Muriel A. Poulin, EdD, RN, FAAN (1925 – 2019)

Guardian of the Discipline
In Memoriam

Contributors: Sarah B. Pasternack, MA, RN
Dorothy A. Jones EdD, APRN, FAAN, FNI

Magnet Study Author and Nursing Advocate, Educator, Leader 

Muriel Poulin was above all – a fierce advocate for nursing. Her disciplinary contributions have transcended her impact on education, practice, administration and policy. Muriel’s work embraced nursing excellence, promoting nursing’s potential in all she did. Above all, Dr. Muriel Poulin modeled what it meant to be a leader in nursing. When she stood up to speak she was articulate, clear and resounding in delivering her sustaining message that nursing made a difference in health care and nursing leaders needed to create the environment for nursing to flourish.

Muriel died on September 6th in 2019 in Sanford Maine. She began her nursing career as a Cadet Nurse, graduating from Massachusetts General Hospital School of Nursing in 1946.  She earned a bachelor’s degree in nursing at Catholic University, a master’s degree in nursing at University of Colorado and a doctorate at Teacher’s College, Columbia University.

Muriel held several nursing positions including the nursing director at the opening of a hospital in Damascus, Syria, during the early 1950s.  She served on the faculty of the University of Kentucky, American University in Lebanon and University of Barcelona. She served as Professor and Chairperson of the Nursing Administration Graduate Program at Boston University School of Nursing from 1972 to the time of her retirement  in 1988. 

As a dedicated leader in promoting the visibility of nursing internationally, Muriel was also unwavering in her promotion of nursing through organizational action. She was a voice for nursing in the American Nurses Association (ANA) throughout her career, holding membership in the organization throughout her career and in her retirement. She was elected Second Vice President of the American Nurses’ Association in 1976 as a Massachusetts member.  

Muriel was a leading force in the early development of the American Academy of Nursing (AAN). She viewed the Academy as the “knowledge arm” of the American Nurses Association, influential, informing and reforming nursing at all levels. She advocated for the early goals of AAN especially the goal that addressed nursing knowledge, development, use and translation to inform education, practice and policy.

During the early 1980s, Muriel was one of four distinguished nurse leaders selected by the American Academy of Nursing to identify and describe clinical practice environment variables that attracted and retained well-qualified nurses.  In 1983 the groundbreaking study, Magnet Hospitals: Attraction and Retention of Professional Nurses was published.  The significant outcome from this study was the establishment of the Magnet Recognition Program by the American Nurses’ Credentialing Center (ANCC) in 1990.  As of August 2020, there are 523 Magnet-designated Hospitals in the US and 10 other countries, with 10 in Massachusetts.  Dr. Patricia Reid Ponte, President of the Board of the ANCC and Clinical Associate Professor of Nursing and Health Administration at Boston College and a former student of Muriel’s, stated “today’s interest in The Magnet Recognition Program internationally can be linked to the efforts of nursing leaders like Dr. Muriel Poulin. This program has had profound positive impact on health care delivery.  Muriel Poulin’s legacy is carried on across the globe through the nurses and advanced practice nurses working in these organizations.” 

Dr. Poulin was honored by ANA Massachusetts as a Massachusetts “Living Legend in Massachusetts Nursing” in 2011 and also as a “Living Legend in Nursing” by American Academy of Nursing in 2012.  In 2016 she was honored by induction into the Nursing Hall of Fame by the American Nurses Association.

Muriel educated and personally mentored many of the current and former nursing executives and leaders in the Boston area and beyond.  Dr. Ponte, stated: “Muriel Poulin was a force of nature – a truly extraordinary nurse, leader, researcher and educator. As a member of my dissertation committee at Boston University School of Nursing in the late 1980s, she pushed me to become a better nurse executive through her mentorship. I will be forever grateful to her. I was able to have lunch with her in the last couple of years when she attended the ANCC Magnet Conference (a real thrill for Muriel) and again at the American Academy of Nursing meeting.”

As a junior faculty (Dr. Dorothy Jones), teaching in the undergraduate nursing program at Boston University, I often wondered if I would ever be able to stand up and advocate for nursing the way Dr. Poulin did in the classroom and at a faculty meeting. One day I got my chance.  I was called to a meeting with Muriel. “I want you to teach my Masters students about health and nursing practice. They need to know this information.” I was pleased and overwhelmed by the opportunity to work with Muriel. We developed a new course that  incorporated holistic nursing concepts  into the Masters in Nursing Administration curriculum. A few years later, she was my AAN Fellowship cosponsor, an honor I will forever remember.

 Dr. Susan LaRocco, Dean and Professor of the School of Nursing, Mount St. Mary College, Newburgh, NY and a graduate of the BU graduate program in Nursing Administration, stated: “Dr. Poulin has been influential throughout my administrative career.  Whenever I had to handle a difficult situation, I could be fearless because she taught me that the patient is the center of all that we do.  When I had to deal with a patient abuse case, I thought that I was going to be fired for pursuing it.  But I knew that I was doing the right thing because a frail elderly patient had been harmed and I could not just look the other way.  After reconnecting with Muriel at a BU History of Nursing Archives event, I had the privilege of meeting her occasionally for lunch.  It was always a lively conversation with this wonderful mentor.”

Dr. Poulin  was an international nursing leader. She worked to prepare nursing organizational leaders, globally, Through her publications, teaching and presentations she influenced a generation of  nurses involved in  leading  hospital and organizational administration today.  Even in her “retirement,” Dr. Poulin exerted her leadership in the profession with service on the Board of Directors of her local Visiting Nurses Association in Maine and with the establishment and management of a very successful second-hand bookstore to benefit a local hospice.  She was a fierce advocate for Nursing and her voice will be missed by many.

COVID-19 – What would Margaret Newman say?

Dorothy Jones and Jane Flanagan
See also Newman’s Theory of Health
as Expanded Consciousness

Although not the only global challenge we face, COVID-19 has the world’s attention while disrupting so many familiar routines. For those so fortunate, there is the new normal of working from home and countless conference calls that seem to blur one day into the next, almost erasing the confines of time while confining us to a physical space.  When things get back to “normal” what will that look like?

For those in service industries, there is the chaos of being the person in the midst of unsafe places whether the grocery store, a bus or as an employee in a hospital.  Making connections while fearing, am I safe? Do I have what I need to protect myself/ my family? And, sometimes knowing you do not have what you need, and in that moment, your awareness of the disparity of those who have and those who do not is heightened.  What will it be like when things get back to “normal?

 Then there are those who in a whirlwind, may have lost their job.  Now they are struggling to pay bills, perhaps visiting food banks for the first time mixed in with home schooling young children or a full house of grown children now back to the safety of their childhood home.  When and what will be that return to “normal”?  For every scenario, there is opportunity, freedom and new ways of being. There is also potential binding or unraveling.  But no matter the reality, there are the chants to “get back to normal”

Dr. Margaret Newman

This idea of “getting back to normal” raises the question; “What would Margaret say?” We think the answer is …actually, not very much.  She would smile gently and acknowledge each person who spoke and told his or her personal story. She would be present and authentically listen.  Her silence would spur more stories until in the sheer dizziness of it all, the cacophony would stop and everyone would look to her and wonder what she is thinking. Again, silence and this time the room would go quiet.  Finally, she would speak: “I’m just curious about people wanting to go back to normal, what do people think of that?”  Then she would sit and wait for us to react…and we would.  We would discuss how we cannot “go back” and about the opportunity in the chaos. What went well in nursing practice during COVID – 19 that was reflective of nursing and what did not?  She would smile, as we would envision a new future that informed by COVID-19, and the inequities of an illness, linked to an environmental crisis and manifested in our most vulnerable. An illness that has stuck down older adults, minorities and is on a path to literally destroying second and third world countries.  Go back?  No, we would not be going back we would be envisioning a new future, one with boundaryless opportunities.

There is for some, an increased awareness, that the inequities of COVID-19 along with the murder of George Floyd and other racial incidences has heightened the issue of structural racism that has always been simmering under the surface. Go back?  Oh no, we will not go back. Not to complacency, not to a world where nurses today are lauded for their actions during a crisis, but who will return to being a hidden entity, part of the bed charge.  No, we are now in a world that recognizes, yes there were many deaths, but because of nursing care, because of nursing’s commitment to meeting the person where they were at, commitment to delving into knowing other, upward of 85% of those who had COVID and were hospitalized were successfully discharged.  Yes, nursing care! It was the authentic presence of nurses who connected with patients in new ways and journeyed with them on a path of discovery, nurses learning to recognize the pattern of the critically ill when the normal mode of communication was no longer possible, and nurses who transformed the care environment. It was not a cure or a vaccine that made the difference; it was “the difference nursing makes” that made the difference.

The COVID-19 virus made visible a pattern of turbulence and disruption within the global whole.  Lack of awareness to growing social challenges, loss of freedom creation of boundaries and isolation confounded the environment within which the virus emerged. Within this context, the virus took on new meaning and yielded variety of responses. Using the theoretical lens of Health as Expanding Consciousness, Margaret would reflectively and carefully suggest that being exposed to the global and dramatic changes of the day has already begun to reshape/repattern us. She would envision the voice of nurses advocating on behalf of patients, on behalf of the myth of curing rather than healing, on behalf of older adults, racial and ethnic minorities.  Margaret would not support “going back”; instead, she would reflect on the meaning of the unfolding pattern emerging before us …within the context of an illness.

The event COVID-19 has served to make visible the invisible for society as a whole.  Recognition that we are all connected and interrelated. The actions and behaviors of one individual directly affecting the very life of another. Response to the virus has revealed a complex, dynamic human pattern of the whole within a dynamic and changing environment. As the illness experience is unfolding, individual responses shaped by factors including  vulnerability,  gender, age and the older adults, race, ethnicity, compromised health status, poverty, lack of insurance, homelessness, exposure to environmental stressors and population density, and personal responses to life challenges have been made visible. Compromised relationships, sustained loneliness and disconnection challenged human becoming and threatened choices about health and wellness. Rather than creating new problems, COVID-19 has manifested not only a serious disease but made visible longstanding global societal challenges that have gone unnoticed or suppressed.

Margaret would caution that “fixing” the illness (i.e. treating to cure) without addressing the whole person/environment interaction that include people and events surrounding the individual experience, could lead to a reoccurring manifestation of the underlying pattern in new ways (e.g. inequities and disparities in care). She would stress the importance of collaborating with individuals and groups in dialogue, she would identify what is meaningful, to acknowledge the collective increased awareness, and seek to uncover an underlying pattern of the whole. COVID-19 then becomes a stimulus for active discussion, identifying barriers that compromise moving forward as individuals and as a society. The insights gained through information and connecting with another create opportunities for new insights, actions and freedom to participate knowingly in actions that promote transformative change.

The importance of relationship is core to advancing the process of discovery. Partnerships that are open and evolving allow pattern to emerge and potentially increase the realization that we are all interdependent and connected within and across environments. Recognizing that what affects one-person or community can have a reciprocal impact on another. Within the discovery process there is freedom to hold on to what gives new meaning to one’s being and what binds and threatens our freedom  to become and engage in sustainable holistic healing. No, Margaret we are not going back. And she would smile, knowing we are with new heightened awareness and renewed energy, accelerating toward new potentials and  transformation.

Additional References

Newman, M. A. (2008). Transforming presence: The difference that Nursing makes. Philadelphia: F. A. Davis.

Newman, M. A., Smith, M. C., Pharris, M. D., & Jones, D. (2008). The focus of the discipline of nursing revisited. Advances in Nursing Science, 31(1), E16-E27. https://doi.org/10.1097/01.ANS.0000311533.65941.f1

Smith, M. C. (2011). Integrative Review of Research Related to Margaret Newman’s Theory of Health as Expanding Consciousness. In Nursing Science Quarterly (Vol. 24, Issue 3, pp. 256–272). https://doi.org/10.1177/0894318411409421