“Put this on my epitaph: Where there are nurses, there will be a way. We will do what it takes. Nobody knows the system better than nurses do. I believe that there’s no one better prepared to navigate than nurses because they have their hands in every element of care delivery. You need a question answered, ask the nurse. You need to figure out how to solve this complex problem that nobody else can pull all the pieces together, ask the nurse.”
MELISSA A. FITZPATRICK, MSN, RN, FAAN
Closing Day 1: “When the Nurse is a Patient: Employing Ethical Competence as We Advocate for Self and Others”
Melissa A. Fitzpatrick was interviewed by Sarah Delgado, DNP, RN, ACNP, a clinical practice specialist in strategic advocacy at the American Association of Critical-Care Nurses and a NNEC Planning Committee Member.
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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’ve been a nurse for almost 47 years, and I’ve never been able to wrap my brain around one very clear-cut definition of the meaning or purpose. I keep coming back to helping others achieve safe passage. I’ve had so many different roles in nursing, and I’ve been around so many nurses in various roles. If you are a direct care provider laying your hands on others – which I did for many years as a critical care nurse – you’re trying to get that patient and family through the care experience safely, without harm, and with the best outcomes possible. I’ve been in leadership roles for decades, where I’ve tried to help colleagues and nurses from one role to another, from one experience to another, from one competency to another, where they’re constantly growing and evolving. Helping to assure their safe passage in their career trajectory as nurses, whatever that looks like. In my role now, I’m president of an executive search firm. I never envisioned this as a stage of my career, but I just love it. We are assuring safe passage for candidates into executive roles, leadership roles and healthcare organizations across the country, making sure they have a world class experience as they pursue new opportunities and new steps along their career journey or ladder. I’ve been a patient. That’s how I got involved with this ethics conference. As a patient there was a huge role for me to play as a nurse. The purpose and meaning of nursing, when you happen to be the patient, is to try to make care processes better for others. I believe that’s what I tried to do with the experience, to help the care team. And now in the process of this conference, helping others deliver care to patients who may not be able to advocate for themselves. We’re always moving from one place to the next, from one experience to the next, from one opportunity to the next. As nurses, we wear so many hats, and we facilitate and enable so many experiences for each other, for those that we serve, and for organizations to achieve safe passage. Maybe it’s the Magnet journey. Maybe it’s for our critical care units to become Beacon Award winners. Something in my brain is sticking with the safe passage.
– Melissa Fitzpatrick
Q:
I love that. It’s both optimistic and acknowledges the gaps. It sounds to me that in your career when you’ve seen a gap, you’ve moved to meet it in order to ensure that things continue on the right trajectory, that the safe passage can happen. That’s really inspiring
We can look at it in a couple of ways. I’m an athlete, so I can look at it as the primary vehicle of offense. We are also the last bastion of defense. Nurses are the only ones in the delivery system that are with patients 24/7. We always have been, and I hope we always will be. Everyone else is important and valued but an episodic visitor to those sites of care in whatever setting that might be. Nurses are the stop gap, the ones that are going to fill in the blank, to fill that hole, to fill that need, to make the difference. We’re the ones that are there. Safe passage, but also creating the route, laying the tracks down. The train’s coming down the track, and we’re laying the tracks as we go.
Sometimes only a foot or two ahead of the train!
The vision of bringing those with us, making sure we’re getting those we serve where they need to be and how they need to get there.
– Melissa Fitzpatrick
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?
I love this question. Nursing is relational care. Caring is relational. It involves people who are opening up their hearts, their minds, their spirits, their talents to serve each other…
That is the core. If you don’t have relationships, then you don’t have partnership, you don’t have collaboration, you don’t have service. To receive service, you have to be in relationships. The ethical obligations of nurses to engage, to be present, to serve. In all of my leadership roles, I’ve tried to be a servant leader. You have to engage to be in a relationship. That involves putting in the time to build trust with one another. True partnership, true collaboration, true service… It all comes back to putting in the time with the best intentions, with a full heart, to engage with somebody and to try to understand them. Certainly, the nurse-patient relationship is the best living example of that. Being present, really trying to get to know someone and understand their needs, their wishes. In so many cases, it will be the nurse who is the only one who knows what the patient wanted. The only one who knows what the patient and family decided but maybe were not able to articulate or weren’t in a position to advocate for themselves. Advocacy is such a huge part of our role and our ethical obligations as nurses. In order to advocate for someone, you need to have established relationships and presence with them to earn that trust, to earn that privilege to be their moral and ethical advocate. That doesn’t happen with a snap of the finger. That happens with time and intention and presence. The relational framework is everything, because it’s all about people serving people, people receiving care from people, people leading people. That’s fundamental to who we are as nurses. That is woven into every element of our ethical framework.
– Melissa Fitzpatrick
Q:
Are there ethical dilemmas or questions that are trending in your line of work right now?
There are so many, and I see them from many different viewpoints. I don’t know if it’s unique, but it’s something special about nurses because we wear so many hats. That plays out in our work every day, no matter what the role is, whether you’re a direct care provider, president of an organization, a researcher, educator, patient. We always wear so many hats, and we bring all of those elements of ourselves to that moment. There are tremendous ethical dilemmas at play in our world. Health care, and certainly nursing, are microcosms of the broader society. We know that society is fraught with challenges right now, dilemmas and moral questions.
Behaviorally, we see those acting out as a result of fear. Every time I try to peel the onion about someone’s behavior. Why are they acting that way? Why are they speaking that way? Why is there such violence that we’re facing now? That’s an ethical dilemma right there. We can talk about violence in the workplace all day. When I peel those onions, I often find a few core things. A lack of knowledge. Maybe somebody doesn’t understand what’s happening, so they’re acting out in a challenging way because they are afraid. What’s happening to me? Why am I going through this? Scarcity plays a role in our challenges, whether we don’t have enough of something right now, such as the workforce challenges, we’re facing in nursing, and in the industry and in healthcare at large. The scarcity mentality drives a lot of behaviors, a lot of conversation, a lot of the challenges we’re facing when you don’t have enough of X. Let’s say it’s that you don’t have enough of the right people at the right place at the right time to deliver the care that we are obligated and privileged to deliver. That sets up a whole internal conflict, when you’re constantly feeling like you couldn’t do everything you wanted to do for that patient. I was raised by the nuns at Gwynedd Mercy University to treat every patient as if he were my own loved one. On each shift, day in and day out, if you feel like you couldn’t do everything you wanted to do for that loved one, that leaves you with moral injury and tremendous conflict over time.
I see ethical questions and dilemmas as organizations try to fill their leadership gaps. The dichotomy of we’ve got to be good stewards, we’ve got to maintain our fiduciary responsibilities, cost effectiveness, eliminating waste, saving money. We also need to provide the highest quality and caliber of leaders with the right numbers and in the right places. It becomes an ethical dilemma. I see it in my work every day where so many organizations say they don’t have enough people. You’re the Chief Nurse of one hospital? Well, why don’t you just go ahead and be the Chief Nurse of all five with no additional support. You’re leading the critical services right now. We want to save money by not filling that position or not putting an interim leader in. So, let’s just have you lead all the emergency services to the ambulatory service and ambulatory surgery center. Get everybody to do more and more and more with less. Not only does that create internal conflict and feeling less than or not good enough, but it’s also the impact of all of those decisions on clinical quality. It’s a vicious cycle, kind of shooting yourself in the foot, where we think we’re saving money by not filling these important roles. And yet, at the end of the day, you’re just frying people, burning people out right and left. Whether you are the president of an executive search firm, frontline staff nurse, or whatever role you might be and in whatever setting, it’s always going to be about trying to manage the challenges of needs versus resources.
Right now, the biggest challenge we’re facing is the ethical dilemma caused by workforce shortages. It’s not a new story. It’s been a long time with a lot of ups and downs in staffing and shortages of all kinds of personnel. At the same time, there’s never been a greater need and demand than now with patient acuity and volume of patients. Those trends don’t seem to be going anywhere. We don’t have to look further back than the pandemic to see how vulnerable our patient care delivery system is. Hopefully we’re not going to see another need like that in our careers. We are not in a situation right now where we’ve got enough of what we need to meet the rising demand presented to us by those we serve.
– Melissa Fitzpatrick
Q:
I appreciate how you looked at that on a system perspective, and also what it means for the individual clinician, what it’s like to go home at the end of the shift and feel like you didn’t do everything. Or for a leader to know we should be putting X in place, but I don’t have the bandwidth, because my span of control is too broad.
It’s demoralizing, and then that becomes exhausting. And then that exhaustion becomes a health factor for the care provider. It’s not inclusive to nursing; we know so many of our colleagues and other allied health professionals are feeling the same thing. We’ve got to figure something out. We’ve been talking about it a long time. Maybe this is the time. A lot of great innovation occurred during the pandemic. We’ll see what some of that can do for us in the long term. I’m very hopeful. We’ve always found a way. Put this on my epitaph: Where there are nurses, there will be a way. Because we will do what it takes. Nobody knows the system better than nurses do. Whatever the system is rural health care, academic health care, academia. I believe that there’s no one better prepared to navigate than nurses because they have their hands in every element of care delivery. You need a question answered, ask the nurse. You need to figure out how to solve this complex problem that nobody else can pull all the pieces together, ask the nurse.
– Melissa Fitzpatrick
Q:
I feel the same way about our profession. I’m so worried in the wake of the pandemic, so it’s wonderful to hear you say this and feel like there is still an element of optimism and belief in the strength that we have.
I’m an optimistic person by nature. We’ve never needed that more. What is our alternative? That’s what I ask myself every day, no matter what I’m working on. If not us, then who? It’s easy when you read a lot today about getting in touch with your “why.” Well, the why for nurses is pretty straightforward. Not easy to accomplish, but easy to understand who we are, why we do what we do.
If everyone took the time to reflect on: Why did I go into nursing? Why did I go down this path? Whether you’re in your early career, a multi careerist, at the end of your career, whatever it might be. If everyone got back in touch with the why of going into nursing, I think it would give us some optimism. We see the goodness and the work ethic and the strength of our convictions and the intentions that we brought into this beloved profession. I am still very hopeful. I see examples every day… Organizations are just people. It’s a lot of people in some cases, but it’s people coming together to fulfill the unified mission and share the same core values. If those are patient-centered, then most bad things won’t happen. I know the power of people who are aligned around a shared mission, vision, and values. How powerful that can be, even if it’s just two nurses at a time.
Being on the receiving end of care, I admit I’m probably not the best patient because you can’t turn off being a nurse. I couldn’t. Are they washing their hands? Is everybody doing what they need to do? I was so grateful for the care and saw the lengths they went to, to take good care of me and to get me through my surgery and all of my treatments. After some of my experiences, particularly with pain and pain management, I just thought this is unacceptable. You’ve got to be kidding me. I’ve got to advocate for all of these women. It was gynecologic surgery, I had endometrial cancer. And then the cancer came back eight months later, and I had to go to 26 external radiation treatments and then five internal brachytherapy treatments. When I got to that phase of my treatment, I’d never felt anything like that in my whole lifetime. I remember thinking, I don’t think I can do four more of these. I can’t do it. Then my next immediate thought went to, there are four other women lined up ready to go. Are they going through this every time? I realized most patients think, I guess this is how it has to be. Or they think, well the doctor said… But this is unacceptable. I’m not going through that again until you figure something else out. What are we going to do? That’s how we got here today. What are we going to do? The CRNA and I came up with a plan and it worked. Then it worked for the second treatment, the third, the fourth, the fifth. I vowed every single time, other women aren’t going to just lay there and take this when there’s an easy solution. I know that if people don’t feel like they have a voice, if they don’t feel empowered to speak up or ask a question, then they’re just a victim to whatever’s going to happen to them. That’s a whole different experience than when you are part of your care plan. I’m a pretty vocal person. I’ve been around a long time; I know what’s okay and what’s not. I talked to every nurse, first one taking my blood pressure, putting the IV in. What do you hear? What do you see? Do people complain about this? Have other women gone through this? What do you do? What do you say? Who do you talk to? You just get to the point where you’ve got to break that cycle of either, I guess that’s the way it has to be or that’s the way it always happens. I kept thinking about if that was my mom laying in there, anybody that you love laying there… those people are all someone’s loved ones. Who’s asking the question and thinks they just have to grin and bear it? That’s how we got to this conference and talking to me. It’s the ethics of advocacy. How do you advocate for yourself and advocate for others? That’s a big part of who we are. Using our knowledge to drive positive change, positive impact on practice for others. There’s got to be an ethical framework for that.
– Melissa Fitzpatrick
Q:
Tell us where you find meaning and purpose in your professional life and also in your personal life?
It’s being the best leader. For our associates, we provide leaders, not exclusively in nursing, but across the whole system, across the whole continuum, all roles. CFO, CIO, presidents. It’s not exclusively a nursing company by any means. But everything I do, everything I am, is informed by the fact that I am a nurse. I try to stay fulfilled by doing board work. I’m on four or five other advisory boards in healthcare. So, staying very active, trying to drive innovation, to drive early adoption of new practices. Trying to lead this company and help all of my associates to lead fruitful and fulfilling lives, to stay with us, to do important work every day. They’re the best in the business.
On the personal side, it’s living for my two sons and their two puppies. My family, my brothers, and my friends. Tying to be a whole and healthy human so I can be the best mom, the best advisor, best community member. We’ve had a lot of loss, so I also try to be a role model for strength. Some days are easier than others. My husband passed away very suddenly four years ago. My boys and I just pulled together and said, we’re going to figure everything out ourselves. It’s been a rough four years, but we kept going through the pandemic and then through my cancer. It’s been a goofy little rollercoaster. I’ve never felt more loved and cared for and connected and optimistic. I think the message for personal purpose is to surround yourselves with the best and brightest and share your heart. You get one heart. Share it and keep trying to build the best future. That’s what I do every day, try to build the best future for my boys. Make sure that everybody I’m engaged with in my life is going to be well, going to be healthy. I’m going to do everything I can to make that happen.