’m going to Disneyland!—I would use my blog to share my PhD journey with readers.

You can now call me
Dr. Tiffany Montgomery!

In February of this year, I asked Mr. Mattson—I told him up front that’s what I would always call him—if he wanted me to continue writing “Taking hold of my dreams” or if I should wrap it up. He responded: “I definitely do not want you to wrap up ‘Taking hold of my dreams.’ As you know, ‘dreams’ is plural in that title, and I’m watching to see more of your dreams become reality.” So, 45 blog posts after I began my journey, here I am, and I hope to continue sharing my experiences with wide-eyed, eager undergraduate and graduate nursing students for many years to come.

If I were to select a handful of past blog posts I’d like future PhD students to read, they would come from various points in my journey. After taking a little time to think about it, I came up with a short, five-post reading list. The following entries are very telling of my time as a PhD student. They reflect conversations I had, things I learned (usually by trial and error), and wisdom I gained. Follow me, if you will, on the five-year journey that I shared with RNL readers. And check out the reader comments!

10 things I learned in my first quarter as a PhD student (December 2011)

This post was an overview of my crash course Grad School 101. When I began my PhD program, I had been an L&D nurse for six years, but I didn’t have the slightest clue as to what it would take to be a successful doctoral student. Nonetheless, I quit my full-time job, took a per-diem position, and dove headfirst into life as a PhD student. I quickly learned that being in a PhD program is starkly different from being in an MSN program. Thankfully, I made a routine of those things that were beneficial to me and let go of anything I found detrimental to my success. Seeing as I completed my first term with a 4.0 GPA, I must have done something right. I hope these tips yield the same positive outcome for you.

What do you do with a PhD in nursing? (October 2012)

After being asked this question more times than I would have liked, I decided to write about it. Must have been a good decision because this post became one of the most-read articles in the history of RNL. I’m glad to know readers had such a great interest in the topic. And, seeing as I am still asked this question fairly often, it’s helpful that I have somewhere to point inquiring minds. Until PhD-prepared nurses are regularly seen outside the hallowed halls of Ivory Tower, people—nurses and non-nurses alike—will continue to ask this question. We still have a ways to go before people realize the importance of nursing research, but we’re further along today than we were when I began my PhD program. As long as we keep moving, we’ll get there.

PhD or DNP? How to choose (November 2012)

This is another topic that came up fairly often while I was pursuing my doctoral degree. Many nurses have the desire to obtain a doctorate, but they are often unsure of the difference between the terminal doctoral degree (PhD) and the practice doctoral degree (DNP). I like to think this blog post does a great job of explaining the differences between these two degrees and helps potential doctoral students decide which one is best for their chosen career path. Neither doctoral degree in nursing is better than the other, although they are vastly different. It’s important to understand and acknowledge these differences before deciding which degree is the one for you.

Ready, set, write: 5 tips for becoming a better writer (April 2015)

Writing is not an aspect of higher education that most students enjoy. When you are forced to write a dissertation, your disdain for writing can turn into pure hatred. As someone who actually enjoys writing, even I found it difficult to write my dissertation. There are many resources available to help doctoral students who are dealing with an aversion to writing. This blog post was my attempt to share what worked for me. Oddly enough, it was my time away from writing—time spent running—that helped my writing the most. In addition to the health benefits of running and the camaraderie I experienced with women in my running group, I was able to take lessons I learned to become a better runner and apply them to my writing. For me, it was running. For you, it may be something totally different. Whatever the case, the tips in this blog post will help you to increase your writing quality and productivity.

Selecting your dissertation committee (January 2016)

This is arguably the most important blog post I have written to date. It is common practice for the chair of a doctoral student’s dissertation committee to determine its members. And while the chair’s ability to work with other members of the committee is of utmost importance, it is also important that all bases are covered from the viewpoint of the student. I cannot overemphasize the need to have a “cheerleader” on your committee. Things happen. Unanticipated hurdles must be overcome. Your cheerleader will be the one to help lift your spirits and keep you headed toward your goal—graduation. I will spare you the details here of what I experienced toward the end of my PhD journey, but I needed all the support I could get. Had I not thought long and hard about the people I needed—yes, needed, not simply wanted—on my committee, I may not be writing this post today. One member in particular was my saving grace. She kept me grounded when everything was going awry. Please do not take this part of your journey lightly. Selecting your committee members is a big deal.

In coming months and years, I will continue blogging about my experiences as a nurse researcher. I recently started a postdoctoral fellowship at the University of Pennsylvania School of Medicine. Wait, I know what you’re thinking. “School of Medicine? Why not the School of Nursing?” These and many other questions will be answered in coming blog posts. I hope you enjoyed following me as I worked toward my PhD, and I hope you will continue to journey with me through my postdoctoral fellowship and into my first job in academia … or the nonprofit sector … or government. There are so many options to choose from. But we’ll discuss that in a future blog post as I continue to take hold of my dreams.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.

Dealing with disappointment

Against my better judgment, I tried out to be selected as one of the student speakers at graduation. One speaker is chosen to represent each of the four degrees that will be conferred during the 11 June 2016 ceremony. I originally hadn’t planned to try out because I don’t like the spirit of competition. I personally know one of the people with whom I would be competing. And the “selection committee”? An audience full of students! Students who believe I am a hardnosed educator. Students who didn’t receive grades they wanted while enrolled in my class. The odds were stacked against me, and I knew it, but I decided to give it a try anyway.

In 2005, I was the student speaker at the San Jose State University Black Graduation, a ceremony that highlights achievements of black/African-American graduates and anyone else who wants to participate. Giving that speech was my proudest moment at SJSU. For weeks before the big day, I wrote and rewrote what I wanted to say. I had 10 minutes to congratulate the class of 2005, inspire graduates and ceremony guests, and leave them desiring to truly make a difference in this world. I was able to do all that and more! People still remind me of the words I spoke at graduation and the impact it had on them. So, although I was scared to death that I would not be selected as one of the graduation speakers at UCLA, I still decided to throw my hat in the ring.

Adam Kazmierski/iStock

As I suspected, I was not selected to represent the PhD graduates. I had mixed feelings about the entire situation. On one hand, I was really proud of myself for doing something that terrified me. Facing our fears is always admirable. On the other hand, although I wasn’t surprised by the decision, I was still disappointed. When I expressed my disappointment to some friends via social media, I received responses such as these: “Girl, you will be at the graduation getting your PhD!!!!! What a blessing in itself,” and “You are graduating, getting a PhD, moving to Philly to start an amazing postdoc. Now tell again, what is the problem?” Another friend sent me a text message saying, “Ummmm, you’re graduating Dr. Montgomery.”

Although these messages were meant to help me see the good in a bad situation, they really struck a negative chord with me, and I’ll tell you why. As someone who has been labeled an overachiever and perfectionist (neither of which I use to describe myself), I am almost always expected to be the best, do the best, and come out on top. When that doesn’t happen, people tend to make comments that actually make me feel worse than if they had said nothing at all. It’s almost as if I’m never expected to fail and, when I fall short of my goals, not to feel bad about it.

In speaking with some of my colleagues, I learned that my experience is not an isolated one, but we rarely share our feelings with friends and family. More often than not, the people who love us the most have no idea what we deal with as PhD students. And, while I can’t speak for all PhD students, I’m sure many will agree with the sentiments of this post.

Dealing with disappointment can be compared to grieving the loss of a loved one. No matter what anyone says, they’re probably going to say the wrong thing. When you are grieving, you typically don’t want to hear someone say, “I know how you feel,” or “It’ll be all right.” And, you certainly don’t want them to compare the person you lost to people who are still with you. You know, “Well, at least he wasn’t an only child,” or “You still have your other grandparents.” In nursing school, we’re taught that these types of comments are nontherapeutic. They harm far more than they help. In a similar fashion, comments I received from my friends about being turned down as a graduation speaker were not helpful. I’m disappointed that I was not selected to address colleagues, family, and friends at my graduation ceremony. Only time will heal that pain.

If I could give any advice about comforting someone who is dealing with disappointment, especially someone you consider to be an overachiever or perfectionist, it would be, “Don’t say a word!” Give him or her the space to be human. Allow that person enough time to experience a range of emotions, which will include anger, hurt, and sadness. In the case of PhD candidates, don’t remind them that they are on the road to receiving a PhD. Obtaining a PhD doesn’t negate our feelings as human beings. Getting that degree doesn’t mean we will never experience disappointment, pain, or sadness. It doesn’t mean we have no other goals we’d like to accomplish. It isn’t the pinnacle of our life’s worth. It just means we worked hard to achieve something that most people will never achieve. It doesn’t make us superhuman.

Not being selected as the graduation speaker was disappointing, but all is not lost. While my classmates won’t ever get the chance to hear my speech, I thought it would be nice to share it with my readers. I hope it resonates with you:

Frederick Douglass once said, “If there is no struggle, there is no progress.” Well here we are, graduating with terminal degrees. That’s progress. But, man, O man, was it a struggle! We’ve seen long days and even longer nights. We’ve laughed together, cried together, and, at times, had to convince each other we weren’t losing our minds. Life didn’t stop because we were in a PhD program. We’ve celebrated births and engagements, and held each other up when loved ones transitioned or relationships didn’t last. While supporting one another as best we could, we endured the lonely road of earning a PhD—emphasis on “earning” because we can all attest to the fact that those three letters were not simply handed to us. But after all the papers, conference presentations, and chapter revisions, WE MADE IT!

From our research on music therapy and hookah smoking to care of elders and text-message interventions, we’ve given voices to the voiceless, provided evidence for changes in practice and policy, and inspired a future generation of nurses to be daring, provocative, and innovative.

We are graduating at a time when the healthcare community realizes the impact nurses have on the health and well-being of people all around the globe. After centuries of viewing nurses as handmaidens, our colleagues in medicine are eager to engage in interdisciplinary practice. Now is the perfect time for us to seize the opportunity we have been given. We have the keys to unlock doors that many people don’t want to walk through, doors that are nonexistent to some and not able to be opened by others.

Today, we join an elite group of nurse scholars. Among the fewer than 1 percent of nurses who have earned a PhD, we have truly accomplished an extraordinary feat. We deserve to celebrate this accomplishment the whole weekend through. But, after the celebration ends, let’s do our part to reach back and help others along their way. Let’s commit to serving as mentors to the nursing students who are following in our footsteps. Let’s take on leadership roles in our various nursing organizations and societies. Let’s leverage our authority as experts in our field to highlight ways under-represented populations continue to be marginalized. And let’s work together to decrease health disparities. Let’s do whatever it takes to fight for changes we want to see in healthcare and in the Ivory Tower.

This is not the end. It is only the beginning. We have long and fulfilling careers in education, research, and administration ahead of us. We have the world at our feet. With cherished memories of our time at UCLA forever engrained in our minds, let’s go forth and change the world. Never stop asking questions. Never stop searching for answers. Let’s go out there and show them what we’re made of. Congratulations, doctors. We made it!

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.

Working while pursuing a PhD? Count the costs!

The costs of obtaining a PhD are numerous. There are financial costs associated with tuition and fees, conference attendance, and research expenses. There may be physical costs, such as times of exhaustion, nights of insomnia, and physiological responses to stress. And, there are emotional costs, such as questioning one’s purpose, dealing with impostor syndrome, and deciding to maintain or dissolve certain relationships. Most people are probably well aware of the financial toll of a graduate degree. But, I’ve found that many are unaware of the costs of working while obtaining a PhD.

In the five years I’ve been in my PhD program, I’ve sat on several new-student orientation panels, and I’ve had plenty of private conversations with men and women who want to earn a PhD. Whenever I talk with potential PhD students, I always try to focus on the costs of working as an employee while working toward your PhD. No matter whom I talk to, my advice remains the same: Work as little as possible.

What do you mean, don’t work?

Thea Design/iStock

The typical response to this advice is a look of surprise (“What do you mean? I have to work!”) or defeat (“Oh no, she said it, too. I guess it’s true.”). Almost any PhD student will tell you that you shouldn’t work unless it’s absolutely necessary. The fact of the matter is, the more you work, the less time you have to devote to your studies. There is no gray area here. It is completely black and white. For most people, quitting a job to obtain a PhD is out of the question. They view working as a necessary evil. There may be children, a spouse, or other relative to consider. There may be bills and other finances that are non-negotiable. Employment may be used to subsidize medical benefits. And, for some, their current position may be a steppingstone to a first job after graduation.

As someone who has been funded by scholarships and fellowships since my time as an undergraduate student, even I understand the need to work. While I am grateful that my PhD fellowships covered the cost of my tuition, fees, and health care, they did not cover all of my living expenses. After paying my mortgage and utility bills, buying gas for my car and other auto expenses, and purchasing groceries and toiletries, I still needed money for clothing, grooming, and entertainment. I mean, really, being a PhD student doesn’t mean you should sit at home naked, unkempt, and bored out of your mind, but I digress. No matter what your situation may be, you should work only as needed.

Trade-offs

Before I ever enrolled at UCLA, I realized that being a working PhD student meant I’d have less time than my non-working colleagues to read, less time to complete assignments, less time for meetings with professors, less time to attend campus seminars and workshops, and less time for pretty much anything school-related. So, I decided to decrease my work status from full time to per diem. This meant I was only required to work eight days every 12 weeks. I could break up my schedule how I wanted, and I didn’t need permission to stay away from work for weeks at a time. I can’t overemphasize the need for flexibility while going through a PhD program. For me, working per diem was the answer.

Once I actually became a PhD student, it was clear that working as a teaching assistant (a requirement for the second and third years of my fellowship) and working per diem meant less time to reflect on my research questions and research design. It also meant less time to write my dissertation proposal or to apply for research grants. There were times when I worked at the hospital one day per week, and there were times when I worked at the hospital once every other week. I did what I had to do to stay afloat in school. I also wanted to ensure I had the time to maintain relationships with family and friends—and time to myself. So, I chose to sacrifice money for time.

When I advanced to candidacy, I made a huge mistake: I started working more. Because I was no longer writing every day, I assumed I had more time on my hands. And I desperately wanted to get rid of the debt I had acquired during my PhD program. So, I began working two days per week in labor and delivery and one day per week in the OB-GYN clinic. I did this for a few months before I realized something had to give.

I had underestimated the difficulty of mentally jumping back and forth between school mode and work mode. After working a 12-hour shift in the hospital, going home to do schoolwork was the last thing on my mind. Just thinking about writing was difficult after a full day of vaginal deliveries and crash caesarean sections. And, it was just as difficult to be in the middle of a fabulous writing groove, only to have to stop writing and start winding down for bed because I had to be up for work at 5 a.m. So, I decided to transfer from labor and delivery to the OB-GYN clinic. I needed to be in a less stressful work environment, and I needed to work fewer than 12 hours per day.

Flexibility is good!

Going back to the OB-GYN clinic was one of the best work decisions I ever made! My new manager allowed me a level of flexibility I had never experienced. To accommodate my need to be at home making phone calls, sending emails, and doing other study-related tasks in the morning, she agreed to let me come in to work from 12 p.m. to 8:30 p.m. Consequently, even on the days I had to work, I was still able to devote time to my schoolwork.

However, after working in the clinic two days per week for most of the final year of my PhD program and conducting a larger-than-anticipated dissertation study, I decided to stop working altogether until I finished writing my dissertation. (I recruited literally twice the number of participants I had originally planned for. What a great problem to have!) While it was not an easy decision to make, working during this phase of my PhD journey means less time for data analysis, less time to write up my findings, and, ultimately, less time to complete my dissertation.

Even with the option of working in the afternoon, I almost always have the dilemma of quenching my writing momentum or stopping study-related tasks so that I can leave for work on time. (Plenty of times, my writing gets the best of me, and I show up to work late. I’m thankful that my manager is very understanding.) With graduation less than four months away, I can’t continue to jeopardize my writing. My decision may seem extreme, but in talking to recent PhD graduates, professors, and others familiar with the process of writing a dissertation, I realize it’s common for PhD candidates to take a leave of absence at work in order to complete their dissertations. Good to know! Now, I don’t have to feel so bad.

We all have the same 24 hours in each day. The question each of us must answer is, “What do you want to do with your 24?” The more time you spend working (or with friends and family, watching TV, or playing around on Facebook), the less time you have to dedicate to your studies. You can sacrifice sleep to get your schoolwork done, but I don’t recommend this because, at some point, you will crash from exhaustion.

Making work or financial sacrifices while in school isn’t for naught. Living on a smaller budget may mean moving to a less expensive apartment, using public transportation instead of driving, eating out less, or refraining from retail therapy, but those sacrifices will pay off in the end. I guarantee it! Just know that there are costs associated with every decision we make. This includes the decision to work while going through a PhD program. My advice is to count the costs, and be sure not to overspend yourself.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.

Ready, set, write: 5 tips for becoming a better writer

Getting a PhD is unlike anything I’ve ever done. Once my coursework was complete, and it was up to me to continue progressing through the program, I was at a standstill. I was surprised, because writing has never been difficult for me. As a child, I loved to write. I wrote songs, short stories, and poems. I’d even doodle my name for hours on end. But it didn’t take long for me to realize that writing the chapters of my dissertation would be much different than the type of writing I was used to.

Because I had never really taken on a task that I deemed too large to complete, I was unsure of how to move forward. I tried talking to a dissertation coach. She helped me break down the overwhelmingly large chapters I had planned into more doable sections. Meeting with her was helpful, but it didn’t do the trick. I still found myself stuck. I tried writing at different times of the day, a technique that had previously been helpful. This time, it didn’t work.

"I started to think of a new, self-inflicted obstacle
I could overcome. It didn’t take long before I
decided that running would be that obstacle."

– lzf/iStock/Thinkstock

I began to feel that the only way to conquer this formidable task was to take lessons I had learned from overcoming other obstacles and apply them to my writing. The problem was, I didn’t have a plethora of previously conquered obstacles to choose from. Until then, I had led a pretty safe life, taking on only those things I knew I could achieve. So, as a way to train for writing, I started to think of a new, self-inflicted obstacle I could overcome. It didn’t take long before I decided that running would be that obstacle.

I have never enjoyed running. Never ever. I used to get in trouble during physical education class for refusing to run. I didn’t mind participating in other forms of physical activity, but running was always tough for me. Several asthma attacks had been triggered by running in cold weather, and those experiences made me hate running even more. I used to say, “If you see me running, you had better start running, too, because there’s probably something chasing me.” As I said, I hated running.

I don't remember the day I decided to run, but I remember exactly how I felt. I thought I was going to die! Upon reaching the end of that first section of bike trail, I was proud of myself. I didn’t die. I didn’t even pass out! And I had achieved a goal I once thought unattainable. As I walked the next section of the trail, my breathing slowed, my heart didn’t beat so fast, and I was ready to run again. I continued to alternate between running and walking each new section of trail, and, by the time I made it back home, I was beaming with pride. I did it! Now that I knew the truth of what could be, there was no stopping me.

Every time I went for a jog—more accurately, a jog-walk—I had to mentally prepare myself. “You can do this. You won’t die. Just keep moving. Whatever you do, don’t stop.” And every time I arrived back home, I was proud of myself. Once again, I had accomplished something I was truly scared to do.

I used the lessons I learned while jogging to help me become a better writer. There is an endless list of tips I could give to help any new jogger or writer, but I’ve chosen five to share with you:

1. Go at your own pace.

You don’t have to do what everyone else does. Quite honestly, you shouldn’t want to. This is your race. You aren’t competing with anyone but yourself. Almost every runner on the trail moves at a faster pace than I do. I don’t care. I’m not running in a competition. My only goal is to do better this week than I did last week. That’s it! When I started walking regularly, my pace was 22.5 minutes per mile. Today, I jog at a pace of 15 minutes per mile. My goal is to get below 12 minutes per mile, and it will happen. I just have to keep going. I’m committed to staying in my own lane, no matter how fast others around me are running.

The same is true with writing. Not everyone will write at the same pace. Even if we did, the dissertation chapters, journal articles, and class papers wouldn’t be the same length or word count. Some people have more references than others. Some people’s methods are more complicated than others. Nothing about a PhD program screams “competition.” I completed my dissertation proposal and advanced to candidacy a full year after some of my classmates. It doesn’t matter. In the grand scheme of things, my job was to write and defend my proposal—and I did. As hard as it is, try not to compare yourself to others. It doesn’t help you progress any faster, and, ultimately, it takes your focus away from the task at hand. In most cases, wearing blinders isn’t a good way to approach a situation. In this case, it’s OK.

2. Use the proper tools.

As I have become a more experienced runner—(I use the term “experienced” lightly—I’ve learned to use proper tools, which keep me from having sore ankles or becoming so irritated while running that I stop midstride. Not too long after beginning to run, I bought my first pair of running shoes. I thought it was the only tool I’d need. I was wrong. When I began running, my keys were in my hand, and the sun beat into my eyes. When it was cold, I wore a very thin warm-up jacket that did nothing to keep cold air from getting to my lungs. After running more than enough days feeling like my chest was on fire, I purchased a light, but very warm, running jacket, and I made sure it had zippers so I could safely secure my keys, phone, and ID.

When it rains, I put the hood on. On warmer days, when I don’t wear my jacket, I put all my belongings in my running pouch. If running after sunrise, I wear a baseball cap or sun visor. Finally, I use the Run Keeper app. It tracks the length of my runs and allows me to comment on my friends’ workouts, as well. These and other tools are staples for “real” runners.

As I’ve become somewhat of an experienced writer, I have also found several writing tools I can’t live without. One of these is EndNote, a reference manager. Once I began using EndNote, I was mad at myself for not discovering it earlier. It’s a true writing assistant! I no longer have to manually enter in-text citations or entries to my reference list, and I am able to group my 750-plus references for easy identification. I can attach article PDFs directly to the references, and EndNote saves the highlights and notes I make on the electronic copies of the articles. It’s an amazing tool, indeed! I’m not suggesting that everyone go out and buy EndNote. It’s the reference management software I like to use, but there are plenty of other software programs that can help organize your references.

Another tool I use, though not as regularly as I did when writing my proposal, is my Pomodoro app. The Pomodoro method of writing says that, for every 25 minutes of writing, you should take a five-minute break. Then, for every two hours of writing, including those brief breaks, you should take a longer break of about 15 to 30 minutes. This technique has been shown to increase productivity for many, including me. There’s an entire science behind this method, which I won’t go into now, but it’s worth checking out.

3. Find a group to encourage you.

Running was OK when I was alone, but it became really fun when I started running with a group. Earlier this year, I began to power walk and run with a local Black Girls Run (BGR) group. BGR has running groups all over the country. Members meet at various times and locations to work out together. One of the things I love about this group is their motto “No woman left behind.” Whether you are a walker, jogger, or runner, you will not have to go it alone.

I experienced this the first day my running partner couldn’t make it to our morning running group. I can’t run as fast as some of the ladies, but they promised not to leave me, and they didn’t. They’d run laps around me, run to a tree, then back to me, or just run alongside me at my pace. There’s something special about doing things with a group. Running is no different.

Just as running groups help you run, writing groups help you write and develop healthy habits. During my third year at UCLA, I joined a writing group on campus. We didn’t actually write together, but we met weekly to report our writing experiences during the previous week, give advice to each other, and thus help increase our writing efforts. We set what we thought to be attainable goals each week. Sometimes we met our goals, sometimes we didn’t, but I loved the community that was built among our group, and I remained in the group for the duration of my third year.

In addition to in-person writing groups, there are tons of group-writing websites, such as AcademicLadder.com and the Text and Academic Authors Association. Social media sites, such as Twitter, also encourage group writing through hashtags that include #AcWri (academic writing), #amwriting (early morning writing), and #shutupandwrite. Anytime you can write in the presence—or virtual presence—of another person, you will be encouraged to do your best. If you have become distracted from writing, I urge you to join a writing group. If nothing else, the group members will hold you accountable. You’ll either get with the program, or you’ll leave the group.

4. Do it even when you don’t feel like it.

If I had a dollar for every time I said, “I don’t feel like running today,” I’d be able to buy myself a nice pair of Jimmy Choo pumps. Whether or not I feel like running when I begin, I always feel great after my run is complete. And never have I regretted getting out of bed at 4:30 a.m. to go for a run. That’s right, my running group takes off at 5:15 a.m. I have plenty of excuses to stay in bed, but getting my run in early has yet to negatively affect my plans for the day. So I run, no matter how I feel.

Like running, writing is not something that comes easy for most people. Even among those for whom writing does come fairly easy, we aren’t always in the mood to write. While completing my proposal, I discovered something about writing: You don’t have to be in the mood to write to be a productive writer. The best way to become a great writer is to write as often as possible. Every day you don’t write is a 24-hour period closer to never writing again. That said, write when you want to write and especially when you don’t. I promise, once you get started, it’s not so bad. The first five or 10 minutes of writing are always the most difficult. After that, your ideas become more organized, and the words just begin to flow.

5. Quiet the mind-chatter.

Running is the most physical thing I have ever done. However, I have learned my mind will give up long before my body does. One of my friends who runs gave me the best advice ever. She told me, “Just keep moving your arms.” She was right. As long as I kept moving my arms back and forth, no matter how badly I wanted to quit, I kept running. At this point in my running journey, I don’t even listen to the negative thoughts anymore: “You’re not going to make it.” “You’re going to pass out.” “Your legs can’t take this.” My mind says these things, but my body hasn’t failed me yet.

Just like running, writing is more mental than physical. Your mind will keep you from writing long before you ever sit down to type. You can’t allow yourself to listen to those negative thoughts. You have to sit down at your desk, at the kitchen table, or wherever else you write and think like the Nike slogan: “Just do it!” While it’s important to take mental health breaks, don’t let negative mind-chatter talk you out of writing altogether. Even if it’s for only 15 minutes, write something! If you manage to write for 15 minutes, you can probably write for 15 more. Once you look up, two or three hours will have gone by, and you’ll be done with your writing for the day!

These tips are but a few that may help you become a better writer. I am no expert, by far, but each of the aforementioned tips has been of great help to me. If you are struggling to write—and even if you aren’t—I encourage you to take on a new and challenging activity, and use the lessons you learn to help you become a better writer.

For me, it was running. For you, it may be swimming, knitting, dancing, or hiking. It may also be something like jigsaw puzzles, computer games, or a musical instrument. Whatever you decide to take on, if you stick with it, you won’t be disappointed. Your writing will be much improved, and you’ll find a new hobby along the way.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.

Grade inflation. (I'm against it.)

I love education—always have, always will. I love being a student. Learning new information, writing papers (yes, I actually enjoy writing papers), discussing with classmates interesting topics—I love it all.

In recent years, I have discovered my love of education from the perspective of an educator. I enjoy creating exams, suggesting curricula changes, and mentoring students. (I tend to have more of a love-hate relationship with grading papers, but that is neither here nor there.)

I get it!
Working as a teaching assistant is interesting, because I am neither the student nor the faculty member of record. I get to see things from both sides. I am closer in age to most of the students than the faculty members are, and, in all of my TA experiences except one, the faculty members are further removed from nursing school than I am. That said, I understand student anxieties and frustrations. “Honestly,” I tell them, “I get it!”

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What I don’t “get” is the overwhelming desire to achieve perfect grades. As an MSN-prepared nurse educator, I appreciate an exam that yields beautifully shaped, bell-curve scores. I understand that not everyone can or should receive a top score. I recognize that, on the NCLEX, more than one answer may be correct but candidates are examined on their ability to choose the best answers. I realize that the drive to have a perfect GPA should never supersede one’s drive to acquire excellent nursing skills.

I will admit that, as a nursing student, I loved it when an instructor granted extra points to compensate for a poorly written exam question. I even had one professor who gave an extra point to anyone who discovered a grammatical error on exams she gave. Free points were an unexpected surprise. However, as an educator, I do not agree with this practice. I think students should receive only the grades they earn. Call me Nurse Educator Hatchet, but I am not a fan of grade inflation, and I have no plans of contributing to it.

Once, after being questioned about the legitimacy of a grade I gave, I sent the following email to a student: I understand, trust me. I once cried in a professor’s office after receiving an A- instead of an A on a paper. I get it. I have also been a nurse for nine years, so I understand the insignificance of grades in “the real world.” Your worth as a nurse will not be rooted in your GPA. To be frank, your worth as a student isn’t, either. You are so much more than the grades on your transcript. Striving for excellence is always the best way to go. As a PhD student, however, I’ve learned that the pursuit of perfection can actually cause more harm than good. You all did a wonderful job in class. You received a well-deserved grade in a fast-paced course with material that is very different from what you are used to. Please don’t be too hard on yourself.

The bigger picture
I sincerely hope this student took my words to heart. We are not the sum total of our GPAs! We cannot allow ourselves to get so caught up in getting the best grades that we miss the bigger picture of getting the best education. As students, we don’t pay tuition with the expectation of buying a stellar GPA. We pay tuition with the expectation of being well-prepared to take the NCLEX or an advanced practice licensing exam.

I have witnessed, via social media, the disrespect of students unhappy with their grades. They say things about their instructors that I’m sure they wouldn’t say to these men and women in person. It seems that they think life is over if they don’t earn an A on every assignment or exam. I remind my students that I have never been asked to show my transcripts during a job interview. No one cared whether I received an A or a C in pathophysiology or pharmacology. In the real world, nurses are judged on their ability to provide appropriate care and to do it with a smile. On the hospital unit, grades are a nonfactor.

It's not just students
Students aren’t the only ones obsessed about grades. Some educators also obsess over whether they are perceived as a friendly, likeable instructor or a hard-grading one. Obsess as we may, we are not here to be our students’ friends. It is unethical to give exams after we have already given the answers to them, or to reward students with grades that don’t match their academic or clinical performance. We need to be supportive of one another and ensure that students actually learn the material we are required to teach. We are not in a profession where we can afford to allow students to enter the workforce unprepared.

I implore educators to take a good look in the mirror. Are we helping students by giving away unearned points? Should we continue to send nursing graduates into the workforce with an unrealistic assessment of their abilities by padding their grades? Are we doing the next generation of nurses any real favors when, to quiet the voices of students disappointed with grades they have earned, we change those grades? Are we giving outstanding students in our classes an opportunity to accurately represent themselves when we inflate grades of students who should be receiving median grades? No, no, no, and no!

I believe the answer to the current obsession with grades is to move from a letter-grading system to a pass-fail system. If grades were given in the same manner as NCLEX scores, students would not have to worry about their GPAs. I honestly believe such a shift in grading would do wonders for the morale of nursing students. Until a shift to a pass-fail grading system occurs—or if it never does—nurse educators must work to ensure students are given the grades they earn, while doing their best not to break the students’ spirits in the process. We need to build up nursing students, while helping them understand that their grades do not reflect their future careers as nurses.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.

Making the leap from theory to practice

As a nursing student, I spent a lot of time learning what nursing practice should look like. Because I was enrolled in a bachelor’s program, I spent less time in the clinical setting than my diploma-school or associate-program counterparts. We spent a lot of time talking about theoretical patients and how they should be cared for. When it came time to take that theoretical knowledge and apply it to real-life patients, I felt slightly overwhelmed.

The same was true for my master’s program. I spent an entire year studying the ins and outs of nursing education. I wrote papers, gave presentations, and took exams. Still, moving from my theoretical understanding of the role of a nurse educator to actually functioning as a preceptor was a giant leap.

Here again

These days, I find myself at this juncture once more. I am moving from life as a PhD student who sits in classes and writes papers to that of a PhD candidate who conducts research and writes data-based manuscripts. This shift feels all too familiar and, just as before, slightly uncomfortable.

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The day I passed my oral qualifying exam, I couldn’t have been happier. Once my exam paperwork was filed with UCLA’s Graduate Division, I officially became a PhD candidate, and I could move from working on my dissertation study in theory to working on my actual dissertation study.

When I submitted my application to the Institutional Review Board (IRB) to ensure adherence to research-related governmental and institutional regulations, I expected to go back and forth with them for several months before receiving final study approval. This is what everyone told me to expect, and, as someone new to research, I assumed the process would go the way everyone told me it would. Imagine my surprise when my IRB application was approved—pending revisions—just two weeks after it was submitted. I made the requested revisions during the holiday break and didn’t expect to hear back from the IRB for at least a few weeks. Again, imagine my surprise when, less than a week later, my study was approved. Exactly one month from the day I submitted my first-ever IRB application, I had permission to begin my study.

Attacked by fear

I was excited, but the excitement was soon overcome by anxiety. Were the people on the IRB really giving me full permission to conduct my own study? Had they made a mistake? Didn’t they know I had never done this before? Did I honestly have the authority to recruit participants, collect and analyze data, and write up my findings—carte blanche? I felt the same way I did when I walked into a patient’s room for the first time—scared to death!

I couldn’t believe I was so fearful of conducting a study I had been planning for more than three years. This was the moment I had been waiting for, the moment my study would move from plans in my head—and the first four chapters of my dissertation—to a real-life research study. Why was I so afraid? What, exactly, was I afraid of?

As a nursing student, I was always afraid I would hurt someone. I never wanted to do anything that could potentially harm a patient. As a nurse educator student, I was afraid my students would have a less-than-stellar educational experience. As a PhD candidate, the fear is similar, yet not quite the same. My research does not require me to use any of my bedside nursing skills, so I have no fear of physically harming someone. There isn’t even a concern about subjecting someone to mental anguish or causing a cascade of emotional unraveling. To be frank, I have no idea what caused this sudden onset of research anxiety. What I do know is that I have been at this theory-and-practice crossroad several times before, and, each time, I made it through unscathed.

Regaining perspective

Never have I been asked to move from theory to practice without having a plethora of assistance at my disposal. This time is no different. I am not being thrown to the wolves with no hope of survival. I have an amazing team cheering me on. I constructed my dissertation committee purposefully. The committee chair and each of the other members have a unique set of research skills and expertise from which I can glean. There are also tons of other resources on campus, including statistics consulting, that I can use, should I get stuck at any phase of my study.

I’ve worked on the details of this study for a long time. It may not go according to plan. I may have to change some of my recruitment methods, or I may discover findings that were not anticipated. So what? It’s actually happening! I’m on the brink of conducting my very first research study (outside of small studies conducted for class assignments). I’m the one in charge, and I have an amazing team behind me. My ideas are coming to fruition. They have moved from my mind to my dissertation proposal, and now they are taking the final leap into reality. How exciting!

As nurses, we each experience times when we are afraid to take the next step. Sometimes, those fears are caused by external factors. But, many times, we scare ourselves. When thoughts arise telling you why you can’t make progress in your nursing education or in the nursing profession, combat them with reasons why you can and will. Surround yourself with people who remind you that the leap from theory to practice isn’t as frightening as you think—and with those who won’t let you fall if the leap turns out to be larger than expected.

Above all else, remember, you were made for this! Trust the training you’ve received. Trust yourself to put into practice everything you know. Trust yourself to flourish in your new role. Maintain faith that you are headed in the right direction. And, keep walking, keep advancing, keep progressing—in spite of your fears.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.

From PhD student to PhD candidate

I am excited to announce I am now a PhD candidate! I have waited for this moment for three long years. For anyone who doesn’t understand the significance of advancing to candidacy, let me explain. To move from being identified as a PhD student to being identified as a PhD candidate, I had to 1) submit a 20- to 30-page paper at the end of my first year of study, 2) complete two years of full-time coursework, 3) write the introduction, theoretical framework, literature review, and methods chapters of my dissertation, and 4) successfully defend my dissertation proposal to members of my dissertation committee. Advancing to candidacy gives me the green light to begin my dissertation study. It is the first of two important rites of passage, the second being successful defense of my dissertation.

Many in academia and research fields recognize PhD(c) as a title for those who have advanced to candidacy. This distinction is equivalent to “all but dissertation” or “ABD,” an informal title given to PhD candidates. I love the term ABD because it accurately describes the status of PhD candidates as those who have completed every requirement for the PhD, except the dissertation.

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When I began my PhD studies, I looked forward with excitement to the point in my program where I would move from student to candidate, because I knew that, once I advanced to candidacy, I could use PhD(c) as part of my credentials. Listing PhD(c) in my credentials would let the world know I had successfully completed two-thirds of my PhD program and that I was on the final leg of the PhD marathon. I knew enough not to list PhD(c) too early, lest I offend those who had already advanced to candidacy. Improper use of credentials is a major pet peeve of mine (see “The 5 no-nos of alphabet soup”), so I have been patiently waiting for the day I could update my credentials.

In the weeks leading up to my oral qualifying exam, it dawned on me I wasn’t required to use PhD(c). I also recalled that using MSN(c) in the last semester of my MSN program had felt strange, as though I was claiming the degree prematurely. I thought, therefore, long and hard about whether or not I now wanted to use PhD(c) as part of my credentials. I even looked for other authors’ opinions on the matter. In doing so, I came across an interesting Advances in Nursing Science blog post on the subject of proper credentialing, and that sealed the deal. As much as I once looked forward to writing PhD(c) behind my name, I finally decided I would not use this distinction.

First, I tend to be very traditional when it comes to special occasions and ceremonies. I don’t open Christmas gifts before Christmas morning. I don’t think brides and grooms should see each other on their wedding day prior to the ceremony. I don’t wear white skirts, white pants, or white shoes between Labor Day and Memorial Day. I’m a traditionalist at heart. For the same reason, I don’t want to use the PhD(c) designation.

I don’t want to become comfortable seeing PhD behind my name until my PhD degree is hanging on my wall, and hope that waiting to update my credentials will motivate me to continue working hard toward graduation. In addition to holding off for tradition’s sake, there are a few other reasons why using PhD(c) might not be in the best interest of a candidate.

PhD(c) isn’t recognized by some of the entities that matter most. Several professional organizations and publications, including the Honor Society of Nursing, Sigma Theta Tau International, do not permit use of degrees in progress when listing credentials. It makes sense. Why would these organizations allow us to use credentials we have not yet earned? If I chose to use PhD(c), I would constantly have to revert back to my former string of credentials, which lists MSN as my highest earned degree. I see that as extra, unnecessary work. So, instead of complicating things and taking the chance of listing unacceptable or unacknowledged credentials when submitting a journal article or conference abstract, I’m choosing to keep it simple. I’ll update my credentials when I am no longer a candidate, but a full-fledged Doctor of Philosophy.

Finally, it is widely estimated that 50 to 60 percent of PhD students never complete their PhD. While it is unclear how many PhD dropouts are ABD, what is clear is that ABD is a means to an end—an end some people never reach. PhD programs, like all other academic programs in higher education, have time limits. Most programs require completion of the terminal degree within seven to 10 years of starting the program. Even if a person has advanced to candidacy, he or she can be asked to leave the program if progression toward final defense takes an exorbitant amount of time. I’m not superstitious, scared of jinxing myself, or fearful I will be put out of my program for taking too long to graduate, because I’m only at the start of my fourth year. I just recognize PhD(c) is a status symbol, not a real credential.

I am proud of myself for reaching this milestone in my education, and I will continue to refer to myself as a PhD candidate, ABD, or, as I’ve heard a few nurses say “PhD, little c,” but I will not include PhD(c) with my credentials. There is something special about a person who has earned a PhD. It is, indeed, an honor. I don’t want to use a credential I have not yet earned. Instead, I want to save the joy of updating my credentials for the moment my PhD is actually conferred. I want to wait until my committee members refer to me as Dr. Montgomery before replacing “MSN” with “PhD” in my alphabet soup.

I feel no less accomplished or excited to advance to candidacy not using PhD(c) than I would feel if chose to update my credentials now. Nor do I fault people who choose to use PhD(c) as one of their credentials. It’s a personal choice. I choose to wait.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.

Maternal-child health nursing in Indonesia

During winter break of my previous academic year—for those of you in the southern hemisphere, “winter” break at UCLA is in December, not July—I had the amazing opportunity to travel to Indonesia to see, firsthand, the work of front-line maternal health workers. I wrote about my experience as a guest blogger for the Frontline Health Workers’ Coalition. The experience was so much more extensive than what I was able to capture in that blog post, so I am sharing more of my experiences here.

Two things I noticed in Bandung, West Java, Indonesia resonated with me more than anything else: use of text messaging by puskesmas (government clinic) staff and the traffic.

I am a lover of technology and an advocate for use of mobile technology in health care, so I couldn’t have been more pleased to see posters on puskesmas walls with instructions for texting patient-referral information to the local hospital. Clinic staff members said that lack of hospital staff to respond to the SMS gateway (the text messages used to refer patients to hospitals) was a large obstacle for them. Still, use of mobile technology among Indonesian nurses is an important step in health care delivery. I may be a bit biased, as my own research focuses heavily on mobile technology, but that’s OK.

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The other very noticeable thing was the traffic. As a resident of Los Angeles, California, USA, I am used to traffic. My daily activities are scheduled around high traffic times. I decide what time to wake up based on anticipated traffic. I group errands so I don’t have to deal with traffic more often than necessary. I know traffic. However, I had never before experienced the type of traffic I saw in Indonesia. What should be an hour-long drive took us more than three hours. Motorcyclists bobbed in and out of lanes, all the while transporting women and children without helmets. It wasn’t just the public that had to deal with traffic. Ambulances sat in traffic with us. Sirens were on, but many of the cars on the road either wouldn’t move over or had no place to move to. It was no surprise that puskesmas staff members reported transporting patients to hospitals as one of their biggest obstacles.

Nursing practice of midwives in Bandung is very similar to practice of labor and delivery nurses in the United States. Here, we have critical events team training (CETT), where we use simulation to practice handling emergencies. In Bandung, the Expanding Maternal and Neonatal Survival (EMAS) program administers similar training.

EMAS focuses on three areas of maternal health and three areas of neonatal health: eclampsia, postpartum hemorrhage, maternal sepsis, low birth weight, neonatal sepsis, and neonatal asphyxia. Clinic and hospital participants of EMAS are selected based on the number of deliveries and maternal-fetal deaths at each facility. Staff training occurs in the home facility. Staff members are given modules and are responsible for training themselves, based on the notion that, if training occurs away from the home facility, midwives won't know what to do when they go back to their home facilities. I love this teaching philosophy!

As participants in the program, puskesmas staff members are taught what to do during maternal or neonatal emergencies. The program helps increase midwife confidence in caring for high-risk women until the patients can be safely transferred to the hospital. Checklists help in emergencies, and they understand that it is within their scope of practice to administer medications such as antibiotics and magnesium sulfate. Just like American nurses, the Indonesian nurses I met use the Neonatal Resuscitation Program (NRP) model during neonatal emergencies. They also give intramuscular Methergine and intramuscular oxytocin during postpartum hemorrhages. Puskesmas nurses said they were grateful for the increased confidence they have as a result of knowledge provided by the EMAS program.

The EMAS program, which is beginning to bridge the gap between clinics and hospitals, encourages ongoing mentoring and quarterly training. The relationship is mutually beneficial for puskesmas and hospital alike. A memorandum of understanding between clinics and hospitals allows sick patients to be referred to the closest hospital. According to puskesmas staff members, the best outcomes of the program are better clinic management and use of texting to enhance communication between clinics and hospitals. EMAS has strengthened the network among physicians and midwives. Midwives are no longer afraid to call physicians, regardless of the time of day or night, an issue some U.S. nurses continue to struggle with.

The puskesmas nurses told me that their greatest motivation was desire to save the lives of mothers. I could tell by their love for continuing education that this was, indeed, true. I had to travel all the way to the other side of the world to realize that nurses everywhere are one and the same. We may have different cultural practices and slightly different patient-care procedures, but we all cherish good outcomes. Going to Indonesia made me feel part of the global nursing profession. For the first time ever, I felt as though nursing was bigger than what I have known it to be in the United States. Nursing for me is now a global endeavor. Almost a decade after graduating from nursing school, I have a clear understanding of the importance of nursing practice, both inside and outside of my country.

I hope to continue traveling internationally to meet other nurses and gain better understanding of how they practice. There is so much we can learn from each other, so much knowledge and love to share. I am honored to be a member of the Honor Society of Nursing, Sigma Theta Tau International (STTI). When I was inducted into STTI, I had no idea I would someday travel the world meeting nurses and writing about them, an honor I do not take lightly.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.

Visiting the library

I recently visited a couple of my school’s libraries—UCLA’s Charles E. Young Research Library and Louise M. Darling Biomedical Library—to check out a few books. In doing so, I realized how long it had been since I last searched through library stacks for a book. Awestruck by the significance of the occasion, I took a picture of book stacks and posted it to my Instagram account.

There was a time when going to the library was normal. As an elementary-school student, I learned all about the Dewey Decimal System and how to use the card catalog to search for books. My class frequented the library to check out and return books. In high school, I studied in the library of California State University, Long Beach. I’d sit there for hours, having given my mother instructions to pick me up in the afternoon. Oddly enough, as a college student, I never studied in the library—only as a high school student. Go figure. However, during the summer months between my freshman and sophomore years in college, I went to the library almost weekly to check out books.

I took a picture of book stacks and posted it to my Instagram account.

I read a lot that summer. Reading for pleasure gave me respite from assigned readings for my summer anatomy class. During my sophomore and junior years of college, I worked in a campus satellite library—the Multicultural Resource Center. Filling my childhood and early adult years are great memories of school and public libraries. The Internet changed all that.

I can count on two hands the number of times I checked out a library book as an undergraduate or graduate student. In fact, before my PhD program, the last time I remember going to a library was during my junior year, and that was to visit friends who worked there. During my MSN program, I never once stepped foot in a library. To be honest, I couldn’t tell you where the library is at California State University, Dominguez Hills—or if one exists at all.

The few times I have visited UCLA’s Biomedical Library, I have been reminded of the joys of going to the library—the smell of books; the short-lived anxiety of searching for a single literary work among thousands of collections; the thought of who may have read this book last. What were they studying? Where did they read it? What did they think of it?

Going to the library was once a staple of the educational experience. Today, it is quite possible to earn a college degree without ever reading a book. As use of technology continues to increase, part of me is beginning to miss the good old days—the days when I either had to visit the library or have no references to cite for a paper (two or three libraries if a needed book was checked out); the days when I wrote papers by hand and went to the computer lab to type them up; the days when the Internet was but a mystery and information wasn’t handed to me on a silver spoon. Those were the days!

Today, I wonder if students are actually getting a college education or simply earning a degree. Getting an education entails so much more than simply adhering to guidelines spelled out in a syllabus and receiving a grade. For me, getting a college education meant sitting in a lecture hall full of people I didn’t know and becoming friends with some of them as a result of our shared experience. It meant engaging in meaningful discussions in a small class section, then hanging around after class to continue the discussion with the professor and a few other students. It meant searching the stacks in the library, hoping—and praying—to find the book I needed. For me, that was what getting an education was about.

Have we lost the magic of the college experience? Are technological advancements removing the very things that made us feel like students? Is technology becoming more of an educational hindrance than a help? I don’t know the answers to any of these questions but, as someone who loves everything about higher education, the thought that I am even posing these questions makes me a little sad.

I want future generations to know the joy of visiting the library—not simply downloading books and articles from Google Books and online research databases. I’m not saying we should return to the days of typewriters and Wite-Out—yes, I also remember those days—but there is a special feeling associated with frequenting a university library. I can only hope today’s educators are encouraging students to experience that feeling.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.