Age is just a number

I have a confession to make: I have a slight complex regarding my age. As I enter the last year of my 20s, I have had a lot of time to reflect on my achievements and accomplishments. I must say, I’m proud of myself! I’ve done a lot in the last 28 years. But I have also been discriminated against and discredited because of my age. Unfortunately, the negative comments about my age had a greater effect on me than the positive remarks I have heard.

During the 5 1/2 years I worked in labor and delivery, there was one question I dreaded more than any other—“How old are you?” I recognize that I look much younger than I am—maybe someday I’ll learn to appreciate it—so it’s not a surprise that my patients have a habit of inquiring about my age. Still, something about asking my age makes me believe I am not as trusted a nursing professional as some of my older colleagues.

Some may say I’m overreacting, but I have seen the look in the eyes of women under my care when I tell them my age. I have also heard the change of tone in their voices. Many a night I swallowed my pride, picked my feelings up off the ground and continued to work through my shift, knowing that, solely because of my age, my patient or members of her family were suspicious of my abilities as a labor and delivery nurse.

I’ve also seen the positive side of telling people my age, but honestly, overly congratulatory folks don’t make me feel any better than their negative counterparts. When they hear that I’m 20-something, their eyes light up and they make comments like, “Oh, my goodness, I am so proud of you!” This type of reaction makes me wonder what exactly are people so proud of.

Now, if I mentioned the awards and honors, scholarships and grants, and leadership experience listed on my curriculum vitae, I would expect the shocked reaction. But, is a reaction like this warranted, simply because I became a registered nurse at age 24? Is that really a great accomplishment? When nursing diploma programs were the most highly coveted way to become an RN, 20- and 21-year-olds were graduating with a nursing license. So again, I don’t really understand the excitement about a 20-something-year-old woman who has decided to become a registered nurse.

What I have begun to tell myself, whether the comments regarding my age are positive or negative, is that age is just a number. There are numerous people who did great things at a young age:

• Martin Luther King Jr. received his doctorate degree from Boston University at age 26. He went on to become the father of the civil rights movement.
• Mark Zuckerburg co-founded the Facebook social networking site at age 20. Time magazine named him Person of the Year in 2010.
• At age 25, Lady Gaga was the highest paid celebrity under 30, according to Forbes magazine. She already has three Billboard Music Awards and five Grammy Awards, and she has set many Guinness world records, including the fastest-selling single on iTunes.
• Bill Gates was only 24 years old when he co-founded Microsoft. His company has become one of the world’s most recognizable and its software the most utilized. As a matter of fact, I am using a Microsoft program to compose this article.

As you can see, a person’s age does not have to be a limiting factor. As nurse leaders, we have to move away from the mindset that nurses need to be in the profession 10-plus years before they can make any notable contributions. There are plenty of young nurses who have the experience and drive to move the profession forward. Those of us in Generation X may not accomplish tasks in the same manner as baby boomers, but trust and believe we can get the job done.

Young nurse leaders, don’t allow your colleagues to look down on you because of your age. Seasoned nurse leaders, don’t discredit the wonderful ideas of your younger colleagues, based on their age. And above all else, take hold of your dreams, no matter your age.

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

What was I thinking?

I went to UCLA for a tour one day and, while I loved the campus and all the facilities I had the chance to see, I felt slightly out of place. I was surrounded by young people in their late teens and early 20s, walking around in what were once known as “daisy dukes.” Am I really ready to be back in this type of environment? I don’t look like the girls in the short shorts. Heck, I didn’t look that good when I was 20 pounds lighter. I am following my dream of earning a PhD and have been accepted to the school of my choice, but the closer I get to the first day of school, the more I am beginning to wonder, “What was I thinking?”

Before even submitting my application to the PhD program, I thought about how nice it would be to live on campus and get the entire “college experience” again. I thought back to my freshman year of college, and I remember it being a blast! Living on campus provides accessibility to campus activities and events that you just don’t get when you live off campus. I envisioned meeting other graduate students and forming lifelong relationships with them. I considered the ease of staying in the library until the wee hours of the morning, then simply walking across campus, unlocking my door and crashing for the rest of the night. I took it all into consideration—and I love the idea of being a fulltime PhD student—but when I went on that campus tour, I started to become slightly anxious.

• How will I fit in on campus?
• How will I relate to the undergraduate students I meet?
• Will people think it’s strange that I desire to join campus clubs?
• What will folks think about an almost-30-year-old living on campus?

Then my thoughts went from the external questions of my appearance and the other students’ perceptions of me to internal questions of my ability to succeed in a PhD program.

• Have I really been in nursing long enough to pursue a PhD in the field?
• Will I be the youngest person in the program? And if I am, will my classmates respect my thoughts and opinions?
• Am I smart enough to be successful in a PhD program?

These and plenty of other questions swarmed my mind until I told myself, “Enough is enough!” I will fit in just right on campus. My presence will bring life and professional experiences that differ from everyone else’s. My being there will help diversify the campus and complement all that every other student has to offer. I will relate to the undergraduate students just as I should—as a mentor and colleague.

Then I told myself that anyone with good sense would be honored to have me as a part of his or her club. I am a hard worker, and I have been a committee member of various organizations at the local, state and national levels. What will folks think about me living on campus? Honestly, who cares? If UCLA thought it was a bad idea for graduate students to live on campus, there would be no graduate student apartments (of which there are plenty). I will be surrounded by other graduate students, and I plan to have a ball getting to know them.

My questions about my intellectual abilities and professional experience were not even worth asking. I did submit an application, and I was offered admission, right? Why would I ever doubt my ability to succeed? Instead of asking, “What was I thinking?” in relation to going back to school, I should have been asking, “What was I thinking?” with regard to all of those negative questions.

As nursing leaders, we have to be courageous in taking hold of our dreams. We can’t allow fear of failure, criticism or the unknown to keep us from running full speed toward our goals, especially as it relates to those of us who are still fairly young in the profession. We must not fall into the trap of counting ourselves out, solely based on our age. Ambition, enthusiasm and a willingness to learn can oftentimes make up for what we lack in experience. And truthfully, experience has more to do with what you’ve experienced, than the amount of time it took you to get the experience.

So, no more questioning myself. No more doubting myself. No more wondering what others will think. I have the dream of a PhD in my sights and I’m going for it! I hope you are taking hold of your dreams as well.

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

A new kind of nursing

When I was in nursing school, a mere six years ago, I couldn’t imagine nursing other than in a face-to-face environment. At the time, I knew there were telephone triage nurses, but I really had no concept of that type of nursing. But hey, nursing is nursing, right?

We all go through the nursing process each time we interact with a patient (even if we swore we would never again acknowledge the term “nursing process” after we passed the NCLEX—I know, I said it too). The nursing process is embedded in each and every registered nurse. I’m sure we could rattle off the steps of the nursing process in our sleep: assessment, diagnosis, planning, implementation and evaluation. So again, nursing is nursing, right? Right! But in my most recent job role, I have been introduced to a new kind of nursing—virtual nursing.

I spend each day at work interacting with patients I have never met, most of whom I probably never will, and I love it! Please don’t misunderstand; the reason I love interacting with patients in the way I do is not because I am not face-to-face with them but, as a proud Generation Xer/ Millennial, I use technology A LOT. I think being paid to e-mail and call patients is the greatest thing since the invention of the IV pump. After all, when I’m not at work, I spend upwards of 50 percent of my leisure time talking on the phone or e-mailing/texting my friends.

People are often surprised to hear that I am a nurse who spends all my time in an office sitting in front of a computer. Sometimes, it is even shocking to me. Back when I was in nursing school, I thought there were only three ways to ever have my own office: 1) become a nursing professor, 2) become a hospital administrator or, 3, leave nursing and work in corporate America.

Boy, was I wrong! I work in neither academia or nursing administration, but I spend all day calling, e-mailing and faxing patients. Each morning I walk into my office, look outside my huge window to see whether or not I can see the Hollywood sign that day (this, of course, dictated by the amount of smog in the air—got to love Los Angeles!), log on to my computer and begin typing my little heart out.

I go through the nursing process with each and every patient encounter; there’s nothing different about that. I triage patient e-mails and telephone calls, deciding who has the most urgent need and who should be contacted right away. I order medications, labs and radiology tests, using standing orders and a list of physician preferences. And I do it all online!

Although I sometimes miss the adrenaline rush of running to a crash Caesarean section or the excitement of a vaginal birth, there are aspects of virtual nursing I love dearly. I love chair dancing as I listen to a popular ringback tone, while waiting for the patient to answer her cell phone. I love reading e-mail responses from patients who thank me for ordering or refilling a prescription. I love receiving a call from the nurses’ station, because a patient has come in for her appointment and she wants to finally meet me. I enjoy establishing relationships with women I have never seen face-to-face!

When I get tired of staring at the computer screen and I need face-to-face interaction, I simply walk out of my office and down the hall. I have the best of both worlds. Now, if only someone would create a way for me to communicate with my patients via Facebook and text messaging, I’d be in nursing heaven!

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

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.