American Association of Critical-Care Nurses

Vol. 23, No. 2, FEBRUARY 2006

President's Note
Engage and Transform
Is It Time to Disengage?

By Debbie Brinker, RN, MSN, CCRN, CCNS
AACN President

What you cannot turn to good, you must make as little bad as you can.
—Thomas More

Life in general can be complicated. More so our work lives. No wonder work situations account for more than a dozen of the 100 things that complicate our lives, which Elaine St. James lists in her thoughtful book, Living the Simple Life. Here are a few: difficult bosses; obstinate employees; grudging coworkers; demanding clients; staff meetings; communication breakdowns; work we dislike just a little—or a lot; working too many long hours, even if it’s work we love; dealing with noncollaborative physicians; coping with office politics; not having any options—or having too many.

Faced with situations like these, many nurses eventually decide it’s time to disengage. “I need to bail out,” they’ve told me. “I tried to engage, to change things. But nothing changed, and now I’m burned out.” Although defeatist, it’s certainly one way to consider disengaging and matches this definition:

dis • en • gage: v. To release from something that holds fast or entangles

What if disengaging meant becoming free? Then our perspective changes dramatically and, coincidentally, matches another definition:

dis • en • gage: v. To free or remove obstruction from

Every Hill Isn’t One to Die On
When you’ve been in a difficult situation, have you ever felt that if you just hang in there long enough, you will be able to make a difference? Many nurses struggle with their role in bringing about change. They vacillate between letting go of an issue and leaving the situation altogether. External issues like limits to overtime pay or internal ones like the unwillingness of coworkers to implement a much-needed end-of-life protocol can affect a nurse’s self-confidence on the job.

When we’re passionate and committed to making a needed change, it can be tough to see things in a different light. Often, it’s about the way we measure accomplishments. Is it by yards or by inches? Measuring in inches may make the most sense. For example, first, get the right consults for the terminally ill patient. Next, check for evaluation of pain and sedation management.

Unhealthy Places or Mismatched Values?
After a recent talk, a nurse told me how my comment about recognizing the time to disengage caught her attention. “It’s time for me to leave,” she confided. “I precept and mentor new staff, but our culture is one of ‘eating our young.’ It’s a losing battle when it shouldn’t be a battle at all. I feel beat up trying to take on all the negative attitudes. But do you know the worst part? Our manager won’t touch it.”

Here’s the best part. A colleague in another unit encouraged her to apply for the manager position open in his department. “Our staff is hungry to move forward,” he said, “and we need leadership like yours.”

Toxic work environments exist. But so do healthy ones where the AACN Standards for Establishing and Sustaining Healthy Work Environments have become the norm with clinicians who truly collaborate and leaders whose authenticity is continually affirmed. Choosing—and yes, it is a personal choice— to leave a toxic environment and engage where our values match the organization’s is the right choice—and a healthy one. Hanging on and getting sucked deeper and deeper into negativity is not.

Courage to Be, Courage to Fail
The titles of two well-worn books come to mind. In his classic The Courage to Be, Paul Tillich describes three kinds of anxiety we all struggle with. One is the anxiety of emptiness or meaninglessness, and thinking that anything we do is meaningless. The “courage to be” means being able to stay open to the future, even if we’ll never see beyond the now.

The Courage to Fail is the second book, Renée Fox and Judith Swazey’s front row analysis of dialysis and transplantation in the pioneering 1950s. That era’s scientists and clinicians tackled a seemingly insurmountable therapeutic challenge despite the uncertainty and pressure that “on the one hand not enough is known and that, on the other, there is too much to know.”

Knowing when and where to disengage or engage takes courage. First, it means taking a step back and looking at ourselves as objectively as possible. Are the issues we face insurmountable for us? How have we handled situations like this before? Have we stayed and tried to make changes or have we left for a new position? Looking at a situation in a new way is liberating and may help us reach the best decision. Seeking the advice of a mentor or coach also helps us see things differently. A mentor can help us rise above to see the landscape and our own part in the situation. She or he can help us discern whether the situation is so toxic that it’s time to move on—or if we need a reality check showing us that our own attitudes or expectations are, in fact, part of the problem.

In his book, Managing Transitions: Making the Most of Change, William Bridges explains that, for change to happen, we need to identify an ending, and then pass through a “neutral zone” to reach a new beginning. Identifying an ending—for example, deciding that we will not contribute to our unit’s “eating our young” attitude—is the first step. Deciding that we will change our own attitude constitutes the ending. When we focus on something that we thrive upon—such as making a difference through the care we give to patients and families—we are free to have a new beginning.

One caution: We may find that what we think is a “neutral zone” isn’t neutral at all. It may be littered with emotions about what we’re giving up, fears of what may lie ahead, and concerns about how others perceive us. Our goal, Bridges tells us, is to reach a new beginning without getting sidetracked in the neutral zone.

How Do I Know?
Knowing when to disengage is about moving ourselves to action. Action to accept the need for change and shift our perspective, refocusing on something we want to participate in. Action to seriously consider alternatives, either in our current job or somewhere new that better matches our values and expertise. Action to look at the balance we need in our lives, allowing ourselves to have more fun, so we can more easily handle the intensity of our work and the changes in our environment. Above all, knowing when to disengage is about discerning where we will re-engage to become part of the transformation of our environment and our practice.

What I do is me; for that I came.
—Gerard Manley Hopkins