As professional nurses, we are in a constant flux of professional development as we work to keep up with regulatory and administrative requirements, evolve our teaching-learning-collaborating skills to meet the needs of a growing body of nursing knowledge, and contribute to the greater collective of nurses and nursing through our organizational affiliations and institutional or system-based initiatives. As members of the human global village it is vital to remember, “The person has one basic struggle: to actualize the real self, thereby developing the spiritual essence of the self,… The nurse caring relationship and human-to-human connection contribute to the person’s developing spiritual essence” [1
]. The purpose of this commentary is to emphasize the personal-professional interplay between who we are as people and who we are as nurses; to offer that there is no separation between actualizing a personal self of compassionate, moral/ethical integrity and actualizing a professional self of compassionate, moral/ethical integrity. We actualize who we are becoming by making peace with who we are being; by releasing the past and creating a future from a clean slate
; by forgiving the confines of our personal and professional pain and embracing the freedom found in the loving-kindness of compassionate human caring.
I once cared for a young Tibetan man who was experiencing fulminant liver failure secondary to an unknown history of Hepatitis B. Ten years earlier he had defected from China and Chinese rule with only his brother into the Dharamsala refugee community in neighboring India. From there he moved onto the United States, became a member of a vibrant, local Tibetan neighborhood and began to rebuild his life. He left behind his parents and countless family members who were unable to leave China. Now, at age thirty-two, and not much older than me at the time, he was dying an imminent and painful death from multi-organ collapse. When I came onto shift he was in acute respiratory distress syndrome, supported by maximum ventilator settings, receiving multiple vasopressor agents to sustain his blood pressure, his brother at his bedside in tears and showing evident distress over his loved one. The patient’s brother relied on the patient’s sister-in-law who spoke broken English at best to understand what was developing and translators were essential to every significant clinical decision and interaction. The attending physician at the time was unwilling to acknowledge my clinical priorities and contributions to the plan of care. I suggested rotoprone therapy, continuous renal replacement therapy, analgesia; all dismissed as something “nurses love to do.” I felt powerless and overlooked.
Without a suspenseful or dramatic storytelling, the young Tibetan man passed away two days later. His bed was surrounded by monks who chanted and ushered him into the land of the dead. The young man’s community prayed and supported his brother who was trapped in his own disbelief and they hurriedly made plans to deliver his remains back to Tibet for burial. I remember thinking, “He was going to die, but he did not have to die this way. He did not have to die that quickly or that inhumanely. He did not have to die because I was a nurse and was not worthy of being considered or seen or heard.”
I became angry; furious at my physician partner who out of pride or ego or possibly even out of sheer ignorance overlooked my suggestions and my ethical obligation to provide human, dignified care for this patient. This resentment has handicapped my ability to fully embody the nurse I have always wanted to be and the qualities of compassion, empathy, and intentionality that make me valuable. I have recently understood I have harbored this upset for quite some time, reminding myself of it each time I see him; distracted by an event four years ago that prevents me from being fully available and present to the current moment, to my patients and colleagues who need my contributions right now. I hereby clean the slate; forgiving myself for the stories I have made up about this person and for the ways I have allowed myself to be held captive by my own resentment.
How many nurses have experienced this collegial, intra-professional, or interdisciplinary disregard of our worth? How many of us have ignored our instincts because our past collaborative histories remind us we are “just nurses” or not due a say? How many of us need to take the breath, the moment, the opportunity to forgive ourselves for holding onto this pain and forgive our colleagues for the behaviors which contributed to it? Are we ready to clean the slate to re-enliven our days, our patient interactions, rediscover our value to health care, and reestablish ourselves as the vanguards of human caring?
Some suggest forgiveness
to be an essential step on the path of self-actualization; a step which “… liberates the psyche and soul from the need for personal vengeance… releasing the control that the perception of victimhood has over our psyches” [2
]. It creates the opportunity to be authentically empowered by ceasing to hold others responsible for the way we experience the world [3
]. Rather, we claim both responsibility and accountability for how we perceive and interact with the people, environments, and circumstances we interact with.Vanzant writes that mastering this art of forgiving will help shed emotional and mental patterns that weigh us down and prevent us from being productive while simultaneously availing ourselves to the fully energizing possibilities of the present moment [4
]. In the refusal to forgive we are intentionally choosing limiting behaviors chracterized by blame and resentment, derailing us from acting in a self-loving way or being able to see the good in ourselves and others [5
]. Through the act of forgiveness we do, indeed, embrace love and release the fear that we will be annihilated if we release the past. Williamson describes forgiveness as “… our most important contribution to the healing of the world… [and] the world’s only real chance to begin again” [6
]. Practicing forgiveness and understanding its importance within the professional paradigm may allow us to return to the art of nursing as the spiritual practice suggested by Nightingale and to fulfill our inalienable human needs to belong and know we are valued [7
Ultimately, the goal of cleaning
the slate for personal and professional self-actualization is to evolve the worldview for the collective of nursing, creating space to “… concern itself more with… notions of evolving consciousness, intentionality, transpersonal, transcendent notions of caring and healing… to make new discoveries of how to be in a professional human caring-healing relationship… to better serve humankind and global civilization” [1
]. By forgiving and reclaiming the power we have lost through harboring feelings of unrest, we create a clearing for the true ethical foundation of personal and professional altruism and loving-kindness
to be sparked and nurtured [9
]. Here is to releasing the past, cleaning the slate, clearing the path, and striving to lead the way toward a caring-healing-loving personal and professional experience of self-actualization