“Creating an environment where people can feel safe when they’re talking with you, and you can ask questions and be asked questions, and you can respond in a way that is genuine and curious. I will say that that’s easier said than done for some things, but ‘I’m curious about’ or ‘Can you help me understand?’ are the golden phrases for me. You might actually learn something that you didn’t know.”
BETH EPSTEIN, PhD, RN, HEC-C, FAAN
Professor and Associate Dean for Academic Programs
“Physics 101: The atomic weight of matter(ing) in contemporary healthcare”
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Q:
The theme for this conference is “It’s Complicated: Responding Ethically from the Beginning to the End of Life.” What does it mean to respond ethically? How does this theme resonate with your current research or practice?
Right now, for me, it means making sure that the people who don’t have a voice, who tend to be under-heard, have opportunities to bring their voices forward. I’ve found myself taking a kind of feminist ethics perspective, and not just the female voice, but really underrepresented voices and primarily those of clinicians. So I’m listening intently to people who’ve had their boots on the ground throughout COVID and who are very committed to their workplaces and feel very undervalued.
It’s responding to staffing. It’s complicated because the [nurse] traveler is still an issue. And I have great respect for travelers. I know why they’re needed and I know why hospitals have hired so many, but it’s not all about money. I do wonder if there might be a different way to address it, so that people who have been very dedicated, who are committed members of a team over the long haul, are recognized for what they’ve done in some meaningful way. I don’t know what that looks like for those folks, if it’s mostly money or if it’s some other kind of recognition.
The other piece I’m reading and seeing and hearing from my colleagues is that health care organizations are increasingly commercialized and the bottom line is the dollar and not the patient. It’s very worrisome from an ethics stance. It’s worrisome for clinicians who you know went into nursing, medicine, respiratory therapy, etc. to take care of patients and when they have to be thinking about how much money you get, getting the patient discharged, readmissions, RVUs, supplies, staffing crunches and all that kind of thing. I feel like decisions aren’t always made with the interest of the patient in mind. And I think that’s worrisome. So it’s responding to those issues.
And I worry about clinicians who just are not feeling like their values really fit anymore in healthcare… It is a weariness. In talking to other colleagues and other institutions, they’re also having difficulty. I’m on the education side of things right now, and finding preceptors for our nurse practitioner students is a challenge. It’s a challenge because there’s so much pressure for RVUs that NPD APPs can’t be released from that chokehold in order to precept and mentor students who will replace them. So you hear all these places that say they have five or so many NPD openings but they’re not able to precept NPs who could fill those spots. It feels deep and it’s a weariness. You have to have a succession plan. You’re shooting yourself in the foot if you’re not allowing people to train the next generation.
– Beth Epstein
Q:
The last few years we have witnessed a disintegration in civil discourse especially with polarizing topics. Nurses can be caught in these dialogues, both with patients and their families, in their communities, as well as when they are sorting through their own values and determining how they honor them while addressing them as a professional. What are your thoughts on this, and can you give one piece of advice to address these challenges in these turbulent times? What is your perception of the current nursing ethical landscape?
My perspective comes from the educator piece, working with our students to make sure they know how to phrase and start those kinds of conversations without creating a wedge between themselves and the people that they’re asking questions. So the one piece of advice that seems to work pretty well for me and for lots of my colleagues is to begin the conversation with, “Can you help me understand?” It seems so minor. “What I’m seeing is this, and I’m having a hard time seeing anything different. Can you help me figure out how I should be, how I could be looking at this differently, or how you’re looking at this? I’m curious to know.” I think that helps open the door rather than what you might be saying in your head: “Why in the world are we doing this? This is ridiculous.” But as soon as you say that out loud, you lose your ability to be neutral. You also create a wall between yourself and the other person, and their defenses go right up. It doesn’t take a lot for other people’s defenses to go up. I think we’re just hyper alert to needing to raise our defenses and protect ourselves. So creating an environment where people can feel safe when they’re talking with you, and you can ask questions and be asked questions, and you can respond in a way that is genuine and curious. I will say that that’s easier said than done for some things, but “I’m curious about” or “Can you help me understand?” are the golden phrases for me. You might actually learn something that you didn’t know.
The other piece is something I learned early in my nursing career. When I’m asking a question of someone who’s a couple of rungs up on the power scale or power ladder, I come with an educated perspective. So I have gone to the library and I’ve read a couple articles. I’ve looked for some data, so what I’m talking with a person about is not from an emotional perspective or emotional point of view. It’s from the cognitive point of view, when you’re talking about facts and evidence. That tends to be better accepted and received.
– Beth Epstein
Q:
What is your perception of the current nursing ethical landscape? Are there ethical dilemmas or questions that are trending in your line of work right now?
I wonder if there are ethical questions about what the nursing role is in complex patient management. This is where my interest in mattering comes from. There’s a huge untapped reservoir of expertise and professionalism and holistic approaches to patient care that is just in nursing and is just completely untapped. You need to know how to tap into that or how to raise awareness that nursing can do much more than is currently expected by the public or by organizational leaders. There’s so much more potential. For me, I think the ethical aspects of nursing is where does nursing contribute and where does nursing belong in the whole healthcare arena? It could be so much more impactful. Nursing is impactful, don’t take me wrong, but I think it’s an untapped resource… [Nursing was growing and] it feels like it came to a screeching halt. Now we’re back to warm bodies.
– Beth Epstein
Q:
Can you tell us where you are finding joy in life, despite the challenges around us?
Oh gosh, I find lots of joy in my life. One is, I love my colleagues. I have just the deepest respect and love for my colleagues and love to do things that are fun together. A bunch of have gone out to dinner. We do Wine and Design. You know, fun things together outside of work, which I think is important to have that kind of support. So when you go to work, you feel like people will miss you if you don’t show up. The other thing is we have a pandemic puppy and as an empty nester we have someone to snuggle with and love. She’s just a doll. And I’ve had time during the pandemic to get back into playing the cello, which I’ve played since I was eight. I’m a busy faculty member and a busy mom. I kind of had to set it aside for a while, but I’ve been able to get back into it and I’m playing in an orchestra. I look forward to Wednesday nights and that’s a lot of fun. I’m in a bunch of quartets and I play with a pianist in the hospital lobby. It’s that kind of thing that gives me joy. And my family.