AACN News—July 2000—Opinions

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Vol. 17, No. 7, JULY 2000

President's Note: Make Waves: Find Courage to Influence Practice

Editor’s note: Following are excerpts from the speech delivered by AACN President Denise Thornby, RN, MS, after accepting AACN’s vision from outgoing President Anne W. Wojner, RN, MSN, CCRN, at the closing session of the National Teaching Institute and Critical Care Exposition in May 2000 in Orlando, Fla.

By Denise Thorny, RN, MS

AACN President

Just as the ocean waves continually shape the landscape by moving the sand, one grain at a time, critical care nurses can make a difference in healthcare, one life at a time. In contemplating the theme for my presidential year, I wanted to emphasize the ability each of us has to be highly influential critical care nurses, who act as ambassadors for AACN’s vision. My message is to “make waves” by having the courage to influence practice.

Nurses have many opportunities to achieve deep meaning and significance in their work. However, the changes, barriers and pressures of the current, chaotic healthcare system can cause us to lose sight of our significance, and the challenges of our workplace can cause us to question whether our contributions are valued.

In talking with members, I hear feelings of anger, frustration, powerlessness and, at times, apathy. I am saddened by these feelings, because each of us has much to contribute toward influencing not only our practice, but also the healthcare system. You can make a difference by pursuing AACN’s powerful and positive vision. However, doing so requires courage.

The word courage is derived from the French word coeur, which means heart. Thus, practicing courage means exercising acts of the heart.

Courage can guide us and strengthen our pursuits. More than a single heroic act, courage comes from the day-to-day actions that spring from our hearts and our core values. Courage means taking risks, letting go of the status quo, and facing hardship and possible failure, as well as confronting our own self-doubts. Often, “taking heart” inspires and motivates others, who then follow us and become aware of our vision and integrity as we engage in daily acts of courage.

In his book, The 7 Acts of Courage, Robert Staub identifies distinct ways we can create the lives we want. These acts encompass the core of who we are and who we can be.

They help us increase our personal power, efficacy and ability. These acts are:

The Courage to Dream
The courage to dream and put forth your dream is the foundation for all the other acts. You cannot choose the right path, if you don’t have a vision of what you hope to accomplish as a nurse.

AACN has provided us a great dream through its vision of a healthcare system driven by the needs of patients and their families and of an environment where critical care nurses can make their optimal contribution. Having adopted this as my personal vision, I know this dream is shared by other members of AACN.

The Courage to See Reality
Courage is required to see current reality, not only those accomplishments of which you are proud, but also the behaviors of which you are ashamed and would prefer to forget or ignore. Recognizing and accepting some of these ugly realities is especially challenging without our usual defenses of excuse, denial, blame and rationalization.

When we fail to identify and acknowledge reality, we delude ourselves and make overcoming issues that undermine our dream-driven intentions difficult, if not impossible.

The Courage to Confront
Confronting problems can move us from reality toward our dream. Confrontation requires us to deal with reality by speaking the truth. Learning to be a truth-teller and courageous messenger in the workplace is key to acquiring the skill to confront and move forward. For many, this is difficult, because they fear change, pain, hurt, embarrassment and punishment. Yet, without the courage to confront, we will not be the agents of change and influence needed to create our preferred future.

The Courage to be Confronted
Learning from criticism can help us keep our dreams on track and make the changes needed. Instead of viewing circumstances as we would like them to be, we should listen and learn from others’ thoughts, insights, criticisms and challenges. Hearing that we are not perfect may be difficult for critical care nurses.

The Courage to Learn and Grow
Initially, the courage to learn and grow might seem less challenging than the other acts of courage. However, it may be a struggle for some of us, because it requires us to let go of our need to be right and in control.

Chris Argyris, who has written extensively about learning organizations, discusses the fact that “smart” people often stop learning, because of their successful accomplishments. They get stuck in what has worked for them in the past. Because they become rigid in the way they think, act and interact, some of our most intelligent, successful peers are slow learners. By insisting that we are right, we can miss the knowledge and the best path to our dreams.

The Courage to be Vulnerable, to Love
The courage to be vulnerable, to care and to love means challenging self-limiting thoughts, feelings and assumptions as we explore new possibilities—to open up to and engage our peers, our workplace and our profession. This act will be challenging if you have responded to the chaos by wrapping yourself in a self-protecting cocoon.

When we engage and open ourselves to others, we create strength of partnership, which enables us to achieve goals that are not possible alone.

The Courage to Act
The last act is the courage to take action, and to make waves. All the other acts empower us to choose how we will behave, think, feel, express ourselves and interact with our world. Although these choices will lead us to our dreams, we will need courage, as well as knowledge and practice, to make the journey.

Make Waves
My hope this year is for all of us, singularly and collectively, to make waves—to have the courage to influence not only our personal practice and the practice of critical care nursing, but nursing as a whole, and also to influence our units, hospitals, communities and, in many cases, our world.

Does this concept overwhelm you? How can your contribution be significant? How can your acts of courage make big enough waves? Remember that each wave starts with a ripple.

Each of us will have a different style of making waves. Some will dance in the surf and make a great splash. Some will ride the wave masterfully and show us the way. Some will ride the waves quietly, yet show us how to shape healthcare in a meaningful and nurturing way. Regardless of your style, it will help to shape our island of healthcare. You have the power to be influential.

The dawn of the 21st century is a time of great change, of much chaos and uncertainty in healthcare. It is a time when courage is most needed. I beckon each of you to reach deep into your core and exercise these acts of courage to achieve our vision. Think about these acts. We are counting on you to join us. Your patients and your communities are counting on you, too.

I ask: What will your act of courage be? How will you influence practice? How will you influence healthcare?

Through AACN, we can collectively find the courage to become the influential, undisputed leaders in critical care, and move our vision from dream to reality.

Suggested reading
Covey SR, Merrill AR & Merrill RR. First Things First: To Live, To Love, To Learn, To Leave a Legacy. New York, N.Y.: Simon and Schuster. 1994.
Frankl, V. Man’s Search for Meaning. New York, N.Y.: Washington Square Press. 1959
Staub II RE, The 7 Acts of Courage: Bold Leadership for a Wholehearted Life. Provo, Utah: Executive Excellence Publishing. 1999.


Thank You, Nurses
I had an amazing time performing for all of you in Orlando. I forgot to say one thing: THANK YOU for saving so many lives and for giving of yourselves for others. And, thanks for laughing (with me or at me)!
Wendy Liebman
Editor’s note: Wendy Liebman was the featured performer at Comedy Night, which was sponsored by Genzyme Surgical Products and AACN at the NTI in Orlando, Fla.

The NTI Was Inspiring
I enjoyed the NTI in Orlando, Fla., very much.

I especially enjoyed the opening address by President Anne Wojner. It was very inspiring.

I also enjoyed hearing Kay Wagner, who spoke on “Just to See you Smile”; Jill Ley, who spoke on “Common Malpractice Errors”; and Kathleen M. Vollman, who spoke on ARDS.
Anne Meade, RN, ADN, AA, CCRN
Ripon, Calif.

Little Things Can Bring Comfort
I became very attached to a critically ill patient who I took care of for several months. He was a very strong man and had gone through much.
For Christmas, I bought him a stuffed bear, which I used to prop his head or arms in different positions. He enjoyed the bear very much.
Eventually, he reached the point where he felt he could not go on. I said a prayer for him as I left the hospital for several days off. When I returned, he had passed away.

I cried and became distressed. I had to pick myself up to take care of my new patients. Then, I received a card from this man’s daughter. It read: “Thank you so very much for taking such good care of my dad during his long stay in SICU. The stuffed bear you gave him in life was with him in death. It was placed in his casket, and now I have it to hug!!! Thanks so much for all the kindness, patience and understanding you gave to me during dad’s illness.”

I taped this card to my drug book and read it every time I feel depressed. This care means so much to me. I never thought such a little thing could bring so much comfort, not only to my patient, but also to his daughter.

Valerie White, RN
Baltimore, Md.

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