Home > RNJ > 2009 > November/December > It Starts with Little Things

It Starts with Little Things
Jane Martinsons, Staff Writer

The following article is based on the Founder’s Address by leaders of ARN and the field of rehabilitation nursing at ARN’s 34th Annual Educational Conference, held October 2008 in San Francisco. The panel of leaders shared their experiences on founding ARN, collaborating with others to further the profession, instilling a personal responsibility, mentoring future nursing leaders, and taking charge of their own careers.

A Blurb in the Newspaper

Albiana Doll, BSN RN, said that long before ARN was established, she had occasionally met other rehabilitation nurses from outside her home in northern California, but she often felt isolated from her professional peers. “The closest rehab center was in Los Angeles,” she said. “And who’s going to travel 550 miles on her day off to meet other rehab nurses?” Moreover, ease of communication in the 1940s, 1950s, and 1960s just wasn’t what it is today.

“In 1974, I was visiting friends and relatives in [my hometown of] Chicago, and I read a little blurb in the [local] newspaper about a group of nurses who just had a display at a [local] health conference. The name and location of the hospital was listed, so I phoned and was told that Sue Novak was in charge of these nurses. She was out of town at the time, so I spoke with Geri Kaminski, another rehab nurse. After a long discussion, I asked Geri what position she held with this group. ‘I’m a member of the board,’ she said. I thought, ‘There’s a board? Good God, where have I been?’ Geri said there were also officers and that they were working on chartering chapters.”

Geri informed Albiana of plans underway for the first ARN conference to be held in Minneapolis the next year. “I told her, ‘I am going to be there. There will be nurses from California that will be there, too. I’m going to get busy and I’m going to have that charter chapter before I come back for that conference. Sure enough, in 1975, I found myself in Minneapolis, and the Northern California Chapter was chartered.”

Albiana expected to be one of about 30 attendees at conference, and was shocked to discover 120 rehabilitation nurses there. “When I saw the group in the assembly hall, I thought it was Christmas. I wondered, ‘Where have all of these people been all my life? How many more are out there?’ Before I went back, I was reassured that there would be a Western regional seminar in Oakland next year. I thought I’d died and gone to heaven.”

Not only was the regional seminar held, but “that same year we found ourselves sitting in the White House, just yards away from the Oval Office in the Roosevelt Room, discussing the future of nursing and rehabilitation nursing. I thought, ‘Can it possibly get any better?’ But that year we also were accepted in the Federation of Specialty Nurses and ARN was the youngest organization to join—something we were very proud of,” said Albiana, who noted that ARN had just over 1,000 members at the time.

Over the next few years, “every time I went to a conference there were always new faces,” she said. “We started with nothing. I was only a voice on the phone when they made me a member of the board … It was like the beginning of the world. It took the stamina and the perseverance of Sue to really see us through—and here we are, 34 years later.”

One Little Phone Call

Cathy Tracey, MS RN CRRN, who is administrator of nursing at a 650-resident continuing care retirement community in Concord, NH, said that before she began working at her facility 5 years ago, many staff members, including nursing assistants, suffered patient movement–related injuries. The facility had difficulty getting workers’ compensation insurance and its insurance premiums were high.

As a result, her facility, Havenwood Heritage Heights, implemented a no-lift program and bought a lot of lifting equipment. Still, people had all sorts of reasons not to use it and continued to get hurt.

“I really struggled with the director of our rehab department, a physical therapist, and another physical therapist in the department who were very opposed to the use of any kind of lifting equipment,” Tracey said. “I understood where they were coming from; their goal is to promote independence and achieve functional goals and they felt the equipment was a barrier to that. As much as I understood that, we were still having people get injured. I was trying to convince them that, yes, [residents] can transfer themselves in the gym at 10 am, but by 7 pm they’re exhausted and they’re a two-person lift.”

To rectify the situation, Tracey called Audrey Nelson, whom she knew as a fellow ARN board member. “Audrey was doing groundbreaking work in safe-patient handling. It really was this one little phone call that got this all started. I asked Audrey, ‘What can I do? Do you have any literature? Do you know of any research? Do you know any therapists? It was just an inquiry call.”

Three months later, Audrey told Tracey that she had been receiving many calls for rehabilitation nurses who were struggling with the same issue. Nelson decided to start a task force to figure out how to promote rehabilitation and prevent staff from getting hurt. According to Tracey, they discovered a few things at their first meeting. First, nurses had very different values than physical therapists. “Physical therapists learn very early on that they should protect themselves from injury, while nurses consider themselves self-sacrificing; they’re willing to go down with the patient, to their own detriment.”

Second, it’s a myth to believe that therapists don’t get hurt because they use proper body mechanics. “Therapists do get hurt,” Tracey said.

Finally, there is no right way to lift a 200-pound person. “We are not supposed to do it,” Tracey said. “It’s not okay.”

For 3 years, Tracey worked with physical therapists at her facility to develop a plan to avoid injuries and promote rehabilitation by publishing a white paper with the Safe Patient Handling Task Force, presenting at a safe patient handling conference and an ARN conference, and assembling a 30-member interdisciplinary group that included 10 ARN members to attend a conference with international speakers on safe-patient handling. “One little phone call led to this,” Tracey said. Now, “both staff and residents at my facility are safer.”

Leave a Voicemail Message or a Note

To be accountable and not fall into taking on the victim role, it’s crucial that nurses be on a peer level with the rest of the rehabilitation team, said Aloma “Cookie” Gender, MSN RN CRRN. “We’re in a difficult position because—compared to physical therapy, occupational therapy, speech therapy, and even case management—rehab nursing is not covered in [the curriculum of] most nursing schools and universities,” she said. “Therapists know what rehab is, but nurses new to the specialty do not.” Gender suggested educating nurses on the specialty practice of rehabilitation nursing and its unique role on the rehabilitation team.

“I was really fortunate to begin my rehab career at Sharp Rehabilitation Center in San Diego where I received a very good orientation on rehab nursing. We actually had a very strong interdisciplinary team. Two years later, I joined ARN and attended my first conference where I was extremely impressed with Albiana’s leadership. She pushed me to start a chapter in San Diego and hold a regional conference. She wouldn’t let me off the hook, actually. I continued to grow with the specialty and serve on numerous committees and network with my peers. I value the input and colleagueship of those early leaders.”

When Gender started working at Christus Saint Michael Rehabilitation Hospital in Texarkana, TX, 5 years ago, she discovered that the nurses had no idea what rehabilitation nursing was. “Even though the hospital had been in existence for almost 10 years, they were practicing med/surg nursing. The nurses didn’t attend team conferences, and the therapists didn’t talk to the nurses at all. None of the nurses in the facility had been to an ARN conference,” she said. “After I took two nurses to the ARN conference, they said, ‘Oh, is this what we’re supposed to be doing?’ It was very, very enlightening.”

To bring staff up to speed on rehabilitation nursing, Gender suggested

  • presenting a thorough rehabilitation nursing orientation for new hires and sending nurses to rehabilitation nursing courses, which are available through ARN and the Uniform Data System for Medical Rehabilitation.
  • educating therapists, nurses, and case managers on each other’s roles. This is critical to avoid blame.
  • encouraging nurses to get certified in rehabilitation nursing. Certification lends credibility to team members and results in better outcomes for your patients.
  • showing interest in and interacting with your rehabilitation therapists. “When one of our nurses, David Markham, started with us as a new graduate 2 years ago, he decided to go to the therapy gym simply to see what the therapists were doing with his patients. You can imagine how shocked and impressed the therapists were; after all, nobody had ever done that before. By doing that, he forged a really good relationship and a communication link with that department.”
  • er added that no one on the team knows the patient better than nurses, who are with patients 24 hours a day, 7 days a week. “We have valuable information to share with the rest of the team. If you work the evening or night shift, leave a voicemail message or a note if you have a concern about discharge planning or a patient transfer techniques. When I started out in rehab, I left notes and the therapist loved it. I immediately became part of the team.”
  • holding celebrations that include both nurses and rehabilitation therapists. “Also, set up diagnostic teams with dedicated therapists and nurses who work side by side with the same patients on a consistent basis. It leads to mutual respect and a good working relationship.”
  • encouraging your nurse manager and your therapy manager to work well together, and support and respect one another. Avoid the “we versus they mentality,” Gender said, “Learning from each other is great for retaining therapists and nurses.”
  • putting the patient first. “This is most important,” Gender said. “If everyone on the team—from therapy to nursing to housekeeping to your front desk staff—asks, ‘What is in the best interest of the patient?’ then everybody is working together automatically.”

An Inspirational Presentation

How do you become a mentor? First, you need to be a role model and a leader, said Marilyn Ter Maat, MSN RN CRRN NEA-BC FNGNA. “When I attended my first ARN conference, I was new to my position as a rehab instructor. The conference was held in two different hotels and I didn’t know anybody. When Gender presented at the conference, I thought, ‘She really knows her stuff.’ She was enthusiastic and positive, and she inspired me to ask questions.”

In the 1980s, at the height of the nursing shortage, Ter Maat moved to Hawaii to serve as director of the Rehabilitation Hospital of the Pacific. “There was no one else around to ask questions. There were very few CRRNs,” she said. “One day I got a phone call and the operator said, ‘I’ve got this CRRN here from the big island.’ And I said ‘Hold her. Tell her to wait.’ I thought to myself, ‘I’ve got a hot one.’ I was going to try to convince Karen Klemme that this was the place she wanted to work rather than living on the big island. We visited, but she didn’t want to move to Oahu. I knew she had move to Hawaii from California, so I asked her to an upcoming conference in California.”

Klemme and Ter Maat kept in close touch over the years. “I continue to encourage her to share her knowledge. She is a wonderful legal nurse consultant and presents at ARN conferences. I have asked her to get involved in committees. Karen continues to network with many people through ARN, and so has become a mentor to others. Karen and I became friends through building trust and listening to each other.”

Likewise, Ter Maat recalled how her own mentors have helped her. One, for example, encouraged her to get her CRRN when she was too busy encouraging others to do so. After the reminder, she got certified.

Another mentor told her to become involved in any way she could. “As a director or nursing, I started asking questions about our local chapter, which was not active. I called the ARN office and they suggested I talk to my regional director, Karen Preston, with whom I became acquainted at ARN conferences. She provided me with a lot of guidance and support while I was in Hawaii, and helped socialize me back into ARN,” she said.

“When I moved to South Dakota, I again looked for a chapter but couldn’t find one, so I started looking for people from the state on the registration list at conference. I found a group of nurses…and after a couple of years, the South Dakota chapter [took root] and grew into a very unique chapter.”

Ter Maat encourages others to volunteer and get involved in their local chapter or other activities. “As nurses, we need to realize that once we get to a certain point in our career it’s time to give back and see who else you can grow. Everyone you meet has something to teach you—a skill, a bit of wisdom, or even a personal success,” Ter Maat said. “Each person has something of value to offer. You are all leaders, either with your patients or your staff. Find someone to mentor or find someone who will mentor you. You’ll never know when you’re going to influence someone’s life.”

A Childhood Visit to a Hospital

How do you encourage the younger generations to consider nursing as a career? By sharing your experience and knowledge. Sharon Duffy, MS RN CRRN, shared with conference attendees the story of her family that has four generations of nurses and a firm tradition of mentorship:

“My story starts in the 1950s when I was about 10 years old. My sister-in-law, Lu, was my mentor at that time and she had just graduated from nurse training in Omaha, NB. She took me up to Children’s Hospital in Omaha. In the 1950s, polio had hit Nebraska and every patient there was a young and in an iron lung. I stood and watched those nurses giving caring and compassionate care to those young people and I decided then that I wanted to be a nurse. Lu didn’t have any idea that taking me there that day was going to decide my career,” she said.

“My family is full of offspring who work in the medical profession…Of my 21 nieces and nephews, 12 went into the medical profession. After graduating from high school, my nephew Ron came to work in the lab at the hospital where I worked and now he’s a medical technologist and head of a lab in Omaha–and he married a nurse.”

Three of Duffy’s nieces came to work at the hospital after graduating high school. Today, one is in vocational rehabilitation; the other two graduated from the hospital from which Duffy graduated and currently work for her at Proactive (the health and fitness center at Madonna Rehabilitation Hospital in Lincoln, NE). One works in cardiac rehabilitation; the 
other, who said that Duffy talked her into becoming a nurse when she was 10 years old, is in occupational health at Proactive. Two other nieces went into nursing, one as a pediatric nurse and another as a nurse practitioner in adult cardiology clinic.

Two great nieces have also chosen a career in nursing. One will graduate with a BSN in December, as will a god-child, who will graduate in May from the same nursing school that Duffy attended. A great nephew married a nurse who works at Madonna, and another great niece, whose mother is a radiology technologist is going into occupational health.

“Why do we have four generations of nurses?” Duffy said. “Happiness. You never know who’s watching you—nor the impression you’re making on people. But they can see if you’re happy or not. We have to live so that people will want what we have.”

Do Little Things

Karen Preston, PHN MS CRRN FIALCP, didn’t actively seek a career as an entrepreneur. But she took hold of the opportunity when it presented itself—and never looked back. Here’s her story:

“I went into home health and had the opportunity to work with some young college students who had various disabilities,” she said. “It intrigued me to know people who were well yet still had some issues. I went into a major rehabilitation center where I learned about spinal cord injury and brain injury, and then I went back into home health.

“I had the great fortune to be able to develop a clinical nurse specialist position as a nurse consultant in home health. It was a very easy leap when a friend of mine who owned a small independent consulting company said, ‘Hey, do you want to come be a case manager here?’ I said, “’Sure, why not.’

“When she wanted to retire about 7 years later, she wanted her nurses to buy her company. So three of us bought the company rather than return to our real jobs again. After all, we didn’t want anybody telling us what to do. We were independent people who controlled our own schedule.

“That decision seemed no more daunting than any other career decision I made in my life. The reason: preparation. Some people have said, ‘Well, you were just lucky. You were in the right place at the right time.’

“There are people who go out and try and set up their own business and do it from scratch. That’s a lot harder. But there’s a saying that ‘luck is preparation meeting opportunity.’ Other people give you opportunities, but you are the only one who gives yourself preparation. Decisions you make every single day are building blocks for preparation.

“It starts with little things: With Cookie’s nurse going to the therapy gym to talk with the therapists, with Albiana saying, ‘I’m going to go to a conference next year,’ with Cathy and Marilyn picking up and making phone calls. It starts with Sharon giving someone advice about what to do. Suddenly, you have built your own repertoire of skills and experiences that very easily positions you to do things you never, ever thought you could do.

“You never know what it is that you do that influences somebody else to follow their own path to leadership and mentor,” she said. “We need to be positive and surround ourselves with positive people. We need to get rid of negative, toxic environments and not tolerate them. When we see it, make positive efforts to change it. Build synergy. Building teamwork in an upward spiral creates so much phenomenal energy.

“Say yes [to volunteering] and start doing little things and building your own personal repertoire. It’s really not that hard. I don’t think it’s that remarkable that I’m an entrepreneur—any of you can do whatever you want to do—and I hope you will.”

There Are No ‘Born Leaders’

Panel moderator Paul Nathenson, MPA BSN RN CRRN, said that despite all the great leaders in nursing—including Florence Nightingale; Madeline Leininger, the founder of transcultural nursing; Martha Rogers, who defined the person as a unified whole—none exemplifies leadership to him more than the character of Captain Kirk of Star Trek.

“Kirk certainly was not the smartest person aboard the Starship Enterprise,” Nathenson said. “After all, there was Mr. Spock, the logical, intellectual first officer; Dr. McCoy, who possessed all the medical knowledge available to mankind in the 2260s; and Scottie, the chief engineer, who had oodles of technical know-how.”

“Captain Kirk was the essence of the dynamic manager—a guy who knew how to delegate, had the passion to inspire, and looked good in what he wore to work—and that’s important,” he said. “He never professed to have skills greater than his subordinates. He acknowledged that they knew what they were doing in their domains, but he established the vision and tone. He was in charge of morale.”

According to Nathenson, true leaders

  • never profess to having skills greater than their subordinates
  • acknowledge that they know their respective role
  • establish vision and tone
  • are engaged and passionate about their 
  • possess competence and skill
  • encourage and mentor peers, colleagues, and their staff
  • know how to expand their perspective, set goals, understand the dynamics of human behavior, and take initiative.

“Good leaders are not ‘born leaders’; they are mentored, groomed and developed,” Nathenson added. “Good leaders develop through a never ending process of self-study, education, training, and experience. If you have the desire and willpower, you can become an effective leader.”

About the Panel

Moderator Paul Nathenson, MPA BSN RN CRRN, has been in nursing for 30 years and involved with ARN for at least 20 of those years. He has served as president of the board, conference chair, and is currently chair of the ARN Health Policy Committee. He is vice-president of corporate planning and long-term care and a nursing home administrator at Madonna Rehabilitation Hospital in Lincoln, NB.

Sharon Kay Duffy, MS RN CRRN, has been in nursing for over 40 years and has been involved with ARN since 1985. She has led the ARN education SIG, chaired the continuing education provider unit, chaired a conference planning committee and served on the ARN board. She is currently employed at Madonna Rehabilitation Hospital in Lincoln, NE, where she serves as manager of holistic health and integrative medicine at Proactive, Madonna’s Health and Fitness Center.

Karen Preston, PHN MS CRRN FIALCP, is an entrepreneur and business owner. Karen has been involved in nursing for over 30 years and has been active in ARN since 1981. She has served on numerous chapter and national committees and chapter boards. She also served as ARN board president in 1994, as well as faculty for the ARN/PRN course for several years. She is currently co-owner of RNS Healthcare Consultants, a consulting company specializing in case management, life care planning, education, and other services.

Marilyn Ter Maat, MSN RN CRRN NEA-BC FNGNA, has worked in nursing since 1975 and has been involved in ARN for 23 years. She has served as ARN director at large, president of the board, and chair of the RNCB board. Marilyn is currently semi-retired and serves as part-time clinical application implementation analyst for the Good Samaritan Society in Sioux Falls, SD. Cathy Tracey, MS RN CRRN, has worked in nursing for more than 30 years and has been involved in ARN for 28 of those years, during which time she served as ARN president. Currently she serves as administrator of nursing at Havenwood Heritage Heights, a 650-resident continuing care retirement community in Concord, NH. Tracey was a member of the Safe Patient Handling Task Force, a collaboration between ARN and the American Physical Therapy Association.