AACN News—September 2002—Opinions

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Vol. 19, No. 9, SEPTEMBER 2002

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.


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

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