I’ve maintained an informal goal to post at least once a month. School busyness propels productivity, perhaps; since summer struck, I’ve been silent here.

Voids don’t stay empty, though. Amateur web design and tinkering with interns, new projects, old projects. Not enough writing or beach time. Work (the bill-paying kind). My world stays busy without the classes – how will it all fit next month, the start of my final fall?

Either way, I’m learning. Mostly about communication, which has always been both my strength and weakness. I’ll never forget the advice of a horribly ill patient’s wife:

“Amanda, you’re an incredible advocate. I’m so glad you’re my husband’s nurse. But you should really smile more…”

These words come to me so often now — talking to MDs about critically ill patients is one thing — when saving a life, most people get over a snippy tone. Talking about staffing and personnel conflicts? Shoot. Gotta be golden and sweet from before my first breath.

Oddly, I’m turning to process more than reflection for help with this in my new administrative role:

• AJN’s conflict resolution series, by nurse and coach Debra Gerardi, help. With them, I feel comraderie in case studies and comfort in evidence – other peoples’ directors also demand outcomes, many systems are failing, not just the individuals I oversee miss the big picture.
• I’ve returned to Pat Benner; From Novice to Expert has helped me see the process we nurses go through to make our clinical judgements, and how they are often so very hard to verbally annotate.
• Today, I attended a LEAN Luncheon, and for the first time, I felt good about swim lanes — mapping out “problem” process is genius! To say to someone, “This is really inefficient what you’re doing here,” holds little weight to a flowchart so complicated that even a baby would point out the waste without a shred of shame.

Nursing has changed a bit for me, and this is okay. Whenever I manipulate the growing vines of wisteria on the fence in my tiny Manhattan yard, I know this. We are, at many different points, many different elements that make up our patient’s experience – vine being trained, fingers doing the training, water soothing, soil incubating, fence supporting – each dependent within our necessary separateness.

The patient is physically far from me now, as I hold up and facilitate, but it is the patient that I will forever work [change, study, write, fight, communicate, strive, advocate, train, care] for. That much hasn’t changed, I guess — they’ve always been the ones I keep busy for.