Nursing’s challenge: The call for transformation



Nursing’s challenge: The call for transformation



Learning outcomes


After studying this chapter, students will be able to:


• Describe the relationship between taking responsibility for one’s life and self-care.


• Describe the major challenges facing the profession of nursing.


• List ways that nurses can protect the image of nursing.


• Describe how incivility escalates along a continuum.


• Explain how nursing’s role in caring for the environment is related to health.


• Describe four major components of the American Nurses Association’s Health System Reform Agenda.


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To enhance your understanding of this chapter, try the Student Exercises on the Evolve site at http://evolve. elsevier.com/Black/professional.


“Make new friends but keep the old, one is silver and the other gold.” Many young girls learned this little song in Girl Scouts and remember it to this day. Some of you probably did, or maybe you heard your sisters sing it (and now, being reminded of it, have it stuck in your head!). Although not exactly a musical masterpiece, its message is an important one in a time of change: Keep what is valuable and move forward (Figure 16-1).


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FIG 16-1 “One is silver and the other gold.” We can honor the best of our past and traditions, yet transform nursing to meet the exciting challenges of the changing times. (Photo used with permission from iStockphoto.com.)

Chapter opening photo from istockphoto.com.


Nursing is a profession steeped in tradition yet responsive to the changing world around us. Nurses such as Lillian Wald and Isabel Hampton Robb were heroes, and their legacies continue today. Yet the work of nursing today rarely feels heroic; sometimes it just feels like the hard work that it is. Often, nurses are referred to as “unsung heroes” of health care. A recent project in the United Kingdom, “Unsung Heroes,” is an oral history and arts project that honors the lives of nurses who trained or worked at the Royal Infirmary of Edinburgh in Scotland (http://talesofthings.com/totem/group_view/55). The researchers in this project have created art pieces (Figure 16-2), usually in the form of a type of nursing badge (known as nursing pins in the United States), based on the stories of the nurses from this esteemed hospital that dates back to 1729, almost 50 years older than the United States.


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FIG 16-2 From the “Unsung Heroes” Project, artist Stacey Bentley created this badge that symbolizes the story of Nurse Annette Barwick, a charge/triage maternity nurse at the Royal Infirmary. Nurse Barwick related her pride in her nursing caps, first wearing disposable paper caps as a student (represented at the top), then getting the blue stripe on her nursing cap at graduation (in the middle), and finally receiving her “real” cap with a stripe at graduation (bottom). This project honors the material traditions of nursing. (Artwork courtesy Stacey Bentley; Courtesy of NHS Lothian and Ginkgo Projects, funded by the Heritage Lottery Fund, photo: John McGregor.)

Heroes—sung and unsung—create change. Those “sung heroes” created large changes that have been sustained over time. Unsung heroes carry out the small changes that, collectively, are transformative. Throughout this book, the word “transformation” has been used several times, including in the titles of both the first and last chapters. Transformation refers to a complete change, a metamorphosis. It is a word laden with possibilities. So is the future of nursing.


You have learned about several papers, books, and policy statements that call for the transformation of nursing in response to the complex needs of society today. In this short chapter, you will be presented with challenges for transformation in nursing that move from the individual—you—to the global. A common aphorism is “Change begins at home.” Change has to start somewhere. Why not with you?




The challenge: Care of self


Nurses face the same stressors as do other members of society. Many nurses enter the profession at a time when they are also of age to become parents. Older nurses face the common situation of the “sandwich” generation. This refers to people from 40 to 60 years of age who face both caring for their own children and providing care for their elderly parents. Family is usually one’s priority over work and career, although the economic reality is that most nurses need to continue to work even though the demands of their families are high. This is very stressful and makes concentrating on one’s work difficult. The link between employment and health insurance coverage is often the reason nurses remain in the workplace despite the needs of their families.


Nursing itself is stressful, as you no doubt know. Nurses bear heavy responsibilities that they take very seriously. There is no question that nurses save lives in ways that cannot be fully appreciated. The works of Aiken and of Buerhaus, both mentioned at different points throughout this book, have shown consistently that registered nurses (RNs) make a profound difference in the quality of care of patients in hospitals. Although the recent economic downturn eased the nursing shortage somewhat by keeping nurses employed, the aging of the workforce and the increasing need for professional nurses will create a shortage of nurses in all 50 states by 2015 and a shortage of one million nurses nationwide by 2020 (American Association of Colleges of Nursing, 2012).


These dire predictions, the hard work of nursing, and the economic and family stresses that nurses often experience can lead to any number of responses, some healthier than others. Selye, who described the body’s response to stress as the general adaptation syndrome, recognized that unresolved stress over time eventually changes one’s body as it attempts to restore homeostasis. Selye noted, “Every stress leaves an indelible scar, and the organism pays for its survival after a stressful situation by becoming a little older” (Selye, n.d.).


You can probably describe the basis of nursing as caring, citing theorists, books, and papers that support this key concept in nursing. Caring for yourself is foundational to being able to care for others, whether it is professional caring in nursing or personal caring for your friends and family. More than 10 years ago, Carolyn Cooper, PhD, RN published a unique text The Art of Nursing: A Practical Introduction (2001) that shows its readers that foundational to caring for others is caring for oneself. Noting that “Nursing teaches hard lessons” (p. 250), Cooper identifies the challenges to self-care for nurses: burnout, professional dynamics, and personal responses to nursing. Notably, what she does not do is create a standard formula for doing those activities that you can read in any self-help book or website: exercise, sleep, eat well—today’s almost clichéd recipe for “taking care of yourself.”


Importantly, what Cooper does do is challenge nurses to pay attention to “environmental challenges that may be depleting” (p. 256). By paying attention, you can name specifically what is depleting you, what can be done about it, and then act on it. What you do is not as important as doing something, thereby positioning yourself to take care of yourself (p. 256). By acting, you are no longer victimized by those things over which you have no control, and you bring to the forefront those things that you can control. You now are making informed choices—and are taking responsibility for those choices. Here is an example:



Alan is a nurse with 2½ years’ experience in critical care; he has developed excellent assessment skills and is known for being calm under pressure. He has taken advanced life support training, and at every opportunity attends classes, conferences and has joined his professional organization. He has gotten the reputation for being a “superstar” on his unit. His dream job gets posted: There is an opening on the flight team. Alan applies and “aces” his interview. He is not hired. He described his response, “I was really mad and took it out on my colleagues for a few days. I was going to quit, I was going to sue, you name it. Then a colleague told me to get over myself and go find out why I wasn’t hired. So I did.” What he learned was that despite his excellent credentials, he had one fatal flaw: he had developed the reputation for being somewhat arrogant and a “hot head.” Alan took this feedback and wrestled with its implications. He could take charge of his responses to stressful circumstances, which he did. Although he is not yet completely “mellowed out,” he has used this humbling experience to take responsibility for his actions. He still wants to be a flight nurse someday.


According to Cooper (p. 257), Alan used this situation to assess his vision of his career and what influenced his career, and he acted accordingly. Knowledge of self is a form of self-care. This allows you to understand changes both in yourself and in the profession of nursing. Change can be difficult, and successful adaptation to change “entails abandoning the hope of always controlling work-related changes, accepting the reality that change is inevitable, tolerating the unpredictability of the future” (p. 257), which can lead to creative problem solving rather than being a victim of one’s circumstances.


Using this view of self-care, exercising, sleeping, and eating well are healthful responses to true caring for one’s self. They are important to your health, which in turn will allow you to be more effective in all of the roles you fulfill in your life—as a nurse, a parent, a daughter or son, and a friend. Your patients will benefit from your choice to take care of yourself.



The challege: Care of the profession


Joining professional organizations


As you have read the previous chapters, you have been introduced to some of the most pressing challenges to nursing today. One of the key problems, and one that you can address easily, is the lack of involvement of nurses in professional organizations and the American Nurses Association (ANA) through your constituent state organization. Professional organizations such as the Association of Nurses in AIDS Care, American Association of Critical-Care Nurses, and Association of Women’s Health, Obstetric and Neonatal Nurses, among others, provide up-to-date information about the state of the clinical practice area in which you work or are interested. These organizations provide many outlets for keeping up with the latest developments, through conferences, webcasts, position papers, websites for members only, and journals. Although there are annual dues, the work of these organizations pays off in keeping you involved and current in your practice.


The ANA and its constituent members at the state level is the official voice of nursing. The code of ethics, scope and standards of care, and articulation of nursing’s social policy are developed and advanced through the ANA. As the official voice for nurses, the ANA publishes position papers on a wide variety of issues and topics and has a political action committee that raises funds from constituent member association members and contributes to political candidates at the federal level whose views of health care legislation and regulation are consistent with those of the ANA. Only 10% of the 3 million RNs in the United States are members of the ANA’s constituent organizations, meaning that nurses are silencing their own voices by not participating in the work of this organization dedicated to the profession.



Protecting the image of nursing


Care of the profession also means that as a nurse, you become aware of the image of nursing in the media and respond appropriately to both negative and positive portrayals of nurses. The Truth about Nursing, discussed in Chapter 2, is a campaign dedicated to “changing how the world thinks about nursing” (www.truthaboutnursing.org). This is a “watchdog” organization that keeps the image of nursing front and center in its mission. They recently featured a “naughty nurse” stereotype—a highly sexualized and demeaning portrayal of the profession—by the NBA Dallas Mavericks dancers, who danced at half time in revealing “naughty nurse” costumes complete with nurses caps, to the tune of an old song that begins “doctor, doctor . . .” Two recent examples of a more insidious negative view of nursing involve the use of the phrase “nursing secrets” on a popular television show hosted by a physician and in a popular magazine. This trivializes nursing knowledge as a list of “tips” rather than substantive science that promotes wellness, prevents serious complications, and otherwise improves lives.

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Mar 21, 2017 | Posted by in NURSING | Comments Off on Nursing’s challenge: The call for transformation

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