How did you get into nursing? Writing?

My father was a surgeon. As a teen, I went on hospital rounds with him. He also saw patients during evening office hours at our house. My mother assisted him and I was often invited in to learn about changing dressings and other related things. I wanted to be a nurse ever since that early exposure. It was my calling.

I seem to have a passion for writing. I started my professional writing endeavors in the late 1980s while working at the UCSF Young Women's Clinic. The other NPs and I developed protocols to assist the master's students with their patient management skills.

At one point, we had so many protocols that we decided to have them published. Our first book was Ambulatory Obstetrics, which won the American Journal of Nursing book of the year award in 1988 and 1990. That book was followed by Women's Primary Health Care: Protocols for Practice. In recent years, I've branched out into short stories and poetry.

Why the need for a book on protocols for practice?

The state legislature's Nurse Practice Act defines a nurse's scope of practice. This varies from state to state. In most states, the role of an advanced practice nurse is dependent on standardized procedures and protocols. The protocol component determines the clinician's scope of practice and provides the means for the APN to move beyond what have been the perceived traditional boundaries.

Protocols generally are utilized in three ways: first, to meet state requirements; second, as a guide to increase practice excellence; and third, as a performance assessment tool for managers. The most efficient use of a protocol comes when the purpose is established prior to use.

The protocols in Women's Primary Health Care are disease-specific and are intended to be used as guidelines for practice. The publication can serve as a "working manual" in many clinical settings, as well as a framework from which to formulate site-specific protocols for practice.

What were some of the rewards and challenges in writing the book?

This edition of Women's Primary Health Care is dedicated to our mothers. We lost five mothers during the three years it took all of us, including contributing authors, to complete the book. That was a great sadness.

It is a challenge to take on a project like this and organize your time. One has to juggle the writing piece with everyday work, family responsibilities and other commitments. Developing a book of this magnitude definitely impacts the day-to-day stress.

I had to set aside a lot of concentrated time, which is difficult to do when everything else is going on. But, producing a manuscript that you feel is a significant contribution to women's health care is well worth the time and effort.

You have said it's important to be heard and get active. How can nurses do this?

I encourage nurses to participate in various forums and to take on new challenges. It is necessary to be vocal in order to effect positive change in one's job and nursing practice. Reading journal articles and other types of literature is a way in which nurses can keep abreast of current trends. Reviewing and critiquing clinical practice issues and collaborating with one's colleagues can promote an active community voice among advanced practice nurses-a voice that can be heard at the local work environment level, as well as in the larger political arena.

Anything you'd like to add?

I've been at Kaiser Permanente for 30 years. I've also had a clinical faculty position at UCSF for some time. So I'm involved clinically and academically. My journey in life has allowed me to interface with incredibly talented people who have taught me well. I feel that my contributions to patients' health and welfare have enabled them to better manage both their physical and psychosocial challenges.