AACN News—October 2003—Opinions

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Vol. 20, No. 10, OCTOBER 2003

President's Note
Rising Above: New Questions, New Opportunities
From Our Town to Our Unit

By Dorrie Fontaine, RN, DNSC, FAAN
AACN President

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 English class.

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 AACN.

Raymond Kelly
Fort Lauderdale, Fla.

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