Transcription:

Bill Klaproth: Hearing stories of others can be an inspiration in these challenging times and understanding the fortitude and will of strength within each of us. It's called Sisu. The American Organization for Nursing Leadership welcomes Dr. Barbara Mackoff. Barbara is a Consulting psychologist, Author of Nurse Manager Engagement, AONL faculty and facilitator of AONLs leadership laboratory. She is a Fulbright Specialist who has worked with leaders worldwide. Her work has been profiled in the New York Times, the Washington Post, and USA Today. Dr. Mackoff will first share stories of Sisu and then answer questions about this inner strength.

Dr. Mackoff: I'm looking out my window on a sunny Seattle day and I can see the top of the space needle and there is a flag that says Seattle, we got this. That's all about the fact that Seattle was the very first epicenter of the COVID-19 virus. Things here have settled down a bit and now my heart and my mind turns to another epicenter, New York City, former home of mine. I wanted to contact some nurses in Manhattan in its epicenter and talk to them about their experiences in this dark pandemic. I contacted Lisa Peters, the really gifted nurse manager at Lenox Hill Hospital on the Upper East Side, who put me in contact with a number of nurses there and I began to receive their emails. It started about 10 days ago. I received a Gallant and gutsy description of the inner work of ICU nurse, arrived in my email box. Her name is Erin Dean and she wrote to me. Every night when I take the elevator up to my floor, I call upon an inner strength to get me through one more night, I became a nurse to help.

I never believed it would require a special courage, but now I know it's true. It's not just me, it's the whole team, the whole floor. The whole hospital is calling upon a unique type of fortitude that allows us to get the job done. And then she goes on to describe how dealing with this horrifying virus had allowed her to witness acts of love that she wouldn't have imagined. And in particular she describes a long married couple, each having a deadly prognosis in beds on separate floors. So she ferried the wife in a wheelchair to her husband's side so that they might die together. And by the time that Erin got back to her station, the wife's bed had already been assigned to another patient and Erin said there was no time for me to be sad. I had another patient to care for. And she said, as nurses, we've all developed the ability to compartmentalize illness and death, but not at this extreme. On the precedented level, we're all drawing on a heretofore untouched well of strength and determination.

There's no end in sight. I am sure we will continue to be tested above and beyond, but I know we'll do it and we'll do it together. When I received Erin Dean's email, I thought about the Finnish language. And Finland has a word for Erin's fortitude and untouched will of strength. It's Sisu. It's spelled S I S U, and it's pronounced Sisu. And Sisu has been defined as extraordinary courage and determination that surfaces only when we are faced with adversity, suffering and hardship, the word is 500 years old. It came back into Finnish vocabulary by the perseverance of finished soldiers who fought in the punishing cold war in 1939. The winter war. They defied the powerful forces of Soviet Armies invasion and preserved Finland's independence. Since then, Sisu is a real touchstone in Finnish culture and it's also thought to be a universal capacity that we all share. And at the core of this idea is the thought that in you and I, in all of us, there is more strength than meets the eye.

I discovered this idea of Sisu when I was working on a Fulbright grant with nurse leaders at Helsinki University Hospital. Here I encountered the work of research psychologist, Emelia Lahti. She is Finland's foremost academic authority on Sisu, and her studies of Sisu have carried this concept for outside her country. What she writes about Sisu, she talks about three elements. Number one, that sees who is this extraordinary perseverance that allows us to move beyond what we think our mental and physical capacities are. Number two, it's an action mindset. It allows us to face our fears, to extend ourselves in moments of suffering, to take action in the most daunting circumstances. And finally, Lahti calls Sisu a second wind that allows us to draw upon previously hidden untapped sources of power and strength. And these elements would sing to my heart and my mind in the stories that I received from frontline nurses in Lenox Hill Hospital in Manhattan.

There's Emily Faucet and Emily faucet was, has been written up and talked about as someone who started Hope Huddles within her unit. And she described to me working a 13 hour shift and she said she was completely physically exhausted and mentally drained. And she said, I could sit here and complain about how my feet are swollen, how I have a headache from a tight mask, how I've already cried three times today, how I miss my family, but I'm choosing not to. And then she described an extraordinary moment of sending off a Navy Veteran and giving him the goodbye that he deserved. And she said, I called him my inner strength and my courage. It no longer mattered that I had not eaten lunch, that I was exhausted. She said all that mattered to me was the patient and his family. They were my strength. They were my courage and if they could be strong, so could I. And she described how her team jumped into action called the family in, gathered up hospital workers who were veterans, and got the music ready and she said, we all gowned up.

The family, said their goodbye, we played the star Spangled banner and we all gave him a final salute. And shortly after he passed away and she said, it is beautiful and it is this moment that will carry me forward into my next shift. And so I contacted Emilia Lahti and shared some of the stories with her and asked her to talk about these exceptional responses. And we had a lively dialogue and she called Sisu the darkness, the friendly darkness of adversity. And she said to me, the Sisu that these nurses have described as unquestionably Sisu. It happened in a moment of adversity and it's invoked by an experience that caused them to stretch and expand. She considered Sisu to be the next gear before, I mean before and beyond fortitude. It begins where grit and perseverance end. It's a deeper reserve. It's our ability to channel a moment and open a pathway. Lahti said the COVID virus is a moment like this, we are witnessing a global expression of Sisu.

We see nurses and healthcare workers digging to layers of strength they didn't even know existed. They are stepping into their previously unprecedented strength and I talked a lot with Emily Lahti about how groups of nurses are gathering together in the sense that these groups, and she described this back to me as I described these groups expressing their Sisu together. They become a kind of a United field force and I heard from an ICU nurse, Joseph Prochet who said he talked about a second wind that he felt at the end of the beginning of his shift that he was running out of fumes and it was like he had to push the car from the back and nobody was steering. He'd seen four patients in a row and there was no way he could handle more. But then he talks about the teamwork, the comradery, the sense that he couldn't have done it on his own. And he talks about what a privilege it is to be a nurse and how confident he is that the team can do this together. Bill, I'm ready for your questions.

Host: That was terrific, Dr. Mackoff, thank you so much. So through your discussion about Sisu, how do you think Sisu can help nurses and nurse leaders in the middle of the COVID-19 pandemic?

Dr. Mackoff: In my view, Bill, the beginning of wisdom is to call things by their right name. And when I started to hear from nurses, I thought this is Sisu. And when I talked to nurses about Sisu, they immediately understood, so this inner fortitude that each of these examples, that each of these nurses on the frontline expressed. This is Sisu. And one of the things that I think our discussion can help is to give a name for the strength, unprecedented fortitude that these nurses are expressing. And that stories beget stories, that when I tell a story to one nurse, he or she remembers another story. And at this point our stories of Sisu become a kind of strategy for coping that nurses and nurse leaders have a name for what they are embodying, what they're seeing, what they're saying. And I want us to be able to introduce this idea, this language, this concept, so that we can tell our stories and that others will be moved to also tell their stories.

Host: So Dr. Mackoff, you mentioned three key components to Sisu, one extraordinary perseverance. Two, having an action mindset, and three being able to get a second wind. Can you talk more about each of those three?

Dr. Mackoff: Yeah, let's do a little anatomy here, right? So first of all, extraordinary perseverance. And when we really take it apart and start name checking some of the behaviors, it's not giving up. It's finishing what you start. Despite the difficulty, it's doing what seems impossible. It's showing integrity, and not taking too many shortcuts at the expense of the quality of your care. And most of all, it's going beyond what you previously thought that you were capable of. And so many of these nurses have, you know, have said in a sense, I don't know where this strength came from, but somehow they have tapped into it. Number two, the action mindset. It's a kind of a consistent, courageous attitude. You know, there's that sense of tapping into a hope and you see that a lot where teams go together. I know I couldn't do this alone, but I have the hope that all of us can do this together.

And what this means in a very specific granular way is nurses and nurse leaders are able to imagine the story where they succeed, where they take action against slim odds and where they really face up to their fears and they're able to be creative as a result of their hardship. And finally, number three, again, back to that sense of a hidden source of a reserve power. Emilia Lahti, in a research paper that she wrote said, that Sisu is a fire that does not fate. It springs from deep within you and it allows you to try one more time. So it's a sense of I can get access to a power and energy during the challenge that I didn't know that I had, that I move toward a vision of where I might go if I just had the nerve to try. And it's a kind of a second wind. I think it's the psychologist William James who said, most people never run far enough to know what this second wind is or to know if they have one. And what we see is nurses running to get that second wind.

Host: So these are amazing stories of amazing people. I'm just wondering, does everyone have the potential of Sisu within them?

Dr. Mackoff: Yes. And the thing to remember about Sisu is that what we're doing in a moment of Sisu, in moments is accessing stored capacity of energy to tap, it comes out in the face of adversity, and it's the sense of we don't begin to have an idea of what we we're capable of. There's more to us than meets the eye. I think of this quote by Rondo Emerson where he said what's behind us and before us is tiny compared to what is within us. And one nurse manager Christopher Bluehajir said to me that this is something for him like a mental game of pushing through, of not accepting a defeat. And so it becomes a deliberate act as well.

Host: So as you say, Sisu is in all of us. Is this something we can learn to access and practice?

Dr. Mackoff: That is really the most searching question of all because Sisu is not like a communication skill or pumping up your listening skills. However, there is some behaviors that can be practiced. And their behaviors that I have heard from different nurse managers and they have to do with squaring off with your fears and having a sense of faith in yourself. I mentioned Lisa Peterson, who is the nurse manager who put me in contact with many at Lennox Hill and she told me an incredible story, which, which I want to tell you. She was talking about getting ready for work and decided to play some gospel music before she left the house. And she spoke about listening to the music and the words of this song and started to cry for the first time. She cried because she was scared for her family and her friends and her community and her patients, and scared because she was a manager and she didn't have answers to when it was going to be over. But she finally took a deep breath and wiped her tears and listened to the words of this song.

And she felt that this song was really something telling her that there was a divine presence, that that did not create her to worry or create her to fear. And her faith took over her fear and she went back to work confident in her strength and her faith. So that sense of facing up to the fears, giving it a name, being able to regularly practice and say to yourself, I've got this, I'm going to dig deep, and you see this in all the stories that we talked about Bill, is these nurses saying, I'm going to dig deep. You know, it's like COVID, you might've won this one but you're not going to get me next time. These are the active behaviors and they also include encouragement and praise of others. And that has to do with, you know, the recognition, calling people and naming their Sisu, and telling them how inspiring that is. Then we are all reinforcing the Sisu that lies within us.

Host: So it sounds like you can learn to summon it or call it up when needed.

Dr. Mackoff: Exactly. And having, I would imagine another conversation I so deeply want to have is to talk to some of these nurses in three months, God willing, six months and be able to say, what did you learn in tapping into your Sisu during this dark pandemic? And how has it changed your practice? Does it make it easier to draw upon that exceptional inner strength in these times and in these days.

Host: So we've been talking about individuals cultivating and learning to practice Sisu. Can teams also do the same with Sisu?

Dr. Mackoff: Yes. And I just tipped my hand a little bit in what we just talked about. I think that teams cultivate Sisu by giving it a name by talking about what they're doing, by talking about how they are digging deep about talking about those few minutes of replenishment like Lisa listening to gospel music and being able to tell each other their stories to take a moment in a team. And this is Emily Faucet started these Hope Huddles. Hope Huddle is a team act of Sisu, when you get together and talk about things that are hopeful but you also talk about those extraordinary moments where for example, a nurse was able to carry a family forward to send off a Navy veteran, and this was also Emily Faucet. And being able to tell these stories and recognize how precious and deeply moving these are and how they are also a source of strength because what you are providing

Host: And we thank you, Dr. Mackoff for your stories of inspiration and your lessons on Sisu. Thank you for sharing your time with us today.

Dr. Mackoff: Thank you, Bill. It's just been a pleasure and also I want to thank all of the nurses for their sacrifices, for their Sisu, and for their hearts and minds in this time.