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Managing Your Career
Navigating Bureaucracy at Work
What nurses can do when the system undervalues you.

Part 2 of a two-part interview with Sally Lemke, winner of the VNA Foundation’s Super Star in Community Nursing award.

It had the potential to be one of the most rewarding times of her life—being honored with the VNA Foundation’s Super Star in Community Nursing award. Thirty-plus news agencies swarmed to the story about Sally Lemke, a Chicago Cook County nurse practitioner making a difference in the public healthcare system. It seemed the media was ready to shed some positive light on the healthcare system, typically scrutinized for its failures.

But within three days, Lemke’s cloud-nine experience vanished. While receiving her first phone call requesting an interview about the Super Star award, Lemke was on her way to the Cook County offices to sign the paperwork to either take a layoff or accept a demotion.

Lemke declined the lower-paying job as a floor nurse, deciding to go somewhere where she would be respected while changing patients’ lives.

In this second part of RealityRN’s exclusive interview with Lemke, she candidly speaks about her experience in the spotlight and offers advice to new nurses about handling bureaucracy:

Describe your experience being in the public eye after being laid off and being offered a lower-paying/ranking job.

Sally Lemke: It was very strange having my “business” on the front page, literally. I was totally unprepared for the media onslaught and found the experience uncomfortable.

Did your publicity help the nursing profession?

I was fortunate to have the opportunity to shift the spotlight to the contributions that community health nurses make and the harm done when they are cut from budgets (as was, and still is, the case with Cook County).

Putting a human face on the loss for the patients and community to see was helpful in making the public understand all the areas nurses make contributions. I think most people associate nursing with hospital-based work and aren’t aware of the full spectrum of our care. The media attention hopefully enlightened the public to the breadth of what nurses do and perhaps drew some nurses to a career in community health.

I also think that the publicity helped to highlight what most nurses know--that our health care system is faulty, inequitable, and unjust. And part of the problem stems from politicians and bureaucrats making decisions about who should receive health care services and how.

As a nurse practitioner, did you ever expect to face bureaucracy?

I think among the community health network of Chicagoland, it’s known that there are certain bureaucratic and organizational challenges inherent in the Cook County Bureau of Health system that nurses, physicians, and employees need to deal with. I knew that when I came on board with Cook County. But I truly believed in the mission of the Bureau of Health: that quality health care is a basic human right. And I felt up to the challenge of dealing with the system.
But the haphazard dismantling of this public health system with little regard for the true mission of the Bureau of Health has really saddened me. So many dedicated and talented people are gone and so many programs that were an efficient use of health care dollars were cut.

In the end, it is truly the patients who have lost out.

What’s your best advice for new nurses facing bureaucracy?

First, stick to your values and remember why you chose to become a nurse. Never compromise your values, especially when it comes to patient care.

Second, find a mentor. I have had many wonderful supportive mentors who have helped me navigate some of the bureaucratic messes I’ve worked in. They’ve helped me keep my perspective and stay confident.

And third, never underestimate your ability to make change. Polls say nurses are the most trusted of all professionals. That puts us in a credible position to be on the forefront of making improvements in how our patients are treated and how our health care systems are run.

Sally Lemke is currently working for the Rush University College of Nursing in their Faculty Practices. She works in organizations (usually non-profits) that partner and contract with the College of Nursing to provide staffing for their programs. The workplaces are, in turn, used as sites to train undergraduate and graduate nurses. Currently, she’s involved in two separate projects: the Healthy Heart Project for women that is in partnership with the Chicago Lights' Center for Whole Health (affiliated with the Fourth Presbyterian Church, downtown Chicago) and the Why Wait? program, in partnership with the Dupage Co. Health Dept., a breast and cervical cancer screening program for uninsured women. In Spring 2008, nurses will be able to nominate their community, public, and home health nursing colleagues for the VNA Foundation’s Super Star in Community Nursing Award. This year, in addition to the grand prize of $25,000, five finalists were awarded $2000 each for their outstanding work.

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