Dr. Nurse

Trembling hands betrayed my nervousness and complicated my drawing up morphine from a vial to a syringe, checking the drug’s Y-compatibility, and then pushing it at the correct rate through the correct port and line of the mannequin’s IV set-up. As I labored to perform skills under the watchful eye of nursing clinical instructors and under the threat of failure and repeat skills assessments for any single mistake, lapse in judgment, or gap in knowledge, my instructor for that lesson asked, “How did you go from a Ph.D. in English to nursing?”

At that moment, I was wondering the exact same thing. Such were the days in the College of Nursing’s skills lab at the University of Illinois at Chicago (UIC). A short seven weeks of nursing lab led to my first medical-surgical rotation on a telemetry unit (cardiac care), which stirred apprehension and exhilaration like none I had previously known.

Nothing against my B.A., M.A., and Ph.D. in English, but the nursing lab, course work, and clinical rotations preparing me to become a registered nurse (RN) stand as the most difficult endeavors of my academic career. Nursing school demands real-time action and critical thinking quite unlike that of the more relaxed humanities curriculum: nursing students must perform head-to-toe physical assessments, collect vital signs (and know what they mean), chart, pass medications, hang IV riders or piggybacks, inject medications, monitor blood sugar and administer insulin; know tracheostomy care, wound care, oral care, nasogastric suctioning; work with patients’ colostomies, urostomies; become proficient in EKG interpretation, labs, rapid responses and codes, inserting and discontinuing Foley catheters, understanding ventilators….

So how does a Ph.D. in English journey from the academy to the hospital, from full-time tenured English professor to psychiatric nurse to psychiatric nurse practitioner? Well, to begin with, I accepted my own teaching advice. As a humanist charged with teaching five composition and humanities courses each semester at the College of Lake County (CLC), a suburban community college near Chicago, I advised scores of students each semester to treat college as a space within which to discover their talents and then to honor those talents with their agency, advice that seemed inspired. My roots seeking new soil, I left the front of the classroom, joined the ranks of students again, and found hospitals were spaces within which to discover talents and then to honor them with application to clinical situations. Of necessity, I also left old ideas such as, “I’m not any good at math and science” — self-imposed limits I rejected from students when they voiced similar negativisms.

Before applying to UIC’s accelerated RN program and stepping onto hospital units, though, my journey into health care began with two relatives’ neurological diagnoses. Like a good academic, after learning of their diagnoses I attended Harvard University’s Mind, Brain, and Education summer workshop to learn about neuroscience. My neuro-appetite whetted, I then completed a Harvard University Extension School course in neurobiology. Since the brain exists in a body, I then enrolled in anatomy and physiology courses through distance education with the University of New England College of Osteopathic Medicine to better understand the brain’s habitus.

As you can tell, mine is a narrative of one thing leading to another. My quest to understand the brain delivered me to the volunteer department at Chicago’s largest hospital, where I joined the patient library service and went door-to-door offering books and magazines to patients and their loved ones on just about every hospital unit. In so doing, I came face-to-face with the power of human suffering, witnessing unrelieved by my customary companions of literary distance and critical theory. The books and magazines were handy props, but I realized my self was the therapeutic tool when I listened to patients’ and families’ narratives of loss and hope, frustration and relief, pain and healing.

Hospital volunteering led to an RN program, which led to master of science in nursing (M.S.N.) in the psychiatric mental health nurse practitioner program. Nurse practitioners (NPs) are RNs who hold advanced degrees and train for a scope of practice that includes ordering labs, prescribing medications, and managing patients’ care. Throughout my journey toward becoming an NP, administrators and faculty at CLC supported a humanist enhancing his teaching by entering the sciences. May all colleges and universities learn from this example: faculty development means nurturing intellectual curiosity rather than encouraging safe residence in academic silos.  

To be sure, English professor and psychiatric nurse practitioner look disjunctive at first glance, so some administrators may shy away from devoting scarce resources to faculty members’ cross-disciplinary and inter-professional endeavors. But consider the ways teaching and nursing intersect. As a science, nursing combines micro (microbiology, pharmacology, biochemistry, dose calculations, medication interactions, physical assessments) with macro (diagnoses, health promotion and disease prevention, illness management, codes, decompensation, catastrophic diagnoses, death, birth). In practicing the science of the human response to illness and healing, nurses stand at the intersection of the small and large, directing medical traffic for patients and lending them hope when their reserves run low. Nurses care holistically for people, not pathologies.

As a professor, I traffic in detail, but like most of my colleagues, I entered the profession because of the big picture. I know with certainty that students can live full lives without ever writing a cogent thesis statement or explaining deconstruction on an exam. I also know with a pretty strong measure of certainty that they cannot live full lives without a sense of belonging, community, dignity, integrity, voice, and hope. Professors serve as leaders of the classroom by celebrating the joy of mastery and lending hope to students so they can push through the frustration inherent in true learning and inhabit more comfortably in mystery or wonder. Professors teach people, not disciplines or mere subjects.

So the RN grew out of rather than opposed my role as English professor. Psychiatric nursing, concerned as it is with biopsychosocial determinants of behavioral health, is a good match for humanists, scholars attuned to language, narrative structures, nuance, human agency, and cultural determinants underwriting or undermining agency. Take note, English graduate students completing Ph.D.s and facing dismal job prospects. Your skills in critical thinking, interpretation, listening, and teaching are transferrable.

Louis Pasteur reportedly said, “One doesn't ask of one who suffers: ‘What is your country and what is your religion?’ One merely says, ‘You suffer. That is enough for me. You belong to me, and I shall help you.’ ” Nurses are the teachers of health care, offering care without judgment. And teachers meet students where they are at, tending to minds and creating learning environments with the power to heal any suffering endured during previous experiences with formal education. Both nursing and teaching are helping professions. Narrative figures prominently in both, in that nurses and teachers become a part of patients’ or students’ stories. Good nurses and teachers are written into those stories as people who cared, listened, taught, learned, prodded, praised, witnessed, and stayed present.

As I stand at the threshold of rooms occupied by patients referred to the hospital’s psychiatric consultation-liaison service and prepare to treat someone in ICU after a suicide attempt, someone on medical-surgical in detox, someone on rehabilitation with delirium or dementia, I ask myself how I wish to enter the patient’s narrative over the next hour. When I stand at the threshold of the classroom, I ask myself how I wish to enter these students’ narratives over the next 16 weeks.

Whether a doctor of medicine, a doctor of philosophy, a nurse, or a psychiatric nurse practitioner, we have the power to bring our best selves to our practices and to use those selves as therapeutic tools.