AACN News—October 1999—Opinions

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Vol. 16, No. 10, OCTOBER 1999


President's Note-The Pinocchio Syndrome: How Long Is Your Nose?

By Anne W. Wojner, RN, MSN, CCRN

President, AACN

In both our personal and professional lives, we are regularly confronted with issues and situations that challenge our value system, stirring within us a deep sense of discomfort. Today’s chaotic healthcare environment causes us to reflect frequently on rights and wrongs, as well as unmet needs that occur regularly within our workplaces. Yet, in spite of our clear recognition of problems and opportunities for improvement, we often do not find the courage to tell the truth about current reality to those who could make a difference in our workplaces. Unfortunately, most of us are uncomfortable with the risk-taking associated with truth-telling. Instead, we remain silent, pretend to be content, or take a passive-aggressive route and complain to others who are powerless to help us. If Pinocchio were a nurse today, his nose would be pretty long!

Telling the truth means calling it like you see it, while suggesting methods that may lead to problem resolution. Talented truth-tellers use a win-win style to communicate their messages. However, even highly skilled truth-tellers occasionally find themselves face-to-face with an individual who thinks problem identification is distasteful, regardless of communication style. When these types of individuals hold the reins of power, long-nosed behavior is encouraged, and telling the truth becomes risky business.

It seems almost obvious that telling the truth about current reality would be a valued asset in most workplaces. Nevertheless, just the opposite is often true.

Environments that stifle truth-telling often fit into one of the following descriptive categories:
• The Egotistical Environment: A place that has no problems; where everything is perfect and new ideas are unwelcome because we always do things right. The mark of the egotistic environment is the “how dare you criticize this place” attitude associated with truth-telling.
• The Politeness-First Environment: A place where identifying problems is considered impolite; where nice people don’t complain is the philosophy. The mark of a politeness-first environment is an “if you don’t have anything nice to say, then you shouldn’t say anything at all,” response to truth-telling.
• The Impotent Environment: A place where problem identification means danger; where peace and happiness should be maintained at all costs to avoid negative consequences. The mark of an impotent environment is an “I don’t think we should say anything about this, or we’ll get in trouble” response to truth-telling.

• The Me-First Environment: A place where the haves and have nots are clearly demarcated; where problem identification is viewed as an attempt to dethrone the power base, while keeping silent and throwing orchids at the enthroned constitute behaviors to be rewarded. The mark of a me-first environment is insecure leadership, coupled with an attitude of “self-protection and removal of those who threaten the self-esteem and power” that is associated with truth-telling.
Creating illusions or facades that do not acknowledge problems is easier than dealing with the truth. Truth-telling charges individuals with a responsibility for problem resolution. Sometimes we are unwilling to confront situations because of our own personal discomfort, fear of recrimination or a general unwillingness to expend the energy required to produce environmental change. Instead, most people would prefer to ignore that a problem exists. In some instances, they find it easier to blame the truth-teller for creating an uncomfortable situation. However, problems, if left untreated, just like malignancies, grow, eventually requiring radical surgery to repair the damage left behind.

Leaders come from all levels within an organization’s hierarchy. Position power does not constitute leadership. Instead, leadership is defined primarily by personal characteristics. One of the fundamental characteristics of a great leader is honesty. Why? Because honesty builds trust. If you believe, as I do, that leaders are charged with creating environments that are healing, caring and support attainment of excellence, then you must take a hard look at yourself and your contribution to the environmental atmosphere. Ask yourself: Do you tell the truth about current reality? If not, why not?

Becoming a truth-teller means starting a journey that, though sometimes fraught with risk, always generates a feeling that you have done the right thing. Have you ever worked with someone who tells the truth about current reality? Often, truth-tellers are classified as the black sheep of their work environments. They are such unusually terrific risk-takers that they could even be described as black sheep with pink and yellow polka dots!

Think about the truth-tellers in your work environment. Perhaps, they are the people who drive you crazy with their constant observations. They are, after all, the ones who continually point out problems and ways to improve your organization. Now, place yourself in their shoes for a moment. Are they comfortable? Probably not. Believe it or not, the truth-teller isn't always comfortable either. Keeping quiet or saying what’s popular is easy, compared to honesty about workplace problems. However, these rare individuals strive for excellence, and truly care about improving their environments. They should be embraced by everyone, instead of being made to feel that they are the source of all evil. The sayings, “honesty is the best policy” and, “no pain, no gain,” are well-suited to the philosophy of the truth-teller and should be accepted as the workplace standard.

In 100 Best Companies to Work for in America, Robert Levering and Milton Moskowitz, state that truly exceptional workplaces possess the following qualities:

• Employees who trust their coworkers and superiors
• Employees at all levels of the organization who take pride in what they do
• Communication that goes up and down and all around
• An appreciation for everyone’s contributions, regardless of how big or small
• An expectation that employees at all levels will provide input into strategic decision making and the need for change.

Great leaders keep their fingers on the pulse of their workplaces. They welcome suggestions and feedback that is aimed at enhancing performance. They also value hearing the truth about current reality. So, the next time you are tempted to tell the truth, go for it! The next time someone tries to tell you the truth, listen. Each of us can be of benefit to our profession, our patients and ourselves by listening and taking action when necessary to support environmental changes that are driven by the truth. As for Pinocchio? Well, I for one, hope his nursing days are numbered!

My Turn: Learning Research Processes Is Valuable to Students at All Levels

Editor’s note: Denise Ayers, RN, MSN, BS, was inspired to incorporate research content into her associate degree nursing classes after reading an article (August 1998, AACN News) about the Distinguished Research Lecture by Suzanne Burns, RN, MSN, CCRN, ACNP-CS, RRT, at the 1998 National Teaching Institute™ in Los Angeles, Calif. Burns’ presentation was titled “Clinical Research: Part of What We Do.” Ayers is an assistant professor of nursing at the Kent State University, Tuscarawas Campus, in New Philadelphia, Ohio. Following is her account of this experience.

By Denise Ayers

As a nursing professor, I seek creative ways to present information to my students, who are studying for their associate degrees. Because we all learn by asking questions, I asked myself whether I could formulate a plan that would incorporate this method in both classroom and clinical settings?

We teach students critical-thinking and problem-solving skills. Why couldn’t we assist them in finding answers to their questions through a systematic, scientific approach—the approach used in research?

Specific training in the research process is a component of the curriculum for baccalaureate and higher levels of nursing education. However, associate degree nurses do not typically receive this type of training, despite the American Nurses Association Commission on Nursing Education guidelines for the investigative function of associate degree nurses. These recommend that the associate degree nurse demonstrate awareness of the value or relevance of research in nursing, assist in identifying problem areas in nursing practice and assist in collection of data within an established, structured format.

Regardless of educational level, research is vital to our profession. Policies and procedures are developed in response to problems identified at the bedside. Because associate degree nurses are at the bedside, research must be a part of their educational base.

I developed a brief introduction to the research process for faculty and second-year nursing students. Presented were the following steps:
• Identifying a problem
• Reviewing the literature
• Developing a hypothesis
• Formulating the research design
• Collecting data
• Analyzing data
• Determining results
• Disseminating findings

Handouts listing commonly used research terms and examples of research published by nursing faculty were compiled.

I had several goals in pursuing this approach:
• To introduce associate degree nursing students to the research process
• To encourage the use of critical thinking in the nursing curriculum through creative research learning strategies
• To broaden the students’ outlook of the changing roles of nurses by acquiring knowledge through research to improve patient care and nursing activities

• To assist the students in understanding the need for an active role in research by using their thoughts and ideas to formulate and implement research activities

The new procedure reflected our nursing curriculum, which is derived from Orem’s Self-Care Theory. During the first semester of their second year, the students were instructed to identify a problem and develop questions related to material included in each of our five teaching modules. I then reviewed and selected questions that would be pertinent and workable.

The faculty developed the hypotheses and formulated the research design with the students’ input. Specific questions, along with a data collection form, were distributed to each student.

After the collected data were returned to me, I performed the analysis and presented the findings to the students. Discussions to examine the results, develop nursing implications and decide how to disseminate the findings took place outside of class.

During the next semester, the project followed a different approach. Each clinical group was assigned a specific module on which to focus. The students were to complete a research activity that would follow the guidelines established in the first semester. The student projects were discussed with the clinical faculty during pre- and post-clinical conferences. They were asked to summarize their results and formulate nursing implications. This information was presented to the entire class and second-level faculty at the final class session of the semester.

The faculty and I were pleasantly surprised with the results. The students demonstrated a basic understanding of the research process and put it into action. Topic areas that were researched included “Registered nurses perceptions of visiting hours in the intensive care unit,” “CPR: Do you know what to do?” and “Do you routinely take an aspirin daily?”

In evaluating the classroom activities for both semesters, the students’ feedback was positive. Among the comments were: “Successful in introducing us to the research aspect of nursing,” “stimulated independent thinking,” “I was contributing something to nursing,” “helpful in understanding research currently being done” and “allowed me to apply what we were learning.”

After completing these activities for a full year, the faculty and I agreed there is value in introducing the research process to students at this level, and we are planning to continue the activity. We hope that, through the incorporation of research and research concepts, new graduates will be interested in furthering their education and being involved in the various steps of the research process.