I literally could not stop shaking when I received the email invitation to be the closing speaker for the 6th National Nursing Ethics Conference next year at UCLA. It is one of the most powerful and in-depth nursing conferences when we consider some of the core heart issues that nurses wrestle with as we are immersed in a profession that puts us face to face with such intimate suffering in this world.
To close out this conference with a 2019 theme of Vulnerability and Presence is no small task. I hope to do justice to the theme, but more importantly, to the courageous attendees who offer up their own vulnerability and presence in order to regularly care for others.
Leading up to the conference, the planning committee publishes various Speaker Spotlights so that people can hear the speakers’ thoughts about ethics and the importance of vulnerability. Carol Taylor interviewed me in late October, and I am happy to share my Speaker Spotlight here with you. Please consider joining us March 20-22, 2019 at the UCLA Luskin Conference Center.
The theme of this year’s conference is vulnerability and presence. In what ways does this theme resonate with you?
I have had so many conversations with nurse colleagues, and so many internal dialogues, trying to work through the very raw and legitimate question of “How do I stay in such heartbreaking and heavy work over the long haul without shutting myself down?” As we prepared to be nurses, not many of our educators or preceptors talked about how hard, how challenging, how confusing vulnerability could be. There tends to be a quiet assumption that every nurse simply needs to find her/his own way with vulnerability. The majority of the preparation as a nurse was teaching critical thinking and technical skills – not so much in cultivating the power of presence. Yet I believe every nurse finds him/herself wrestling deeply with the issues of vulnerability and presence, the longer we spend with the sick, suffering and dying. We have long needed a conference that brings us into rich, open, safe and shared conversations about vulnerability and presence as nurses. We need this for ourselves as much as we need it for our patients and their families.
You’ve been to this conference before. What would you like to say to nurses who are thinking about attending for the first time—or deciding about whether or not to return?
This conference is extraordinary to me in the courage and hope with which it tackles some of the deepest internal challenges we face as nurses, as human beings. It gives such intentional space for open acknowledgement and exploration of the issues that we so often do not have time to talk through with colleagues in the midst of such busy work days, but experiences we carry with us all the time. We grieve, hope, and vision together in this conference for the preservation and advancement of the true heart of nursing, and that is a truly sacred experience of community.
You’re a practicing nurse. What are some of the everyday ethical challenges you encounter and can you describe what helps you stay centered so that you can advocate effectively for patients, families, your colleagues and yourself?
I work in a pediatric intensive care unit, where so many parents understandably hold on to so much hope that modern medicine can keep their critically ill child with them for as long as possible. We see many children placed on life support with debatable quality of life. We see children who are abused and yet family members want “everything done” when they appear to only have a lifetime of suffering or minimal engagement with the world ahead. As I am constantly revisiting what helps me stay centered, a few key factors come to mind: 1.) It serves me better to take more time asking questions of families and colleagues and listening carefully before I allow myself to jump to conclusions about an ethically challenging case. This has often helped me filter out voices of people who do not actually know the real situation, and helped me build greater empathy for those most closely involved in the decision-making. 2.) I am learning the value of the very hard work of communicating my own concerns to patients’ families and to colleagues in ethical dilemmas, rather than staying silent. I try to do this with a constant posture of humility and openness to hear the other perspectives, but it helps me resolve some of my own ethical tension when I give myself permission to speak up in a way that is clear but not antagonistic. 3.) I recognize that I cannot avoid ethical dilemmas or grief if I want to be a nurse, so this is not an expectation I hold of myself or of the profession. I try to pursue love, wisdom, humility and compassion above all as I learn to navigate the gray areas together with all of my amazing colleagues.
All nurses are reporting heavy caseloads and multiple demands on their time, energy and expertise. If we believe that we owe every human we encounter the gift of our compassionate and healing presence, how can we keep ourselves energized and focused? Do you have secrets to share?
I am growing increasingly convinced that it is through entering into what seems to be the hardest things that we ultimately find ourselves more energized and focused than if we avoided them. Avoiding them simply leaves me feeling muddled and weighed down. If I am honest, I can easily use all my nursing “tasks” as a reason for me to shy away from pulling up a chair next to a grieving or “angry” family member, because the tasks will always be there. Quite frankly, performing the tasks come more naturally than opening myself up to hard conversations, to vulnerability and presence with a stranger. But every time I have chosen to spend even just 5-10 minutes listening closely to a family member, I find myself with such a deeper understanding of why we all are where we are with the patient’s care, and how it seems we ought to proceed. It helps me focus and prioritize my tasks better because I understand better what is important to the patient and family, not just to me.
Please join me for my Closing “Creating Safe Spaces for Vulnerability and Presence” at NNEC 2019.
Questions, please email Janine Mariz Burog at JBurog@mednet.ucla.edu