AACN News—January 2000—Opinions

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Vol. 17, No. 1, JANUARY 2000


President’s Note: No One Makes It Alone When Riding Through Rough Terrain

By Anne W. Wojner, RN, MSN, CCRN
President, AACN

As critical care nurses, we often feel trapped in a world that consists exclusively of our work. The intensity of what we do each day in our units can zap our energy to be able to take care of, and do things for ourselves. Because obligations to family or significant others add to our workload, we may believe that we don’t have time for the other things in life that we enjoy.

However, failing to take the time to care for ourselves can interfere with our ability to effectively care for those in our service. Do you make time to escape to a place that allows you to enjoy a relationship with nature, or to pursue a hobby? Do you find the time to enter a world free of the challenges associated with work? I hope you do. In addition to providing us the "down time" we need to recharge our batteries, leisure activities are a way to learn more, while taking time to "smell the roses."

For me, escaping to the barn to ride and care for my horse, Rocky, is a fulfilling and nurturing experience. Viewing Rocky’s world from the saddle provides a glimpse at the importance of meeting his basic needs for trust and safety. Interestingly, exploring unknown terrain on horseback is much like experiencing the change going on in our work environments.

Although we would like to believe that we are well beyond the developmental stage of a horse, the change occurring around us can easily send us cantering madly down Maslow’s hierarchy and back to the basics.

Trust is at the heart of my relationship with Rocky. It’s also at the heart of our comfort level and ability to feel like an optimal contributor on the job. Trust cannot be mandated; it must be earned and supported by clear, consistent communication; empathy; and mutually supportive behaviors and actions.

Trusting relationships with horses are built on an understanding of life on four hooves. Horses are social animals that live in family units. Although they are peaceful vegetarians, they may fall prey to more aggressive animals. Their vulnerabilities have caused them to evolve and adapt to their environments in a manner that serves to protect them from danger. Riders see horses’ protective instincts in action as a constant alertness to their environment, which changes as their comfort level with the changing landscape around them shifts.

Rocky has taught me to pay close attention to his comfort level. Subtle changes in his body movement, the tilt of his head, the twitch of his ears and the movement of his eyes serve as markers of comfort and, sometimes, fear. Rocky relies on me to know what he’s thinking, and to protect him. He places importance on my ability to communicate clearly. I try my best to communicate to Rocky in ways that he understands, using soothing words, the shifting of my body and the movement of my seat, legs and hands. We depend on each other when we’re on the trail. He depends on me for a clearly communicated, accurate assessment of his surroundings, and I depend on him to listen to me, to have confidence in what I’m asking of him, and to safely execute my commands. Sometimes, we communicate exquisitely; other times, there’s significant room for improvement.

What gets in the way of our communication and jeopardizes our trust for each other and our safety is usually one of two things: distractions from the environment that cause us not to listen clearly to each other, or my underestimation of his concern for a given situation. Common sources of distractions include an unknown object; sudden movement or sounds; and unsteady ground or changing terrain. Both the rider and the horse are usually well aware of shifts outside the comfort zone. However, when a rider underestimates a horse’s level of comfort, problems are likely to unfold. Both the rider and the horse must stay alert, listen clearly to each other, trust each other and strategically tackle unknown situations.

Of course, the same is true in our workplaces. The number of distractions occurring daily cause us to move outside our comfort zones, often dramatically affecting our ability to do our work in a manner that best meets the needs of patients and families. Sometimes, we communicate our discomfort with the utmost clarity; at other times we’re ineffective in our communication. Sadly, a lack of trust is frequently cited as the source of mismatched communication.

Leaders are charged with the responsibility to create environments that bring out the best in those who have placed themselves in their service. For a bedside nursing leader, that means making certain that the patient’s and family’s experience is one that meets their holistic needs. For managers and administrators, bringing out the best in nurse employees means identifying potential and actual distractions, accurately estimating comfort levels and collaborating with staff to develop strategies that enable performance excellence. Regardless of the type of leader, the ability to accurately assess distractions and comfort levels, coupled with the implementation of strategically supportive interventions, builds the level of trust attained in a relationship. The bottom line is: Accepting the role of leader mandates a responsibility to build trust and support those you serve.

Rocky has also taught me the importance of respecting others’ sacred rituals. In his world, when it is time to eat, nothing should interfere. When I visit him, my pockets will certainly be sniffed and investigated until they produce some sort of acceptable treat. Each of his pasture playmates accepts a ritualized position within his horse society. These rituals are part of what make up Rocky’s world, and need to be respected and reinforced to bring out the best in his performance, his health and his well-being.

When we implement change in our work environments, we can lose site of the importance of rituals and traditions. Changing how a schedule is made out or how evaluations will be conducted is not a simple task. These activities are tied to our comfort and trust for known events. When we change things in our environment without consideration for the traditions and rituals that they are tied to, we risk shoving some outside their comfort zone into the land of the unknown.

I’m not suggesting that we should bind ourselves inflexibly to rituals and traditions that no longer serve us well. When we do this, we place ourselves at significant risk for becoming irrelevant in a world that no longer tolerates the status quo. We must resist the need to maintain systems that no longer work effectively, respecting the discomfort that change produces for some. For Rocky, change is difficult. For nurses, change can open the door to a wonderful adventure, allowing for exploration of new territories, methods and roles, when leaders skillfully direct the journey and meet the needs of the travelers.

Bill Brewer, executive vice president of the American Quarter Horse Association, recently wrote about the experience of seeking approval from the United States Equestrian Team (USET) for the adoption of reining. He described a significant change experience for a group, like USET, that is traditionally oriented to English riding. At the heart of Bill’s message was a belief that no one makes it alone, that at times of great change, we must pull together, enhance our ability to understand each other’s concerns, accurately assess the road ahead and move forward as one cohesive unit. Such is the charge for nurses today.

My relationship with Rocky is truly a blessing in my life. Our relationship emphasizes the value of trust and the meaning of servant leadership. Time in the saddle provides the perfect backdrop for reflection about the changing terrain on the trail—and in the workplace. Yet, it also pulls me away both mentally and physically from a busy, hectic world, and allows me to enjoy the peace and beauty of nature.

Nurses, more than other group of healthcare professionals, know that no one makes it alone. As we begin a new century in nursing, I hope that each of you will recognize and rise to the call for servant leadership, cementing the trust we need to move together as one. I also hope that you will take the time to "roll in the daisies" and reflect on all your blessings and the joy of life. The wisdom gained from experiences outside the workplace strengthens our ability to relate to each other, work together and travel the unexplored terrain that lies ahead.

Letters

Truth-Telling Respected
Thank you for your wonderful article (President’s Note, October 1999 issue, AACN News). I thoroughly enjoyed it and couldn’t agree with you more.

I have historically been a "truth-teller," and wonder why so many other nurses have trouble with it. Weren’t they taught to tell the truth when they were growing up?

Ultimately, the entire healthcare system suffers because of the lack of truth-telling, and it also reflects poorly on the nursing profession. I have found that institutions either favor or oppose truth-telling and that this position is determined at the top ranks of the hospital or company.

Currently, I work in a large family practice office, as well as in an ICU at a medium-sized hospital. I certainly appreciate when truth-telling is respected. Thank you for encouraging other nurses to pursue and vocalize the truth.
Gina M. Mitchell, RN, BSN, CCRN
Lee’s Summit, Mo.

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