Reclaiming Our Priorities
Getting Priorities and Core Values to Align
Dave Hanson, RN, MSN, CCRN, CNS
How can we go about aligning individual priorities with our core values of patients and families, safety and reliability? Since announcing my theme at May’s National Teaching Institute & Critical Care Exposition, I’ve thought about this a great deal because we cannot effectively reclaim priorities unless we consider their context.
The Meanings of “We”
The former editor of St Louis magazine once wrote that people identify in concentric circles, starting with family then rippling outward as far as they dare. So the word “we” refers to different groups depending on the situation.
Sometimes “we” is personal. It might mean me and my patient and even expand to mean the nurses on my shift or in my unit. Other times “we” becomes public and might refer to my hospital, my AACN chapter, AACN itself or even the nursing profession. “We” can also refer to my community and my personal life. We usually zoom back and forth without even noticing. This concept is critical because, even when a priority spans more than one circle, we will need to carefully define the priority one circle at a time. Different priorities may take precedence according to the situation at a given moment.
Understanding which circle we are in is important for another reason. Were we to compare notes, many of us would probably identify similar work priorities. Patient care, collaboration and communication, charting technology and documentation, staff education, staffing and financial resources are some examples. But the exact lineup of priorities at any point in time will be unique for each of us, and it will depend on which circle we are in at the time.
Start With Probing Questions
Let’s consider charting technology and documentation as an example. This bubbled up as one priority of concern in a straw poll at this year’s NTI that asked about work priorities and how they are overshadowed by competing priorities.
There is no denying that charting technology and documentation demands an increasing amount of our attention in clinical practice. It is complex because it affects more than one circle and directly competes with other priorities.
Personally, I will start to align charting technology and documentation—let’s call it CTD for short—with our core values by asking probing questions such as the following, which are relevant to three common circles: me and my patient, me and my unit, me and my hospital. I urge you to do the same.
• How does CTD directly benefit my patients and their families today? What about in the future?
• Are the reasons and requirements for documentation inappropriate or misunderstood?
• How does CTD help reduce errors and assure safety?
• How does CTD support my reliability—that is, my trustworthiness and dependability—as a nurse?
• Does my unit have unique CTD requirements that differ from other units? If so, why are we different?
• What aspects of CTD compete with fulfilling my other priorities?
• If we’re using charting technology, is it being poorly implemented? Has the technology been badly designed?
• Perhaps more alarming, is CTD being implemented without seeking and incorporating the experienced perspectives of clinicians?
How Will You Answer?
Sharing our experiences will be invaluable as we chart our individual courses of reclaiming priorities. Here are some questions to jump-start the sharing. I look forward to receiving your answers at firstname.lastname@example.org.
First, what is one priority of your work that is being overshadowed by competing priorities? What are those competing priorities?
Second, is charting technology and documentation one of your priorities? If so, what is getting in the way and how should it be tackled? How can AACN help?
Probing questions and subsequent answers will continue giving us unexpected opportunities to learn together. As the astrophysicist Neil deGrasse Tyson once said, “The larger the area of our knowledge, the bigger the perimeter of our ignorance.”