AACN News—June 2001—Opinions

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Vol. 18, No. 6, JUNE 2001

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

By Denise Thornby, RN, MS
President, AACN

Editor’s Note: Following are excerpts from the presidential address delivered by AACN President Denise Thornby, RN, MS, at the opening session of AACN’s National Teaching Institute™ and Critical Care Exposition in May 2001 in Anaheim, Calif.

We all entered nursing to make a difference in the lives of others, to care for those who are ill, to do meaningful work rich in significance and to be respected as a healthcare professional. Unfortunately, many of us have lost not only the sense that our contributions are valued and respected, but also the feeling of satisfaction in a job well done.
Instead, we feel afraid, insignificant, angry, frustrated, worn down and, at times, even apathetic. How could this happen to a profession whose core is imbedded in the opportunity to gain deep and significant meaning?

Many of us are waiting for someone else to fix healthcare and realize the dire straits nursing is in. Yet, we can have a role in influencing the way the critically ill are cared for and how nursing will be practiced. How many patients must suffer before we’re bold enough to say, “This is not right,” and then do something about it? Now is the time to step forward with a voice that will not be silenced to influence needed decisions and our practice.

We face a healthcare system where cost containment seems to be valued more than compassion—a system where the voices of nurses are often drowned out by more powerful, better financed lobbying groups that frequently offer different ideas about the intensive care we’re experts in providing. We’re at risk of becoming disengaged from our calling at a time when we need to be stronger than ever. All that we value is at stake—our essential role in providing care for the most vulnerable, critically ill patients, the trust of everyone who depends on us to provide that care and the credibility our noble profession has earned throughout history.

A Legacy of Leadership
Critical care nurses have a proud legacy of leadership and influence. We can be counted on to step up to challenges to ensure that we provide the best care for our patients. We are the soul of AACN. Our contributions have been significant, long lasting and meaningful. The leaders before us made significant waves that we’ve all been riding throughout our nursing careers. Think of the impact we’ve had on our patients since the visions of these former leaders were first articulated. As we enter the 21st century, we must all embrace a similar role of leadership and influence to preserve the nature of caring that is the very essence of healthcare.

Even today, when cynicism abounds and many of us are disengaged, unenergized and frustrated by our work, we must have the courage to not give in, the courage to not walk out and the courage to take the necessary risks. Most of all, we must have the courage to not remain passive in the face of situations that threaten the soul of our work. We must take action to build our authority, leadership, visibility and voice. Only then can we shape our profession to meet our vision.

Whether we are bedside staff, managers, clinical specialists, educators, faculty or nurse practitioners, we must see ourselves as empowered and influential professionals. Influential nurses are those with a dream or vision of how healthcare should be and nursing’s rightful place at its center. We will be influential only if we engage in credible relationships where those we lead can trust that the path we take them down is the right one and that the journey is worth taking.

A Workplace in Crisis
As our ranks are diminishing at the bedside, our patient load is growing. Today’s staffing ratios are a public health crisis that threaten the last thread of the “personal touch” for which nurses were once known—the essence of humane, healing and compassionate care that results from the connection we make with patients and families as we listen to their fears, whisper encouraging words and help them be comfortable.

How many of us enter our workplaces afraid of making mistakes, because we are assigned too many patients and our workdays are stretched beyond reasonable limits? We’re terrified because we wonder if this will be the day when we’ll miss something vital or make a mistake that ends up costing someone his or her life.

Have we accepted as the norm working conditions that would have appalled nurses a generation or two before us? How can we be silent about the issue that threatens the very heart of our profession? Where is our outrage? What’s stopping us from building our influence from a small swell to an epic tsunami to ensure that our patients are safe and our reputations remain sound?

The Power of Nursing
Sometimes we feel as if there are forces more powerful than us determining the quality of patient care we provide. Yet, remember that nurses offer something more powerful than all the new drugs and latest medical technology—our personal connection with our patients in knowing what they need and how to provide that all powerful healing effect of simply caring.

One of the most vital signs that a healthcare facility is alive and well is that the element of caring is well represented at the table where decisions are made. AACN strongly advocates for nurses to be part of the decision-making team. AACN members are part of that voice, whether that is in the dialogue regarding staffing, workplace issues or end-of-life care. Because AACN is the undisputed leader in critical care nursing, we have earned a place at the table whenever dialogue or decisions are needed.

Using our united voice, AACN is turning up the volume in the corridors of state and federal power, because the debate over healthcare is not complete until critical care nurses are heard. Voicing our concerns about workplace issues and the nursing shortage in our state legislatures and in Congress is a priority for AACN. Your own, single voice is also significant. Your contribution does not have to be dramatic. What’s important is that you get involved, raise your voice and make waves.

A Better Future
In my first “President’s Note” column in July 2000, I shared the acts of courage that author Robert Staub identified in his book The Seven Acts of Courage. Do you remember these acts of courage—the Courage to Dream, the Courage to See Reality, the Courage to Confront, the Courage to be Confronted, the Courage to Learn and Grow, the Courage to be Vulnerable and to Love, and the Courage to Act? Integrating these acts into our professional lives will take us where we want to be and turn the ripples we make into a collective surge that will wash away the failed policies of the past.

I invite you to envision a new future, to escape the world of mandated overtime, understaffed units and unlicensed substitutes who lack the training and bedside judgment that our patients need, deserve and expect. In this future, you actually look forward to work. You feel valued and respected, not only by your patients, but also by the physicians and your manager. They listen to you and ask for your input on important decisions. You feel secure and supported.

You also know that the public admires the noble role you play. You feel free and empowered to be your innovative self. Your manager invites you to suggest new approaches to patient care and seeks your advice on how to improve patient outcomes. Of course, you work hard, but the work is rewarding and challenging. Your job is filled with meaning and significance.
Some would scoff that this is fantasy. I disagree. This picture is born of need. This will be the future of our profession. It’s up to us to determine how soon that future arrives. We can either build it ourselves and leave a lasting legacy to those who follow us, or we can leave it to the next generation of nurses to build for themselves.

Obviously, there will still be pressures in tomorrow’s critical care practice. We knew coming into this work that the challenges would be great and many. We also knew that the rewards would be rich and meaningful. In fact, that’s what attracted many of us. It takes a special breed of person to aspire to this demanding profession.

By building our authority, leadership, visibility and voice, we can shape the profession we love and share. We can’t depend on others to do the work for us. We’ve each got a stake to claim. By having the courage to make waves – big waves—we can create the critical care nursing practice of our vision.

Every day, you make choices about how to act or respond. Through these acts, you have the power to positively influence. What will be your act of courage? How will you influence your workplace? What will be your legacy?

To obtain an unabridged copy of President Denise Thornby’s presidential address at the NTI, call (800) 899-2226. Request Item #6100.
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