AACN News—June 2005—Opinions

AACN News Logo

Back to AACN News Home

Vol. 22, No. 6, JUNE 2005


Live Your Contribution
Our Quest for Excellence

Following are excerpts from the President’s Address delivered by President Kathy McCauley, RN, PhD, CS, FAAN, FAHA, at the opening session of the 2005 National Teaching Institute and Critical Care Exposition in New Orleans, La. The full text with references is available online at www.aacn.org > NTI or by calling (800) 899-2226. Request Item #006106.

The unique contributions we live as nurses have never been more explicit, with science, the best available evidence and exquisite clinical judgment as our guides.
To our patients and their families, we contribute far-ranging knowledge of our role and ourselves. We bring integrity, truth and a sense of ethics, along with competence, compassion and collaboration. To each other, we also bring the gift of knowledge, coupled with mentoring and coaching.
We contribute because we want to make an impersonal healthcare system more personal—more caring, more focused, more effective and certainly safer.

AACN’s Contributions
AACN also lives its contribution. It does so because it is crystal clear, bold and confident in its purpose and direction. The energy of our founders’ contribution has charged AACN with the tremendous responsibility of helping nurses to become and remain competent, to stay on top of a body of knowledge that grows exponentially with each passing year.

Although AACN contributes in many ways, its boldest initiative is perhaps the landmark Standards for Establishing and Sustaining Healthy Work Environments.

Nursing’s Contributions
As a profession, nursing lives its contributions.

Nursing is a metaphor for conscience, so we may become for others an uncomfortable reminder that health professionals are not infallible. But because nursing is a metaphor for conscience, we also contribute integrity to healthcare. In fact, according to recent polls, nurses are the professionals most trusted to act honestly and ethically.

Nursing is also a metaphor for presence. Nurses’ relationships with patients are roadmaps for the best care because they grow from being fully present. Nurses know how to overcome barriers to understanding what a patient feels and needs in the moment. We overcome those barriers because of presence that is anchored not only in emotion, but also in knowledge.

Our Missed Contributions
We also must reflect on how our blind spots keep us from recognizing obvious contributions that we may fail to make. Competence, compassion and collaboration are three of these.

Competence
In addition to technical skills, critical-thinking skills, decision-making abilities, patient advocacy and making a disjointed system work for patients and families, competence means fine tuning our skills in communication and collaboration. To become fully competent, we must understand, hone, recognize and celebrate it. But above all, we must demand it.

If competence is not optional, then incompetence cannot be ignored. In fact, we are ethically obligated, not only to maintain our own competence, but also to support one another in becoming competent and to call out incompetence when it appears.

Compassion
If anything is the hallmark of a nurse, it’s our compassion. However, though we intend to be compassionate, we don’t always deliver. Today, so much derails our good intentions that we often feel as if we can’t nurse a patient until we have nursed the broken systems.

Compassion makes an impersonal healthcare system personal and turns the worst day of someone’s life into the best day it can be. To avoid or recover from the consequences of intense nursing requires a caring and compassionate healthcare team—managers, colleagues with counseling skills, each other. Their compassion is the essential and renewable resource we need to constantly give of ourselves.

Collaboration
Compassion opens the door for true collaboration. Extensive evidence shows the negative impact of poor collaboration on various measurable indicators, including patient and family satisfaction, patient safety and outcomes, professional staff satisfaction, nurse retention and cost.

Most health professionals genuinely intend to collaborate. Yet, more often than we care to admit, the best intentions become lip service. Then one day, a patient situation demands that we all intersect. Or even collide. Whether it’s between professions or within our own, we come face to face with the reality that we don’t practice true collaboration. It’s usually a high-stakes situation.

Our Practice Home
AACN has boldly gone on record describing what our practice home should look like. AACN did this because work environments and patient safety are directly connected. When we don’t address one, we are not addressing the other. Creating healthy environments is imperative to ensure patient safety, enhance staff recruitment and retention, and maintain the financial viability of a healthcare organization in the face of mounting evidence that unhealthy work environments contribute to medical errors, ineffective delivery of care, and conflict and stress among health professionals.

AACN’s Standards for Establishing and Sustaining Healthy Work Environments presents the blueprint to build our practice home. We know where we’re headed. We also know that long-standing cultures, traditions and hierarchies must be confronted in order to create a healthy work environment.

The standards clearly outline the unique skills we need to reach our destination of excellence: skilled communication, true collaboration, effective decision making, appropriate staffing, meaningful recognition and authentic leadership. For me, skilled communication and true collaboration set the stage.

Skilled Communication
The standard says, “Nurses must be as proficient in communication skills as they are in clinical skills.”

A culture of safety and excellence requires that individual nurses and healthcare organizations make developing communication skills a priority. Healthcare organizations must include skilled communication as a criterion in performance appraisal systems. Organizations also must establish zero-tolerance policies, enforcing them to address and eliminate abuse and disrespectful behavior in the workplace.

Self-awareness, inquiry and dialogue, conflict management, negotiation, and advocacy and listening are skills that will enable us to focus on protecting and advancing collaborative relationships, on inviting and hearing all relevant perspectives, on building consensus and common understanding, on finding solutions.

True Collaboration
The standard says, “Nurses must be relentless in pursuing and fostering true collaboration.”

If true collaboration means communication based on mutual trust and respect, I believe that is what most health professionals genuinely intend to do. Sometimes we don’t collaborate because we get sidetracked. But often it’s because we just don’t know how to collaborate.

True collaboration is an ongoing process that grows over time. Eventually, it opens the way to a work culture where joint communication and decision making become the norm.

True collaboration is how we will become full partners. It will not tolerate behavior that intimidates and stifles divergent opinions. In return, true collaboration holds each person accountable for presenting an honest and thorough perspective, supported by evidence that helps to consider alternatives. This means that we agree on what happens when someone refuses to collaborate because true collaboration isn’t optional and patients are harmed by its absence.

Our Next Step
What should be our next step as individuals? Why not start with a personal inventory and measure ourselves with the critical elements for these two standards? Look for a coach or two in your own backyard. Who are the best communicators in your unit? In your hospital? Who are the best collaborators? Watch them carefully with new eyes. What makes them so good?
How do their skills align with the critical elements? Would they be willing to coach you if you asked?

We should also pay attention to people we think are less skilled. Say we’ve become skilled communicators and someone still won’t collaborate. Instead of blowing them off, we need to figure out a way. After all, people who are talented and well meaning don’t usually say stupid things. They just might have a different perspective, one that we’re not getting.

It’s All About Us
So you see, it really is all about us and how we’re responsible for ourselves.

We certainly are confronted by daunting challenges. But how different are they from the ones we joyously take on each time a new patient rolls through the door? If anything, these challenges present us with endless opportunities to astonish ourselves by the depth of our dedication and talent. And when was the last time we did that?

I encourage you to swap stories, especially the good ones. The ones that inspire us because they are about our successes. Some are the stories we love to tell about our dramatic saves. But others are about how we worked well together, how we overcame adversities that appeared to be beyond our control. Remember those good stories that you hear and continue to tell them far and wide.

The Latin words engraved on an iron gate at the University of Pennsylvania sum it up for me: Inveniemus viam, aut faciemus. We will find a way, or we will make a way.
Are you coming with me?

McCauley Inspired
To President Kathy McCauley:
I have enjoyed reading your “President's Notes” throughout the year and wanted to thank you for your hard work and inspiration this year. It is easy to “Live Your Contribution” when we have leaders like you in critical care nursing.

As you finish your term as president, I wanted to share the impact you have had. Thanks to your encouragement, we have worked hard at Moury Health System developing a number of new programs. These include a systemwide competency-based orientation with shared competencies for critical care, the Preceptor Empowerment Program, a new preceptor training program and several retention strategies for our critical care nurses. The processes for all were simplified by the accessibility of AACN resources.

However, probably the most meaningful contribution was an easy one: a “Nurse's Storytelling Contest” based on Benner's clinical guidelines for writing critical incidents. The stories my colleagues have shared with me are amazing.

Thanks for “living your contribution” and sharing it with all of us.

Melanie Keiffer, RN, MSN, CCRN
Southfield, Mich.

Send Letters to the Editor to AACN News, 101 Columbia, Aliso Viejo, CA 92656-1491; fax, (949) 362-2049; e-mail, aacnnews@aacn.org.