AACN News—February 2008—Opinions

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Vol. 25, No. 2, FEBRUARY 2008

President’s Note Reclaiming Our Priorities

Mind the Gap

Travelers to London often remark on the recorded warning broadcast repeatedly throughout the city’s underground rapid transit system. “Mind the gap” warns passengers that sometimes there is a sizeable space between the edge of the platform and the train door. Passengers who aren’t mindful about the gap risk harmful or even lethal consequences.

The same happens to us as acute and critical care nurses whose work can be littered with similar gaps and the risk of equally serious dangers. Talk with a colleague while reading the label on a drug vial and we risk administering the wrong medication or incorrect dose. Turn our attention from a distraught family to answer a team member’s interrupting question and we jeopardize devaluing the family’s fragile state of mind. Ignore a new nurse’s apparently trivial concern and we gamble squelching his or her effort to become a committed, compassionate and competent team partner.

My colleague at Indiana University, Dr. Patricia Ebright, confirms this in her ongoing studies about healthcare provider decision making and the influence of work complexity on patient safety and quality of care. When we cannot or do not pay attention, clearing the clutter from the moment, we create untold hazards that can endanger us and others.

Carrying Our Guns Mindfully
Thích Nhát Hanh, the Vietnamese poet and peacemaker, independently makes the same point. Nhát Hanh calls it mindfulness and defines it as “the energy of being aware of what is happening in the present moment.” He believes that “mindfulness is a part of living. When you are mindful, you are fully alive, you are fully present.” Not just in certain critical situations, but in everything we do.

This perspective intrigued me because it seemed out of sync with achieving power, the focus of his most recent book, “The Art of Power.” A radio interview with Cheri Maples, a Wisconsin police captain, helped me to sort it out. Maples wondered if Nhát Hanh’s teachings could be incorporated into law enforcement. That is, until she came across one of his most basic principles, vowing never to kill. “I can’t do that, I’m a cop,” she said. “I might be in a position where I have to kill somebody at some point.” Which is when one of Nhát Hanh’s associates challenged Maples with this probing question: “Who else would we want to carry a gun except somebody who will do it mindfully?”
Couldn’t we incorporate this perspective within acute and critical care nursing? Unlike law enforcement officers, we don’t carry around traditional weapons and yet the risk of harm and death is ever present in all we do. In our work, the gun serves as a powerful metaphor that illustrates how our inattention to what we are doing at the moment and its subsequent effects can unleash hazardous and even fatal firepower.

The rest of the interview is fascinating. You may want to pursue it if, like me, you recognize the many “guns” you carry and the multitude of gaps you continually confront in your work as an acute or critical care nurse. Each gap and gun carries the risk of injuring or even killing a person’s body, mind or spirit.

The Story of Devon
One of the case studies in the new AACN-AONE online Essentials of Nurse Manager Orientation tells the story of Devon, an emotionally drained and physically exhausted nurse manager who found himself concerned that his new job was taking a toll on his life. He found himself completely exhausted because he had become so consumed in taking care of everyone else without refilling his personal bucket. There was no one to blame but himself, so Devon took charge of his life and reclaimed his priorities, actively seeking ways to nurture his intellectual and emotional self.

Six months later, Devon’s colleagues remarked about how refreshed, optimistic and productive he had become. He knew it was because he had recognized and committed to caring for himself. I’m fully convinced that Devon’s remarkable transformation occurred because he learned a valuable lesson. He became mindful. He chose to learn how to focus his energy on the priority of each present moment rather than squandering it disjointedly among a jumble of competing priorities. (Maybe Devon even read another of Nhát Hanh’s books, “Anger: Wisdom for Cooling the Flames.”)

Master or Seeker?
Are you someone who has embraced or even mastered the art of mindfulness? Or perhaps, like me, you now recognize and seek its power. Either way, I invite you to tell me your story by writing to me at priorities@aacn.org.

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