The Choice to Care

by Marie Manthey

I am one of the lucky ones….I knew nearly all my life that I wanted to be a nurse. When I was 5 years old, I was hospitalized for a month during which time I truly felt abandoned by my parents and worse yet, when they did come, a very painful procedure was performed on me. During this time, a nurse named Florence Marie Fisher colored in my coloring book. For reasons only known to God, that meant to me that she cared for me….in the fullest sense of that word care.

I knew from then on that being able to do that for another person was exactly what I wanted my life to be about…..and I’ve never looked back!

What made it full of wonder is that I have been able to learn so much about how to live from my work. A beautiful framework for living came through my work when I was involved in the original development of Primary Nursing. The framework links the concepts of responsibility authority and accountability in a dynamic relationship that can serve to correctly inform the proper relationship among people….the proper structure for an organization….the proper content of a job description. When each of those three elements….responsibility, authority and accountability are viewed in their proper sequence….when responsibility is legitimately allocated and authority commensurately delegated and accountability mechanisms are designed for recognition and education (and not for punishment)….then all aspects of an activity can be functional….and personal relationships can be healthy. But the most important thing I finally learned (sometime in my mid-forties) is that these same elements are at work in my life. The moment I call my epiphany occurred with a blinding flash of insight…..during which I instantly saw that as long as I blame someone else for whatever is wrong in my life, I am not accepting responsibility for myself. I decided to learn how to change that, and I have never found it necessary to feel victimized by any person or situation or institution again.

What does all this have to do with work? I believe we all have choices every day about all aspects of our work …..and that the choices we consciously (and unconsciously)make have the power to either expand our spirit….or to destroy it. I am continually amazed at how many people tolerate working in dysfunctional systems …..or in toxic workplace cultures, of for mean-spirited power hungry immature bosses. I know there are many factors operating that may reduce ones awareness or perception of choices. Nevertheless, I have come to believe that even in the most oppressive environments….consciousness of choice instead of consciousness of victimization is the key to being able to grow spiritually.

Ultimately, I think the real lesson to be learned is that we have a choice to manage ourselves…..or not. Self management means being aware of the importance of healthy interpersonal relationships. Open communication (no back-biting) functional trust and mutual respect are the three key ingredients to healthy interpersonal relationships. Open communication means taking the time to learn the tactful way to talk about difficult issues with co-workers….it is a skill we can choose to learn. Trust is a choice we need to be willing to risk giving…..because withholding it breeds only more mistrust….and mutual respect requires the judgment to see everyone (at all levels of status and education) as being of equal importance to the overall workplace morale. And I learned that morale influences the quality of the product more that any other single or combination of factors. In my world that means that the morale of a nursing unit staff will have more impact on the quality of care patients receive than does any other single or combination of factors. And morale is solely determined by the way staff members treat each other in the context of workplace realities….including the reality of more work to do than time available.

These incredibly valuable lessons came to me from my work experience…..and they dovetail completely with what I have learned in recovery.

Consciousness of choice ….of how to respond to my co-workers….of how to be present in my work…. of my values of integrity and authenticity…all of these and more are the opportunities of learning and growth I have received through my work. And I know that all of this came about because Florence Marie Fisher colored in my coloring book when I was five years old. She created a caring relationship with me…..and permanently influenced my life.

She never knew that. I published a book about Primary Nursing in 1979, and dedicated it to her. The publishers tried to find her, but where unable to. Recently I came across those onion-skin copies of the publisher’s letters to a couple of State Boards of Nursing trying to find her and remembered that they were unsuccessful in locating my Florence Marie Fisher. But I thought to myself that afternoon few months ago……Google! And so I googled her and found her obituary….which also listed her survivors. I have since had the pleasure of meeting her son and grandchildren and telling them about the impact she had….not only on my life…but also on my work, which has in turn influenced the experience of nurses and patients throughout the United States….and now also internationally. Of course they had no idea…..her simple act at work of coloring in my coloring book was a sublime act of co-creation. As nurses we can all find ways to choose to color in a coloring book. It is a choice we have to make, individually, and repeatedly.   It is a choice that will not be documented….cannot be charged for….but that has a major impact on the lives of at least two people, the patients we care for and on ourselves.  The choice to ‘be with’ the patient, instead of just ‘doing for’ changes the nursing experience for each individual who experiences this choice.