KATIE BOSTON-LEARY, PhD, MBA, MHA, RN, NEA-BC
Plenary Day 2: “The Necessary Transformation and Reshaping of Healthcare”
Click to Share this 2024 Spotlight!
Q:
The theme for this conference is “Claiming Meaning and Purpose in Nursing: Why It Matters.” From your perspective, what is the meaning and purpose of nursing? How does this theme resonate with your current research or practice?
I believe the meaning and purpose in nursing, for nurses, is personal. It’s individualized. When you talk to nurses, there are a number of different reasons why nurses went into the field. That is a driver for what sustains them. When you look at the definition of nursing, it’s about integrating the art and science of caring and focusing on the protection, promotion, and optimization of health and human functioning; prevention of illness and injury; facilitation of healing; and alleviation of suffering through compassionate presence. It is the diagnosis and treatment of human responses and advocacy in the care of individuals, families, groups, communities and populations, in recognition of the connection of all humanity. This is an important definition because of all the forces that seem to work against us, more than for us, in nursing. The more task-oriented and oppressive nursing is, the more transactional nursing becomes, which is not what we want. When you talk about claiming meaning, it means stating or asserting without providing evidence or proof. We should not have to prove our value in nursing. However, that is the place that we’re in today. Now we’re at this place where we have to continue to fight to show that we add value, which connects with mattering. One very pointed statement someone made to me is that purpose is about finding meaning. He mentioned something that I’ll never forget, that he hopes that he dies not figuring out his purpose. Because once you figure it out, what’s next, right? So, I think we all should continue to strive to find our purpose, but it’s a continuum. It’s a continual wavelength of what drives us. We find things along the way that continue to water us. But most importantly, what keeps us here is a social contract that we have. What keeps me here is a social contract that I have for the people that I serve: nurses, patients, communities, countries, regions, the world. I was at the Nigeria Nurses Association meeting, and they made a very interesting comment that the planet is my patient. So my purpose is to continue to make the planet my patient, in everything that I do.
– Katie Boston-Leary
Q:
In addition to core ethical concepts and principles, clinical ethics is about relationships and values. How does nursing’s relational framework influence the ability to fulfill ethical obligations?
The relational framework is our foundation for what keeps us grounded in terms of our ethical obligations. I just listened to a presentation about how nurses are practicing in violent systems. What makes them violent is that some of the systems that we practice in are designed to inflict harm. And even worse, there are people that profit from that harm. The relational work that we’re in is deliberate action. It requires facilitation that creates a net of connection that is visible and invisible. There are people that we touch that we will probably never physically meet. Especially when you talk about families of patients. At the same time, there are also more people that we touch and impact that we do physically meet, where it’s more tangible. So in the relational mode, you hear about person-centered care, relation-based care. The basic pieces become visible. But we need to make sure that it doesn’t become solely transactional. We have to recognize that this framework is our foundation. But it’s powered with our ethical obligations, to continue to keep us centered on what’s important. We’re in a very busy world with so many distractions. We have to stay focused in on what’s most important.
– Katie Boston-Leary
Q:
Are there ethical dilemmas or questions that are trending in your line of work right now?
The number one issue is staffing, and it’s driving everything right now. For the first time, we see staffing and well-being inextricably linked, empirically linked, and that’s presented a lot of ethical dilemmas for nursing and for nurses. The moral distress nurses feel time and time again, everyday giving grace and being hopeful that every succeeding day would hopefully be better and not getting that in return is creating harm. It’s important for that to be understood because we’re so forgiving. As nurses, it’s easy for that to be taken advantage of. There are so many macro dilemmas and then there are micro. The macro is staffing, and then that gets into the micro dilemmas that all compound and impact workplace violence, racism, cognitive and physical overload, all those different pieces that make it hard for nurses to do the simplest things. It’s important for all that to be understood in terms of what’s driving a lot of the challenges that nurses face right now.
If you think about the Code, provision five, which is the duty to care for the self, this hits directly at that, right? If you can’t care for yourself, unfortunately people see that. The Code is more about what happens after work, but it is for us while we’re at work. We have to continue to remind people that manage the systems that caring happens. It’s the right type of caring, not the convenient occasional pizza party kind of caring. It’s the every day, help to make my day, less hectic kind of caring. That’s what needs to happen. Unfortunately, because of the situation that we’re in, the ethical dilemma, it’s hardly that we’re having to make choices between good and bad options. It’s bad and bad and bad, or worse. Bad or worse. You would never accept any of these under normal circumstances, but you’re forced to because you have to pick a lane. It has a weathering effect on nurses, a visual idea that even the toughest material can erode after some exposure to things that cause it to erode, like water dripping on a piece of concrete. These dilemmas that nurses face and have to face every day, that’s why we’re seeing the exodus of talent outside of nursing, outside of healthcare, and outside, most importantly, where people are the sickest.
– Katie Boston-Leary
Q:
Can you tell us where you are finding meaning and purpose in your professional life? In your personal life?
It’s a constant shifting or balance. Kind of like on a skateboard where you’re constantly shifting your feet to stay on. So on a personal and professional level, I’m reevaluating what is and who is more important in my life. I stive to put things in the right order of importance, starting with my family, and aligning everything I do with my values. Part of my values are about fighting for justice. But the way I fight for justice is recognizing that it’s a larger war, and there are many battles in a war. I’m going to win some, I’m going to lose some. There might be a draw in some, but I never lose faith that I will eventually be on the side of the folks that win the war, the good. I’m intentional about keeping the main thing or main things the main thing and not apologizing for it. And lastly, I try to look for things that give me joy, and I keep them in my line of sight as much as I can. It’s important that we do that every day, particularly given the times we’re in as a society. It’s intentional work, but it’s necessary to save our souls and to have some peace of mind. In all these trouble spots that we’re in… it’s interesting you asked me this question. I was in a challenging situation professionally, where I started to lose the essence of who I was, changing how I came across to other people and all that, and I didn’t like that side of myself. I deliberately disconnected because I had to get my soul right and get back in line with where I’m supposed to be. We should never hesitate to take ourselves out of the game. You find that things are not aligning with who we really are, and that’s why it’s good to understand that for us to be in a good place, we need a community around us. To surround ourselves with people who would tell us that we’re off. I was surrounded by people that said, “Oh, you’re not okay,” and I’m grateful for that. It was a hard truth. Definitely unfiltered, but needed. I was able to take myself out of the game, took off for two weeks where I didn’t work and came back. And now I feel as if I’m ready to take on the world.
– Katie Boston-Leary
Q:
Do you have anything else to add?
Yes, it’s about leadership. This is a quote from the last election cycle where I was flipping channels, and it was Raphael Warnock from Georgia in his victory speech. I usually don’t listen to those, but I caught his speech, and he said one thing you need, we all need, to recognize is the importance of good leadership. To lead the people, you need to be able to love the people, be of the people. You need to be able to know the people, and to know the people, you have to walk amongst the people. It’s beautiful. You do those things, and that makes you a good leader, particularly during challenging times.