keynote address, sigma theta tau, national honor society of nursing, biennial convention, 1973

lngeborg Mauksch, Associate Professor and Family Nurse-Practitioner, Department of Community Health and Medical Practice, School of Medicine, University of Missouri, Columbia.

Many years ago, when my husband was a graduate student a t the University of Chicago, he received a letter one day inviting him to membership in Phi Beta Kappa, honorary society: to my surprise I was included in the invitation to attend the initiation dinner. This turned out to be a much more memorable event than I realized at the time because the speaker, who was a professor of Greek, spent the entire time of the address assuring the as- sembly that they were a group of extreme- ly important people. They represented the elite of society they were told and as such he outlined for them what their pri- vileges were. I have thought about this ever since. When I was invited to join Sigma Theta Tau, my first response was that i f this were to be an organization which will assure me only that it will make me an elitist, then I woulc‘ certainly not be i t s member and I would have none of it. Of course, I know since I have become a member, this i s not the way we look at ourFelves. So I decided tonight that I need to look with you toward the year 2000. I need to look with you at those criteria of our organization whicii d j s i j i us in pointing towards the job which I be- lieve we have to do to make the future better by making nursing better. That is our job - not to think of ourselves - but to think of the profession.

There are many criteria which sociolo- gists particularly use to describe the pro- fession. I would like to discuss the signifi- cant criteria of self perception and of un- derstanding about who one i s a member of the group, because one needs to under- stand the group, i t s mission, i t s fl;nciion, i t s concerns, and i t s mandate. To me, one of the things which has been lacking in nursing to a large degree has been i t s sense

of self, whicll has prevented us from hav- ing a collective sentiment and which has prevented the all important “we“ feeling. I believe that as members of Sigma Theta Tau, we need to assist our members to close the ranks of nursing as we look to- ward the year 2000 and to start all efforts necessary to create this important “we” feel i ng.

Today, were I to characterize nursing, I would have to say that generally speak- ing, i t i s an “I” and an “ I ” group, rather than a “we“ group. There are many rea- sons why this is so, but it is not possible for me to explore them all. I will attempt, however, to give you an overall concept in terms of how I look a t the problems which we need to overcome in order to succeed in making nursing a group that i s whole, exciting, and resourceful.

Our employment status brings us in contact with many individuals, notably physicians whom we view as attaining higher status and enjoying higher prestige than we do, and this, among other things, results in our feelings t i i z t they indeed are our chief reference group. This i s the group to which we turn in many ways for many of our rewards rather than to each other; and they, until recently, were ex- tremely instrumental indeed in affirming our success and value of our own contri- bution to the care of people.

We have, a t this point in time, a real big job in substituting reference groups and reference individuals within our own smallest field of activity and within thL largest field of nursing in the delivery of health and illness care.

This enables us to look to each other and say this is the most important person

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i t 1 terms of my ciitical tclationships. One 1-eason we are having a very hard time es- tablishing cohesion is due to the fact that a large number of us are still working in hospitals and the hierachial nursing struc- ture in hospitals is different and probably more bureaucratic than any other system of which I can think.

It is not possible for any one social system to have equal dimensions which reach horizontally and vertically. Nursing as you know i t today basically lacks a sound horizontal structure. We are in es- sence the most vertical structure that exists both in the health and iilness care delivery field and in other professional fields. I can think of no other that is as strictly and stringently vertically organized as nurs- ing. This has indeed ,cted as a very de- visive element, a devisive instrument i f you will, in preventing us irom developing the kind of cohesion we need in order to de- velop the kind of self-concept and self- worth which will enable us to deliver care to people on the level that 1 know we are capable of doing a t a time and in the way which i s very badly needed.

You see, I do not believe that nursing noeds to survive for the year 2000 so that you will have a job. l know that you will have a job even i f i t isn't under the label of nurse. I believe, and this is a very ser- ious consideration of mine. that nursing must survive because that which i t has to offer to peopie is precious and undupli- cable. I f we do not provide it, no one will and society will indeed be the poorer and worse for that.

Rather than sticking together, we find ourselves having nurse pitted against nurse and nurse counter-acting nurse. Tiie so!- legial relationships which we observe in other professions have not as yet develop- ed. I think a very practical way to ex- plain this is to use the nursing office in the hospital as a territorial entity and to ask you to try and search for its equiva- lent in any other profession. I don't be- lieve you will find it. On the other hand, I can think of territorial meeting grounds that other professions have, be it the teachers' r o o m i r i the public schools or the surgeons' coffee room in the operating room suite. ! t is a simple way of explain- ing collegial relationships, but t h e more we think of i t the more you realize how signi- f i can t i t is.

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Our practice i s beginning to take shape and to have real meaning. Basically, our motivation always had meaning and it also had mote humariity and mure caring com- ponents than that o f any other profession. Now is :he time to put it a l l together - to put i t into that kind of collegial con- text which will enable us to pull together and to learn to l ive toge'rher.

When I talk with my husband who is a sociologist about nursing, he reminds me that nursing indeed has exhibited a l l the characteristics of a minority group over the years, regardless of the fact that num- erically i t i s not a minority group. The fact that i t still i s essentially a women's group, primarily consisting of secondary wage earners, certainly has not helped. When one looks at the research literature of minority group behavior one is struck with the similarity o! behaviors of the in- dividual against another individual. Put- ting someone down in order to lift one's self up, not supporting each other, but fighting each other are typical. Looking toward a higher status in a group or look- ing outside for any source of reward rather than being mutually supportive and pro- viding rewards for each other i s typical. I strongly believe that we need to under- stand this now because we must start im- mediately to overcome it. I feel that we can. As I look to the year 2000, it occurs to me that we need to do this thru a triad of thrusts, al l of which are very much with- in the province of Sigma Theta Tau. I believe these thrusts are reflected potent- ial!y in the talents of the leaders and acti- vists in cursing. They could become in- struments of change through:

I. Nursing Practice: the ahr-don- ment of nursing the Desk and the thrust toward nursing the Patient.

I I . Total restructuring of our Health Care Organization so that in hospitals we do not have nursing services, but nursing departments divested of managerial acti- vities and focused on nursing practice. I think we have done much better in com- munity health agencies, but we s t i l l have a long way to go.

1 1 1 . An all-out effort toward peer support and peer recognition.

Not long ago I said to one of my child- ren, "Name three teachers in your lower

grades that you think were outstanding.” I t was very easy for this enumeration to take place. Then, turning this around, I said to a number of nurses, “Name three of your classmates from Nursing School who have become outstanding nurses.” I didn’t say famous or rich - I said out- standing. I t was very difficult for them to list three outstanding nurses. Think about how well you could do. I am sure you will agree with me that chances are that there are three outstanding nurses who graduated with you. But do you know about tham and do you let them know that you think they indeed are outstand- ing nurses?

Essentially we are a materialistically oriented society. The kinds of reward a l l groups in our society seek are no different than those we seek in nursing. Obviously, they are power, prestige, and economic rewards. We have not done very well in obtaining them. We have not looked for money because basically that was against our ethic. We have not obtained prestige, because money and prestige are very close- ly associated in our society. I believe we have shunned power because in many ways we have felt that power is something ugly. Indeed, it is an ugly thing i f misused; we are now witnessing that in Washington in one of the greatest dramas in the history of :he Uniteci States. However, will you agree with me that power can be used pro- perly? It can be used for those whom one wishes to serve. I f this i s indeed the case, we have failed very badly. I t took us all too long to recognize that the decisions made affecting health and illness care of p e a p l ~ a1.e iiiade piiriidiiiy b y iiiose wiio indeed have power. These have not al- ways been the best decisions, have they? Now, we as a group recognize that we have a serious responsibility; we must under- stand what power means, how i t is ob- tained, and how to use it to the advantage of those we serve.

We have alternative routes of obtain- ing power, prestige, and the kind of status which will enable us to assume our right- ful place under the health and illness care delivery sun. But we cannot do it as indi- viduals; we must do it as a collectivity. Furthermore, we must start by respecting each other. Rrhaps I should say first of al l by respectii:.g ourselves and by knowing

our own w,-r?h. Once we know this, we can learn to lc;,x?ct each other, and only then will we succeed and do for our pa- tients what i s due them.

I hope we will learn that anything that affects one nursc a f fec ts us all, and any- thing that one of us does, wnether good or bad, we all do. How better can we ful- fill the objectives of Sigma Theta Tau which our founders so beautifully put be- fore us?

I would like to conclude by telling you a simple story from the Bible which to me exemplifies better than I can, what brotherhood and sisterhood means. It i s the story of two brothers who were farm- ing together. One was married and lived in a house with his family; the olher was single and lived in another house down the road. One night the married brother could not sleep. His thoughts went some- thing like this: It is really terrible to think that my brother has no children who will take care of him in his old age. It is not right that we always share our harvest alike. I must get up now and take some of my cctn and take i t into his barn while he is asleep so that he will have more than I have. I have children who will look after me; I will be taken care of. H e gets up and takes big sacks of grain and places them under his brother’s roof. A t the same time, the single brother cannot sleep. He says to himself: there is probably no way that I could convince my brother that he should have a larger share of our harvest because he has all these children to feed and I hav. only myself t o look after. Sinco he will not be reasonable about this, the only thing for me to do i s to get up in the middle of the nigt-,t whi:e he i s asleep and get some of my corn under his roof before he awakes in the morning. And in- deed this is what he does. This goes on for many nights, until m e night they meet in the middle of the field. They know im- mediately what is happening; they em- brace an3 cry. Their tears hollow the ground, designating the place where the Lord decided that the temple be built.

As I look a t you on this special oc- casion of the 50th Anniversary, I have the feeling that Sigma Theta Tau might be the place upon which the Temple of Nursing for the year 2000 might be built.

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