AORN JOURNAL
MARCH 1992, VOL 55, NO 3
President’s Message Fidelity, nursing, and ‘the great white lie’
hen will it change? Images that people have about individuals involved with health care in our country-nurses, physicians, administrators, health care regulators, insurers, attorneys, and anyone else remotely connected with “the system”-continue to be dismal. Last summer, some legislators and the media convinced many people that they were sure to catch acquired immune deficiency syndrome (AIDS) simply by going to the hospital or physician’s office. The fear factor was fanned by the public’s perception that it had been deceived about the safety of silicone breast implants. What became of the trust that our citizens had in health care and its providers? The latest trial, conviction, and sentencing of the health care system is presented in The Great White Lie: How America’s Hospitals Betray Our Trust and Endanger Our Lives, by Walt Bogdanich. The title alone indicts hospitals and those who work in them. It took me a while to read the book because the stories in it made me sick at heart and angry that these things occur in our health care system. At times, I had to put the book down to reflect on what it meant to me. I felt betrayed by my health care colleagues. How could they let this happen? The trouble is, I know these stories are true because I have heard of similar instances throughout my career. And you have too. I have heard about terrible tragedies from medication errors; equipment malfunctions; overworked, exhausted nurses; incompetent surgeons; and inadequately trained staff members who are expected to do what they are not 700
qualified to do. Bogdanich describes our health care system as one of the “great white lies” in which “hospitals and doctors are equally good and deserving of our complete, unquestioning trust.”’ He left no segment of the health care professions unscathed. The tale begins by describing derelict nurses who work as permanent and temporary staff members, providing care during the time of increasing nursing shortages while hospitals, agencies, and state boards ignore their addictions and incompetence. He accused administrators of failing to deal with causes and effects of the nursing shortage. During the last decade, the burgeoning temporary nurse agencies have become the stopgap answer to staffing problems. He talked of the travesty of one nurseowned agency whose director was so seduced by greed that “nurses” sent to ease the nursing shortage were not licensed and, in some cases, were not even nurses. Another chapter described the investigation of an unusual epidemic of deaths in an intensive care unit. Many of the deaths had a common denominator4ne nurse. Even though she was not convicted, this tale left a strong taste of mistrust and anxiety that is easily generalized by the public to all health care professionals. What happened to the notion of fidelity, of commitment to our patients? What of the promise we made to care for them and to protect them from harm? What can we do as perioperative nurses to foster and, in some instances, regain the trust of our patients? I believe that fidelity, the commitment,
AORN JOURNAL
begins with each of us. Attaining and maintaining competence is one of the primary responsibilities that we have as professional nurses. Our licenses to practice nursing are only the beginning of competency. For new and returning nurses, it also involves a transition into the work setting by participating in a preceptorship, internship, or intensive orientation. For nurses in clinical settings, it means staying current in their practice areas, learning about new procedures and surgical technology, and participating in in-service and continuing education activities. It means having the courage to say that they have not used a particular piece of equipment before and need some instruction before they can competently participate in the procedure. Nurses protect patients from harm and injury by following recommended practices and reporting unsafe occurences. Competency also is projected by the image that we present to our physician colleagues and patients. Professional image is more than how we look; it is the demeanor we display and the way we interact with other people. Nurses in management create the environment that fosters fidelity to patients. They provide a safety net when employees are faced with difficult situations, such as coping with abusive behavior. How are advanced directives followed when patients come for surgery? Do we honor the trust they have placed in us? Do we keep our promises to respect their wishes and their autonomy as persons? With new reimbursement methods for surgical services a reality, many perioperative nurses have already begun to feel the indirect effects of this change through demands to increase productivity by participating in more surgeries. The potential for cutting corners and looking the other way is always present. Our fidelity to patients can get lost in the midst of pressures to participate in more surgeries, cut costs, and contend with an avalanche of paperwork, meetings, and regulatory requirements. Take a few moments to revisit the promise and commitment you made to your patients. Talk about it with your nursing colleagues. It sometimes helps to reach for the reason we 702
MARCH 1992, VOL 55, NO 3
became nurses-to care for other human beings who are sick or suffering. Reconnect with the humanness of nursing, and convey that to your patients through competent, caring, nursing activities. For me, that is an essential component of my nursing practice. During the past year, I have maintained my fidelity and commitment to the members of AORN. I have met my goal to represent you as President with pride and competence, and I have always tried to project a professional image. Let us continue to work together as an Association to foster and regain the trust that our patients and the public have for the profession of nursing. JEAN M. REEDER, RN, PHD, CNOR LIEUTENANT COLONEL, ARMYNURSECORPS PRESIDENT Tne opinions or assertions contained in this article are the private views of the author and are not to be construed as ofJicial or as reflecting the views of the US Army Medical Department or the Department of Defense. Note 1 . W Bogdanich, The Great White Lie: How America’s Hospitals Betray Our Trust and Endanger Our Lives (New York City: Simon & Schuster, 1991) 29.
MARCH 1992, VOL 55, NO 3
President’s Message Fidelity, nursing, and ‘the great white lie’
hen will it change? Images that people have about individuals involved with health care in our country-nurses, physicians, administrators, health care regulators, insurers, attorneys, and anyone else remotely connected with “the system”-continue to be dismal. Last summer, some legislators and the media convinced many people that they were sure to catch acquired immune deficiency syndrome (AIDS) simply by going to the hospital or physician’s office. The fear factor was fanned by the public’s perception that it had been deceived about the safety of silicone breast implants. What became of the trust that our citizens had in health care and its providers? The latest trial, conviction, and sentencing of the health care system is presented in The Great White Lie: How America’s Hospitals Betray Our Trust and Endanger Our Lives, by Walt Bogdanich. The title alone indicts hospitals and those who work in them. It took me a while to read the book because the stories in it made me sick at heart and angry that these things occur in our health care system. At times, I had to put the book down to reflect on what it meant to me. I felt betrayed by my health care colleagues. How could they let this happen? The trouble is, I know these stories are true because I have heard of similar instances throughout my career. And you have too. I have heard about terrible tragedies from medication errors; equipment malfunctions; overworked, exhausted nurses; incompetent surgeons; and inadequately trained staff members who are expected to do what they are not 700
qualified to do. Bogdanich describes our health care system as one of the “great white lies” in which “hospitals and doctors are equally good and deserving of our complete, unquestioning trust.”’ He left no segment of the health care professions unscathed. The tale begins by describing derelict nurses who work as permanent and temporary staff members, providing care during the time of increasing nursing shortages while hospitals, agencies, and state boards ignore their addictions and incompetence. He accused administrators of failing to deal with causes and effects of the nursing shortage. During the last decade, the burgeoning temporary nurse agencies have become the stopgap answer to staffing problems. He talked of the travesty of one nurseowned agency whose director was so seduced by greed that “nurses” sent to ease the nursing shortage were not licensed and, in some cases, were not even nurses. Another chapter described the investigation of an unusual epidemic of deaths in an intensive care unit. Many of the deaths had a common denominator4ne nurse. Even though she was not convicted, this tale left a strong taste of mistrust and anxiety that is easily generalized by the public to all health care professionals. What happened to the notion of fidelity, of commitment to our patients? What of the promise we made to care for them and to protect them from harm? What can we do as perioperative nurses to foster and, in some instances, regain the trust of our patients? I believe that fidelity, the commitment,
AORN JOURNAL
begins with each of us. Attaining and maintaining competence is one of the primary responsibilities that we have as professional nurses. Our licenses to practice nursing are only the beginning of competency. For new and returning nurses, it also involves a transition into the work setting by participating in a preceptorship, internship, or intensive orientation. For nurses in clinical settings, it means staying current in their practice areas, learning about new procedures and surgical technology, and participating in in-service and continuing education activities. It means having the courage to say that they have not used a particular piece of equipment before and need some instruction before they can competently participate in the procedure. Nurses protect patients from harm and injury by following recommended practices and reporting unsafe occurences. Competency also is projected by the image that we present to our physician colleagues and patients. Professional image is more than how we look; it is the demeanor we display and the way we interact with other people. Nurses in management create the environment that fosters fidelity to patients. They provide a safety net when employees are faced with difficult situations, such as coping with abusive behavior. How are advanced directives followed when patients come for surgery? Do we honor the trust they have placed in us? Do we keep our promises to respect their wishes and their autonomy as persons? With new reimbursement methods for surgical services a reality, many perioperative nurses have already begun to feel the indirect effects of this change through demands to increase productivity by participating in more surgeries. The potential for cutting corners and looking the other way is always present. Our fidelity to patients can get lost in the midst of pressures to participate in more surgeries, cut costs, and contend with an avalanche of paperwork, meetings, and regulatory requirements. Take a few moments to revisit the promise and commitment you made to your patients. Talk about it with your nursing colleagues. It sometimes helps to reach for the reason we 702
MARCH 1992, VOL 55, NO 3
became nurses-to care for other human beings who are sick or suffering. Reconnect with the humanness of nursing, and convey that to your patients through competent, caring, nursing activities. For me, that is an essential component of my nursing practice. During the past year, I have maintained my fidelity and commitment to the members of AORN. I have met my goal to represent you as President with pride and competence, and I have always tried to project a professional image. Let us continue to work together as an Association to foster and regain the trust that our patients and the public have for the profession of nursing. JEAN M. REEDER, RN, PHD, CNOR LIEUTENANT COLONEL, ARMYNURSECORPS PRESIDENT Tne opinions or assertions contained in this article are the private views of the author and are not to be construed as ofJicial or as reflecting the views of the US Army Medical Department or the Department of Defense. Note 1 . W Bogdanich, The Great White Lie: How America’s Hospitals Betray Our Trust and Endanger Our Lives (New York City: Simon & Schuster, 1991) 29.
