AACN News—April 2001—Opinions

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Vol. 18, No. 4, APRIL 2001

President's Note: Make Waves Build Bridges Instead of Barriers

Denise Thornby, RN, MS
President, AACN

In these trying times, we may be tempted to want to build a castle, complete with a moat, and then to pull up the drawbridge so that no one can get in. I see this tendency in healthcare, where departments such as heart services, oncology, housekeeping, physicians, nurses, administrative services, the emergency department and the coronary care unit continue to struggle to collaborate and achieve an organizational mission or desired vision.

We feel the need to protect ourselves, because the degree of change, chaos and uncertainty has driven us to limit the scope of what we can attend to and manage. Withdrawal is a normal response. Although intellectually we do understand the phenomena, we have difficulty resisting this urge to withdraw and become self-focused.

Despite a great deal of talk about collaboration, I see more evidence of competition, and win-lose thinking. This is a serious issue for us if we are ever to achieve AACN’s vision in a time of significant transformation in healthcare and the most serious nursing shortage in our lifetimes. Never has it been more important for all healthcare professionals to work together. “United we stand; divided we fall” pretty much sums up the situation.

My concern is that, if we become too self-absorbed with our own professional issues, we will lose sight of what is most important—our patients and their families—and we will lose credibility.

I was disappointed recently when multiple physician organizations challenged the appropriateness of certified nurse anesthetists (CRNAs) to practice without the supervision of physicians, when the evidence supports the fact that CRNAs provide effective anesthesia care. In fact, in many underserved settings, CRNAs have been the sole providers of anesthesia services for patients who would otherwise not be able to receive care in their own communities. Is this not in the best interest of patients? It is difficult to not interpret the challenge by physicians on this issue as self-protective of their scope of practice.

This self-protective phenomenon was recently seen again when one of the state medical boards passed regulations giving respiratory therapists the sole right to manage ventilator therapy, thereby prohibiting nurses from this critical dimension of their practice. Whose needs are we meeting? Although the desire for self-protection is understandable, it is the wrong dialogue. The critical issue is who can provide the best care for patients in a given setting and how can all of us support their preparation, education and advancement.

We are facing unprecedented shortages in all of the health professions. In confronting this reality, we must be vigilant in understanding and pursuing collaboration in a way that is new and very different from the past. Collaboration is not necessarily about agreeing. However, it is about respecting the contributions and perspectives of others who are members of the interdisciplinary team.

It would be easy to become angry, draw a line in the sand and say we are at war over certain issues. As with building castles, that would be the feudal method of settling disagreements. Instead, I believe it is a time to be assertive, express our views, encourage communication and look for win-win solutions. Instead of pulling up the drawbridge, build bridges. Only by staying at the table, can we influence and create an opportunity for change.

I would be remiss if I focused all my attention on our relationships with physicians or respiratory therapists, many of whom are positive, committed to patients and their families and embrace the true principles of collaboration. In fact, AACN has a strong collaboration with the American College of Chest Physicians, which invited me to sit on its Board of Regents because they value the perspective we bring to their discussions.

I think nursing must also be cautious, both on an individual level and as a profession. The growing nursing shortage and worsening workplace issues frighten us. Yet, we must not lose focus on our vision or focus only on our workplace issues.

This fear drives us to be self-protective, though with good reason at times. However, if we give into this fear and anxiety and are unable to articulate our concerns in the context of how our actions will affect the care of the critically ill, we will not be influential in the dialogue around the solution. The American public is quick to recognize self-serving actions of professionals, and we must learn from the lessons of others.

In addition, as nurses we must work well with other nurses. There is no room for the sibling-type rivalry that goes on between units, the inter-shift battles and the non-supportive behaviors we sometimes exhibit. The patients in our units deserve nurses who respect and support each other. They also have the right to expect that we would always act in their best interests when preparing them for transfer to another unit or their care to another caregiver. Every time you sense you are taking the “low road” in your interactions, ask yourself: Is this in the best interest of the patient? The next time you are reporting on your patient, whether that be to a co-worker or to someone in another unit, make sure you are working together to achieve a smooth transition. Take a leadership role in building bridges between team members, units and departments, all in the name of doing what is in the best interest of patients.

Following are some ways you can cultivate collaboration and build bridges:
• Listen closely to the perspectives of others—other disciplines, other nurses, families and patients. They will help you to recognize blind spots in your thinking or challenge your paradigms
and help you reach the best outcomes. When people listen to me, I feel that my perspective is valued, regardless of whether they act on my suggestions or agree with my view.

• Engage in dialogue. Talk with those with whom you would like to partner. When talking and listening, make sure your intent is to discover and understand, not to persuade.
• Invest in relationships with those with whom you want to collaborate. If you spend time getting to know them and letting them know you, finding a common ground will be easier.
• Acknowledge the strengths and contributions that others bring to the care of patients or the outcomes the team achieves. In care conferences, acknowledging the value of their contributions
will go a long way toward making everyone feel valued.

• Always role model collaboration and maintaining partnerships. Influence others by your actions. Talk with them about its importance and guide newer staff in developing their
collaborative skills.

• When working on a problem or a project, pay close attention to group dynamics, communication and decision-making processes. Often, the root of conflict starts when there are
misperceptions about the intent behind a breach in process.

• Learn together. Find opportunities to learn with the physicians, therapists, nurses from other areas by attending classes together or sharing articles and Internet resources.
• Celebrate your success together, acknowledging the role and value of collaboration.
• Collaboration is not easy when there is disagreement on the common goal, vision or purpose. Spend time finding common ground, so that all parties can work toward a shared
vision or outcome.

• Lastly, and most importantly, always take the “high road” in partnerships. Keep your eye on the goal of collaboration.

All of us must use our skills of influence and step up to the plate to collaborate with all disciplines, including physicians, therapists, administrators, politicians, other nurses and our communities, that join us in caring for the critically ill. It would be easy to build walls, hunker down and hope it all blows over. However, we will only arrive at a successful future by building bridges, joining hands and creating a shared vision of a healthcare system driven by the needs of patients, where all caregivers can make their optimal contribution.


‘High Road’ Is a Timely Topic
As a pediatric ICU nurse and member of AACN, I very much enjoy reading the articles in your publications.

The “President’s Note” by Denise Thornby is an outstanding column. The “Always Choose the ‘High Road’” topic (AACN News, February 2001)is one that our unit struggles with on a daily basis and I believe this article will benefit many of the nurses.
Debbie Graves, RN, BSN
Chicago, Ill
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