Because healthcare is so complicated now and not really focus very well on coordination that it can often take a tremendous amount of time and energy for this very basic ordinary thing to happen. So for example one of the patients in the book is misdiagnosed, the classic thing that happens, the patient comes into the emergency department. A medical problem is perceived, she perceived, she goes to a medical floor, it turns out she has a very serious surgical problem. I was talking with one of the surgeons involved on my behalf i just felt so angry, and he said it happens all the time. Host i dont think the public really appreciates how complicated it can be. It does cause to even try to work harder to coordination. Guest i dont want to scare people and make them think the hospital is chaotic in a mess. That is not the case. Host right, but it takes a lot of work and a lot of effort. On behalf of the entire team and nurses were there every day. Guest yes, that is what motivated me to write this book. I think the average person does not know how important the nurses are to quality patient care. If you do well in the hospital it is likely some of that is going to have to do with your nursing care. Host absolutely. So, your practice setting and the book of course is a cancer ward. When i was in direct practice, i practice in pediatrics. I would sometimes have people say to me i dont know how you take care of sick kids. Im guessing people say to you i dont know how you take care of patients who have cancer, seem so so depressing. Guest yes, thats exactly what they say. Host im often struck by the use of humor and healthcare. Humor in a setting that you normally think of depressing and difficult, but patients and families use humor, certainly nurses and Healthcare Teams use humor. Talk a little bit about the use of humor to talk about difficulty. Guest within the classic of humor which people not healthcare can find very offputting if not to say disturbing. I dont think it comes out of being callous or on caring. But in the book i had a patient die, i had not known him for very long. I got very attached to him. After he died he had a lot of narcotic left over so i had to waste it, get rid of it. Another nurse helps me. You me. You have to give a reason why you are wasting. A patient died is not one of the reasons. So together we decide on patient refuse which struck us as hilarious. We are laughing so hard that people hurt us in the hallway. But somehow it helps, it helped with my grief to do that. Host great example. You talk about how it is to work in a Healthcare System that seems to forget that it is working with human beings and that, you know sometimes we are caught up in the bureaucracy are focused on healthcare as a business. Say more about the empathy that is needed, certainly to give direct care to patients and that mental toughness that it may take to be a nurse. Talk about that. Guest it is so important to totally be there and it is incredibly difficult because we are constantly getting pulled away. The phone is ringing, low alarm is going off, someone needs you, you, someone else need something from you. That is a constant challenge because sometimes a patient just needs you to be there for them. Either because they are in pain, they are vomiting, they are scared, all kinds of things. Being able to come to that patient with your whole heart and at the same time being to go through your to do list is very difficult. Nurses have to be good at turning on a dime. Host i think it is a challenge, we certainly hear from patients and former patients who feel that their nurses seem so busy they do not want to ask them for thanks. Things that are important for them even if it is just spending a few minutes with them to explain the medication. Guest yeah, thats tough. I remember talking to another nurse and saying i just do not have time to do all of the little things. And and she said yeah, thats right those are the things that really make you feel like you have contributed. Host yes. Really. So lets shift a little, we know that research on staffing has made it pretty clear that more patients a nurse has above a certain number, of course it is very dependent upon how sick the patients are, but the skill level is from various nursing staff on the unit that day. We know that number may contribute to an increased likelihood about patient outcome. About patients who could die. So, staffing issues are an ongoing concern at the American Nurses association, it has been a lot of our work in the last few years. In fact, we we have worked with congress to reintroduce that registered Nurse Staffing act. Talk about how staffing impacts nurses and your patience. Guest this is such a great question and an important issue. I applaud the ana for their work on this. For patients is a standard load on my floor. I i start with three in the book. To show people what a difference it can make to have three, with 4i am just hopping all of the time. I really want people to understand that. Initially people think that for patients, whats that . That sounds like nothing. Then they read the book and said zero wow, now i really get it. The scary thing to me is ive been doing a number of interviews and nurses safe for patients, ive ive never had fewer than eight patients. The patients that i take care of , it is very distressing to me to say that eight patients may be relying on one nurse. How can one person possibly meet all of those needs. Host it is difficult and yet with the constraints and funding for healthcare these days we have to find the right balance to get the right level of nursing care for the patients, we know it fortunately it can contribute to bad outcomes. Additional work is needed for sure. Do you think patients understand how stretch nurses can be . What if you had patient say to you and that regard . How could we engage patient or individuals who are involved in the Healthcare System to better advocate in the third . Guest thats a great question. I think a a lot of patients get it. Ive had patient say youre busy, dont worry about this, when you get a chance. A chance. Ive heard other patients say dont give me that about change a shift, i need this right now. Neither cases either great for the patient to be so frustrated that their needs are met or to feel like they can ask for something because theyre too busy. What i would like is that people read my book or learn more about nursing, to see how important we are and if they are going to write to legislators or make a point about how to improve hospital care, that they talk about the nursing care. We are very focused on Patient Satisfaction now, which i value and theres value talking about it. But also having enough nurses lead to have a more satisfied patients. The equation of enough good nurses able to do the job and patients doing well needs to be even more solidly established in the public needs to say, this is what we want. Host i think there is ever increasing opportunities to educate the public around what kind of questions they should be asking before they have to go into the hospital or maybe one of their family members has to. Whether they have a magnet designated hospital in their area or even a question about what is the average staffing . What is is the average nursing staffing for unit. So there is a great deal of work that we are all engaged in right now about what are those measures particularly related to nursing care that we would like to see publicly reported, and that patients can go to, or individuals can go to and look online before really and what would they want to know especially when they have the ability to compare different hospitals, different healthcare providers, different facilities. Guest that type of transparency would make a huge difference because that hospitals would know. They can see the hospital across town actually has more nurses, and general than we do on the floor. We cannot tell people how much an mri cost or an apathetic to me for complicated reasons but surely we can tell them how good the nursing care is. Host absolutely. Im going to shift a little bit to the image of nurses. You talk about various things in the book about getting to the issue of image and relationship, among healthcare professionals. You give an example about Nurse Practitioners and physician assistants are not listed on the board. The board is up on the wall so individuals can see who is caring for home. Who is assigned to whom. How those individuals as well as nurses are often elicited by first name but we use physicians, residents residents often are listed by their last name. Say more among the relationship among individuals and what kind of issues to we have in our setting that keep this challenge as we work on nurse, physician relationships or respect among the Healthcare Team. Or understanding what Healthcare Team members do. Guest there is a clear hierarchy. Doctors have Certain Authority that nurses do not have. But theres a bigger problem with hierarchy and that nurses find themselves in situation where we feel our contribution is not looked at as being significant. So the dr. Be in doctor brown and the nurse always being, tresa reinforces that sense. That the dr. Is the expert and the authority and the nurses something between a waitress and a best friend. I dont mind at all having patients call me teresa, in fact i like it. I would like the formality that doctors work with us, i find it so strange to be talk into physician and theyll be talking about another dr. And theyll just say dr. Sometime its a really, last name like doctor scott, doctor brown, doctor miller. You have. You have no idea who theyre talking about. So on a very basic level, this reinforcing hierarchy with titles can get in the way of really elementary things like care like who is the dr. . How do i call that person . Host another example used in the book is how nurses are certainly trusted to administer a drug that could be very damaging on an individual particularly in an oncology unit, a cancer unit. You are administering medication through the vein yet you counter that example how you are not quite sure that you can use google without filters. So it is likely have this the dynamic of full confidence and trust and yet we have these barriers that seem to impact respect we would have her professional. Guest that is a great contrast. On the the one hand we are very skilled technicians. I attended quite extensive classes that my job provided to give patients chemotherapy. Many jugs required specific knowledge of how you give them. We carry a lot of that around with us. That is quite a responsibility. On the other hand, sometimes i would try to google things at the hospital like i would look up something about a chemo drug and i would not be able to use google. It seemed to come and go, that authority. Then another nurse said there is another way to pull up the ekg and then there is a way to circumvent it and they found that out. But the idea that we are intelligent people who might actually need to look up something. The point is to keep us from getting on facebook, i guess. I just have been seen that happening a lot. Host youre too busy. Besides this issue of first late name, last name and access to internet resources that may be needed for patient care, are there any other areas you can think of, anything else you have had in your experience in which nurses need to be focused about getting more respect from their physicians and who they are is a key member of the Healthcare Team . Guest nurses are notorious for the phrase, nurses eat their young. I have experience that. It is really horrible. But we could change that. I think it happens out of a sense of frustration. Not being listened to. Not being taken seriously. That anger has to go somewhere. So then nurses take it out on each other. It could be younger nurses again older nurses, new nurses against old nurses, its just bullying. We could stop it if we really looked at it as a management problem and a Work Environment problem. And say why are these nurses so frustrated . Host i would agree with you, absolutely. You do a great job in the book talking about your relationship with these four patients, even smother patients you elude to that you cared for before, or who had been on your unit previously. Our relationship with patient, particularly in your setting, patients who is on time go in and out of the hospital so you get to know them or than just a single episode. They are complex leading relationships with the patient. Talk more about that, particularly when we have the challenges in healthcare about Patient Satisfaction scores in the dynamics of, you know know them for that. Of time and then you send them off and of course is used in the book on a cancer ward you hope to never see them again. Guest yes, we say that to people and weve had people say that to me. I hope you i never see you again. Unless maybe at the mall. I think anyone who goes into nursing, maybe especially ecology or safe you just have that impulse to connect hearttoheart with other people. I remember as a new nurse talking about this and she said that she when you stop caring thats when you need to get a different job. I really took that to heart as well. The idea that sometimes it is going to be really painful and youll get attached to people, and they will die. And that hurts. But it is part of the job. I look at it as a sort of said idea of i go in, i do my best for these people, i tried to make their lives better, their care good, and i do my bit and then i leave. In our training that really gets reinforce. You show up on the floor together for clinical, you leave together, there is no calling to see how is mr. Jones doing . You do your bit and then someone who is every bit as good as you are is going to take over for you. Host you also talk about other things that impact patient care. Paperwork is one of those things. You use is great example that i want to talk about and read from about your time with the patient you just mentioned a minute ago. You say, teresa you just cannot stop bothering doctor coyne can you. Our secretary calls out loud enough for anyone standing nearby to hear, this is a moment when i find her abusiveness difficult. I try to ignore her. But then i feel it, upset. The secretaries, and suggest suggest i am not adhering to the expected md, rn relationship and it is not the first time as nano pinion 80, even pushing nurse, but why is that . Should i . Should i not feel asserted and responsible instead. Isnt it a core guide used for all healthcare professional. So talk a little bit about physician, nurse relationship. Paperwork that impacts, those things that get in the way of getting in the care that we know our patients knee. The time that you wanted to spend with sheila and her family, and yet this balance of needing to feel pushy and to put ourselves out there. Guest it is interesting that i will describe myself like that, like im being a pushing nurse. My husband says youre not being pushy, thats your job. But he is why dont i see myself as the assertive. Again, i think its a way a way that nurses can be hard on ourselves. The environment does not always reward the outspoken nurse, i was going to say opinionated by thought dont say that because that also sounds negative. Direct, assertive, forceful forceful nurse that is advocating for his or her patient. Paperwork is a more complicated issue. As i show in the book theres just a constant demand and you can never get away from it. It hangs over us for the entire shift. All i still still have to do one my full assessment or at the end of a 12 hour shift and you are turning the stuff that happened at nine in the morning because you do not have time to do it before. A lot of nurses feel like more and more charting, paperwork requirements are being placed on us. But none drop off on the other end. So we are spending more, and and more time at the computer. I know physicians feel this way, physical therapist, respiratory therapist and even chaplains feel this way. We are not alone in this. Again, as a society we need to be talking about these paperwork requirements thinking about how we can streamline them, making them more efficient. What we what we really want to know need to know. Paperwork is never going to be more important than being with your patient. Thats what matters. Host i sometimes think we need to ask yourself the question is, how are are we going to use this information . With the Electronic Health record, we are really looking a lot at how can we extract information from the record, not a single patients but across the board and see, are there certain things we are doing or not doing that may contribute to good patient care, negative falls with patients, those kinds of things. There is a lot of documentation that is not useful. That if we dont think about how we are going to use this information. I certainly think looking for opportunities to streamline that. You talk about spending time with sheila and her family and how that was one of the most important things to do that day yet, it was not on your to do list, it was not on your dropdown menu on the Electronic Health record. Spending time with the patient with a lifethreatening diagnosis, unfortunately that was not one of those things whereas starting id be, giving the medication, all those all those things. We understand from a legal perspective certain things certainly need to be documented. It is that balance, how do we balance documentation and direct care because we know that patients value that time of comfort. That is what they look for. Often, that is what they talk about when they leave. Guest that is exactly right. That is very important for a patient and their family members. It is what nurses are so good at, what we are trained to do. It is what we are therefore along with a bunch of other things. But i feel like it is not legitimated in the paperwork. Or you do not have time for it because like when you hung an iv, and when you took an iv down, and on and on. Host right, exactly. You also talk about how in the same age, of course i finish Nursing School and did my earliest work in the direct care in the hospital setting in the 1980s. It has been a little while. Nurses were educated completely separated from physicians, i think to a large extent that is still the case. Although, we are finding in some schools of nursing, schools of medicine, they are doing some classes together, better understanding roles and those kind of things. I think the the most part and you even talk about it in the book and these have mds have a little idea what nurses do, they do not necessarily understand that nurses are performing independent functions, independent verifications, checking the map, checking the order, making sure the right drug is to right track gets to the right patient and why that is so important. Making sure the patient is ready for that medication. How, you use the phrase, our work is often invisible to each other between positions and nurses. Talk more about that dynamic and what we can do to improve that. We talked about respect earlier. Talk about the actual need to understand each others role and work well together, to optimize the care that were giving. Both in different roles and as a patient. Guest is so important, it strikes me as very strange that nurses do not learn in Nursing School how to work with doctors and doctors do not learn a medical school how to work with nurses. You put the two groups together on hospital floor and thats how patient care happens, those two groups working together. Im not sure why anyone thinks this is a really good way to achieve the best result possible. As you said, their programs now starting to focus on interprofessional education, that is a great start. I think for each of us to have empathy for the other makes a huge difference. I read books by doctors partly to know what theyre thinking, what theyre doing, and i would love it if doctors would look at writing by nurses. Try to find out what it is we are doing all day, get a sense of how we are trained, how we are able to accomplish im thinking of a story where we had a patient who was doing very badly and did not want to go to the icu. We did not have a do not resuscitate form that said it was okay. Host x line that do not resuscitate means. Guest at this point, the patient was making a choice between two i want more aggressive treatment or do i want to just have my symptoms managed and that is more direction going towards hospice. What the patient wanted was, not to go to the icu, not have aggressive treatment, but without this form that said i do not want the aggressive treatment, our hands were tied. We are calling the intern and resident, the younger doctors who are learning their job and they kept putting us off and putting us off. I was helping out a nurse and finally i called them myself and force the issue and said, we really need to hear. What is going on . And she said we are dealing with a crisis across the hall. That was so helpful because then we knew they were not just in a meeting, not just blowing us off, they were actually in the middle of something that was just as hard for them as what we were going through. Then, because you tell me that we could work out a plan and they came over soon as they could, we get the form filled out, and it worked. But neither side is revealing. Neither group is all that good at explaining to the other what is being pulled in a million different directions. I think just explaining that and helping them understand can go a long way. Host so lets just talk about work, life balance. You do you do a great job in the book talking about your shift over from your family life in the morning and getting to work. How you dont call your family while you are at work unless you have to because you want to stay in control and focused on your patience. Then you talk about the shift as you kind of shed that as you leave the hospital and then really try to get focus to get on your family. Tell us more about the demands of nursing really impact your life and the life you have with your family. Guest what 12 hour shift rises up to be a 13 hour shift. Long days. I leave before no one is up and get home, really after dinner time, but they would wait to have dinner with me so that is nice. The stress of the day, not not just the physical exhaustion but the emotional fatigue, i would come home and really be not that able to be a mom to my kids. I have a great husband so he is a great father and they knew but it definitely is challenging to work that hard and have so many demands put on you and they come home, you cannot just turn that off right away. The interesting thing is no matter how many shifts i have, every day when i was at the hospital it was okay, im ready to go. I think we just get that trained into us. But then coming home, it could be just so completely exhausted. Host nursing is not the only profession that does this, but i think especially since we know that we have turned over our care to someone else i used to find myself on my drive home kind of going through a mental checklist. Did i do this, did i chart this . , every once in while having to call back to the unit to say, can you double check this, sign my name on this form or something. Guest right. I write my bike to work and ride my bike back home. Its uphill going back because having to work that hard would get stress out but that is exactly what i would be doing. I belike did i tell the nurse this or that. I would call and i thought after while these phone calls were not always that helpful, it was just me being overly conscientious and not being able to let the day go. Host you do a great job talking about how you work to shed your day so to speak so you can reenter your family life. That is very important. In your chapter about no time for lunch, you talk about work for demands, demands on on the unit, then you talk about the need to not be vulnerable. Especially in front of someone who has power over you. You want to show that you can do it all, you say that you want to show that you can be that good, to be super nurse. We know that one of the key issues, or factors in burnout on any job in particular but especially for those of us in nursing, is a point like feel like we do not have control over our Work Environment. That is really status quo for us. We dont really have a lot of control, not only because we cannot control illness but there is so much to the system in delivering care. Are the expectations really high on nurses and how do you think we adapt to that other than, use the example you do not want to show vulnerability, how does that impact us longterm . Guest well it is not good for you. The expectations are very high and i remember thinking i am never going to learn how to do this. Then i did, but so many details to juggle and remembering to call when, what needs to happen at this time and zero wait, i just just found out something that throws that whole schedule off and a new schedule is in place. It is incredibly taxing because we feel such a incredible responsibility for our patient. So we do ask a lot for nurses and their worries now about if we are going to have enough nurses. I think we really need to be looking at that and how we can make the Work Environment bear there. Theres so much much we cannot control, that is exactly right. For example, the no time for lunch, when it be huge is every nurse knew that he or she would get lunch. Host i think it is sometimes too simplistic for people to say, really your can planing about not having a lunch hour . Its not just about that, its about the mental break that we need to have to really keep this pace up of giving patient care. Ive been so responsible for things that are so important for the patient. Delivering delivering them right medication, giving them the patient care they need, keeping all those things and juggling those, so in some ways a lunch break is almost a proxy of how we have to allow the time to mentally take that break in order to keep the pace up. Guest thats very smart. Thats right. Host you do talk about the need for calories for energy of course. Particularly when doing a 12 our ship. I think it can be relentless. It is hard to do when you think about i cannot count on downtime necessarily. Guest so even if a patient gets coded in the book which means someone takes a very severe turn from the worsted weight bring in a Rapid Response team and they get sent to the icu. I remember a code in the hospital when a minister, in fact hes coming up later in the book i really like this particular woman. She said, im trying to talk to people we have a code, they want to talk about what happened. And i said i would really like to talk about what happened but i cannot right now. She came back half an hour later and said you want to talk about what happened . And i said yes i do, and i think she came back three or four times. It is so hard to see someone you care about, and cared for suddenly really not be doing well. Or even die. Yet, you do do not get breaks when that happens. Host we have not really done a good job, i think were doing a better job in some places, some hospitals, some areas, about allowing for that time for debrief. Emergency departments are notorious about dealing with catastrophic issues and moving on and not really allowing or trying to carve out time to deep breathe and let people work through what happened. How to cope with that, great example. For a chat on tran chaplain to see the need and try to provide the resources. Guest i would really never cry at work and not was part of that Holding Things in. I remember going to see one patient in icu and sort of hiding in the bathroom to cry. It was one of the few times i ever cried in the hospital. I just thought i dont have time for this and i do not have the space for this. I need to be here for other people. Host i certain i can appreciate that. Sometimes i was by myself in that car ride on the way home tried to process those things. You just do not have the time all your there. You make reference to one in five nurses quitting a job within one year. You make reference to susie, who is a good nurse and you do not want her to be part of that 20 believe, so talk about other than some things we mentioned already, getting lunch breaks, being able to debrief, looking at issues of respect, are there other things we need to be doing . I will talk in a minute about some of the resources maybe we need to be providing to help nurses feel supported in that environment. Anything you can think of . Guest is such a sink or swim mentality, its tough enough to make it. No one is going to go out of their way necessarily to help new nurses along. Some people will but it is not builtin to the institution. At least in my experience and from what i have heard from other nurses. So having a nurse residency program, thats a great idea where nurses could actually work in a training capacity but they are not actually doing the job, then then they are much better prepared to start the actual job when they get there. Having real mentorship programs were new nurses can check in with people and they know they will be safe. Like this happen, i think i made made a mistake, how should i have handled it . Then that person can counsel them about how to cope with situations about that. Send mistakes mistakes happen, lets look at it. See how you might do differently next time. Also at the Cleveland Clinic i feel like a nurse is deficient in certain skills when she first starts and gets out of school, they will actually do a week of special training in a Simulation Lab to bring that nurse up to speed. I think that is so incredible instead of saying where you are just going to throw you on the floor and if you do not make it, youre gone. Host or youll learn on the job so to speak. So i think we are Getting Better and i think theres any purse consistency across the board. We all probably know some good examples of where they do get it as our increasing needs for nurses will increase as baby bombers start really ramping up their retirement and the need for new nurses to come in. We are going to have to address this, we cannot really keep losing 20 every year in the hospitals. And certainly some of those nurses find their way to other settings, they go into giving primary care, being School Health nurses, public health, great opportunities to find other settings. That is wonderful. I have lived my whole career moving in and out of different settings. That is a Real Advantage for nursing. But currently, the stain age, we still have in the range of almost 60 of nurses who actively work in the hospital setting. We have to continue to make it a positive working environment for those resources. Guest it is expensive for hospitals to train a nurse and that for them to leave in six months or one year. Not that money should be the motivator, but it is real money. Host it is really one of the major factors of the cost constraints continue to come down on the system. The American Nurse Association is focused on developing resources to help with this work, life balance. Also to deal some of the Work Environment issues. So that we have resources on fatigue, safe safe patient handling and mobility, on workplace violence, even support for nurses to be healthy, believe it or not, nurses on average are less healthy than the average public. I think we internalize too much stress, we do not practice what we preach sometimes. We certainly need to be better about that. Are there other things that come to mind, ways that we need to make sure nurses are aware of these resources and can look to how they can bring them into their own practice setting . To their own facilities . We want them to be fit for their work as well is to be good role models and for their family. Guest and to just be healthy. I wonder what we need also is a Culture Shift that healthcare has become a more more complex and more more specialized. So nursing now is not what it was in 1950, it seems like an obvious thing to say but what it means is that the demands on each individual nurse has really increased expectations, technically and intellectually there so much more that goes on in a hospital so we need to value ourselves as professionals and also expect the Larger Community to value us in real life. Healthcare is only going to get more more complex. We are just going to need better and better nurses to meet all those complex needs. Imac. Or do you think many nurses unfortunately use this phrase that i am sure we both hate. We see that some time. Talk about black empowerment of what needs to be incurring. I think a lot of nurses dont feel empowered as fully as we could. And it comes from the accumulation of having moments when you tried to have an opinion of bring something up that you thought was important and the physician will you off. Even if it only happens one out of every ten times it has an effect on your assertiveness and wanting to dive in. Why should i dive in the fund is going to be pushed out. Out. In my going to look ridiculous . I observation stupid . So there are nurses who are in that respect. Doctors will listen to them. That is me putting it like that where in that respect, we should all get that respect. It should not have to be something that is earned. Again, to me that goes back to physician training. Being taught to recognize his colleagues. Right. And being clear. So i am very interested, very glad to know that we are finding some educational colleges and universities really starting to look at this. And they really emphasize a focus next year as we roll out a programmatic work on a culture of safety. So developing within the healthcare setting the need to focus as an entire entire culture what we can do to support that, you some examples in the book about safety issues, giving the right medications can you talk about that. This gets back to documentation. The assessment setting of a computer. In every patients room talking to them about what they and i can do together. So having the pit, being there to keep people safe is one problem, but i think we also can get so caught up in our systems doing this is happened that really doesnt happen not even close. And its so simple and so important. An example of questions like this, there was a refrigerator, walk in the door to the room. And the door to the refrigerator opened so that if it was open no one could get the narcotic dispenser. Refrigerator someone using the narcotic dispenser. You know what, when i 1st started working that would have really bothered me. And there are obvious things that we have gotten so used to thinking this doesnt work. And so we do some sort of work around. Instead of really focusing on improving. They almost become invisible because you adapt yourself which is not ideal if you want to really keep the focus on building a culture of safety and delivering safety. Right. A shift, and you talk about holding these lives in your hand trying to make order out of chaos during this is the ever shifting day comes and goes and really trying to stay focused certainly on your patience as human beings and the care they need. What did you want readers to take over the book . Ii really wanted peers readers to get a sense of how Important Patient care and to do them a tactile detailed sense of that and writing a book seemed like a great way. The beginning of the day. You more or less find out how they did. But it lets people no what the shift is really like. A great example. We had just recently in social media barrio flareup about a talkshow host talking about stethoscopes and not clearly understanding the role of nurses and what they do. I am pleased that we have tens of thousands on social media and really focus to try and educate the public about the work that we do and try to help them understand the value. Great examples in the book, great recent example we about the social media, the opportunity which we ought to take advantage of. Right. And that is my hope that i do commence by or moremore nurses, just talk about what you do. What you do the work. Thank you so much. I enjoyed reading the book. He did a great portrayal. I wish you good luck with whatever your next book is going to be about. As i understand that you have now shifted from the hospital and a focused on doing karen the home these days. I am. Thanks so much. Thank you. That was afterwards. Authors of the latest and nonfiction books are terminated. Watch online. What gave you the idea to write about Sandra Day Oconnor and Ruth Bader Ginsburg . I write books about social movement. I was interested in how women achieved far more legal equality which is a happy story. So i started thinking, you cant think about that subject. From hersubject. From her time on the court but more importantly from when she was at the aclu in the 70s until she went on the bench. So it was an obvious subject, but if you think about it she one 2nd on the Supreme Court. Sandra day oconnor came to the Supreme Court 1st. She was the symbol and the icon that women could rise to the highest jobs in the land. She did a lot for women equality as well as ginsburg. Do they know each other . No. The answer is no. They know each other. But they made an alliance, and affectionate alliance was made both of them more powerful than it would have been alone. When reagan appointed her it is okay to be the 1st, but i do not want to be the last. And she paved the way for Ruth Bader Ginsburg without question. When ginsburg came, i was happy is ginsburg is so excellent that her job that she would be another successful woman just like oconnor had hoped. Which is a model for women in the future to no that you can be allies without being bffs and how you can together make the world better than either one of you could alone. And when i started looking at the cases where turns out the cases are very interesting. I wanted to make it for readers to be able to understand how they did a casebycase. It will be a big case in the Supreme Court this coming june. And i wanted my readers whether they were lawyers are not to understand how these women did it. How they change the law for women. So i did all of those things in this book. Did you find a significant case where they each wrote opposing opinions . There was a case where they disagreed. They were couple. There was one where they struck down a portion of the violence against women act. The Supreme Court said it was beyond the authority of the federal government to write that law. And oconnor is always very conservative. She is a republican, always very conservative on what was for the state and what was for the federal government. She said it was unconstitutional. Ruth Bader Ginsburg says that met the constitutional standard. That was one of the very, very, very few cases of the women were they disagreed. Theyre mustve been 25 cases that they saw together, an all but two of them. Even though one was a republican was a democrat all was a blonde and one was a burnett, very important distinction come on womens issues 22 cases out of 24 same side. So its pretty good record and a pretty good reflection of what they knew was important. A big grant interviews direct. I met with each of them. A car so there was not enough material here for a book. Almost 400 pages. And what is wonderful as it tells the story of how ginsburg started at the aclu and an goes to the dc circuit command oconnor picks up the baton and carries women equality forward on the Supreme Court of the United States and then at the critical moment and 93 she comes on the Supreme Court and now she has been carrying the torch. Torch. So i was able to go back and forth between them without much difficulty. A very orderly way. Now we have sotomayor or nagin who are carrying it forward in a different and more powerful way built on the shoulders of the women who preceded them. It was easy to write. Is there a Nonfiction Author or book you would like to see featured on book tv . Send us an email, book tv at cspan. Org. Post a comment on our wall. Good evening. Good evening. Welcome to politics and prose at busboys and poets in brooklyn. Thank you for coming out this evening