The soul behind the song: “It is Well with my Soul.”

Many of us are very familiar with the hymn that has been sung in church for over 150 years: “It is Well with my Soul”. It wasn’t until a guest pastor revealed the story behind the lyrics that the power of the song really sank in my heart.

A man by the name of Horatio G. Spafford (1828-1888) resided in Chicago with his wife, Anna, & 5 children. He was a successful entrepreneur, lawyer & devout Christian, but he was no stranger to tragedy. He lost his son to pneumonia, &, later that same year, he lost most of his fortune in the Great Chicago Fire of 1871. His real estate investments along Lake Michigan shoreline were lost in the fire.

In search of respite & renewal for a grieving family, he planned a European trip for the family, including Spafford, his wife & his 4 daughters. Due to last-minute business affairs, he sent his family traveling across the Atlantic, planning to follow behind them after a few days.

The wife & 4 daughters set sail aboard the Ville du Harve to cross the Atlantic into Great Britain. 4 days into the trip, the ship had a tragic collision with a Scottish ship, the Loch Earn. Within 12 minutes, the ship sank into the dark depths of the Atlantic with 226 passengers, including all 4 of Spafford’s children. His wife Anna, however, was  spared. She was found & rescued by a Scottish sailor while floating on some wreckage, arriving in Wales 9 days later. She sent her husband the following telegram: "Saved alone, what shall I do?"

Spafford booked the next available ship to join his grieving wife. About 4 days into the journey, the captain of the ship called him into his cabin. The captain informed Spafford that they were sailing over the location of the tragedy that took his 4 daughters' lives. It was during this time that he wrote these soulful lyrics:

When peace, like a river, attendeth my way,

When sorrows like sea billows roll;

Whatever my lot, thou hast taught me to say,

It is well, it is well with my soul.

The couple went on to have 3 more children & relocated to Jerusalem for the remainder of Spafford’s life. 

I included 2 versions of the song via YouTube that I love; I hope it stirs your soul with the same power that it does mine.

2 Weeks After My Final Dose of COVID-19 Vaccine: Reflections on Life

Today is the day my body achieved a full immune response to my 2-dose COVID-19 vaccination series. While I have always been pro-vaccine, the past year makes this day so much more meaningful & powerful. A year ago, I was in Queens, NY as a frontline RN. CNN, the NYT, or any other media organization could not have possibly adequately prepared me for what I witnessed firsthand. The staff, patients, families, & communities who suffered & died before they had the opportunity to be vaccinated are weighing on my mind today.

When you witness people die alone, with no family at the bedside, due to a lack of resources (equipment, beds, staff, knowledge, treatment, support, etc.), you grieve. Grieving is ugly & messy. I definitely revealed some of the uglier, messier parts of myself in the aftermath of it all. I wish I could rent a blimp to fly high in the air that says "I apologize" to anyone who had to deal with my anger & frustration during this process.

There were nightmares, moments of panic when I thought, "This is where my life will come to an end; it's inevitable." Paternalistic rants to friends who were anti-mask, vaccine-hesitant, or saw truth in conspiracy theories surrounding the pandemic actually ended friendships. And then there's the presidential election. Presidential elections are usually my Super Bowl. I don't sleep until victory is declared. I was so terrified that the incumbent would be re-elected, given the Administration's response to the pandemic, I had to close my laptop & keep the TV off. In my mind, at the time, his re-election would have set an expiration date on humankind's existence. Phew. Extinction averted. Realize I'm being hyperbolic & humorous to a point, but I did sweat it out.  My tendency to freak out over infection control issues at work & outside of work was escalating. On a positive note, this may explain why I remained PCR & antibody negative all year.

Worst of all, there still is a part of me that wonders if I was a better nurse, could I have changed the outcome for any of the patients in Queens. A better nurse won't increase the availability of BIPAP machines, ventilators, & ICU beds, & it certainly wouldn't have prevented me from handing out hydroxychloroquine when there were no known, effective treatments readily available. However, there is guilt that is slowly subsiding.

I realize now that a lot of the previous 2 paragraphs is full of irrational thoughts, & I also realize I'm healing, not just from April 2020, but from everything traumatic or painful I've experienced in my life.

Nothing will make you value your life &, life in general, more than witnessing so many people lose theirs in such a tragic way. Death is inevitable, & I've obviously witnessed it before as a nurse, but it is why & how those people lost their lives that makes it difficult to find peace & come to terms with those most affected by the pandemic.

Going through this grieving process, I am now entering a healing phase, & that healing process has allowed me to honor the victims who suffered the most in the best way possible. I value my life more than I ever imagined possible now. I value life in general in a more profound, meaningful way. I look at human beings with more compassion than I did before April 2020, and it has led me to re-prioritize my goals to focus on what is most important to me. My faith in God has been renewed. 

My desire to live a purposeful life is enlivened. My hope & prayer is that I will continue to honor those who have suffered the most by maintaining this momentum in a way that allows me to thrive & contribute in a positive way to the issues that came to the forefront over the past year: the need to push harder for social justice, to have compassion for ALL our fellow human beings* (see disclaimer) & the valuable contribution science and accurate knowledge can make to the quality of all our lives.

It feels good to be protected. It's a good day.

DISCLAIMER: Please don't misinterpret this statement to be a reference to the preposterous argument over which lives matter. I'm 100% in support of BLM. I’m also a huge fan of the many 1st responders who serve & protect honorably, respectfully, indiscriminately, & equitably.   

Tampa Bay Times, AP

ABC News

Ways to Give

Resources

Forest Hills Post, April 2021: Op-Ed: A Temporary Lifeline For Queens’ Desperately-Needed Hospitals Isn’t Enough

"Based on the unnecessary deaths that occurred in Queens, you would think hospital capacity would be expanded. But, instead, New York State wants to decrease capacity. St. John’s Episcopal Hospital in Far Rockaway, Queens has been a lifesaver for its pandemic-ravaged community, as the only hospital on the entire peninsula–which the New York Times dubbed 'One of New York’s Deadliest Zip Codes.'"

Queens Daily Eagle, March 2021: Mayor, candidates and Queens leaders slam plans to downsize Rockaway hospital

"De Blasio joined a cavalcade of candidates, unions and Queens leaders condemning a consulting firm’s plan to drastically cut beds and services at St. John’s Episcopal first reported by the Eagle Wednesday. The safety net hospital is located in a Far Rockaway zip code with New York City’s second-highest COVID death rate and serves predominantly Black residents of the region."

Harvard T.H. Chan School of Public Health: Health disparities between blacks and whites run deep

CDC: COVID-19 Racial and Ethnic Health Disparities

Nurse Managers: Who is Really Running Your Department?

graphicriver.net

It was my 1st travel assignment, & I was assigned a preceptor we will call Gertrude. Gertrude sat in her chair all night, &, literally, did nothing productive. She demanded the attention of her co-workers as she talked about her favorite topic: herself, which further lowered productivity. She made derogatory remarks about Human Resources, co-workers, & the Nurse Manager. She was particularly frustrated with HR because they recently figured out she was overpaid, & they lowered her pay to the appropriate level. She acknowledged that she already knew she was overpaid, but she played stupid. She told me just to copy & paste the last nurse's shift assessment in my EMR. I later found out Gertrude had some negative things to say about me, & other staff bought it. In fact, staff seemed to readily adopt any pessimistic point of view Gertrude had about work. I went & spoke to the Nurse Manager in her office the next morning about my performance, & she mentioned that my preceptor, Gertrude, was her strongest nurse on the unit. If she only knew how Gertrude behaved when no one of authority was watching.

                   rebubble.com

           

This is a universal problem though, & here is what Nurse Managers need to hear loud & clear. You may be hitting it out of the ballpark on the following:

Strong leadership skills

• A strong moral compass
• Fantastic clinical knowledge & critical-thinking skills
• Education, training, & experience perfect for the job
• Compassion for patients & staff alike
• An even temperament & ability to remain objective
• Emotional Intelligence
• High intellectual capacity
• Excellent communication skills
• Whatever the heck else makes you a good fit for the job

New Orleans Artist Terrance Osborne

                                                                      
                                                                                                          

However, there is one critical issue, if ignored, will absolutely destroy your ability to effectively lead. IF YOU ARE UNABLE TO DETECT & EFFECTIVELY MANAGE MANIPULATIVE BEHAVIOR AMONG YOUR EMPLOYEES, YOU ARE NOT EVEN IN CHARGE OF YOUR UNIT OR DEPARTMENT. Who is running your unit? Gertrude - & she is undermining everything you are doing to create & maintain a safe work environment.

If you do not recognize & deal with manipulative behavior, it is whatever staff members who have the strongest narcissistic & borderline personality traits that can wreak havoc among other staff. They are running your unit. It will have a detrimental impact on patient care & on the careers of other staff - & possibly your own at some point.

One of my biggest pet peeves, particularly in the workplace, is manipulative behavior. When fresh out of nursing school, I was experiencing frustration with a co-worker with these tendencies. What do I do? I buy a self-help book specifically on the topic of recognizing & managing manipulative behavior at work. Here is the most important lesson I have learned from reading self-help books over the years. YOU CANNOT IMPROVE YOUR INTERPERSONAL SKILLS BY READING A GOSH DARN BOOK. The book did teach me a lot about RECOGNIZING manipulative behavior, however, it did nothing to reduce my frustration or improve my ability to control it. I realized, over the years, that the only way to deal with it is from a position of authority. It requires someone with the ability to discipline & terminate this person to at least subdue these tendencies. If you leave it to your staff, you are leaving them high & dry.

Imgur, 2020

Let me tell you about the worst encounter with manipulative co-workers I have ever experienced. We will call her Katrina because, like a Category 3 hurricane, she appears somewhat manageable. If you are not prepared for her, however, she is going to flood your entire unit - with dirty flood water. Katrina tells lies so far-fetched, that you would assume that any rational human being would second-guess them. WRONG. Katrina has management so wrapped around her finger, & she has mastered the art of manipulation so well, she will have management saying & doing things as bizarre as her. Otherwise intelligent & rational human beings will band together behind Katrina to take out whatever "terrible" person she convinces them has wronged her. It got to the point that I am worried she is going to convince these people to storm the walls of the capitol & steal Nancy Pelosi's laptop or form a legitimate gang in which everyone wears the same color, packs heat, sells illicit drugs, & uses their designated gang hand signals. Even worse, they have reported false statements to the Board of Nursing on behalf of Katrina. They are seriously lying to a regulatory board & wasting the BON's time fighting for whatever cause Katrina invented. It is the most insane form of groupthink I have ever witnessed in a work environment. Following behind Katrina & banded together, their behavior becomes less & less rational or logical. These are managers putting their own careers at risk because the levy that should have prevented her from flooding the unit was broken. In other words, management lacked the foresight to recognize & manage her manipulative behavior.

I lived in New Orleans, LA in 2005, until 2 weeks before the hurricane hit. I moved to Baltimore, MD to start nursing school, as fortune would have it. It hit the day I started school, & I shed tears the whole week for the city I loved. Katrina ran a lot of good people out of NOLA, just like the Nurse Katrina runs off good employees. She also lowered morale, which led to looting & violence, just like Nurse Katrina managed to increase incivility & bullying at work. Local, state, & federal politicians & organizations were often at odds with each other instead of working together because of the mastermind Katrina. Nurse Katrina works in such a way as well, & this lowers the quality of care & causes patient safety issues. Worst of all, Katrina wreaked havoc on the weakest & most vulnerable of the city; they were defenseless, which made it so easy for Katrina to cause destruction in their lives.

I am going to stop speaking in metaphors & similes & spell out what behaviors to expect from a manipulative employee.

Dr. Ann Brown, 2017

Any time I must deal with a co-worker who is both manipulative & covertly or overtly aggressive, I see the same set of behaviors.

1.      Nurse Katrina will engage in rude & disrespectful behavior, &, if a co-worker attempts to stand up for themselves, Nurse Katrina will try to convince others she is the victim in the situation, rather than the perpetrator.

2.     Nurse Katrina will upgrade to a Category 5 hurricane if someone insults her fragile ego, over even the smallest slight that your average joe may not even notice.

3.     She will gather up troops by manipulating other people (both co-workers & managers) into joining her in destroying people. Some co-workers who can see through it may comply with them anyway to avoid becoming her next target. As the army grows, as in most groupthink behavior, they become less rational & increasingly aggressive, as if their frontal lobe is no longer functional.

4.     There is no limit to how far Nurse Katrina is willing to deviate from the truth to build a case against someone she is after, & there is no limit to who she is willing to flood with outright falsehoods, managers, HR, BONs, the Pope, the President of China, whatever.

5.     There are 2 types of co-workers Katrina targets: the "easy" targets who have some sort of weakness that makes it easy for her, or someone who has a strength that makes her feel threatened. Katrina must eliminate any threats to her power & control.

6.    
The managers are usually the last people to figure out that a staff member like Katrina is causing problems by engaging in the disruptive behavior because they experience a completely different version of that Katrina. She can be charming, persuasive, & seemingly harmless if that is what the situation requires to gain or maintain control. They may see Nurse Katrina or Gertrude as one of their top performers or even a good friend.

                                                                                                                                                                     Clark, 2011

What covertly or overtly aggressive & manipulative behaviors am I talking about?

1.      Speaking to her target in an accusatory or condescending tone in front of patients & other staff to discredit & shame you. She may make you feel like a misbehaving child.

2.     Making negative remarks or making fun of you to others as you walk away, possibly hoping you will overhear.

3.     Withholding information necessary to do your job.

4.     Shutting you out of conversations with other staff in attempt to alienate you from others.

5.     Questioning your clinical competency, sanity, or whatever else she can think of to convince others you are an unreliable simpleton with a screw loose who cannot be trusted to perform well or deliver accurate information to others.

6.     ANA on Incivility: Incivility can take the form of rude & discourteous actions, of gossiping & spreading rumors, & of refusing to assist a coworker. All of those are an affront to the dignity of a coworker & violate professional standards of respect. Such actions may also include name-calling, using a condescending tone, & expressing public criticism (Andersson & Pearson, 1999; Read & Spence Laschinger, 2013). ANA Position Statement

7.     ANA on Bullying: Actions may include, but are not limited to, hostile remarks, verbal attacks, threats, taunts, intimidation, and withholding of support (McNamara, 2012). Such actions occur with greater frequency and intensity than do actions described as uncivil.

Frandsen, 2015

Nurse Katrina is obviously capable of other equally disruptive behaviors, which you can review in the resource links below. The bottom line is that it is up to people capable of setting expectations & enforcing consequences to deal with manipulative staff: Management & HR. Outside of work, years of intensive therapy may help, but your staff, no matter how adept at reading Katrina, are unable to control her behavior; it is up to you. Unaddressed, the consequences are significant. From an individual perspective, every Nurse Katrina I have encountered is always the main factor in the workplace that just seems to suck all the joy out of nursing. Please, Nurse Managers, deal with Katrina in a way that allows you to truly be the leader on your unit & allow for a safe, peaceful work environment for your hard-working, dedicated staff who want to focus on their patient care & career growth instead of Katrina's never-ending storm. Your staff deserves you, the qualified, designated Nurse Manager, as their leader.

123rf.com

ADDENDUM: All humor aside, this is coming from someone who went through some very painful experiences as a younger, naïve nurse. In today’s climate, &, in light of a heartbreaking, global pandemic, it is more crucial & necessary than ever that we protect & support these newer, younger nurses on the frontline of this war. All healthcare disciplines & all staff, from the bottom to the top of the food chain, should hold themselves accountable for ensuring that our less seasoned nurses are given what they deserve, which is nothing less than respect.

Resources

ANA https://www.nursingworld.org/practice-policy/nursing-excellence/official-position-statements/id/incivility-bullying-and-workplace-violence/

NSO https://www.nso.com/Learning/Artifacts/Articles/Create-effective-anti-bullying-policies

JCAHO https://www.jointcommission.org/resources/patient-safety-topics/sentinel-event/sentinel-event-alert-newsletters/sentinel-event-alert-issue-40-behaviors-that-undermine-a-culture-of-safety/

Nursing Management: Journal of Nursing Excellence in Nursing Leadership https://journals.lww.com/nursingmanagement/fulltext/2016/01000/decreasing_workplace_incivility.8.aspx

AANAC Workplace Bullying: The Signs and What To Do By BETTY FRANDSEN, RN, NHA, MHA, C-NE/MT

The Psychology of Mob Mentality https://www.psychologytoday.com/us/blog/facing-trauma-together/202101/the-psychology-mob-mentality

9 Classic Strategies of Manipulative People https://www.psychologytoday.com/us/blog/in-flux/201610/9-classic-strategies-manipulative-people

DSM-V Borderline Personality Disorder Traits: https://www.medscape.com/answers/913575-165741/what-are-the-dsm-5-diagnostic-criteria-for-borderline-personality-disorder-bpd

DSM-V Narcissistic Personality Disorder Traits: https://www.medscape.com/answers/1519417-101764/what-are-the-dsm-5-diagnostic-criteria-for-narcissistic-personality-disorder-npd

In Sheep's Clothing https://www.amazon.com/Sheeps-Clothing-Understanding-Dealing-Manipulative/dp/1935166301

What Can Organizations Do to Tackle Workplace Bullying? https://www.psychologytoday.com/us/blog/what-doesnt-kill-us/201605/what-can-organizations-do-tackle-workplace-bullying

Actual Letter from Nurse Katrina to the BON: Dear BON...