James is a person born in California to essentially farm workers with little education. His parents gradually grew into business owners: his father a restaurant owner and his mother a beautician. In retrospect, the tumultuous environment was marked by many arguments about money and fidelity. I went to high school in a community of about 5000 population that was largely military and agrarian. My school is unremarkable in my memory. When I graduated, I went to a local community college and flunked out, then transferred to another community college and flunked out, and then transferred to another community college where I just barely passed. I spent the next number of years taking courses in biology and chemistry and began to understand the anatomy and physiology of the human body, which greatly inspired me. After completing coursework for an associate degree, I went into the Navy as a corpsman. I spent two years on active duty at the Naval Hospital in Oakland, California. Upon discharge, I wanted to enroll in nursing school but was accepted into respiratory therapy school first. I spent 10+ years as a respiratory therapist, then decided to continue in nursing school. I had little money but a lot of ambition, so I enrolled in a nontraditional nursing school program that allowed me to obtain my RN license through my military background and respiratory therapy experience. I graduated with an ADN degree. My first RN position was in the NICU in Central California. NICU was problematic for me for personal reasons, so I searched for other positions in the area. I was finally offered a position at the Veterans Administration Hospital in San Francisco again because of my military background, respiratory therapy experience, and nursing license. I spent approximately 12 years at the VA and retired in 2010. In 2010, my wife and I decided to move to Missouri. I got my bachelor’s degree in healthcare administration from the University of Missouri, Columbia. I then enrolled in the VA-sponsored MSN program at the University of California, San Francisco. I was awarded my MSN in 2010.

After retirement, I had time and space to reflect upon my healthcare career in both respiratory therapy and nursing. This is what brings me to where I am now. I always had ambitions to progress in management and nursing, but I was never able to secure a permanent position. In retrospect, with a lot of independent study, I began to realize why I was only able to secure a couple of temporary management positions that lasted a handful of years. I began to realize that my lack of progress in the nursing career I wanted was not a result of my nursing knowledge and clinical experience, but of my inability to fit into the administrative hierarchy. I never accepted the rationale that nurses were lazy that I was forced into. I never accepted the rationale that nurses are the cause of the healthcare system’s problems. I never accepted the idea that nurses were a cost item rather than a profession. With this background and frame of reference, I began to study the nursing shortage and why it exists. I concluded it is not a nursing problem; it is a healthcare administration problem. Today, I am more than convinced that the healthcare industry is doomed because of its beliefs, its manifestations, and its structure. Healthcare administration is a hierarchical system that prizes one-upmanship; as long as they can feel more important than someone else, they are happy. Consequently, their decisions are made from that position without ever asking whether this is the right decision. Even today, I believe most healthcare administrators do not understand the dilemma that they face with the nursing shortage; they don’t understand why burnout occurs, why sick call occurs, why nurses leave suddenly for new jobs or new professions. The why is what I am beginning to understand.

Somewhere along the line, I picked up a book called The Psychology of Self-Esteem by Nathaniel Branden, and I began to believe there is nothing more important than what a person thinks about himself, and what a person thinks of himself is largely controlled through his environment, his perceptions, and his beliefs about himself. Through more reading, studying, and research, this thought solidified in my mind. I was then able to apply that to my history as a nurse, and I could see why the hierarchy in healthcare systems was one of one-upsmanship. “I have to feel better than someone else in order to feel important personally” was the conclusion I drew from the managers who created the environment I worked in for decades.

Today, with that understanding, I came to Mona to share my perspective with Mona’s membership. To participate in advocacy and membership, because both are closely intertwined and reflect how people feel about themselves. Advocacy and membership are essential to one another. Membership adds strength to the organization’s vocabulary, whereas advocacy provides members with structural reasons to join. Both are essential, and to understand them, it is necessary to start from ground zero, with purpose, with mission, and foresight. Mona possesses all three, and when channeled into a productive role, the nursing shortage becomes a stepping stone to revitalizing healthcare, where nurses can apply their professional acumen to address many of healthcare’s dilemmas.