AACN News—June 1999—Opinions

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Vol. 16, No. 6, JUNE 1999


Editor’s note: Following are excerpts from the presidential address delivered by AACN President Mary G. McKinley, RN, MSN, CCRN, at the opening session of the 1999 National Teaching Institute™ and Critical Care Exposition in May in New Orleans, La.

Change is a part of our everyday life. We all have difficulty dealing with it. However, in this time of radical change in healthcare, nursing is suffering from an inability to cope. The symptoms include feelings of disorder, frustration, hopelessness and powerlessness.

I understand these feelings. I know how frustrating it is to face earlier patient transfers or discharges, while you struggle to provide high-quality care. I know you feel powerless when a long-term, ventilated patient or an end-stage heart failure patient is sent home without the proper home care follow-up.

The situation is not likely to improve in the next year as we face the greatest nursing shortage ever. This shortage is not “typical” of past shortages, because it is a shortage not only of numbers, but also of experienced, competent nurses who can deliver the patient care that is required in today’s complex healthcare system.

At the same time, nurses seem too willing to accept a role of hopelessness and powerlessness. Sometimes, we play the victim too well. I chose the “Power of Nursing” as the theme for my presidential year partly because I believe we can no longer play this victim role. Instead, it is power that will sustain us in our journey of change.

When my brothers and I faced tough problems, my father encouraged us by saying, “Fit the fight.” It is essential to our survival in nursing that we do just that. Never before have we faced such a nursing shortage. Never before have we had such high-acuity patients, who need not only the right number of nurses but also the right kind of nurses. Never before have patients and families counted on us more to assist in their care and ensure them safe passage through the healthcare system. Never before have we had such an outstanding opportunity to “fit the fight,” to use the power of nursing to positively affect the healthcare system.

Power is neither good nor bad; its value is in how it’s used. For example, when a nurse uses the power of persuasion to motivate a patient to take prescribed medications, that nurse is using the power of knowledge and expertise in a positive way. If a nurse uses the power of position to keep a family out of a patient’s room, that nurse is making a negative use of power.

Power is the ability to influence the behavior of others. It is a synergistic force that exists when we create a collaborative relationship, where the input of all participants is valued. This type of power has three ingredients—strength, energy and action. In other words, power is the can, the will and the do. All these elements, which must work in conjunction with one another, are present in nursing.

When I asked AACN members to explain what they consider to be the power of nursing, their consistent responses centered on caring. As the essence of our profession, caring transforms the theory or the science of nursing into action; it blends the art and science of nursing.

Just about anyone can be trained to take a pulse, but it is the professional nurse who evaluates the circulation, perfusion, hydration, skin integrity, overall physical and emotional status of the patient while taking that pulse. Part of the problem with acuity systems is that they don’t allow for the critical thinking and blending of art and science that is so much a part of what we do.

Nursing’s strengths are diverse. Communication, flexibility, adaptability, knowledge base and collaboration are some of our strengths, but there are others that are essential to the profession’s growth in this time of chaotic change. These are the concepts, the competence and the connections we have to create a healing, humane environment.

Critical care recognized the concepts of research-based practice earlier than most specialties. AACN has had a research agenda since the mid-’70s. The groundbreaking AACN Demonstration Project, Thunder projects, and National Study groups have provided research information to assist in furthering critical care nursing practice.

Because of the increasing acuity levels of patients within today’s complex and highly technical healthcare system, maintaining clinical competence is crucial to our patients. Critical care nurses use their expertise in clinical judgment and decision making to ensure that the patient’s specific needs can be met and to create a healthcare system that is driven by those needs.

Through our connections, we create networks within the healthcare system to help provide our patients and families safe passage through the complex healthcare system. These networks extend beyond the hospital walls to include resources for care within our communities.

So, what is holding us back? Why aren’t we moving forward on our journey? What are the “molds” or traditions in nursing that must be broken to increase the power of nursing? I see these as falling into three categories.
Self-concept is one. This is the “will” part of the power equation. A negative self-concept can sap our energy; a positive self-concept can increase our power.

Commonly heard expressions such as, “But we’ve always done it that way,” “I am just a nurse,” and “We eat our young” do not form a positive image for nursing and must be eliminated. We will miss opportunities to improve and grow if we lock ourselves into the “we’ve always done it that way” mind-set. When we lock ourselves into the past, we are not being fair to our patients or to our profession. The idea of “just a nurse” minimizes the work we do, makes it seem regular. To paraphrase a quote by Uta Hagen: “We must overcome the notion that we are regular, it robs us of the chance to be extraordinary and leads us to the mediocre.” The work that critical care nurses do every day is extraordinary—not regular, not ordinary, not “just a job.”

The expression that we “eat our young” is a nasty one, especially when applied to a nurturing and caring profession. We should be ashamed that this feeling exists. In light of the upcoming nursing shortage, it is imperative that this image be eliminated.

The attitude that we are victims in the face of change is also defeating. Our tendency to avoid accountability and our lack of conflict resolution skills makes us willing victims. We must define new expectations and take accountability for our profession. We must learn how to deal with and resolve conflict, not only in the healthcare system, but also within our profession.

Nursing also must improve its educational system. We must establish a consistent level for entry into practice. Although this issue has been around since the 1950s, it still causes disparity. We cannot operate from a position of power if we continue to support multiple entry levels. It is not fair to our public, nor is it fair to our profession. The potential of nursing brings to mind this quote: “Some make it happen, some watch it happen and some say, ‘What happened?’ You don’t want to be asking what happened.

To influence the future, we must focus on the basis of our power, our practice and our caring. We will be in a position of strength if we stay focused on what we bring to the healthcare environment and give nursing a voice to educate the public about what nursing is and the part nursing plays in the healthcare system.

To accomplish this, we must create emotionally intelligent critical care units. Daniel Goleman writes about this emotional intelligence in the work place, about how we manage our feelings and relate to others. Nursing uses emotional intelligence on a daily basis in caring for patients and families, though we don’t use these skills enough.

How do we create emotionally intelligent critical care units? First, we must have a sense of shared mission and a vision for the future. AACN’s vision of “a healthcare system driven by the needs of patients and families in which critical care nurses make their optimal contribution” is clear and easy to understand. I saw it come to life in the ICUs I visited during my travels the past year. I saw nurses working as a team to make a difference in the lives of their patients.

Creating an emotionally intelligent unit also means bringing respect to the workplace not only for our patients, but also for each other and for the contributions of all members of the healthcare team. We must provide constructive and helpful feedback to improve performance, help solve problems and enhance the capabilities of others.

In summary, critical care nursing has the power to manage the transforming healthcare system. We have the necessary components-the can, the will and the do. I am proud to be a critical care nurse. I am excited about the future of the profession. If we can unleash the power that is within us, we can create a new culture in healthcare.

When I examine the history of critical care nursing, I think of this quote: “We have not followed where the path may lead … instead we have gone where there is no path and left
a trail.” I wish you luck in blazing new trails for critical care nursing.