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President's Note: A Journey of
Rediscovery: s the Glass Half Empty or Half Full? Maybe, It's Just Bigger Than
Needed
By Michael L. Williams, RN, MSN, CCRN
President, AACN
While writing this column, I tumbled headlong
into the familiar trap of either-or. Black or white. Right or wrong. Staring at
my computer, I recalled how some days it's my best friend. Others, I'd gladly
throw it out the window.
Do you feel like Chicken Little some days? Your
world is bleak. The sky is falling. The good old days were better. Are there
other days when you feel like Pollyanna? Everything is cool. Nothing is really
wrong. Sometimes it's reassuring to be so naive.
These thoughts helped me to rediscover what it
is that influences my responses to many situations. It's usually not objective
reality, but how I choose to view the situation. When it comes to critical care,
it means that I can accept the current state of affairs by default or I can view
it as something that I can influence and design.
This requires me to consider new possibilities.
For example, wondering whether �the glass is half empty or half full� limits my
choices. How about a third choice? The comedian Gallagher playfully suggests
that sometimes the glass is twice as big as it needs to be. How would this
change our view of how to respond to some familiar critical care dilemmas?
Either we accept unlicensed assistive
personnel or we don't.
With clearly delineated responsibilities,
thorough training, appropriate communication skills, continuing education and
supervision based on established delegation principles, UAPs might be part of
the shortage solution in some care environments�certainly not as a replacement
for RNs, but perhaps as a valuable adjunct.
Either we enforce limited family visiting
hours or we don't.
What about family visiting arrangements?
Although the evidence shows that maximizing contact is in the best interest of
both patient and family, there can be extenuating circumstances. For example,
visiting policies may demand flexibility when a patient's daily life involves
multiple caregivers. And, certainly restrictions would be
necessary if a visitor was abusive.
Either we embrace evidence-based practice or
we don't.
We must embrace the value of evidence-based
practice, even though we know that there may not be sufficient research to
support clear-cut guidelines. Recently, some of our nursing students could find
only four research-based articles on oral care of intubated patients�and no
consensus among the findings. However, aware of the limitations and
controversies surrounding available information, the students now have a working
base from which to personalize care to the extent possible.
Either we accept a shortage of staff or we
don't.
We should never have to accept inadequate
staffing numbers. However, staffing needs are not static. They change from shift
to shift, even from hour to hour. We may need five nurses one shift, but only
four the next and six the following. There needs to be continuous critical
analysis by all nurses involved. The blurring of optimal staffing, safe
staffing, adequate staffing and unsafe staffing is truly a continuum that
constantly changes, making it difficult to predict and prevent. Even in the
worst of staffing times, expert nurses can use available data to make staffing
decisions.
Either we embrace standards of practice or we
don't.
Standards are not �recipes� for nursing care.
They are guidelines that should be adapted according to our critical judgment in
each clinical situation. It is indeed the expertise of the critical care nurse
assessing the patient, the family and the scenario and then shaping care options
that makes the art of critical care nursing apparent.
Either we embrace multidisciplinary practice
or we don't.
What do we mean by multidisciplinary practice?
There are many definitions and models from which to choose. For example, with
certain patient populations and in particular clinical environments, having
anything less than round-the-clock pharmacists and respiratory therapists in the
unit may be inappropriate. With others, consultant pharmacists and respiratory
therapists may fit the bill.
Either we provide critical care in ICUs or we
don't.
It is common knowledge that today's hospitalized
patients are sicker than ever. The needs of most border on requiring critical
care. How should we meet those needs? We could endlessly expand traditional ICU
beds. Or we could reconsider the range of what defines critical care. We could
then consider creative alternatives to traditional ICUs that are appropriate to
particular clinical environments.
Alternative thinking isn't optional. It's
required if we are committed to never compromising a patient's clinical
outcomes. Think about it. People were automatically admitted to ICU after
angioplasty. Bypass patients were routinely sedated until the third
postoperative day. If someone hadn't tested a different way, we'd still be
practicing in ways that are inappropriate, substandard or, in some cases,
barbaric.
So, when you face your next dilemma, stop and
wonder. Is the glass half full? Is it half empty? Or is it twice as big as it
needs to be?
My Turn
Teach the Children Well�Before They Decide
Did you know that children make up their minds
by the fifth grade about what they want to be when they are grown? Did you know
that April 25, 2002, is National Take Your Son/Daughter to Work With You Day?
What a phenomenal impact we can have on our children's lives by exposing them to
critical care nursing!
We can show our children the significance of
what we do professionally. We can influence a child to explore the possibilities
of critical care nursing. As AACN President Michael L. Williams has asked each
of us to do this year, we can �Look In and Reach Out.� We can make a difference
in the lives of our youths and in the nursing shortage. If just one son or
daughter thinks about joining the nursing profession, what a difference we can
make! If all 65,000 AACN members took one child to work and these children
decided to join the nursing profession, what a tremendous impact they would have
on the nursing shortage.
My challenge to all of you is to ask your
hospitals, directors and administrators to allow your daughters and sons to
spend the day observing what it is that you do as a critical care nurse.
Recommend that your institution offer this opportunity to children over 14 years
of age, who obtain a TB screening and sign a confidentiality agreement. Perhaps,
having the students attend in four-hour increments may be more accepted than
observing for an entire shift (1100-1500 for the day shift so that they do not
interfere with the busy morning rounds of the physicians). Have the students
write a paper on what they observe. There will be many benefits to the hospital
by having this program: community outreach, assisting with the solutions to the
nursing shortage, and influencing the youth of today.
If we open the door to our youths to see first
hand what it is that we do, they will gain a greater understanding for our
profession and for us as parents. How are these youths to decide on a career in
nursing if the door is shut? We need to open the door widely, invite these
youths in to our critical care units, and shout as loud as we can just what it
is that we do for a profession. If we influence just one son or daughter to
become a critical care nurse, we will have created a positive solution to the
national nursing shortage.
Lynn Smith Schnautz, RN, MSN, CCRN
Evansville, Ind.
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