NURSE POWER: FIND IT, KEEP IT, GROW IT, SHARE IT! - INTRODUCTION

Nursing is a dynamic and ever changing field. The millennium has brought a flood of new technologies and new challenges to the nursing profession. This book was written to unite, inspire and illuminate the stories of nurses working in the current healthcare industry. Within their stories, they’ve shared their advice, their coping mechanisms, and insights by sharing their experiences. All of the nurses interviewed work from the perspective of personal power and a desire to work for the good of all their patients.

With the advent of electronic medical records, technology that assists safe prescribing practices, outsourcing, and corporate takeovers of small medical practices, the world of nursing has been turned on its head. The good news is that today, more than ever, there is growing diversity in the nursing corps. More men are joining the ranks, a new influx of immigrant nurses are playing a strong role, Bachelor’s and Master’s Degree entry nurses are finally pursuing their heart’s desires later in their careers, and nurse practitioners are operating their own clinics.

The biggest challenge the medical field will be facing in the coming years is directly related to the general populations’ ever increasing need for medical care. Whether in the areas of Hospital Inpatient Care, Ambulatory Care, Nursing Home Care, Home Health Care, Hospice Care, or Preventive Care the demands placed on our healthcare providers in the coming years will be tremendous. The need for nursing services is increasing and the issues nurses contend with will only become bigger. Leadership and management are working hard to create solutions to these challenges with the institution of on-call traveling nurses, outsourcing, and 12 hour shifts, but these solutions are neither cost effective nor human effective. Finally, no crystal ball is needed to predict what is about to happen to the health care industry, the quality of care patients receive, and the costs they will pay if the industry continues on in this downward direction.

With every challenge comes opportunity. I believe nurses, when trained to operate from a common set of interpersonal skills and a sense of purpose and direction, can become the powerful force needed to change the face of healthcare. With the right training, they can make a difference, wherever healthcare is being delivered. Together, they can create the kind of work place where the staff feels nourished, new hires can flourish, and other professionals are welcomed. These skills can be taught and it will take a personal commitment from each of these professionals to create, invite, conduct, and sustain this change. Dollars are plentiful for this type of training but medical staff simply doesn’t have the time to take part. They need faster ways of training so that they can “get it” and move forward. The layout of this book is based on this need for time efficient training.

I realize many organizations offer communication and leadership style workshops in an attempt to teach employees how to better relate to others. Course outcomes are frequently tied to employee and patient satisfaction and performance evaluations. These are great, but they don’t go far enough. They need to be presented as fundamental to learning more about oneself. Ultimately, if you don’t know who you are and don’t respect your own needs, how in the world can you expect anyone else to know and respect you?

The development of nurse identity is reflective of how nurses see themselves personally and professionally. For example, their identities can be affected by non-billable status, gender bias, a label of angel, and a persona of mother. These points lead to a ”one-down” or “secondary” status in the leadership decision-making model.

The reality is that we expect nurses more than any other health care provider to limitlessly care for and care about others no matter what they have to endure. No one can maintain a positive team attitude in the face of total disregard. Yet these nurses are taught to “buck-up”, measure your worth by your stamina, “break” in new nurses, and in the process, they also leave their jobs at a rate of 60% in their first year.

It doesn’t take a rocket scientist to do the math. Compare the demographics of the nursing population to the aging population. What is predicted is the worst shortage of healthcare workers, specifically nurses, which the health care industry has seen. The whole society has been changing, patients are more self-centered, less empathetic, and more demanding and nurses are in for a very stressful future if immediate action is not taken to remedy these situations.

My intention is not to perpetuate a conversation about what’s not working, but to reach out to individual nurses, discuss the nursing profession and its inherent dignity, as well as to provide tools for leaders to take charge. I am proposing a wholeness approach to reclaim the nurses who have left the profession, to re-inspire those who are bedraggled, and empower new nurses to make the workplace a professional and healthy environment.

The ability to fix “it” resides in each of you. The situation can no longer be framed within an environment of fault and blame. Critical thinking and communication are the key skills to getting problems identified and handled with the utmost respect. I’m talking about a change that starts with the premise of assessing and valuing the contribution of nurses. Nurses are not angels, minions, or servants. This seems so fundamental, but the effects of these limiting attitudes are pervasive. Nurses are evaluated by the shared professional mandate of patient safety and care in all circumstances. That sometimes means that their own personal needs are of little consequence in the meeting of the mandate. They may not even notice, and worse, they may not be aware of how they are actually perpetuating this expectation. These professional healers need to ask themselves where their role ends, and where someone else’s begins. They also need to ask who is in charge of them, and where their own focus of control lies. Nurses have to comply with the rules….and yet, there is often flexibility in some areas of these organizations that allow them to start making strides toward wholeness and balance. Getting to the truth of where the flexibility lies can help nurses retain and gain empowerment over their working environments.

Between February and November 2006, over 100 nurses spent time with me to reflect on their past achievements, challenges, and hopes and dreams. I asked them to contribute their stories in hopes of creating a better vision for the future of healthcare.

The pages that follow tell their stories. There are nurses who have risen above the perils of the profession and followed their own path. Some trembled with emotion, literally, when they talked about why nursing is meaningful to them, I am still not sure if this was from fear, sadness, hope or if they just felt they weren’t permitted to express their feelings on this subject. Others breathed so shallowly that their words went skittering across the conference table like pebbles. There are stories of nurses who have transcended all the hierarchy, regulations, and focus on minutia in order to touch their own souls, their patients, and their colleagues. Those interviewed were all career nurses, who having been living with this medical model for 15, 20, even 30 years. In my mind, no one story is more important than another. Each story presented an intersecting point in the web of lives that creates this picture of the nursing profession.

Together these stories have revealed the power of nursing. They have also illuminated 11 points of pressure that appear to be consistent stressors within the workforce.

These points include:

• values conflicts


• power struggles with leadership


• educational hierarchy


• physical and productivity demands


• inadequate staffing levels


• lateral oppression and bullying


• interpersonal, leadership


• work and life balancing skills deficits


• the changing face of patients, allied health care providers, and physicians


• The influx of immigrant nurses


• society’s views and value of women


• the gender shift within the profession.

It also became clear that what was missing from the picture they shared was the landscape of self-identity and acknowledgement of what patients, administrators, and the profession as a whole commanded from them.

The following stories are arranged according to the eight motifs that the nurses themselves brought to the surface. These themes became the organizing outline for the chapters in this book. The interviewees agreed that the key to nursing is critical thinking. They also expressed the belief that finding a niche in nursing requires imagination, creativity and perseverance.

Through their stories nurses identified the following themes:

• Nurses are the eyes and ears of the doctor.


• Nursing is all about reaching out. The power of nursing is in the hands. That feel and touch can heal.


• Nursing is all about heart, empathy, connecting, and respecting.


• Others have said they personally are the voice of nursing and vocal advocates for the patients, their families, for other nurses and the nursing profession as a whole.


• Other stories share experiences of taking a stand, in spite of being afraid of the consequences for the sake of justice, respect and dignity. They shared tales of courage, integrity and the importance of having a strong backbone.


• And lastly, there were nurses who said that nursing is their form of spiritual connection, however that can be defined.

I’ll be writing directly to you whatever part you play in the medical profession of nursing.

If I, as your future patient, have any hope of being healed you must take action now to build your leadership skills so you can take your place at the policy table, surgical table, and bedside; in our community meeting rooms, our homes, the school room, and every other venue in which you practice the art and science of your chosen field as a whole being.

I believe that you all realize that the medical model as we know it is at the breaking point and you can and need to make the changes necessary to bring this transformation a reality. That’s right, YOU! Time is of the essence and I ask you to realize that your dissatisfaction with your profession is probably not only about wages. I think that it probably is about your desire for more tangible evidence of respect, dignity, safety and personal sovereignty for your selves and for your patients. Sovereignty is all about self-authorizing and establishing personal sanctity within your chosen boundaries; as well as taking ownership of your negotiating power. Defining your own power and taking personal responsibility for it can free you to see new opportunities. Understanding where this power comes from, how to get it, keep it, and how to use it so that you and others can benefit from your insight is what this book is all about.

These stories contain moments of inspiration, ideas for personal motivation and practical advice, from one nurse to another. I provide information, tools and exercises to help you explore your thoughts, goals, and dreams. You can do this work on your own and I have designed the exercises so that you can do them during your 30 minute in-services. I encourage you to take time to focus on your own personal development, to be accountable for getting what you need to learn and grow, and to start talking with each other and begin the journey toward a better medical model.

Never doubt that a small group of thoughtful, committed citizens can change the world. Indeed, it's the only thing that ever has - Margaret Meade
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