Category Archives: nursing faculty jobs in Hawaii

#6 – tips for teachers – are you a nag at clinical?

has this ever happened to you at the hospital?

you start the day with the best of intentions, but then – a student arrives late who didn’t call. somebody else lacks the written preparation that is part of the class. You need to remind the whole group to put their hair up. A staff nurses takes you aside to tell you that the student in room 316 left the bed “up” with the side rails “down.”  The nurse manager takes you aside to tell you that the staff has noticed that your students don’t follow the hand washing protocol. Oh and by the way, when they did pre-clinical prep the day before, they did not have a name tag and brought their lunch to the nurse’s desk.

mother, puh-leaze!

All of these things disrupt the good karma of the day, and they prevent you from living up to your potential as the warm, wise, collegial faculty member you set out to be when you decided to teach. You wanted to be able to spend time talking about the higher-level things….  showing the students something unique about the patient assigned to them perhaps, and yet – you never quite get there because you find yourself nagging.

The history – reacting against ritualism and militarization at school

We have all heard the jokes about strict nuns at Catholic Schools (not limited to nursing schools – elementary schools were included!) who expected a set of ritualistic behaviors and stopped at nothing to obtain them. For the first hundred years or so, nursing school was like that. In some parts of the world, it still is. Nursing school was like Marine Corps boot camp for many young women. When I take beginners to the hospital, I put this issue on the table. “Are nurses educated? or trained?”  There needs to be a balance. The fact is, there will always be a group of teachers who think that it is somehow beneath them to give the students feedback on simple stuff  – because the teacher is reacting philosophically against the harsh quasi-militaristic traditions in which nurses formerly needed to learn to do things a certain way.

The Paradox

These faculty are young and idealistic and they mean well. Paradoxically, their students are sloppy and the ward staff complains about them more. This is a fact of life. and the faculty says “you would think the students would be grateful that I am such an enlightened faculty member.” Nope. You need to model the right micro-behaviors from the beginning, over and over.

The fact

The fact, the sad fact, is that the student does not know any better. Don’t get into the negative spiral of blaming the student for your lack of control. All they know is, stuff keeps happening, and there seem to be an endless set of rules that nobody told them about. If the clinical experience consists of getting nagged at from all sides, students learn to dread clinical when they ought to be learning to love clinical. I wrote a previous blog on the subject of “the unwritten rules of a student nurse job description” – this blog is a continuation of that same theme.

The solution

Believe it or not, you can have clinical time in which you truly do focus on the actual patient instead of “the rules” – Don’t wait until clinical to start teaching these little micro-behaviors. You can be in control without being controlling.

the secret? use your learning lab as if it was the hospital. Establish rules at lab; enforce them; explain them there; and follow them at lab always. The lab is more than just the place where skills are learned; it is also the place where professional work behaviors are taught.

examples:

we start off the  first day of Lab saying ” you think you are at the lab, but this is actually University General Hospital and we will teach you certain ritualistic behaviors that are used in any hospital.

The rule is,

If there is something you would be doing in the hospital, do it here; if there is something you would not be doing in a hospital setting in front of patients, don’t do it here.

always wear name tags at lab.

always wear a uniform at lab. We have the clinical uniform (scrub suit) but in lab we use the “polo shirt uniform” – green polo with logo on it and khaki trousers.  Faculty wear the uniform too. closed-top footwear ( no slippers – something we need to enforce in Hawaii but probably not an issue if you teach in North Dakota…)

no food in lab

adjust height of bed high when working; low when away. side rails accordingly.

all mannikins have a wristband, and it is checked as part of every procedure.

all mannikins have a chart and there is an order in it for every skills we practice. the order is checked.

begin each run-through of  any given skill by washing hands and introducing yourself to the patient.

lounging on the bed is not allowed

horseplay is not allowed

use the over-the -bed tray to promote body mechanics.

always spend the last ten minutes cleaning up the lab for the next class.

we do make two exceptions: we don’t don clean gloves all the time (too wasteful since we are not actually in contact with anything) and we don’t always pull the drapes (so the faculty can observe everything)

In other words, professionalism in lab will pay off in clinical. you get the nagging out of the way, so that the expectations are known before you get near an actual patient.

The Nurse’s Brain

oh and by the way, you can also remind each student to add these little things to their “brain” – see the previous  entry on Nurse’s Brains….

Why?

I rationalize it by saying that though I do not wish to promote ritualistic behavior, there are certain habits that are best learned by repetitive reminders and that just because the student is getting feedback, does not reflect on whether they are a good person. “you will thank me later.”  repetitive behaviors can be “evidence-based.” go watch a clarinet player sometime: they learn how to move the fingers by practicing each finger thousands of times. The basic skills can only become second-nature if you practice them as if they were your clarinet.

HANDOUT AVAILABLE

this is all explained in a handout we give students at the beginning of lab. send an email to joeniemczura@gmail.com and I will send it to you as a Word document.

I will devote a future blog to a mini-theme of mine – How to use low-fidelity mannikins to enhance your high-fidelity sim-Man experience. If your school has the $$$$$$ hi-fi mannikins, you can really boost your performance by changing the way the students interact with the low-fidelity mannikins. It’s true!

Finally,  please consider subscribing to this blog, and sharing it with others.

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#4 – for teachers – ask yourself about your own role in the “Inner Game”

Latest in a series about classroom management.  please share with nursing faculty members. why not subscribe?

مرحبا بكم في بلادي القراء من الناطقين بالعربية الأراضي. الرجاء المشاركة ويرجى النظر في الاشتراك. السلام!

not too long ago I worked with a new faculty member who was – shall we say? – a diamond in the rough.  When the class was assembling, she would get their attention by saying “sit down and shut up!” or “start paying attention!”

Ooooh Nooooooooooooo

And the odd part was, she seemed to think it was normal to treat students this way. I had this idea that  she grew up in a family where people were ordered around, or maybe she had spent too much time in a work setting where the boss told everyone what to do next. There has got to be a better way to get people to be a part of the team……

The Inner Game

The idea for the day is, The Inner Game. Recognize your own role in becoming the “little voice inside the student’s head” that tells them how they are doing and what to think about themselves. What message was that faculty person delivering?

The Inner Game applies to any profession in which a person needs to learn a highly complex skill set that has to be coached in person. It is unquestionably true in Advanced Cardiac Life Support (ACLS) training, but applies anywhere that a person needs to perform a skill while people are watching. Just like tennis.

Did this get your attention? keep reading…….

Let’s back up a bit. The Inner Game of Tennis was a best-selling book in 1974. The idea was simple: when you play a competitive individual sport, you have two opponents. The first is the person on the other side of the net. You need to respond to them and score more points than they do. The second opponent is not so obvious. The second opponent is the little voice in your head that tells you how you are doing. If the little voice in your head is fearful, full of doubt, and negative, you must beat that opponent first before you can beat the person on the other side of the net. The book was a pioneer in the genre of sports psychology, but also in the study of peak performance – the search for “flow” and “playing in the zone” – which has also been studied by such nursing luminaries as Patricia Benner and Marlene Kramer.  The author started a sort of franchise – the Inner Game of Skiing, the Inner Game of Investing, etc – but the original metaphor still remains strong. The book is about how to eliminate self-defeating thoughts from your quest for excellence in what you do.

I won’t recap the whole book for you here. You can get an updated copy via Amazon, inexpensively. Or go to the Inner Game website.

Newbies

The bottom line is: We as faculty need to be especially careful not to supply self-defeating thoughts. Nursing students rely heavily on cues from faculty to guide them (a sort of variation on WWJD) and the voice of the faculty becomes the little voice in the student’s head. If you as the faculty use language that is negative, or if you supply negative imagery, you (the coach) will create the conditions for that person to limit their own potential.

Be a model of positive inner dialog about challenging situations.

The Inner Game is the basis for successful problemsolving. if the person says “I’m a student and I will never figure this out” they create a self-fulfilling prophecy. If the student says ” there must be a better way to address this problem, I will come up with it if I work at it” – they reframe the issue in a way to succeed.

I think i will also write a companion blog on The Inner Child as it relates to nursing……

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2 of “10 tips.” – – – Mantra for New faculty. need to repeat this over and over until they “get it”

We are all in search of the eternal truths of life, and nursing education is no different.

hint: be sure to click on the hyperlinks. These show up as underlined text or sometimes as text of a different color.

If I had just one magic incantation for new  nursing faculty, it would be this one:

It’s not about what you know, it’s about what the students learn

Medically-oriented knowledge

Do you know a lot about physiology? This is the answer to a common pitfall for new faculty who are trying to decide what to focus on when choosing material for a lecture. You have just come from graduate school in nursing and you make up your mind that you will be a better teacher than your undergraduate faculty were; the students will learn more advanced concepts from you than they ever learned from somebody else.

result: you spend time lecturing on some physiological problem that doesn’t happen that much. students are left confused. they don’t know whether it was important, or not. they scratch their heads.

hint: if you are discussing some physiologic problem that you personally have not dealt with, or for which you can not give an example from your practice, it’s probably waaaay over the student’s head.

working with beginning generalists

Or else maybe you are feeling imposter syndrome and you need to reassure yourself how smart you are and that you really do belong here.  You can tell if this is happening to you because you have the uncontrollable urge to share your qualifications or to talk about the finer points of some unusual medical illness that maybe the other faculty haven’t even heard of.

hint: this is nursing school, not medical school. what does the nurse need to know about the topic at hand?

Exams by a new faculty – what do they measure?

Or maybe you are looking at the item analysis report for an exam the team just gave, for the very first time and you see that the students scored a “0.0%” on the correct answers for all your questions; you find yourself arguing that they really ought to know that answer.

hint: when nobody chooses the correct answer for a question, you really do need to consider the possibility that there was something wrong with the question, or perhaps that your teaching was not effective. This is humbling.

Truth: if the entire class scores poorly on any given exam,  it is a reflection on you, not on them. How could you have presented the material better? in the meantime, drop the question overboard without ceremony. you will do better next time.

ability to test reality

I only recently heard about a phenomenon known as the Dunning-Kruger effect.

The Dunning–Kruger effect is a cognitive bias in which unskilled individuals suffer from illusory superiority, mistakenly rating their ability much higher than average. This bias is attributed to a metacognitive inability of the unskilled to recognize their mistakes

Even though you may not heard of this by name, surely you seen it at work – I know I sure have.  As clinical faculty, one of our main jobs is to give students a dose of reality-testing strong enough so that they can develop a sense of their own limits and abilities.

The Dunning-Kruger Effect applies to you as a new faculty member. You will be evaluating not just what they students learn, but how. The same applies to evaluating your own skill in a new dimension.

Pearl of Wisdom

I guess the executive summary of this blog entry would be: when you start a teaching career, leave you r ego at the door. be humble. trust yourslef that you do belong there, but in the meantime, start thinkiing about the goal, which is to enhancestudent  learning – not to show how much you know. I will end this blog entry with The First Rule of Knowledge (according to Buddha) which is:

admit what you do not know

PS please pass this along to as many faculty and nursing students as you know and encourage them to subscribe to this blog. hey – why not subscribe yourself?????

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Myths about becoming a nurse practitioner – things to consider about grad school in nursing

9781632100085-SOTG-Nepalt.indd

If this were a bookstore, you would read the back of the book-decide to buy. Find this on Amazon at https://goo.gl/PGTW30

 

UPDATE:  as of February 3rd, 2015, this entry has 38,633 (thirtyeight thousand, six hundred and thirty three) separate views. It’s the single most popular blog entry I have written. Please feel free to add your feedback and comments. 

UPDATE #2 My book, The Sacrament of the Goddess, was published in April 2014 in USA.  Click here to see reviews on Amazon and order a copy. see the cover on the left, below. People  in USA think of Everest when they think of Nepal. Or maybe the earthquake of April 2015. Right now, the political situation in Nepal is precarious; and one aspect of working in a Low Income Country is the feeling of being out on a limb. My book explores the peculiar terror of being a neutral medical volunteer when everyone else is choosing sides. It’s a fast-paced pageturner! The book has nothing to do with APRNs, but might give you some insight as to why any body would ever want to be a nurse…. why not buy it and become one of the cool people? 

related link about paying for NP education, click here!

Disclaimer: I myself went to grad school fairly early in my career – after just one year as an RN. In those days (the 1970s) the federal government supported nursing education with generous grants and stipends which we knew would not last forever. I did not incur any debt for grad school, whatsoever. sweet!  I continued to work as an RN after grad school, and the MS credential surely came in handy when I finally needed to have it. So – I am in favor of graduate education.

Buzzwords. The Trend Du Jour.

Advanced Practice Nursing is a big buzzword nowadays and we are using the idea of it to attract people to the nursing profession. Throughout the USA there is a proliferation of “three-year’s wonder” programs, the idea being that the student does an entire nursing program the first year, then takes NCLEX, then spend two more years getting their MSN and NP while they work part-time as an RN. It’s particularly attractive during the down economy we are experiencing, because there are plenty of people out there with prior BS degrees who are looking for a fulfilling job. It is oh-so-seductive to think they can gain the RN skill in just one year.

Okay, so it’s a wave – lots of schools and universities are offering these programs. there are plenty of stats to provide a rationale for the career track we are inventing.

The aging of the population

The lack of Medical Doctors to provide primary care

the overall need for RNs to replace the RNs in the baby boom who will be retiring soon.

etc etc etc

I am not disputing those trends, but I am bemoaning some things that seem to be getting lost along the way.

Myth One – no need to learn basic personal care

To begin with, role socialization into nursing goes out the window when the time is compressed. Many of the persons who come from these programs seem to me to be unaware of how nurses work as a team, how nurses work in a hospital, and how to do any kind of personal care for a sick person. In other words, such things as cleaning up “fecal incontinence.”  When this comes up in conversation, they say “oh, well, I am going to be a nurse practitioner and I will be in an independent practice, I don’t need to learn those things.”

Oh Really?

My retort would be: If You are hoping to get a part-time nursing job to put yourself through school while you get the next two years of grad school under your belt, you will be judged according to the standard of the nurses around you, not to the other standard. It is extremely unlikely that you will be getting anything other than a staff nurse job while you work during school. 

also, don’t discount what a staff nurse learns. accountability and integrity are a big piece of the socialization process. A staff nurse in a labor-intensive setting like a hospital, gets daily role modeling from the older nurses. daily mentoring. any new nurse needs to develop trust with those already in the setting, and people will trust you more if you aren’t afraid to get your (gloved) hands dirty.

Think about this: if a patient has been incontinent of feces, no real nurse ever just lets them lay there. Never ever. You may not have to clean them yourself, but you do need to know how. Being clean is a critical element in the dignity of human beings. a very simple precept, really….. and if you as a student disrespect this, you will not gain the trust of the nurses around you.

Myth Two – independent practice

The next myth for Advanced Practice is that “I will be in an independent practice and I am not going to need to learn to work in the kind of subservient hierarchy that a traditional staff nurse needs to navigate through”

If that is truly the case, you will need to borrow money to rent office space, hire a billing agency, advertise to the community, all those things just like you were opening up a furniture store. Ask yourself if you have the business skills to do it, or to get a loan. There are some great resources out there, I particularly recommend one book by Carolyn Buppert; but – is that what you want to do? Most Medical Doctors gave that up twenty years ago, the hassle of “hanging out a shingle” was way too much. We are training you to provide population-based care, which means many of you will be making frequent rounds in a Long Term Care Facility, as part of a group practice. The retired frail elderly population of USA is burgeoning, right? your job will consist of freeing up time for the doc you work with so they can focus more on the technical side.

The small population of ARNPs who will be doing more acute care will be drawn from among those nurses who went the hospital- nursing route and solidified their skills before they enrolled in NP school.

let’s reserve the topic of subservience for some future blog, shall we?

Myth Three

I will be making a lot more money than a staff nurse

In many states the recertification requirement for any ARNP is 40 to 80 hours per year. If you maintain dual-certification, you may have more. This works out to ten working days per year where you are in classes (or being online). When you are in class, you are not seeing patients, and your income is affected. You will also have to pay higher malpractice costs. If you are in a family specialty, you will have many patients who don’t have insurance.  All these things detract from the bottom line.

Myth Four

If it doesn’t work out, I can always fall back on a job as a faculty member somewhere.

Yes, we do have a shortage of nursing faculty. and the minimal requirement to teach is a Master’s Degree. This is one that puzzles me.  For years now there has been such emphasis on going the NP route, that very few nurses enroll in an education track for graduate school. The result? a shortage of faculty, now being filled by recruiting from among those Master’s Prepared nurses who are unsatisfied with an NP job, and who get hired to teach.

There is a problem with this. A converted-over NP with a MS degree does not automatically have the clinical knowledge base to teach in an inpatient clinical setting; and they also don’t have any course work in pedagogy, the science of teaching, how to lecture, how to construct a valid exam, none of the things an educator needs to know in order to be effective.

So far this trend has been under the radar. Any school of nursing where the administration is addressing this, will be ahead of the game.

Myth Five “I can work as an RN after the first year, and use that money to pay for the second and third years, so it’s really not so expensive after all!”  go to my latest blog entry to explore this one. Plan carefully.

Got it off my chest!

So, what you have just read was a “rant” –  the kind of complaining I always dislike. If I were to stand up at a professional meeting,  I am sure there would be  a pregnant pause when I was done. People would look around the room, and then some sweet and wise person would bravely ask And what do you propose that we do about this?

My answer would be:

for the student: realize that you are entering a profession with a long history of service and where you will learn from all those around you in any setting you enter. The more responsibility you are given, the more direct (and sometimes brutal) the feedback will be.

study the idea of role socialization. don’t let it be a hit-or-miss proposition. realize that your thinking style will be changed by becoming a nurse. oh yes it will…..

don’t disrespect the basic skills of personal care. paradoxically, the more likely you are to work in critical care, the more you will need the kind of  teamwork and excellent personal care skills you learn at a basic level.

don’t disrespect the work done by staff nurses, whether it is in a hospital, long-term care facility, or other setting. not ever.

for the schools: be realistic when advertising what a fast-track program can provide and how it fits into a clinical track. When a MEPN student is disrespecting the work of staff nurses, call them out.

emphasize the whole role socialization piece. Insist that the skills portion of undergrad curriculum is rigorous and incorporates socialization, not simply mechanical performance.

insist that converted over NPs who take on a faculty role be given the maximum in mentorship

reclaim the nursing focus of advanced practice nursing. I think it is too easy to slip in to a purely medical model…..

I am fully aware that I will get feedback on this one……. I don’t pretend that this is the end-all and be all of the discussion – But, as oif you have another idea, 2016 this comment section is closed.

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part two: About Hawaiian Culture for the Travelling Nurse

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Review of “Peoples and Cultures of Hawaii: The Evolution of Culture and Ethnicity”

Welcome to the Islands

When I moved to Hawaii seven years ago, I attended an orientation for new faculty at the University where they said “you either love teaching here or you hate it.” In that cohort of faculty was a blond-haired blue-eyed woman with a German accent hired to teach in one of the science departments. I did not see her again until running into her on campus seven months later when she told me she was leaving “the students here are rude and disrespectful and I have not had a successful experience. Every day is a struggle to get their attention.” I thought back to that orientation session… in the intervening time I was having a terrific cross-cultural experience learning about Asian cultures and what exactly it was that makes a classroom at the University so different that one on the mainland. Clearly, here was a person who was not able to grasp the interpersonal insights and skills we’d spent time talking about that day, and which were a continual thread to the discussions of how to help students in my department. I guess that helping her address these issues was less important among faculty in her department.

Reach out to Multiculturalism

She was not alone, and in the intervening years there are many other examples of people who either “get it” and enjoy this special place, or who just can’t quite fit in, and don’t have the tools to figure out how to cope. This extends beyond faculty at the University into every sphere of work. Of course, in some areas you can structure your work day and your life in such a way that you never come in contact with anybody who is not a “haole” – if that is the case, you are missing out on the richness and cultural heritage here. If you can learn and grow, Hawaii is a wonderful place to enjoy world cultures and the unique local culture. I truly believe Hawaii is a model for the rest of the USA in terms of how to realize that we all are persons and we all deserve respect on our merits, not just on a stereotype.

UH has an office named The Center for Teaching Excellence which helps faculty to make the adjustment to teaching in the islands. In a parallel way, I expect the UH Medical School (known locally as JABSOM) to continue their rich tradition of multicultural sensitivity and inclusion. The first edition of the book “Peoples and Cultures of Hawaii” was a solid effort in this regard, published in 1980. I’d written a review of that one a couple of years ago, since I felt that it was better at addressing Hawaii-specific issues than the usual textbook resources on cross-cultural nursing. This second edition came out in 2011 (while I was in Nepal, on an entirely different cross cultural quest…) and is due to be a beacon of hope to all medical sailors seeking harbor on our shores. Aloha!

Take a Peek

A nice feature of Amazon nowadays is to see the Table of Contents and peek inside the book; for that reason I will not repeat here what you can read in the author’s own words. The book seems to be about twenty percent longer, and chapters have been added on some of the more recently prominent immigrant groups from Asian countries that had barely been on the radar in 1980 (Cambodians and Koreans, for example). A wider variety of contributing authors are included, and often the writer is from the group they are describing. There is a glossary of terms from the anthropology literature in the back, seemingly designed to give medical practitioners a more solid footing to describe the friction points in acculturation, etc.

For these reasons, I think this book should be handed to every MD, RN, RPT, or medical professional of any type who comes to the Islands, along with their Hawaii license.

Suggestions

Now, all of this is not to say that the book is still perfect. From the nurse’s point of view, I wish that some of the chapters had been written or reviewed by nurses; I think the perspectives of medicine and nursing are different, and that some very practical tips on how to interact with patients and families would have improved this. For nursing, one of the main resources on cross-cultural interaction is Lipson & Dibble (from UCSF) and they too categorize each cultural group by country-of-origin; The nursing schools here tend to use that one as required reference books for student work that includes obeisance to the cultural origin of the patient at hand… with a little different focus this book would have had every right to supplant these others as the index text for this subject area.

Eye contact – or no?

Next, one of the friction points in general communication between persons from the mainland and persons from an Asian culture is body language – such things as how long to wait for an answer when you ask a question, how far apart to stand, eye contact, etc – these things are very specific and though they often sometimes vary from one Asian culture to another, they constitute an area to work on. For that reason, I think a “how to” on this subject would add.

“Local”

The book makes an excellent effort to look forward – where do all the cultures go from here? But did not really look at the underclass and the “locals” as if they were a distinct subgroup – which they are. The youth of today are not major consumers of health care in the way that the elderly population would be, and youth culture evolves at the speed of light – but I would have loved to read the authors’ assessment of this. Of course, this is a moving target, and today’s “Jawaiian” craze could be obsolete long before the 3rd edition rolls out. I wish there was a website specific to this book where the authors could archive some of the updated web resources on subjects such as pidgin.

Addendum April 10 2012

One of the nifty things that happens at the school of nursing where I teach is when students do a video project for the community health class. Sometimes these end up on YouTube. Click here to see one which I think is particularly good. The student who plays the role of the Filipino lady in this video, deserves some sort of oscar – not just for  the acting, but for the sense of humor which is so evidently on display.

In summary, your preparation for Hawaii should consist of more than just the Lonely Planet Guide. Get this one!

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part one: Guide to Hawaiian culture for the Travelling Nurse

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Exotic Hawaii?

I have a friend from the mainland who thinks Hawaii is really really exotic. and I suppose, compared to Indiana, it is. Then again, Indiana would be considered exotic in its own way if an anthropologist from some other country were to visit there. For me, having lived in Nepal, the answer would be – no. Pretty bland compared to Patan. We wonder why people think Americans ( the WASP kind) are arrogant? it’s because they(we?)  assume that the yardstick culture, the frame of reference by which everything is to be judged, is the one “they” grew up in. (whoever they may be….)  There’s a great poster from Syracuse Cultural Workers that applies, here.

Images from TV

Ask yourself what your image of Hawaii is. Chances are it’s from television.  Or maybe the movies. The Chamber of Commerce here is alway thinking of ways to promote Hawaii on the mainland. It’s no accident that the Pro Bowl is played here. (In January when everyone else is freezing.) What is Hawaii like from the inside?

For Travelling Nurses

Anyway, there has always been a subculture within nursing, of Travellers. Nurses with specialized skills who come to Hawaii for an exotic experience.  Now that I have been here seven years, I feel comfortable enough to compile a quick guide to cross-cultural nursing as applied to Hawaii. Particularly Honolulu.  Every nurse that goes to nursing school here already has learned these things.

The first question is, How did everyone get here? Honolulu is the most “majority-minority” city in the USA, the only state where European descendants have never been in the majority. You expect to find Hawaiians here, and 40% of all Hawaiians in the world, live on Oahu, as is fitting. but they are now a minority.

Yes, this is an issue.

Resources

IMHO, the best book on Hawaiian culture is Peoples and Cultures of Hawaii, written by two guys from the John A Burns School of Medicine. UPDATE: I am pleased to report that a new edition of this was released in 2011 –  There is only one review of the 1980 edition written on Amazon, but I think that reviewer knew what he was talking about,  it is incredibly insightful. The book is a classic, I will run down to the store and get the new one!

From a sociological or anthropological perspective, nurses absolutely need to learn about and respect the culture of which ever person they are caring for.  Frankly, that has always been something I loved about nursing. The variety of manifestations of the human spirit is what makes earth a great place.

Most nursing school nowadays require students to buy and use a reference book on this topic. Many of these books have a section on Hawaiian culture.  And also about Nisei, and about Pacific Islanders and Samoans.  All well and good. There is a gap in the professional literature. When we assign students to ask about the culture of a given client, they sometimes come back and say

“Well, he said he is part Pordagee, Hawaiian, Chinese, Filipino and Swedish. What do I put down on the assessment form? do I have to look up all of them?”

“Nah, just put down ‘local’

Local?

So then the question becomes, “Is there a distinct culture known as ‘Local’ around here, and if so, what is it?”

It’s a chapter waiting to be written in the edition of all those cultural atlases. Take note: whoever wishes to tackle this can become famous in a scholarly way. I do have to warn you: this is a minefield of political correctness. Be prepared to be flamed.

I don’t think I am the one to write it, but I will give suggestions to whomever is brave enough to assume this task.

Pidgin

First, language. There is a specific dialect of English spoken here, known as “Pidgin.”  And yes, you will hear it spoken, but only if you listen carefully. Pidgin, or “local talk” is also, a loaded political subject, since the colonialist Americans tried to eradicate it. You can find it on YouTube.  Because of the musical inflection of pidgin, it is not possible for a person from the mainland to fake it and pretend they are local; but if you are here you need to learn  how to enjoy it. I also highly recommend the book “Pidgin to Da Max” as a hysterically funny guide to the subject. There are examples on YouTube.

I suppose that Rule Number One rule for any person from Da Mainland would be, never assume that a person speaking pidgin lacks intelligence. ( a terrific link!)  Think of pidgin as a whole different language which just happens to contain elements of English. In fact, college students often are able to slip in and out between the King’s English and Pidgin just as if they were two different languages.  The decision to use one or the other is very sophisticated, situationally driven, and a conscious one. Because of historical active discrimination against pidgin-speakers, if a bilingual Pidgin/English speaker thinks you are condescending toward them because of it, you will find your job here much more difficult. Trust me.

A student of mine who was Asian, had studied on the mainland ( Nebraska!) for a year, and she said that one of the reasons that she came home was, she was tired of the fact that the Nebraska-based students assumed she didn’t speak English well. She said that prior to that experience, she never considered whether Asian-Americans could be the subject of racism. It had simply never occurred to her.

The former Saint Francis Hospital had a rule about language: The official language of the hospital was English, and employees were forbidden to speak any other language in the daily conduct of their work. Think about that one. The patient population was multicultural in a dazzling way, though, and if the patient initiated the conversation, it was okay. The staff there was capable of greeting them in the same multitude of languages. Actually, it was something I loved about working there.

Rule Two

Which leads to rule number two: learn about the culture of your coworkers, just as much as you learn about the culture of the patients. After all,they are probably one and the same. We had a new faculty person from New Orleans, Louisiana – a fascinating and wonderful American culture all of its own. One day at class break, I asked for volunteers to teach her how to fold a paper crane…. and ten students happily shared time to talk with her about origami and what it meant for them. Wicked cool.

Rule Three?

rule three is – “chill.” as in learn to chill.  (read every definition!) Be advised, this is also the most “Asian” City in the USA. Certainly the most polite of any city I have been in, and I have lived in a few. The most respectful and mellow. If you drive like you are in Boston or New York City, you will have a problem on the roads here. Here you will learn patience and how to enjoy a gentle sense of humor.

Food – sometimes only Zippy’s will do!

Next is food. there is a distinct Hawaiian cuisine, known as the plate lunch. You can get rice for Breakfast at McDonald’s.

I would be remiss if I omitted some of the great comic talents of Hawaii that are able to examine and poke fun at their own culture. Then of course, so much of cultural knowledge consists of little tidbits; discrete factoids that we would call “Pearls of Wisdom”

The North Shore is Going Off!

There is a distinct surf culture in Hawaii.  Subject of a whole nother blog.

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