AACN News—October 2000—Opinions

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Vol. 17, No. 10, OCTOBER 2000

President's Note: Make Waves; Have the Courage to Confront

Denise Thornby, RN, MS
President, AACN

Although I usually do not follow college basketball, I have been intrigued by the news of Bobby Knight’s removal as head basketball coach at the Indiana University, Bloomington, because of unacceptable behavior. Here is a talented and successful coach, who has failed to master self-regulation, an essential people skill. I have run across some Bobby Knights in my career as a nurse, and many have been my own peers.

Coach Knight is one of the most successful college coaches in history. With 763 victories and only 290 defeats, Knight was a star, much like many of our brilliant physician colleagues or expert nurses. However, his behavior, which has included verbal and physical abuse of players, has been a problem for more than two decades. As a result, Indiana University President Myles Brand placed Knight on “zero-tolerance” status, following a lengthy investigation of his behavior pattern. Brand recently fired Knight, following another alleged incident of aggressive behavior with a student. Many have been critical of this disciplinary action. Inappropriate behavior, it seems, can be accepted, if you produce results.

I see this same attitude in healthcare. I have heard it said countless times: “She is such a good nurse, but I hate it when she is in a bad mood.” If we are to truly create environments where every critical care nurse can make his or her optimal contribution, all of us must be skilled in interpersonal relationships and have a high degree of emotional intelligence. I cannot understand why we would excuse unacceptable behavior in someone, simply because we so highly value his or her clinical skills and experience. To be a fully expert critical care nurse, you must not only have expert technical skills, knowledge and judgment, but also effective people skills. The truth is that those who possess a high degree of emotional intelligence are the ones who truly become star performers within their profession. Daniel Goleman1 has written extensively about the five components of emotional intelligence at work:
• Self-awareness: the ability to recognize and understand your moods, emotions and drives as well as their effect on others

• Self-regulation: the ability to control or redirect disruptive impulses and moods, and the ability to suspend judgment and think before reacting and taking action
• Motivation: a strong drive to pursue and achieve goals with energy and persistence, and a passion to work for reasons that go beyond money or status
• Empathy: the ability to understand the emotional makeup of other people and skill in relating to people according to their emotional reactions
• Social skills: the ability to find common ground and build rapport and managing relationships

I think these skills are particularly relevant to our profession, especially in the 21st century, as we continue to face the increasing pressures of a chaotic healthcare system and a nursing shortage. AACN is also committed to this believe and, infact, the 2000-01 Leadership Development Work Group is pursuing ways to assist members in developing skills sets such as conflict management, effective dialogue, self-awareness and how to influence change.

We practice nursing through relationships. If we are to be effective nurses, we must always be able to have effective relationships with our patients, their families and our coworkers, as well as everyone else in our work setting. To reach our desired future of a healthcare system driven by the needs of patients and their families, where critical care nurses can make their optimal contribution, we must have more than only selective relationships that are positive.

To have very effective teams within our critical care units, we must confront those who show a lack of interpersonal effectiveness, regardless of whether they are often seen as “untouchable.” I have heard staff members who bully and intimidate others referred to as barracudas, or worse. I would not want this type of adjective used in reference to me or someone who was caring for me

We must exercise the act of courage to confront these types of individuals, so that they can make a choice to change or to leave. Confronting them is not easy, as evidenced by the reaction to Brand’s firing of Knight. It is, however, the correct action to take. I also would encourage us to confront ourselves and exercise the skill of self-awareness. Could we be the type of individual who intimidates, bullies or is just plain unpleasant to be around? To build teams within critical care that attract and retain the best of the best, we must be accountable for having the skills necessary to confront our coworkers, to coach them in gaining effective interpersonal skills, and to support them in their efforts to develop the skills of emotional intelligence. So, the next time you hear yourself saying: “He (or she) is a good nurse, but …” remember that there cannot be any but about it!

Our patients are the most vulnerable patients within the healthcare system. They are cared for in a highly stressful environment. Th ey deserve highly skilled, committed and compassionate nurses to care for them. All of us deserve respect and team support from our coworkers, managers, physicians and others. Let us begin this new century with the commitment to create an environment where each of us can make our optimal contribution.

Goleman, D. What Makes A Leader? Harvard Business Review, November-December 1998:93-102.


The Culpability of Silence
In response to AACN President Denise Thornby’s column titled “Make Waves: Be a Courageous Messenger” (August 2000, AACN News), I agree that each of us needs to discover our pro-active voice. However, I wonder how many of us acknowledge the accountability that corresponds to our decision to remain silent in the advent of problems that impact patient care and outcomes?

Silence can never be justified, because of what it may cost us as individuals when remaining silent jeopardizes or threatens those who cannot speak for themselves and who have entrusted their care to us. Patient advocacy is not and cannot be elective; it is the core of who we are and what we do as nurses.

Finding our voice amidst the fear of retaliation, labeling or inaction is a difficult undertaking. If a choice must be made, I would rather offend by speaking out than be convicted of silence and allowing bad things to happen to those I serve.
Bridget M. Raleigh, RN, CCRN
Spokane, Wash.

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