The Discomfort of Trying to Create Change in Health Care and Beyond

In complex systems, change takes persistence.

Over the years, coworkers have often described me as “the dog with the bone.” Once I become invested in something, I tend not to let it go. That persistence has helped me create meaningful change within health care systems. It has also shown me how much organization, follow-up, patience, and emotional stamina meaningful change often requires.

I have also learned how often the answer is no. Sometimes the “no” is direct. Other times it comes through silence. Some ideas take longer to gain traction within large organizations than people initially expect. Creating change in any environment can be difficult. In health care systems, it can feel especially challenging.

Health care organizations are responsible for large numbers of patients, employees, regulations, budgets, and risks. Decisions that appear simple from the outside often involve layers of oversight, approvals, coordination, and competing priorities that most people never see. Still, understanding those realities does not necessarily make the process less discouraging.

The temptation to give up.

I have experienced this in clinical practice when advocating for patient education initiatives, operational changes, or workflow improvements that initially seemed straightforward. In health care, even small changes can require multiple approvals, coordination across departments, competing priorities, and […]

Men in Military, Psychiatric, and Anesthesia Nursing: A Historical Continuity

A history obscured by titles

Unidentified Civil War male nurse at Mt. Pleasant Hospital, Washington, D.C., in uniform

Men were not absent from nursing’s history. They worked in military and psychiatric hospitals, men’s wards, hospital schools of nursing for men, anesthesia departments, and nursing practice committees. However, records confined them to being known by other titles, including attendants, orderlies, hospital stewards, corpsmen, soldiers, anesthetists, and brothers. These labels mattered; they determined who was considered a nurse, allowed into professional nursing associations, and included in nursing histories.

Military hospitals and bedside work

One of the most impressive examples of this trend is military medicine, with the lines between nursing and transport, sanitation and medical care often blurred. Men carried water, changed bedding, moved the wounded, washed the soiled body, took the temperature, distributed food, helped to dress wounds, attended wounded men in their delirium, and sat with them while they died. For the U.S. Civil War, the majority of those contracted to provide nursing services for Union forces were males. Since many were soldiers, hospital stewards, or civilian helpers, the work was often remembered as military labor rather than nursing labor.

Civil War hospitals in Washington, DC, such as Armory Square Hospital, had wards filled with rows of wounded […]

2026-06-26T10:43:04-04:00June 26th, 2026|Nursing|0 Comments

250 Years of American Nursing—and More AJN July Issue Highlights

The July issue of AJN is now live.

Here are some highlights. Some articles are open access or temporarily free; others will require log-in for access.

A Military Encampment in Hyde Park by James Malton, 1785. This drawing is featured in the Nursing the Revolution exhibit currently on view at the Barbara Bates Center for the Study of the History of Nursing. For more, see On the Cover.

In recognition of the 250th anniversary of American independence, this special issue of AJN examines nursing’s role in early U.S. history.

  • A photo-essay features images from Nursing the Revolution, an exhibit at Penn Nursing’s Barbara Bates Center for the Study of the History of Nursing in Philadelphia that sheds light on nursing at a time when the concept of the “professional nurse” had yet to emerge.
  • In her Guest Editorial, “American Nursing: 250 Years and Counting,” Penn Nursing professor and dean Antonia M. Villarruel urges amplification of “nursing’s past, present, and future contributions.”
  • In her Viewpoint article, “Nursing the Revolution,” J. Margo Brooks Carthon, the Barbara Bates Center’s director, calls for a reexamination of nurses’ influence on U.S. health care’s roots—and a reclaiming of this history.

Additional articles this month include a

2026-06-25T09:38:01-04:00June 25th, 2026|Nursing|0 Comments

Rethinking Nurse Identity and Burnout Using Structured Coaching Spaces

Nurses have become fluent in the language of “burnout.” We use the word to describe a range of internal states such as exhaustion, disengagement, frustration, and compassion fatigue, states that are often attributed to staffing shortages and other systemic pressures. The term has become so embedded in our professional vernacular that it risks lumping distinctly different experiences into a single narrative.

Identity erosion as a framing device for understanding burnout.

In my coaching work with nurses, I have found that framing these experiences through the lens of professional identity adds a layer of clarity that is often missing from burnout conversations. Many nurses are beginning to see that their professional identity has been shaped over time by the environments in which they work, sometimes in ways that have lessened their sense of self.

Naming this as identity erosion does not separate it from burnout, but instead helps explain the deeper impact while opening the door to a greater sense of control. This shift in thinking explains why some nurses are asking deeper questions about their values, purpose, and how their work reflects who they are.

To be clear, health care systems deserve scrutiny. Nurses are working within environments that often demand increased productivity while constraining time, autonomy, […]

2026-06-22T11:15:07-04:00June 22nd, 2026|nurse staffing, Nursing, nursing career|1 Comment

What ‘Stronger Than Chemo’ Means

During a safety huddle, one of my colleagues, an oncology nurse and breast cancer survivor, spoke honestly about what cancer felt like to her. “Every day you’re scared. Is the treatment or the cancer going to kill me?” she said. “You think about it all the time.” Her words struck me because of how open and exposed they felt. There was nothing polished or inspirational about them. Just honesty.

woman looking at spacious landscapeFor oncology nurses, a day at work may feel like another clinic day, another infusion, another patient assignment. But patients walk into the same space carrying entirely different realities. Fear. Grief. Uncertainty. Hope. Devastating news. Relief. Sometimes all at once. Her words reminded me how important it is to respect that difference and remain mindful of it.

I remember entering a patient’s room smiling ear to ear. She asked me why I was so happy. Without thinking, I answered, “It’s a good day.” Looking back, that response feels insensitive. I later learned that earlier that day she had been told her cancer was metastatic. Shortly after I left the room, I heard her sobbing behind the curtain. That moment stayed with me because what felt like an ordinary good day to me was one […]

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