President's Note: Bold Voices: �Doctors
Cure; Nurses Care��Oh, My!
By Connie
Barden, RN, MSN, CCNS, CCRN
Language is
a powerful tool. In civilized societies, it
is the way people commonly relate to one
another. As we grow in our willingness to
use our voices to make positive changes in
nursing and healthcare, it is useful to
reflect on the power of language and how we
use it to craft our messages.
For example,
�doctors cure; nurses care� is often used to
explain the difference between medicine and
nursing. Of course, this message is both
inaccurate and ineffective. Doctors don�t
always cure and nurses do more than care.
And, because it conveys no useful
information or clarification, this response
may do more harm than good by perpetuating
the dilemma that, though the public has high
regard for nurses (because we care), it has
little idea of what we really do.
So, how do
we craft an effective message about nursing?
Some of the following ideas may be helpful
when using your voice:
� Avoid
using jargon. Too often the language we
choose fails to convey what we do or what is
needed to provide excellent patient care.
Whether talking with administrators or
patients� families, our language must
represent our skills as nurses. (�I�m
keeping a close eye on the patient� versus
�I�m watching the patient closely for
bleeding, signs of infection, heart failure
or trouble with breathing while he�s
recovering from his surgery.�)
� Focus on
describing our skills, knowledge and
training instead of personality traits such
as caring and compassion. You are not an
expert simply because you follow physicians�
orders or care about your patients. You
should be revered for talents such as
analytical thinking, inquiry and observation
skills; patient advocacy expertise; and the
sound clinical judgment required daily at
the bedside to prevent catastrophe,
complications and even death. Yet, when
asked what it takes to be a nurse, we often
simply reply, �compassion� and fail to
emphasize the incredible intellectual skills
required to be an expert practitioner. (�A
nurse must have in-depth knowledge about
health and illness. I must know how to
determine where my patient is along his path
of illness, and whether he is getting better
or becoming worse. I then need to know the
right steps that will help him continue to
improve or what to do if his condition
deteriorates. I am in frequent communication
with my physician colleagues about the plan
o
f care, and
I simply and thoroughly keep the family
informed about what�s going on.�)
� Deliver
the message effectively by sticking to the
facts, even when difficult working
conditions and other challenges evoke
passionate emotions that are hard to
contain. (�You�re making me work twice as
hard; you just don�t understand what we�re
trying to do here with this patient� versus
�Here is what�s happening and why it
interferes with my ability to monitor this
patient, completing the therapies he needs
and making sure his medications are given on
time.�) Outbursts, accusations, blaming and
demanding are ineffective ways to achieve
positive outcomes in most interactions.
Using our voice means seeking out solutions,
and few solutions are found in a
finger-pointing atmosphere. Many of the
barriers for others to understand nursing
result from long-standing social and systems
issues. Dwelling on fault and blame will
mire a conversation. Focusing on solutions
gives the interaction a goal and a purpose.
� Prepare.
Opportunities to talk about nursing present
themselves every day. Whether at a ball
game, in a patient�s room, at a party, in
the board room, at church or in your own
living room, people are interested. What may
seem routine to us can be fascinating to
others. Being ready to share your stories
will help them understand what nurses really
do.
Although no
one can inform others about nursing better
than nurses, we have not done a good job of
this. In the future, think about the words
you use and the phrases you choose, and
start to speak purposefully and
enthusiastically about what it takes to be
an expert critical care nurse. Caring is
vital but, without expert knowledge, skill,
judgment and decision making, it doesn�t
save lives.
Using
language is another skill we need to
conquer. We must prepare a powerful message
and get beyond our fear of speaking up about
what we do and the demanding expertise
required of critical care nurses.
Letters
Critical
Thinking Is More Than Problem Solving
As someone
who is passionate about teaching and writing
about critical thinking and nursing process,
I enjoyed Diane Salipante�s article,
�Critical Thinking Spans the Continuum� (AACN
News, July 2002). However, I wanted to
address the following statements in her
article: Unlike the five-step nursing
process, critical thinking cannot be taught
as a competency in a basic educational
program. Critical thinking is a
problem-solving method that becomes a part
of each nurse�s character through the
acquisition of knowledge and experience.
These two
statements are likely to be interpreted in
ways that are out of sync with the most
recent critical-thinking literature. A major
point stressed today is that critical
thinking is more than a problem-solving
method. If you have only a problem-solving
mentality, you�re not a critical thinker.
Critical thinkers look at their practice
critically, even when no problems exist.
They ask: How can we do this better? How can
we give more value? How can we promote
creativity? How can we ensure that we�re
looking at outcomes over time?
The other
issue is that critical-thinking skills can
be learned. If we say they can�t, do we not
teach them? In talking with educators, both
from hospitals and schools of nursing, it is
clear that many organizations are making
significant improvements in how critical
thinking is taught and evaluated as a
competency.
Studies show
that the most important factor that
determines whether something is learned is
whether it�s believed that it can be
learned. As Ms. Salipante points out so
well, critical thinking requires developing
nurses� character through the acquisition of
knowledge and experience. It is learned, and
principles related to character and values
must be taught. Theoretical and experiential
knowledge are best gained under the guidance
and coaching of skilled, knowledgeable
preceptors and teachers. Critical thinking
must begin in basic education, and we must
continue to find ways to nurture and
evaluate it as a competency. As a colleague
of mine says, �Fostering, supporting, and
rewarding critical thinking is key to
recruitment and retention. If we don�t
encourage nurses to grow in these skills,
they become task-oriented and frustrated
with the organization, thinking �I�ll just
do as I�m told, try not to think too much,
and not say a word.� �
We have too
many wounded, good thinkers in nursing.
Nurses and leaders must become familiar with
and sensitive to issues related to teaching,
nurturing and evaluating critical thinking
in diverse thinkers. In many cases, we don�t
have to make nurses smart. We have to stop
making them stupid.
Rosalinda
Alfaro-LeFevre, RN, MSN
Stuart,
Fla.
Generational Story Hit Home
I enjoyed
reading about Margaret Ecklund and Suzanne
Prevost�s daughters making a commitment for
the fall when entering into college and
choosing the profession of nursing (�The
Voice of Certification Can Strengthen
Nursing�s Voice,� AACN News, July 2002).
I am a
critical care nurse. My husband is an ER
nurse. Since my son was 3, he has stated
that, when he gets older, he is going to be
a nurse and work at the VA for my boss. He
states that he wants to help the sick
people. I don�t know if my boss will
postpone her retirement until he is old
enough to be a nurse. However, I am proud of
my son for knowing what he wants.
Thanks for
sharing in the AACN News.
Marthe
Moseley, RN, PhD, CCNS, CCRN
San
Antonio, Texas
Your
opinions are important! Share them with
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dialogue each month in AACN News. Send your
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Viejo, CA 92656; fax, (949) 362-2049;
e-mail, aacnnews@aacn.org. AACN News
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