Amanda Anderson MSN, MPA, RN, CCRN, is a critical care nurse who currently works in nursing administration at Mount Sinai Beth Israel. Amanda also serves as a contributing editor at the American Journal of Nursing, and her writing has appeared in AJN, Pulse, Scrubs, Journal of Hospital Ethics, and various nursing publications. You can find Amanda on Twitter @ajandersonrn, on her personal blog,This Nurse Wonders, or zipping around Manhattan on her trusty bike.
What were your main priorities when you went into nursing, especially in the areas of quality and safety?
When I finished nursing school, I started in the intensive care unit as a new graduate. I don’t think I had any specific quality or safety priorities, per say, except survival. My first year was a blur, and I struggled to find my footing amidst things I had never experienced before – working in a big city, working with people of all kinds of cultural backgrounds, keeping up with the endless learning and new clinical information.
To process the stress and change that I found myself surrounded by, I turned to writing. After work and on my days off, I wrote about the care I had given, the things I had seen, and the stories that my patients had started in my world. For many years, nobody read my blog, or my writing. I don’t even think my own mother read the words that flowed out of me — my search for meaning or clarity for the things I daily dealt with at work. But I didn’t mind, and kept writing my stories of care for myself.
This practice brought me through many difficult patient care situations, many ethically complicated cases, and it painted my life for the first seven years of my career, which I spent at the bedside. When I look back on the words I crafted – about the family members that embraced me as their loved one died beside us, the silent moments on night shifts, and the crazy hours – I’m transported back to the stories that I lived at the bedside.
After about seven years of nursing, I started a dual degree masters’ program out of Hunter and Baruch Colleges that combined degree programs in nursing administration and public administration. During my second semester, I was approached by Dr. Diana Mason, a professor of mine at Hunter-Bellevue School of Nursing, about a pilot project that she had launched the semester before. She asked me to serve as a peer writing mentor, assisting students with academic and professional writing and research construction, and I quickly became the director. Writing, it seems, had played more of a part in my career than I had realized. I went on to develop a program that has served hundreds of students in the past three years and is currently undergoing research.
A little over a year ago, while working as a per diem critical care float at Mount Sinai Beth Israel, my manager asked me to consider a nursing supervisor position. I accepted, and worked until last September, when Maddy Pearson, the then-new Chief Nursing Officer of MSBI, asked me to work in a new writing-heavy capacity, managing special projects and developing the communications of our patient care services department for the first time. Since, my writing has carried me through ghost writing, newsletter development, survey writing and validation, the beginnings of research creation, and the construction of Mount Sinai Beth Israel’s first Stories of Care Rounds, which we’ll launch this year during Nurses Week.
My whirlwind start as a new graduate in the ICU sent me towards writing for comfort and contemplation, and has moved me forward in each stage of my career. Believe it or not, this ties directly back to the original question about safety and quality – writing to process stress, trauma or change is actually a well-researched evidence-based practice called reflective writing, or narrative writing. Although not many schools offer it as a discipline, the research is astounding; Dr. James Pennebaker, often thought of as a pioneer of the science, has gathered data showing direct health and emotional benefits after consistent engagement in the practice. Quality improvement initiatives incorporate reflection to combat falls and other events in hospitals, leading to improvement in safety and quality. Others find reflective writing as a way to combat depression or treat other mental health diagnoses, and the science of narrative medicine, largely founded here in NYC, has to do with the practice of engaging patients in their own road to healing through writing.
When I first opened the blog window and began typing my first story of care back in 2007, I had no idea that this research existed, or that I’d be impacting my health, my career, or the safety or quality of my care simply by writing. It makes me happy to see the thread of words woven throughout my career path, and to strive each day to really engage nurses in the same benefits that writing has bestowed upon me. I think this is important partially because I believe nursing as a profession will only improve with further education of the public through stories of what we do, but mostly because of writing’s incredible impact on each person pushing the pen.
What do you think are your major accomplishments in these areas?
While in graduate school, I had the privilege of interning at the American Journal of Nursing for three semesters. I fulfilled my clinical placement requirements, but I also began to see the great importance of curating information to nurses as a whole, and I started to realize how powerful words are for reaching large audiences and shaping practice. After graduation, I was offered a contributing editor title, and a seat on the editorial review board, which feels like an incredible honor an accomplishment in and of itself.
As contributing editor, I coordinate a column that will begin to be printed in June of this year. This column, at the request of Shawn Kennedy, the editor in chief, speaks specifically to new graduate nurses, and will be titled “Transition to Craft.” In it, I pull research and evidence on varying topics that we don’t typically discuss in nursing school, but are often very difficult to manage as new graduates – dealing with stress, communicating clearly, organizational skills – things that we don’t necessarily do large, technical research studies on, but that often keep us up at night as new clinicians. This platform, this voice, and this place from which to draw other nursing voices into the public light from, feels great.
I’ve also really loved and felt privileged to develop the voice of MSBI. Although we are sometimes limited by tools and resources, we’ve started carving out a bit of a place for ourselves in the MSHS web world, and I have felt happy to see our nurses coming forward to engage in new initiatives, and new modalities of care. We’re in the process of launching our Council Structure, and our Strategic Vision is transparent and visible to all on our new intranet Patient Care Services website. We’re sharpening our awards and recognition structure, and everybody in leadership is really working to engage bedside nurses in all we do. It’s hard, but when I leave a meeting where all disciplines and levels are present at the table, it feels like a major accomplishment, and very rewarding.
We’re also launching our first Stories of Care rounds on May 10, 2016, during Nurses Week. I’ve organized this event to mirror an event called “The Bedpan Confessionals,” that I’ve curated and led for Hunter since 2014. This narrative event at MSBI will be modeled similarly — writers will meet to review edits and changes in their story of care, and together, we’ll “sculpt” their stories for a public audience. What I love most about this event model, is that at Hunter, we pair expert writers and experienced nurses along with new writers, and we all craft our stories together. Amy Berman, senior policy officer and world-renowned writer and speaker for the John A. Hartford Foundation, Kenya Beard, nursing diversity scholar and academic, and a host of other published writers, joined in past events, alongside students and new writers. I hope to accomplish the same mix of experience at MSBI, and look forward to helping nurses see that their words and stories aren’t just entertaining or interesting, but healing, and that they already possess the skills to share them, too.
What personal experience has inspired you professionally?
I don’t know if I can pinpoint one professional experience that inspired me. I didn’t go into nursing for any reason in particular – I was a confused college sophomore who had a conversation with an old hippy friend that encouraged me to “pick a trade.” Since then, I’ve come to realize that nursing is likely the most dynamic and inspiration profession that exists. I’ll try to pick a few:
I’m inspired by my very first preceptor, Victoria Gill, who is the best intensive care nurse I have ever met. I’m inspired by the doctors that I’ve worked with who have sat with me beside critical patients until they stabilized, who aren’t afraid to get dirty at work, and who have become friends and mentors. I’m inspired by patients who have overcome grave illnesses with poise, and beauty, and kindness. I’m inspired, too, by the ones who have been outwardly cranky and awful, only to warm with time and effort. I’m inspired by nurse researchers like Linda Aiken who spend their lives fighting for things like staffing and work conditions, without much press from major media outlets, or the public. I’m inspired by nurse writers that publish quietly, like Cortney Davis, and by nurses everywhere, who, no matter how busy or understaffed or unfair or unattractive their jobs may be, commit to work as hard as they can every day, because they never stop seeing who they work for – the people in the beds who depend on them.
In your opinion what is the biggest opportunity you see for nurses in research?
First, I think nurses need to realize just how crucial the role of nursing research actually is. For example – hourly rounding is based on nursing research. Rapid response processes and standards – nursing research. Interdisciplinary communication – nursing research. Just about every, single problem at the bedside could be turned into research, led by nurses, if it hasn’t been already.
I think the biggest hang-up, and perhaps the biggest opportunity, is making research methods translatable to nurses. We’re busy at the bedside, yes. But maybe if the process of creating a study, getting it off the ground, sticking with it, its benefit, and bringing it to completion was a bit less intimidating, we’d get excited about it and do it. When I was a new nurse, I had a terrible experience with a very ethically complicated family and their mother’s death. I was so moved by what I thought should have happened, that I connected with a bioethicist and began working on a potential pilot project that would allow us to screen patients and their families on admission, so that we could start end of life discussions and bioethics consults early on. The pilot never came to realization, but a monthly moral distress journal club, did. At the end of my time at that hospital, my colleagues thanked me for all of the meetings I led – research allowed them a chance at discussing the ethically complicated cases and scenarios they faced on a daily basis.
I’m a big nerd, so I like to read the fine print and analyze the details of results and methodologies of studies. But this isn’t for everyone. So I’d say that what nurses might start with is to follow that spirit of inquiry we all have in our guts, and chase it with the question, “Huh. Could this turn into research?” Maybe yes, maybe no. But you never know what you might find along the way.