This is the time of year when I enjoy getting out into my garden and getting my hands a bit dirty.  Soon it will become too hot and humid for it to be enjoyable, but I will always be amazed by the miracle that occurs when I put a dry, dead-appearing seed into the ground.  I wait eagerly, checking daily for that first little peek of green.  Even when I know it will be days and days before it happens – I can’t help myself.  Out to my tiny garden I go to look for the little sprouts.  Then it happens! Lo and behold, a brand new plant life.  When I look upon this burgeoning garden, all I see are tiny two-leafed green threads.  There is very little that would promise the hearty meals to come.  If I did not label my rows, I often would not even be able to discern what kind of plant is growing, but in a few weeks time, each plant’s nature begins to emerge.  In these early days I watch carefully, water frequently and cover these little baby plants when the air threatens to freeze in the night.  It is a labor of hope and love.  

In my life as a nurse I have had a number of roles and responsibilities.  I have nursed tiny premature babies from incubator to car seat.  I have walked with families through a devastating diagnosis and shared the life their child cut short by genetics out of anyone’s control.  Now, I find myself growing new nurses.  It is a role that I relish and cherish.  No longer do I experience the rush of adrenaline in an urgent life and death sort of way.  Instead, it is more like my time in the garden.  But instead of the gardener, I am the dirt.  It is only when I remember my role as dirt that I can truly successfully help in the effort to raise nurses.  

We are all gardeners of our own lives and careers.  When students come to us, they have realized that they carry a seed, a desire to do something beyond themselves.  With recognition of this seed comes the need to find the right medium to move from thread-like sprout to productive plant.  

EMU is a lovely garden.  It is well cared for, lovingly tended, and thoughtfully fertilized.  We know that the dirt is important in our gardens, but we often don’t consider the whole of what it provides.  Each season, dirt receives seeds.  Seeds are sometimes carefully covered and tended, sometimes land accidentally in the dirt, and sometimes fall into insufficient dirt.  For a seed to germinate and grow, the dirt must have nutrients available.  It must be able to hold water around the new seed in a way that causes that seed to burst open and push for the light.  The dirt must allow itself to be moved by the new roots and shoots that spring from the seed.  

As I reflect on what that means for me, a teacher, I realize it is a very humble job.  I do not get to choose my students.  They decide whether or not to be planted in the garden I occupy.  It does not matter how much I know or how fancy my pedagogy, the real work belongs to the students.  If I lack the proper tools, encouragement, and knowledge, my students certainly will not grow.  I cannot force those tools and knowledge on to the students, but my ability to hold space, lead gently, allow warmth to penetrate, and create room for growth is essential.  It is a privilege and a joy to watch students sprout.  Like dirt with seeds, I have an up close view of the beauty and struggle of growth.    

I am dirt.  My work is to be good dirt.  

In what ways can we all be good dirt?  As nurses, we watch our patients emerge and grow into health.  We equip ourselves with critical thinking and compassion. We nourish, hold water to quench thirsts, assess for safety, and give space for good growth. We promote and allow healing.  As nurses who are teachers, we follow a similar path with our students.  

Growth cannot happen without good dirt, and I like to think that here in the EMU Nursing department, there is a lot of good dirt.  

-Dr. Audrey Myers, Assistant Professor EMU Nursing

We nurses learn about professional boundaries during nursing school and in practice.  refers to the ways in which we are to therapeutically relate to our patients and our colleagues while separating personal from professional life.  The boundaries delineate what personal information is appropriate to share and what should be kept private.  They also define what types of relationships are appropriate between nurse and patient and nurse and colleague — for example, expressing romantic affection is off-limits.  Unspoken boundary rules promote the idea that nurses (and doctors) are stoic, steady, and emotionally “strong.”  They are expected to be calm in the face of crisis, and the expression of negative emotion (e.g. anger, sadness, fear, grief) in professional settings is often frowned upon.

Clear professional boundaries do serve us well — most of the time.  But what happens when maintaining boundaries inadvertently leads to feelings of shame or unworthiness, or when they prevent us from authentically sharing our stories and who we are with each other?  What happens when boundaries cut off our avenues to connectedness, deep caring, and collegiality?  What results occur when there is no forum for emotional expression, naming of our grief, distress, and sadness?  We can begin to feel demoralized and emotionally exhausted.

Boundaries need to be healthy ones that have some permeability and that still allow to occur.  Bonding occurs when we experience a place of safety and support.  Bonding is what happens when we listen well and make space for each other to be heard.  The bond between a nurse and patient (and between nurses and their colleagues!) can form well when there is attunement to the patient’s needs on the part of the nurse, as well as an ability of the nurse to differentiate self from the patient’s self, not personally taking on the needs of the patient, but creating a space for them to be held and handled with care by the nurse.

is a psychological concept that may at first glance seem paradoxical to forming safe bonds with others, but it provides another framework for defining healthy boundaries.  Self-differentiation means being able to clearly name and own your personal thoughts and feelings and to distinguish them from others’ thoughts and feelings.  We can also think of self-differentiation as a process of not losing connection to self while still being able to stay deeply connected to others, including people whose views may differ from our own.  Self-differentiation enables the nurse to deeply care for self at the same time as caring for people who have so many needs that it would be impossible for the nurse to meet them all.  It enables the nurse to maintain a permeable boundary that is open to deep caring and bonding.

Nurses and healthcare professionals need to take the time to attend to permeable boundaries, healthy bonds, and self-differentiation.  Attention to these concepts provides the space for healing and wholeness to occur, for the nurse and the patient.  I’m grateful to be able to say that at EMU, I experience permeable boundaries, healthy bonds, and self-differentiation in my interactions with colleagues and nursing students on a daily basis.  May each of you continue to find your way toward such beautiful boundaries and bonds, too.

Dr. Laura Yoder, Program Director and Associate Professor