AACN News—November 2003—Opinions

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Vol. 20, No. 11, NOVEMBER 2003


President's Note
Rising Above: New Questions, New Opportunities Giving Credit, Saying Thanks

DorrieFontaine,RN, DNSc,FAAN

Several years ago, Donna Diers wrote an editorial about giving and taking credit. At the time, the former dean of the Yale University School of Nursing was editor of Image, the journal of Sigma Theta Tau International. Using her gift of simple and elegant communication, Donna had a talent for making us rise above to pause and reflect about what really matters.

In rereading the editorial, I was again moved to recognize the power of her words and their value to nursing practice. Giving credit. Saying thank you. Who are we forgetting to thank? What should we take credit for as nurses and, as a result, stand taller?

As we approach Thanksgiving Day and the holiday season, I find myself thinking about those I must thank for their wisdom and care. Many are fellow nurses.

Recognizing the Potential
You may know Mary Foley as a talented hospital nurse executive or immediate past president of the American Nurses Association. I know her as a fellow teacher and doctoral student in the School of Nursing at the University of California, San Francisco. The teacher part came about last summer when Mary decided to tackle the growing shortage of nursing faculty head on. She became one. (By the way, did you know the shortage of nursing faculty is even worse than that in nursing as a whole? On average, nurses are in their mid-40s. Faculty are in their mid-50s.)

Typical of Mary, she chose to teach fundamentals, drawing in students with her passion and enthusiasm. I smiled when a new master's entry student told me proudly "how cool" it was to learn patient assessment from a past ANA president. I smiled because I knew her students were learning far more as Mary introduced them to the magic of their new career. Thank you, Mary Foley, a fellow association leader and stellar teacher.

Note for Rising Above: Would more bright and clever nurses combine teaching with an advanced practice role if they experienced the satisfaction and rewards of this logical combination? What if we identified these nurses early on and coached them in that direction?

Identify Allies
Although Shelley Weilerman, critical care nurse manager at the University of Mississippi Medical Center, may not be as well known, the cleverness and impact of her actions are no less than Mary's. Shelley introduced her institution's chief financial officer to the AACN white paper on certification. She followed up with a meeting where she vividly outlined how patient care and staff retention are improved by supporting CCRNs. The outcome? Staff nurses who are certified can now earn up to $5,000 more per year. New nurses in Shelley's units can count on being asked, "When will you be joining AACN?" And, "When will you take the CCRN exam?" Thank you, Shelley Weilerman, for rising above and finding new avenues to bring about the changes we strive for.

Note for Rising Above: Am I rubbing elbows with potential allies, but don't notice until I rise above? Should every nurse aim toward certification or only the more dedicated ones?

Take Credit, Tell Stories
Two decades may seem like a long time. But it is the blink of an eye for Patricia Benner, who celebrates the 20th anniversary of her landmark book From Novice to Expert next year. The monumental studies of Pat, her colleagues and students-many of them in critical care-continue to point the way to developing expert clinicians. Coincidentally, the first words printed on the coverleaf of her book are a vignette of a nurse and patient with a "thank you" theme:

He could not speak, as he was intubated. He could not write, as he was quadriplegic, and we didn't allow him to nod his head due to his unstable neck fracture. His only communication was with his eyes and his amazing ability to mouth words clearly and understandably � I just knew we could resolve his problem � so I intervened in his behalf with his multiple physicians � This incident is critical to me because it was what nursing is all about for me. The point was made by one simple statement he made later in the day. His words were: �Thank you. You've really helped me a lot. I don't want to imagine what would have happened to me if you weren't here and hadn't cared.1'

Thank you, Pat Benner, for teaching many generations the gift of taking credit for excellence in clinical nursing.

Note for Rising Above: How can we counter the potentially damaging effect of media scare tactics by helping more nurses to take credit and tell stories of clinical excellence? How can the trailblazing work of Patricia Benner and her colleagues on clinical wisdom in critical care help nurses become experts who think in action?2

Take Advantage of Wisdom
The 75-year-old mother of fellow nurse Ann Williamson has resumed nursing practice. This is good, because patients, families and nurses need her wisdom and care. Her decision couldn't have been simple or easy, but I have no doubt that it was inspired by the same commitment to patients and families that drew each of us into nursing. I hope that Ann's mother will accept the gratitude of her nurse colleagues for leading the way by her example.

Note for Rising Above: Will grateful colleagues and excellent technology be flexible enough to allow us to benefit from the wisdom of Ann's mother instead of burning her out as she runs up and down hallways working overtime?

Thanksgiving 2003. A time to be thankful. Thank a colleague and take credit for what you do each day for excellence in patient and family care. And, at the table on Thanksgiving Day, honor them in a quiet moment of gratitude.

P.S.: Share the Energy of Confidence
"Let me know the day [you take your CCRN exam], and I promise to send you positive energy and good thoughts," I told Julia during the NTI in May. I said the same to each one of you in my August note. "E-mail me your exam date at dorrie.fontaine@aacn.org. I promise to think of you and send each of you good thoughts as well. It's the least I can do to help you create the possibility of CCRN for yourself." Thank you to the many nurses who took on the challenge of becoming CCRNs and accepted my offer. I've been told that my "passing rate" is near perfect, so it's not too late for me to think of you. Send me a note.

Note for Rising Above: I marvel at how confidence from a respected stranger can be as energizing as that of a trusted friend. What does this mean for my work and home lives?

References
1. Benner P. From Novice to Expert: Excellence and Power in Clinical Nursing Practice. Upper Saddle River, NJ: Prentice Hall; 2000.
2. Benner P, et al. Clinical Wisdom and Interventions in Critical Care: A Thinking-In-Action Approach. Philadelphia, Pa: WB Saunders; 1999.


Letters

One Voice Is Better Than None
In response to the letter from the nurse who was retiring (AACN News, September 2003), I am sorry to hear that she, like many others, chose to retire early with a broken heart.

If every nurse whose heart aches decides to retire without speaking up, then nothing will change. If we as nurses feel passionately about how we are treated and fear for our patients, it is our obligation as professionals to do something about it.

We may each have just one voice, but that one voice can say so much and inspire so many others to speak up. If we all choose to do nothing to change the way things are, you can be sure no one else will do it for us.

Mary T. Carlisle, RN, MS, CCRN, CCNS, ACNP
Bowie, Md.

Think More About Our Families
Regarding the President's Note column (Is It a Snake or a Rope? AACN News, September 2003), the "snake" or "rope" analogy is terrific. I hope many readers will begin to think more about the families in critical care (our second set of patients) and how we all look at end-of-life issues and nursing competencies in that arena.

I will now adopt the AIR squared mindset as an attitude for myself and encourage others to do the same, especially the graduate students. Thanks for such an inspiring lesson!

Terry Tucker, RN, MS, CCRN, CEN
Baltimore, Md.

Saying �Hello' to Something Different
When I retired from critical care a few years ago, I knew I had to shake things up in order to say goodbye to my once wonderful and powerful world. I did not retire with a broken heart.

I bicycled for 366 days around the world. I travelled 20,000 miles through 46 countries on six continents and saw so much good in the world.

My views toward material possessions have changed. In many countries my bike and baggage had more value than some of the people would accumulate in their lives. But, they seemed content and happy. Listening to people talk about their hope for the future and "good health" was inspiring.

I do miss giving special care to special people, but I left many coworkers who were intelligent, attentive, responsive and reasonable.

Else Von Schopp, RN, CCRN
Brentwood, Calif.

Respect Key to Retention
Commenting on solving the nursing shortage by education and retention methods, companies still don't get it. You can keep infusing new blood, but it gets old and then it gets treated the same. Companies save a few bucks with the new crop of nurses and get rid of tried and true nurses, and the nightmare goes on.

As far as retention schemes go, most nurses perceive them like the prize in the kiddie box at McDonald's. When companies abide by standards like proper staffing and begin to treat nurses with more respect, they will keep them around. Until then, I will travel and not depend on some "suit" that has never been an RN to dictate numbers as a guide to healthcare.

Steve Jaubert, RN, MN, CCRN
Kenner, La.

Your opinions are important! Share them with others by contributing to the printed dialogue each month in AACN News. Send your "Letters" to: AACN News, 101 Columbia, Aliso Viejo, CA 92656; fax, (949) 362-2049; e-mail, aacnnews@aacn.org. AACN News reserves the right to edit letters for style, clarity and space.