Encourage yourself

It’s human nature to desire those in your circle of friends, family and associates to celebrate your achievements. When you are proud of yourself, you expect others to be proud of you; when you ask others for their support, you expect that support.

What I’m learning as a budding nurse leader is that not everyone is as proud and supportive of you as you may like him or her to be. A small part of me—probably the young, naive part—still believes that everyone should celebrate everyone else’s accomplishments, but life has shown me this is not always the case. We can’t always expect the same celebratory reaction from others that we have for ourselves. As nurse leaders, we need to remember it is sometimes lonely at the top.

Not everyone desires to take on leadership roles, nor do they understand the mindset of those who step into those roles. Not everyone appreciates the time and effort it takes to be on a national committee, or to produce a successful webinar, or to write and publish an article in a nursing journal. The beauty of the world comes through its diversity. If we all desired to do the same things, the lack of variety might bore us to death. Still, it doesn’t feel good when you accomplish something that was, at one time, only a dream, and the people with whom you share this information are less than congratulatory. We typically expect the people we surround ourselves with to be excited for us, so when that does not happen, our feelings are hurt. But when we put things into perspective, we begin to realize the things that are important to us are not always important to those around us. For this reason, we must learn to celebrate ourselves!

India.Arie sings a song I absolutely love. It’s about the artist’s difficulty in finding someone with whom she can celebrate her birthday. She sings, “I’m having a private party. I’m learning how to love me, celebrating the woman I’ve become.” When I first heard this song, years ago, I was reminded not to depend on the accolades of others to feel good about my accomplishments. It’s OK to celebrate yourself, whether by choice or default. There is another song I love that speaks of encouraging one’s self. This song, written by Donald Lawrence, says, “Sometimes, you have to encourage yourself. … Sometimes, you have to pat your own self on the back.” I love this!!!

Whether you are a current or future nurse leader, make the decision to celebrate yourself and pat yourself on the back. Don’t wait for others to congratulate you. Congratulate yourself! Sometimes, people don’t understand all you had to do to get where you are and, quite honestly, some people just don’t care. So don’t expect everyone to be as excited about your latest, greatest accomplishments as you may be. And, just in case you never hear it from anyone else, CONGRATULATIONS from me to you!

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

The night hello meant goodbye

It was a night I’ll never forget. It started off like any other night in Labor and Delivery; we were short-staffed and running around like chickens with our heads cut off. I was assigned to work in triage and, considering I love working in triage, didn’t mind the constant flow of incoming patients.

A late-preterm patient, with a sweet disposition, came in complaining of ruptured membranes. She wasn’t scared, wasn’t anxious, just slightly inconvenienced. I introduced myself and began to do all the things a triage nurse does when a new patient is admitted. I had her change into a gown, noted the fluid and attempted to place the fetal monitor and tocodynamometer (the ultrasound device used to record uterine contractions).

I tried for a few minutes to locate fetal heart tones and, when unsuccessful, put a request in to the physician on call to assist me. While waiting for the physician to arrive, I brought the ultrasound machine to the patient’s bedside and tended to other patients.

The on-call physician examined the patient and asked for the assistance of another physician. Any experienced Labor & Delivery nurse understands that, when a physician is using ultrasound to locate fetal heart tones and calls for a second opinion, it’s actually to confirm absence of heart tones. Stopping what I was doing, I walked to the patient’s bedside. The second physician confirmed that there were no heart tones. I called my charge nurse to let her know I would no longer be working in triage, because I wanted to take on the assignment of the patient with the fetal demise.

I began to admit the patient while she was in triage, and she called her family to let them know what was going on. She complained to me that she was leaking a lot. I pulled the sheet back and noticed bright red blood. Leaking small to moderate amounts of blood, which we call bloody show, is a normal sign of labor progression, but this was different. Within seconds, the patient had bled through the Chux pad, down her leg and onto the sheet. It was a little more bleeding than I was comfortable with, but I wasn’t highly concerned.

As I continued to get the woman ready for transfer to a private room, she began to bleed again. This time I was concerned and called the physician, who decided the patient would be taken to the operating room for a Caesarean section. There was no urgency to save the life of the fetus, but the life of the mother was now in question. She would hemorrhage if we didn’t move quickly. The surgery went off without a hitch. The physician confirmed placental abruption as the cause of the bleeding.

I carried the baby over to the warmer and began to wipe her off. She was beautiful! A perfectly formed, beautiful little angel. I wrapped her in a blanket and carried her to the recovery room. The circulating nurse remained in the operating room with the patient while the physicians closed the incision, and the family members came with me. We were not very busy in triage anymore and there were nurses on the unit with no patients, so I decided to take my time and give the best possible care to my patient and her family.

I began postmortem care by doing something I’d never done before to a deceased infant—I gave her a bath, preparing a basin just as I would for any other baby. I washed and dried each part of her body, then her hair. After placing a T-shirt and beanie on her, I let the family sit with her as she lay under the warmer. Later, the mother came into the recovery room to grieve with her family. (There were no other patients in the room, so I allowed the family to come in, without worrying about the one-at-a-time rule.)

As morning drew near and the night shift was ending, I transferred the patient from the recovery room to her room in Labor and Delivery. Once she was settled, I excused myself and walked into the restroom, because I didn’t want her to see me cry. After a few minutes, I was able to pull myself together.

The infant was the most beautiful baby I had ever seen. Although I had taken care of plenty of women with intrauterine fetal demises in the past, this one was different. I was emotionally invested in this family’s unfortunate circumstances. I had cared for the infant as if she were my own living, breathing child. I did not want to believe we all had to say goodbye before we ever said hello.

Walking back to the patient’s room, I told the mother goodbye. I will probably never see her again. She may or may not remember me. But the experience I shared with her will stick with me forever. I have no answers to why such a beautiful baby girl was gone before she ever breathed her first breath, or why this assignment affected me in such a severe manner.

What I do know is that, when I have my own children someday, I will cherish each cry, and each rise and fall of their small chests. Not every parent gets the opportunity to hear their baby scream or feel their baby’s breath on their face. Sometimes, saying hello means saying goodbye.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

I'm going to Disneyland!

After working as a labor and delivery nurse for 2 1/2 years, I decided it was time to head back to school. It wasn’t a hard decision to make; after all, I’d spent the better part of 18 years in an academic environment, and the 2 1/2 years I spent working full time made me long to be back inside a classroom. So, I went to back to school, complaining about how long it was going to take to finish. There were many days of seemingly relentless stress and nights when I burned the candle the whole night through but, before I knew it, I was lining up to walk across the graduation stage. They called my name—“Master of Science in Nursing … Tiffany Monique Montgomery,” I shook the hand of the college president and walked off the stage. Now what?

Before the start of my last year of the MSN program, I began to throw around the idea of going back to school one last time for my PhD. The thought of obtaining a PhD was somewhat of a fairy tale but, once graduation was over, it became an idea that was very real. I began to think about my high school ROP* instructor, who told me that each level of my educational process would be a little easier than the level before.

When I was an anxious high school senior preparing for graduation and not knowing what life as a college student would hold, she told me my high school diploma was the most taxing diploma I would ever earn. At the time, I thought she was nuts, but now, as I looked back, I understood what she meant. Each time I graduated and decided to return to school, I was studying something I wanted to study—something I was interested in, something I got excited about, something that made me want more knowledge. She was right; each diploma was a little easier to obtain than the one before, not because the coursework required less effort, but because my hunger for knowledge was a little stronger. After reflecting on the words of my ROP instructor, I decided I would allow my education to take me as far as I could go. I was going to earn my PhD!

I began the application process the same day I attended the PhD program orientation at the University of California, Los Angeles (UCLA). When I walked into the orientation, UCLA was one of two universities I was considering to pursue my PhD. By the time I left, I had decided it was the only program I would apply to and, if I did not get in on my first try, I would continue applying until the university accepted me. That evening, I created my profile on UCLA’s online application website. I completed as much of the form as I could and began piecing my statement of purpose together. Little did I know at that time, I would be logging on to the site multiple times each week, and my statement of purpose would be revised almost every other day.

I learned during the program orientation that, after applying to the PhD program, meeting with current professors to discuss potential research areas is a good place to start, so I scheduled meetings with two nursing professors. Before those meetings, I thought I wanted to study nursing education, but they inspired me to study an area of nursing that I loved and not simply list an interesting research question in my statement of purpose.

It didn’t take long to acknowledge the area of labor and delivery I loved most—working with teenage patients. Don’t get me wrong, I don’t like the fact they are pregnant, but caring for a pregnant teen brings out a sense of compassion and motherly protectiveness that I never felt when caring for adult women. I realized my desire, more than anything else, is to prevent teenage girls from having to face the harsh realities of motherhood. This is when my research focus changed from issues in the labor and delivery triage unit to teen-pregnancy prevention.

I wrote and rewrote, edited and revised my statement of purpose more times than I can count. Fifty revisions is probably on the conservative side. I changed the order of some paragraphs and completely deleted others. The part of writing the statement that I found most difficult was discussing my personal achievements. I understood that, because the PhD program does not include an interview as part of the application process, I had to “sell myself” on paper. But no one has a more difficult time than me when it comes to boasting of my accomplishments. While I enjoy keeping my friends and family abreast of my latest professional endeavors, I am not one to brag. I reviewed an early version of my statement of purpose with one nursing professor who told me I needed to do a better job of marketing myself. So, I went back to the drawing board and, as difficult as it was, I boasted of some of the wonderful successes I have experienced.

After working on my application for about two months, I finally pressed the Submit button. All of the transcripts had been mailed and letters of recommendation requested. Now, all I had to do was to wait … and wait … and wait. Waiting was, by far, the most challenging part of the entire application process. Once, during the waiting period, my mother asked me, “What are you going to do when you get in?” I remembered the old commercials from my childhood featuring Super Bowl champions, and I replied, “I’m going to Disneyland!”

Waiting to hear back from the school seemed to take forever, but that fateful day finally came. When I learned that I had been accepted to the program, I was overjoyed. I can’t quite put into words the way I felt. My dreams were coming true. Not long after word of my acceptance came, I was informed that I had also been awarded a fellowship. This was news I could not prepare for; for about a week, I felt like I was in a dream. Every time I told someone my good news, I smiled uncontrollably and wanted to pinch myself to make sure I wasn’t dreaming. I’m still in shock and in awe that I am entering a nursing PhD program in a few short months, and my tuition is already paid for.

When I was a high school senior, you couldn’t have paid me to believe I would someday be accepted into a PhD program. Me? No, not me! I’m the young woman from a broken home in Long Beach, California, who almost didn’t go to college because my mother couldn’t afford it. I wasn’t poised to become a nurse researcher then, but here I am, 11 years after my high school graduation, remembering the wise words of my high school ROP instructor and looking forward to all of the struggles and triumphs this PhD program will bring.

Disneyland, here I come!

*Regional Occupational Program (ROP) is a career-training program for high school students.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.