Lois Copeland, RN


Topics in Advanced Practice Nursing eJournal. 2003;3(1) 


Dear Editor:

I am writing in response to your editorial, "Doing the Right Thing," published in the current issue of Topics in Advanced Practice Nursing eJournal.[1] I am a 58-year-old home care and hospice nurse. I was absent from nursing for many years while I raised children, returned to school, and started a second career -- a policy associate for a national feminist policy organization. My project was "violence against women." I wrote policy/published reports, worked in coalition with other groups, and met with members of Congress on this issue. Being a small organization, we all had our own projects but assisted others. Projects included: women and AIDS; women, work, and welfare; educational issues; women's health decision-making; and girls and violence.

In 1992, while working for the policy organization, I became ill with inflammatory bowel disease. In January 1993, I had a colostomy, and 1 year later I experienced more extensive surgery with revision of the ostomy. After several years of juggling work, family, illness, and a death in my family, I decided to resign from my position. The organization I worked for lived their beliefs, supported my struggles, and never asked me to resign even though there were only 10 employees. It must have been a hardship for them while I was on medical leave; however, they were flexible and responsive to my needs until December of 1994 when I resigned.

By the summer of 1995, I felt well enough to return to work, having endured 4 surgeries and 5 hospitalizations since the summer of 1992. I decided on a third career or a return to my original career -- nursing. I was inspired by the support I received from the hospital staff nurses, the ET nurses, and home care nurses during my hospital stays and while recuperating at home. I returned to school and did an internship to update my skills. I needed to learn many new procedures: for example, drawing blood, starting IVs, using IV pumps, and wound care techniques. Nurses did not do these procedures when I previously worked in nursing. With my newfound knowledge, I became one of several nurses who other nurses would call when they could not find a vein, had trouble accessing a port, or unable to master wound care techniques. Thus, I found my niche in home care nursing.

I have an ostomy, so I brought special expertise to the home care office, which did not have an enterostomal therapist. I was able to teach my coworkers and give ostomy patients the physical and emotional support needed to learn to live with an ostomy. While at this job, however, I suddenly lost my 21-year-old son. I returned to a supportive work place and brought an even greater compassion to my work, especially with the very ill and hospice patients.

However, as time went on, I could not work every other weekend due to family demands. I was forced to convert to as-needed status and give up my case management role. Case management was very important to me because I enjoyed developing a bond with the patient, family, and caregivers. The director could not be flexible on this issue, however, even when I and several other nurses presented the idea of case sharing in which patients requiring the most care could be seen by me or the usual case manager. This would still allow for continuity of care. The idea was turned down.

The other nurses embraced the idea, however, so we implemented it on an informal basis. It worked well, especially for patients with multiple wounds. We felt that nursing care was better, the patients were able to see fewer nurses, and documentation was better. When administration found out, they were furious. I was given a warning, then asked to resign. I said that I was not sorry and would do the same thing again. The change we implemented allowed me to practice at my fullest capacity and was best for patient care. I felt I was doing the right thing, but now I do not have a job.

While in school, I wrote a paper called "The Interface of Nursing, Feminism, and Health Care Reform." In doing my research, I found that nursing and nurses do not support each other like other professions. We seem to be stuck in the 1950s and early 1960s. We can do more technically, but are still rigid and insecure in our roles. I found through my experience, like you mentioned in your editorial, that I have significantly different philosophical beliefs about patient care from those of the administration I worked for. Why couldn't the administration work with me, and others like myself? Why are capable nurses unemployed during such a severe nursing shortage? Why don't nurses support each other's efforts and differences? Why can't organizations find creative ideas to keep nurses? Why can't the nursing profession value differences? Why does the administration (nursing and healthcare management) still feel nurses are expendable? Why aren't nurses valued?

When I do return to nursing, I will continue to put my patients first and do the right thing. I don't want advancement or a supervisory position; I just want to care for patients.

Lois Copeland, RN


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