Be of good courage - Guest Editorial - surgical nursing

Jane Rothrock

Perioperative nurses may be ordinary people, but they are extraordinary nurses. During Perioperative Nurse Week, Nov 10-16, 2002, we celebrate our specialty and all that is good in our profession. Throughout history, we, as perioperative nurses, have refused to lower the bar on our professional practice standards. We have tackled difficult issues with collective energy and wisdom. We have politely declined offers from others to step in and solve our problems--and worked them out for ourselves.

HEALTH CARE AS A TEAM EFFORT

One of the recommendations made by the Robert Wood Johnson Foundation regarding the current nurse shortage suggests reinventing work environments. (1) In part, there is a clarion call to foster cooperation among disciplines and place a high priority on health care as a team effort. In perioperative practice settings, the team is the essence of care delivery.

Perioperative nurses do not create professional silos. We have always worked in a culture of teamwork. We have a shared mission with our professional colleagues (ie, excellent patient care). We help each other as nurses, and we help the team achieve the best possible outcomes for the patients in our care.

We also understand the importance of helping novice perioperative nurses. Each of us can point to perioperative nurses who helped us early in our careers. Whether they were called buddies, preceptors, or mentors, these nurses helped us learn the work and values of perioperative patient care.

During emergencies, trauma, or national disasters, we each help our neighbor nurses. We can work tirelessly without food, sleep, or a break during such events, for we are like Milton's character in Paradise Lost. "Care sat on his faded cheek, but under brows of dauntless courage." (2)

THE QUALITY OF CARE

Care is at the heart of all nursing endeavors. Embedded in the nursing care we deliver is an organized body of knowledge, with sets of skills that relate to the science and technology of our practice.

Some would suggest that caring is an intangible part of perioperative nursing, and it is not as visible as the acts that require skill and technology. Most of us would dispute that statement, however, because caring is the core of our practice. We meet and recognize each patient as a unique individual and attempt to understand the human experience of his or her illness. We freely share tenderness, touch, and comfort with our patients. We hold a hand, dry tears, and provide a pillow and warm blanket as we engage in healing relationships. We are not just about sterilizers, instruments, and sutures. We are about caring practices that transcend aseptic or surgical technique. In the rush to be efficient, we relentlessly keep care sitting on our cheek.

ADVOCATING FOR OUR PATIENTS AND OURSELVES

Many times, market economics and cost management dictate constraints on our style of practice. In some instances, such constraints have led to collective bargaining. Historically, however, when nurses participate in a collective bargaining event, there are motives beyond mere money (ie, caring for and about patients, taking care). Consistent themes during different circumstances and different times have included poor working conditions, lack of professional respect, and inadequate salaries. Remedying each one of these components is necessary if we are to adequately and safely care for patients and take care of ourselves too.

Taking care of ourselves involves, in part, having the resources to engage in lifelong learning (ie, joining our professional association, attending some of its professional meetings). In 1918, it was noted "Nurses, we need nurses--a bleeding, wounded, sick and suffering world is calling." (3) That world still calls, and we still respond. To respond with excellence, we must have work environments that provide an orientation process, ongoing inservice programs, and other education to maintain and improve our competence and critical thinking skills.

DESIGNING OUR PATHS

"Life shrinks or expands in proportion to one's courage." (4) Each of us must live a life that allows us to expand ourselves. Life itself is a go and grow, give and get experience. Without growth, there is stagnation and a shrinking of meaning and purpose. We owe it to ourselves to take our own professional and personal inventory. Who are we as perioperative nurses? What fulfills us? What do we want from our nursing life, and what do we need in our personal life? Once we have identified those wants and needs, we have the ability to design a path to achieve them. Such a path may not be easy, but we can expand our lived experiences only if we have the courage. "Ah, yes--courage. If one only had that.... then life would perhaps be livable, after all." (5)

OVERCOMING OUR FEARS

In the perioperative nursing course I teach, each RN student must review an aspect of the history of perioperative nursing and relate it to what he or she understands to be an essential part of practice in 2002. Through the years, my analyses of student responses has revealed a stunning ability by these novice perioperative nurses to associate almost any historical area with patient advocacy. They have a clear, articulate understanding that their primary responsibility is to the patient.

That does not mean they are not afraid of not knowing the name of an instrument, how to do something, or making a mistake. During the course, we work on mastering that fear by using resources, seeking support, networking with other novice nurses, and speaking up when we need help. "Courage is resistance to fear, mastery of fear--not absence of fear." (6)

Just as the Joint Commission on Accreditation of Healthcare Organizations' "Speak-Up" campaign encourages patients to become active, involved, and informed participants in their own health care, the RN students in our program are encouraged to resist and master fear by seeking answers and being informed participants in patient care.

IMPROVING MORALE

Our state of mind guides the way we frame our work world. The business of health care combined with staff turnover and being short-staffed can affect a perioperative nurse's morale.

   Morale is a state of mind. It is steadfastness and courage and hope. It is
   confidence and zeal and loyalty. It is elan, esprit de corps, and
   determination. (7)

At the Joint Commission's meeting on the nursing shortage in May 2002, Lilee Gelinas, RN, MSN, vice president and chief nursing officer of the VHA, noted that the nursing shortage does not just affect morale; it also has an impact on the bottom line. (8) Without enough perioperative nurses, surgery is delayed or cancelled, which results in lost revenue. While the cost of recruitment and retention varies in different reports, all validate that it is financially significant. Quality of care clearly suffers when the nurse workforce is unstable with high turnover.

In the OR, we know how this affects our efficiency and productivity, as well as the safety of patient care. Doing the right thing is effective care; doing the right thing right is efficient care. With courage and determination, each of us can contribute to identifying and solving issues related to the nurse shortage. We can recreate an esprit de corps that helps improve morale in our workplaces.

With a national focus on patient safety, conditions that are central to our provision of quality care are receiving significant attention. Each of us has a zeal and passion for our work, or we would not still be doing it. We are loyal to our workplace, or we would not still be there. With courage and steadfastness, we will help prove the relationship between our ability to initiate professional nursing interventions and the resulting improvement in patient outcomes.

FINDING SERENITY

As we have done in the past, we will continue to take the helm and forge our own destiny. We will do so with wit, wisdom, and a willingness to listen as well as speak-up. As we continue to create our future, we can be guided by the Serenity Prayer, which says

   God, grant me the serenity to accept the things I cannot change, courage to
   change things I can, and the wisdom to know the difference. (9)

There are some things we cannot change right now. During past nursing shortages, we tried immediate solutions when what we actually needed was systematic research. We must maintain our serenity as we wait for more of that research. At the same time, we must be unafraid to inform the public about our worth.

Being serene is not the same as being timid. As we have done throughout history, we will work together within our work settings and within AORN to change the things we can. We do not have to summon our courage; we are and continue to be ordinary people who have extraordinary courage and resolve. That is why we are perioperative nurses. We are, indeed, of good courage.

JANE ROTHROOK
RN, DNSc, CNOR, FAAN
EDITORIAL BOARD MEMBER

NOTES

(1.) B Kimball, E O'Neil, Health Care's Human Crisis: The American Nursing Shortage (Princeton, NJ: The Robert Wood Johnson Foundation, April 2002). Also available online at http://www.rwjf.org/newsEvents/nursing_report.pdf.

(2.) J Milton, Paradise Lost, The Electronic Literature Foundation, http://elf.chaoscafe.com/milton/(accessed 9 Oct 2002).

(3.) "Nursing shortage! Nursing shortage!" American Journal of Nursing 10 (October 2000) 33.

(4.) A Nin, Quotegarden.com, http://www.quotegarden.com/confidence.html (accessed 13 Sept 2002).

(5.) H Ibsen, Hedda Gabler, Project Gutenberg, ftp://ibiblio.org/pub/docs/books/gutenberg/etext03/hddgb 10.txt (accessed 9 Oct 2002).

(6.) M Twain, The Tragedy of Pudd'nhead Wilson (Hartford, Conn: American Publishing Co, 1894).

(7.) G Gatlett Marshall, Military Review (Oct 1948).

(8.) "Recruitment and retention: The business case for a stable workforce," OR Manager 18 (August 2002) 13.

(9.) R Niebuhr, The Serenity Prayer, http://www.prayer4u.org/famousprayers/serenity.html (accessed 12 Sept 2002).

COPYRIGHT 2002 Association of Operating Room Nurses, Inc.
COPYRIGHT 2002 Gale Group