Realistic and optimistic

I recently attended a meeting of global nurse leaders convened by the Honor Society of Nursing, Sigma Theta Tau International. Several speakers touched on the topic of equity, a concept all too often confused with equality. Sharing something equally does not mean that this distribution is equitable.

For instance, a person paid $20 an hour in San Francisco cannot support a family above the poverty level whereas the same salary—$20 an hour—would make life bearable in other parts of the country where the cost of living is less. Do both individuals make an equal amount of dollars? Yes. Is their buying power the same? No. This is a very simple example of equality that is not equitable.

This kind of inequity plays itself out in healthcare across the globe every day. Because variables that complicate this reality are as numerous as the stars in the sky, I will limit myself here to three observations.

hocus-focus/iStock

Nursing innovation is often co-opted or outright appropriated by other disciplines. That statement is based on years of personal observation. As a service profession, nursing often does not step up and take credit when credit is due. When simple recognition is not given—never mind monetary reward—value created is co-opted or wrongly acknowledged. When it comes to innovation, could nursing be the source of its own inequitable treatment?

Nursing has only recently begun to be represented in a manner that impacts equitable allocation of healthcare resources. Initiatives are underway in many countries to place nurses on governing boards of healthcare providers and consumer organizations. Imagine if nursing was equitably represented on these boards in proportion to the population nursing serves and the healthcare spending it influences. Keep in mind that nurses and midwives make up 87 percent of the global healthcare workforce. To have an equitable voice at the table and articulate its value, nursing needs to communicate in the language of business. We have a ways to go.

I am not disheartened by these realities or the challenges that lie ahead for nurses in improving global health—quite the opposite. Nurses who are out in the world advancing global health inspire me! At a meeting in Washington, D.C. recently, I had the honor of meeting leaders who represent these nurses, and the foundation for nursing equity that these leaders are laying on behalf of nurses around the world will result in greater healthcare equity for the populations they serve.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.

A bottle of water

I’m back. I was off the grid for a while doing some reflection.

While I was gone, I took time to read the blog entries I have posted over the last several years. Sadly, they have generated very little dialogue, their original intent. I also realized that most of them focused on challenges faced by our society or profession. To say they have been negative is, I hope, too strong. I prefer to say that, in an effort to spawn conversation, I have pointed out challenges.

It may have been the challenges I see at every turn that resulted in my writer’s block, which brought me to this reflection. It would be easy for me to go on a tear about the state of the current electoral process in the United States or cruelties being inflicted around the globe. Either of these topics, as well as many others, could get ugly very fast. Who knows, they might even generate some discussion.

Ugliness seems to be one of the few things that gets people engaged these days. Sadly, getting to the ugliness does not seem to move us to the open and honest dialogue we need to have about so many topics. So, rather than adding to the negativity that abounds, I am using this edition of “Does this strike a chord?” to share a short story of optimism.

I was on a lengthy motorcycle ride recently. For safety, I wore my black leather jacket. To say it made for rapid warming anytime I stopped would be a major understatement. It turns out the route I took, which was desolate, was under repair. At one point, I was stopped in traffic for 45 minutes just before noon hour. I was caught totally off guard when the gentleman in the minivan in front of me stepped out of his vehicle to walk back to my bike. Rather than asking about my bike or complaining about the traffic, he simply handed me a bottle of water and returned to his vehicle without a word.

I was caught totally off guard by 16.9 fluid ounces!

I was so stunned that the words “Thank you” barely made it to my lips before the door to the minivan closed. I am not sure if the driver even heard me. I vowed I would pay his kindness forward three-fold daily. I would do one thing for a person, one for an animal, and one for the planet. I’m not going to tell you what I have done because that is totally unimportant. What is important is that the world is hurting in a bad way for the type of kindness that was shown to this stranger on a highway.

I shared my story about the minivan driver on Twitter. I asked others to share their stories about being the recipient of a random act of kindness. I did not receive a single like, retweet, comment, or post about that random act of kindness. I can only hope this lack of response has to do with my vast Twitter following. Not! As for me, three random acts of kindness a day don’t seem too much to ask. I may not always be able to complete my three acts of kindness per day, but hope the world will be a better place for my trying.

Have you been the recipient of a random act of kindness lately? Have you paid it forward?

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.

Something else to lose sleep over, health data held for ransom

Data breaches have become as commonplace as men walking on the moon at the end of the Apollo program. They’ve become white noise, and people aren’t paying attention. Millions of personal credit records can be exposed, and it’s barely a blip on the evening news. The personal email of the CIA director has been hacked. Really?

First-generation cyber criminals followed a similar pattern when committing their crimes. Using some form of malware that was downloaded to a computer via email or website, they accessed sensitive data, such as personal credit information, including U.S. Social Security numbers. To complete the transaction anonymously, they downloaded a copy of the data by bouncing it off several servers around the planet and then sold that data on the dark internet using an electronic currency known as bitcoin. The recipient of this valuable information then committed fraud by creating as many transactions as possible before the account was shut down. In response to these data breaches, the custodians of our digits generously provided us with one year of credit monitoring.

From strips to chips
To decrease credit card fraud, credit card companies have recently begun replacing our traditional, magnetic-strip credit cards with so called “chipped” cards,” a practice that has been in place outside the United States for years. The user of a non-U.S. chipped card is given the opportunity to select a personal identification number (PIN). The merchant presents the card processing machine to the cardholder. (The card never leaves the sight of the cardholder.) The customer then enters his or her PIN, and the transaction is complete.

– kaptnali/iStock

Until recently, the U.S. model did not provide this level of security, and most vendors still do not offer that protection. Instead, normal practice often required cardholders to relinquish possession of their cards for brief periods—your server taking your credit card to the register for swiping, for example. But even when your card remains in your possession—or sight—during a transaction, your personal data can still be acquired through the use of “skimming” technology. When installed in a transaction device—a gas pump, for example—a skimmer harvests data free of detection.

Now broadcasting from your credit card
Instead of protecting us, the chips that have been added to our credit cards now help criminals steal our data by accessing signals broadcast from those chips. Millions of dollars are being spent on migrating to chipped cards in the United States that are inferior and already outdated, compared to those used in other developed countries. Omission of a feature as simple as the ability to enter a PIN has made our data less secure.

Enter the second-generation cyber criminal. He or she is not a fraudster. No, they have taken the game to the next level. They kidnap data and hold it hostage. The software used by these evildoers is known as ransomware. Like malware, it is downloaded to your computer, as discussed earlier, but a ransomware virus, once downloaded, does not copy your data. Instead, it locks up your system, blocking access to its data and functions. To have your system unlocked, simply fork out a ransom—payable in bitcoin—as instructed by your infected computer.

The first report of a U.S. healthcare system being held hostage by ransomware recently hit the headlines—a full three days after it was reported in the international media, I might add. The victim hospital had to resort to using a paper-based system for more than a week. In the end, the hospital system reportedly paid the ransom, and their systems were freed. It is safe to say this will not be the last of this type of attack on healthcare systems and the valuable data they hold.

Questions in search of answers
Knowing that the evolution of most information technology systems in healthcare lags behind that of the banking industry, I shudder to think about the many difficult questions that lie ahead, all of which require innovative answers.

Have we reached the point in time when the client must be the custodian of his, her, or its own data? If so, what technologies will be used? Some PIN-driven smart card? What does this mean for system interoperability? What about amassing big data for research? Is the client responsible for any untoward outcomes resulting from the client not keeping records up to date? What about …? What about …? And what about …?

If the patient is not the custodian of his or her own health data and a healthcare organization is, is that organization liable for any untoward outcomes suffered by the client during a period when the client’s health data is unavailable? Is the healthcare system responsible for a more robust backup system than in the past? Is the healthcare system responsible for providing an updated copy of the client’s medical record at every encounter?

In the face of ever more innovative cyber threats, answers to these questions and many others will ultimately determine where the liability for security lies.

Your thoughts?

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.

How real is the danger of artificial intelligence?

Year after year we see amazing advances in health care with many of them driven by technology. From surgical robots to ingested cameras to cochlear implants to nanites that carry out tasks at cellular levels, technology is invading our bodies. These technologies currently share one common factor—there’s a human in the loop. But for how long?

In an open letter to world leaders and the public, business magnates that include Elon Musk, CEO of Tesla Motors and SpaceX; Warren Buffet, CEO of Berkshire Hathaway; Bill Gates, former CEO of Microsoft; and others, have requested that artificial intelligence (AI) not be used for military purposes. I believe this is a reasonable request. 

If technology takes over in health

care, is it still health care? 

— Photo by Danil Melekhin/iStock

Just imagine—drones equipped with facial recognition capability (now commonplace) that stay aloft and search for targets 24 hours a day with no human involved. The idea of machines usurping man’s authority has been present in my consciousness since I saw the film “Colossus: The Forbin Project” (1970), and the theme has been repeated in novels and more recent films, such as “The Terminator” (1984) and “The Matrix” (1999). The question is not if the theme will continue to be repeated, but rather if fiction will become reality.

Science fiction of the past very often becomes the reality of the day. Nearly 50 years after men traveled to the moon, man-made probes are exploring the current state of the universe and orbital telescopes are visualizing its past while, here on earth, physicists are unlocking its foundational elements. The ability of technology to collect and interpret data is quickly outpacing human ability to do the same.

So far, man has remained in the loop to make corrections in situations that computers, in our human opinion, are unable to adapt to, but we are slowly giving over control to technologies under the guise that machines are more precise. I wonder how long it will be before Moore’s Law catches up with us and the first lawsuit is filed in response to a plastic-surgery robotic laser gone wild, à la the science-fiction classic “Barbarella” (1968), starring Jane Fonda.

British scientists recently demonstrated that the brain of one primate is capable of controlling the motor function of another primate when mediated by a computer. Using 36 electrodes, the researchers connected a conscious monkey that had an implanted brain chip to the spinal cord of an unconscious avatar—another monkey—to measure responses to various stimuli. Ninety-eight percent of the time, the master correctly controlled the avatar’s arm. Upon hearing this news, the report continued, “The scientists from Harvard Medical School in the U.S. envisage their findings could go towards creating machinery to help patients.” Machinery to help patients? Sounds like another very slippery slope!

As technology pervades every aspect of our daily lives, personal privacy is disappearing as rapidly as the technology propelling society forward is advances. Our ability to map and manipulate the human brain is being refined equally as rapidly. Will we see the day where excess capacity in the human brain is used for secure storage of data because it is the only private place left (Gibson, 1986)?

I shudder to think about the brain being manipulated for nefarious reasons. Imagine, implanted “machinery to help patients” being hijacked by a computer virus that can be triggered by something as simple as an image, leaving the source of the virus undetected. The undetectable computer virus part already exists. Assisted by technology and artificial intelligence, it appears we are well on our way to external manipulation of the brain and nervous system.

You hold in your hand today a communicator thousands of times more powerful than that used by Captain Kirk in “Star Trek” or the computers that sent man to the moon. If science fiction is as close a predictor of the future as it has been in the past, we as health care professionals and as a society will be facing some very difficult decisions about the boundaries of AI, some of which may already have passed us by.

Where do you think the boundaries should be in use of artificial intelligence to explore the human brain? Do you think AI-assisted exploration of the human brain will lead to taking us completely “out of the loop?”

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.

Can health care and capitalism coexist?

Recent news of a hedge fund manager purchasing a small pharmaceutical firm and raising the cost of a medication 5,000 percent thrust the rising cost of health care back into the headlines—for a few days. The medication in question was developed in the 1950s and has served the world well for the more than 60 years it has been on the market. The CEO’s justification for raising the price so outrageously? The profits will be used to develop new and better drugs.

What is this 30-something former hedge-fund manager’s motivation? I find it difficult to believe that it is altruism. Given his background, I suggest it is, as Pope Francis calls it—“the dung of unfettered capitalism,” otherwise known as profit.

Pogonici/iStock

Until recently, one of the few sectors doing well in the current economic environment was the pharmaceutical industry, and stocks leading the pack have been, by far in that sector, the small companies. This is because, as in many other sectors and has been the case for decades in the United States, it is the small companies that innovate.

People like this former hedge fund manager turned CEO purchase these small companies speculating that large pharmaceutical companies will purchase them at an obscene price in hopes that one of the drugs in the smaller company’s pipeline will be the next multibillion dollar seller. When this inexperienced CEO raised the price on a newly acquired drug so dramatically, however, stock prices of most pharmaceutical companies tanked. Why, you ask. The answer is simple—fear of regulation.

Since passage of the Affordable Care Act (ACA), the cost of pharmaceuticals in many cases—if not most—has risen more than 100 percent. These are commonly used, effective drugs that have served—and will continue to serve—humanity well. Examine stock market trends and you’ll find that on any day there is some affirmation that the ACA will remain in place—Supreme Court rulings and the like—stock prices across the health care sector jump. Why, you ask. Again, the answer is simple—profits. Investors know that events that affirm the ACA prompt the U.S. government to throw more unregulated cash at a health care system that ranks 37th in the world—based on outcomes—at a cost dwarfing its closest competitor.

There is, without a doubt, need for innovation in health care, but innovation should not be solely for innovation’s sake and increasing profits. Why do we need new and improved drugs if an existing product works well? When there is need for innovation, it needs to be incentivized. Expectation of profits is one way to do that. However, in other sectors, innovation funded by capital markets results from expectation that a product will stand on its own in being adopted and creating profits. You don’t see Elon Musk, founder of Tesla, buying a small car company for the purpose of raising prices to fund development of electric-powered cars. Why, you ask. Another simple answer: These sectors can’t count on unfettered capital being bestowed upon them by the government.

We can no longer allow capitalism to run roughshod over our health care system. The result, predicted by many moderate economists, will be bankruptcy of our nation. Along about now, you may be asking yourself, “Who is this guy making these claims?”

I am a capitalist and an entrepreneur. I am the former CEO of a high-tech company telling you that innovation can still occur the old-fashioned way. I created jobs. I founded a successful—and profitable—health-care IT company that positively impacts patient outcomes. We built our company the old-fashioned way, through hard work. We did not raise capital, thereby becoming beholden to investor whims and quarterly-earnings expectations. Yes, it still can be done. The American Dream is still alive. And that dream does not—and should not—have to come on the backs of the American taxpayer.

I could share my thoughts on finding a solution to what is truly a crisis, a crisis below the radar of the average citizen, but that has never been the purpose of this blog. I want to hear from you.

What are your thoughts? How can the United States, leveraging a capitalist system that has made it the most innovative country on the planet, but which also may contain the seeds of its demise, repair its broken health care system?

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.

What's not to like?

Everywhere we turn we are being asked to “follow” or “like” something on social media. We all understand that the more “likes” a site gets, the more “Google juice”—higher search ranking—it gets. Companies hope that higher search rankings will help them achieve business objectives. Our likes, follows, and other electronic activities allow profiles to be built on us by anyone from marketers to employers to government agencies.

In return for sharing information, our searches are optimized or we are given things. More importantly, we are given the opportunity to offer personal opinions on everything from politics to products.

Recently, language has appeared in the terms and condition statements of many websites—even service contracts—stipulating that any negative statements made by users or their associates, anywhere on the Internet, will incur monetary charges. What used to be “likes only, please” has become “likes only, or pay the price.”

Igor Stevanovic/iStock/Thinkstock

As net neutrality has declined, so too, it appears, has the right to free speech. Having paid for my “free speech” through erosion of my privacy, I now get to pay more to honestly say something negative about a product or service. What’s next, a sliding price scale based on how unkind my opinion is? What about web services that provide recommendations based on customer feedback? What will they do in a world of nothing but likes? I sense the edge of a slippery slope.

I recently came across an article in the British media in which a general-practitioner surgery facility requested that all comments be directed to the administrator and not be posted on social media. A sign to that effect was even displayed in the waiting room. I wonder how long it will be before that same language makes it onto the hospital’s consent form? And how long will it take for the practice to “cross the pond” to the United States and other countries?

Have we indeed come so far that we have to pay if we express a negative opinion about what is truly bad service or an inferior product? I have searched Facebook high and low. Can anyone tell me where that darn “unlike” button is?

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.

Colossal misdirection play?

We have learned of the games held in the Roman Colosseum, either through recorded history or as replicated by Hollywood and embellished for the viewer’s pleasure. To outshine their predecessors, Roman emperors would expend vast sums enhancing the imposing structure. There is evidence, according to some archeologists, that it was even modified to enable flooding for the purpose of reenacting victorious Roman sea battles. And, as people watched the games, for which no expense was spared, that great society fell into decline.

Sound familiar in a scary way? It does for me, too. It’s called the “misdirection play.” I learned it in fourth grade while playing “the game” of peewee football. It scared me then, too, just as it does today, because every time I was deceived by the misdirection play, I got hurt.

As I observe the world today, I wonder if I am witnessing the undoing of another great society. There are certainly many parallels that can be drawn between today and Roman times, and there are certainly many more coliseums. If history is on a path to repeat itself, what will the role of technology be? Savior or contributor to the destruction?

As people watched the games, for which no expense was spared,
that great society fell into decline.

The reason I ask this question is because of a recent vacation experience I had with two children, of whom I am not the parent. The purpose of this vacation was to expose these kids—ages 6 and 9—to the “Great Outdoors.” I applaud their parents for choosing this option over a theme park-based trip. But, as it turned out, when given a choice between going inside to play with technology or going outside to take a walk in the woods and experience nature—perhaps to see real animals in lieu of stuffed ones at gift shops in town—they chose technology.

As I processed these children’s interactions with technology, my mind was flooded with questions: Will they use it to cure cancer? Will they use it to go to Mars and back? Will they use it to find a way to solve the problem of the world’s ever-increasing demand for energy? One could ponder many other questions about the dark side of technology. But the question I kept coming back to was not how they might use technology, but how technology would be applied to them?

Recent events reported in the media have put “Personal Big Data” front and center in the public eye. There is no doubt that social media with all its underlying and associated technologies—one source of big data—have been demonstrated to have positive social benefits. But, in all fairness, we have also seen its negative social impact. So, two questions: 1) “Is technology in the hands of future generations going to have a net positive or negative effect on the future?” And 2) “Will technology, in this coliseum of the future, be a big misdirection play where everybody feels like they are in the game, but where no one goes outside to see the animals until, finally, they’re not there to see?”

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.

A few words on time

Once upon a time, I taught a course on budget and finance for nurses. In the first session, I would introduce the concept of scarcity and ask the class to provide real-world examples of the concept. Every year, the conversation immediately would become lively.

One example mentioned consistently was the “gas crisis” of the 1970s. Some in the class had no idea what was being talked about, but there were always a few students my age that recalled sitting in the back seat of their parents’ car, waiting hours for a few gallons of gasoline. When stories about entertainment devised to pass the time waned, I would burst the bubble of this walk down memory lane with the fact that the energy crisis of the 1970s was a man-made supply crisis and that, to this date, oil has flowed endlessly.

Usually, a student would then bring up the disappearance of the dinosaurs that “became the oil,” and I would acknowledge that, yes, such creatures are scarce—if you don’t include animals such as the alligator, caiman, crocodile, and komodo dragon. I would also acknowledge that, through genetic engineering, the possibility of a real-life Jurassic Park is not far beyond mankind’s reach.

Like sands through the hourglass ...

— Serggn/iStock/Thinkstock

Land was often cited as another example of scarcity. “Location, location, location” was a never-miss contribution. As I have watched the planet change over the years since teaching this course, my perception of location, location, location has altered a bit, supported by Steven Hawking’s recommendation that we find another planet to live on. Today, as then, my response to perceived issues of scarcity is that human ingenuity will overcome such problems.

Usually, about the time discussion closed on the topic of land scarcity, the class would become frustrated and press me for my definition of scarcity. I would agree with the concept, as defined in the textbook of the semester. However, as far as a real-world example that would impact me in my lifetime, I thought of nothing more proximal and more in my control—yet, at the same time, completely out of my control—than time. As they say, once it’s behind you, there’s no getting it back, and you have no idea how much is in front of you.

Now, one could make the case that the issue of time scarcity will also be solved through human innovation, that we’ll be able to extend life by hundreds of years through genetically designed replacement parts. But do you really want a 240-year-old me hanging around the joint? I think not. And where would we put all the other billions of 240-year-olds, not to mention those middle-aged 150-year-olds? A discussion for another day.

Given current realities, our time is scarce. There never seems to be enough of it, and when it’s gone, it really is gone. We give so much of our time to others through work and service, but often don’t take time for ourselves—a topic widely discussed in the nursing profession. Feminists such as Mika Brzezinski and Ariana Huffington make the case that, even in a world of glass ceilings and disparities in pay, one metric of success to strive for lies beyond the title, the corner office, and the package. It is control over one’s own time.

Although I agree with this position, I readily recognize that control over one’s time is not easily attainable. However, the emotional component of how I spend my time should be within my control, and could easily be the driver behind why so many of us have chosen to enter caring professions. But have we lost sight of the fact that control over the emotional component of our day-to-day lives is in our hands?

In our hometowns, we are bombarded constantly with images from around the globe of absolutely horrifying situations. As human beings, we rise to these crises and respond to the best of our ability. However, I doubt there is a person reading this blog who does not agree that the overall stress level of our world has increased.

So, given the world we live in, we can spend our time being fearful, frustrated, and stressed. Or, we can take control of the emotional component of the moment and make our workplace, and maybe someone else’s workplace, a better place—by turning a negative into a positive, a moment of frustration into one of growth, and a moment of anger into a teaching moment.

We have all heard it said, “If I had just one more hour to live, I wouldn’t want to spend it at work.” Given just one more hour, on what random act of kindness would you spend your time?

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. Comments are moderated. Those that promote products or services will not be posted.

Setting the stage

My first image of a nurse is still vividly and indelibly stamped in my mind. Her spotless white uniform was starched and pressed. The cap that identified her as a graduate of Bayonne Hospital School of Nursing was perfectly positioned on her head. Her navy-blue cape flowed in the breeze as she explained to me that she had to go to the park without me because, in case there was a disaster, she needed to practice helping people. I was 4 years old, and that nurse was my mother. The year was 1964.

Shortly afterward, we moved from Bayonne, New Jersey, to Miami, Florida, and my mother, who was single, did what many nurses do. To provide for her family, she took a good job that was available instead of the dream job she had hoped for. But she fell in love with long-term care and has been involved with it one way or another ever since. I recall pulling medical records—charts in those days—around in my little red wagon to the various facilities she worked at, doing my best to help.

As I grew older, she advanced in the profession. To expose me to the many facets of health care, she encouraged me to volunteer and assisted me in attaining, first, volunteer positions and then paid positions such as “transporter.” As with many nurses who had sons, she hoped I would one day consider being a physician.

As a teenager, I was scared to death by the thought of spending that much time in school. So, I took the passion for health care and helping people she had instilled in me and worked as an ER tech while becoming a firefighter paramedic. I loved my work but, after several years, the 24-hour shifts became daunting, and I decided it was time to go back to school and explore other professions.

I was standing in line to register for business classes when the thought struck me like a .45 slug to the back of the head: I did have a gift, and it wasn’t playing the guitar. It was being able to hold down my lunch and be compassionate in situations that would send some people running in another direction, screaming for help. I also realized that I had honed skills that should not be squandered. So, I registered for prenursing courses and have never looked back.

I’m sharing this story as my first blog post so that you know I have been close to health care and nursing all my life and am extremely passionate about both. A great deal has changed since that image of a professional nurse was imprinted in my mind. Some has been for good, some not so much. And, as we are all acutely aware, there is a lot more change ahead.

There are hundreds of blogs out there you could spend your most valuable asset—time—reading. I could write a similar talking-head blog, but I don’t believe the profession needs another. What is needed is respectful discourse about the topics of our time, and I hope this blog will be a catalyst for that. If you agree, let me know by posting a comment. If not, then don’t, and that will be my indication that I need go no further or that I need to find a different forum to stimulate conversation in hopes of positively impacting health care, nursing, and the population we serve.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.