AACN News—January 2003—Opinions

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Vol. 20, No. 1, JANUARY 2003

President's Note

Bold Voices: Listening Improves a Bold Voice

By Connie Barden, RN,MSN, CCRN
President, American Association of Critical-Care Nurses

Since introducing our shared goal of "Bold Voices: Fearless and Essential" at last May's NTI, you have let me know how nurses as individuals and AACN as an organization can leverage the power of our collective voices. You are responding in heroic and inspired ways to this call to action. Your hundreds of e-mails, calls and conversations have energized me. They have also turned my attention to a dimension of voice that we often overlook. A dimension so critical that our efforts will fail without it.

This vital dimension is listening.

Listening is essential as we go about the day-to-day business of living�in our personal relationships, our work connections, our interactions with patients. It is a skill that demands conscious vigilance to avoid being distracted or detoured from the solutions we seek. I am convinced that listening is so important that, unless we become focused and committed listeners, nothing will change.

But I am a focused and committed listener, you remind me. After all, I'm a nurse. I'm in the "people" business, and I learned all about listening in nursing school. When asked, most nurses can confidently describe the skills of a good listener. Maintains eye contact. Attends to body language. Restates what the other person has said. You know the drill. Yet, though these behaviors may convey that someone is listening, we can't let ourselves believe they automatically make a good listener.

What does it take to become an effective and committed listener? Becoming a truly committed listener requires us to admit that we may not be one. Author Meg Wheatley confirms this in her book Turning to One Another. "We've spent many years listening to others mainly to determine whether we agree wit h them or not," she points out. "We don't have time or interest to sit and listen to those who think differently than we do."

We listen to others through the filter of our beliefs, values, stories and experiences. Even our excuses. This filter inevitably colors everything we hear, and until we recognize it in ourselves, we're incapable of genuinely listening to what someone says. Not recognizing this involuntary reflex locks us into a search for
evidence-evidence that we are right and they are wrong.

Skilled listeners are generous listeners. Generous listening means allowing others to have their point of view and being determined to find what is "good" in it. It means having the willingness to consider someone else's point of view as valid and offering them the benefit of the doubt.

Skilled listeners listen to learn. They don't just wait to speak or for others to be silent. They listen for new information, acknowledging they may not know all the facts and authentically anticipating there may be more to learn. Listening in this way-openly and willing to learn-creates an environment where new possibilities for the future can emerge and new solutions can truly be found.

Wheatley suggests our listening should be "curious rather than certain." Listening for surprises and differences can be a useful way to discover our own invisible beliefs-beliefs that block our ability to see new options and possibilities. "Sometimes we hesitate to listen for differences because we don't want to change," Wheatley explains. "If we don't listen, things can stay as they are, and we won't have to expend any energy. But most of us do see things in our life or in the world that we would like to be different. If that's true, we have to listen more, not less."

I challenge us to notice how or if we really listen to others. To look at the filters�beliefs, values and experiences�that alter how we interpret what others say. I challenge us to notice when we're waiting for others to finish talking so we can speak, enlighten and set the record straight. Notice how often we think we already know what someone else is going to say. How often are we in a conversation to win or be right instead of to learn from another point of view?

Whether talking to our patients, our family, our colleagues or our CEO, focused and committed listening is our key to creating new possibilities. A bold voice is essential, but without openness to others' voices and viewpoints, it will fall on deaf ears. A bold voice enhanced by focused and generous listening is the prescription to heal nursing, healthcare and the world we share.


Editor's Note: In the November 2002 issue of AACN News, AACN President Connie Barden, RN, MSN, CCNS, CCRN, asked members to share the challenges and successes in creating a collaborative, supportive environment. Some of the responses to her "President's Note" column, titled "Bold Voices: Stop the Abuse and Disrespect," are presented here.

Nurses Must Be Assertive
In my 27 years as a nurse, I have found that dealing directly with the offensive person first works best. Nurses should say how they feel and what they want in a nonaggressive way. If resolution is not achieved, they should then follow the chain of command and remain assertive when dealing with their superiors.
Early in my career, certain situations motivated me to take an assertiveness training course, an invaluable tool for dealing with difficult people. In addition to the individual nurse being assertive, the institution needs to take a stand and set the tone for the environment. Administrators must realize that the problem exists, define their standards and follow through on meeting expectations. This needs to be an ongoing commitment for the environment in which nurses work.

I agree that "accepting and waiting for someone else to find the solution is never a real solution." The first step in dealing with a problem is for nurses to become assertive, because we most likely will never work in an ideal environment all the time.
Joanne Levesque, RN
Harwinton, Conn.

Nurses Should Mentor and Respect Each Other
At 29, I have been a critical care nurse since graduating college in 1995. For the last two years, I have been a travel nurse, working in the ICU, CCU and ER at six hospitals, three teaching and three nonteaching. Sadly, I see abuse and disrespect everywhere I go. However, I see it the most not from the doctors but from the older nurses toward the younger ones. It doesn't matter how big or small the hospital is or where in the country it is located.

In general, the younger nurses seem to respect each other more, mentor each other more and are more eager to learn. I have seen a younger nurse cry because the older ones are "eating her alive" and talking behind her back instead of helping her to learn. Although I don't look forward to the future shortage or working short staffed, I think
it will be better for nursing in the long run when the older ones retire. I would not have become a nurse if I had had a realistic view of what it was like before I went to school.

My goal now is to be a nurse anesthetist. I can't work in the ICU forever. The only reason I am a travel nurse is because it's the only job in staff nursing where I feel that I am fairly compensated for the work I do.

If nurses would respect and mentor each other as professionals, the future of nursing wouldn't be so bleak.
Jennifer Austin
Whitehall, N.Y.

Unit �Raises the Bar' for Professional Behavior
Your column was surprisingly on target with what I had been seeing in my own work environment. I had noticed a gradual decline in professionalism�such "disrespectful and noncollaborative behavior" as peppering conversations with four letter words, criticizing colleagues within ear shot of other staff and visitors, and not participating in the general needs of the unit. Here is how we have attempted to address these problems:

I am a staff nurse at a large teaching hospital and work in the neuroscience ICU, where I have also been the unit educator. Last year, I brought together a core group, including the nurse manager, to determine what competencies we should address�not as skills checkoffs but as ways to improve our practice.

This year, I voiced concerns about a decrease in the level of professional behavior. We realized that we would need a positive approach to address this problem and chose "Raising the Bar" as the theme to indicate that, though we are good, we can be better. Each staff member has been given a folder that includes the vision,
mission and values statement of our institution. Each has also been given a card with Marie Manthey's Commitment to My Coworkers and asked to sign and support these values. Our nurse manager felt this would also be an opportunity for everyone to review the unit values, which address professionalism, ethical practice, expertise, and
education and teaching.

For the year, we have asked each nurse to observe and write on index cards three examples of nurses who demonstrate some of these values. These cards, making us more aware of positive behaviors, are placed on the "bar" for two weeks. I was happy to find that there are staff members who shared my concerns. In the face of
budget cuts and organizational changes, times are difficult. Improving our workplace can only enhance patient-focused care. We are good, but we can certainly be better.
Susan Kuthy, RN, BSN, CNRN
Hopewell, Va.

Live by the �Be' Attitudes
This article really hit home. We had just talked about this at our work and formulated the "Be Attitudes for Health Care Workers." We encouraged everyone to add their comments to the posted list. Here are some of them:

Be Caring
Be Courteous
Be Kind
Be Helpful
Be Honest
Be Proud
Be Respectful
Be Supportive
Be A Teacher
Be Well Informed
Be A Positive Role Model
Diana Bess, RN, BSN
Stafford, Va.

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