AACN News—December 1999—Opinions

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Vol. 16, No. 12, DECEMBER 1999

President's Note: The Best Gift Is From the Heart

Anne W. Wojner, RN, MSN, CCRN

Gifts, whether given or received, bring us pleasure. Have you stopped to consider the types of gifts you have received throughout your life that have made you what you are today? While you’re at it, consider the gifts you have given that have significantly affected the lives of others. The holiday season provides the perfect backdrop for such reflection.

Although some gifts have material value, the most powerful gifts are those from the heart--those that embrace the spirit, the inner being of the receiver. Sadly, we often take these nonmaterial gifts for granted. Sometimes, we don’t recognize their value or, even worse, we categorize them as "expected behavior." Nurses tend to be guilty of this. Although we give of ourselves all day, we often fail to recognize the significance of our acts. Instead, we see our work as a job "expectation," ignoring its importance as a gift in the life of another.

Bedside critical care nurses are perfectly positioned to give the most beautiful gift of all: spiritual, physical and psychosocial care to patients and families at the most vulnerable and fearful time in their lives. The honor associated with this type of nursing is of the highest merit. In fact, I cannot think of another nursing position that offers a similar opportunity to holistically affect human life. Expertly imparting the gift of critical care is truly a magnificent act of beauty. Given this, why do we withhold from ourselves the same nurturing, supportive, holistic care that we dearly deserve and need?

It has long been said that nurses "eat their young," pull apart instead of stick together and work in environments sometimes characterized by anything but holistic caring for the caregiver. Given the mission of our profession, these characterizations are extremely ironic. Are these descriptions accurate, or are they just associated with a not-so-proud past? If they remain an accurate description of nursing today, I know the gift I would like us to give to each other.

The editors of Nursing99 pondered this question, and recently published the results of a survey that was aimed at determining if nurses were still "eating" their own.1 Staff nurses were asked to rate how they were treated by nursing school faculty, nurse administrators/managers and fellow staff nurses. The responses included potent comments that illustrated examples of poor treatment. The editors of the journal concluded that, as professionals with a reputation for eating their own, nurses still have a hearty appetite.

Shooting down survey results is relatively easy; thus, I decided to examine the issue myself. During a typical workday in both a hospital and an academic setting, I counted the supportive and complimentary comments I heard nurses direct toward one another, as well as the negative, sabotaging comments. I was shocked. In an eight-hour day, I heard 19 negative, unsupportive statements made behind the backs of other nurses, but only two positive, supportive comments. I also spoke with a high-ranking individual in the American Association of Colleges of Nursing about her perception of unsupportive treatment of students by nursing faculty. Again, I was disappointed to hear that this treatment thrives in many schools of nursing, and is a challenging problem to repair.

Although my survey methods may not be flawless, the findings certainly caught my attention! Why do nurses expend so much energy creating healing, caring environments for their patients, when they do not routinely care for and support each other? Why do some of us hold grudges, attempt to sabotage others and pride ourselves in making one of our own, or a future nursing colleague, feel badly, instead of recognizing how unprofessional we are when we act this way?
In her book, Woman to Woman 2000: Becoming Sabotage Savvy in the New Millennium, Judith Briles describes the following sabotaging behaviors in female-dominated professions:

--Talking negatively about another behind his or her back
--Lying or deceitful behavior aimed at causing pain to another
--Setting up another for failure or ridicule
--Stirring the pot by trying to pull uninvolved parties into a controversy
--Juicing up a story to mislead other parties into believing something negative about another
--Withholding the truth or necessary information, which causes another to fail2

Briles’ research specifically identifies nursing as a profession that has a sabotage problem. Does that make you proud? How can we attract new nurses into a profession that is associated with behavior that is unbecoming of the very principle with which we should be most closely aligned--caring?

Sabotage can take on different appearances, depending on the setting. Sometimes, sabotage is deliberate; at other times, we fail to recognize that we contribute to it. In schools of nursing, sabotage may take the form of "imposter" faculty, who teach course content for which they themselves are not proficient, or who use verbally abusive or condescending behavior aimed at students or peers. In practice, sabotage may take the form of a failure on the part of nurse administrators to consult with and educate staff nurses about changes in staffing patterns or to educate staff on the use of new equipment and technology.

However, the most common form of sabotage in nursing occurs every time we forget that, as a practice profession, every nursing position beyond the bedside exists to support excellence in bedside practice and to properly equip these bedside heroes to meet the needs of patients and families. Those of us in the background (nurse academicians, nurse educators and nurse administrators) must be vigilantly connected to the essence of nursing--patient care. We must commit to becoming expert servant leaders, capable of washing the feet and rubbing the backs of the staff nurses, who are in the trenches doing the most important work of all. Such a charge is consistent with the title nurse, which in Latin translates to "nurturer."

The gift that I think we could each benefit from this holiday season doesn’t cost money; it costs only deep soul searching and reflection, as well as a commitment to stop the slaughter, the hatefulness and the division in our profession. It is a gift from the heart that replaces the negativity and anger that lurks in some of us with a spirit of forgiveness and love.
Interestingly, the Chinese interpretation of the word "anger" is an "enslaved heart (Figure 1), and the interpretation of the word "forgiveness-" s a "similar heart" (Figure 2).
3 It is time to tear down the prison bars that bind our enslaved, angry hearts, and take an active role in creating environments in which our hearts are linked by love, mutual respect, appreciation and, of course, caring.

We must look deep inside ourselves and examine how we contribute to sabotage and unsupportive behavior. Once we have identified our faults, we must take responsibility for them, not justify or excuse them. We must see our faults as opportunities for self-improvement, and act deliberately to destroy nonsupportive behaviors. This type of self-examination is not easy; it requires enough strength of character to accept that you still face a significant journey of inner reflection and improvement. Until we cure ourselves of the demons within us, we cannot give the gift of a supportive, nurturing heart.

As we near Jan. 1, 2000, let’s consider making a New Year’s resolution to give to each other the same kind of holistic caring that we give to the patients and families in our charge. As we reflect on the goodness in our lives this holiday season, let’s take time to give thanks for each other and for the profession that provides us with endless opportunities to positively affect the lives of others.

1. Nursing99. (1999). Nurses, are we still eating our young? Nursing99, 29(11):48-49.
2. Briles, J. (1998). Woman to Woman 2000: Becoming Sabotage Savvy in the New Millennium. Far Hills, N.J.: New Horizon Press.
3. Chang, J. (1999). Personal communication. The University of Texas at Houston, School of Nursing. Houston, TX.

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