A few weeks ago, my registered nurse license renewal notice arrived in the mail, and for the first time in forty years, I didn’t automatically send in the fee to maintain it. Before the end of May, I have to decide if I’ll keep my license active (requires a certain number of nursing practice hours and CE—continuing education—hours), move to retired active status (requires significantly fewer practice hours and the same number of CE hours) or inactive (no CE requirement, and I couldn’t practice nursing).

I’ve been discerning this step ever since I renewed my license a year ago. Then, there was no question, as I was still working as a nurse. But a month after last year’s license renewal, I left my school nurse position. I’m not looking for another nursing job. Instead, I’m seeking a publisher for my memoir, starting a new writing project—BOUNTY — about farmers on Lopez Island, and submitting proposals to teach writing workshops.

Some people say I’m retired, but this doesn’t look like the “retirement” I saw when I was growing up. Instead, I think the term a friend uses­ describes this phase of life more accurately. I say, “I’m refocused.”

Regardless of what I call it, I do feel I’ve reached a milestone. My friend Nancy thought so, too, and she offered to host a party to honor it. When I walked into her living room, a dozen or so friends—most wearing white nurses’ caps on their heads and stethoscopes draped around their necks—greeted me. One male friend guzzled beer (I trust) from a urinal and escorted me to the beverage table. Catheter bags dangled over it, one bulging with a pale yellow liquid and labeled Pinot Grigio, another filled with a dark red Cab-Merlot.

“White or red?” Nancy asked as she reached for a plastic urine specimen cup from the stack on the table.

Few of these friends had ever observed me in my role as a nurse, and none had seen me dressed as I was at nursing school graduation. Since moving to Lopez Island nearly twenty years ago, I’ve worked as a nurse in other locations—around the country as a Head Start reviewer, throughout the state of Washington to train child care health consultants, from my desk in my home office to write manuals and handbooks for nurses, and most recently on another island as a school nurse.

That night, these friends seemed eager to hear stories from four decades of my career. We laughed at photos from my school of nursing yearbooks—so many earnest young women wearing blue-and-white checked seersucker uniforms, starched white aprons buttoned to the waistbands. I unfurled the queen-size quilt made of squares my mother and grandmother had cut from those dresses and aprons.

I read an excerpt from my memoir, Hiking Naked, that traced my path as a new graduate in a surgical intensive care unit at Indiana University Hospital, nursing people following open heart surgery, radical neck surgery for cancer, motorcycle accidents, and small bowel resections. Then I told of my transition to a visiting nurse agency, caring for patients in their own bedrooms and sitting with them at their kitchen tables to count out doses for their pill containers. I checked their blood pressures and listened to their lungs in their living rooms instead of in sterile exam rooms. Elderly patients told stories of the children and grandchildren whose framed photographs lined fireplace mantles and bookshelves. I read, too, about how I eventually found a home for my passion in public health, caring for pregnant women and their children, promoting health and preventing communicable diseases, and shaping public policy to promote safe and healthy childcare. Finally, I spoke of my realization twenty years in that, like so many others in helping professions, I had burned out.

For two years I wrestled with whether I was being called from nursing to different work. I railed on the pages of my journals about the changes in health care since my early days in ICU and my disappointment when the public health system succumbed to the same focus of hospitals and private providers on the ledger sheet’s bottom line. That clear leading blurred and I despaired over who I would be if I weren’t a nurse.

Ultimately, I discerned that while I was still drawn to serving others as a nurse, my spirit needed other forms of creative expression. For nearly another twenty years, I found ways to use my nursing skills and expertise part-time and to pursue book arts and writing. Now, having earned an MFA, it’s the writing that receives most of my attention.

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At the end of my “retirement” party, I refolded my quilt, the puckered seersucker under my fingers a symbol of the strength, care, and memories of this work. A flag of sorts to honor nurses still at bedsides. Today, I picked up the license renewal form and circled my status—inactive—though I’m tempted to rename it. For me it should read, refocused.