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.

Selecting your dissertation committee

The selection of a dissertation committee is one of the most important decisions a PhD student can make. The members of this committee serve as dissertation “overseers.” They have been through the process of completing a PhD and have, it is hoped, helped countless others also navigate the process. Your committee will be with you every step of the way. They hold the key to your degree.

I started thinking about potential members for my committee during the break between my first and second year of study. As a first-year PhD student, I had the opportunity to interact with numerous faculty members in the school of nursing. I had also taken a couple of courses in other departments, so I knew non-nursing professors as well. During the summer between my first and second years, I let my faculty adviser know I wanted her to chair my dissertation committee. The type of research career I would like to have closely mirrors her research career. We share the same passion for women’s health and intervention research, so it seemed to me the perfect fit. Just as I imagined, she gladly accepted my invitation.

Steve Debenport/iStock

During the first quarter of my second year, I met with my chair to finalize the list of potential committee members from the school of nursing. Next, I asked each professor on that list if they would consider being a member of my committee. Finally, after taking a non-nursing course with a fabulous psychology professor, I met with my chair again to discuss adding this person as the “outside” committee member.

For each academic institution, there are specific guidelines for selecting members of dissertation committees. Most PhD programs require a minimum of three to five members, one of which should be from a department other than the student’s home department. Typically, a maximum number of committee members are allowed. Regardless of the number you choose, I have identified, in addition to the mandatory committee chair, a few key roles you should include in your committee. Depending on the size of the committee, one person may take on multiple roles. It is also possible that several committee members may share the same role. No matter how the roles are divided, I’ve found that each role is necessary.

Committee chair

The chair of every committee comes from the student’s home department. The first member of the committee to be selected, the chair is the shot caller, the head honcho, the person in charge. They have the final say on every decision made by the committee, as well as the final say on who should be asked to join the committee. The chair may or may not be the most senior faculty member on the committee. His or her length of time in academia is less important than familiarity with the dissertation topic. The most important aspect of the committee chair is the person’s relationship with the student. When selecting a chair for your committee, consider personality compatibility. If in the past you and a potential chair have not worked well together, find a different person to fill that role.

Content guru

At least one person on your committee should be an expert in the subject matter of the dissertation with extensive publications in that area. Their names should be synonymous with the subject matter. If they teach a course on the content, that’s even better! The content guru will serve as the go-to person when writing the literature review chapter.

Methods expert

Similar to the content guru, the methods expert should be well versed in qualitative or quantitative methodology. If the dissertation is a mixed-methods study, both qualitative and quantitative experts are needed. These experts will serve as the go-to persons when writing the theory and methods chapters.

Committee regular

The committee should have a member who has been on numerous other dissertation committees. This is very important! If the dissertation committee consists of only faculty members who are experts in their fields but have not been through the dissertation process many times, the student may get caught in the middle of trial-and-error issues. Someone who has had experience in dealing with multiple committees can shed light on the dissertation process, appropriate timelines, and disagreements, whether major or minor. Because they have a history of participating in many dissertations, they will have the wisdom needed to help the student navigate the dissertation writing and defending processes.

Cheerleader

Lastly, every committee needs a cheerleader, a person the student can go to when times are tough. The cheerleader will help the student remain focused on the end goal. He or she should also support the student when disagreements arise. The main job of the cheerleader is to ensure that the student does not become discouraged or feel alone.

As the dissertation committee is being formed, remember to remain flexible. Always have a list of back-up faculty members in case a potential member falls through. For instance, one of the people I wanted on my committee was already over-committed. I totally understood and had no problem asking someone else. Then, after having my committee approved by the graduate division, I lost two committee members.

One had to attend an out-of-state meeting on the day I was to defend my dissertation proposal. There was no way to reschedule my defense, so I had to reconstitute my committee. Another member took a position at a different university after I had advanced to candidacy. That required me to reconstitute my committee again. I began with six committee members (the maximum number allowed), but I am currently down to four (the minimum number allowed). I have learned to go with these types of unexpected, uncomfortable changes.

Do your homework!

Before selecting a committee, do your homework. Talk to other students to determine how well potential members work with students and other committee members. Each committee member from my department has served as dissertation chair for at least one of my colleagues. So, before selecting committee members, I had a good idea of how they worked with students. Furthermore, I had attended quite a few dissertation defenses in my department, and someone from my own committee had chaired the vast majority of these committees. So, in addition to talking to students about their experiences with my committee members, I have also had the opportunity to see those members “in action.”

After speaking to other students, select, if at all possible, only committee members with whom you have worked. For instance, I have taken a class with everyone on my committee. In fact, from one of my committee members, I took three classes and also worked as her teaching assistant for two years. Before agreeing to be on my dissertation committee, each potential member was familiar with my topic, knew my writing abilities, and my personality.

Whomever you choose to serve on your committee, remember that they are supposed to be working for you—not the other way around. They should be helpful, available, and committed to the successful completion of your dissertation. You shouldn’t have to chase them down to pose a question. They shouldn’t make your life any more difficult than it already is. Consider these things before collaborating with your chair to create a short list of potential committee members. At the end of your journey, your committee will be the only thing standing between you and your degree. Choose wisely!

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.

Evaluation etiquette

A topic I have wanted to address for some time is teacher and speaker evaluations. I kept toying with the idea, but never acted upon it. Now is as good a time as any. I’m sure this post will resonate with educators and conference presenters, as well as other speakers.

As a nurse leader, I have had the opportunity to review many conference evaluations, including my own. As a teaching apprentice, I have become used to receiving quarterly student evaluations. Although most are positive and some are fairly constructive, there are always several that are downright mean. I’m not sure why members of the most trusted profession in the United States feel the need to anonymously bully their peers or superiors, but I see this as a trend.

Andrey Popov/iStock/Thinkstock

Two evaluations of presentations by me stick out like sore thumbs. The first came from an attendee of a major annual nursing conference. In presenting national legislation that supports teen pregnancy prevention programs, I spoke of a new law in California that prevents insurance companies from sending explanation-of-benefits (EOB) information to anyone other than the receiver of health care services. I observed that this was a great move for reducing teen pregnancy, because minors and young adults on parental insurance who consult a health care provider no longer have to be afraid their parents will be notified. In evaluating my presentation, one person wrote that he (or she) couldn’t wait until my 16-year-old daughter came home pregnant. I was devastated when I read this! How does advocating for reproductive health autonomy lead someone to wish such an unfortunate circumstance on my future children? Why would someone write something like that?

In another instance, a student wrote that I should be kept away from students because I made him (or her) sick. Again, what would cause someone to write something like this, especially since, in this case, I didn’t interact with the class enough to make anyone dislike me that much. What could I have possibly done that this graduate student was repulsed by my very presence? Not only was this comment hurtful, it made me wonder what kind of people we are preparing to care for those who are vulnerable?

I have seen or heard other inappropriate comments, including references to the presenter’s or instructor’s hairstyle, nail polish, and accent. Yes, someone actually commented on another person’s mispronunciation of a word! I still can’t believe some people are so petty.

If you’ve read enough of my other posts, you know I like to provide lists of action items to assist readers. Well, at this point, I thought it might be nice to remind you of a few important elements of properly written evaluations. Here goes.

Be constructive, not just critical.

If your comments won’t help the speaker become a better educator or presenter, keep them to yourself. Everyone who gives a presentation wants to do a good job, and most of us are open to constructive comments. Critical comments—especially those that refer to dress, style of hair, or pronunciation—are not only unwarranted, they are just plain mean.

Say about others what you would have them say about you.

We have all heard this advice in one form or another. Before commenting, stop and think, “How would I feel if someone were saying this about me?” Apart from the truly constructive comments I advocate above, if what you are preparing to write isn’t a comment you would want to receive, don’t write it. We are always representing our family, our employers, and the nursing profession. We should never act without considering those we represent. How would your employer feel if someone wrote about you what you have written about others? Keep these thoughts in mind the next time you fill out an evaluation.

Don’t write anonymously what you wouldn’t say directly.

Some people hide behind anonymity. It happens with social media, and it happens on evaluations. Just because your identity is concealed is not a good reason to write cruel remarks about someone. Maintain integrity even when commenting anonymously. After all, almost all evaluations—especially electronic ones—can be traced back to the author. Although many companies involved in processing evaluations won’t go to the lengths necessary to identify commenters, it can be done. So, when completing an evaluation, do so as if you are signing your name at the bottom of the page.

Put yourself in his or her shoes.

When completing evaluations, we should consider what it feels like to be evaluated. Giving a presentation requires a great deal of effort. Lecturing is no easy task. In addition to the preparation and travel time involved, a certain level of vulnerability comes with speaking in front of an audience. Imagine what that feels like. Then imagine, after giving your best effort, the horror of reading a comment that is completely devastating. Think of the embarrassment of knowing that what has been written about you is available for all of the organization’s top-level administrators to read. Imagine the confidence that needs to be rebuilt before you would be able to give another presentation, one that may very well be scheduled for the next week or even the next day. If we played these images in our minds prior to completing conference or classroom evaluations, we would be more kind with our comments.

It’s not about you.

This tip is not for evaluators, but those being evaluated. Unfortunately, the powerful impact of negative evaluations may discourage educators and other presenters from reading evaluations altogether. While I encourage my students and those who attend my conference presentations to complete their evaluations, I know many nursing colleagues who refuse to read them. After reading the negative comments that come with each set of evaluations, it’s easy to become disheartened. Even if there are only one or two nasty comments in a hundred, the mean, hurtful and negative comments are the ones that tend to stick with us. They are the ones we remember, the ones we dwell on. Still, try not to internalize them. They aren’t about you. Mean and inappropriate comments say more about the person who wrote them than they ever say about the person about whom they were written.

Wrapping it up

Evaluations are a necessary component of program assessment. It’s important that those involved in program development and members of curriculum committees receive meaningful feedback. Asking workshop attendees and students to provide that feedback is necessary to refine programs for better outcomes, but negative, unconstructive, and inappropriate comments are not helpful. Rather, they reveal the immaturity of certain attendees and students and, are not useful in making accurate assessments.

I hope I never see another nasty comment about a presentation or lecture I have given, but I know this is a big wish. More than anything, I want nursing students and fellow nurses to be compassionate with each other. I want us to be kind to one another. I’m not asking that we sugarcoat bad presentation styles or ineffective teaching, but we should be considerate in what we say. This isn’t too much to ask.

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.