August 23, 2006
A left brain-right brain approach to healthcare has created a unique career for San Juan Capistrano, Calif., resident Barbara Klein-Robuck.
On the 'left-brain' side as an independent rehabilitation nurse consultant/case manager for the last three decades, Ms. Klein-Robuck works within the mainstream medical community to coordinate medical rehabilitation for worker's compensation, long-term disability care assessment and private clients. In 1965, when very few nurses held bachelor's degrees, she launched her nursing career with a year as a staff nurse at Montefiore Medical Center, Bronx, N.Y., and then she went into teaching. She spent four years as a clinical and lecturing instructor of obstetrical and medical–surgical nursing at Lenox Hill Hospital, New York, N.Y. In 1969, she became a liaison nurse at the Casa Colina Hospital for Rehabilitative Medicine. In 1976, she started a one-year stint as a rehabilitation nurse specialist for International Rehabilitation Associates, Pasadena, Calif., and then launched her consulting practice.
A registered nurse (RN) with a master's degree in healthcare administration, Ms. Klein-Robuck earned her bachelor's degree in nursing from Wagner College in Staten Island, N.Y., in 1965. She received further training at Teachers College, Columbia University, New York, N.Y., in 1968 and at California State College in Los Angeles in 1972. She received her California Vocational Educational Certificate from Mt. San Antonio College in Walnut, Calif., in 1973, and completed her master's degree in health care administration at the University of La Verne in La Verne, Calif., in 1990. A licensed nurse in the state of California, she also holds a state public health nurse certificate and is a certified case manager, certified disability management specialist, certified rehabilitation counselor and has a lifetime community college instructor credential in nursing.
On the 'right-brain' side, Ms. Klein-Robuck is a certified holistic nurse who offers treatment that combines therapeutic touch, integrative imagery and Jin Shin Jyutsu, an ancient Japanese art that harmonizes and balances energy using methods similar to acupressure and acupuncture. Her holistic training includes coursework and advanced workshops on numerous alternative/complementary modalities including therapeutic touch and certification in both integrative imagery and Jin Shin Jyutsu. Ms. Klein-Robuck's practice focuses on energy balance, stress and pain reduction and self-empowerment to promote healing of acute and chronic conditions. "I have been doing energy healing work for almost 20 years, I guess even before I knew there was a name for it," she says.
A member of the American Holistic Health Association (AHHA) and the American Holistic Nurses' Association (AHNA), she was named AHNA's Holistic Nurse of the Year in 1996 and became a Certified Holistic Nurse (H.N.C.) through the organization in 1997. A founder of the Holistic Alliance of Professional Practitioners, Entrepreneurs and Networkers, Inc.( HAPPEN) (no longer in existence), she has also been instrumental in the development and leadership of organization including the Orange County Wellness Network (1980s – 1991), the Orange County Network for the American Holistic Nurses' Association (1991- 2001) and created Wellness Enterprises in 1991 to sponsor holistic continuing education opportunities for nurses. Ms. Klein-Robuck is also a speaker/lecturer on various holistic health issues and modalities at hospitals, churches, colleges, professional and civic groups, local workshops, and at national and regional conferences.
To those interested in the holistic aspects of healing, Ms. Klein-Robuck offers this advice: "You have to have courage to stand up to people who want to dismiss 'all of that.' It helps to be a free thinker. As I look back, I feel I've spent my career on the cutting edge."
You & Your Career
Tell us about your career shift from traditional nurse to certified holistic nurse.
I don't know that there's really been a shift. I joke about it and say I have a left brain and a right brain. When I went back to school in 1987 to get a master's in healthcare administration, I jokingly referred to that as a way to see if I still had a left brain, because I had been studying holistic modalities and emphasizing a lot of non-academic things. I see myself as crossing over the line constantly, because I do both. In the pure traditional medical sense, as a registered nurse with my own practice, I do workers comp case management and long term care assessment. Healthcare needs are very universal. In those arenas, I'm limited, I don't do hands-on work, though I give people suggestions to explore on their own if they so choose.
How did you build on your career in rehabilitation nursing to allow you to advance to where you are today as an independent case manager?
I no longer do any hands-on rehabilitation nursing, but I do the case management part, coordinating the care. In this day and age, it may simply be helping the people making decisions in healthcare understand why the doctors are requesting things. We have a utilization process, where every treatment goes through review to be approved. For instance, I had an adjuster say 'what's the numbness got to do with diabetes?' She wasn't a medical person, so I wrote back and explained that the neuropathy could be from an underlying diagnosis such as diabetes. As a nurse and a medical care facilitator provider, I'm in a position to teach people at both ends of the spectrum. Our job is to educate them. And it is my joy to do that, empowering the gatekeepers as well as the patients and clients. Sometimes I attend appointments with patients, visit in the home and assess what factors may be in play.
What factors in your nursing career drove you to pursue nursing opportunities outside of traditional western medicine?
Most nurses with degrees have been driven away from the bedside. In most hospitals, no RN is doing direct care except maybe wound care and pushing IVs. Having a holistic practice gets me back to the bedside, hands on; I can touch people.
I became involved with the AHNA, which endorsed a program in healing touch that built on my experience in therapeutic touch. I had surgery on my toe in 1990, and a friend said, "Let me help you with that," and she worked on me using Jin Shin Jyutsu, a healing art from Japan. I was astounded, because I could feel the shift. Jin Shin Jyutsu focuses on the energy pathways and supporting and opening releasing the safety energy loss through the body. After I experienced it, I said, "I have to learn to do that." So through the years, I pursued that program. To be certified, you have to take a five-day course three times. Jin Shin Jyutsu is a lifelong study. You never really are done learning; that's why it's called the practice of medicine.
Three years ago, I finished the program in integrated imagery sponsored by AHNA, called "Beyond Ordinary Nursing." That is a beautiful process. If you consider simple guided imagery grammar school, than integrated imagery is graduate school. It brings the clients to a safe place where they can access their own truth, their own wisdom. It's a beautiful, sophisticated process.
How do you utilize the training to treat your clients? Do you tap into your 'mainstream' medical training?
I combine the three areas (therapeutic touch, Jin Shin Jyutsu and integrated imagery). I have a room in my home designated as a healing room. I often use aromatherapy, and I have a wonderful treatment table supported with extra foam. With my rehab background, I don't just have people hop on the table. I position them. I put pillows under the parts of their body – under their feet, their arms, their neck – so that there is total body alignment, and there's no way they can not relax. That goes back to rehab, when you are taking care of people who have had a stroke or who have paralysis, they can't move. It's our job as nurses to position them and reposition them in good alignment and comfort positions.
In these modalities, the clients are completely clothed. When you are relaxed, your temperature drops, so I often cover clients with blankets.
I do the two energy modalities first, and cross back and forth a lot, and then when the person is totally relaxed, then I go into the integrated imagery process. Some integrated imagery therapy people simply use a direct relaxation process. We're not counselors; we're just helping people access their own insight. For example, if you ask the person to allow an image to come to them or to access a feeling, something that represents a symptom or a pain, that could come in the form of an animal or a stone or a flower or a sage or a healer, it could be just about anyone or anything. We facilitate the dialogue between the image and the patient. The image comes from within. I've seen some astounding things happen, people coming up with "Oh my god, my mother really did love me." When they see the image, they feel it and get in touch with it, and it is profoundly healing. It's an honor to be a part of that process.
Can you describe an energy-healing session?
Jin Shin Jyutsu is based on a process called jumper cabling. If you've had a battery on your car die, you have had to get it re-charged. There is a positive and a negative lead, and if you attach only one, it doesn't work. What Jin Shin Jyutsu practitioners do is create energy jumper cables with two hands, touching the body gently in two places to help the energy flow through. The client has this wonderful experience of being gently touched, often feeling very profound changes. I tell them to be aware of what is going on. What happens is they will be given breath releases, when the pulse has come through, out of nowhere, they let out a deep breath. That's prompted by the energy. They don't need to know what they released; we're not psychologists. But they do know they feel better or lighter or different, or they just feel something change. I've never seen anyone unhappy afterwards. I encourage people not to wait until they have a problem. In Jin Shin Jyutsu, we call it a project. A problem could be insurmountable, but projects are a whole re-framing of that process, you can get in there and work on it. The framing dovetails beautifully with my metaphysical beliefs.
You are a member of numerous holistic healthcare organizations, and helped found several of the groups. How do such groups support your professional goals?
Each group has had its time and place in my career path, and I'm still actively involved in some. Being nominated as the AHNA Holistic Nurse of the Year was one of the most humbling experiences you could have. Several people on a local level took on the task of gathering information and testimonials from my patients -- 64 of them – and submitted the materials to national. When the founder of AHNA was presenting the award to me, she said "I don't think I've ever seen a book like this before." The fact that the local network put together such praise and support and loving statements was really awesome. If I ever get depressed or discouraged, all I have to do is think about that book sitting in my office, and I know I've made a difference, and I'm delighted to have had the opportunity. That's what we're here to do. My whole career path, which has balanced the left and the right, leads me to be someone who is very easy to be around.
What unique challenges and rewards come from working with your patients in an independent naturopathic care setting?
With each client, I learn something. There's never a time where you don't have a new insight about it. When I go into my treatment room with a person, my intent is to leave my ego at the door. I don't heal anybody; it's a matter of creating a safe space, a sacred space in which the wisdom can just bubble up, and make us open to that guidance. I don't have any canned speeches. Sometimes I start out saying, 'What would you like to see happen today?' The skeptics, I tell them that they will experience profound relaxation, 'to a degree that you probably haven't felt in many moons, but beyond that, there are a lot of other gifts to be had.
My energy work doesn't require me to do reports, but I do. I create a sheet, check off, diagrams of the body for areas of the body that I can, note things that I have done during the session, feedback, recommendations I make. That paperwork is easy. The paperwork for workers comp and long-term care is another thing, that's tedious. But challenges in the holistic arena, I wish I had more of them. My intention is to build that, and not to be dependent on workers comp work anymore for a living. My heart is in my energy work.
I don't market myself very well. I do finally have a brochure. A challenge is when you don't have a regular cliental. And my work is not like, "Come back for 10 sessions." Sometimes people come one time, though I recommend that they have three sessions so that they can get a sense for what happens, to build on it, do a third and final. Some people just keep coming. Some people call me up two years later and want to come in, and some of them are working on the same issues. Having a regular cliental is a challenge; the financial part varies greatly. The advantages are that I can set my own time; I can gauge my time. It can be a challenge to keep motivated after 29 years of being self-employed. I don't know if I would have had the courage if I had known then what I know now.
What are some of your professional goals for the future?
I do want to expand my practice and be less dependent to the insurance industry. Here, the insurance does not pay for what I do, as wonderful as would might be. For instance, if a physician referred someone to me prior to surgery to prepare the body with the right energy, the results would be phenomenal. The clients I have that have gone into surgery have done so well and have less pain to manage afterwards. It's just a good thing. So much of our society rewards us for being is our heads. A lot of people try to consciously ignore the body. We're physical beings, in a physical body, having a physical experience, so it behooves us to pay attention to what the body is telling us.
The Actual Work
Describe a typical day of work for you. What are your key responsibilities? On a basic level, what skills does your job demand?
One thing I do is to empower the client, is to say, "Take a trip through your body, from head to toes, working all the way up, and see if there is a place where it is harder to get through. Where does it get stuck?" I ask them what their experience was, where they felt things are a little jammed up. I have them point to the area, and inevitably it is the chakra that might not be functioning well.
Then I show them with the pendulum where the issue is, that's New Age, but it shows them, and they're amazed. It's not me doing it. I'm facilitating. I tell them to exhale, and they lighten up, the energetic pictures changes. All healing is self-healing. They say, "I can do that?" That's where it's at for me, it's not about me taking away the pain, it's showing them how to do it themselves.
Here's an example. I was with a friend. He had just gotten out of gall bladder surgery. He had asked for pain medication, and the nurse was getting it. While he was waiting, I had him breathe down and release, and imagine that each time he exhaled that he was peeling back a layer of the onion. He looked more relaxed, and ten minutes later the nurse came back with the medicine. He said he didn't need it any more.
Other skills are listening, being open, being present. Sometimes that's all a person needs. Just like kids; they don't expect you to fix it, they just want to be able to tell you it hurts, and that's part of the process of letting it go.
What are the tools of the trade that you use the most? Favorite gadget?
My tools are my hands. When I scan a person, I feel like I have 10 eyeballs. I'm not clairvoyant, I'm kinesthetic. I translate through my hands; it comes out to me as a question; "what's going on here?" In Jin Shin Jyutsu, the process is a self-help tool that uses that finger. Each finger corresponds to a different attitude. The thumb is connected to worry; that's the finger most babies suck – they're worried if they are going to get more food. The third finger is anger, just what it is used in our society for; the second is fear, the fourth, ring finger is related to sadness, the pinky finger is the co-dependent finger. I scan a person with my hands, and often get a sense for the project at hand. For instance, I was treating a woman and was getting a buzzing on my ring finger. I told her that I sensed a sadness; she burst into tears and the whole story came out. When the sadness finger was talking to me, it gave me the courage to talk to my client. If you treat your fingers every day, you treat your whole body, because the energy pathways go everywhere.
When it comes to gadgets, I show people how to assess the major chakras. A lot of New Age people use crystals, but I steer away from that kind of stuff. I have a heart made of alabaster, but you could use a teabag or a ring on a string. There's nothing special or unique about particular crystals, there's no magic in the object.
What are some common myths about the holistic nursing profession?
I don't know that most people identify a holistic nursing profession. Nursing is holistic by its very nature. We're the only discipline that crosses all lines. Even acupuncture is very mechanical; though its eastern medicine, it's not holistic unless you combine it with assessments. It's not just a matter of poking needles. But most nurses don't have the time to be holistic. They are pushing pills, directing bed baths; they don't have the time and staffing and to be a nurse in the true sense. Every eight hours, the nurses change, there is no care continuity, no carryover. When I was teaching in New York back in the 70s, people stayed in the hospital for more than 24 hours, so we got to know the patients as people, not just as the gall bladder in the fourth room from the left.
The nursing training nowadays, they take people out of school, send them into a one-year program and make them a nurse. I don't know how they do that. My four-year program was a departure from traditional training in those days, most people went to a hospital nursing program. Those girls were slaves, but their clinical exposure was phenomenal. But they were not trained think out of the box. When I graduated only (some) nurses in the country had a bachelor's degree. We didn't have the clinical exposure, but we had the critical judgment exposure. Now there is more of an emphasis on two-year associate degree programs, and I'm not sure it is adequate.
Who are the biggest inspirations for your career?
Mother Theresa was selfless and giving. In a perfect world, which she didn't live in certainly, I would love to not have to charge people. I'd love to have people give a love offering rather than to worry about the mortgage and the car repairs. People don't understand the value and the potential good of this, which could be used as preventative medicine. It would be so fabulous if people could see the value of true preventative medicine. People see each other as a physical body, but that's just the density part of who we are. In a person's energy field, we carry around all the junk – it's a blueprint of what will come into the body. The blueprint, that first layer of our field is like a backpack we carry around, if we would learn to regularly assess it and clear it. I often use the visual of taking yourself to a perfect waterfall in Hawaii, and the water is the perfect temperature that is washing away the troubles. Who of us takes the time to do that?
Best patient care tip for a novice?
Evaluate, but don't judge. There's sometimes a very fine line there.
Education Information & Advice
How did you decide to build on your nursing education to seek holistic healthcare training?
One patient told me I had healing hands. You know when you connect with people, you put a hand on the shoulder. We spend a lot of time being discreet about people's space, not wanting to invade, and it's a function of having the license to touch as a registered nurse. It's sad that psychologists can't really touch people. I can't imagine not hugging people.
What did you like and dislike about your traditional nursing education?
My bachelor's degree opened doors for me that I wouldn't have had if I was schooled in a hospital setting. I applied for jobs that I didn't know I could do. Looking back it was scary. My first job out of college was in a hospital; they put me in charge of a floor and a group of nursing students. There were things universally I could help students with. I decided I would really like to be an instructor. I could give nursing care, but with student nurses, I could give 10 times the nursing care. I'd only been out of school one year and I worked like banshee and re-learned nursing.
What should students expect from a holistic health curriculum?
You would expect to have the teachers have qualifications. At a nursing school, you have to experience something before you go out and do it. So you want to have the proper supervision, the same expectations you have out of any training. The students need to have experience. You make mistakes as you learn, and one mistake shouldn't be construed as your whole profile. A pattern shows us what's true, not one example.
To be a certified holistic nurse, one of the requirements was to seek out direct hands-on experiences with ten other modalities. We got thrust out into the world and that was wonderful exposure. I went and got some acupuncture, talked to an aroma therapist.
How do you feel that the healthcare educational system could be changed to better serve society?
Blended is the newest term. The best way to prevent and treat most disease is a skillful blend of alternative and traditional healthcare. The educational process should include blended medicine and give exposure to it.
What other advice can you give to prospective students thinking about an education and career in the holistic healthcare field?
You have to have courage to stand up to people who want to dismiss 'all of that.' It helps to be a free thinker. As I look back, I feel I've spent my career on the cutting edge.
Industry Trends, Information & Advice
How can the reality of nursing as a career differ from typical expectations? How does the field of holistic healthcare differ?
In holistic health, it's still day and night. It would be wonderful if every nurse in the hospital and the floors had the time and would choose to approach people from a whole perspective, not just on a task orientation.
What issues are emerging in the overall healthcare field that will impact holistic care?
The biggest is funding and compensation for people who have a skill through insurance, instead of purely private pay. Once they tie money to it, everyone will get in on it and they will have to worry about quality control. I liken it to in the field of workers comp when they passed a law in 1973 mandating vocational rehab. There were only three qualified people with masters in vocational rehab in California; I knew one very well. He had a degree from Michigan. They made a lot of injured workers vocational counselors, they glutted the market, and the quality went down. Two years ago, the canceled mandatory vocational rehab. When it's money-driven, then you have to worry about the quality.
The other part is that it's hard to establish quality assurance for what we call preventative medicine. In traditional Chinese medicine in the back woods, people pay their healthcare providers every month, and when they get sick, they stop paying them. How do you think that would work with the American healthcare system? I'll pay you when I'm well, but when I'm sick, you take care of me. That's really what it's about: How do you evaluate preventative care?
What are considered the hottest holistic specialties developing over the next decade?
If we get any more, I don't know what will happen. There are all kinds of people out there doing all sorts of things, unfortunately often without much background and without much training. Let the buyer beware. Some people just want to make money. I tell people I am a healthcare professional and a healthcare provider. I do have a patient care contract. It explains what the practice is about, and points include, "I will not treat you if I feel you should be seeing someone in traditional healthcare and you are not." If someone comes to me with some rare form of cancer and wants me to wave my magic hands over them, they need to be following up with the appropriate healthcare professionals that are licensed to treat the issues they have, and I am happy to support that care and add my skills.
How is the job market now in the naturopathic and holistic healthcare field? How do you think it will develop over the next five years?
Nobody knows about it. When people come to me, they often say my friend insisted I come to you and I don't know why. I tell them that I never quite know what's going to happen, and, "I'll let you decide afterwards if it was worth your while." Then they'll say, "Now I see." If five people came to me with the same five 'diagnoses,' it would still be five totally different sessions. That's why we have to listen and be individuals; to stereotype people doesn't work.
What other career advice can you offer future naturopathic/holistic healthcare specialists?
We need to network locally as professionals. No one person has the answer for everybody. People want to go to the mystical healer on the mountaintop, but they need to have 'healer' access at the candy store level. If you have to go to a special place 1,000 miles away, only the rich and famous can do that. What does Joe Blow do or the plumber? We need to have some local access. I'd love to fund a center where people could come and experience modalities that allows people to put your money in the basket on the way out, whatever you feel it's worth to you.
Editor's Note: If you would like to follow up with Barbara Klein-Robuck personally, click here.