Nurse Ratched’s Place: Interview with Terri Polick

15/09/11 2:00 AM

Nursing: Beyond the BooksFor the eighth section of this series, we reached out to Terri Polick, well-known for her online contributions as MotherJonesRN. Her bio states: “Terri Polick, RN is a psychiatric nurse and freelance writer living in Maryland.  She is the author of numerous nursing articles and the proprietor of Nurse Ratched’s Place, which gives readers an insider’s look at the mental health system.  Terri graduated from Lake View Medical Center School of Nursing.”

The bold statements are taken directly from her posted works, followed by our questions and her responses.

Nurse Ratched's Place

Sometimes, I think nurses get a little crazy about collecting letters behind their name. I’ve met nurses who wear credentials like kids wear designer jeans. It’s all about the label. When I graduated from nursing school a bizillion years ago, you got an RN, period! Do you feel that an ability to perform in working environments, regardless of the letters in your title, is enough to compete, given how hospitals and care centers are changing? Meaning: it may have been easier in the past to be “only” an RN, but are you limiting yourself today by approaching it with only licensure?

Does a degree give you a competitive edge?   It depends on what you want to do.  For example, you must have a formal degree to teach or go into research, however you do not need a degree to give excellent bedside nursing care.  Nurses were doing that way before anyone had heard the term “BSN.” Much to the chagrin of the ANA, many nurses reject the notion that you must have an advance degree to be a professional nurse. Knowledge is a tool that allows an individual to complete a task or achieve a goal.  Individuals can obtain knowledge through different pathways.  Attending inservices and reading nursing trade papers are a great way to add to your knowledge base, and let’s not forget good old fashion life experience. I am not anti-education, but college is not the only path to a successful career.    I am a three-year diploma nurse and I have never felt limited in my career.  Employers have always judged me based on the quality of my work, not the letters behind my name.

I told a group of medical interns that I graduated from a three-year diploma nursing program. One of the interns innocently asked me, “What’s that?” I felt so old when he asked me that question that I expected a museum curator to come out of the woodwork and cordon me off with a velvet rope. In the new breed of nurses coming-up today, what do you see as the one greatest challenge they will need to overcome more today than nurses did in the past?

Every generation of nurses have faced the same challenges throughout the years.  For instance, we have always worked short handed and long hours since the days of Florence Nightingale.   I think the impending nursing shortage will be the greatest challenge for the next generation of nurses.  Hospitals will be critically under staffed when older nurses finally retire from the profession.  It will be interesting to see how new generations of nurses deal with the crisis.

(referring to Millie, a nurse who worked with her “country” doctor growing up) When I graduated from high school, I decided to become a nurse. I never thought of nursing as a subservient profession because of Dr. Estes’ relationship with Millie. Do you feel that in your years of nursing, the nurse has been seen as a subservient role in most situations? How do newer nurses work specifically to combat this perception? Do you see change happening?

Has nursing been viewed as a subservient role in the past?   Yes, but not because it was nursing per say, but because women, which made up most of the nursing profession, were viewed as subservient to men. It was truly a man’s world back then and society’s view on women greatly influenced the balance of power between doctors and nurses, and how nurses were viewed as a profession.  When I was going up in the 1950’s I was surrounded by messages that told me that women were not equal to men, but I didn’t get that message when I went to the doctor’s office.  Dr. Estes and his nursing staff truly had a collegial relationship, which was unusual for the times.  As time passed, societal norms changed, which had a major impact on the working relationship between doctors and nurses.  Young people today have a hard time wrapping their heads around what nurses had to put up with before the Women’s Movement.

Part of my job as a psychiatric nurse is to help people learn to communicate more effectively with others. What skills that are not taught in nursing school apply here? How would a nursing student improve on these necessary skills before they are called-on?

I’m appalled that most nursing schools these days just skim over specialties like psych.   I learned my best communication skills during my psych rotation. My rotation was three months long and I worked 8 hour shifts on an inpatient psych unit three days a week.  My classmates and I worked with seasoned psych nurses.  We modeled our nursing practice on what we observed on the unit and I honestly learned more by watching the nursing staff talk to patients than I ever learned out of a book.  The staff gave me excellent feedback on how to improve my communication skills, which serve me well to this day.  Today’s students can improve their communication skills by turning off their cell phone, sitting down in a chair, and having a conversation with their patient.  Too many nurses don’t take the time to find out what’s on their patient’s mind.

I urge all health care professions to join the cause to promote health care reform. Whatever you believe, get involved. How has getting involved affected you professionally – both pro and con – or has it?

My zest for political action has enhanced my life.  I’ve met nurses serving in Congress, in state and federal offices, and in private industry that have passed on valuable life lessons.  These individuals all have one thing in common; they had a vision and worked hard to improve the lives of the American people.   These nurses taught me that one person could truly have a positive impact on others.   I’ve incorporated this core value into all aspects of my life, including my professional career.

Standing up for your beliefs sometimes comes with a cost.  My outspoken stance on issues cost some writing jobs, and I was taken off of a masterhead of a prominent nursing magazine because I locked horns with a certain nursing organization.  I don’t let things like this get under my skin.  I know I’m doing the right thing.

I’ve noticed that different types of talk therapy fall in and out of favor over the years, and I’ve seen a lot of changes throughout my nursing career. What are the constants, if there are any? What causes change, in your opinion?

The need to be heard and understood is a constant in any human relationship.  Theories about how to make this happen are based on new research, popular belief, and financial constraints.   Freud and his theories surrounding psychoanalyses were very influential when I graduated from nursing school.  Later on, in the 1980’s, Dr. David D. Burns popularized cognitive behavioral therapy in his book, Feeling Good: The New Mood Therapy.  Each theory has something to offer, but I believe that the push for cost containment is playing a big roll in which modality is chosen for patients.  For example, psychotherapy is time consuming and very expensive while cognitive therapy can be conducted more quickly with less cost.  HMOs influence the options we use for our patients.

As a nurse, I’ve watched HMOs grow into mutated monsters. It makes me mad as hell when my patients can’t get access to care, even with insurance. Today, I’m very careful about embedding key words into a patient’s chart so their claim will not be denied, and even then, the hospital has to fight in order to get paid. Believe me, HMOs are all about making money and they won’t stop until your bank account is stripped clean. How much control does a nurse have in insurance situations? How does a newer nurse understand how to protect the patient’s needs, even if they are not articulated?

Nurses can greatly impact insurance situations.  Hospitals hire nurse care managers to deal with insurance companies.  Their primary goal is to make sure that insurance claims are not denied and that the hospital gets paid.  These managers are in daily contact with insurance companies, and they must constantly justify why patients are still in the hospital.  Nurse care managers use information found in patient charts when talk to insurance companies. The information must validate why the patient still needs to be in the hospital.  I’ve asked case managers to tell me exactly what needs to be in my nurses notes so they can do their job more effectively.   All nurses need to team up with their nurse case manager and learn how to chart for insurance companies.

I was also taught that anyone willing to work long, hard hours could obtain the American Dream. …  I’m a nurse for life, which means I’m not going to retire. In other words, I’m going to die with my Nurse Mates on. At this point in your career, it is safe to say you’ve worked long, hard hours as a compassionate caregiver. In retrospect, is that American Dream now your story? What would provide the happy ending? What were the necessary steps, unavoidable, to get there?

Yes, I am living the American Dream thanks to my parents and to my nursing instructors.  I learned my work ethic through their example.  My parents worked hard and made sacrifices so I could have a better life, and my teachers passed on their knowledge and wisdom when I was under their tutelage.  With their support I was able to work weekends as a nursing assistant which allowed me to gain extra bedside nursing experience and graduated as one of the top students in my class.  My life is blessed thanks to those who came before me and prepared the path that I followed.

People who want to be a nurse must understand that the profession is demanding.  I have worked countless weekends, night shifts, and holidays, and I have trudged through blinding snowstorms, hurricanes, and floods to get into work.  Personal issues must be set aside.  Patient care always comes first.  Nursing also has its rewards. Nurses bear witness to the most intimate moments in a patient’s life. I’ve held newborn babies in my arms, and I’ve held the hand of the dying.  I’m honored that I’ve been a part of so many lives.  What would provide my happy ending? I hope that I can keep just one nurse from throwing in the towel by passing on what I’ve learned. I am going to die with my Nurse Mates on because it’s who I am.  Once you are a nurse, you are a nurse forever.

Was there a specific point in your career where you started looking at nursing as a whole, rather than being more focused on your own part in nursing? Not saying you’re altruistic or neglecting your personal growth, but more if there was a point when you started seeing it from a larger perspective, or if you have always done so. Not every nurse travels to Washington for what they believe in about healthcare – so what makes you different?

I come from a politically active family, so I’ve been immersed in politics all my life.  Nurses have immense collective power and my nursing instructors always encouraged my classmates and me to get involved in the legislative process by joining our professional organizations. I quickly became disillusioned with nursing organizations because they don’t represent the best interests of my patients. In 2005, I teamed up with like-minded nurses and became a founding member of the National Nursing Network Organization.  We are a 501(c)4 non-profit legislative advocacy organization that is dedicated to insuring that the same quality of health care afforded to past generations of Americans is available to future generations. Our mission is to promote, encourage, and support a National Nurse for Public Health and other projects that promote wellness and disease prevention. We also support the creation of opportunities for licensed practical and registered nurses to work together to solve our country’s health care crisis and improve the health of all Americans.  Thanks to our supporters, H.R.1119 — National Nurse Act of 2011 was introduced in the 112th Congress. I will continue to work with NNNO team members to promote the nursing profession and health care in America.


Terri PolickThanks for sharing your insight and experiences, Terri! Be sure to visit Nurse Ratched’s Place to read the work Terri has been regularly offering there since 2006.

Tune-in tomorrow, and in part nine of this series we will be talking to Lorry Schoenly about some of the challenges and misconceptions often held in becoming a correctional/specialty nurse.

Nursing: Beyond the Books

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