AACN News—March 2003—Opinions

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Vol. 20, No. 3, MARCH 2003

President's Note
Bold Voices: A Message From the Inside

Last December, an article titled "The Terrorism of Caring" was published in the Journal of the Association of Nurses in AIDS Care. The author described the stress of critical care as "a time bomb exploding on a regular basis." "Something has to be done" and "no more lip service" he said, as he detailed, in a chilling and raw account, his experience as a patient in emergency and critical care. A description of pain untreated and symptoms ignored. A saga of impersonal care and indifferent caregivers. An accounting of cries for help and compassion met with sarcasm and insensitivity. This was a tale of our healthcare system-brutal and real-that can only be told by someone who has lived it and knows it from the inside.

I learned of this article on an Internet listserv, where colleagues from around the country discussed it for days. Although the failure of our healthcare system to provide effective and compassionate care to patients is not new to any of us, this tale of the pain and anguish of being a patient was still shocking-especially because its author was a nurse. Yes, one of our own. A colleague who had seen enough, lived through enough and now couldn't tell us enough about the system that had failed him personally.

Richard Ferri, RN, PhD, ANP, ACRN, FAAN, has done exactly what I have asked that we all do this year: He spoke out with a bold and fearless voice about patients in jeopardy. Ferri spoke from personal experience, describing his perceptions as both a patient and a family member in critical care. To amplify his message, he gave examples that are vivid and undeniable. He issued a bold call to action. Stress on staff and patients in the ICU is beyond measure, he says, and "it needs to be identified and dealt with immediately." He urged nurses to reclaim their leadership role in humane care and the management of symptoms and pain. He is an effective messenger, though the pill of truth he delivers is difficult to swallow.

Bold voices are easy to support when they reinforce our own beliefs and values. The difficulty comes when the message is one we do not want to hear or with which we disagree. Dissenting and unpopular opinions often reveal our most basic survival instincts and lead to win-lose, right-wrong, good-bad conclusions. When we feel threatened, our tendency is to become defensive. We argue and hunt for evidence to prove us right and others wrong. We go on the offensive, attack the other point of view, assail the messenger, and we take it personally.

That's how I reacted when I first read Ferri's article. I wanted to defend his caregivers. I hoped to find him wrong. I looked for reasons to discount his point of view. I read the article a second and then a third time. And, as I re-read his words-courageous and stark words from a patient, a son and a nurse-my reaction changed from defensive to inspired. I understood and admired Richard Ferri. He had spoken with a fearless and an essential bold voice, and I, of all people, had almost missed it!

In my January column, I talked about the importance of listening to learn and listening generously. I spoke about giving validity to another's point of view and admitting that we may not know all the answers. Ferri's article has provided us an excellent opportunity to listen. He spoke from a place of passion as a patient. He amplified his voice through compelling data, in this case his own experience. And, he championed a clear call to action for all of us to work together to improve the system so that our patients will not experience the type of pain and anguish he suffered.

What is inspiring when individuals speak out with difficult messages? First, we are inspired by their willingness to speak up at all. Many people know of wrongs and injustices, but few take the time or go to the trouble to speak up, especially when the stakes are high and the consequences unknown. Second, we are inspired by the truth of their messages. A patient recounts his or her experiences and perceptions of repeated encounters with our healthcare system. He tells us how he felt violated, afraid and ignored. How can we deny the truth of these feelings? Third, and perhaps most intimidating to all of us, we are inspired by the courage to speak up, knowing we may face disagreement and criticism from peers and colleagues.

We must listen to the bold voices that deliver the difficult messages. Richard Ferri voiced messages we can each hear from our own patients about nurses, hospitals and critical care. We do not need to wait for higher authorities to do what needs to be done. Nurses are the highest authority when it comes to addressing pain and creating safe and humane environments. We must find solutions. We must listen and act from the inside out.


'Bold Voices' Gives Us Strength
I think that President Connie Barden's "Bold Voices" campaign has given a name to what nurses have felt for a long time.

I am seeing nurses become more vocal about their roles, both proactive and reactive, but at least with less passivity. I think that nurses are learning to use their voices, both for patients and nurses.

The visibility that has come with "Bold Voices" has strengthened an entire profession. Please know that what you are doing is vital and good.

Larraine Yeager, RN, BSN
Spencer, Ind.

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