AACN News—February 2002—Opinions

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Vol. 19, No. 2, FEBRUARY 2002

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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