AACN News—October 2007—Opinions

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Vol. 24, No. 10, OCTOBER 2007

President’s Note- Reclaiming Our Priorities

Dead Ends and Dips

Dave Hanson,

If you’ve got as much as you’ve got, use it.
—Seth Godin

Reclaiming our priorities doesn’t need to be complicated. But it does require us to distinguish between those situations we can control and those we can’t. In “The Dip,” Seth Godin’s little book (yes, it’s less than 100 pages), you’ll find a refreshingly practical perspective on how to tell the difference and then when to persevere or when it’s appropriate, even necessary, to quit.

Godin playfully suggests that “being the best in the world is seriously underrated.” Wouldn’t you agree that being the best in the world is what nurses are all about? Notice I didn’t say being perfect. Rather excelling in the different worlds that make up our professional lives because we have thoughtfully sorted our priorities and reclaimed those that matter, those that directly support our core values of patients and families, safety and our reliability as nurses.

Knowing when to push ahead and when to quit is essential in our quest for excellence as acute and critical care nurses. One way is to distinguish between a temporary setback that can be overcome if we keep pushing—Godin calls that a “Dip”—and something that will never improve no matter how hard we try. He calls that a “Cul-de-Sac,” otherwise known as a “Dead End” or, in its original French meaning, the bottom of the bag.

The Dead End
The Cul-de-Sac happens when nothing changes despite our most dedicated and energetic efforts. We don’t see improvement and things may even get worse. Our biggest challenge with a Dead End is to immediately recognize it. And, if feasible, we need to promptly change it into a Dip. But if necessary, we should quit doing it as swiftly as possible. Otherwise we squander our precious resources of knowledge, energy and time. When that happens, we incur what economists call opportunity cost, the cost of something in terms of what could have been done instead. We shouldn’t limit opportunity costs to money, either. Instead, our view should expand to include whatever is of value to patients and their families, to us and to our organizations.

Godin poses three questions we should ask before deciding to quit. Am I panicking? The decision to quit shouldn’t be made on the fly because panic-induced quitting is dangerous and expensive. Who am I trying to influence? When we think of quitting, it’s usually because we’ve been unsuccessful in being influential either because it’s the wrong person or group to influence, or because we need to hone our influencing skills. What sort of measurable progress am I making? Sometimes we’re measuring the wrong things and overlooking notable progress.

The Dip
Taking on something new is fun at first. The novelty and exploration can be energizing. Remember learning about ECGs? When identifying basic rhythms and measuring intervals and complexes revealed windows to a whole new world? I vividly recall the excitement of successfully recognizing a first-degree heart block. Not to mention how it felt when I could differentiate second- and third-degree heart blocks.

Then came the Dip. I had to master more challenging, but equally important concepts, such as using a 12-lead ECG to determine the presence of ischemia, injury and infarct patterns. Also distinguishing right and left axis deviation. More frightening yet was correctly identifying right and left bundle branch blocks or left anterior and posterior hemiblocks. In short, the Dip is what happens between basic knowledge and mastery. Between calculated yet hopefully lucky guesses and consistently repeatable mastery.

Dips nearly always occur. How should we handle this inevitability? Something that is worth doing will likely have a Dip along the way because that is where success happens. Success doesn’t mean riding out the Dip. It means pushing harder, working and thinking smarter and recognizing our measurable progress. Even more vital—it means making the right decisions.

Some Questions to Ask
Godin suggests some questions to guide our way through Dead Ends and Dips. Here are a few that may be especially useful.

Is this a Dip or a Dead End?
If it’s a Dead End, can I change it into a Dip?
When should I quit?
If I quit a Dead End, will it increase my ability to get through the Dip onto something more important?
Is doing nothing better than planning on quitting and then doing something great?

To paraphrase, we and our organizations have the power to bring about transforming change in healthcare. How dare we waste that power by settling for mediocre just because we’re busy struggling with too many priorities, racing against time to achieve what will never get done. Imagine a world where acute and critical care nurses understand and recognize the difference between Dips and Dead Ends. In that world we would be well on our way to reclaiming our priorities.

Tell me about your Dips and Dead Ends. How have you gotten past Dips? How did you get the courage to quit a Dead End? Write to me at priorities@aacn.org.
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