La política y el cielo

The following section describes the theme of what it is that they feel sets them apart from their colleagues. Subthemes touch on expertise and practice setting. This next exchange illustrates how these participants feel about their roles within industry; they seek to support sales, while looking out

for the best clinical interests of the patients. It captures a discussion about how they see their role as nurses within the larger context of industry and making products available to patients. Below is an example of how they approach product selection for patients considering some challenging economic barriers. As Gwen so eloquently states, coming into industry, she feels that they are now positioned at a new vantage point, to see beyond the ‘silos’ that they formerly practiced within and learn about and use information on payer sources, to manage resources within a complex reimbursement system. So, she believes that she is seeing the larger picture and acting in a role as mediator for patients in a system that turns on a dime. Gwen begins the conversation very engaged, leaning forward with expressive arm motions, reaching out with upper body movement to be with the participants surrounding her. She speaks with passionate conviction, with her hand over her heart and she is met with affirmation from her peers.

(Gwen) I think something that we all see is when we were in our different silos, that’s a fair word to use, we didn’t have the big picture of regulatory,

reimbursement, payer sources that we have to have, and that’s a learning curve, it was for me. But to understand who the payer source is, if it’s a Part B or

reimbursement insurance information, why aren’t they willing to supply those products? Well, you know what, they cost too much. (17)

(Gwen) So your challenge sometimes is, well I’m a nurse first, I tell everybody that. But here’s the reality, the dollars and cents aren’t adding up so we have talk about what can be provided. And that can be a real conflict for us as nurses . . . but it’s the reality. (18)

(Gwen) We’re nurses first. (40)

(Iona) Safety for your patients and your nurses. (40)

As evidenced by this excerpt, it appears that Gwen is acknowledging the need to align the caring mindset that is the optimal image of the bedside nurse to the reality of the current healthcare climate and find creative ways to satisfy patient needs. In her industry role, Gwen is privy to not only what may be the most appropriate clinical product for a patient, but she now is responsible for product selection based upon the reality of financial considerations. Gwen is acknowledging the compromise that must be made. She knows that is a challenge in healthcare today and she admits to conflict and

feeling a tension between the nurse and the industry reality, that is expressed by her facial grimace. Always at the heart of the matter is the grounding of being a nurse. In her experience, at the end of the day, this ability to see the larger picture and provide for the most appropriate patient need differentiates the CWOCNIIs from the hard-core business of profit and loss. The conversation below is expanding on how they see their role; their perspective on how they function and what sets them apart from others outside their group.

(Fay) We’re more willing to think outside the box, than the typical person . . . You don’t hit walls, you move walls, you have to. If you don’t, your patient suffers and we’re advocates at the end of the day . . .(18)

(Dora) I agree with that. (18)

(Dora) I think that in this role, you can’t be that nurse that’s bounded by boundaries, you have to be open to what people have to say (18)

These participants are excited by the opportunity to draw on their resources, to be creative in the way that they think about care delivery. Free from the task of daily caregiving, they can focus on innovative ways to navigate the system to provide for patient needs across a more broad landscape. There is a definite sense of excitement that is portrayed by their body language; they way that they lean in toward others in the group, visibly reaching out with positive facial expressions and arm gestures. Part of what they feel sets them apart is their unique work setting. They practice within their own

microenvironment, positioned within their own company. Within the context of industry, these participants share a common bond that includes a work setting that merges home with professional role and blurs the distinction between the two environments. Dora feels that was a hard transition. Dora expresses a tension associated with transitioning to establishing her work setting within her own home environment. She also speaks to the organizational skills required to do so.

(Dora) I think the tough thing for me was organization. I’m not sure that I could just . . . because nursing is so regimented, you get up, you go to work, and then you leave. But with this role, you’re your own self-motivator. You have to be highly organized. Your house is now your home office. That was the hard transition. (41)

Fay reiterates the feeling of merging the two settings of home with work when she observes that for her, she never turns off work. With the fluidity of the settings, Fay feels that it is difficult for her to leave work behind at the end of the day.

(Fay) You never turn it off. There’s never an eight hour day. (41)

Cate cites an example of how her work and home life are blurred and how her work schedule or lack of schedule impacts her life. This example rings true for the other participants who affirm that they share the unpredictability of work time.

(Cate) . . . the fact is, when I first started this job, I had to move to a different city so I looked for places that I could go and even do volunteer like at the street clinics and things like that, well, they kind of want you on a schedule and unfortunately with our life . . . you know, I’m trying to have new windows put in my house. When will you be there, well let me get back to you. (54)

The sense of self-satisfaction from work done is spoken of by Fay when she states that despite the lack of hands on experience, she can see how her work and the work of her colleagues in industry has made a difference. She speaks not only for herself, but for all the participants in the group. Indeed, she says that they all acknowledge and are united in the intent ‘to pay it forward’ with a sense of determination.

(Fay) So you actually, you’re not hands on, but at the end of the day you can see where you made a difference. (52)

(Fay) We all understand the importance of paying it forward. That’s us, at the end of the day. (57)

(Fay) One word, determination. (16)

Cate speaks of the feeling of camaraderie and love that each of the participants share as one group set apart from other nurses. She feels that over time the participants have come to share an emotional kinship that extends beyond the professional interface. Like the merging of work and home, for these nurses, their network merges professional and personal.

Cate) We have all known and grown to really love many of the people in this room. And it is because, please if you come away with nothing else, what you need to understand, at least in this group and many other people in industry, don’t ever be afraid to voice anything, because we all have at one time or another, I mean because like basically, it’s like seriously, I’m doing this for what? (39)

Cate feels there is something else that is special and sets her group apart. Beyond the challenge, the adventure, the autonomy, each participant shares the desire to learn, to be open to learning. For her, being the educator is inextricably linked to learning. She also sees this as a driving force that goes beyond learning simply about the product that a company sells, but rather learning about how to impact the general quality of patient care. Cate feels that this openness to learning sets her and her cohort of CWOCNIIs apart.

(Cate) The other thing is, everybody talks, I mean everybody, person around here, talks about the adventure, the autonomy, the challenge and all that but here’s the thing, each and every single one of us here at this table and many, most of the people that I know in industry always are open to learning. You talk about education, you cannot deny that every time you teach, you learn something new. We are driven to learn more about whatever. O.K. so you work for Company X, you know wounds, O.K. but every single one of us don’t stop at just doing wounds. We want to know more about all that impacts our patients. We’re just never satisfied. (17)

In the exchange below, Iona speaks to research; both the performing of it and the dissemination of it. Performing of and sharing the research is integral to their role in industry and their ability to perform sets them apart and adds perceived value to what they do in the eyes of their customers and their employers. The comments then expand on how their clinical background enhances their ability to disseminate research and how to stay clinically relevant.

(Iona) And that’s the other part of our job, is research. Whether we’re doing the research or reading the research, we’re sharing that research and that is very valuable to our colleagues, back still doing patient care. Not back, but on the other hand, doing patient care. (34)

(Cate) I honestly believe that one of the primary roles of any nurse is education. It’s what our life is about. (35)

(Cate) So yes, a nurse who comes into industry, who maybe doesn’t have this background (as a CWOCN), will want to learn it. But if you haven’t gone through the excruciating course to get that . . . (laughing) you don’t understand. (35) (Iona) And the other part of that is, you can go through the excruciating course to get it, but if . . . you don’t follow up with going to conference, continuing to learn, ordering the journals, reading the journal, listening to the educational programs that are offered, then you become not very valuable and I sometimes think that those people may bring our industry nurse image down. (35)

(Gwen) . . . boots on the ground (35)

Cate speaks to the ‘excruciating course’ as a term to describe the empirical experience that is their roots and she shares her observation with a knowing chuckle. Despite the fact that they have transitioned from patient care, they have roots to patient care and they see this as enabling them to connect with their customers. The historical source of their knowledge is the link that associates them with their customers and derives the value perception. This places them in a unique position within the larger nursing society and sets them apart. To maintain their roots these participants feel that it is important to keep themselves and their knowledge relevant in various ways, through reading and being involved in research, by attending conferences and professional meetings. They feel that if they do not maintain their roots with follow up such as attendance at conferences, reading journals and continuing education, they feel that they are not perceived as ‘having boots on the ground.’ It sounds like the reference to boots on the ground is an historical link to their heritage. It is quite interesting that they call their own career path an ‘excruciating course’. That is an area for further probing. Within the scope of their role, they perceive themselves as educators and as advocates, for their customers, both patients and caregivers. In addition, their non-nurse colleagues within industry are also their clients, in effect, their client base has multiplied. The concept of education comes up many times throughout the course of the focus group. Education is at the essence of their role. As such, for them, to be relevant in educating means that they target their communication with their audiences appropriately and they are acknowledging this below when they describe…..

(Iona) I’m just like Cate, I have the gift of gab and I don’t mind talking. I know people everywhere, so now it’s learning how to talk to different people. And I think that was my number one drawback, I had to learn how to talk with nurses,

administrators, it’s all a different conversation. (36)

(Fay) If you want me as a patient advocate, you’ve got the right person. If you’re asking me for a mouthpiece, you don’t need me. (40)

(Iona) Safety for your patients and your nurses. (40)

Iona explains her experience in learning how to develop this skill of speaking with and relating to different people. She explains how even with her natural tendency toward being loquacious, she has had to learn how to speak to different audiences and that was not easy for her. Her ability to

communicate on multiple levels and the judgement that enables this is part of what sets these participants apart. They have moved from being just caregivers of patients to caretakers for both caregivers and patients, retaining the advocacy role but expanding upon it. Fay states that for her, engaging with industry meant being true to her role of being an advocate. What sets them apart contributes to the way that they are perceived by others.