AACN News—August 1999—Opinions

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Vol. 16, No. 8, AUGUST 1999


President’s Note: Nurse Pioneers Forge a Path to the Future

By Anne G. Wojner, RN, MSN, CCRN

President, AACN

Each year, the incoming AACN president identifies a theme that will guide his or her year in office. The theme I have selected as we move into the next century is, “Pioneering in a World of Innovation.”

What is a pioneer? The Random House Dictionary proposes 12 definitions, which use powerful action words such as:
• One who first enters or settles a new region
• One who opens a region for occupation and development by others
• One who is among the first or earliest in any field of inquiry or enterprise
• A foot soldier who opens the way for the main body of an army

Pioneers are powerful people. What makes them powerful, determined people is the dedication they show toward their work. Think of a famous pioneer, real or fictitious, and you cannot help but immediately make that connection. Whether it be Lewis and Clark in their exploration of the western United States or Star Trek’s Captain James T. Kirk determined to go “where no man has gone before,” pioneers are clearly driven by a powerful vision of what they believe the future should hold for themselves and for others.

Nursing proudly boasts a significant share of powerful pioneers such as Clara Barton, who established the American Red Cross, Harriet Tubman, who led slaves to freedom in the Underground Railroad movement, and, of course, Florence Nightingale, whose epidemiological and professional contributions are legendary.

Becoming a pioneer is not a simple process. It involves risk taking, innovative thinking, a love of adventure and an ability to inspire others to step into newly charted territory. For every pioneer, there are many who are reluctant to follow; few are willing to rise and take up the call. Stepping out as a pioneer takes courage. Indeed, coming out with innovative ideas certainly does not guarantee popularity with the masses. In fact, we often look upon pioneers as strange, dangerous and potentially damaging people.

Each of us has concerns about today’s healthcare system. Many of us share a vision of a healthcare system driven by the needs of patients and families, in which we as nurses are able to contribute optimally. To get there from our current position will require some heroic nursing pioneers. In spite of our reluctance to move into uncharted or newly discovered territory, we must learn to embrace, support and follow those nursing pioneers who come forward to lead the way. We must strive to build climates that will stimulate the emergence of nurse leaders who will pioneer new trails for our profession in the next century.

Our choices are few. We can passively sit back and be handed our future, or we can follow those nurse pioneers who come forward to craft our profession for us. Our challenge is not only to learn new skills, but to toss aside what we knew before and create a new reality for nursing practice.

I challenge each of you to deeply examine who you are and identify where you want to be as a nursing professional in the next five years. Should you find that you don’t want to remain in nursing, then move on, but whatever you do, actively pursue a pioneer’s course in creating a rich, brilliant, personal and professional future for yourself and those around you. For those who choose to remain in nursing, reach out and support those who wish to boldly forge a path into the future. For those few budding pioneers out there, be cautious, be strategic in your decisions, but be deliberate in determining our destiny.

Our ability to craft our future will be determined by our ability to generate leaders, support innovation, fortify our professional value and cohesively pull together as an army behind a few powerful nursing pioneers. It’s time we packed up and headed for the trails!

My Turn: How Do You Create Safe Passage?

By Margaret Ecklund

In keeping with the Synergy Model, AACN Certification Corporation adopted “Creating Safe Passage” as its motto.

Dealing with critically ill patients means dealing with life-threatening issues. Despite our best efforts when using technology and medication, the patient and family may suffer, and the patient may die. Creating safe passage means trying to minimize the impact of this suffering.

I challenge each of you to examine your daily practice and determine where you create safe passage for your patients and families.

For example, when the husband of one of my former patients experienced neurological symptoms related to carotid stenosis, I suggested he see a vascular surgeon with whom I had worked. An arch angiogram determined that this patient had 80% blockage of his left carotid artery. So that I could comfort him, I was allowed to observe the procedure, which was performed on the first anniversary of his wife’s death.

One week later, he had a carotid endarterectomy under local anesthesia and conscious sedation. Once again, I was allowed in the operating room so that I could be at the patient’s side to provide reassurance.

I was also there when the drapes were removed to provide encouragement, support and explanation. His recovery was smooth and he was discharged one day postoperatively.

Did I affect the outcome? No. Did I create safe passage? Yes. I provided advocacy and support in the world of healthcare at a time when this patient was most vulnerable. When his armband and allergy band were ripped off but not replaced by the anesthesiologist, I put them back on. When he felt claustrophobic under the surgical drapes, and he was too hoarse to speak because of the local anesthetic, I asked the anesthesiologist to raise the drapes to allow more air to circulate.

Through the years, I have created safe passage in a variety of ways for my patients, who are ventilator-dependent and who have complex pulmonary needs. These patients provide a challenge to both the system and discharge planning.

I worked with the emergency department on resources for a patient who would need a tracheostomy change, but did not have the appropriate equipment at home. As a result of our collaborative efforts, the patient was discharged within an hour.

In the past three years, I collaborated with our multidisciplinary team to organize family education and advocate for community resources that allowed for home care for five ventilator-dependent patients. For these patients, the opportunity to sit in an easy chair, eat at the family dinner table or be licked by the dog provided a feeling of serenity and acceptance of their circumstances. I helped create safe passage for each of them.

These examples do not represent heroic efforts, even though the healthcare world can be a jungle to navigate. Instead, creating safe passage means ensuring that the edges are smooth and that there is advocacy for the patient. It involves introduction and communication. It involves going the extra mile or two. It is worth it. It is looking back on the situation and saying, “I did the best I could and created safe passage.”

Margaret M. Ecklund, RN, MS, CCRN, CS, is secretary of the AACN Board of Directors and a director of the AACN Certification Corporation Board. She is an advanced practice nurse in pulmonary medicine at Rochester General Hospital, Rochester, N.Y.