DIALOGUE IMAGE welcomes letters in response to previously published articles. Letters should be addressed to the Editor, should be typed double-spaced and should not exceed two typed-pages. The Sigma Theta Tau Intenuztional afiliation (if applicable) of the letter writer should be noted, Anonymous letters will not be considered for publication, but names may be withheld upon request. In general, letters in response to articles published more than two issues previously will not be considered. The original authors may be asked to respond to letters.
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To the Editor: I read “The Imposter Phenomenon in the Clinical Nurse Specialist Role” (Arena and Page, Spring, 1992) with great interest, recognizhg in the quotations from the literature and the authors’ “recognition of the phenomenon” a picture I first saw documented early in the 195Os, in a completely different context, while working with undergraduate students in a general medical clinic. Although our focus was an entirely different one (why, in a teaching program which emphasized to students of medicine and nursing that there was no such thing as an “uncooperative patient” were a small minority of patients in that busy clinic identified by a good professional staff as “uncooperative”? What was responsible for this labeling? Our finding was that a patient became labeled as “uncooperative” when hisher behavior caused a professional staff member of any health discipline to feel ineffective. A small number of patients seemed to have a special ability (like an eye for color, or an ear for music) which caused a staff member who believed herself (and who usually was) above such childish behavior to respond with sudden anger. The worker then regretted this reaction and felt @ty because hisher self image was of a professional generally able to deal objectively with a wide range of human problems and responses. This is an area, which combined with the descriptive research Arena and Page recommend, could well use further investigation. If done by nurses who were epidemiologists, the search would try to identify “causative factors,” “susceptible hosts” and the “mode of transmission” to track down an explanation. If a similar problem engaged the attention of an agriculturist, he would probably say he was about to look at “the seed” “the soil” and “the method of husbandry” in tracking the solution. But the search in either case would be a challenging one as the hunt proceeded. More power to the researcher who tackles it! Is it the same feeling of frustrationthat is responsible for the overuse of restraints?
Doris Schwartz, RN, FAAN (Retired) Gweynedd, PA 246
To the Editor: Re: Arena and Page, “The imposter phenomenon in the CNS role” (Summer, 1992): So that is what’s been bugging me! I feel as if a lo00 lb. weight has been lifted from my shoulders! What a relief -knowing that it’s not just me! Although I have known, in my heart-of-hearts, that it’s not possible for a CNS to become an expert in administration, education, research, consultation and clinical nursing in two short years of graduate school, I have somehow felt that I was supposed to. A point on which the article doesn’t elaborate: not only does the CNS expect her/himself to be a walking, breathing encycloma of nursing knowledge, so do her co-workers. In my first CNS position, I functioned beautifully as an inservice education director; of course, there was almost always enough time to research and analyze each new issue. But when I moved to another town and began working as a staff nurse in critical care (after a seven-year absence from bedside nursing), I was more than a little rusty, a fact that was frequently brought to my attention with negative feedback from my co-workers. The reinfomment of my own feelings of incompetence was very detrimental to my self esteem. It was only my love of nursing that made me perservere, and with time and experience I have continued to learn and grow. My growth has taken a giant leap forward with what I’ve learned by reading the article. Thanks to Arena and Page for writing it and to IMAGE for publishing it!
Betty Sorrentino, RN, MS, CCRN San Luis Obispo, CA To the Editor: I read with much interest the study by Arena and Page. I have worked as a CNS for the VA now for three years, and I know first-hand what these authors have so eloquently described, only now I have a label for it. I came on board with no mentor, charged with the clinical nursing responsibility for two units in Long Term Care (LTC), over 200 patients. As a new graduate and CNS, 1 immediately faced a situation where our facility was undergoing a JCAHO review. Our LTC unit lacked a comprehensivebowel and bladder program, for which it had been cited the year before. I “white-knuckled” it through that first year, taking refuge in the support I was offered by my fellow CNSs, and in the literature that assisted me in developing and adapting a program to meet our needs (and JCAHO’s requirements). Other budding CNSs did not fare so well. One, a CNS in Psychiatric Nursing, quit after three short months because “management” did not embrace the suggestions she offered about care of difficult patients, even though these recommendations were well-based in the current literature. I underscore the loss to the profession because CNSs bring with them an ideal of what nursing is, and should continue to be, regardless of the setting. However, we are not experts at all things, and I, for one, IMAGE:lournal of Nursing Scholarship
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To the Editor: I read “The Imposter Phenomenon in the Clinical Nurse Specialist Role” (Arena and Page, Spring, 1992) with great interest, recognizhg in the quotations from the literature and the authors’ “recognition of the phenomenon” a picture I first saw documented early in the 195Os, in a completely different context, while working with undergraduate students in a general medical clinic. Although our focus was an entirely different one (why, in a teaching program which emphasized to students of medicine and nursing that there was no such thing as an “uncooperative patient” were a small minority of patients in that busy clinic identified by a good professional staff as “uncooperative”? What was responsible for this labeling? Our finding was that a patient became labeled as “uncooperative” when hisher behavior caused a professional staff member of any health discipline to feel ineffective. A small number of patients seemed to have a special ability (like an eye for color, or an ear for music) which caused a staff member who believed herself (and who usually was) above such childish behavior to respond with sudden anger. The worker then regretted this reaction and felt @ty because hisher self image was of a professional generally able to deal objectively with a wide range of human problems and responses. This is an area, which combined with the descriptive research Arena and Page recommend, could well use further investigation. If done by nurses who were epidemiologists, the search would try to identify “causative factors,” “susceptible hosts” and the “mode of transmission” to track down an explanation. If a similar problem engaged the attention of an agriculturist, he would probably say he was about to look at “the seed” “the soil” and “the method of husbandry” in tracking the solution. But the search in either case would be a challenging one as the hunt proceeded. More power to the researcher who tackles it! Is it the same feeling of frustrationthat is responsible for the overuse of restraints?
Doris Schwartz, RN, FAAN (Retired) Gweynedd, PA 246
To the Editor: Re: Arena and Page, “The imposter phenomenon in the CNS role” (Summer, 1992): So that is what’s been bugging me! I feel as if a lo00 lb. weight has been lifted from my shoulders! What a relief -knowing that it’s not just me! Although I have known, in my heart-of-hearts, that it’s not possible for a CNS to become an expert in administration, education, research, consultation and clinical nursing in two short years of graduate school, I have somehow felt that I was supposed to. A point on which the article doesn’t elaborate: not only does the CNS expect her/himself to be a walking, breathing encycloma of nursing knowledge, so do her co-workers. In my first CNS position, I functioned beautifully as an inservice education director; of course, there was almost always enough time to research and analyze each new issue. But when I moved to another town and began working as a staff nurse in critical care (after a seven-year absence from bedside nursing), I was more than a little rusty, a fact that was frequently brought to my attention with negative feedback from my co-workers. The reinfomment of my own feelings of incompetence was very detrimental to my self esteem. It was only my love of nursing that made me perservere, and with time and experience I have continued to learn and grow. My growth has taken a giant leap forward with what I’ve learned by reading the article. Thanks to Arena and Page for writing it and to IMAGE for publishing it!
Betty Sorrentino, RN, MS, CCRN San Luis Obispo, CA To the Editor: I read with much interest the study by Arena and Page. I have worked as a CNS for the VA now for three years, and I know first-hand what these authors have so eloquently described, only now I have a label for it. I came on board with no mentor, charged with the clinical nursing responsibility for two units in Long Term Care (LTC), over 200 patients. As a new graduate and CNS, 1 immediately faced a situation where our facility was undergoing a JCAHO review. Our LTC unit lacked a comprehensivebowel and bladder program, for which it had been cited the year before. I “white-knuckled” it through that first year, taking refuge in the support I was offered by my fellow CNSs, and in the literature that assisted me in developing and adapting a program to meet our needs (and JCAHO’s requirements). Other budding CNSs did not fare so well. One, a CNS in Psychiatric Nursing, quit after three short months because “management” did not embrace the suggestions she offered about care of difficult patients, even though these recommendations were well-based in the current literature. I underscore the loss to the profession because CNSs bring with them an ideal of what nursing is, and should continue to be, regardless of the setting. However, we are not experts at all things, and I, for one, IMAGE:lournal of Nursing Scholarship
