Like the strong women who mentored her, Lanette E. Tanaka, MSN, RN, assistant teaching professor at the University of St. Louis–Missouri (UMSL) College of Nursing, has courage, strength, and poise, and she exhibits unyielding perseverance in seeing a goal through to completion. While enjoying Oysters Rockefeller at a local St. Louis restaurant, I ask Tanaka what contributed to her possession of these qualities.
She smiles. “So, you want to know what I have endured and survived?”
Strong women, strong values
Tanaka credits her mother as her role model. Her mother was a civil service nurse at Scott Air Force Base in Illinois when she coaxed Lanette into being a candy striper there. Later, as a staff nurse, Tanaka worked with her mother at St. Elizabeth Hospital in Belleville, Illinois. Working with her mother, who continues to be a valued nursing colleague, helped Tanaka develop and solidify her commitment to nursing excellence.
While finishing up her BSN—she graduated in May 1980—Tanaka felt a “strong tug” toward the Air Force and, upon completing Officer Training School at Sheppard Air Force Base in Texas, was commissioned a second lieutenant in the Air Force Reserve. Later, while working on the cardiothoracic step-down unit at Barnes-Jewish Hospital (BJH) in St. Louis, Tanaka set her sights on flight nurse school, despite the lengthy and rigorous training involved. But when she received orders to attend the school and requested a leave of absence to do so, she was surprised to hear her supervisor say: “No, I can’t let you go for two months. You are in a senior role. I am going to have to post your job.” When Tanaka, despondent by the news, told her friends about it, her best friend, outraged by the supervisor’s response, declared, “I’m going to start a petition!”
The petition, which included signatures from all the nurses as well as the chief cardiothoracic surgeons, affirmed that Tanaka should be allowed to go to flight nurse school with no untoward consequences to her job. The petition worked, and she kept her job! From this, Tanaka learned the power of collegial relationships and that there is strength in numbers.
Serving her country helped Tanaka become the strong leader she is today. Prior to the Gulf War (1990-91), a conflict that encompassed Operation Desert Shield and Operation Desert Storm, reserve-unit status was considered non-mobile. This meant that individual reserve nurses were to backfill stateside assignments as needed. When Iraqi troops invaded Kuwait, however, things changed. All Reserve medical units became activated and given “mobility” status, meaning, said Tanaka, “We could be, and were, deployed globally together with active duty personnel working the same dangerous missions during the Desert Shield-Desert Storm War.” In addition to other challenges of deployment, leaving behind her 10-month-old son was a concern for Tanaka. As she headed into harm’s way, her husband would have to be “Mr. Mom.”
After arriving in the Middle East, Tanaka was made officer-in-charge of the surgical step-down unit in a Fourth Echelon tent hospital in Seeb, Oman. “Tent City,” as it was called, was located near the Air Force refueling center and was surrounded by underground fuel depots. Because planes refueled at night and fueling of fighter jets makes quite a commotion, sleep was nigh to impossible.
Living in a 22-person tent, the staff was trained to handle “the worst Saddam Hussein could throw at us,” Tanaka recalls, and Hussein could throw a lot, she continues. “You were not prepared unless you had a plan in mind.” The plan had to include preparation against chemical weapons of mass destruction, such as mustard gas, and quick deployment of decontamination procedures.
“If you take the oath to serve your country,” observes Tanaka, “you keep your commitment. My major lesson learned was, we are stronger if we work together as a team. Basically, we needed to see each other in a positive light and identify all our strengths.” Although the Gulf War ended quickly, Tanaka was stationed in Oman for 3 1/2 months.
“Experience,” says Tanaka, “is to know.”
Upon returning home and back to her position at BJH, she was surprised to find that the previously negative attitude of the hospital administration toward staffing holes caused by the war’s call-up to active duty had changed. Changed for the better! It was a turning point, she says, in the way reservists are viewed by the public. Before the Gulf War, few realized how many nurses and doctors in the reserves also had civilian jobs. When those people were called up to serve, hospitals had to cope with their absence.
So, she did care!
At BJH, Tanaka gained a reputation for caring leadership, influenced in part, ironically, by the same nurse who informed Tanaka her job would be posted if she attended flight school. After earning flight-nurse status, Tanaka had returned to her fulltime job at the hospital, fulfilling her military obligation by working two weekends per month as a flight nurse, transporting patients throughout the continental United States in a C-9 Nightingale. (Throughout Tanaka’s 22-year-career as an Air Force Reserve nurse, not including her Gulf War deployment, she was employed fulltime as a civilian nurse, while fulfilling her military commitment by working as an Air Force Reserve nurse one weekend per month and doing a two-week “annual tour.” While working as a flight nurse, however, Tanaka often flew two weekends per month, to maintain skills currency.)
It may have been the C-9’s bad air exchange combined with the erratic pressure changes that accompanied the nine to 10 takeoffs and landings the aircraft made per day that brought on Tanaka’s respiratory infection, chest pain, and lingering cough. Although two physicians examined her, including an ER specialist, her symptoms remained.
One day, the head nurse, who was also Tanaka’s mentor (and the one who had threatened to post her job), said, “I have an appointment for you to see the chief cardiothoracic surgeon. Just bring your X-rays. I am so worried about how long you have had that cough.”
The surgeon percussed Tanaka’s chest bilaterally and then, even before looking at the X-rays, announced, “I bet you have a bunch of fractured ribs.” He counted them—three on the right and four on the left! Her severe cough had cracked seven ribs!
Tanaka reflects, “What you endure helps you grow; what you learn helps you adapt.” From this experience, she learned that not only is it proper for a supervisor to care about the health and well-being of those he or she works with, it’s vital.
A serendipitous encounter led to Tanaka earning her master’s degree and, ultimately, moving into nursing education. While flying to Sheppard Air Force Base to attend Officer Training School, she struck up a conversation with a nurse faculty member from St. Louis University, who was also preparing to become an officer.
“I want you to meet a special educator who has expert experience similar to yours,” said the professor. “She is looking for a nurse who has experience in working with pulmonary patients to be a potential recipient for an American Lung Association Nurse Fellowship. Five scholarships are to be awarded this year.” Tanaka followed her advice, applied for the fellowship, and graduated with an MSN degree with dual certification, as a pulmonary nurse specialist and nurse educator. When Tanaka wondered how she could possibly thank the professor, her benefactor said, “All I ask is that you do something nice for someone else.”
Tanaka says, “Sometimes, you think about what didn’t happen. Then you think about what did happen, instead, and it’s better.” Was her meeting the faculty member while en route to officer training really a chance encounter?
Teach someone to fish
“Experience,” says Tanaka, “is to know.” Armed with her dual MSN degree and experience at BJH as a pulmonary nurse specialist, Tanaka was asked to demonstrate the use of various chest tubes to nursing students and faculty members at Barnes Hospital School of Nursing. (The prestigious, diploma-granting Barnes Hospital School of Nursing would later merge with the University of Missouri–St. Louis to provide part of the foundation for today’s University of Missouri–St. Louis College of Nursing.) They were impressed, and she was soon offered a teaching position at the school!
Applying her “experience is to know” philosophy to education, Tanaka today asks her UMSL students to reflect on their clinical performance by writing “The letter to my patient that is never sent.” Considerable evidence suggests that, when students are required to deliberate on their clinical performance, they gain insight from that reflection. To help the students get started in writing the letter, Tanaka provides the following template:
I felt really good about the care I was able to provide you today. Concerning communication, I felt comfortable introducing myself to you today, but I also felt that I could have made more effort to teach …
When the student, through reflection, analyzes his or her performance, measuring it against clinical objectives, the result is better than if an instructor points out deficiencies. Tanaka calls this “experience-based, evidence-based learning.” Recognizing that some students do not like to share weaknesses in front of a group, she also gives personal, one-on-one feedback. Says Tanaka, “Self-evaluation is helpful in guiding realization of what you need to learn—another form of active learning.”
Asked what is the most effective way to help students learn, Tanaka reflects on her experience as a reserve nurse in the U.S. Air Force and what she learned about the importance of teamwork: “Sometimes, the best way to help students who do not feel confident is to pair them so they teach each other without realizing it. For example, in a medication pass, tell the one who has previously passed medications correctly, ‘You have done it successfully, so now you’re the experienced one. Help your partner go through the six rights of a medication pass before I get back.’ This way, they build on their strengths and build their confidence while reinforcing their own learning. As a result, hands shake a lot less, there is less sweating and fewer pills dropping on the floor, and more smiles as a result.”
“Teamwork!” Tanaka concludes. “In nursing, as in the military, your team’s chain is only as strong as the weakest link. And you don’t ever want to be that weak link!”
PhD, RN, teaching professor at the University of Missouri–St. Louis, is editor of the recently published book Evidence-Based Leadership Success Strategies for Nurse Administrators, Advance Practice Nurses (APN) and Doctors of Nursing Practice (DNP).
A pilot, Sredl is also the author of two aviation-related books, Airborne Patient Care Management: A Multidisciplinary Approach,
which addresses aerohemodynamics nursing theory, and Pilot Quest,
a work of fiction that addresses the rigors of flight training.