President’s Column: Unstoppable Nurses Know When to Stop

Mar 02, 2020

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A household with teenagers unlocks a whole next level of parenting. Fortunately, I have two pretty good kids who strike a good balance between keeping me on my toes and allowing me to enjoy who they are becoming.

However, teaching a teenager to drive changes everything. I was blindsided with this challenge. After experiencing a six-hour wait at the Department of Motor Vehicles (DMV) for a learner’s permit for my daughter, I knew there was no turning back.

As my daughter pulled the car out of the DMV lot and approached a four-way stop, she slowed down and looked both ways but performed what I call a Hollywood stop. The wheels were still turning; she did not come to a complete stop! I challenged her decision. She replied that, since nobody else was at the intersection, a full stop didn’t seem necessary. To a teenager, the clear, obvious stop was unnecessary. But for a mom, with years of driving experience, a full stop adds an element of safety that may not be explicit in a driver’s handbook. (Deep breath.) This is why teens have learners’ permits — they’re still learning.

That experience, combined with AACN’s theme, “Unstoppable,” got me thinking: We can’t always be unstoppable. In nursing, when must we stop? Sometimes there are clear distinctions when we must stop, to prevent harm to a patient, ourselves or colleagues. But, there are also scenarios when we must stop, although it is not laid out precisely in a policy, guideline or best-practice example. It is not always as clear as a large red stop sign.

One example is the pre-procedural pause. How often do we pull a Hollywood stop, even though the sole intent of that stop is ensuring patient safety? What about the many workarounds that we perform in acute care? There is wisdom in knowing when to pause or stop, and not just plow ahead to try to fix what is broken.

Sometimes, we may need a pause to clear our head; to say no to an extra shift so we can sleep and recharge; to speak up to stop a colleague from working eight shifts in a row and risking the safety of patients and nurses alike; to stop violence in our workplaces in whatever form it takes; to ask a family to pause and discuss their loved one’s prognosis, and help them understand that stopping care may be reasonable and humane; or, at the end of a patient’s life, taking time for a beautiful pause created by Jonathan Bartels at the University of Virginia, when the team pauses together for a moment to honor the life of a patient who has just died.

As hard as it is to slow down or stop in our hectic day-to-day lives, don’t we have an accountability to speak up when we see that being “stoppable” is sometimes the best approach? Those may be uncomfortable conversations, especially if something isn’t initially obvious. Do you remember a time when you stopped and the steps you took after? Tell me at