As nurses, are we still in our adolescence? - perioperative nursing - Editorial

AORN Journal, July, 1997 by Beverly P. Giordano

Tim Porter-O'Grady, RN, EdD, PhD, CNAA, CS, FAAN, stated during Closing Session at Congress, "It's time for nursing to move from adolescence to adulthood."(1) What did he mean? How do we feel when someone essentially tells us to "grow up"?

HALLMARKS OF ADOLESCENCE

During the transition from childhood to adult life, adolescents mature from focusing primarily on the present to considering the future implications of their current actions. Young adolescents have limited capacities to see beyond simple solutions to complex problems, whereas older adolescents develop tolerance for ambiguity and begin to recognize that many issues have multiple causes and interrelationships.(2) This psychological maturation is not achieved without some degree of angst--adolescents question everything, they are argumentative, and they challenge parental authority as they learn conflict resolution skills.

As nurses, are we still in our adolescence? Do our responses to recent health care changes reflect adolescent or adult attributes? Are we focusing primarily on the present? Are we demanding simple solutions to complex problems? Are we questioning everything, being argumentative, and challenging all authority as we react to these changes? Are we misdirecting our anger and lashing out at each other, as angry adolescents often do? A nurse researcher who has studied stress, anger, and depression writes,

Unfortunately, nurses'

anger is often managed

ineffectively, undermining

rather than empowering

us.... One of the most

lethal manifestations of

nurses' misdirected anger is

horizontal violence (eg,

faultfinding, backbiting,

needling, name-calling)....

In times of fear, nurses put

their wagons in a

circle--but start firing at each other.(3)

CHARACTERISTICS OF ADULTHOOD

During adulthood, individuals learn to pursue careers, assume civic responsibilities, find congenial social groups, establish and maintain economic standards of living, develop adult leisure-time activities, and accept and adjust to physiologic changes of aging. Transitional periods in adulthood are marked by self-inquiry and reassessment of past choices and resulting consequences--especially personal relationships and career choices. Adults typically emerge from these transitional periods with different perspectives toward life.(4)

TRANSITION TIME FOR NURSING

If we agree that it is time for nursing to move from adolescence to adulthood, how can we make this transition? Dr Porter-O'Grady believes that this passage involves

* seeing health care delivery changes in a broad context;

* moving from jobs to roles; moving from responsibility to accountability;

* moving from conflict to collaboration; moving from entitlement to contribution; and

* applying the principles of partnership, accountability, equity, and ownership.(5)

Melanie C. Dreher, RN, MSN, CPNP, FAAN, international president of Sigma Theta Tau, echoes this advice on making the transition in nursing. She writes,

If we, as nurses, want the

public to think of us as

expert blood hangers, IV

starters, pulse takers, [and]

dressing changers, then we

should continue to argue

for the exclusive right to

do these things. But if we

want citizens to think of us

as the professionals who

will provide education,

guidance, advocacy and

comfort, based on scientific

research, in their most

desperate times and

through their most treacherous life events,

then we

have to send a different

message.(6)

A national speaker urges nurses to adopt a more all-encompassing perception of what we have to offer to patients and health care delivery. He warns,

When we identify ourselves in

terms of what we do instead

of who we are, we become a

human doing instead of a

human being.... We are not

paid by the hour. We are

paid for the value we bring to

that hour.(7)

TRANSITION TIME FOR PERIOPERATIVE NURSING?

How can the perioperative nursing specialty make the transition from adolescence to adulthood? The comprehensive perioperative nursing practice model introduced at this year's Congress meets some of Dr Porter-O'Grady's transition criteria (eg, viewing health care delivery changes in a broad context; emphasizing roles rather than jobs and accountability rather than responsibility, focusing on collaboration, partnerships, ownership). Past President Linda K. Groah, RN, MS, CNOR, CNAA, described the model as being,

designed to provide options

for people who want

direction if they either desire

or are forced to move along

the continuum of

perioperative patient

care....It expands beyond

what we started out as

because our patients need

more from us now than when

we first entered nursing.(8)

The Nursing Practices Committee will continue working on the model. They need to hear your opinions about the model and its potential implications for the perioperative nursing specialty. See the notice at the bottom of this page for instructions on submitting your comments about the model.

ARE WE READY?

As rebellious adolescents, we challenged the status quo--just because it was there. As adults who represent a profession and various nursing specialties that are moving into adulthood, we must be more selective in what we challenge.