AACN News—April 2003—Opinions

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Vol. 20, No. 4, APRIL 2003


President's Note
Bold Voices: What Stops Us From Speaking Up?

By Connie Barden, RN, MSN, CCNS, CCRN
President, AACN

Most of the time, the issues that rally us to use our bold voices are clear-doing the right thing for patients, defending families' rights, speaking up for each other, advocating for high-quality patient care. We speak up courageously, regardless of potential risks or consequences.

Sometimes, however, something stops us. We recognize the need to dissent, take a stand, ask a question, challenge an action, and yet, we don't. It happens to all of us.
We feel uncomfortable, even distressed when we choose not to act. Maybe we could have. Maybe we should have. Maybe we might have made a difference and did not.

In talking with thousands of nurses around the country this year about using a bold voice, I've been moved by countless examples of courageous speaking. I've also heard that often an honest and straightforward voice was not used, and I have talked with many of you about why. Each scenario plays a little differently, because each person's unique view of the situation and knowledge about the players factor into the equation. Yet, there are countless, shared reasons that we all use for not speaking boldly, even when something important to us is at stake.

As I've reflected on this, it seems that the real issue is usually one of two things: fear or resignation. Although the details of the story may vary, what often stops us seems to go something like this.

I'm not saying anything. I'm better off if I just keep my mouth shut.
This is one of the most common scenarios in aborted communication, whether at work or at home. Keep quiet. Stay out of it. Suppress what you think and feel. Don't get involved. For most of us, this is our automatic, first response when we encounter a difficult situation, especially when we believe that the other person has more authority or power than we do. It reveals our fear of the consequences of speaking up, which seems like too much of a gamble with unknown results.

When I find myself silenced by my fears, I ask: Even if I feel better keeping silent, is it worth the risk? Will I truly be better off? Will my patients? My coworkers? My unit? Does the "safety" of not speaking up outweigh the cost of maintaining the status quo? Without dialogue around challenges, nothing at work will ever change.

If I do speak up, I will appear disrespectful and be seen as a troublemaker.
This is one of the most common themes I hear from nurses. We fear being labeled as loudmouths-disrespectful, disloyal troublemakers-labels that might jeopardize our standing at work. If speaking with a bold voice means looking for solutions to what we know and care about, then our boldness cannot include a blaming, insulting, accusing or disrespectful approach.

When this fear arises in me, I ask: Am I being disrespectful of others or just stirring up trouble? If I answer "yes," then the consequences are unpredictable, and my actions will indeed be risky. An honest appraisal of my methods and motives is mandatory. If we notice ourselves being anything other than collaborative and furthering the good of the issue, we must stop and reassess the situation. People who genuinely seek solutions are heroes, not troublemakers.

Why should I speak up? It's not worth the trouble, because nothing will ever change around here.
Everyone in healthcare has at some time thought that things will never change. Some days, it's easy to feel defeated. Systems that don't work, abusive behaviors, uninspiring workplaces, chronic shortages of resources-the list is endless-all seem to be symptoms of "that's just the way things are." But resigning ourselves to this way of thinking is dangerous, because so many people agree, and it is easier to just go along and accept the status quo.

Ignoring circumstances or behaviors that aren't in the best interest of patients, nurses, families or others doesn't make them cease to exist. Staying quiet at best maintains circumstances as they are, leaving no room for creative and inspired solutions.

Fear and resignation are the enemies of inspired work that makes us feel enlivened by what we do. They thrive in large systems and maintain the status quo. They keep us mired in the daily grind of recurring problems. They are traps we can fall into, causing us to lose touch with our purpose and forget our ideals and vision. They cause us to forfeit accountability for the world around us, as if we are unable to cause any change or make any improvements. If we want a healthy and inspiring workplace that produces the best possible outcomes for patients, families, nurses and the entire healthcare team, we must be the ones to create it. The first step is your bold voice-speaking your vision and taking a stand for how it will be.

It has been said that courage is not the absence of fear. It is the willingness to take action even in the presence of fear.

I invite you to notice when fear stops you, when resignation says you're too tired. Then notice that, instead, you can choose to speak of the vision that inspires you with a message that will make a difference.

Resignation will always whisper that speaking up won't make a difference. I truly believe, however, that it is the only thing that will.