Marie-Eileen Onieal, PhD, CPNP, FAANP

 As health technology and methodology advance, the need for continued learning and scholarly activities has driven many of us to pursue advanced degrees. Many are poised in various states of completion, with as many reasons for being stalled in one stage as there are degree programs. Recently, in a conversation with friends, we reminisced about our “all-but-dissertation” days. While the pain of the process has finally become a mere wince in recollection, the memory of how much support we each received is ever present in our minds. 

The common African proverb, “It takes a whole village to raise a child,” is poignantly applicable when a spouse, significant other, or parent ventures into the “terminal degree” vortex. Acknowledgements in the preface of the (finally) finished document are mere prattle compared to the words of encouragement, the editing assistance, daily sounding board, and relief from day-to-day responsibilities that allowed us to chase our dream. Through months of listening to ideas in which fewer than a dozen people in the world have any interest, the vague responses to questions posed, the ninety-dollar technical words, and the necessary absence from family time, a few phrases are hardly sufficient to recognize the sacrifices our families made so we could complete the #$%^&* dissertation.

We have all heard horror stories about the dissertation phase, the dissertation committees, and the frustrations of topic approval, conducting the research, writing the manuscript, and defending the work. What those of us who have survived the process often fail to tell are the stories of who made our success a reality, and how. After the year I spent languishing in the preproposal phase, my spouse and I had a lengthy heart-to-heart conversation about whether I was “in” or “out” of the dissertation; was I going to be “ABD” or “PhD”? That was my reality check. Had I spent too much time with my computer and not with my spouse? Had that much time gone by without my realizing it? I knew I just couldn’t walk away—I had to finish—but how could I do that and maintain our relationship?

There are several guides to assist the “disserter” to finish the blasted doctoral degree: books, Web sites, and support groups. My dissertation buddies and I met monthly. Our motto was “focus to finish.” We listened as each of us gave an update on our progress, or lack thereof. We guided each other through committee selections, topic refinement, and survey development. We cheered each success and consoled each setback. 

When the idea for this editorial popped into our conversation, my spouse and I recalled the approach we took to “getting it done.” We searched our computers for the documents that were my guide and provided my daily structure. Alas, they were long gone. Much to our pleasure and laughter, we found a guide1 almost identical to the approach we had put together for me. What this meant was that we had created something that also worked for someone else. The concepts are intuitive and simple, although they require a great deal of discipline from both the “disserter” and, more significantly, the associated person in the disserter’s life. 

True to my spouse’s profession, project management processes were established; we first decided on a target date for the proposal, then another for the defense. I sent a schedule for my deliverables and a list of my expectations to each member of my dissertation committee. Once I had received agreement and approval from them on the proposed timelines, I posted the schedule on my computer. I held not only myself to the identified milestones and dates, but also my committee members. When I missed the mark, I advised them; when they didn’t provide feedback within the approved timeline, I presumed they had none. That was the deal we agreed to, and more notably, my project manager was ensuring that I stuck to that deal! —Not so easy when the peace of the household was at stake and a dangling carrot of a trip to a private island in the Caribbean hung in the balance. If I finished on schedule, I was going!  

I was privileged to be able to quit my job and have “only” the dissertation be my sole responsibility. I was reminded that the dissertation was not my life’s work, but my current job. I started every day just as though I was going to an office, and I stopped working at the end of that day. Evenings and weekends were time to spend together and to visit with friends and family. Life at home was getting better! Discussions about the dissertation were off limits at those times, and the break often helped restore the energy I needed to maintain my world of project management discipline. More importantly, keeping that time sacrosanct meant that our relationship was not only not lost, but actually improving along the journey. 

Completing my dissertation was a momentous achievement, but I could not have done it without the support of my sweetheart—a project manager extraordinaire. We shared in the commitment to get it done. We celebrated each milestone and cursed the stalled days. But the motivation and management never wavered. Whenever I lost my momentum, to say that I was prodded to keep moving would be an understatement. And with the same zeal, I in turn prodded my Chair—who after I was finished, called me a “bully”! That comment never ceases to make us chuckle. I guess she had never before been “project managed” by a professional with 20+ years’ experience of moving projects to success. And yet, that is what it takes to finish: a relentless perseverance to stay on task with your timelines—and a family whose desire to finish is as great as your own. 

To those of you who are taking the step into doctoral studies, I highly encourage you to bring on your family as a key component of your staff—because it is the family that finishes the dissertation. And just in case you become too preoccupied with your degree completion and success, do not forget to say thank you to your family. 

Thank you, Sweetheart!

 As health technology and methodology advance, the need for continued learning and scholarly activities has driven many of us to pursue advanced degrees. Many are poised in various states of completion, with as many reasons for being stalled in one stage as there are degree programs. Recently, in a conversation with friends, we reminisced about our “all-but-dissertation” days. While the pain of the process has finally become a mere wince in recollection, the memory of how much support we each received is ever present in our minds. 

The common African proverb, “It takes a whole village to raise a child,” is poignantly applicable when a spouse, significant other, or parent ventures into the “terminal degree” vortex. Acknowledgements in the preface of the (finally) finished document are mere prattle compared to the words of encouragement, the editing assistance, daily sounding board, and relief from day-to-day responsibilities that allowed us to chase our dream. Through months of listening to ideas in which fewer than a dozen people in the world have any interest, the vague responses to questions posed, the ninety-dollar technical words, and the necessary absence from family time, a few phrases are hardly sufficient to recognize the sacrifices our families made so we could complete the #$%^&* dissertation.

We have all heard horror stories about the dissertation phase, the dissertation committees, and the frustrations of topic approval, conducting the research, writing the manuscript, and defending the work. What those of us who have survived the process often fail to tell are the stories of who made our success a reality, and how. After the year I spent languishing in the preproposal phase, my spouse and I had a lengthy heart-to-heart conversation about whether I was “in” or “out” of the dissertation; was I going to be “ABD” or “PhD”? That was my reality check. Had I spent too much time with my computer and not with my spouse? Had that much time gone by without my realizing it? I knew I just couldn’t walk away—I had to finish—but how could I do that and maintain our relationship?

There are several guides to assist the “disserter” to finish the blasted doctoral degree: books, Web sites, and support groups. My dissertation buddies and I met monthly. Our motto was “focus to finish.” We listened as each of us gave an update on our progress, or lack thereof. We guided each other through committee selections, topic refinement, and survey development. We cheered each success and consoled each setback. 

When the idea for this editorial popped into our conversation, my spouse and I recalled the approach we took to “getting it done.” We searched our computers for the documents that were my guide and provided my daily structure. Alas, they were long gone. Much to our pleasure and laughter, we found a guide1 almost identical to the approach we had put together for me. What this meant was that we had created something that also worked for someone else. The concepts are intuitive and simple, although they require a great deal of discipline from both the “disserter” and, more significantly, the associated person in the disserter’s life. 

True to my spouse’s profession, project management processes were established; we first decided on a target date for the proposal, then another for the defense. I sent a schedule for my deliverables and a list of my expectations to each member of my dissertation committee. Once I had received agreement and approval from them on the proposed timelines, I posted the schedule on my computer. I held not only myself to the identified milestones and dates, but also my committee members. When I missed the mark, I advised them; when they didn’t provide feedback within the approved timeline, I presumed they had none. That was the deal we agreed to, and more notably, my project manager was ensuring that I stuck to that deal! —Not so easy when the peace of the household was at stake and a dangling carrot of a trip to a private island in the Caribbean hung in the balance. If I finished on schedule, I was going!  

I was privileged to be able to quit my job and have “only” the dissertation be my sole responsibility. I was reminded that the dissertation was not my life’s work, but my current job. I started every day just as though I was going to an office, and I stopped working at the end of that day. Evenings and weekends were time to spend together and to visit with friends and family. Life at home was getting better! Discussions about the dissertation were off limits at those times, and the break often helped restore the energy I needed to maintain my world of project management discipline. More importantly, keeping that time sacrosanct meant that our relationship was not only not lost, but actually improving along the journey. 

Completing my dissertation was a momentous achievement, but I could not have done it without the support of my sweetheart—a project manager extraordinaire. We shared in the commitment to get it done. We celebrated each milestone and cursed the stalled days. But the motivation and management never wavered. Whenever I lost my momentum, to say that I was prodded to keep moving would be an understatement. And with the same zeal, I in turn prodded my Chair—who after I was finished, called me a “bully”! That comment never ceases to make us chuckle. I guess she had never before been “project managed” by a professional with 20+ years’ experience of moving projects to success. And yet, that is what it takes to finish: a relentless perseverance to stay on task with your timelines—and a family whose desire to finish is as great as your own. 

To those of you who are taking the step into doctoral studies, I highly encourage you to bring on your family as a key component of your staff—because it is the family that finishes the dissertation. And just in case you become too preoccupied with your degree completion and success, do not forget to say thank you to your family. 

Thank you, Sweetheart!

 As health technology and methodology advance, the need for continued learning and scholarly activities has driven many of us to pursue advanced degrees. Many are poised in various states of completion, with as many reasons for being stalled in one stage as there are degree programs. Recently, in a conversation with friends, we reminisced about our “all-but-dissertation” days. While the pain of the process has finally become a mere wince in recollection, the memory of how much support we each received is ever present in our minds. 

The common African proverb, “It takes a whole village to raise a child,” is poignantly applicable when a spouse, significant other, or parent ventures into the “terminal degree” vortex. Acknowledgements in the preface of the (finally) finished document are mere prattle compared to the words of encouragement, the editing assistance, daily sounding board, and relief from day-to-day responsibilities that allowed us to chase our dream. Through months of listening to ideas in which fewer than a dozen people in the world have any interest, the vague responses to questions posed, the ninety-dollar technical words, and the necessary absence from family time, a few phrases are hardly sufficient to recognize the sacrifices our families made so we could complete the #$%^&* dissertation.

We have all heard horror stories about the dissertation phase, the dissertation committees, and the frustrations of topic approval, conducting the research, writing the manuscript, and defending the work. What those of us who have survived the process often fail to tell are the stories of who made our success a reality, and how. After the year I spent languishing in the preproposal phase, my spouse and I had a lengthy heart-to-heart conversation about whether I was “in” or “out” of the dissertation; was I going to be “ABD” or “PhD”? That was my reality check. Had I spent too much time with my computer and not with my spouse? Had that much time gone by without my realizing it? I knew I just couldn’t walk away—I had to finish—but how could I do that and maintain our relationship?

There are several guides to assist the “disserter” to finish the blasted doctoral degree: books, Web sites, and support groups. My dissertation buddies and I met monthly. Our motto was “focus to finish.” We listened as each of us gave an update on our progress, or lack thereof. We guided each other through committee selections, topic refinement, and survey development. We cheered each success and consoled each setback. 

When the idea for this editorial popped into our conversation, my spouse and I recalled the approach we took to “getting it done.” We searched our computers for the documents that were my guide and provided my daily structure. Alas, they were long gone. Much to our pleasure and laughter, we found a guide1 almost identical to the approach we had put together for me. What this meant was that we had created something that also worked for someone else. The concepts are intuitive and simple, although they require a great deal of discipline from both the “disserter” and, more significantly, the associated person in the disserter’s life. 

True to my spouse’s profession, project management processes were established; we first decided on a target date for the proposal, then another for the defense. I sent a schedule for my deliverables and a list of my expectations to each member of my dissertation committee. Once I had received agreement and approval from them on the proposed timelines, I posted the schedule on my computer. I held not only myself to the identified milestones and dates, but also my committee members. When I missed the mark, I advised them; when they didn’t provide feedback within the approved timeline, I presumed they had none. That was the deal we agreed to, and more notably, my project manager was ensuring that I stuck to that deal! —Not so easy when the peace of the household was at stake and a dangling carrot of a trip to a private island in the Caribbean hung in the balance. If I finished on schedule, I was going!  

I was privileged to be able to quit my job and have “only” the dissertation be my sole responsibility. I was reminded that the dissertation was not my life’s work, but my current job. I started every day just as though I was going to an office, and I stopped working at the end of that day. Evenings and weekends were time to spend together and to visit with friends and family. Life at home was getting better! Discussions about the dissertation were off limits at those times, and the break often helped restore the energy I needed to maintain my world of project management discipline. More importantly, keeping that time sacrosanct meant that our relationship was not only not lost, but actually improving along the journey. 

Completing my dissertation was a momentous achievement, but I could not have done it without the support of my sweetheart—a project manager extraordinaire. We shared in the commitment to get it done. We celebrated each milestone and cursed the stalled days. But the motivation and management never wavered. Whenever I lost my momentum, to say that I was prodded to keep moving would be an understatement. And with the same zeal, I in turn prodded my Chair—who after I was finished, called me a “bully”! That comment never ceases to make us chuckle. I guess she had never before been “project managed” by a professional with 20+ years’ experience of moving projects to success. And yet, that is what it takes to finish: a relentless perseverance to stay on task with your timelines—and a family whose desire to finish is as great as your own. 

To those of you who are taking the step into doctoral studies, I highly encourage you to bring on your family as a key component of your staff—because it is the family that finishes the dissertation. And just in case you become too preoccupied with your degree completion and success, do not forget to say thank you to your family. 

Thank you, Sweetheart!

In November 2009, my colleague Randy Danielsen wrote on the effectiveness of continuing (medical) education, noting, “Most continuing education for clinicians is aimed at improving performance and/or optimizing patient outcomes.”¹ He also acknowledged that the actual reason for his attendance at a particular conference was “the opportunity to rub shoulders with old friends and new leaders in my profession.”¹ In addition, he mentioned the camaraderie, networking, and the benefit of “just getting away.”

I had not thought about his comments until recently, when I had the occasion to attend two professional meetings: the annual meeting of the American Academy of Nurse Practitioners, in Phoenix, and the 21st International Research Congress of Sigma Theta Tau International Honor Society of Nursing, in Orlando. Like Randy, I attended these meetings not for the educational credit; rather, I was there to represent Rocky Mountain University of Health Professions. What I did not realize until I got home was the education I had acquired while at these events. Therefore, I want to take Randy’s comments a bit further.

All too often, we measure the value of professional meetings by the customary tangible outcomes: new skills, new knowledge, or the number of CE/CME credits we have gained. If we walk away without a measurable benefit from taking the time out of our busy schedules to attend these meetings, we feel in some way cheated or as if we have wasted our time. Measurable outcomes are the gold standard of our professional activities, whether they are of an educational or patient-care nature. I agree, but I submit that the intangible outcomes are frequently the most valuable.

In the world of business, networking is a key component of the job. Getting to know new people and being known in the community is paramount to success. The ability to interact with others in the same or a similar field helps build your repertoire of associates and subject-matter experts upon whom you can call for resources or to whom you can refer clients.

The face-to-face contact affords you the opportunity to build new relationships that are more personal than those made through the Internet, and are longer lasting. Because of their frequency, “see and be seen” events can be the venue where you set yourself apart from others in your field. Think about it: How often is the gold medalist in the Olympics an “unknown”?

While social networking Web sites serve a purpose, I think one-on-one connections—the kind that occur at conferences and other professional meetings—are the better way to reconnect with old colleagues and meet new ones. These connections are often the foundation for friendships that endure, regardless of how frequently you see the other person. I refer to these friends as my “conference buddies.” The two conferences I attended this summer allowed me not only to reconnect with old friends, but also to be motivated by my new acquaintances to get going on my professional “bucket list.”

However, almost more important than the motivation was the opportunity to meet new people and to contribute to the development of new ideas or new ways to look at an issue faced by these new contacts. It was exciting to be involved in the various discussions that evolved from a conference session or a common interest. I found myself re-energized by those new ideas and new acquaintances.

These events provided me contacts that will allow me once again to give back to my profession—to return the support and mentoring that I was privileged to have early in my career. They opened new doors to me, allowing me yet another experience that I doubt I would have had if I did not attend these conferences. Because of those discussions, I found myself considering my next trajectory and doing a bit of self-reflecting.

The ability to reflect about oneself is an opportunity we perhaps do not often exercise. We are, I believe, preoccupied with the day-to-day activities of family and work. When there is playtime, we still manage to multitask, ever attached to the phone or another electronic interrupter. I have a love-hate relationship with connectivity. I am usually bothered when e-mail access is limited at conferences, but that was not the case at these recent meetings. Walking around the exhibit areas and corridors, knowing that others had limited electronic access to me, I felt free to be 100% attentive to my surroundings.

I must admit, I frequently found myself eavesdropping on conversations when the people involved were animated, simply curious about what was being discussed. On several occasions, the comments gave me pause and got me rethinking how I would handle a similar situation or what my opinion on a particular subject would be.

I appreciate the requirements to confirm that the objectives of conferences for CE/CME have been met. I am not sure that if I used only those objectives as a measure of the value of attending those meetings that I could have considered them worth the time away.

To measure my learning from these events, I need to consider Whitehead’s concepts of education and learning. His philosophy has been summarized as, “The primary acquisition of knowledge involves freshness, enthusiasm, and enjoyment of learning.”² Using that, I did achieve learning—and came home with a new appreciation for networking and a few changed views.

What were your conference experiences this year? I’d enjoy hearing about them. You can reach me at [email protected].

In November 2009, my colleague Randy Danielsen wrote on the effectiveness of continuing (medical) education, noting, “Most continuing education for clinicians is aimed at improving performance and/or optimizing patient outcomes.”¹ He also acknowledged that the actual reason for his attendance at a particular conference was “the opportunity to rub shoulders with old friends and new leaders in my profession.”¹ In addition, he mentioned the camaraderie, networking, and the benefit of “just getting away.”

I had not thought about his comments until recently, when I had the occasion to attend two professional meetings: the annual meeting of the American Academy of Nurse Practitioners, in Phoenix, and the 21st International Research Congress of Sigma Theta Tau International Honor Society of Nursing, in Orlando. Like Randy, I attended these meetings not for the educational credit; rather, I was there to represent Rocky Mountain University of Health Professions. What I did not realize until I got home was the education I had acquired while at these events. Therefore, I want to take Randy’s comments a bit further.

All too often, we measure the value of professional meetings by the customary tangible outcomes: new skills, new knowledge, or the number of CE/CME credits we have gained. If we walk away without a measurable benefit from taking the time out of our busy schedules to attend these meetings, we feel in some way cheated or as if we have wasted our time. Measurable outcomes are the gold standard of our professional activities, whether they are of an educational or patient-care nature. I agree, but I submit that the intangible outcomes are frequently the most valuable.

In the world of business, networking is a key component of the job. Getting to know new people and being known in the community is paramount to success. The ability to interact with others in the same or a similar field helps build your repertoire of associates and subject-matter experts upon whom you can call for resources or to whom you can refer clients.

The face-to-face contact affords you the opportunity to build new relationships that are more personal than those made through the Internet, and are longer lasting. Because of their frequency, “see and be seen” events can be the venue where you set yourself apart from others in your field. Think about it: How often is the gold medalist in the Olympics an “unknown”?

While social networking Web sites serve a purpose, I think one-on-one connections—the kind that occur at conferences and other professional meetings—are the better way to reconnect with old colleagues and meet new ones. These connections are often the foundation for friendships that endure, regardless of how frequently you see the other person. I refer to these friends as my “conference buddies.” The two conferences I attended this summer allowed me not only to reconnect with old friends, but also to be motivated by my new acquaintances to get going on my professional “bucket list.”

However, almost more important than the motivation was the opportunity to meet new people and to contribute to the development of new ideas or new ways to look at an issue faced by these new contacts. It was exciting to be involved in the various discussions that evolved from a conference session or a common interest. I found myself re-energized by those new ideas and new acquaintances.

These events provided me contacts that will allow me once again to give back to my profession—to return the support and mentoring that I was privileged to have early in my career. They opened new doors to me, allowing me yet another experience that I doubt I would have had if I did not attend these conferences. Because of those discussions, I found myself considering my next trajectory and doing a bit of self-reflecting.

The ability to reflect about oneself is an opportunity we perhaps do not often exercise. We are, I believe, preoccupied with the day-to-day activities of family and work. When there is playtime, we still manage to multitask, ever attached to the phone or another electronic interrupter. I have a love-hate relationship with connectivity. I am usually bothered when e-mail access is limited at conferences, but that was not the case at these recent meetings. Walking around the exhibit areas and corridors, knowing that others had limited electronic access to me, I felt free to be 100% attentive to my surroundings.

I must admit, I frequently found myself eavesdropping on conversations when the people involved were animated, simply curious about what was being discussed. On several occasions, the comments gave me pause and got me rethinking how I would handle a similar situation or what my opinion on a particular subject would be.

I appreciate the requirements to confirm that the objectives of conferences for CE/CME have been met. I am not sure that if I used only those objectives as a measure of the value of attending those meetings that I could have considered them worth the time away.

To measure my learning from these events, I need to consider Whitehead’s concepts of education and learning. His philosophy has been summarized as, “The primary acquisition of knowledge involves freshness, enthusiasm, and enjoyment of learning.”² Using that, I did achieve learning—and came home with a new appreciation for networking and a few changed views.

What were your conference experiences this year? I’d enjoy hearing about them. You can reach me at [email protected].

In November 2009, my colleague Randy Danielsen wrote on the effectiveness of continuing (medical) education, noting, “Most continuing education for clinicians is aimed at improving performance and/or optimizing patient outcomes.”¹ He also acknowledged that the actual reason for his attendance at a particular conference was “the opportunity to rub shoulders with old friends and new leaders in my profession.”¹ In addition, he mentioned the camaraderie, networking, and the benefit of “just getting away.”

I had not thought about his comments until recently, when I had the occasion to attend two professional meetings: the annual meeting of the American Academy of Nurse Practitioners, in Phoenix, and the 21st International Research Congress of Sigma Theta Tau International Honor Society of Nursing, in Orlando. Like Randy, I attended these meetings not for the educational credit; rather, I was there to represent Rocky Mountain University of Health Professions. What I did not realize until I got home was the education I had acquired while at these events. Therefore, I want to take Randy’s comments a bit further.

All too often, we measure the value of professional meetings by the customary tangible outcomes: new skills, new knowledge, or the number of CE/CME credits we have gained. If we walk away without a measurable benefit from taking the time out of our busy schedules to attend these meetings, we feel in some way cheated or as if we have wasted our time. Measurable outcomes are the gold standard of our professional activities, whether they are of an educational or patient-care nature. I agree, but I submit that the intangible outcomes are frequently the most valuable.

In the world of business, networking is a key component of the job. Getting to know new people and being known in the community is paramount to success. The ability to interact with others in the same or a similar field helps build your repertoire of associates and subject-matter experts upon whom you can call for resources or to whom you can refer clients.

The face-to-face contact affords you the opportunity to build new relationships that are more personal than those made through the Internet, and are longer lasting. Because of their frequency, “see and be seen” events can be the venue where you set yourself apart from others in your field. Think about it: How often is the gold medalist in the Olympics an “unknown”?

While social networking Web sites serve a purpose, I think one-on-one connections—the kind that occur at conferences and other professional meetings—are the better way to reconnect with old colleagues and meet new ones. These connections are often the foundation for friendships that endure, regardless of how frequently you see the other person. I refer to these friends as my “conference buddies.” The two conferences I attended this summer allowed me not only to reconnect with old friends, but also to be motivated by my new acquaintances to get going on my professional “bucket list.”

However, almost more important than the motivation was the opportunity to meet new people and to contribute to the development of new ideas or new ways to look at an issue faced by these new contacts. It was exciting to be involved in the various discussions that evolved from a conference session or a common interest. I found myself re-energized by those new ideas and new acquaintances.

These events provided me contacts that will allow me once again to give back to my profession—to return the support and mentoring that I was privileged to have early in my career. They opened new doors to me, allowing me yet another experience that I doubt I would have had if I did not attend these conferences. Because of those discussions, I found myself considering my next trajectory and doing a bit of self-reflecting.

The ability to reflect about oneself is an opportunity we perhaps do not often exercise. We are, I believe, preoccupied with the day-to-day activities of family and work. When there is playtime, we still manage to multitask, ever attached to the phone or another electronic interrupter. I have a love-hate relationship with connectivity. I am usually bothered when e-mail access is limited at conferences, but that was not the case at these recent meetings. Walking around the exhibit areas and corridors, knowing that others had limited electronic access to me, I felt free to be 100% attentive to my surroundings.

I must admit, I frequently found myself eavesdropping on conversations when the people involved were animated, simply curious about what was being discussed. On several occasions, the comments gave me pause and got me rethinking how I would handle a similar situation or what my opinion on a particular subject would be.

I appreciate the requirements to confirm that the objectives of conferences for CE/CME have been met. I am not sure that if I used only those objectives as a measure of the value of attending those meetings that I could have considered them worth the time away.

To measure my learning from these events, I need to consider Whitehead’s concepts of education and learning. His philosophy has been summarized as, “The primary acquisition of knowledge involves freshness, enthusiasm, and enjoyment of learning.”² Using that, I did achieve learning—and came home with a new appreciation for networking and a few changed views.

What were your conference experiences this year? I’d enjoy hearing about them. You can reach me at [email protected].

These past few months have been quite the roller coaster ride—the ups and downs of politics and the economy, and the changes that have occurred in the health care arena. For the first time in my career, I have been more of an observer than an activist. Not apathetic, mind you, but more calm in my reaction to what has transpired.

My readers may not agree; I have raised the ire of some and caused others to stop and think about their roles and responsibilities not only as health care providers, but also as people. I too have had the opportunity to be challenged on several matters, and my editorial this month will address one specific topic on which I have frequently been asked to comment. My colleagues have already suffered through my pontification on this subject!

Before I continue, please know that this issue has been raised for decades, and there has never really been a firm decision made with regard to it. Yet we have embraced the concept and, in my opinion, have clumsily struggled forward. The topic is nursing education—more specifically, the educational routes to becoming a nurse practitioner.

When I was first deciding my future, I chose to pursue a career in nursing. I was guided away from the traditional hospital-based nursing school program toward the “up-and-coming” college program. My advisors were well-established, successful nursing professionals, all of whom were “diploma grads.” They convinced me that college-educated nurses were the wave of the future, and that there was much more to learn than the technical skills of nursing.

I decided on an associate’s degree program. Once in school, I wondered whether I would have the skills that were required of a “real nurse,” the ability to assess and quickly assist a patient who was in distress. I envied those students who had hours of experience on the floors, taking care of multiple patients, really getting to understand what it was to be a nurse. I quickly learned, just as I had been advised, that those skills would come, and problem-solving skills (we didn’t call it critical thinking then) would become the asset to serve me well throughout my career. 

Six years after graduating from nursing school—picking up a bachelor’s degree along the way—I started my NP program. My classmates came from different educational backgrounds, yet we all had that underpinning and commonality of nursing. Despite our education, we had experienced years of what it was, and what it meant, to be a nurse. We had been, as a dear friend recently articulated, “socialized” into the profession. As I added new skills to my basic education and began my role as an NP, it was nursing that I continued to hold as the foundation of what defined my practice and my identity.

It is that socialization and identity that I fear we might lose as we make advances in education, suggesting that the preparation of the next generation of NPs should occur at the doctoral level. How will we hold onto our nursing roots? We have bridge programs that allow those with a bachelor’s degree in any discipline to learn basic and advanced nursing in three to four years. Is there a plan to develop bridge programs for people who have a master’s degree to progress toward the NP role in a similar fashion?

I have every confidence that the critical thinking and diagnostic skills needed to practice are acquired through the current educational programs. Nevertheless, I wonder whether students are learning about the heart and soul of nursing—the societal obligations, the fact that, as Sellew and Neusse eloquently wrote in 1929, we as nurses are a group “set apart to serve society.”¹

Will the students in these programs understand that they are truly nurses first, and that the NP role is an extension of that? Have they learned that “society looks to nurses for community service and leadership”²? Have they embraced the responsibility of being “concerned with the larger society, and [taking] part in securing the conditions that put good health within reach of everyone”¹? How do these graduates progress from novice to expert when their experience as a nurse is limited? 

The question is whether the cost for advancing our profession educationally will be the loss of our nursing history. Do we maintain our robust and admirable foundation and include that in the curriculum? Do we share the stories of how and why we decided to become a nurse first, then a nurse practitioner? These are the questions I wonder aloud when I am asked about NP education.

How we become advanced practice nurses is not about whether we took the short road or the long road. Years spent at the bedside do not necessarily make a better NP. But it is important to remember that we are first nurses, and that our strong roots in nursing are what differentiate us from other health care providers. It is imperative that we hold onto those roots, firmly grounded in the ancestry of our nursing predecessors and leaders. Let us keep that history alive, and take the initiative to ensure our next generation remembers those of the past.

Send your comments to [email protected].

These past few months have been quite the roller coaster ride—the ups and downs of politics and the economy, and the changes that have occurred in the health care arena. For the first time in my career, I have been more of an observer than an activist. Not apathetic, mind you, but more calm in my reaction to what has transpired.

My readers may not agree; I have raised the ire of some and caused others to stop and think about their roles and responsibilities not only as health care providers, but also as people. I too have had the opportunity to be challenged on several matters, and my editorial this month will address one specific topic on which I have frequently been asked to comment. My colleagues have already suffered through my pontification on this subject!

Before I continue, please know that this issue has been raised for decades, and there has never really been a firm decision made with regard to it. Yet we have embraced the concept and, in my opinion, have clumsily struggled forward. The topic is nursing education—more specifically, the educational routes to becoming a nurse practitioner.

When I was first deciding my future, I chose to pursue a career in nursing. I was guided away from the traditional hospital-based nursing school program toward the “up-and-coming” college program. My advisors were well-established, successful nursing professionals, all of whom were “diploma grads.” They convinced me that college-educated nurses were the wave of the future, and that there was much more to learn than the technical skills of nursing.

I decided on an associate’s degree program. Once in school, I wondered whether I would have the skills that were required of a “real nurse,” the ability to assess and quickly assist a patient who was in distress. I envied those students who had hours of experience on the floors, taking care of multiple patients, really getting to understand what it was to be a nurse. I quickly learned, just as I had been advised, that those skills would come, and problem-solving skills (we didn’t call it critical thinking then) would become the asset to serve me well throughout my career. 

Six years after graduating from nursing school—picking up a bachelor’s degree along the way—I started my NP program. My classmates came from different educational backgrounds, yet we all had that underpinning and commonality of nursing. Despite our education, we had experienced years of what it was, and what it meant, to be a nurse. We had been, as a dear friend recently articulated, “socialized” into the profession. As I added new skills to my basic education and began my role as an NP, it was nursing that I continued to hold as the foundation of what defined my practice and my identity.

It is that socialization and identity that I fear we might lose as we make advances in education, suggesting that the preparation of the next generation of NPs should occur at the doctoral level. How will we hold onto our nursing roots? We have bridge programs that allow those with a bachelor’s degree in any discipline to learn basic and advanced nursing in three to four years. Is there a plan to develop bridge programs for people who have a master’s degree to progress toward the NP role in a similar fashion?

I have every confidence that the critical thinking and diagnostic skills needed to practice are acquired through the current educational programs. Nevertheless, I wonder whether students are learning about the heart and soul of nursing—the societal obligations, the fact that, as Sellew and Neusse eloquently wrote in 1929, we as nurses are a group “set apart to serve society.”¹

Will the students in these programs understand that they are truly nurses first, and that the NP role is an extension of that? Have they learned that “society looks to nurses for community service and leadership”²? Have they embraced the responsibility of being “concerned with the larger society, and [taking] part in securing the conditions that put good health within reach of everyone”¹? How do these graduates progress from novice to expert when their experience as a nurse is limited? 

The question is whether the cost for advancing our profession educationally will be the loss of our nursing history. Do we maintain our robust and admirable foundation and include that in the curriculum? Do we share the stories of how and why we decided to become a nurse first, then a nurse practitioner? These are the questions I wonder aloud when I am asked about NP education.

How we become advanced practice nurses is not about whether we took the short road or the long road. Years spent at the bedside do not necessarily make a better NP. But it is important to remember that we are first nurses, and that our strong roots in nursing are what differentiate us from other health care providers. It is imperative that we hold onto those roots, firmly grounded in the ancestry of our nursing predecessors and leaders. Let us keep that history alive, and take the initiative to ensure our next generation remembers those of the past.

Send your comments to [email protected].

These past few months have been quite the roller coaster ride—the ups and downs of politics and the economy, and the changes that have occurred in the health care arena. For the first time in my career, I have been more of an observer than an activist. Not apathetic, mind you, but more calm in my reaction to what has transpired.

My readers may not agree; I have raised the ire of some and caused others to stop and think about their roles and responsibilities not only as health care providers, but also as people. I too have had the opportunity to be challenged on several matters, and my editorial this month will address one specific topic on which I have frequently been asked to comment. My colleagues have already suffered through my pontification on this subject!

Before I continue, please know that this issue has been raised for decades, and there has never really been a firm decision made with regard to it. Yet we have embraced the concept and, in my opinion, have clumsily struggled forward. The topic is nursing education—more specifically, the educational routes to becoming a nurse practitioner.

When I was first deciding my future, I chose to pursue a career in nursing. I was guided away from the traditional hospital-based nursing school program toward the “up-and-coming” college program. My advisors were well-established, successful nursing professionals, all of whom were “diploma grads.” They convinced me that college-educated nurses were the wave of the future, and that there was much more to learn than the technical skills of nursing.

I decided on an associate’s degree program. Once in school, I wondered whether I would have the skills that were required of a “real nurse,” the ability to assess and quickly assist a patient who was in distress. I envied those students who had hours of experience on the floors, taking care of multiple patients, really getting to understand what it was to be a nurse. I quickly learned, just as I had been advised, that those skills would come, and problem-solving skills (we didn’t call it critical thinking then) would become the asset to serve me well throughout my career. 

Six years after graduating from nursing school—picking up a bachelor’s degree along the way—I started my NP program. My classmates came from different educational backgrounds, yet we all had that underpinning and commonality of nursing. Despite our education, we had experienced years of what it was, and what it meant, to be a nurse. We had been, as a dear friend recently articulated, “socialized” into the profession. As I added new skills to my basic education and began my role as an NP, it was nursing that I continued to hold as the foundation of what defined my practice and my identity.

It is that socialization and identity that I fear we might lose as we make advances in education, suggesting that the preparation of the next generation of NPs should occur at the doctoral level. How will we hold onto our nursing roots? We have bridge programs that allow those with a bachelor’s degree in any discipline to learn basic and advanced nursing in three to four years. Is there a plan to develop bridge programs for people who have a master’s degree to progress toward the NP role in a similar fashion?

I have every confidence that the critical thinking and diagnostic skills needed to practice are acquired through the current educational programs. Nevertheless, I wonder whether students are learning about the heart and soul of nursing—the societal obligations, the fact that, as Sellew and Neusse eloquently wrote in 1929, we as nurses are a group “set apart to serve society.”¹

Will the students in these programs understand that they are truly nurses first, and that the NP role is an extension of that? Have they learned that “society looks to nurses for community service and leadership”²? Have they embraced the responsibility of being “concerned with the larger society, and [taking] part in securing the conditions that put good health within reach of everyone”¹? How do these graduates progress from novice to expert when their experience as a nurse is limited? 

The question is whether the cost for advancing our profession educationally will be the loss of our nursing history. Do we maintain our robust and admirable foundation and include that in the curriculum? Do we share the stories of how and why we decided to become a nurse first, then a nurse practitioner? These are the questions I wonder aloud when I am asked about NP education.

How we become advanced practice nurses is not about whether we took the short road or the long road. Years spent at the bedside do not necessarily make a better NP. But it is important to remember that we are first nurses, and that our strong roots in nursing are what differentiate us from other health care providers. It is imperative that we hold onto those roots, firmly grounded in the ancestry of our nursing predecessors and leaders. Let us keep that history alive, and take the initiative to ensure our next generation remembers those of the past.

Send your comments to [email protected].

In recent years, the term health literacy has been discussed more frequently, especially in conversations about the importance of communicating with our patients. We hear and use this term often, but do we fully comprehend its meaning and implications?

Health literacy, “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions,”¹ is being increasingly recognized for its importance to health and health outcomes.² We, as health care professionals, have embraced health outcomes as the gold standard for measuring the care we provide; I find it odd that in the debates I have heard regarding health care reform legislation, the loudest arguments have not included the importance of outcomes or of health literacy.

The focus on health literacy is, for the most part, an extension of the focus on issues related to culture and language and their impact on racial and ethnic health disparities. For the past decade (at least), concerns about our capacity to be culturally competent have been a key element in the discussion about health care equity and access. We have often struggled to communicate with our patients who have limited English proficiency. We know that understanding is more likely to deteriorate when the provider speaks English but the patient speaks English as a second language. Too frequently, the outcome of such encounters is a missed opportunity to reduce the inequities of health care and improve the health status of our patient.

But people’s comprehension difficulties go beyond linguistic competency. A minor oversight in our endeavor to reduce disparities caused by linguistic discrepancy is that even patients whose primary language is English can be at risk for poor health outcomes.

For years, we have been instructed that patient information must be written at a grade 7 or 8 reading level. What became evident through work by Chew and colleagues³ is that people who can read at the sixth-grade level or less have limited health literacy. That the person can read the words provides some comfort, but it doesn’t guarantee that the words are understood.

Using another person to interpret (even in the same language) is not the answer, either. The listener/interpretor must know the meaning of the words and the context in which they are being used to convey the information accurately.⁴ Moreover, the interpreter must be able to explain the implications of what is being said on both sides of the conversation.

For years, Joint Commission standards⁵ have included the principle that every patient has the right to effective communication; somewhat less directly, this includes health literacy. There are also requirements for providing patient education—that information be conveyed to patients at the right time and place, in a way they can understand, remember, and act on correctly.⁶

Do our elected officials and the public understand the inner workings of the health care system? And do they appreciate the difficulties involved in educating them about the system? Do the average “Harry and Louise” comprehend the impact this new health care reform bill will have on the health care system as they know it?

I don’t ask these questions to be condescending, but to express my concern that opposition to the overhaul is based on a misunderstanding of what is going to happen as a result. And those with limited health literacy are especially challenged to understand the dialogue about health care reform and its potential impact.

Historically, our focus has been on providing quality care, lowering costs, and eliminating access disparities; yet unless we concurrently work on improving health literacy, all our efforts to address the rest will be for naught.

What has become glaringly obvious is that health literacy is fundamental to health reform in this country. The recent workshop sponsored by the Institute of Medicine⁷ was a call to all of us to attend to the issues and complexities of health literacy. We need to move forward to develop and improve tools to measure health literacy—and mitigate the disparities that result from people’s inability to understand exactly what we are saying and what it means.

How often have you been in a situation in which you realized a patient had not understood your explanation of their condition or treatment options, or could not repeat back your instructions? What strategies or advice can you offer to provide more effective patient education and improve health literacy? I would welcome hearing from you at [email protected].

In recent years, the term health literacy has been discussed more frequently, especially in conversations about the importance of communicating with our patients. We hear and use this term often, but do we fully comprehend its meaning and implications?

Health literacy, “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions,”¹ is being increasingly recognized for its importance to health and health outcomes.² We, as health care professionals, have embraced health outcomes as the gold standard for measuring the care we provide; I find it odd that in the debates I have heard regarding health care reform legislation, the loudest arguments have not included the importance of outcomes or of health literacy.

The focus on health literacy is, for the most part, an extension of the focus on issues related to culture and language and their impact on racial and ethnic health disparities. For the past decade (at least), concerns about our capacity to be culturally competent have been a key element in the discussion about health care equity and access. We have often struggled to communicate with our patients who have limited English proficiency. We know that understanding is more likely to deteriorate when the provider speaks English but the patient speaks English as a second language. Too frequently, the outcome of such encounters is a missed opportunity to reduce the inequities of health care and improve the health status of our patient.

But people’s comprehension difficulties go beyond linguistic competency. A minor oversight in our endeavor to reduce disparities caused by linguistic discrepancy is that even patients whose primary language is English can be at risk for poor health outcomes.

For years, we have been instructed that patient information must be written at a grade 7 or 8 reading level. What became evident through work by Chew and colleagues³ is that people who can read at the sixth-grade level or less have limited health literacy. That the person can read the words provides some comfort, but it doesn’t guarantee that the words are understood.

Using another person to interpret (even in the same language) is not the answer, either. The listener/interpretor must know the meaning of the words and the context in which they are being used to convey the information accurately.⁴ Moreover, the interpreter must be able to explain the implications of what is being said on both sides of the conversation.

For years, Joint Commission standards⁵ have included the principle that every patient has the right to effective communication; somewhat less directly, this includes health literacy. There are also requirements for providing patient education—that information be conveyed to patients at the right time and place, in a way they can understand, remember, and act on correctly.⁶

Do our elected officials and the public understand the inner workings of the health care system? And do they appreciate the difficulties involved in educating them about the system? Do the average “Harry and Louise” comprehend the impact this new health care reform bill will have on the health care system as they know it?

I don’t ask these questions to be condescending, but to express my concern that opposition to the overhaul is based on a misunderstanding of what is going to happen as a result. And those with limited health literacy are especially challenged to understand the dialogue about health care reform and its potential impact.

Historically, our focus has been on providing quality care, lowering costs, and eliminating access disparities; yet unless we concurrently work on improving health literacy, all our efforts to address the rest will be for naught.

What has become glaringly obvious is that health literacy is fundamental to health reform in this country. The recent workshop sponsored by the Institute of Medicine⁷ was a call to all of us to attend to the issues and complexities of health literacy. We need to move forward to develop and improve tools to measure health literacy—and mitigate the disparities that result from people’s inability to understand exactly what we are saying and what it means.

How often have you been in a situation in which you realized a patient had not understood your explanation of their condition or treatment options, or could not repeat back your instructions? What strategies or advice can you offer to provide more effective patient education and improve health literacy? I would welcome hearing from you at [email protected].

In recent years, the term health literacy has been discussed more frequently, especially in conversations about the importance of communicating with our patients. We hear and use this term often, but do we fully comprehend its meaning and implications?

Health literacy, “the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions,”¹ is being increasingly recognized for its importance to health and health outcomes.² We, as health care professionals, have embraced health outcomes as the gold standard for measuring the care we provide; I find it odd that in the debates I have heard regarding health care reform legislation, the loudest arguments have not included the importance of outcomes or of health literacy.

The focus on health literacy is, for the most part, an extension of the focus on issues related to culture and language and their impact on racial and ethnic health disparities. For the past decade (at least), concerns about our capacity to be culturally competent have been a key element in the discussion about health care equity and access. We have often struggled to communicate with our patients who have limited English proficiency. We know that understanding is more likely to deteriorate when the provider speaks English but the patient speaks English as a second language. Too frequently, the outcome of such encounters is a missed opportunity to reduce the inequities of health care and improve the health status of our patient.

But people’s comprehension difficulties go beyond linguistic competency. A minor oversight in our endeavor to reduce disparities caused by linguistic discrepancy is that even patients whose primary language is English can be at risk for poor health outcomes.

For years, we have been instructed that patient information must be written at a grade 7 or 8 reading level. What became evident through work by Chew and colleagues³ is that people who can read at the sixth-grade level or less have limited health literacy. That the person can read the words provides some comfort, but it doesn’t guarantee that the words are understood.

Using another person to interpret (even in the same language) is not the answer, either. The listener/interpretor must know the meaning of the words and the context in which they are being used to convey the information accurately.⁴ Moreover, the interpreter must be able to explain the implications of what is being said on both sides of the conversation.

For years, Joint Commission standards⁵ have included the principle that every patient has the right to effective communication; somewhat less directly, this includes health literacy. There are also requirements for providing patient education—that information be conveyed to patients at the right time and place, in a way they can understand, remember, and act on correctly.⁶

Do our elected officials and the public understand the inner workings of the health care system? And do they appreciate the difficulties involved in educating them about the system? Do the average “Harry and Louise” comprehend the impact this new health care reform bill will have on the health care system as they know it?

I don’t ask these questions to be condescending, but to express my concern that opposition to the overhaul is based on a misunderstanding of what is going to happen as a result. And those with limited health literacy are especially challenged to understand the dialogue about health care reform and its potential impact.

Historically, our focus has been on providing quality care, lowering costs, and eliminating access disparities; yet unless we concurrently work on improving health literacy, all our efforts to address the rest will be for naught.

What has become glaringly obvious is that health literacy is fundamental to health reform in this country. The recent workshop sponsored by the Institute of Medicine⁷ was a call to all of us to attend to the issues and complexities of health literacy. We need to move forward to develop and improve tools to measure health literacy—and mitigate the disparities that result from people’s inability to understand exactly what we are saying and what it means.

How often have you been in a situation in which you realized a patient had not understood your explanation of their condition or treatment options, or could not repeat back your instructions? What strategies or advice can you offer to provide more effective patient education and improve health literacy? I would welcome hearing from you at [email protected].

The earthquake in Haiti on January 12, and the time it took to mobilize aid to that country, reactivated my cynicism about our ability to quickly respond to a disaster anywhere. In Haiti, an impoverished country about 3,000 miles from the Florida coast, the people struggled to rescue those buried in the rubble and waited for help to arrive—waited and waited for what must have seemed like an eternity to them.

As I watched the news coverage, I wondered what had happened to the lessons we allegedly learned from the Hurricane Katrina disaster in 2005. I wondered about our ability to respond to the concurrent storm threatening to unleash mudslides in Southern California. But what intrigued (more accurately, irked) me was that the news crews managed to arrive in Haiti, before anyone else, to report on the devastation.

Somehow, planes carrying the reporters were able to land when others could not. Size notwithstanding, those planes could surely have carried more than the crews and their equipment. Just as the buses that were sent to transport the people out of New Orleans could have been stocked with food and water, so too could those planes been filled.

Yet as the reporters surveyed the damage and commented on the unbelievable conditions, all the while looking hydrated and clean, they repeatedly pointed out the lack of supplies. One reporter noted with embarrassment the ability to get her to the disaster zone, but not people who could assist in the rescue or care for the injured; nor was advantage taken of their transport to carry water and medical supplies to those in need.

The frustration was audible in comments from the Haitians, who were tirelessly digging and searching in the rubble that was once their homes, businesses, and community. Some of the newly homeless—hungry and dehydrated—huddled in the remains of churches and other structures, waited, and prayed that help would soon arrive.

Meanwhile, poised to be that help were the teams of health professionals who had traveled from the United States to Haiti and were confronted with difficulty getting there. In the newspapers, reporters recorded the dismay of the US military officers at the fact that confusion or disagreement as to who was in charge contributed to the delay in getting aid into Haiti.

In the US, relief efforts are coordinated through the White House, yet the bottleneck at the US-controlled Haitian airport seemed a contradiction to coordination. Again, I am intrigued. Since the events of 9/11, control and coordination of rescue and relief efforts have been stressed repeatedly.

Most, if not all, who are involved in any type of disaster response have been trained on the Incident Control System (ICS), a structured approach to facilitate activities in five major functional areas: command, operations, planning, logistics, and finance/administration. It is a standardized, on-scene, all-hazards incident management approach that:

• Integrates facilities, equipment, personnel, procedures, and communications operating within a common organizational structure

• Enables a coordinated response among jurisdictions and functional agencies, both public and private

• Establishes common processes for planning and managing resources.¹

This is not the first international disaster to which the US has responded. We know the importance of quickly identifying the complexities of an incident.

Yet, to my eye, it is clear that we have not been able to apply those lessons of quickly unraveling the complications of a natural disaster to this tragedy. The evidence is in the knowledge that equipment and supplies, such as the US military mobile field hospitals and health kits from the International Medical Corps, must be transported by the military, because of their weight.

Coordinating the delivery of supplies is also difficult and controversial. Relief teams from civilian organizations are delayed because military flights get precedence over civilian ones. So in some instances, the equipment and supplies are there, but there are not sufficient health care providers to utilize the tools that are available. Therefore, the ability to help is hampered once again, because there is no structure to enhance the ability of all responders to work together more effectively.

To the extent that they can, many nations respond to disasters such as the earthquake in Haiti. It seems illogical to me that despite the “history” of going beyond borders to help others, there does not seem to be an international version of ICS. If we have agencies such as the United Nations and the International Medical Corps, why isn’t there an international ICS? If there is one, why doesn’t it appear to be effective and efficient?

I will admit, as the years have passed and as the US has continued to provide to other countries while we struggle to recover from the financial tsunami and other devastating events that we have faced, I have been tempted to become more of an isolationist. Then I am reminded, by my conscience and my colleagues, that we reach out and extend the helping hand because despite our own looming problems—financial ruin, unemployment, and homelessness—we are resilient, and the world looks to us as the “safety net.” Good, bad, or indifferent, we help because we can.

Yet, I wonder, can we respond better? And if another natural disaster hits the US, have we learned what not to do from the Haiti tragedy? Will we be ready to help ourselves?

The earthquake in Haiti on January 12, and the time it took to mobilize aid to that country, reactivated my cynicism about our ability to quickly respond to a disaster anywhere. In Haiti, an impoverished country about 3,000 miles from the Florida coast, the people struggled to rescue those buried in the rubble and waited for help to arrive—waited and waited for what must have seemed like an eternity to them.

As I watched the news coverage, I wondered what had happened to the lessons we allegedly learned from the Hurricane Katrina disaster in 2005. I wondered about our ability to respond to the concurrent storm threatening to unleash mudslides in Southern California. But what intrigued (more accurately, irked) me was that the news crews managed to arrive in Haiti, before anyone else, to report on the devastation.

Somehow, planes carrying the reporters were able to land when others could not. Size notwithstanding, those planes could surely have carried more than the crews and their equipment. Just as the buses that were sent to transport the people out of New Orleans could have been stocked with food and water, so too could those planes been filled.

Yet as the reporters surveyed the damage and commented on the unbelievable conditions, all the while looking hydrated and clean, they repeatedly pointed out the lack of supplies. One reporter noted with embarrassment the ability to get her to the disaster zone, but not people who could assist in the rescue or care for the injured; nor was advantage taken of their transport to carry water and medical supplies to those in need.

The frustration was audible in comments from the Haitians, who were tirelessly digging and searching in the rubble that was once their homes, businesses, and community. Some of the newly homeless—hungry and dehydrated—huddled in the remains of churches and other structures, waited, and prayed that help would soon arrive.

Meanwhile, poised to be that help were the teams of health professionals who had traveled from the United States to Haiti and were confronted with difficulty getting there. In the newspapers, reporters recorded the dismay of the US military officers at the fact that confusion or disagreement as to who was in charge contributed to the delay in getting aid into Haiti.

In the US, relief efforts are coordinated through the White House, yet the bottleneck at the US-controlled Haitian airport seemed a contradiction to coordination. Again, I am intrigued. Since the events of 9/11, control and coordination of rescue and relief efforts have been stressed repeatedly.

Most, if not all, who are involved in any type of disaster response have been trained on the Incident Control System (ICS), a structured approach to facilitate activities in five major functional areas: command, operations, planning, logistics, and finance/administration. It is a standardized, on-scene, all-hazards incident management approach that:

• Integrates facilities, equipment, personnel, procedures, and communications operating within a common organizational structure

• Enables a coordinated response among jurisdictions and functional agencies, both public and private

• Establishes common processes for planning and managing resources.¹

This is not the first international disaster to which the US has responded. We know the importance of quickly identifying the complexities of an incident.

Yet, to my eye, it is clear that we have not been able to apply those lessons of quickly unraveling the complications of a natural disaster to this tragedy. The evidence is in the knowledge that equipment and supplies, such as the US military mobile field hospitals and health kits from the International Medical Corps, must be transported by the military, because of their weight.

Coordinating the delivery of supplies is also difficult and controversial. Relief teams from civilian organizations are delayed because military flights get precedence over civilian ones. So in some instances, the equipment and supplies are there, but there are not sufficient health care providers to utilize the tools that are available. Therefore, the ability to help is hampered once again, because there is no structure to enhance the ability of all responders to work together more effectively.

To the extent that they can, many nations respond to disasters such as the earthquake in Haiti. It seems illogical to me that despite the “history” of going beyond borders to help others, there does not seem to be an international version of ICS. If we have agencies such as the United Nations and the International Medical Corps, why isn’t there an international ICS? If there is one, why doesn’t it appear to be effective and efficient?

I will admit, as the years have passed and as the US has continued to provide to other countries while we struggle to recover from the financial tsunami and other devastating events that we have faced, I have been tempted to become more of an isolationist. Then I am reminded, by my conscience and my colleagues, that we reach out and extend the helping hand because despite our own looming problems—financial ruin, unemployment, and homelessness—we are resilient, and the world looks to us as the “safety net.” Good, bad, or indifferent, we help because we can.

Yet, I wonder, can we respond better? And if another natural disaster hits the US, have we learned what not to do from the Haiti tragedy? Will we be ready to help ourselves?

The earthquake in Haiti on January 12, and the time it took to mobilize aid to that country, reactivated my cynicism about our ability to quickly respond to a disaster anywhere. In Haiti, an impoverished country about 3,000 miles from the Florida coast, the people struggled to rescue those buried in the rubble and waited for help to arrive—waited and waited for what must have seemed like an eternity to them.

As I watched the news coverage, I wondered what had happened to the lessons we allegedly learned from the Hurricane Katrina disaster in 2005. I wondered about our ability to respond to the concurrent storm threatening to unleash mudslides in Southern California. But what intrigued (more accurately, irked) me was that the news crews managed to arrive in Haiti, before anyone else, to report on the devastation.

Somehow, planes carrying the reporters were able to land when others could not. Size notwithstanding, those planes could surely have carried more than the crews and their equipment. Just as the buses that were sent to transport the people out of New Orleans could have been stocked with food and water, so too could those planes been filled.

Yet as the reporters surveyed the damage and commented on the unbelievable conditions, all the while looking hydrated and clean, they repeatedly pointed out the lack of supplies. One reporter noted with embarrassment the ability to get her to the disaster zone, but not people who could assist in the rescue or care for the injured; nor was advantage taken of their transport to carry water and medical supplies to those in need.

The frustration was audible in comments from the Haitians, who were tirelessly digging and searching in the rubble that was once their homes, businesses, and community. Some of the newly homeless—hungry and dehydrated—huddled in the remains of churches and other structures, waited, and prayed that help would soon arrive.

Meanwhile, poised to be that help were the teams of health professionals who had traveled from the United States to Haiti and were confronted with difficulty getting there. In the newspapers, reporters recorded the dismay of the US military officers at the fact that confusion or disagreement as to who was in charge contributed to the delay in getting aid into Haiti.

In the US, relief efforts are coordinated through the White House, yet the bottleneck at the US-controlled Haitian airport seemed a contradiction to coordination. Again, I am intrigued. Since the events of 9/11, control and coordination of rescue and relief efforts have been stressed repeatedly.

Most, if not all, who are involved in any type of disaster response have been trained on the Incident Control System (ICS), a structured approach to facilitate activities in five major functional areas: command, operations, planning, logistics, and finance/administration. It is a standardized, on-scene, all-hazards incident management approach that:

• Integrates facilities, equipment, personnel, procedures, and communications operating within a common organizational structure

• Enables a coordinated response among jurisdictions and functional agencies, both public and private

• Establishes common processes for planning and managing resources.¹

This is not the first international disaster to which the US has responded. We know the importance of quickly identifying the complexities of an incident.

Yet, to my eye, it is clear that we have not been able to apply those lessons of quickly unraveling the complications of a natural disaster to this tragedy. The evidence is in the knowledge that equipment and supplies, such as the US military mobile field hospitals and health kits from the International Medical Corps, must be transported by the military, because of their weight.

Coordinating the delivery of supplies is also difficult and controversial. Relief teams from civilian organizations are delayed because military flights get precedence over civilian ones. So in some instances, the equipment and supplies are there, but there are not sufficient health care providers to utilize the tools that are available. Therefore, the ability to help is hampered once again, because there is no structure to enhance the ability of all responders to work together more effectively.

To the extent that they can, many nations respond to disasters such as the earthquake in Haiti. It seems illogical to me that despite the “history” of going beyond borders to help others, there does not seem to be an international version of ICS. If we have agencies such as the United Nations and the International Medical Corps, why isn’t there an international ICS? If there is one, why doesn’t it appear to be effective and efficient?

I will admit, as the years have passed and as the US has continued to provide to other countries while we struggle to recover from the financial tsunami and other devastating events that we have faced, I have been tempted to become more of an isolationist. Then I am reminded, by my conscience and my colleagues, that we reach out and extend the helping hand because despite our own looming problems—financial ruin, unemployment, and homelessness—we are resilient, and the world looks to us as the “safety net.” Good, bad, or indifferent, we help because we can.

Yet, I wonder, can we respond better? And if another natural disaster hits the US, have we learned what not to do from the Haiti tragedy? Will we be ready to help ourselves?