It is very flattering, yet daunting, to have someone ask you to write about yourself. Like many nurse leaders, I do not think of myself in terms of leading. I am dedicated to caring for older adults with cognitive loss, and during the course of many years, I have expanded my practice to help elders receive better care. In addition, I am easily bored with routine and thus require change or a variety of things to consider at any given moment.
My earliest recollection of wanting to be a nurse was about age 5 while I was wearing a nurse's cap during a visit to the home of a family friend. The owner of the cap presented it to me at the end of the visit. I played with it until it fell apart.
In school I hoped to become an artist until my father explained: “You are probably going to have to support yourself some day, and it probably won’t be as an artist. Think seriously about something else.” In my sophomore year, a film on nursing was presented. I knew instantly that I was going to be a nurse and enrolled in science and math classes. The next summer I became a candy striper and announced my plans to my parents.
“You cannot be a nurse!” my mother moaned. “Don’t you know what nurses have to do? The only decent thing they get to do is arrange flowers. Why don’t you become a switchboard operator? There will always be a need for switchboard operators.”
My resolve strengthened during “negotiations” that lasted more than 2 years. I applied to a diploma program. The interviewer told me I belonged in a baccalaureate program, but I assured her I would probably get married and raise a family, never needing a baccalaureate degree. I entered Temple University Hospital School of Nursing in 1964, where I learned to work hard and volunteered for any new assignment as an adventure.
After I completed my bachelor's degree, I worked part-time as a staff nurse in neurology, neurosurgery, tuberculosis control, medicine, an emergency department, and a nursing home. Once finished, I started teaching at other diploma programs: rehabilitation nursing, neurology, operating room, pediatrics, and immune system diseases. Neurologic rehabilitation finally captured my interest, and from that I gravitated to caring for older adults. One year I supervised a proprietary home health agency and finally decided to become a nursing rehabilitation consultant for a large insurance corporation. The disadvantage of changing jobs frequently was that my resume wasn’t strong, yet the breadth of my practice helped prepare me for the complexities of gerontology.
In an odd twist of fate, I went to California for orientation to the insurance company. While out for dinner the second night, I met my future husband and, a year later, moved from Philadelphia to Iowa to begin my career. Undereducated, I worked as a public health nurse, a staff nurse in neurology at the Veteran's Administration hospital, and then found a position as an interdisciplinary team member in Iowa's first elder case management project. Much of the project depended on establishing links within the community and across the state, tasks that introduced me to public policy work.
Later my husband and I moved to Portland. I started a gerontology assessment program for Good Samaritan Medical Center, where my practice consisted solely of people with dementia illnesses. To support the program, I served on community task forces for elder care. I was introduced to the Alzheimer's Association, and a long and mutually profitable alliance was formed.
Returning to Iowa, I was offered my “dream job”—gerontology clinical nurse specialist at University of Iowa Hospitals and Clinics. The position was offered contingent on completing a master's degree in nursing. This move was a turning point in my career as I met and was mentored by some of the kindest, brightest, and most generous nurses I have ever met.
Kathleen (Kitty) Buckwalter, PhD, RN, FAAN, had just completed her doctorate and was enrolled in a gerontologic postdoctoral program when we met. We forged a partnership that lasted throughout my student years at University of Iowa. Kitty made sure I was adequately challenged during my master's program by encouraging me to embrace gerontology and dementia with a passion. She hounded me to publish each class paper. We wrote together, spoke together, and became mutually strong. When I finished my master's degree in nursing, she insisted I begin my doctorate.
Other nurses who encouraged and mentored me in educational and clinical settings include Sally Matthes Hartwig, RN, MA; Myrtle Kitchell Aydelotte, PhD, RN, FAAN; Geraldine Felton, RN, PhD, FAAN; and the late Nancy Melvin, PhD, RN, FAAN. Each contributed to my professional growth in tangible ways. I also have had the privilege to work with nurses who have international reputations in their fields of expertise and have tried to model my practice according to their example.
Clinical practice has always been the driving force in my career. Without practice, my heart doesn’t beat. My patients are my passion, and I have striven to be the best clinician I can be. When I started my Alzheimer disease (AD) practice, families had few resources. I made a commitment to rectify this shortfall through community action, serving on boards of a senior center and local Alzheimer's Association chapters. In 1984, I served on the Iowa Task Force to Develop Standards for Alzheimer's Units, and in 1986 I was asked by the governor to chair the Iowa Governor's Task Force on AD and later the Iowa Legislative Advisory Panel on AD.
At the same time, I wrote the Progressively Lowered Stress Threshold Model, which Kitty and I published in 1987. Its publication triggered a landslide of approximately 70 others. My research has centered on the use of the theoretical model for planning and evaluating care in nursing homes, homes, and hospitals. Once I started publishing regularly, I was asked to serve on editorial boards of several journals, including Journal of Gerontological Nursing, Journal of Mental Health and Aging , and Alzheimer ’s Care Quarterly . I also review articles for other journals and grants for organizations, have consulted on restraint reduction in acute care, and have served on a few expert panels for the Alzheimer's Association.
In 1988, I was inducted into Sigma Theta Tau and won the Finkbine Award as Outstanding Graduate Student Leader. An evidence-based protocol on constipation won the Sigma Theta Tau Springer Award in Gerontology in 1994.
In 1998, with help from Nancy Melvin and faculty from Arizona State University College of Nursing, I completed my dissertation, dedicating it to Nancy. Unfortunately, she died the day before I was to give her a copy. In 1999, I was deeply honored to be inducted into the American Academy of Nursing.
In 1996, I accepted an advanced practice position in the Department of Neurology at the Mayo Clinic in Scottsdale, Ariz. There my clinical skills were practiced in a pure and ideal form, yet I missed collaborating with peers and academics. I learned from Nancy Melvin's death that we do not go on forever. If any benefit from my work would continue, I would have to begin to educate and mentor others (beyond the hundreds of continuing education units I’ve offered). I returned to the University of Iowa in 2000, where I now teach in the adult and geriatric advanced degree programs, am director of the master's of science in nursing programs, and practice one day a week.
In addition, I serve as the policy director for the Hartford Center of Geriatric Nursing Excellence, am the coprincipal investigator of an Administration on Aging Alzheimer's grant to eight rural counties in Iowa, and continue to be active in public policy. At this writing, I am participating in a task force to develop policies for dementia-specific care in assisted-living programs.
In my spare time for the past 6 years, I have been serving as an informal professional advisor to the Washington University (St. Louis) Alzheimer's Disease Research Center's on-line support group. Three years ago, I started taking art lessons. I even sell a few pictures from time to time. Maybe my father was wrong!
For me, leadership was not an aim or goal. If I am a leader, it is because I’ve learned the following along the way:
•I am relentless in my pursuit of providing better care to older adults.
•I cannot outthink many people, but I can outwork most.
•Life sends us many opportunities. We have to be open to them and take advantage of them.
•Life also sends people to help along the way. There is not one person I’ve met who hasn’t taught me something, but I have to be open to listen and learn from them.
•Nurses who “eat their young” or who do not share their expertise fail to grow and do not contribute to the profession. It is only through sharing and active mentorship that professional nursing will survive.
•You have to look at your practice in a variety of ways. Working hard for 8 or 12 hours a day at one task won’t help you grow.
•Community and policy work are both frustrating and rewarding, and nurses offer a unique and balanced perspective. A nurse is often the sole person at the table thinking about the welfare of the patient.
•I have learned to take my work seriously without taking myself seriously.
•I have also learned that success is a lot like winning a pie—eating contest for which the prize is another pie—there's always more to do!
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