AACN News—January 2008—Opinions

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Vol. 25, No. 1, JANUARY 2008

President’s Note Reclaiming Our Priorities

Am I Up to the Challenge?

If I were critically ill, which one of my critical care nurse colleagues would I want to be “My Nurse?”
— Grif Alspach

Have you read Grif Alspach’s editorial in the December 2007 issue of Critical Care Nurse? In it she deftly prepares us for January’s traditional season of New Year’s resolutions. But I’m getting ahead of myself.

I hope that by now you will have enjoyed the holiday season, feeling more festive than frazzled. Sometimes the greatest barrier to joyful holidays comes from our inclination to overachieve, making the New Year an opportunity to discard some bad habits and start afresh. Instead, let’s invite a little recess into our lives as a welcome incentive to reclaiming our priorities through some carefully chosen resolutions.

What are resolutions all about?
If you’re at all like me, broken resolutions are likely to get more attention than those you keep. But if or when we achieve a resolution may not be the real issue. I believe the real issue is about what makes its way onto our list and why we make resolutions at all. As nurses we have mastered the art of creating lists. We make lists of patient names and rooms, physicians, treatment schedules, medication regimens. Our list of lists is endless.

When it comes to resolutions, another list, we generally overlook the obvious. Ourselves. We resolve to exercise, eat more sensibly, lose weight, save money or be less irritable. Yet instinctively we deprioritize ourselves, neglecting our own needs. Think about it.

We become so involved in providing safe, quality care to patients and their families that we ignore our bodies. We forget to drink water, snack nutritionally especially when a full meal break is impossible, or even go to the bathroom. We agree to work overtime when we’re fatigued and our judgment may be impaired. When we attend the National Teaching Institute & Critical Care Exposition, we drain ourselves trying to go to every event.

When we don’t put ourselves first, some of us write it off as being admirably selfless. Others call it a sign of martyrdom. Is it quality care when the caregiver isn’t at the top of his or her game? Would I want someone hungry, tired and distracted taking care of me? Ignoring our basic needs extracts a huge toll, physically and emotionally, professionally and personally.
Going home to ourselves

In his thought-provoking new book, The Art of Power, the renowned Vietnamese peacemaker and poet Thích Nhát Hanh insists that our desire to make a meaningful mark on the world can only be realized if we first take care of ourselves, body and mind. One way of achieving this is by blurring the distinction between work and play and family, as suggested in this book by Yvon Chouinard, the founder and CEO of Patagonia, the highly successful outdoor clothing company.

Nhát Hanh explains that this paradoxical approach recognizes the interconnectedness of all things. It helps us to realize that “everything good that you do for yourself, you are doing for all of us.” He suggests that self-understanding and self-love are the foundation for understanding and loving another person. The first step is what Nhát Hanh calls “going home to ourselves.” Taking care, understanding, accepting and being compassionate to ourselves.

Does this seem self-centered? On the contrary. I suggest it is necessary and good if we are to optimize ourselves when caring for patients, their families and each other. Which is where Grif Alspach’s editorial comes in. In it she challenges us to consider an alternative mindset by identifying who we would want to care for us if we ever became critically ill. “I cannot think of a more straightforward way for one critical care nurse to recognize another,” she writes, “than by placing his or her life in the other’s hands.”

Am I up to the challenge?
I challenge you to do the same and take it a step further. Ask yourself: Am I up to the challenge if someone selects me as their designated caregiver? If not, what’s missing? Do I take care of myself as well as I would take care of them? Am I skilled at going home to myself?

If you honestly believe you’re up to the challenge, your New Year’s resolution may focus on helping you remain at this level. If there’s even a flicker of doubt, your resolution may focus on removing that doubt, one small change at a time. Otherwise, you will place at risk the care of someone who trusts, respects and admires you.

We benefit in three ways when we keep resolutions. We prove that we have the power to change. We prove that we can depend on ourselves by keeping our word. And we benefit from the positive changes those resolutions bring into our lives. I’m interested in learning from your successes and challenges. Would you share your experiences by writing to me at priorities@aacn.org?

Letter to the Editor

I recently attended “Waves of Wisdom” [an AACN Coast-to-Coast Chapters educational event] in Orlando, Fla. and was motivated by the “Powered by Insight” lecture, presented by Mary Fran Tracy, RN, PhD, CCRN, CCNS, FAAN [immediate past AACN board president], to write this letter to promote the excellence at my workplace. I also felt encouraged by the nurses at Waves of Wisdom who asked how my unit increased the number of CCRNs.

I work in the Coronary Intensive Care Unit at Holmes Regional Medical Center, Melbourne, Fla. Our unit recently celebrated completion of a new building, the addition of new equipment and our enhanced work environment … along with the challenge of becoming a stroke unit in a new stroke center, with a variety of new patients. With technological advances and shorter ER to cath lab times, we have fewer MI patients, which is great; however, we are seeing more pneumonia, venous thrombosis with TPA from specials, surgical, uroseptic and hyponatremia, which has been quite challenging. Included in this challenge is the transition of additional staff to complement our growth.

We, through insight, looked at our challenge and turned it into growth and excellence in knowledge through true collaboration. Approximately one year ago the process of striving for excellence started with a CCRN review by Cammy House-Fancher. This two-day course was filled with knowledge, encouragement and laughter. It was the cornerstone of the CICU’s challenge and continued with small groups studying together in preparation for the CCRN exam. Slowly, changes began to occur. One nurse would take the test and return to share the experience and mentor those who were about to take it. Materials would be discussed and shared, as well as insights on what tools to buy. Linda Wiley, a dayshift charge nurse, prepared a guide filled with information and formulas that was incredibly helpful.

The additional patients led to growth in knowledge and experience, and, as Mary suggested in her speech, we linked experience and knowledge. We were seeing examples of true leadership in our staff including tremendous collaboration. Our manager, Yuri Mykoo, also took the CCRN exam. We began with nine CCRN-certified nurses out of 32 staff and added nine more CCRNs. How awesome it is to have seen this success!

I have been an RN for 16 years, with nine of those years in the CICU. I feel so proud of our unit for all that we have accomplished. Through our challenges we “strived for excellence” and achieved it.
Johnna Brockell, RN, AS, CCRN, FCCN
Space Coast Chapter member
Satellite Beach, FL

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