Transformational Leadership: Advocacy and Influence TL6: The CNO advocates for organizational support of ongoing leadership development for all nurses, with a focus on mentoring and succession planning. TL6a: Provide one example, with supporting evidence, of mentoring or succession planning activities for clinical nurses. Introduction The origin of the concept of mentorship is said to have originated from Homer’s Odyssey, in which Mentor, a wise and trusted friend, took on the rearing of Odysseus’ son in his absence. Over the centuries, the concept of mentorship has come to mean a long term relationship with the focus on supporting the growth and development of the mentee. The mentor is the source of wisdom, teaching, and support who encourages and guides, but does not tell the mentee what to do. Rather the mentor helps guide the mentee to make the best decision. The following story describes how Barbara Cashavelly, RN, MSN, NE-BC, OCN, Nursing Director (ND), Hematology/Oncology Unit (Lunder 9) mentored Bethany Groleau, RN, BSN, CHPN, a clinical nurse on Lunder 9, as a nurse fellow in the Massachusetts General Hospital (MGH) Global Nursing Fellowship.

The Global Nursing Program Founded in 2006, the MGH Center for Global Health (Center) builds on the hospital’s rich history of leadership in clinical care, medical education, and humanitarian aid while crafting innovative solutions to some of the most intractable challenges facing our global community. The Center has partnered with Mbarara University of Science and Technology in Uganda to enhance patient care for a diverse range of medical conditions and support local clinicians. The Global Nursing Program, a program within the Center, provides nursing education and promotes nursing leadership to increase the capacity of nurses and midwives across the globe to improve clinical outcomes for the populations they serve. The Global Nursing Fellowship Program offers short-term fellowships to address requests for specific clinical expertise from partner organizations across the globe. Fellows foster a sense of commitment to the global nursing community, elevate the role of nurses in delivering clinical care, and provide fundamental nursing education to advance nursing practice. In 2016, the Global Nursing Program launched the MGH Global Health Oncology Nursing Fellowship Program. This fellowship offered an oncology clinical

nurse the opportunity to teach, mentor, and work with oncology nurses at Mbarara University to foster both professional development and excellence in clinical practice.

In March 2016, Patricia Daoust, RN, MSN, FAAN, Director of Nursing for Global Health and Mary Sebert, RN, MPH, International Nurse Program Manager, forwarded a call for applications to the Nursing Directors (ND) of the MGH Oncology Units. Cashavelly forwarded the application to her staff on March 18, 2016. Groleau reviewed the email and application and emailed Cashavelly on March 21, 2016 and indicated her interest in applying for the fellowship (attachment TL6a.a). Responding to Groleau’s obvious enthusiasm (“If you think I could be a candidate I will start the essay and application process today!”) Cashavelly responded in kind with an enthusiastic “That is great! Let’s talk about it and definitely complete the application.”

Groleau joined the Lunder 9 clinical nursing staff in March 2014 after having practiced on a surgical/oncology unit for 1 ½ years. Groleau had achieved certification in chemotherapy administration and in Hospice and Palliative Care. Cashavelly viewed her as a respected clinician who developed therapeutic relationships with her patients and had positive relationships with the interprofessional team. Cashavelly felt that Groleau would be an impressive candidate for the fellowship but wanted to learn more about Groleau’s interest and how she could mentor her in the application process and, if she was successful, during the fellowship.

Following that email, Cashavelly and Groleau met to discuss the fellowship. Groleau shared with Cashavelly her commitment for teaching and mentoring less experienced nurses as well as her desire to help the underserved. Groleau spoke of her community service including volunteering at a soup kitchen and with the Boston Serve Empowering People for Inclusive Communities (EPIC) which prepares young people with disabilities to be actively engaged community leaders through education, leadership development and community service. Cashavelly recognized Groleau’s passion as well as her concern that she had never practiced in a setting similar to the setting in Uganda. Cashavelly asked her to consider situations where she had to deal with minimal resources and educational barriers. This question allowed Groleau to recognize her strengths in teaching, working with patients with limited resources, and how she could use these past experiences not only in her application essay, but in her work in Uganda. Cashavelly’s ability to have Groleau reflect on her own strengths and potential is a key attribute of a mentor—to see in the mentee what they might not yet see in themselves.

Cashavelly also shared with Groleau her own experiences consulting on nursing practice around the world (i.e. China, Kazakhstan, Qatar) and the impact of culture, societal norms, the role of nursing, and other factors had on how one taught and what could be achieved. By sharing her own experiences, Cashavelly allowed Groleau to more fully understand the experience she would be facing in Uganda and the challenges she would face – specifically, how to respect the culture of the country as well as to teach the nursing staff to improve patient care. Following their conversation, Cashavelly enthusiastically supported Groleau’s application for the fellowship and

offered to assist Groleau on writing her essay, which Groleau gratefully accepted. Groleau submitted her application on April 11, 2016 (attachment TL6a. b).

Cashavelly’s role of mentor can be seen in her letter of support as she identifies Groleau’s clinical knowledge and ability to seek out resources:

“I would describe Bethany as a dedicated professional nurse that has a very solid nursing practice. She demonstrates a spirit of clinical inquiry that supports her clinical knowledge and decision-making expertise. She is reflective and thoughtful. With her intuition and nursing experience, she is able to identify subtle changes in her patients. She seeks out resources and information when needed to understand her patient’s diagnosis, treatment or clinical condition.”

Cashavelly directly addresses that while Groleau does not have global health experience, she has reflected on the experience, and what she needs to fully commit to it:

“Bethany is extremely interested in this Global Health opportunity. She has thought a lot about the fellowship experience and the commitment. This opportunity is very exciting for her and she feels she will be able to contribute to this program in a very meaningful way. Although she has not participated in Global Health/international projects, I do think she would be a strong candidate. I highly support Bethany Groleau for this Global Health Fellowship program.”

Cashavelly is a highly respected ND at MGH and her past experience consulting around the world gives her organizational credibility to not only assess Groleau’s skill and knowledge as a clinical nurse and educator, but also her ability to be successful in a foreign country with limited resources. As a mentor, Cashavelly is telling the leaders of the program that Groleau has her full support. The following announcement was posted on the MGH Global Nursing web site:

Global Nursing Fellowship Program

Nursing Fellow: Bethany Groleau, RN

Bethany Groleau, RN from the Lunder 9 oncology unit at MGH was awarded the first Global Nursing Fellowship in 2016. On being awarded her Fellowship, Groleau said, “I am so excited for this opportunity, I feel like this was an extension of my nursing, a way to give to others and something that was so much greater than myself.”

Preparing to Leave

As her mentor, Cashavelly provided emotional support to assist Groleau in preparing for the experience. In an email exchange on May 3, 2016 (attachment TL6a.c), Cashavelly addresses not only Groleau’s concerns about her schedule, but also offers to provide any needed resources:

“Let me know if you need anything before you leave this weekend and remember I can send you anything - this is happening really quickly! I am so happy you will be having this opportunity; you are going to have such an impact on the nurses, their practice and all those patients.”

Staying Connected

Groleau left for Uganda on May 11, 2016, but despite being half a world away, Cashavelly continued to provide encouragement and support to Groleau (attachment TL6a.d). The email exchange illustrates that mentorship can occur in many ways as Cashavelly is “thinking of her, and sending her positive thoughts.” Cashavelly also cheers Groleau on, as well encouraging her to explore and enjoy the experience, writing, that “They are so lucky to have you. I am sure you have had a great week! Hope you are relaxing and exploring on the weekend.”

Coming Home

On June 19, 2016, Groleau left Uganda and returned to her position on Lunder 9 deeply grateful for the experience. Cashavelly knew from her global work, that transitioning back to an environment of great resources can be quite jolting. She met with Groleau frequently upon her return to debrief and process her experience in Uganda. Groleau was excited and grateful for the experience and was appreciative of Cashavelly’s support for her application and during her stay. Cashavelly encouraged Groleau to share her experience by co-writing an article for Caring Headlines with Kara Oliver, RN, MSN, ACNP-BC, a Nurse Practitioner who was also a Fellow, and Daoust (attachment TL6a.e).

In her article, “The MGH Global Nursing Fellowship: Spotlighting the Importance of Nursing Mentorship” Groleau wrote of how she “worked with Cashavelly and the MGH Global Health nursing team to better understand the needs of nurses and patients in resource-limited settings.” Groleau wrote that during her six-week deployment, she “continued to reach out to Cashavelly and colleagues back home for clinical information to help the Mbarara team.”

Since her return to Lunder 9, Cashavelly has asked, and Groleau has enthusiastically agreed to, to precept nurses visiting from other countries (i.e. China). Cashavelly

believes that Groleau’s time in Uganda has given Groleau insight on how visitors from one country can transfer nursing practice and new learning from a foreign country back to their home country. Groleau has also approached Cashavelly to orient to the resource nurse role on the unit as well as to precept more students and newly-hired clinical nurses.

The pride and respect her colleagues on Lunder 9 have for Groleau is evident when Rebecca Loh, RN, BSN, OCN, nominated Groleau in February 2017 for the Brian M. McEachern Extraordinary Care Award (attachment TL6a.e). This award recognizes Patient Care Services staff whose passion and tenacity exceeds the expectations of peers and colleagues. Loh wrote that Groleau’s time in Uganda teaching and influencing nursing practice was “a transformative experience for all involved.” In the narrative she wrote for the award portfolio Groleau wrote of her experience “I gave six weeks to Africa, I was given the world.” Groleau received the Brian M. McEachern Extraordinary Care Award in May 2017.

Throughout this life-changing experience, Cashavelly served as Groleau’s mentor by creating opportunities, ensuring resources were easily available, and most of all showing care, concern, and unwavering encouragement and faith in Groleau.

From: Cashavelly, Barbara J.,R.N. Sent: Monday, April 11, 2016 10:09 AM To: Daoust, Patricia A.; Subject: Bethany - Global health letter

Hello Again Here is Bethany's support letter. If there is anything else you need let me know.

Thanks!

Barbara

Bethany - Global health letter.docx

From: Bethany Groleau [mailto:bgroleau@gmail.com] Sent: Tuesday, April 05, 2016 10:21 PM To: Cashavelly, Barbara J.,R.N. Subject: Global Health Fellowship

Hi Barbara,

Attached is my Fellowship application essay along with my resume. I am very grateful for this opportunity and everything you have done. Maybe if there is time tomorrow we can discuss

further.

Thank you for all your help.

Bethany

Global fellowship Bethany Groleau, MGH, Bethany Grolea Resurre 2016.doc

MGH Global Nursing Fellowship Program

Application Process

The Massachusetts General Hospital Global Health is offering a fellowship in global health nursing. The Global Nursing Fellowship Program sponsors nurses to serve in low-resource settings with the primary

objective to promote professional nursing through education and clinical practice. Fellows will have extended placements of two to three months. The goal of the Fellowship program is to foster a sense of commitment to the global nursing community, to elevate the role of nurses, and to provide support and fundamental nursing education to advance nursing practice.

The Global Nursing Fellowship Program is focused on support of the Enhanced Specialized Nurse Training Program (ESNTP). Fellows will work closely with MGH and local physicians, nurses, nursing faculty and students to train and mentor in-country nurses in advanced nursing skills.

Applications that focus on the ability to teach and share knowledge, contribute to a growing body of teaching tools and methods, interact well with a multicultural team, contribute to the advancement of nursing education and practice, and demonstrate the ability to be flexible to the needs of a low resourced nursing community are highly desirable. The ideal candidate will be a nurse who has the capacity to share his/her knowledge in the classroom and at the bedside, as well as contribute to the development of future programs.

Priority will be given to individuals with a continued professional commitment to MGH and who have demonstrated leadership and a commitment to nursing education and continuing their nursing career at MGH.

Eligibility

The Global Health Fellowship in Nursing is open to members of the MGH nursing community who are at least 5 years post-licensure and have been employed in their current service for at least 2 years. Experience as a clinical preceptor and/or classroom lecturer is required. A demonstrated ability to work across and within diverse cultures and resource-scarce settings is preferred.

Fellowship Award

• Commitment of two months to three months of teaching and learning in a resource limitedacademic/health care institution.

• Transportation and logistical support• Accommodations• Round-trip, coach class airfare to Entebbe, Uganda with ground transport to Mbarara• A modest monthly stipend

Fellowship Selection Process

Applications will be scored on academic excellence, prior record of teaching and mentoring accomplishments, clinical experience and expertise, and potential to bring diverse ideas and experience to the field of global health nursing. Final selections will be made by the Global Nursing Fellowship Program committee.

Application Requirements

1. Three (3) page (maximum) personal statement (12 point font with 0.5 inch margins), including:

• Description of career objectives and alignment with Fellowship goals• Description of previous experience with domestic or global programs of working with

underserved communities• Description of dealing with a challenge depicting your ability to be flexible• Description of how your clinical care expertise at MGH can be translated to improving the role of

nursing in a low resourced setting.

2. Current CV

3. Letter of recommendation from manager/department head/program director

Fellowship Requirements

Priority will be given to members of the MGH nursing staff. Fellows will participate in pre-departure briefings and orientation activities including meeting with mentors, and travel clinic evaluation and clearance. Monthly progress reports, and final Fellowship report, will be submitted to the Center for Global Health and MUST.

Application Submission

Please submit all components of the application as a single bookmarked PDF to: globalhealth@partners.org. Include “Global Nurse Fellowship Program – NAME OF APPLICANT” in the subject heading.

Please submit questions to: pdaoust@partners.org or msebert@ partners.org and include “Global Nurse Fellowship Program” in the subject heading

4/10/16

Dear Global Health Team, It gives me great pleasure to write a letter of support for Bethany Groleau for the Uganda Global Health Oncology Nursing Fellowship project. I have had the pleasure of working with Bethany for the past 2 years as her Nurse Director on an inpatient Medical Oncology unit. This 32 bed, acute care, medical oncology unit cares for patients admitted for management of complex, medical oncologic complications related to their treatment or disease, administration of chemotherapy regimens, palliative care, symptom management and end of life/hospice care. Bethany joined Lunder 9 as an experienced oncology nurse. Each day Bethany arrives on the unit with enthusiasm and a strong desire to provide compassionate care for her oncology patients. I would describe Bethany as a dedicated professional nurse that has a very solid nursing practice. She demonstrates a spirit of clinical inquiry that supports her clinical knowledge and decision-making expertise. She is reflective and thoughtful. With her intuition and nursing experience, she is able to identify subtle changes in her patients. Bethany is always asking questions. She seeks out resources and information when needed to understand her patient’s diagnosis, treatment or clinical condition. With her knowledge and solid nursing practice, Bethany provides safe, individualized, compassionate care to her patients and families. I also would describe Bethany as a strong nurse educator. She is a preceptor for new nurses to the unit and nursing students. She most recently was a “Super User” for the unit to support and educate the staff on the implementation of a new electronic medical record – EPIC. This was a huge undertaking! Bethany was exceptional with her organizational skills; she prepared unit based classes, developed unit guidelines and worked with staff one on one. Bethany’s educational skills, enthusiasm, organization and patience really shined with this project! Bethany is also a valued member of the team with her nursing colleagues and other disciplines. She brings a sense of dedication and commitment to her colleagues, the patient care team and the oncology unit practice. The team trusts and respects her judgment. She ensures that collaborative and respectful relationships are maintained by always communicating in a patient focused and constructive manner. Bethany is extremely interested in this Global Health opportunity. She has thought allot about the fellowship experience and the commitment. This opportunity is very exciting for her and she feels she will be able to contribute to this program in a very meaningful way. Although she has not participated in Global Health/international projects, I do think she would be a strong candidate. I highly support Bethany Groleau for this Global Health Fellowship program. Sincerely yours, Barbara Cashavelly RN, MSN, NE-BC Nurse Director

B E T H A N Y G R O L E A U 22 ECHO AVE, READING, MA 01867 (603) 391-4224 | bgroleau@gmail.com

E D U C A T I O N Rivier College—Nashua, NH Bachelor of Science in Nursing (May 2012) Saint Anselm College—Manchester, NH Bachelor of Arts in Sociology (May 2006) L I C E N S E / C E R T I F I C A T I O N Active Massachusetts (RN) Registered Nurse License BLS Certification, current CHPN Certification, current Chemotherapy Certification, current EPIC Super User W O R K E X P E R I E N C E Registered Nurse, Oncology Unit Massachusetts General Hospital—Boston, MA (March 2014– present)

• Provide specialized cancer-related care including implementation of oncology treatment plans; administering chemotherapy, research-based protocols, biological therapies, blood products, and supportive treatments

• Manage patients' pain with non-pharmacologic and pharmacologic interventions; experienced in high-concentration medication administration, titration, and adjunctive therapies. Skilled in applying guided imagery, focused breathing, cryotherapy/heat treatment

• Able to proficiently step into the position of team lead nurse with the responsibility to serve as a supportive presence to other RNs through practice, policy, and experience

• Experience in managing crisis situations while demonstrating good judgement, clinical knowledge, and critical thinking • Skilled in assisting patients and families during transition of care and discontinuation of life-saving measures; to maximize patient

comfort in accordance with the interdisciplinary plan of care through nursing assessment, pain/respiratory management, nursing presence, end of life education, and additional comfort measures

Registered Nurse, Surgical/Oncology Unit St Joseph Hospital—Nashua, NH (May 2013 – September 2014))

• Provide specialized direct/indirect patient care within Oncology/Surgical unit • Exhibit safe administration of blood products, oral chemotherapy, hydration • Significant experience in areas of Telemetry, feeding tubes, diagnostic labs, catheter insertion/CBI’s, accessing/de-accessing Port-A-

Caths, Central/Peripheral line maintenance, anticoagulation therapy, etc. • Communicate with physicians and healthcare team to directly assist in the development of treatment plans; act as patient advocate • Awareness of disease processes; strong understanding and support of both physical/psychological effects on patient and family

Registered Nurse Per Diem III St Joseph Hospital—Nashua, NH (July 2012 – April 2013)

• Work effectively in a variety of clinical settings providing safe, specialized care for patients with varying medical conditions • Demonstrate knowledge unique to unit/equipment (Medical/Surgical, Neurological, Orthopedic, Telemetry, Oncology, Rehabilitation,

and Senior Adult Mental Health) • Administer medication by means of oral, intravenous (peripheral/central), intramuscular, subcutaneous, as well as administration of

enteral and parenteral nutrition • Obey HIPPA policy and advocate for patients and their rights

New Graduate RN Residency Program St Joseph Hospital—Nashua, NH (April 2012 – July 2012)

• In a 208-bed Magnet designated hospital, participated in a three-month New Graduate RN Residency Program • Worked one-on-one with experienced preceptor, fostering skill through clinical and classroom application • Prioritized the needs of patients and families, specifically relating to acuity and plan of care • Applied communication and critical-thinking skills to develop rapport with patients and staff

R E L E V A N T W O R K E X P E R I E N C E Corporate Catering Sales Manager Crowne Plaza—Nashua, NH (2008 – 2012)

• Coordinated and supervised all aspects of corporate catering events for a high-volume conference facility, cultivated strong client relationships with community businesses, political affiliates, and non-profits

• Served as primary contact for corporate clients; calculated estimated costs and formed budgets; managed contracts and specific event details; ensured adherence to clients' requirements and deadlines; and generated revenue for multiple departments

A voice, simply, that's my hope. I breathe in slowly as though I've been reminded of my own, held delicately below my chest. I recognize it, this feeling of opportunity, of challenge, and I reach my hand out to grasp it. To collect experiences that contribute to understanding and growth; a student, a teacher, I am both. I've been lucky, I know. I think about it often, my fingers gently tapping the keys as my thoughts exhale into sentences on my screen. Thinking about the city that is now home and the hospital where I work, I understand we do not all have this. Beyond here, there's a world very different from my own, a nurse not so different from myself. The mission of global health draws the inspiration that I write of. I want to work with nurses in a low-resource setting to provide education and guidance. Though the resources of Uganda will be different from what I use today, the strength of my clinical judgment and experience will remain consistent. Ability to prioritize, assess, and communicate, are strengths that I am grateful to have built over the years. During this fellowship, I hope to help other nurses learn safe chemotherapy administration and assist by sharing the knowledge I have developed at Massachusetts General Hospital. Through education and guidance I hope to help in the advancement of their practice and to be a part of the development of future programs. I've heard people say before that a cancer diagnosis is a family diagnosis, and over time I've come to better understand. Cancer changes everything. For many reasons it changes the life of a patient, personal identification slowly takes on new meaning, and families are left to do the same. An engineer becomes a patient, a sister now her care-taker, and new roles within the family are established. It was after taking care of a patient for a few days that I really began to understand what this meant. Due to her disease, the patient was quickly becoming more dependent on others for care and her family had become the primary ones to provide that care. The patient's sister was extremely attentive by her side and certainly her advocate, but at times it started to feel as though she were creating a division against the medical team. Known on our unit for being difficult, the sister would challenge us with an attitude of disrespect, she frequently alluded to a notion that the plan of care set forth by the team would do more harm than good. I felt very frustrated after multiple attempts to better understand her until I finally realized the answer. It was actually not about a division of team verses family at all, but instead about inclusion. From the moment the patient's life changed, rightfully so, her family's life had too. They had all taken on new roles, including ones at home that paralleled our job as nurses. If this sister wasn't included and able to complete her new role anymore, how could she be there for the patient? It was shortly after the start of my third shift with this family that things changed. Holding a warm wash cloth over the bed, I gently outstretched my hand and asked the patient’s sister if she would like to help wash her too. Quietly, she moved across the room and softly began wiping her sister’s face, as though she were illustrating her features for the last time; a moment so sad and beautiful.

At MGH and prior to, I have worked along-side nurses to precept and guide. Clinically and professionally, I care very much about education and helping others to grow. Recently, for approximately a three month period, I precepted a new nurse to MGH. She was less than a year out of school and unfamiliar with a hospital environment. The foundation of her teaching from me focused on safety and prioritization, and gradually grew in complexity to include safe multitasking while caring for heavy, clinically difficult patients. I reflect back to many positive experiences during this preceptor-ship, yet also remember the depth of patience and flexibility it required, ability to teach and then step back. This experience was challenging but ultimately very rewarding; not only did she learn during this time, but certainly I did too. In the past, when working with students that need improvement to their practice, I have met challenges by trying to understand the background behind the problem. Is there a lack of knowledge? Is there a misunderstanding that could be further clarified? Could I try a different approach to help them better understand? I hope to be a resource for questions and a reminder of one's confidence. In Uganda, my previous experiences of precepting students will be helpful as I become a resource to the nurses I work with there. I hope to be a mentor, who can build upon their knowledge base while instilling confidence as they gain new skills. Experience allows me the opportunity to teach clinical knowledge, skill, and safety to others, yet it is by example that I hope to offer my greatest lessons. Over the past months at MGH we have been working to roll out a new computer system that will improve much of our current daily workflow. As part of this process, I volunteered to become what has been termed a Super User, a person who learns the program well so they may answer questions, educate, and act as a resource for others. Changing the familiarity of our current system is foreign, frightening, and overwhelming for some. I have enjoyed this role as it allows me the opportunity to assist other nurses in finding answers and to provide additional support to my coworkers. Whether at MGH or in a rural clinical setting, I want to be a support to other nurses who will also need this strong foundation of education. Although I have yet to work in a clinical setting such as the one I seek to be a part of in Uganda, I have been exposed to obstacles associated with minimal resources and educational barriers. Inability to read, limited understanding of disease, and embarrassment, can become a challenge in any setting. It is through focused education, improved communication, and explanation, that I have helped patients meet these barriers in the past. At a small community hospital I encountered many patients with limited insurance coverage, leaving limited local options for any type of assistance after hospital care. I have found from past experiences that good communication among multi-disciplinary teams and a commitment to change have proven to be effective stepping stones toward improvement.

Much of my experience with under-served communities comes from volunteering. While in school for Nursing, I spent time in Nashua, NH, preparing food, serving, and cleaning at a local soup kitchen. I got to know some of the families quite well and came to really appreciate the hard work that it required. More recently, I’ve had the opportunity to volunteer with organizations that encourage youth with disabilities to be active in their communities and to reach their goals. At a Boston Serve event through EPIC I met some amazing students and worked with them to sand and repaint a school that was in jeopardy of being closed due to its poor condition. The changes we made that day were impressive; the students that day were just as much. Waypoint Adventure is another organization that, through adventure, allows people with disabilities to grow and participate in really incredible experiences. This past Fall, I was part of a team that included multiple members with disabilities that ran a Spartan race through Fenway. Physical and developmental disabilities never limited the success of these teammates as we were challenged with distance and obstacles during this run. Part of the idea behind this type of race is that you finish together, always remaining a team to help and encourage the other. That day, with the finish line behind us, our accomplishment felt so great. Diversity is the theme that unites us. Personally, I have had the privilege of working in a small community hospital and a nationally recognized health institution. I have developed and gained valuable insight from both ends of the healthcare spectrum. I am excited for further growth and for opportunities to work with those who have different backgrounds than myself. Drawing from our own experiences we all adjust our lens differently to gain perspective, and I find such value in that. Across cultures, languages, and oceans, I am eager to be part of a multicultural team that shares a goal to educate and support. Flexibility I can give, to the way people work and the way they learn. I can accommodate to lesser resources, and will remain mindful that nothing is accomplished without respect. Respect not only for each other, but for the community and culture we meet. A representation of MGH, I want to be an extension of the diversity this fellowship can offer. To be a part of the global health fellowship to Uganda draws both excitement and fear. I am not naïve to the challenges that face this opportunity, but more greatly motivated by the goals of this possibility. Whether in a classroom or at the bedside, I hope to support the growth of other nurses so that they may further do the same. For continued education that contributes to advancing the nursing practice in Uganda, that will be my goal. It's quiet around me, now late, and I'm reminded that sleep should be with me too. A slow exhale of excitement as I think forward to my hopes for May. My curser blinks and as I stare at the page above I'm reminded of how I write of balance, of teaching and learning, and of giving something greater. For Massachusetts General Hospital, for Global Health, for the nurses I don't yet know, I want to be a voice.

From: Cashavelly, Barbara J.,R.N. Sent: Friday, March 18, 2016 5:46 PM To: Aguilar, Kathryn R.,R.N.; Alexander, Christina M.,R.N.; Alvarez, Violeta,R.N.; Arellano, Amy L.,R.N.; Bauer, Catherine V.,R.N.; Brown, Sarah F.,R.N.; Burns-Britton, Betty Ann, R.N.; Callie; Carbone, Doreen M., R.N.; Cioffi, Christina P.R.N.; Cochran, Callie Whitney,R.N.; Connolly, Kristen Marie,R.N.; Cormier, Aurelie,M.S.,A.P.R.N,B.C.; Defreitas, Allison M.,R.N.; Dubb, Maridel S.,R.N.; Elias, Denise; Filicicchia, Bonnie J, R.N.; Filipi, Jennifer G.,R.N.; Finn, Susan M., R.N.; Flom, Lindsay L.,R.N.; Fulham, Kate,R.N.; Garbitt, Heather N.,R.N.; Goode, Elizabeth; Gorynski, Kristen Leigh,R.N.; Granese, Lisa M.,R.N.; Groleau, Bethany,R.N.; Hanks, Mary Katherine,R.N.; Hansen, Andrea S., R.N.; Heavey, Maureen, R.N.; Hughes, Megan A., R.N.; Iannalfo, Stefanie,R.N.; Kane, Claire J., R.N.; Karakouzian, Alyson P.,R.N.; Kavanaugh, Hannah M.,R.N.; Kayser, Ashley Elizabeth,R.N.; Kenneally, Colleen,R.N.; Lavadinho-Lemos, Maria F.,R.N.; Loh, Rebecca,R.N.; Mackinnon, Jesse P.,R.N.; Malvey, Meredith K.,R.N.; Mammen, Chantal,R.N.; Marmen, Christine M.,R.N.; McCormack, Lynne A., R.N., MGH; McGovern, Elizabeth A.,R.N.; McGuire, Jessica,R.N.; Mercier, Noreen,R.N.; Miceli, Francesca,R.N.; Mullane, Kelly Erin,R.N.; O'Brien, Jennifer A., R.N.; O'Brien, Nancy P.,R.N.; O'Connell, Colleen,R.N.; O'Malley, Amy E.,R.N.; Packer, Lisette, R.N.; Peterson, Gayle M, R.N.; Prada, Brianna; Quinn, Lisa W.,R.N.; Riley, John P., R.N.; Rocheford, Sarah M.,R.N.; Rosenlieb,Natalie M.,R.N.; Schmeissing, Kristen Ferwerda,R.N.; Seguin, Claire M., R.N.; Shea, MariessaJeanne,R.N.; Smas, Malgorzata Ewa,CNP; Stacy, Kendra Elizabeth,R.N.; Sweet, Amanda Marie,R.N.;Thurston, Christine Rose,R.N.Subject: Global Health Oncology Nursing Fellowship

Global Health Oncology Nurse Fellowship –

Dear Staff

I wanted to share an exciting opportunity, Oncology Nurse Fellowship, offered by the MGH Global Health. This Oncology Nurse Fellowship is a program for an oncology nurse that will teach, mentor and work with oncology nurses in Uganda. The MGH has a Global Health relationship with this hospital and Cancer Center MDs/NPs have been working over there this past year (Kara Olivier NP and Dr Abramson). MGH Global Health is focusing on providing education to the Ugandan oncology nurses and has developed a curriculum for the next several months.

This fellowship is a 6-8 week fellowship in mid May/June. I would hire a travel RN to fill the position for that time. The time line is tight – but it might be a nice opportunity after Epic :)

If you are interested please let me know. I can have you meet with Kara Olivier to answer your questions. She will also be going over with the fellow for the first 2 weeks. FYI - There is a MGH House/hotel near the hospital with other MGH MDs/RNs.

Global_Nursing_Fellowship_Program-Applic

Please review the attachments for more information. Have a good weekend!

Barbara

From: Bethany Groleau [mailto:bgroleau@gmail.com] Sent: Monday, March 21, 2016 8:19 AM To: Cashavelly, Barbara J.,R.N. Subject: Fwd: FW: Global Health Oncology Nursing Fellowship

Good Morning Barbara,

I am very interested in this fellowship and would love the opportunity to learn more and apply. If you think I could be a candidate I will start the essay and application process today! Thanks for sending along this information!

Bethany

From: Cashavelly, Barbara J.,R.N. Sent: Monday, March 21, 2016 8:59 AM To: 'Bethany Groleau' Subject: RE: FW: Global Health Oncology Nursing Fellowship

That is great! Let’s talk about it and definitely complete the application. Barbara

MGH Global Nursing Fellowship Program

Application Process

The Massachusetts General Hospital Global Health is offering a fellowship in global health nursing. The Global Nursing Fellowship Program sponsors nurses to serve in low-resource settings with the primary

objective to promote professional nursing through education and clinical practice. Fellows will have extended placements of two to three months. The goal of the Fellowship program is to foster a sense of commitment to the global nursing community, to elevate the role of nurses, and to provide support and fundamental nursing education to advance nursing practice. The Global Nursing Fellowship Program is focused on support of the Enhanced Specialized Nurse Training Program (ESNTP). Fellows will work closely with MGH and local physicians, nurses, nursing faculty and students to train and mentor in-country nurses in advanced nursing skills.

Applications that focus on the ability to teach and share knowledge, contribute to a growing body of teaching tools and methods, interact well with a multicultural team, contribute to the advancement of nursing education and practice, and demonstrate the ability to be flexible to the needs of a low resourced nursing community are highly desirable. The ideal candidate will be a nurse who has the capacity to share his/her knowledge in the classroom and at the bedside, as well as contribute to the development of future programs.

Priority will be given to individuals with a continued professional commitment to MGH and who have demonstrated leadership and a commitment to nursing education and continuing their nursing career at MGH.

Eligibility

The Global Health Fellowship in Nursing is open to members of the MGH nursing community who are at least 5 years post-licensure and have been employed in their current service for at least 2 years. Experience as a clinical preceptor and/or classroom lecturer is required. A demonstrated ability to work across and within diverse cultures and resource-scarce settings is preferred.

Fellowship Award

• Commitment of two months to three months of teaching and learning in a resource limited academic/health care institution.

• Transportation and logistical support • Accommodations • Round-trip, coach class airfare to Entebbe, Uganda with ground transport to Mbarara • A modest monthly stipend

Fellowship Selection Process

Applications will be scored on academic excellence, prior record of teaching and mentoring accomplishments, clinical experience and expertise, and potential to bring diverse ideas and experience to the field of global health nursing. Final selections will be made by the Global Nursing Fellowship Program committee.

Application Requirements

1. Three (3) page (maximum) personal statement (12 point font with 0.5 inch margins), including:

• Description of career objectives and alignment with Fellowship goals • Description of previous experience with domestic or global programs of working with

underserved communities • Description of dealing with a challenge depicting your ability to be flexible • Description of how your clinical care expertise at MGH can be translated to improving the role of

nursing in a low resourced setting.

2. Current CV

3. Letter of recommendation from manager/department head/program director

Fellowship Requirements

Priority will be given to members of the MGH nursing staff. Fellows will participate in pre-departure briefings and orientation activities including meeting with mentors, and travel clinic evaluation and clearance. Monthly progress reports, and final Fellowship report, will be submitted to the Center for Global Health and MUST.

Application Submission

Please submit all components of the application as a single bookmarked PDF to: globalhealth@partners.org. Include “Global Nurse Fellowship Program – NAME OF APPLICANT” in the subject heading.

Please submit questions to: pdaoust@partners.org or msebert@ partners.org and include “Global Nurse Fellowship Program” in the subject heading

---Original Message----- From: Groleau, Bethany,R.N. Sent: Tuesday, May 03, 2016 12:28 PM To: Cashavelly, Barbara J.,R.N. Subject: A few questions

Hi Barbara,

Hope your week is off to a good start! Just wanted to touch base with you on a few quick things before I leave on Friday. Currently I'm scheduled to work that day (as a super user I think) but just wanted to make sure that there's coverage.

This may already be settled but I believe I had taken June 12 as a vacation day- since I'll still be away, can I either change that date or cancel that request? With regards to the schedule, I know we had talked about possibly having a few days off when I return. I should be back on the 20th so maybe we can finalize my return to Lunder 9 date with Kelly and Lisette too? (I had originally put myself on for a few days on the schedule since I didn't know at that time when I was traveling back).

I will be at security training tomorrow from about 11-12:30, maybe I could plan to meet with you either before or after if you'll be available and if it would be convenient for you.

Thanks so much for all your help and encouragement! Bethany Sent from my iPhone

On May 3, 2016, at 12:38 PM, Cashavelly, Barbara J.,R.N. BCASHAVELLY@PARTNERS.ORG> wrote:

HI Bethany So glad you emailed! I was planning on calling you today to catch up. Let's meet tomorrow to review the details and take care of any last minute questions. Coverage is all set. I can meet tomorrow at 12:30.Let me know if you need anything before you leave this weekend and remember I can send you anything - this is happening really quickly! I am so happy you will be having this opportunity, you are going to have such an impact on the nurses, their practice and all those patients.

Barbara

-----Original Message----- From: Groleau, Bethany,R.N. Sent: Tuesday, May 03, 2016 12:49 PM To: Cashavelly, Barbara J.,R.N. Subject: Re: A few questions

Hi Barbara,

Perfect, thank you!

I can't believe I leave for Uganda this week, so crazy and exciting! Thank you for this opportunity and all that you have done to prepare me for the trip.

Tomorrow around 12:30 sounds great. I will be walking over from Nashua street so I might be just a little late but I'll head on over right after. :)

Thanks again, Bethany

Sent from my iPhone

Email Correspondence between Groleau & Cashavelly during Fellowship

On May 11, 2016, at 10:53 AM, Groleau, Bethany,R.N. <BGROLEAU@PARTNERS.ORG> wrote:

Hi Barbara!

Hope your day is going well! Things in Uganda are good! I've been able to see how both the clinic and classroom typically go, and I'm already starting to become more familiar with things. Kara is wonderful and really everyone I've met so far here is great! Thank you for all your encouragement and resources. I did have another quick question though and was wondering, when you get a chance, if you could send me some of the "notes on caring" for the following chemo/regimens?

If we don't have them on some that's no problem, just thought it's an easy thing to make bullet points from!

Cytarabine Gemcitabine Cyclophosphamide Ifos Bleomycin 5-fuOxaliCarboplatinCisplatinMtxDocetaxelR-epochR-chop

Thanks so much! Bethany

On May 11, 2016, at 7:40 PM, Cashavelly, Barbara J.,R.N. <BCASHAVELLY@PARTNERS.ORG> wrote:

Glad All is well! I will send the teaching sheets later today! Let me know if there is anything else you need.

Thanks Barbara

On May 14, 2016, at 3:37 AM, Cashavelly, Barbara J.,R.N. <BCASHAVELLY@PARTNERS.ORG> wrote:

Just wanted to say hi, send positive thoughts and hope you are settling in! It's been 1 week. They are so lucky to have you. I am sure you have had a great week! Hope you are relaxing and exploring on the weekend!

The weather is finally warmer here in Boston. The leaves are starting to come out. Take care Barbara

From: Groleau, Bethany,R.N. Sent: Saturday, May 14, 2016 11:20 AM To: Cashavelly, Barbara J.,R.N. Cc: Olivier, Kara M.,N.P. Subject: Re: Thinking about you!

Thank you Barbara!

It's been great so far; seeing and learning so much! Thanks to Kara I already feel like I'm settling in and really am just feeling so lucky to be here!

Yes, exploring this weekend in a different part of Uganda-I am spoiled with the beautiful scenery!

Thanks so much for checking in and happy to hear it's FINALLY starting to warm up in Boston. Please tell everyone I say hello!

Warmly, Bethany

Sent from my iPhone

Page 6 — Caring Headlines — September 1, 2016

Global Nursing

The MGH Global Nursing Fellowship

spotlighting the importance ofnursing mentorship

— by Bethany Groleau, RN, staff nurse; Kara Olivier, RN, nurse practitioner; Pat Daoust, RN, nursing director; and Barbara Cashavelly, RN, nursing director

or more than a decade, the MGH Center for Global Health has part- nered with Mbarara University of Science and Technology in south- western Uganda to enhance patient care and support local clinicians in managing a diverse range of medical conditions. Recently, the partnership expanded to include nursing mentorship and educa-tion through the innovative MGH Global Nursing Fellowship. In this new program, nurse fellows in under-served areas provide instruction in the classroom and guidance on clinical units to foster both professional development and excellence in clinical practice.

Earlier this year, Barbara Cashavelly, RN, nursing director for the Lunder 9 Oncology Unit, mentored staff nurse, Bethany Groleau, RN, to help prepare her to apply for the inaugural fellowship. In May, work ing with Pat Daoust, RN, nurs-ing director for Global Health, Groleau was recruited, oriented, and deploy ed to Uganda as the first global nursing fellow.

MGH is a champion of specialized nurs-ing, recognizing it as an essential compo-nent of high-quality, patient-centered care. Partnering with local healthcare facilities where MGH enjoys long-standing rela-tionships, MGH nurse educators work

with local staff to improve the quality of care in low-resource settings. During her time at Mbarara Univer sity, Groleau, worked with her Ugandan col-leagues to provide oncology nursing education and develop culturally sensitive approaches to overcome the social stigma associated with cancer in that country. Groleau spent six weeks in Mbarara teach-ing a customized, oncology-focused curriculum and F

continued on next page

In the MGH

Global Nursing

Fellowship, nurse

fellows in under-

served areas

provide instruction

in the classroom

and guidance

on clinical units

to foster both

professional

development

and excellence in

clinical practice.

(Photos provided by staff)

Communications and Recognition

September 1, 2016 — Caring Headlines — Page 7

Global Nursing (continued)

caring for patients on inpatient and outpatient units. She worked closely with Sister Sarah Nabu-sh awo, RN, charge nurse of the oncology unit at Mbarara Hospital.

As an oncology nurse at MGH, Groleau cares for patients with complex cancer diagnoses and sup-ports patients focusing on symptom-management. Groleau’s work on Lunder 9 inspired her to seek out opportunities to care for patients with similar diag-noses but who lack access to state-of-the-art re-sources. For cancer patients and families in Uganda, long distances, long waits for diagnoses and treat-ment, and inconsistent drug supplies complicate ef-

fective chemotherapy treat-ments that could potentially save many lives.

In the months prior to her departure, Groleau worked with Cashavelly and the MGH Global Health nursing team to better understand the needs of nurses and pa-tients in resource-limited set-tings. Mindful of cultural dif-ferences and sensitive to communication barriers, she focused her preparation on

practice differences and the stigma associated with a cancer diagnosis.

When Groleau arrived in Mbarara and met the nurses who tirelessly care for patients lined up out -side each day, they proudly shared their desire to improve care and welcomed her as a valued resource. During her six-week deployment, Groleau contin-ued to reach out to Cashavelly and colleagues back home for clinical information to help the Mbarara team. While the challenges faced by pa-tients, families, and providers in resource-limited settings can seem overwhelming, the collabora-tion between these remote facilities, MGH Global Health, and the MGH Cancer Center is a good reminder that the compassion and motivation to provide better care is universal.

Says Groleau, “Sharing knowledge and helping others grow in their clinical practice was a privi-lege. Through the Global Nursing Fellow ship, I’ve been fortunate to build lasting professional and personal friendships with my Ugandan colleagues. I’m grateful to have had the opportunity to help educate such wonderful nurses and I thank them for all they taught me in return.”

For more information about the Global Nurs-ing Fellowship, contact Mary Sebert, RN, at 617-643-9197.

Opposite page: Mbarara nurses in oncology clinic

during classroom presentation.Below: Groleau (right) with

Sister Sarah Nabushawo, RN.Below right: Mbarara clinic

nursing team

'd' MASSACHUSETTS,p' GENERAL HOSPITAL

. THE lNSTITUTE FOR PATIENT CARE

Patient Care Services Award Program Nomination Form

Nominations are due February 28 1", 2017

Take a moment to honor a colleague. We are seeking nominations for the 7 PCS Awards

Award name _Brian M McEachem Extraordinary Care Award_

Nominee name and title: _Bethany Groleau, RN_ (please prln1 cleorly)

Unit/ Extension: _Lunder 9, Ext 8-5900_

Nominated by: _Rebecca Loh, RN_

Date: _2/4/17 __

Are you the nominee's director/manager? J No D Yes

If yes, I attest the nominee Is In good standing D

Please review the award descriptions, elig\bility, and criteria as you consider whom to nominate. Your nomination should include how the candidate meets the criteria for a specific award along with the following information:

• How you know the nominee?

Bethany Groleau has been my co-worker as a staff RN here on Lunder 9 for the past ( almost) three years, since her hire in 2014.

• Why do you feel the nominee be the recipient? Please provide o description ofthe nominee's practice and experiences as they relate to the individual awardcriteria? In your response please provide specific examples of the candidates'practice ond how the candidate fits the particular award criteria.

Bethany is known for being a compassionate, hardworking, intelligent nurse, and it has been a pleasure to work with her. Whenever I pass patients back and forth with Bethany, I find evidence of her extraordinary care: she communicates well with the team and her patients, gives attention to her patients' most basic needs and most complicated medical issues, and works with the team to develop the most thoughtful, appropriate care plans for our patients, Her patients speak highly of her,

We recently had a profoundly sad situation on our floor, in which a young patient with terminal illness had a sudden downturn in his respiratory status that ultimately led to his death. Bethany was this patient's nurse during what was truly a challenging and scary time for the patient and his fam!ly. Although the treatment team was ready to go to extraordinary lengths to intervene to provide this patient with a little more time, the patient himself was tired of treatments and asking to die,

In this situation, Bethany mobilized the treatment team and galvanized her co-workers into action. Instead of emergent surgical and pulmonary intervention, the palliative core NP was called in, and the patient was provided with medications to assist with air hunger, pain, and anxiety. Bethany remained at the patient's side, holding one hand as his mother held the other, and offered her soothing presence as the patient drifted into unconsciousness. She stayed well past the end of her shift to provide her support not only to the patient, but to his distraught family.

Watching Bethany in action that day, I witnessed the practice of o truly great nurse. With tears in her eyes, Bethany pushed through her own sadness to advocate on behalf of her patient, obtaining the necessary medications to maximize the patient's comfort, and attending to the emotional needs of the room as she worked,

I am truly lucky to have Bethany as a co�worker. and I genuinely believe her practice is extraordinary, I would love to see Bethany recognized for the amazing work she does.

• Please provide examples of the nominee's contributions to their respectiveprofessional roles in genera!?

In addition to being a valued team player who contributes to our floor's reputation for excellence in nursing care, Bethany recently took her compassionate care to a new global level when she became the first MGH nurse to travel to Uganda as part of the Global Health Fellowship in Nursing, There, she helped teach local nurses basic oncology nursing skills, in what !'m sure was a transtormative experience for all involved. Bethany truly represents the best of MGH nursing, and clearly demonstrates a willingness to grow as a nurse and contribute to the profession to the best of her ability.

Eligibility:

Brian M. McEachem Extraordinary Care Award Award Criteria

MGH staff across all role groups in Patient Care Services.

Award Criteria: This award is establisJIBd. to recognize the passion and tenacity of an individual who exceeds the expectqtions of peers and colleagues. The criteria for this award will illustrate those behavtGr-s that exemplify acts extraordinary acts of compassionate patient care and service throc:i-gh advocacy and empowerment. PERSONAL SAMPLE BEHAVIORS ATTRIBUTE Patient Advocate

Empowerment

Commitment to Extraordinary Patient Care and Service

Compassion and Caring

Demonstrates flexibility in providing care based on the wishes of the patient for compassionate and individualized care. Is described by patients, families and colleagues as influencing attitudes and _foc_L.Jsing on solutions. lsrviewed by patients, families, and colleagues as someone who takes the time to lisfen and understand their concerns. Values and respects the one-on-one relationship. Is respectful of the values and beliefs of patients, families and colleagues. Consistently fosters ongoing relationship building. Is able to work within the formal and informal structure to meet the needs of patients and families Has visions of "what should be" and sees beyond what is apparent Able to negotiate on behalf of the patient/family to improve the quality of care/life

- -_a_cr;_oss the continuum of care. ls�a-stronq advocate for patients and families. Consistently seeks appropriate resources to empower him/herself to better meet the patient's needs. Utilizes resources to empower patients and families Always put the interest of the patient and family first. Is dedicated to ensuring quality patient care and service. Works as a team player. Shows flexibility in meeting the needs of the patients, families, unit, department, and the institution. Isn't afraid to take risks on behalf of the patient when it is safe to do so. Respects patients decisions and ensures they are upheld. Provides care and service that is individualized and compassionate, culturally sensitive, and holistic- sees the person in the patient. Provides care and service which demonstrates skills of involvement with patients and families and respect for patient's values Described by patients, families and colleagues as kind, considerate and thoughtful.

A Difference

Bethany Groleau February 2017

"You have it already, everything you need," my pencil pauses on the paper as I know she won't believe

me. A shiny stethoscope and new initials behind my name - I was there once too. It seems almost like

yesterday, if not for the patients and how they've changed me. To a "new nurse" I write, hoping that

you'll remember my letter to you, for these are the greatest lessons I have learned.

Use your eyes to look beyond what others might see, our vision can often be so limiting. In May, I met

a girl in Uganda who wore a scarf wrapped around her head to cover a tumor; it bled, it distorted her

face. There was cultural shame as she felt people in town talked about her. I couldn't remove the scarf

immediately because of the flies; it had crusted to her body. She was sweet, and shy, she loved singing.

Dressing changes and wound care and talks of her favorite foods. She was sixteen and I shouldn't say

it, but my favorite. She sat cross-legged, so quietly, so patiently. She vomited because of the pain. Her

mother beside her, I hope you would have seen her beauty too.

Listen, it is how you'll understand. There are sounds that fill each moment, fidgeting fingers, deep

breaths, sadness and joy. Be there to hear the whispers when a voice is too soft to speak, it's most

important then. Times too many to count I have heard the plea of a patient, the cry from his eyes, from

his hands, from within. What will you do? Know the days beat, like a heart, there's volume and sound.

Running footsteps on tile to crescendo and silence. Sadness so deep you wonder if you're screaming

too, but you take his hand and you've only told him you're there. Silence.

I wouldn't blame him if he is feeling tired, I am in here again, but no medications this time._ Ivory

soap, I can smell it even now, fresh, white, it smells comfortable to me. Warm water, suds, and with it I

hope to wash away the dirt of this day. He's wishing I'd just leave, I'm sure, but this is important also

you know. It helps to heal him in a different way. "Your shades too, I want them up," I tell him.

"Enough so that the sunlight shines in." Enough so he can imagine that he's outside in it, and just for a

moment he's free.

In Uganda, I wrapped my hand under the arm of an older man too weak to stand on his own. Slow steps

to another chair, and I knelt down to remove a thread thin sock and shoes that looked his age. "Thank

you, height and weight for chemotherapy" I explained. He seemed so grateful. Multiple snapshots like

this and hundreds of patients later I think back to him. "You are special" she said to me that day. "You

aren't afraid to touch them". People, patients, Sister Sarah's voice, heartbreak for hearing this was

different than anything he had felt before.

Travel when you can, be part of something bigger than yourself. Recognize opportunity, reach out and

grasp it. Rise to challenges! Whether in a classroom or at the bedside, support the growth of other

nurses and encourage them to do the same. I gave six weeks in Africa, I was given the world. Scared,

brave, one of the greatest adventures of my life. Collect experiences that contribute to understanding

and growth; a student, a teacher, I am both. I wish the same for you.

Patients, like waves, pass quickly and blend with the next, but sometimes there is one that pushes you

harder, catches you off guard, brings you to your knees. Your hands clutch the sand for stability, but

you feel it slipping from your grip until you realize it wasn't yours to keep. You believe it is more

powerful than you. Forgive me. I have asked myself, "could I have done something more?" You will

rise to your feet, you will remember his strength. For his mother, his father, his brother, you will

remember his fight. "You've done great", I thought to tell him. My hand to his hand, I've said nothing

and yet everything. Many haven't been here before, but I have. When he can no longer be the guide, I

will carry his map forward with me. This journey was his.

Lucky, really, that is what we are. I share with you a small collection that I've found to be the most

delicate lessons of life; I hope you'll learn them too. Listen to the words they say, see without looking,

taste opportunity, know the scent of hope, and touch with your heart. When I no longer remember,

please remind me again. This is why I became a nurse, this is who I am.