Sunday, August 02, 2015

A little-known career

Sean P. Murphy

I used to spend my days reviewing essays, referring students to the writing center, offering advice to students about their academic paths, writing lesson plans and assessing the effectiveness of these lesson plans after their implementation in the classroom. I was an English professor. I taught five classes per semester, with maximum enrollments of about 140 students.

Now I spend my days reviewing psychiatric notes, referring patients to higher levels of care when the services of an adult outpatient psychiatric clinic cannot ease their suffering or when life and safety are at risk, offering advice to patients about health and wellness, writing treatment plans and prescribing medications, and assessing the effect of those treatment plans and medications on the lives entrusted to my care. I am a psychiatric mental health nurse-practitioner. My caseload hovers somewhere around 300 patients.

I admire my health care colleagues’ bravery in rushing into the breach to enter patients’ narratives on what may be the worst day of their lives, and I find myself thinking, “So-and-so is a good nurse or physician because she’s a good teacher.” I wonder if good teachers are good nurses, but they don’t know it?

In any case, a leave of absence from my first career as tenured professor of English and humanities at a comprehensive community college has enabled me to practice my second career as a board-certified psychiatric mental health nurse-practitioner. “First” and “second” suggest linearity and separation, neither of which matches my lived experience of crossing over from careers in English to nursing, teacher to prescriber (see my earlier essay, “Dr. Nurse”).

I was never a proponent of academic silos, but moving from humanities to sciences did not strike my fancy -- until it did. As an academic, I pushed for cross-institutional collaboration by creating the Graduate Student Internship Program (GSIP), in which English M.A. and Ph.D. candidates teach at a two-year college before earning their degrees and entering the job market, but I would have been surprised to learn I would advocate cross-institutional collaboration between English departments and health care facilities, as I now do.

Neither did I anticipate returning to school midcareer, to the University of Illinois-Chicago’s accelerated registered nurse program and then to its master of science in nursing (MSN) program. For those of you unfamiliar with nurse practitioners (N.P.s), we are registered nurses (R.N.s) who complete additional advanced practice training and graduate degrees. Once degreed and licensed, we are health care providers who assess, order and interpret labs and diagnose and treat patients (including prescribing medications), all within the holistic framework of nursing practice (different from the allopathic perspective of M.D.s and the osteopathic perspective of D.O.s), which sees disease prevention and health promotion as essential to health care. N.P.s provide primary care to children and adults and provide specialty care in areas including women’s health, midwifery, acute care (emergency, critical care, hospitalist), gerontology and psychiatric mental health.

Taking cues from medicine before I knew anything about medicine, I wrote about English graduate students’ lack of exposure to the different sectors of higher education as detrimental to their preparation to work in higher education:

Teaching fellowships and assistantships serve graduate students well, on balance. But a physician would not dream of practicing medicine after having spent time in one medical school and one portion of the medical system. Much can be said for rotations, and doctoral candidates might do well to follow the medical school model by teaching at a range of institutions during their course of study.

How many types of institutions had I gained exposure to, and a little bit of practice teaching in, on the way to a professorship? My master of arts at a comprehensive state university included a graduate assistantship with time tutoring in the writing center and assisting a professor with one composition course. For my doctorate, taken at a research-intensive state university, I taught two courses per semester and, if available, one course each summer, all at the main campus, for five years. Two institutions in seven years.

By comparison, at the University of Illinois-Chicago, while completing the 16-month accelerated program for the R.N., my medical-surgical rotations included a telemetry (cardiac) unit at a major university hospital in Chicago and a gastroenterology unit at a community hospital outside of the city. The postpartum and labor and delivery rotation saw me at a different university hospital in the city, inpatient psychiatry at a community hospital just outside of the city proper, and pediatrics back in the city at a university hospital. Community health involved experiences at the Chicago Department of Public Health, a maximum-security prison infirmary in Indiana, a nonprofit nurse-run primary care van serving the homeless on rolling night shifts, inpatient and home hospice services, and an HIV/AIDS nonprofit organization. As a psychiatric nurse in training, my capstone or final rotation was on a 10-bed inpatient geriatric psychiatry unit in a small urban hospital. The nurse-practitioner rotations for my M.S.N. brought me to an urban pediatric outpatient clinic near Chicago’s North Lawndale neighborhood, the consultation-liaison psychiatric service of an urban safety net hospital near Englewood on the South Side, an FQHC nurse-run adult outpatient clinic affiliated with UIC’s College of Nursing, and a safety net hospital’s adult outpatient clinic. Fifteen institutions in four years.

Given my restless nature, I’m surprised I stayed planted in graduate school on the way to the English life. And although I am restless now, I must leave the work of partnerships to those with more time who may read this article and think, “Yes, the great talent present in English departments in the form of graduate students should be leveraged on behalf of a greater good.” Are nurses, physician assistants, pharmacists, dentists and physicians being trained on your campus? Perhaps English 101 can wait in favor of courses led by graduate students to help health care providers communicate more effectively. After all, one rarely hears high marks awarded to health care when it comes to communication with patients. How about the rhetoric of disease, illness, care, cure, healing, hope? Can English students help increase adherence rates among patients, many -- most? -- of whom will not “follow the doctor’s orders”? Would future humanists benefit from understanding narrative theoretically and from practically entering patients’ very human narratives on hospice units, mobile health care units, oncology units?

To be sure, my English colleagues took pleasure in the discipline, but the great teachers enjoyed people. Health care workers of all stripes like science, but they must like people even more to communicate, connect, empathize and help. Even if medical treatment stops, care continues. I see English graduate students and professors as essential to the communication that takes place after treatment stops, when care continues but the narrative’s closure shifts from cure to palliation. When it counts most, we need help making meaning of disparate strands of life, and those most talented with words and meaning can surely assist.


By Popular Demand: Worthwhile Revisions to AP History Exam

Finally, some good news for a change. The College Board, the nonprofit organization that administers AP exams to high school students, has announced yet another revision to its history framework. But this time it’s for the better. Previously, the College Board painted American history in far too negative a light, emphasizing our nation’s sins while ignoring or minimizing its uniqueness and greatness. Some Founders, such as Declaration of Independence author Thomas Jefferson and Constitution writer James Madison, were mentioned; that’s it — mentioned. But they were taught as examples of Western class, gender and racial evil.

And while teachers could choose to teach the Constitution as it’s written, they would disadvantage their students by doing so because the real Constitution wasn’t on the test. After numerous scholars objected in an open letter, however, the College Board worked to make revisions.

Neglected Founders are back, and there’s even a new section on the concept of “American exceptionalism.” A College Board official insisted they meant no harm, and that American exceptionalism was previously omitted because they assumed they didn’t need to spell it out.

We don’t buy it, and the changes don’t go nearly far enough, but perhaps the episode proves that strong, principled voices on the Right can make a difference.


Colorado school district settles church-state case with Jewish teacher

A Colorado district settled a church-state lawsuit with a Jewish teacher who claimed that one of its schools “operates largely to promote the evangelical Christian ideals” of a particular church.

The settlement, reached Tuesday, stipulates that the Florence district stop allowing numerous religious activities cited in the lawsuit.

Robert Basevitz, a history teacher at Florence High, sued the Fremont RE-2 district in May, contending that school officials violated the separation of church and state by allowing the Cowboy Church at Crossroads to hold numerous activities at the school during school hours and school officials to participate in and promote the activities while acting in their official capacities.

According to the lawsuit, two large signs promoting the church hang on school property; school officials participate in daily morning prayer services at the school’s flagpole, often preventing others from entering the school until it is over; and church leaders regularly use the school’s public address system to promote its activities to students.

Basevits is, “to his knowledge,” the only Jewish teacher in the district, the lawsuit said, noting also that he is kosher observant and a veteran of the first Gulf War.

The teacher’s attorney, Paul Maxon, said in a news release that “neither party admitted liability or wrongdoing but entered the agreement as a compromise settlement,” the Denver Post reported.

Under the settlement, the Post reported, the district will make the following changes: a district-wide ban on prayers at any school-sponsored event; no longer allow the Cowboy Church at Crossroads to use the district facilities for worship services; and student-led religious groups must be student-led, with district employees attending only as observers to make sure rules are being followed.


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