AACN News—August 2004

Vol. 21, No. 8, AUGUST 2004

President's Note
Live Your Contribution
Blind Spots and Harsh Truths

Synchronicity: The relationship that exists when things occur at the same time. It took place the morning of May 17.

In Orlando, Dorrie Fontaine challenged nearly 7,000 acute and critical care nurses from across the nation to rise above—to ask new questions and pose new solutions. In Philadelphia, rock star Bono challenged graduates at the University of Pennsylvania—my former students among them—to fix the problems they can. “We can’t fix every problem, but the ones we can, we must … Amen,” he said.1.2

Both Dorrie Fontaine and Bono (Did you ever imagine those names in the same sentence?) struck the same nerve, daring their audiences to commit. To live a contribution.

But how?

Bono quoted from the epic poem Book of Judas by the Irish poet Brendan Kennelly. “If you want to serve the age, betray it.” To him, betraying the age meant “exposing its conceits, its foibles, its phony moral certitudes. It meant telling the secrets of the age and facing harsher truths. In other words, it meant owning up to the often painful truths behind the blind spots that block us from living our contribution.

Blind Spots
What are these blind spots? These harsh truths? Some are personal. Many are systemic. And often they involve challenging age-old practice beliefs and the narrowness of practicing without a systems perspective.

Some of my personal blind spots still haunt me. For example, backing down when more experienced nurses and physicians pushed for bypass surgery, minimizing a patient’s uncertainty and fear. My best efforts to ease the terror were inadequate. The harsh truth: Some died during surgery. Others, still scared and losing hope, died when overwhelmed by postoperative complications.

Another example: Treating multisystem septic organ failure with full pressors. Ventilators. Dialysis. But without any discussion about what the patient or family might want. It didn’t feel right. But our moral, narrow certitude could not entertain the possibility that aggressive treatment is not always the right treatment. The harsh truth: No end-of-life care.

What about blind spots in the systems that should support our practice? Consider these:

The clinical world of healthcare has long been a world of secrets, and concealing medical errors has been among them. Ironically, these errors are often caused by bad systems, not bad people. The harsh truth: A culture of blame replaces a culture of healing.

All too often, good manners get checked at the hospital door. Or so it seems when an experienced nurse is heard diminishing the exuberance of a student or new graduate. Or when a physician demeans a nurse colleague for making a late-night call to double-check a dose. The harsh truth: Abusive behavior impedes essential communication.

In the hierarchical world of healthcare, professionals often see themselves at a higher level than patients and families. Limited by this blind spot, we may feel that some families deserve access to patients, while others do not. The harsh truth: Families are excluded when patients most need their loving energy.

A Monthly Dialogue
As we begin a monthly dialogue about how to live our contributions, tell me about your blind spots. The personal ones. The systemic ones. And above all, let’s learn how together. Once we acknowledge the harsh truths our blind spots conceal, we can ethically live our contribution—through presence, self-knowledge, competence, compassion, collaboration and mentoring.

“We can’t fix every problem, but the ones we can, we must … Amen.”

Please e-mail your comments to Kathy.McCauley@aacn.org.

References
1. Bono. Because We Can, We Must. University of Pennsylvania 2004 Commencement Address. Almanac. 2004;Vol 50,No 34.
2. Bono. Because We Can We Must. Available at http://www.upenn.edu
/almanac/between/2004/commence-b.html. Accessed July 12, 2004.

My Turn
Remember Why We Became Nurses

By Teri Gorder, RN
Baraboo, Wis.
Why do people choose a profession that has the potential for daily heartaches and personal injury? We don’t make the kind of money we feel we deserve in comparison to the risks. Too often, we feel disrespected, unappreciated and forgotten. Yet, we choose this profession and carry the pride and heartaches of what we do every day with personal pride and self-respect. We are the nurses who truly care for our patients. We strive to make a difference in the lives of every person we touch through our knowledge, skills and attitudes.

I remember the first day of my nursing program. I sat in the back of the room not knowing anyone around me. My instructor asked one question, which elicited a multitude of answers from the 24 students in the class. The question was simple: Why do you want to be a nurse?

I had only one answer: I care about people and want to impact someone’s life in a meaningful way. To this day, I feel the same.

Nursing is an opportunity, a journey and an honor. Many of us feel the strains of the highly publicized nursing shortage, the continuous reminders of financial burdens on our facilities and the overall stress of the profession. I see a profession that needs as much healing as the patients for whom we care.

However, this personal strain and stress is why we need to be reminded why we chose this profession and what we are truly here to do. We are support systems. We are resources. We are teachers. We are friends. We are nurses. We have the opportunity to make a horrific experience in the lives of our patients and families one they can remember as one when a stranger who cared for and respected them was there.

I’m not referring to a nurse who patted them on the shoulder and said, “It’s going to be OK.” I am referring to the a nurse who can kneel next to a patient who just learned he or she has a terminal cancer and hug them tightly, cry with them and listen to them express their fears. We can be the one who takes a child who died, wrap him in a warm blanket, bring a rocking chair into the room, hand the precious child to the parents, and give them the privacy and quiet time to say goodbye in a respectful and loving way. We can be the one to listen as a wife cries over the loss of her husband who died of a massive heart attack and allow her to be angry at the world.

We also must be able to care for ourselves and be able to share. We cannot expect our patients to receive the best part of us if we are overtired, emotionally exhausted and malnourished from skipping a meal in a 12-hour shift.

This struck me when a dying patient asked me to sit down and relax for five minutes in her room when she sensed my exhaustion after working 14 hours, being pregnant and not eating. That patient saw me as a person who cared only for my patients, not myself. I felt terrible that my patient was worrying more about me than she did about herself at that moment. Feeling honored that she cared, I felt our roles had reversed. The experience made me realize that our patients do notice our strain, and it impacts them in a way that could be potentially stressful to an already ailing body. We need to care for ourselves for our personal health and also for the patients and families we care for on a daily basis.

As nurses, we are responsible for taking the time to reflect on the positive roles we can play in the lives of our patients and families. Nursing is a profession that deserves respect and pride. The emotional strains we undergo daily in our careers watching people die, sharing devastating information, and listening to our patients’ fears are heart wrenching. Yet, we continue to go to work because we love people and caring for them in the best ways we know. We also must take the time to let our tears flow, share with our coworkers and reflect on our personal needs. We must care as much for ourselves as we do for those who lie in our beds, are discharged home from our care and die in our arms. We have to be proud of our accomplishments and accept that we are human in our feelings. We have to continue to care. We have to be nurses.

AACN News—August 2004—Opinions

Vol. 21, No. 8, AUGUST 2004