Peplau’s Core Of Steel with Dr Nancy Valentine

A cigarette rolled on a classroom desk. A challenge to choose steak over hamburger. That’s how Hildegard Peplau first hooked a young Nancy Valentine—and set a course for a lifetime of nursing influence, autonomy, and unapologetic change. We sit down with Dr. Valentine to trace the real story behind the “psychiatric nurse of the century,” from working-class beginnings to rooms with the greats of psychiatry, and the unflinching decisions that helped save the American Nurses Association.

We share vivid moments that reveal Peplau’s method: build interdisciplinary alliances, follow through when doors crack open, and keep the focus on doing care with patients, not to them. Dr. Valentine reflects on how nurses advanced psychotherapy from a handful of trainees to thousands of practitioners, why recognition and reimbursement still lag, and how professional associations remain essential to policy wins and referrals. If you’ve ever wondered how to hold your ground in rooms full of power, this conversation offers a blueprint: influence over titles, persistence over popularity, and a core of steel.

The future comes into view as we explore telepsychiatry, AI-assisted summaries, and nurse-led consortiums that expand access without losing the interpersonal core Peplau championed. We talk concrete strategies to keep new nurses in the field—structured first-job choices, yearlong coaching, and honest forums that catch burnout early. Dr. Valentine also shares insider lessons from VA care: mission-driven teams, nurse access to research funding, and a model that blends specialized in-house expertise with community referrals.

Subscribe, share with a colleague, and leave a review to help more nurses find this conversation. What’s your next step to build influence—and where will you bring Peplau’s spirit to work tomorrow?

Let’s Connect

Dr Dan Wesemann

Email: daniel-wesemann@uiowa.edu

Website: https://nursing.uiowa.edu/academics/dnp-programs/psych-mental-health-nurse-practitioner

LinkedIn: www.linkedin.com/in/daniel-wesemann

 Dr Kate Melino

Email: Katerina.Melino@ucsf.edu

 Dr Sean Convoy

Email: sc585@duke.edu

 Dr Melissa Chapman

Email: mchapman@pdastats.com

Transcript

Musical Prologue And Warm Welcome

SPEAKER_00 0:00

Yeah, we don't hold a flash before it's not before that we have to flash it. That's pressing a few. We are a common stone, the beacon of hope, every beat, every breath, we are in the host. From night sticks to day break, love in our tone. We're fluent to fusions, we read a five care, not just beds and machines, we're pressing the spread, with hands that comfort, eyes to see truth. Filling in a try, notice what we do. We are nurses, we're hearts wide open.

Introducing Dr. Nancy Valentine

SPEAKER_02 0:31

Well, thank you, Nancy. Uh, welcome everybody to our next episode here of Peplow's Ghost. Thank you for joining us. I'm really excited about our next guest. We have Dr. Nancy Valentin here, who I will just say is a living legend here in the nursing world. She's has a real deep understanding and experience actually being with Dr. Hildegard Peplow, which is what the podcast is actually named after. So super excited to have this. I I also encourage everybody to go back and listen to that intro. I mean, it's, you know, as the kids say, it's fire, right? I mean, it's it was so energetic, it's it's it's timely. And I really want to, you know, put a shout out to our previous guest, Marcelli Pascal Rodriguez, the owner of Transformation Aesthetics and Wellness. Please really encourage you. I'll put that in the notes on how to contact him if you're interested. If you're in the area, you want to collaborate either with his music or his expertise as a PMHNP as well. So thank you again to uh Marcelli. He is actually a previous guest on our podcast. So feel free to reach out and go back in our history and check out his episode. It was really great too. But but right now we've got Dancy, Dr. Nancy Valentine here. And and so again, just really want to kind of open her up and just kind of learn a little bit more about her experience with Dr. Peplau. And so, kind of the first question we have here is just, you know, Dr. Peplau is, you know, considered a lot in our field as the mother of psychiatric nursing. You know, she's really, you know, just a legend. You know, we all kind of know her, we all get taught her probably multiple times throughout our nursing program. So so what was your first impression, or what do you, you know, what do you, what did you kind of when you first met her or started reading about her, what was your first take on uh Dr. Pepplau?

First Encounter With Peplau At Rutgers

Steak Versus Hamburger And Higher Education

Biography Insights And Early Influences

Networks, Interdisciplinarity, And Resistance

Saving The ANA And Paying The Price

Peplau’s Theory And Hospital Pushback

SPEAKER_04 2:17

Well, my first impression was when I was 19 years old, and I had just started in the nursing track at Rutgers University College of Nursing. And this woman came in to speak to us. She was introduced as Dr. Hildegard Peplow. None of us had ever heard of her before. We were just getting into nursing because our first year was arts and sciences. And she was quite a character right from the get-go. She sat on a desk and she then took out tobacco and started rolling her own cigarette and started smoking it, of course, which I guess was not that unusual at the time, and then started chatting us up about why we were in the right place, that, you know, being a psychiatric nurse in particular would be very, you know, much a thing that she would advocate. And then she really was pushing her whole raison d'etre for being with us that day was not to be pushing psych nursing so much as a specialty, but to really get us thinking about going for our master's degree, you know, advanced education. And I remember sitting there thinking, advanced education? I hope I just like pass my first nursing course. I don't know how I could ever even think of going for, you know, another degree right now. But her point was her cell job, I remember this so vividly, she said, Do you want to eat steak or do you want to eat hamburger? It's up to you. So she immediately put it in economic terms. And honestly, that was the first and last I ever saw of her in undergraduate school. Because being in the graduate program was a world away from the undergraduates. I mean, we saw her, I was thankful in years past, years then that came that I had gotten to meet her first at that time. But then my next opportunity to meet her was really through the American Psych Nurses Association, even though she was not a founding board member. She was, you know, very influential. Her work, of course, was always being quoted, et cetera. And then the next time I really spent any time with her is that, I mean, it was many years later. Yes, it was at least three degrees later, when she was one of my advocates for becoming a fellow. She wrote one of the letters of endorsement to become a fellow in the American Academy of Nursing. So I was very grateful to her for that. But I think that to really tell your audience how to really learn about Hildegard Pepplau is not just through her theory and her work in psych nursing. But I had the pleasure of uh pulling out in preparation for this podcast a book and biography on her entitled Hildegard Pepplau, Psychiatric Nurse of the Century. And this, I don't know that you can see it, and it's I know this is mainly going to be a verbal dialogue with your audience, but Barbara Callaway was actually working at the School of Nursing. She had become a dean when they started running out of nurse deans because they had problems with each and every one of them. So she stepped in and she was no doubt a very able administrator, but she had no plans of staying for the long term because of not being a nurse. But she was so impressed with Hildegard. And I have to say that Barbara really deserves a shout-out. Dr. Callaway, if she had not written so much incredibly detailed information, we would not have this background on this woman who is such an exemplar. I was just ooing and eyeing as I was reading every chapter about how remarkable her whole life was. She didn't just become a legend because she like decided to have this like interesting theory and it sort of popped out of the box. It was a lifelong endeavor. And I'd like to just tell your audience that there were three themes that I thought really set her apart. One was her incredible curiosity as well as courage. She actually grew up only an hour's drive from where I am in Philadelphia, where I grew up. And she was in a poor area that was very working class or lower working class. I mean, it was a tough life, I'm sure, when she was growing up. She had immigrant parents, they were very much trying to make it in the new world, but it came with a lot of baggage for the kids. And she couldn't wait to get out. And she finally escaped by going when she was finished school, she got into nursing school. Nobody really thought that was, you know, anything that they advocated because education for young women was just not heard of. But she got out of that and she went and took an opportunity at Bennington College in Vermont. And this is why I think it just started her on a road to success that no one could have ever predicted. Because as she would take these different roles and responsibilities, all of which were very entry-level, she met all the greats in psychiatry. At Bennington, someone said, Well, you know, you really should go to a psychiatric hospital in Maryland and meet Dr. So-and-so. You know, I mean, she met all of the greats, including Harry Stack Sullivan, through all these people that just sort of, you know, would steer her in the right direction, and then she would follow up and follow through, which is another great characteristic. It's one thing for people to get prompts, it's another thing to follow through. And then I think that her ability to develop relationships that were interdisciplinary. No one had to tell her how to do that. She actually, if I really were to editorialize my opinion, she actually felt more comfortable with people outside of nursing because when she tried to make relationships with other nurses, she really found that they were basically not receptive. She felt that they were not, they were very parochial, they were not open to new ideas. It was very frustrating to her. But that ability to have this incredible network over many decades of people who were highly influential, that thought very highly of her work, really helped her to become the psychiatric nurse of the century. She did not have to be introduced to people. She was already a well-known person to that group. And then I think the third thing that I came away with is that her uncompromising desire to make change, no matter what people thought, she was not trying to be popular. In fact, she was very unpopular. She was really very isolated and ostracized by nursing colleagues in various places that she worked, including Rutgers, which was her last academic post. And I think it's just very, very unfortunate, but I think she had a somewhat of a caustic personality because she was really focused on doing business and getting the job done, and did not want to just keep what she would probably think pussyfooting around with other people. You know, she just wanted to cut to the chase and get the job done. This included the A. She became president and they, well, she had been the executive director, which is more influential, quite frankly, than the president. And she saw what great, what horrible shape they were in financially. And she had this acumen for financial astuteness, and she had to make some very tough decisions. But frankly, she saved the American Nurses Association. They were just about ready to go down the tubes if they were on such a slippery slope. She could have been the closer rather than the revitalizer. But she revitalized it, but it turned so many people off that they did not appoint her as a permanent executive director. She was acting for a couple of years. And they gave her the consolation prize of being the president, but she found that even more frustrating because then they put, in her mind, another inept person into the into the like the receivership, so to speak, of being the executive director. And again, it just didn't flourish the way she thought it could. So there are many, many different renditions of what I told you, but I think they are the personal characteristics that got her through. So back to her theory, you know, of interpersonal relationships. It was groundbreaking. And a lot of people didn't want to do it, including the hospitals where she actually was trying it out, Graystone and even others. She had to really work with primarily, in some cases, the physician who was running the institution because the nurse lead had wanted nothing to do with it. They found they felt it was immediately competitive. They didn't want nurses to be actively involved in care. You know, they were really in stewardship kind of roles, doing for the patient, whereas she wanted them to do things with the patient and to give the patient more independence and freedom, etc. So that's just the capsule version of how I have gotten to know this woman. But this book was so riveting, I cannot emphasize enough the value. And in fact, this whole idea of nursing history, which I think would be a wonderful opportunity for students to learn more about nursing figures who have made such a fundamental difference. But in in nursing curriculums, they do not really emphasize nursing history. Nursing history is something people generally stumble across. Maybe like 1% or 2% of all nurses really get involved with nursing history.

SPEAKER_02 12:01

Well, thank you, Nancy. That's great. I mean, I again to encapsulate someone's life so so succinctly, I appreciate your time, your your effort in doing that. It's uh reminds me, you know, a lot of just you know, you have to kind of put your head down and do something, which we've heard from other people who've met Peplow as well. And so thank you. And uh Sean will have the next question here. So thanks.

Psychotherapy Today And Peplau’s Ripple Effect

SPEAKER_01 12:19

You're welcome, Dr. Valentina. I'm gonna start with a comment responding to something you said and then ask you a specific question. I I you were talking and talking about Dr. Peplo's nature, which is you know, I I would suggest that Dr. Peplow didn't feel full of way. In my mind, I was thinking when you were talking, if you were a man, how much more can you rate my feelings within the system, right? Because of the value of the feeling just kind of in my hand. But let me let me ask you a question, are you left-handed or right-handed? I want you to imagine that when your right side of your shoulder is you, and then your left side of your shoulder is a good idea. I think you can think of a current presence in psychiatric nursing, specifically advanced practice psychiatric nursing, and kind of make an evaluation. Give us a grade about our ability to kind of fortify and deliver psychotherapy. How what's your grade and what do you think Dr. Peplow's grade would be?

SPEAKER_04 13:22

Well, I don't know that I'm in any position to give a grade. I think I would be saying to her, you would have no idea just the extent to which your influence has been brought to bear. Look at how many nurses there are that are doing psychotherapy. It's still a very small percentage of people who are in mental health care. But she only had at the highest level, I think that she was given credit for training 125 students to become psychiatric nurses in that therapeutic track. That's a small number. Now we have, you know, obviously thousands that are doing that. So the ripple effect has been tremendous. And I think as far as giving a grade, I don't know. I mean, there are so many different people doing this work. I'm sure some are excellent and maybe some are okay, and maybe some need, you know, more buffing up as well. So I think on an individual basis that would vary. As a cohort of nurses that are doing psychotherapy, I think that it's hard to be advocates for self as a group. And we are still really low on the totem pole of reimbursement, of being even acknowledged as therapists. It's striking to me that it's been a long, such a long haul to get that visibility and to get that recognition in ways that make a very profound difference, such as reimbursement and referrals, getting more referrals. I don't know what would be the best way to reposition some of that for more success. Maybe there are others that would be in a better position to make those recommendations, but I would just urge people to be involved with their professional association. Use those platforms to help leverage advocacy. It's impossible to do it as an individual. People are busy, they're doing their work. So you have to find other levers to make that that mark.

SPEAKER_01 15:26

At the risk of me asking you to mind read, how do you think Pepla would perceive us in history right now?

Core Of Steel: Holding Ground In Policy Rooms

SPEAKER_04 15:32

I think she would be both happy and and not satisfied because the woman was, you know, chronically unsatisfied. She wanted to always push for the next the next step. I think she would blame the nurses for not doing more. You know, I think she felt that nurses, you know, even today, by her standards, would be seen as much more, you know, nimble, but she would be wanting them to do things, just like I said, to really band together, to find smarter ways, you know, to get to their mark, maybe to be influential with other disciplines, to much like she was, you know, get to know people, don't stay so isolated, which is a chronic problem for nurses in all areas of practice. So I think that she would be pleased that the numbers are growing. I don't know if they've plateaued, quite frankly, but I think that part would be good. But she would want people to do more.

SPEAKER_01 16:30

Thank you very much.

SPEAKER_03 16:33

So I'm going to ask about Paplau's having famously core of steel, described as having a core of steel when it came to nursing autonomy. And you've navigated the highest levels of healthcare policy and the VA system. So I'm wondering if you could share a moment from your own career where your personal connection to her helped you stand your ground in a room full of administrators and policymakers? That's a wonderful question, Melissa.

Digital Therapeutics And Entrepreneurial Paths

Keeping New Nurses In The Profession

SPEAKER_04 17:01

Because as I was reading this book, I kept thinking to myself, this is just incredible. I hardly knew the woman. You know, I I've already given you a full blow-by-blow of the few times I really got to spend time with her. But we are so strikingly similar, it was almost uncanny. I was wondering, is there such a thing that if you just walk around in the same building, you sort of get inoculated? But I think some of those same personality characteristics of, you know, always shooting for, you know, best practice, best, best achievement possible, not ever being satisfied with the status quo was a very similar characteristic. And I think that I was always very conscious in my career that the most important thing for me in taking any position was not the title, not the salary, because many of my positions paid much less than some of my colleagues that were in similar jobs. But I took them in sometimes more daunting, you know, environments where the salary was never like at the top. What was most important to me was how much influence I could have. Influence to me is the number one capital. You know, if you're in a job where you can have influence, that's the only thing that counts at the end. And I was very fortunate to have those kind of positions. But the core of steel that that took was something that I had to develop over time. And I think that what I never could have anticipated as I got moving along, and you have to understand that in this era of today, this may sound to some of your listeners like, oh yeah, that comes with the territory. In my day, that was not the same situation. The unending criticism for anything that one tried to do that was going against the norm. The criticism came not just from nurses, but it came from interdisciplinary so-called partners. And I had to learn to pick them wisely because they could be in assigned jobs that would assume that they would be partners, like Dr. So-and-so and at a chief medical officer level with the chief nursing person, which in this case would be myself. You would hope and expect that that would be a, you know, sort of a natural partnership. But it wouldn't be because of the different personality characteristics that that person just didn't want to partner. They wanted really to not either be bothered with the programs that I was interested in and would wave me off to like, oh, well, you know, talk to so-and-so about that. You know, like I don't really feel like being bothered with it. Or they would be openly not supportive. So it really required weaving around and dodging some of these folks and finding those who would be willing to align in order to get things done. Because number one, you cannot do any of these major policy shifts and organizational revamps like a one-woman show. It's just not possible. You have to find a team that you can work with in your own department, hence nursing. And I did find those folks. I had to pick and choose as well. But you have to find the external people that you can align with that will have the credibility in other circles, sort of to advance the program. So I think it took the ability to withstand that kind of criticism, to just not waffle under it and just keep going no matter what.

SPEAKER_03 20:37

Kind of this unflappable part of core of steel, right? And persistence, and I love the chronically unsatisfied. That kind of resonates with me as well. Especially because any curious person that wants to create change has to have these characteristics. Thank you. You're welcome.

SPEAKER_02 20:52

Yeah, this is, you know, and again, this is great, you know, that the image of that is like a bridge in some ways, and we all need kind of multiple supports to help us. And we and I like how you said, you know, you got to pick those supports very carefully, you know, people that will have your back and and and support you during that time. It's and so so though, and and and what you've said too about the idea that you maybe haven't had many actual interactions with Dr. Peplau, but it's you know had this resonating effect, like you said, that 125 students that she educated just kind of you know proliferated throughout the throughout the profession and such. So my next question gets a little bit more, maybe thinking into where we currently are today, but even into the future, you know, this kind of the concept of interpersonal relationships and how does that look in our digital world? You know, as we as we move into like telepsychiatry and and other things like that, how how do we maintain that? How do we how do we preserve that peplow type of you know theory that continues to that should continue to kind of stream through kind of our interactions with people?

Lessons From VA Care And Research

SPEAKER_04 21:51

That's that's a that's a very good point as well, Dan, because actually theoretically, by having digital communication. People doing therapy with Zoom calls, et cetera. You really should think that that can actually expand the influence rather than hinder it. And I do believe that the intensity of a Zoom call face-to-face, where you're really having the interaction, and now with AI, you get a printout of uh and the next steps. I think that even enhances, you know, the therapeutic uh, like what did we talk about? And what do you want to do next kind of thing? That could that could be an enhancement. I I would hope that more people would take advantage of that. And this is a sort of an entrepreneurial opportunity for psych nurses to really maybe begin some of their own businesses and consortiums to have a multi-dimensional set of offerings. And people have different specialties, uh, different populations of interest, but if they could band together and start a small LLC and really offer it, or partner with an already existing organization and add to their to their value by having this program, I think that it could proliferate. So I want to be optimistic. I mean, just personally, I'm involved as you can, I know your audience will not be able to see this of mainly listening, but the banner and back is nurses navigating the complexities of the healthcare system is really what I'm focusing on now. I'm starting a program for uh young nurses who are ready to graduate from their school of nursing and get them prepared for their first job because the whole idea is that their decision making around their first job will be very pivotal to their long-term success. They can't just jump into the first thing that they're offered and then be floundering, hence the enormous turnover statistics for nurses in their first one and two years. And what I hope to do is bend the curve of those who actually leave the profession, which is estimated to be 35 to 50 percent by year two. That entire investment is not utilized to its maximum. What these folks do, I don't know. I don't know that anyone's tracked on their like next steps career-wise, but it's not in nursing. We need nurses. So I'm hoping to work with that. And then there's a companion program that again really goes back to the psychiatric nursing basis, and that is being ground zero, talk me off the ledge. It will be a year-long coaching for nurses in their first year, and will be a combination of presentations by experts on a topic, and then another session every month that will be just an open forum to talk about all the stuff that they're seeing that is absolutely throwing them over the edge and would lead very quickly to, I can't do this, I'm quitting.

SPEAKER_02 25:01

Yeah, thank you for sharing that. That's because again, that I think that's that can't be said enough. I mean, the the the nursing need is out there, and then to have such high levels of people, like you said, you know, completing their education, spending all that money on tuition, and then feeling like they've made it, they've made a mistake, you know, and then that's got to be crushing personally, professionally. It is, it is and where they go, you're right. It's it's it would be nice to know. But but thank you for that work. It's it's definitely very much needed. And and I I think it it builds on this digital world we have too. We could have these consortiums and things meet. And we met last night, I'm current president of ISPN, and and we had a listening section session for the board. And and that was one of the things that came up too is mentoring, you know, getting support, especially in our early careers, you know, how we can do that.

SPEAKER_04 25:47

So again, so it's so necessary. It's vital.

SPEAKER_02 25:51

Absolutely. Yeah. So, Sean, I'll let you take the last question.

Closing Reflections And Listener Invite

SPEAKER_01 25:54

Yeah, Dr. Valentine, I as a veteran, I I share your passion and interest for veteran care. Can you share a few pearls that could have only been sourced from serving those who have served?

SPEAKER_04 26:04

Oh, that that is a wonderful question. Well, thank you, Sean, for your service. I appreciate it. I think that what people don't really appreciate about VA is the enormous dedication of the people who work there. We only hear all the bad news stories. And in 163 medical centers, there are clearly going to be, you know, moments where, you know, people make some pretty, pretty disastrous mistakes. But overall, the work that's being done is being done by people who are self-selected, truly, to give care to veterans and really care about that population. So I would say that what I learned and what I would impart to our audience is that VA is a wonderful employment option. Now, today I don't want to comment on it's being under assault by the current administration, unfortunately, but hopefully it will it will stand the test of time. The second is the amount of research that is poured into veterans' care is also not to be overlooked because so much of the outcomes of that research, including in psychiatry, are utilized by other people in other domains of healthcare. So the the work that that exemplifies is really important. And one of the things I was able to do in my tenure there was to open it up so that nurses had the same opportunity as anyone else to compete for those research funds, because believe it or not, they were not allowed to before I arrived. I couldn't like find, I couldn't believe that. I was like, what? That's that's ridiculous. So that would be an example of, okay, we're going to change this. And we did. I think the third thing about veterans care is that we need more emphasis and and to be positive about it, which I was really sort of saying earlier, but I think people need to recognize what the contributions are rather than again just be looking at it being a cost center, something that we can do without, we can mainstream everyone into the private sector. And theoretically that could happen, but they're not going to get the same focused care in the private sector, I don't believe. And then and today, the way, the way the options work is that if you need a specialist that they don't have, you can be referred out. So you really have both options as a veteran.

SPEAKER_01 28:34

Thank you. You you share Pet Lao's core of steel.

SPEAKER_02 28:39

I do I can hear it. I can hear it. Maybe you were immaculated just spending a little bit of time with her. That's uh that's amazing. So so thank you again, Dr. Nancy Valentine. This has uh been a wonderful um educational and inspiring for me. I I think again after this episode, I I do feel like Peplau's ghost is with us. Maybe she's not turning over in her grave as much as I had feared when we first started this podcast. So thank you for for inspiring me and and really kind of continuing to believe what she believes and carry on her spirit. So thank you again for this opportunity. And uh thank you all for listening and and really look forward to another episode here coming soon. In another week or so, you should have another episode in your inbox, in your Apple Podcast, wherever you get your podcast. So please like, subscribe, please comment. We'd love to hear from you on how we're doing and who else you maybe would like to hear from. So, and again, please enjoy the outro Marcelli Pascal's Rodriguez beautiful and uh inspiring music as well. So, all right, we'll see you in the next episode. Thank you so much.

SPEAKER_00 29:46

We are nurses, the world can't forget.

unknown 29:49

We give all no regrets.

SPEAKER_00 29:56

We are nurses.