Nurse Navigator Quotes

Undoubtedly, my dear Dick. Just note the progress of events: consider the migrations of races, and you will arrive at the same conclusion assuredly. Asia was the first nurse of the world, was she not? For about four thousand years she travailed, she grew pregnant, she produced, and then, when stones began to cover the soil where the golden harvests sung by Homer had flourished, her children abandoned her exhausted and barren bosom. You next see them precipitating themselves upon young and vigorous Europe, which has nourished them for the last two thousand years. But already her fertility is beginning to die out; her productive powers are diminishing every day. Those new diseases that annually attack the products of the soil, those defective crops, those insufficient resources, are all signs of a vitality that is rapidly wearing out and of an approaching exhaustion. Thus, we already see the millions rushing to the luxuriant bosom of America, as a source of help, not inexhaustible indeed, but not yet exhausted. In its turn, that new continent will grow old; its virgin forests will fall before the axe of industry, and its soil will become weak through having too fully produced what had been demanded of it. Where two harvests bloomed every year, hardly one will be gathered from a soil completely drained of its strength. Then, Africa will be there to offer to new races the treasures that for centuries have been accumulating in her breast. Those climates now so fatal to strangers will be purified by cultivation and by drainage of the soil, and those scattered water supplies will be gathered into one common bed to form an artery of navigation. Then this country over which we are now passing, more fertile, richer, and fuller of vitality than the rest, will become some grand realm where more astonishing discoveries than steam and electricity will be brought to light.

It’s not always so easy, it turns out, to identify your core personal projects. And it can be especially tough for introverts, who have spent so much of their lives conforming to extroverted norms that by the time they choose a career, or a calling, it feels perfectly normal to ignore their own preferences. They may be uncomfortable in law school or nursing school or in the marketing department, but no more so than they were back in middle school or summer camp. I, too, was once in this position. I enjoyed practicing corporate law, and for a while I convinced myself that I was an attorney at heart. I badly wanted to believe it, since I had already invested years in law school and on-the-job training, and much about Wall Street law was alluring. My colleagues were intellectual, kind, and considerate (mostly). I made a good living. I had an office on the forty-second floor of a skyscraper with views of the Statue of Liberty. I enjoyed the idea that I could flourish in such a high-powered environment. And I was pretty good at asking the “but” and “what if” questions that are central to the thought processes of most lawyers. It took me almost a decade to understand that the law was never my personal project, not even close. Today I can tell you unhesitatingly what is: my husband and sons; writing; promoting the values of this book. Once I realized this, I had to make a change. I look back on my years as a Wall Street lawyer as time spent in a foreign country. It was absorbing, it was exciting, and I got to meet a lot of interesting people whom I never would have known otherwise. But I was always an expatriate. Having spent so much time navigating my own career transition and counseling others through theirs, I have found that there are three key steps to identifying your own core personal projects. First, think back to what you loved to do when you were a child. How did you answer the question of what you wanted to be when you grew up? The specific answer you gave may have been off the mark, but the underlying impulse was not. If you wanted to be a fireman, what did a fireman mean to you? A good man who rescued people in distress? A daredevil? Or the simple pleasure of operating a truck? If you wanted to be a dancer, was it because you got to wear a costume, or because you craved applause, or was it the pure joy of twirling around at lightning speed? You may have known more about who you were then than you do now. Second, pay attention to the work you gravitate to. At my law firm I never once volunteered to take on an extra corporate legal assignment, but I did spend a lot of time doing pro bono work for a nonprofit women’s leadership organization. I also sat on several law firm committees dedicated to mentoring, training, and personal development for young lawyers in the firm. Now, as you can probably tell from this book, I am not the committee type. But the goals of those committees lit me up, so that’s what I did. Finally, pay attention to what you envy. Jealousy is an ugly emotion, but it tells the truth. You mostly envy those who have what you desire. I met my own envy after some of my former law school classmates got together and compared notes on alumni career tracks. They spoke with admiration and, yes, jealousy, of a classmate who argued regularly before the Supreme Court. At first I felt critical. More power to that classmate! I thought, congratulating myself on my magnanimity. Then I realized that my largesse came cheap, because I didn’t aspire to argue a case before the Supreme Court, or to any of the other accolades of lawyering. When I asked myself whom I did envy, the answer came back instantly. My college classmates who’d grown up to be writers or psychologists. Today I’m pursuing my own version of both those roles.

The other feature of this list is that many of these signals could easily be viewed as obvious and redundant. For instance, do highly experienced professionals like nurses and anesthesiologists really need to be explicitly told that their role in a cardiac surgery is important? Do they really need to be informed that if they see the surgeon make a mistake, they might want to speak up? The answer, as Endmondson discovered, is a thundering yes. The value of those signals is not their information but in the fact that they orient the team to the task and to one another. What seems like repetition is, in fact, navigation.

With the lens of Jobs to Be Done, the Medtronic team and Innosight (including my coauthor David Duncan) started research afresh in India. The team visited hospitals and care facilities, interviewing more than a hundred physicians, nurses, hospital administrators, and patients across the country. The research turned up four key barriers preventing patients from receiving much-needed cardiac care: Lack of patient awareness of health and medical needs Lack of proper diagnostics Inability of patients to navigate the care pathway Affordability While there were competitors making some progress in India, the biggest competition was nonconsumption because of the challenges the Medtronic team identified. From a traditional perspective, Medtronic might have doubled down on doctors, asking them about priorities and tradeoffs in the product. What features would they value more, or less? Asking patients what they wanted would not have been top of the list of considerations from a marketing perspective. But when Medtronic revisited the problem through the lens of Jobs to Be Done, Monson says, the team realized that the picture was far more complex—and not one that Medtronic executives could have figured out from pouring over statistics of Indian heart disease or asking cardiologists how to make the pacemaker better. Medtronic has missed a critical component of the Job to Be Done.

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Journal Entry – April 17, 2013/May 10, 2013 Hollow. Numb. Empty. Nothingness. Are these feelings? Or are they just words in the English language? I ask these questions, because these words best describe how I feel right now as I sit here in my hospital room. The waiting game. My mind and thoughts swishing around my head, and my eyes burn feeling as if I am going to cry at any moment. Breakfast has come and gone. Vitals have been taken. And the five to ten minute check in with my assigned morning nurse has occurred. It has been three hours since I woke up, and I have twelve to thirteen hours to survive before I can go to sleep for the night. My day will be made up of one education group, lunch, dinner, and the remainder of the day and evening doing nothing but laying on the bed curled up in a ball depressed waiting for the time to pass looking at the clock hanging on the wall periodically wishing the time would move faster… on the flip side…a few days later…Writing in an attempt to keep my mind and head out of the skies. My heart feels as though it will beat outside of my chest, and my brain is on its own axis within my skull. I feel like I am on top of the world. I feel like I could do anything. I feel like I could write forever. I feel like my mind is on the spin cycle of a washing machine. Or, like I am hooked onto a pair of windshield wipers stuck on a speed mode. Although, my brain has spun faster than this and I feel that the meds are keeping the jerks at bay, I still feel that all too familiar whirling feeling. It is indescribable. It is hard to pinpoint. Some of it must be anxiety. Some of it must be that I am locked up like a caged animal ready to pounce. Then again, some of it must be nature. My brain misfiring and backfiring and causing itself to spin in every which direction at all sorts of speeds none of which are consistent or in the same direction. Inconsistency. Slow, fast, in between. A complete blur. I have trouble tracking. I have trouble focusing. I have trouble remembering…My mind is obsessing. I try to stop my mind from racing. I try to stop my eyes from darting across the page. I try to stop my legs from jittering. To no avail. It all starts again. My internal engine drives the show. It is as if I have a compulsion to move and dart and jerk. It is uncomfortable. My thoughts are scattered. My thoughts do not make sense. I find I have to edit my own thoughts or at least dig through the mess. I must navigate the thoughts to find the ones that fit together all in time before the memory loses focus and the tracking loses hold and “poof” the statement or thought is gone forever. Frustrating. I am intelligent. I feel stupid. My mind is in 5th gear and climbing at an unprecedented rate of speed. It is magical and amazing, but terrifying and exhausting. How to remain “normal” – is it possible? Is there a possibility of the insanity to stop? Is it possible for the cycle of speed to come to an end? I like the productivity, but the wreckage is too much to take. I just want a break. I want to be normal. I don’t want to be manic.