Rising Above: New Questions, New
From Our Town to Our Unit
By Dorrie Fontaine, RN, DNSC, FAAN
Good karma exists if we pay attention when
things converge. For me, it was about Thornton Wilder's masterful play Our Town.
Earlier this year Paul Newman appeared on Broadway playing the stage manager. I
wanted to see him. Didn't get to, but now I notice the production will be on the
PBS"Masterpiece Theatre" this fall.
Then, in May, a commencement speaker
referenced Our Town. I needed to re-read it. Couldn't find my dog-eared copy
from high school, but in a San Francisco bookstore I came across a first edition
of the 1938 play. I savored it all summer. A few weeks ago, Our Town showed up
on my kitchen counter as required reading in my son Sumner's eighth-grade
Our Town. A three-act ensemble play about
two families experiencing life's routines-birth, marriage, work, death-in
Grover's Corners, an imaginary turn-of-the-20th-century New England town. A
parable of everyday messages. Some magical, some corny, all timeless.
As I wondered whether this convergence
might signal a lesson, the similarity between Our Town and"our unit" became
obvious. Wherever we care for critically ill patients and their families-ICUs,
stepdown units, high-acuity med-surg units, emergency departments-nurses form
part of an ensemble cast delivering timeless messages as part of our everyday
work. We practice true collaboration with our colleagues in medicine, pharmacy,
respiratory therapy and other disciplines. We protect patients-save lives, ease
pain and provide for a peaceful death. As Pat Benner reminds us, we make"our
unit" a less scary place for patients and families.
"Our unit's" stage manager is none other
than the equally versatile nurse manager. One moment, setting the stage.
Another, directing the players. Yet another, offering wise reflections and
advice. And, on occasion, pinch-hitting to marry childhood sweethearts or run
the soda fountain at Mr. Morgan's drugstore.
Looking further, I found another similarity
in 26-year-old Emily Webb's new realization as she looks down from heaven."It
goes so fast," she says with amazement."We don't have time to look at one
another. I didn't realize. So all that was going on and we never noticed .Do
human beings ever realize life while they live it?-every, every minute?"
Emily's observation matches my invitation
that each of us rise above, asking ourselves new questions and seeking new
possibilities as we survey our unit from another perspective. Here are some
questions we might ask as we compare"our unit" with Our Town.
� Who are the key players on the stage
of"our unit"? AACN is unyielding in its conviction that patient and family are
central and that their needs must drive the action. Do they drive the action in
your unit? I recall one where all chest x-rays were taken at 3 in the morning to
be ready for 6 o'clock physician rounds. It may seem corny, but that unit's key
players had certainly been upstaged. Not to mention how sleep's vital
contribution to healing was entirely ignored. If patients themselves tell us how
important sleep is for them-in fact, right up there with pain relief-how can we
blithely ignore it? How will our unit's stage manager fix this?
� How is the vital and precious resource
called nurse handled in"our unit"? The nursing shortage has reaffirmed that
nurses are vital and precious resources. We must be precious when a hospital is
willing to pay a temporary staffing agency up to $30 million dollars a year.
Yet, how do we handle these resources? Do we protect nurses? Shelter, honor and
respect them? Or do we require them to work double shifts, ignore their
solutions to effective patient care and exclude them from important decisions?
Respect and value go hand in hand. When vital resources are not part of decision
making, wrong decisions are bound to be made. The scenes don't play right unless
all viewpoints are included, and the reviews will be terrible.
� Like the stage manager in Our Town, does
the nurse manager influence the action of every scene in"our unit"? Does the
manager create the context and understanding for the unit? Are the nurse manager
and the medical director genuine partners who share understanding, respect and
true equality? Can and does the manager say,"I know what the budget is telling
us, and we must protect patients with a level of staffing matched to patient
needs?" These are timeless and magical questions, not corny ones, and we are
obligated to answer them for"our unit."
� Is"our unit" as well positioned to be
award-winning as Our Town was when it received a Pulitzer Prize? AACN is
preparing to invite units across the country to evaluate how well they meet
standards of critical care excellence. (See page 1.) AACN has products to help
managers set the stage for excellence and resources that units need to qualify
for the new Beacon Award for Critical Care Excellence. Will your unit be ready?
Emily Webb was right. It all goes by so
fast. And, unless we rise above, asking new questions and seeking new
possibilities, there will be so much going on that we will never notice. As each
of you try seek to rise above, know that I am cheering you on, hoping you"break
a leg," and that I am eager to applaud your encore.
Certification Reiterates Professionalism
I was pleased to read of AACN's white paper
on certification for nurses. (AACN News, January 2003). As a British-trained
nurse, certification has been a way of life for many years. Once nurses have
gained experience, they moved to specialize. Certification was available in
areas such as care of the elderly, coronary care, critical care oncology and
orthopedics. In fact, to climb the career ladder, specialization was a must.
I can see your white paper being of great
support to nursing, particularly at a time when there is so much bad publicity
about care in hospitals and the number of deaths due to poor care. It is also a
way for nurses to once again establish themselves as the professionals they
should be and prove their competence in caring for patients in whatever field
they specialize. In turn, these nurses will be able to help the new grads in a
more positive and informative manner.
My main concerns are that certification
should follow a baccalaureate program so that nurse education is of the highest
level and so that hospitals will understand the need for these programs and
support them financially. I hope that this is the first step in one of many that
will help put nursing back on a professional footing. I applaud the efforts of
Fort Lauderdale, Fla.