Be careful what you wish for…

2020 was the year that… “Be careful what you wish for,” once again became imprinted in my brain as truth.

In early 2019, the World Health Organization (WHO) announced that 2020 would be the “International Year of the Nurse and Nurse Midwife.” Among colleagues, there was lots of excitement about this. What would we do to recognize and celebrate this recognition? I heard many ideas—editorials, articles, museum displays, seminars, webinars—maybe we’d even get a stamp! The last time we had a commemorative nurse stamp in the US was 1961, almost 60 years ago. Seems like we were overdue for one.

And then, two months into our memorable year, COVID-19 hit. The world started locking down before the US, but for me, my unforgettable day was March 13 (a Friday, of course) when a symptomatic friend tested positive for the virus. Suddenly, everything changed. We all went into lockdown and remote work became the norm. I tried to figure out how to run a free clinic by phone and email (believe me, it’s not easy). I experienced two weeks of panic, followed by three months of bewilderment, and then settled in for the long haul, which is still ongoing.

Meanwhile, nurses were everywhere. The evening news was flooded with images of nurses in ICUs, EDs, nursing homes, and more. There were interviews with nurses crying, their faces bruised from their PPE googles, mourning their dying and dead patients, wondering if they could have done more. They worried about having enough PPE, their families, and their own health. At the same time, we were celebrated with impromptu parades, celebrations, signs on the street: “Heroes Work Here!”. I was offered a 50% discount at the car wash, but I declined. I figured that as a small business, they needed the money more than I needed a modest saving on washing my car.

We even got a TV show, creatively named NURSES with this tantalizing description: “The series follows five young nurses working on the frontlines of St. Mary’s hospital dedicating their lives to helping others, while figuring out how to help themselves.” Will those nurses be nursologists? Time will tell.

On the other side of the coin, the virus was taking its toll in multiple ways. As of the end of October 2020, the WHO presented an analysis that 1500 nurses worldwide had died of COVID-19, although they admitted that this figure was probably grossly underestimated. The White House put together a coronavirus task force in January that included (according to the New York Times) “internationally known AIDS experts; a former drug executive; infectious disease doctors; and the former attorney general of Virginia” but no nurses. President-elect Biden also put together a task force that seemed more diverse but once again, nurses are conspicuously absent from the membership. At a meeting of nurses in the Oval Office to commemorate National Nurses Day in May, Sophia Thomas, President of the American Association of Nurse Practitioners was rebuked by Donald Trump when she stated that there was sporadic access to PPE throughout the US. “Sporadic for you, but not sporadic for a lot of people,” Trump said. “Because I’ve heard the opposite. I have heard that they are loaded up with PPE now.” Thomas was bullied into politely agreeing and backing down from her original statement. This is not the first time I’ve seen this happen, and it makes me angry every time.

Where is the correct middle ground? Do we want to be “angels,” “heroes,” and members of the “most trusted profession” (according to Gallup, 15 years and running)? Or do we want to be nurses at the table, nurses setting policy, nurses seen as leaders, decision makers, and agents of transformation through research, practice, and education? In other words, nursologists? 2020, our “year” gave us lots of the former, not so much of the latter. And thus I say, “Be careful what you wish for.” I worry that our year of recognition will ultimately reinforce stereotypes and not result in meaningful change. To those in our ranks who have sacrificed their lives, and to others who are dealing with ongoing health issues from COVID-19, both direct and indirect, I hope that is not the case. Maybe with the spotlight off, we can get back to business and work to make incremental, but lasting change, which seems to be what nurses do best. That is my wish for 2021—but I’ll be honest—I would still like a stamp!

Virtual Nursology Theory Week – March 17-24, 2021!

Registration open!

Details of the program for the March 17-24 Virtual Nursology Theory Week are now available on the Nursology Theory Conference Website, including details of the “breakout sessions” for the week! Once you register, you will have access to any and all of the conference virtual events, as well as the digital Guidebook containing all of the conference program information, information about all speakers, and slides that will be included for many of the sessions.

The 3 General Sessions (Wednesday March 17, Monday March 22, and Wednesday March 24) will be Zoom Webinars (only the speakers and moderators will be visible; participants will interact using “chat”). The 30-minute Breakout sessions will also be Zoom Webinars with 3 “breakouts” in each webinar block, giving each presenter time to present and respond to questions and comments posted in the chat. Each day will end with “Daily Discussion” – Zoom regular meetings – open to all conference participants where you will be visible to one another and can have open discussion of the issues of the day.

The preliminary program schedule is subject change as the time for the conference nears. All who register will have access to the conference “Guidebook” which will show the final program schedule along with zoom login details for each session, and any slides used in the presentations that speakers want to share with participants.

If you registered for the 2020 conference and held over your registration for 2021, you are all set! If you registered for 2020 and asked for a refund, you will be able to now register for 2021 at a “renewal rate,” and will be contacted by Leslie Nicoll to work out the details. If you have not previously registered – you can do so now!! This promises to be a landmark event – so hope you can “be there!”

Rozella May Schlotfeldt, RN, PhD, FAAN (1914-2005)

Guardian of the Discipline
Nursology author Leslie Nicoll
Guest contributor: Elizabeth R. Berrey

Rozella M. Schlotfeldt (photo credit)

Rozella Schlotfeldt was among the great leaders in nursing in the years when nursing education was first shifting away from hospitals and becoming established in universities.  Students were educated for entry into the nursing profession and graduate programs were established to prepare them to take on roles as leaders in practice and as scientists equipped to advance nursing knowledge through research and theory development.

This week, nurse scholars are gathered at the Frances Payne Bolton (FPB) School of Nursing at Case Western Reserve in Cleveland, OH, to recognize the earliest conferences dedicated to the development of nursing theory. Held one-half century ago, in 1967, 1968 and 1969, these landmark conferences were recognized with the publication of the proceedings in Nursing Research (see volume 17, issue 3; volume 17, issue 6; and volume 18, issue 5). The first symposium, held October 7, 1967, was the third in the series of conferences held at FPB but the first on theory development. Rozella Schlotfeldt was the Dean of the School at the time; regarding the conference, she noted, “Publication of the proceedings was sought with a view toward assisting in promoting discussion and debate among nursing’s intellectuals,” (Schlotfeldt, 1986, p. 98). Lucille Notter, then Editor of Nursing Research, commented in 1986, “I had the pleasure of being invited to attend this symposium…I was most enthusiastic about the papers given. Now, in retrospect, the symposium has proved to be a landmark in nursing…The decision to publish the symposium proceedings was a good one. Students…often use these papers in their quest for understanding the meaning of nursing theory and how nursing theory evolves,” (Notter, 1986, p. 97).

Rozella Schlotfeldt served as Dean at FBP from 1960-1972 and continued as a Professor until her retirement in 1982. Even after that, she continued to be active on the international, national, and local levels. I (Leslie) was fortunate to have Rozella serve as a member of my dissertation committee in the mid-1980s. She provided the leadership and vision to establish the PhD program at FPB in 1972, the third PhD program in nursing at that time.

Like any doctoral student, I was a little intimidated to have her as a committee member–she was invited at the request of my chair–but once I got to know Rozella, I appreciated her kindness, insight, intelligence, and warmth. Every doctoral student has “pearls” that they pick up through their studies; one pearl from Rozella was that “time has no points.” Never write, “At this point in time,” she said, “Just say, ‘At this time.’” I think of her practically every time I sit down to write something and remember the pointless time in which we exist! She also taught me how to always remember the difference between affect and effect: “Affect is to influence; effect is to bring about.” See the quote further on which uses “effect”–pure Rozella, and perfectly used.

Elizabeth R. Berrey’s doctoral dissertation was a feminist critical hermeneutic study to identify the themes and patterns in Rozella’s life that informed her thinking about nursing. Using oral history as a tool, Rozella’s remarkable life was documented, along with the unprecedented vision that Rozella brought to the development of the discipline of nursing.  Elizabeth and I were in the same PhD cohort at FPB; she provided the following summary of her work, focusing on those dimensions that exemplify Rozella as a “guardian of our discipline.”

In 1918, when Rozella Schlotfeldt was 4 years old, the Great Flu Epidemic claimed her father’s life. Her mother, along with Rozella and her younger sister, were spared. Her mother immediately went to work as a nurse to support her family. She impressed Rozella with her creativity and innovation in caring for her patients, greatly influencing Rozella’s choice of profession. “From an early age, no doubt about it, I determined to be a nurse!” The household in which she grew up was characterized by practicality, hard work, and doing that which needed to be done, as well as busyness, energy, and vigor. These generative themes and patterns of her life are reflected in, and affected, her thinking about nursing.

Rozella received her BSN in 1935 (in a time when that was uncommon) from the University of Iowa. She served in the Army in the European Theater during WWII, then earned her MS in Nursing Education/Administration in 1947 from the University of Chicago. In her words, “I already had a notion of being influential and not let anything encroach upon that.” She said, “I suppose that translates itself into mapping out what you do with your personal life, as well. She speculated that getting married to a man “would have stood in the way” and “I would have been bored to death …. maybe I was 30 years ahead of my time so far as independence of women.”

Rozella took a leave of absence from Wayne State University, where she was Professor and Associate Dean for Research, to earn her doctorate in 1956 from the University of Chicago in Education and Curriculum Development. While at Wayne State, she “was bitten with the research bug and did all kinds of research… we really got the [nursing] faculty going for research while I was there.” While at the University of Chicago, Rozella met Rosemary Ellis. Hallmarks of their friendship were their “mutual respect for and admiration for one another, their love of and commitment to nursing, and their readiness to share their best critical thinking for advancing nursing knowledge.” When Dr. Schlotfeldt, came to Case Western Reserve University (CWRU) as the Dean at FPB, she recruited Dr. Ellis to the faculty.

It was at CWRU that Dr. Schlotfeldt made what she considered her most significant contributions to nursing: the “collaboration model” between the faculty of the school of nursing and University Hospitals; her paradigm of nursing–to attain, retain, and regain health; and the Nursing Doctorate (ND) in which she was “shifting the emphasis from learning how to do, to learning how to know.” As she liked to say, “Nothing like knowledge!” With these aforementioned innovations, and her leadership locally, nationally, and internationally, Rozella Schlotfeldt changed forever the face of nursing, first in Cleveland and, as her ideas reverberated more widely, throughout the world. During her tenure as Dean, amongst several boards and commissions on which she served, she was a co-founder of the Midwest Nursing Research Society, held leadership roles in both Sigma Theta Tau and the International Council of Nurses, and was the first nurse member of the Council & Executive Committee of the Institute of Medicine.

In Safier’s 1977 publication, Rozella was named as “one of nursing’s most original thinkers” and as “an educator with innovative, progressive and sometimes startling concepts of education for nurse[s]” (p. 338). Rozella loved this! After her retirement from the deanship, she remained highly sought after for her intelligence, wit, creativity, and sheer clarity about, as she often said, “nursing qua nursing.” (Once she said to me with a chuckle, “I know exactly what nursing is! And if they’d just ask me, I’d tell them!”). And while Rozella wanted to be influential, she worried that she should not be seen as an exemplar of nursing excellence, some so-called ideal, whom all nurses should emulate. Rozella was simply and uniquely herself, a woman who was passionate about our discipline and, as she said, “I just think there is nobody more passionately involved in having nursing move toward what it could become. I always say, ‘what it could become,’ because it’s not there yet.” Rozella’s sights were set on nursing as a combination of her mother’s example, her liberalizing, research-oriented undergraduate education, and her own competitive ambition that helped her to emerge with a vision of herself in nursing. “Vision of herself in nursing” is a purposeful statement, for there exists little separation of her vision of nursing from her vision of herself in nursing.

In her first published article in 1949, addressing the nursing care component of educating a patient with the medical diagnosis of TB, she opened with a strong statement that includes nurses as professional members of the healthcare team that are responsible for prevention of communicable disease, based upon “constant scientific study and research… [by these] competent professional workers,” (p. 375). (Note: this flew in the face of the extant practice of nurses employed by hospitals and physicians of the era.) In 1960 she made a point in an article with Safford, that nursing care was defined as care rendered by, or that took place under the direct supervision of, the registered nurse, a clear statement of the autonomy of nursing practice.

During the mid-60s and into the early 70s, Rozella repeatedly called upon nurses to recognize their profession’s rightful role in society and to support that role through increased research, education, and leadership. Examples of her actions include a symposium she held at CWRU, through the Legislative Committee of the Ohio Nurses Association, and through forthright challenges to nurses and legislators to “fulfill their public trust” to enact a mandatory nurse licensure act. She brought her extensive political and social savvy to bear to speak for the profession and the discipline and thereby be recognized for her effectiveness.

In 1969, along with Janetta MacPhail, she published a series of three articles describing the nationally-known and heralded “experiment in nursing,” aka, “the collaboration model.”  The three articles themselves are landmarks for the clarity, care, and specificity with which the new concept was presented to the nursing community. Briefly, the new concept of inter-institutional organization invested the school of nursing with the authority and responsibility for controlling the quality of nursing education, nursing care, and nursing research in the health center.  The heads in the clinical departments were the heads in both practice and education, with 50/50 appointments in each institution. Example: head nurse given the new title: Senior Clinical Nurse to help with the transition. Rather than waiting on physicians or spending all her time charting or ordering supplies, “she spent her time being the authority on nursing.” Here’s another example that Rozella remembered with relish: The medical director of OB/GYN came over to see her at FPB because some physicians’ noses were getting out of joint “due to the sophisticated care being provided by the master’s prepared nurse clinician.”  He demanded that this nurse be fired.  “I said to him, ‘I don’t think you can tell me that. What is your rank?’ He said he was an assistant professor…in the medical school. I said, ‘Well, I happen to be a full professor. I’ll be very happy to listen to what you have to say and then I suggest that you go to your Dean and I’ll talk to your Dean.’”

The following year (1970), tired of medicine’s intrusion into nursing, she wrote an article, an unequivocal assessment of the relationship of nursing and medicine, in response to an AMA Board action, devoid of any appeasing, deference, or gratuitous caveats.  She audaciously defined medicine, concluding that, “the physician’s contacts with patients of necessity are episodic, with each episode of relatively short duration. The primary focus of the physician‘s work is to effect cure.” She further wrote a statement intended to counterbalance, and serve as a contrast to, her definition of medicine, which was purposive in its intention to draw a marked distinction between the practice of medicine and the practice of nursing, concluding with, “Each discipline represents some but not all of the skills needed to keep people well.”

In 1972, determined to “set forth a straightforward and unambiguous conceptualization of nursing in terms of the profession’s goal and the phenomena with which nurses must be concerned,” she stated succinctly and unequivocally, “nursing…is healthcare.” She claimed that “nurses are independent, professional practitioners…the goal of nursing is to attain, retain, and regain health.”

When the American Nurses Association came out with a statement about the Baccalaureate degree being the degree for entry into practice she said, “I even wrote to the ANA President…and said, ‘We already have programs that recognize that nursing is a complex profession and that we should have first professional degrees that are based upon liberalizing education and a strong scientific, humanistic base.’”

Rozella readily gave her successor as Dean, Janetta MacPhail, credit for completion and implementation of the ND, while counting her early work in conceptualizing the ND as one of her own significant contributions to the profession. Due to her dissatisfaction with the amount of knowledge that nursing students had, she “began cooking in my head about the ND…. The result was an educational model designed to give students a solid foundation in nursing’s knowledge base prior to caring for patients: shifting the emphasis from learning how to do to learning how to know.” It was also designed to put nursing parallel with two other major professions, medicine (MD) and law (JD).

Dr. Schlotfeldt’s  papers are archived at the University of Pennsylvania Library.  The collection includes her addresses, articles, and files, reflecting her association with various academic institutions and professional nursing organizations; her personal correspondence, and photographs.

Sources:

Berrey, Elizabeth R. (1987). Researching the lives of eminent women in nursing: Rozella M. Schlotfeldt. Unpublished doctoral dissertation, Frances Payne Bolton School of Nursing, Case Western Reserve University.

Notter, L.E. (1986). The author comments.  In Perspectives on Nursing Theory, 1st ed. (L.H. Nicoll, ed.), p. 97.

Safford, B. J., & Schlotfeldt, R. M. (1960). Nursing service staffing and quality of nursing care. Nursing Research, 9, 149-154.

Safier, G. (1977). Contemporary American leaders in nursing: an oral history.  New York, NY: McGraw-Hill.

Schlotfeldt, R.M. (1949).  Safer ways in nursing to prevent spread of Tubercle Bacilli. National Tuberculosis Association Transactions, 45, 375-377.

Schlotfeldt, R.M. (1970). Nurses and physicians: Professional associates and assistants to patients, Ohio Nurses Review, 45(March), 6-12.

Schlotfeldt, R.M. (1972). This I believe: Nursing is health care, Nursing Outlook, 20(4) 246-246.

Schlotfeldt, R.M. (1986). A colleague comments. In Perspectives on Nursing Theory, 1st ed. (L.H. Nicoll, ed.), p. 98.

Schlotfeldt, R.M., & MacPhail, J. (1969a). Experiment in nursing: Characteristics and rationale, American Journal of Nursing, 69(5), 1018-1023.

Schlotfeldt, R.M., & MacPhail, J. (1969b). Experiment in nursing: Introducing planned change, American Journal of Nursing, 69(6), 1247-1251.

Schlotfeldt, R.M., & MacPhail, J. (1969c). An experiment in nursing: Implementing planned change, American Journal of Nursing, 69(7), 1475-1480.

 

About Guest Contributor Elizabeth R. Berrey, RN, PhD

Now retired, Elizabeth has been a featured speaker at nursing conferences and conventions, focusing on the importance of nurses as agents for change and advocates for better healthcare.  She was the first nurse appointed to the Cleveland MetroHealth Hospital Board of Trustees (1985-1990), the first private practice in nursing in Ohio (1980-1986), and appointed to the Ohio Board of Nursing (1987-1992) as the first clinical nurse specialist to serve on the Board, advocating for nursing autonomy and control of our own practice.  She now lives in New Mexico and remains a leader in the Albuquerque community, focusing on political advocacy on behalf of nurses and nursing.

In describing her relationship with Rozella, Elizabeth says: “. . .  not only did I write my dissertation on the themes & patterns of Rozella Schlotfeldt’s life, I was in her life right up until the end, as her power of attorney for healthcare. So in addition to knowing Rozella since the mid-1970s, as my dean, then Dean Emerita, I spent close to 2 decades with her at the end of her life, spending time at least weekly with her in the last 15 years.”