AACN News—March 1999—Opinions

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Vol. 16, No. 3, MARCH 1999


President's Note: The Power of Nursing: Research Validates What Nurses Do

The profession of nursing is steeped in tradition. Often, we are able to gain a new perspective because of our past experience. However, our traditions sometimes get in the way of our progress. For example, consider how we view the role of research in nursing.

Although there is a traditional belief that nursing is not science based, there is evidence to the contrary. In fact, critical care nursing has a wonderful cadre of nurse scientists whom we can be proud of and whom we can certainly turn to for assistance in our clinical practice. Many of our standard nursing journals provide a wealth of science-based studies that can enhance your practice.

The problem is in research utilization—in translating research into everyday clinical practice. For a long time we fussed and fumed over the lack of nursing research. Yet, now that this research exists, we often ignore it. What a waste!

An example is the continued use of saline for endotracheal suctioning in some units, when research clearly shows not only that it offers no benefit, but that it can be harmful.

Clinical research serves multiple purposes such as helping to expand our professional knowledge base as well as to validate our practice. Research can help us measure our impact and demonstrate our worth in today’s rapid cycle change and restructuring healthcare environment. It can help us to become more efficient and effective. Ultimately, research improves outcomes, which is ultimately what we all seek.

What can we do to encourage research utilization, when even the best-documented and supported studies sometimes “sit on the shelf,” unused and ignored?

First, we can create an environment where we can question why we do something, without having fear of intimidation. There are routines in every unit that may be based on a long-standing policy, procedure, or protocol. We should question these ways of doing things. Unfortunately, most of us don’t. We must get away from the “but we've always done it that way” frame of reference. This type of thinking doesn’t serve our patients or us.

Next, we should review the literature. If you have visited a library lately, you may have been in for a digital shock. The Internet has made real-time, online information available in even the most remote places. However, just because research information is online doesn’t mean that it is valid and ready to implement. Once identified, research must be critically evaluated to determine if the process, methods, and sampling were adequate.

Implementing change based on research is the most difficult step, because the old ways of doing things are often more comfortable. However, change can be accomplished in many ways, from formal announcements to more subtly infusing research into practice. The trick is not how it is done, but that it is done.

Consider the following story:

The standard gauge (distance between the rails) for railroad tracks is exactly 4 feet, 8.5 inches. How did such an unusual standard get set? The explanation is that the design of American trains was based on English tramways, for which the distance was based on the tracks of wagon wheels. Why did the wagons have such an unusual spacing? The reason is that the wagon wheels would break if they were any other size, because that was the spacing of the wheel ruts already in place on old roads. Who built the roads? The first long distance roads were built by the legions of Imperial Rome. Their design was based on the wheels of chariots. Thus, the answer to the original question is traced back to the specifications of an Imperial Roman war chariot.

So, the next time you are asked to do a procedure and wonder why, remember that the train tracks are just wide enough to accommodate the back ends of 2 horses. We don’t want to do things for patients because we are blindly following traditions, but, instead, because we know—and can validate—that it is the right thing to do.

Letters

Donkeys Loved
and Cared For

I am writing to respond to those who expressed concerns that the donkeys used in our donkeyball game were somehow being mistreated.

I would like to assure any concerned readers that the participants of the game were given a 40-minute training and education session by the owner of the donkeys, particularly emphasizing his love and concern for his animals. We were asked to ride them minimally, and sat on them briefly for certain plays in the game (all with the owner’s encouragement).

We, too, had the utmost respect for these animals and would never have agreed to use them in a game without the reassurance that they were well cared for. We appreciate your concerns, but feel we need to clarify our position and assuage any fears your readers have had about potential animal abuse supported or engaged in by our Kansas City chapter.
Mary Conaty, RN, CCRN
Public Relations Chair
Kansas City Chapter of AACN

Landers Column Gets Response

Following is a letter written by AACN President Mary G. McKinley, RN, MSN, CCRN, to syndicated columnist Ann Landers in response to letters by disgruntled nurses that were printed in the Landers column.

This response is followed by excerpts from letters written individually by members of the AACN Public Policy Advisory Team. Accompanying these responses are letters from 2 members who took exception to the McKinley’s message in her “President’s Note” column in the December 1998 issue of AACN News.

McKinley Response
To Ann Landers:
I would like to comment on your recent column regarding nursing and nurses.

Although it is true that today’s chaotic healthcare environment presents all practicing nurses with extraordinary challenges, there are many nurses who are meeting this challenge head on and making a difference in the lives of their patients every day. What nursing is not good at is articulating what it is that we do.

Studies have shown that the public believes that nurses are important to their healthcare, but, when asked, most people can’t say what it is that nurses do that is important. Even though it may not be entirely clear to the public, I know that there are thousands of nurses on the front lines of this tumultuous healthcare system who are committed to ensuring patients and their families safe passage in their journey through this challenging process.

Within my association, we honor our colleagues who demonstrate excellence in the care of their patients. These nurses share their wonderful stories through the AACN Circle of Excellence Caring Practices award. It is these stories that illustrate to me why nurses continue to practice nursing. Although only a few awards can be given, I know that every nurse has a similar story to share. Each story may be unique, but there are common ideals that the stories describe and it is those ideals that give nurses the satisfaction, pride, and strength to make their optimal contribution to the lives of patients and their families as well as to the

profession. These ideals include the following:
• Believing that nursing is a profession with rights and responsibilities—not just another job
• Promoting the essence of nursing, which is caring, through our knowledge and skills
• Acting as advocates for patients and their families

However, as strongly as we embrace these ideals, the reality is that it is becoming increasingly difficult for nurses to do the job that they are asked to do every day.

I ask, Ann, that you and the public unite with nurses to share these ideals. Nurses are a vital component of the healthcare system. There are more than 2.5 million nurses in our country, and 90% are currently working in the profession. Nurses work in virtually every aspect of healthcare to try to create a healing and humane environment for their patients. We are experts in healthcare and focus on prevention and education as well as the implementation of treatment.

Nurses are committed to serving as an advocate for the vulnerable through personal caring, compassion, and dedication to the ideals of the profession of nursing.

The challenge before us today to provide high-quality care to patients and their families while maintaining our professional ideals is a true struggle. I will tell you that, even though it may be a struggle, thousands of nurses are delivering that care every day, and they do it very well.
Mary G. McKinley
RN, MSN, CCRN
President
American Association of Critical-Care Nurses

Individual Responses
Many nurses have kept their sanity and even idealism through the years for one main reason: They have chosen to be proactive instead of reactive … Ann Landers said “unless something is done to help our nurses, there won’t be any.”

The public cannot help us, we must help ourselves.
Jane Bircheat, RN, MSN, CCRN
Pine Mountain, Ga.

Caring for people is both challenging and difficult, but it also has many rewards. The healthcare system is in great turmoil, and, by sheer numbers, the nursing profession is in the midst of being greatly impacted by this chaos. However, it

is also for this reason that I believe that we can make a difference.
Theresa E. DeVeaux, RN, CCRN
Pasadena, Md.

It is true that it is not always easy to care for the people who are ill; it is hard work. Conditions are not always ideal, and I understand some of the frustrations that were published from across the nation.… Nursing has given me choices no other profession could have. The opportunities have been vast and the rewards immeasurable.
Colleen E. Reagan, RN
Galveston, Tex.

The day-to-day routines and problems can be overwhelming for nurses, but in looking at the big picture, I have felt extremely rewarded to be a part of such a caring and dynamic profession. Would I encourage someone to enter our profession? Absolutely! I cannot think of a better career choice.
Mary Holtschneider
RN, BSN, MPA
Durham, N.C.

Yes, it is true what most of the nurses wrote in their letters. But there are also the innumerable rewards that keep me in the nursing profession … Nursing is a profession where I can interact every day with real people. I can make a critical difference in their lives.
Joyce Simones, RN, MS
St. Cloud, Minn.

Other Views
Re: “President’s Note,” December 1998, AACN News

I agree that there is some personal responsibility to be happy and committed as a bedside nurse. However, most of the changes that impact our ability to provide quality care are realistically outside of our control.

When we speak out about nurse-patient ratios, continuity, etc., we are labeled as troublemakers. Even working together in a more protected union environment does not ensure positive changes.

I resent the implication that, if we put on a happy face and champion nursing, we will be able to have better control over quality of care. We have little say. The public doesn’t really want to hear how bad it can be. The public prefers to view hospitals through rose-colored glasses to allay their own fears.

My background is 25 plus years of bedside critical care nursing. I still do it for the benefit of my patients and peers. I do it out of a sense of moral responsibility. I do champion patient and RN rights. The thanks I get is my own satisfaction. I get very little from my coworkers and none from the hospital administration.

Joanne Musgrave, RN, BS, CCRN
Harrisburg, Pa.

Re: “President’s Note,” December 1998, AACN News

It is this type of thinking that has assisted nurses to the level of frustration and job dissatisfaction we feel every day as we struggle to give optimum care to our patients with less than optimum staffing. We are the ones who have to work every day with unlicensed, unskilled personnel taking our place with patients because administration has spread us, the RNs, too thin.

You speak of fairness and decreasing unit stress as “shared responsibilities.” Yet, administrators seem more concerned about cutbacks, money, and greed than about fairness. We are all overworked, underpaid, frustrated, and unrespected. We are tired and angry.

Instead of this type of rhetoric, why not lobby for legislation to prevent retribution against nurses who speak out about the medical injustices of patient care or to increase hospital stays. It’s time for nurses to make an impact, to speak loudly and proudly, to be heard by all without fear, and to change the way we take care of our ill. This is a positive goal for nursing. This is nurses championing themselves.

Marilyn T. Kovach, RN, BSN, CCRN
Berlin, N.J.