Interview With Juliana Adams, Author Of “The Joy Of Nursing”

We have all read books that surprise us in their power to inspire. At one time or another, most people have come into contact with a nurse, whether it’s because they have been sick or injured, or a friend has related an experience they had with a nurse or someone they know has chosen to work in health care.

Releasing just in time for National Nurses Week, “The Joy of Nursing: Reclaiming Our Nobility” reveals Juliana Adams’ journey from being a young, excited girl just starting out in her career to a woman feeling challenged to discover a deeper meaning of what being a nurse has embodied for centuries. Adams’ book is more than a memoir; it is the candid reflection of the search for what ultimately led her to the concept of nobility. The book will be available on May 1, 2016. Until then, you can learn about Adams’ inspirations and aspirations:

Why did you go into nursing?

I had a completely idealized belief of what nurses did. I had only one personal experience as a patient, which was comforting and served to support that it was glamorous being a nurse. No other family members had been ill. Movies, the press and novels about nursing were very singular in their depiction of nurses as being kind, strong, respected and part of a team, where babies, soldiers and “sick people” were comforted, got better and, I guess, went home.

My decision to be a nurse came at the middle of the Women’s Movement. Choosing to be a nurse was not a default decision for me; in fact, it took some courage to follow into this profession when I heard “you could go to medical school instead of just wanting to be a nurse.”My first position was in the heart transplant unit at Stanford, and from there I went on from one challenging, exciting and diverse setting to another. I have never worked “on a floor” in my entire career! My earliest images were met, and I’ve always wondered if the stereotypical beliefs of what being a nurse is like today would have negatively influenced me to not becoming a nurse.

How did your perception of health care change during your 50 years in the field?

Technology has impacted the relationship of every person that provides a skill or service to persons entering the health care arena – and all for the better in regard to options, speed, accuracy, predictability and improved health. The paradox is that for the enormous effect that technology has had on wellness and illness, the need, desire and complete unchangeable aspect of what patients have always needed and wanted has remained unchanged for centuries.

Patients want to feel cared for. Embodied in the concept of feeling cared for is the feeling that each of us is respected as a unique individual who has thoughts and feeling regarding our own personal practices for achieving or maintaining wellness and health. Viewing wellness from a holistic approach with nurses being advocates for introducing and supporting practices that support personal beliefs and cultural and ethnic diversity is exciting. I can think of no other profession that offers the variability of where and how the skills, knowledge and behaviors of one’s profession, is as diverse as what being a registered nurse opens up to those choosing this as their life’s work.

Why should it matter what the issues affecting nurses are?

There are 3.1 million nurses, the largest of any work group delivering health care. Their presence and their utilization in more and more diverse settings have made the need for even more of them, at alarming levels that the public does not know where they have been replaced. There is a national shortage of nurses today that is estimated at being approximately 100,000 today and 120,000 in 2020. The number of nurses retiring in the next 5 years alone is not being replaced by those entering the profession.

With the increase in the number of people older than 65, the use of health care resources is growing and their need for competent nursing care is unlike any other time in history. The increase in technology both in the amount and the speed at which it is being implemented into health care will require an educated workforce. The continued and probable “do more with less”in the realm of paying for health care employees is resulting in decreasing the education preparedness down to those organizations paying for health care to churn out more nurses.

The development of more and more persons calling themselves “nurses” such that what this title means to the public is more blurred and less trustable.

There is a wait time on average of four years for qualified nursing candidates to be accepted to BSN programs. The level of preparedness of nursing educators is a PhD and the incentive for nurses to remain in teaching is low due to low university salaries. This has caused the backlog of educating future nurses. There are no cost incentives for those seeking admittance to nursing school to alleviate student loan debt for nurses.

There is strong empirical evidence that is not refuted by anyone in the health care system that the lower the education is from being an RN, the greater the incidence of medication errors, falls and post-operative infections. Education cannot be replaced by training, by the “tasktification” of what BSN prepared nurses provide in their assessments and the differential diagnostic thinking that they utilize in patient care.

Nurses remain as the persons that patients spend the most time with. What nurses do remains invisible to many, and there is a need for nurses to speak out. The attention the media gives to police, fire and rescue personnel in stories has resulted in their being able to procure “media machines” to keep their activities front and center.

What are some common misconceptions about nurses? Some common misconceptions include being over worked, having poor pay, being “handmaidens to physicians.” Some people wonder, why be a nurse when you can be a doctor? Nurses are not respected for the amount of responsibility they take on and the level of education that is expected from being hired to throughout their careers is inadequate.

What should be done to address the shortage of nurses in the United States?

We need more positive publicity regarding this career option. We need “the best and brightest”to consider this profession. There is nobility in nursing; this is not hyperbole. There is no other professional career choice that I can think of that opens doors to working indoors, outdoors, with individuals, with populations, don’t want to work in a hospital, don’t like blood – all of this is only a very limited understanding of what where nurses can go and what they can do.

I worked in two foreign countries, did research, started a very successful business that was so successful that I realized that I hated being “on” all of the time, I made big money when I needed to, had two children and was “with them” due to the various hours I was able to work. I have taught and have been in leadership and management, all of which were exciting. I did have some disillusioned years that had I not experienced these non “Camelot” experiences, I would never have realized what a rewarding and meaningful career choice being a nurse was. I have had students that worked on cruise ships, in jails, in preventative health, developing programs that are developed and managed solely by nurses.

There are many career options that are autonomous and reflective of new positions being conceived all of the time in science, industry, government and the private sector. Nursing is voted year after year as “the most trusted of professions.” There is no limit to what this basic BSN can lead to.

What is “Camelot” nursing?

This concept I put into print in a chapter in my book about how the care we gave at one of the busiest, short staffed, tough clientele to deliver care to, turned out to be Camelot –“Camelot is located nowhere and can be anywhere.” It is when everything seems perfect, even when it may not appear that way. It was a time when I had never worked harder in my nursing life, but it was the most rewarding time in my career. I encourage nurses or anyone to recognize that the times that seem the most frustrating and imperfect can stay with you for a lifetime for all they did “give” to you.

Tell us about the concept of nobility in nursing and how you discovered this.

I personally did not discover this answer until years into my career. The answer is that nobility in nursing is not what I had imagined. The nurse is not noble because he or she chose to work with patients, because it is often unglamorous work – this was their choice. It is the patient that brings nobility to the nurse-patient relationship. Their pain, their need to not be invisible, what we, as those who provide care, realize is that we learn from them and sharing their fear, their inward journeys into health and illness is a gift to us. It has always been the patient that was noble, not us.

In “The Joy of Nursing,” you mention “morale decay” and “dialogues of discontent,” can you explain these concepts and how they affect nursing more than ever today?

Morale decay is a term that has been utilized specifically in health care. It is different than “burnout.” It implies that to choose to be a nurse, to choose to acquire knowledge, skills and behaviors that are a value to patients, all of those things that we deliver is in a sense secondary to the most important thing that patients want, and that is that we bring the care. Nurses bringing the care means that we feel personally committed to seeing the patient as the center of what their health journey will be. Health is not just the absence of disease.

A nurse’s approach to patient care is more holistic. It has been known for the last 20 years that when nurses leave nursing, they do so due to not being able to find an acceptable threshold of competing missions – the mission of the institution that they work for and their own mission to provide care. Morale decay is also a result of not feeling respected for the value of their contributions to patient care. Respect referring to environments that are still hierarchical in being physician and/or financially driven such that they, who spend the most time with patients, contributions are subservient to others.

Unless there are dialogues of discontent that are invited and valued by those in management positions, the frustration, the personal toll at not being able to be heard eventually spirals down to putting energy into not caring. Nurses bring the care, and to do this they need to have their solutions to how to best deliver patient care not just “listened” to but put into place. The irony is that so many people are employed to deliver patient care, but it is the nursing staff that spends the most time with patients, and do have the education and experience to identify the right problems and the most optimal solutions. But their input is often ignored.