PERIANESTHESIA CULTURE
Happiness in the Work of Nursing Maureen V. Iacono, BSN, RN, CPAN THE WORKPLACE IS CHANGING. Perianesthesia nursing is not excluded from change, as change is fast paced, and all encompassing. There is no ‘‘bubble of protection’’ or isolation from the institution, as may have been the case in the past for postanesthesia care units. Some of the changes have to do with the workforce itself and the work of nursing. Other changes, and perhaps increased pressures, stem from forces outside our units or the immediate staffing matrix within the unit. There can be a sense of frustration, and loss of control over nursing practice for the individual nurse. There are often laments, spanning the issue from the pressures and workload expectations in individual nursing units, to the more broad concerns of administrative decisions and dictates. Some of these decisions seem out of touch, questionable, and even quite ridiculous. Some of the dictates are generated because regulatory bodies change requirements and conditions of participation, and institutional compliance becomes mandatory. The steps toward compliance and enforcing necessary changes can be tedious and problematic based on the existing culture of the workplace. Additionally, there is an increasingly commonplace practice in hospital systems to spend sums of money to hire ‘‘experts’’ from outside to direct changes that make little sense to the front line staff. With mounting frustrations, the question of happiness at work is a sobering one. Can the nurse find happiness, or create happiness, in the workplace and in the work of nursing in particular? We work for many reasons. We earn money and make a living, accomplish goals, and may or may Maureen V. Iacono, BSN, RN, CPAN, is a PACU Nurse Manager, St. Joseph’s Hospital, Syracuse, NY. Conflicts of interest: None to report. Address correspondence to Maureen V. Iacono, St. Joseph’s Hospital, 301 Prospect Avenue, Syracuse, NY 13202; e-mail address: [email protected]. Ó 2014 Published by Elsevier Inc. on behalf of American Society of PeriAnesthesia Nurses 1089-9472/$36.00 http://dx.doi.org/10.1016/j.jopan.2014.09.003
not experience personal validation. Health and well-being in work life also includes how we are treated, what kind of strength and support exist in work-based social networks, and what ability we have to achieve balance for ourselves. Worklife balance is essential to support the person we bring to work, and the person we want to be outside of work. Despite multiple challenges, each nurse has the ability to decide how to live his or her life, and the power to improve the quality of life experiences. We owe it not only to ourselves but also to the people we care about, to maximize joy and contentment. It is helpful to return to the work of Florence Nightingale; to reconsider the impact she had on the origins of nursing practice and the implications for us today. It is further beneficial to apply Nightingale’s teachings to the meaning of nursing’s work, and to focus on what really matters. Nightingale taught that the profession of nursing required a sense of calling and of service in healing. She asked for a personal commitment to the work of nursing in the world. She encouraged nurses to reflect and to know that there is deep meaning and purpose in real nursing work. The work itself, and the dedication to that work, would provide insight to the highest level of ethical choices and possibilities. She taught that nurses need to be role models, in word and action. Role modeling portrays self respect and dignity; it’s a simple message. She stressed that nurses facilitate healing, using knowledge, skill, experience, instinct and intuition. Nurses showcase this particular esthetic through conduct, attitudes, narratives, and actions. The provision of care for patients, their families, and colleagues is what nurses do. It is worthwhile to get back in touch with the why in nursing and to reconnect with the fundamental awareness of the joy in meaningful work. With serious, intentional thought to the actual work of nursing, there is a happiness to be found everyday. This is not to say that inequities in the workplace and struggles to make sense out of administrative
Journal of PeriAnesthesia Nursing, Vol 29, No 6 (December), 2014: pp 511-513
511
512
decisions and mandates require less than thoughtful, rigorous attention. Nightingale was famously at odds with administrative layers and continuously battled bureaucracy to champion causes for patient care, institutional improvements, and the profession of nursing. Nightingale spoke to ethical issues and criticized existing hospital systems. She knew nurses were held back from doing the right thing at times, particularly regarding unsafe practices and serving as patient advocates. However, equal attention ought to be given to the meaningful work and contributions of individual nurses, and for this column, perianesthesia nurses, everyday, with dedication, insight, thoughtfulness, and expertise. It is much more difficult to control or even make sense of the forces outside your own unit and can be draining and discouraging. So take some time to focus on yourself, your work, and the importance and value of the accomplishments of perianesthesia nurses. It may help to regain perspective related to the joy which can be found in perianesthesia nursing. Nightingale believed that nursing is a calling; she asked for nurses to do the right thing, and to perform nursing to the ‘‘best of one’s ability.’’ It is certainly noble and worthy of consideration. Nursing is worthwhile, profoundly important work. The specialty you have chosen requires attentiveness, critical thinking, clinical reasoning, and swift action. Perianesthesia nurses have frequent reminders that vigilance is not merely a word used in orientation, but a very real and necessary attribute to provide astute care to very vulnerable patients. It can set us apart, make all the difference in patient outcome, and preempt emergent situations or potential patient decline. So, it is a calling. We are called to provide expert care and prevent harm, assess patients critically and smooth their recovery, communicate accurately, provide safe transitions of care, and follow through on many details to do the right thing and to be the best. It is an amazing calling. It is an amazing privilege. In addition to the technical aspects of patient monitoring, perianesthesia nurses are attuned to the nuances of patient safety, comfort, energy level, and emotional and spiritual needs. We are mindful of the difference made by well-chosen words, simple touch, nursing presence, calmness, and confidence. Nurses sustain caring with actions and words.
MAUREEN V. IACONO
How does the consideration of Nightingales’ legacy promote the recognition of joy and happiness in our work? The first step is that nurses ought to thoughtfully review what nursing work means to the individual—to the nurse, and the patient. It is easy to underestimate the power of this work, and the impact. So, first, recognize the importance of the work of nursing. Seek every opportunity to refocus, and to again find meaning in meaningful work. Provide support for one another, for nurses, in the work of nursing. We are at the front line of the provision of nursing care. It is important for this work to be highlighted and valued. We need to honor our work and contributions. When we speak of our work, we ought to speak with pride and intelligence. We ought to question why, seek evidence to promote best practices, and share the answers to the questions with colleagues. We ought to seek answers to difficult questions, and reframe the questions when we are not heard. Nurses can highlight the beauty and unique contributions of individual nurses (self and others) at work. In fact, it is inspiring and uplifting to recognize and celebrate colleagues in the work of nursing. Simply writing exemplars about nursing care in your unit has a profound effect on esprit de corps. Submitting nominations for nursing practice and leadership awards within the institution or through professional nursing societies speaks volumes about the respect for our specialty practice. Perianesthesia nurses can survey patients for their perceptions of care in our units, as our specialty is underrepresented in formal survey questionnaires. The patients and their families bear witness to the stamina and excellence of nurses; and they are very honest. I am often delighted and encouraged to have my nursing staff mentioned and thanked for expert care from grateful patients and their families. Patients are often frail and uniquely needy. They depend on dedicated nurses for their care and sometimes their survival. Take control of your inner dialog, particularly when multiple factors affect your happiness at work. The factors, and their related events can be challenging. But the manner in which we react to these factors can make a critical difference in the power they hold. Do not get stuck in the negativity. Remember that negative people
PERIANESTHESIA CULTURE
513
can be like sponges and drain joy from others. Make a conscious effort to move in a positive direction from wherever you are at the moment. Change the focus of the words you say to yourself and look at troubling situations in a nonjudgmental way. Seek ways to understand the impact of outside events, and choose to focus on what is still okay and what is still good in the workplace, to stay in the moment, and find your happy. Seek to clarify goals and expectations when confusion or conflict arises in the workplace. Support nursing autonomy to achieve these goals, as each nurse can have creative solutions to work challenges. Expect, and when necessary, demand resources to enable nurses as individuals and as a team to accomplish the work that is required. Work toward a culture in your units that provides a mechanism to support and learn from mistakes. Foster the respect and recognition of excellence in nursing care delivery. Encourage colleagues when the going gets tough, and share emotional support when needed. Try to avoid the drama of
consistently needy nurses and focus on developing a cohesive, positively focused work team. It takes courage to rise above the troubles and trials of work pressures and inconsistencies. It is prudent to understand that your work is hampered when your outlook is narrow and uninspired. Do not allow the troubles to overwhelm you. Choose instead to focus on what is good and noble in the work of nursing. Choose to believe that nursing is a calling, and that we are fortunate and blessed to be able to provide expert and essential care at fundamentally important moments in the lives of others. It is a sacred trust, one to which we have a duty. Be the best you can be; commit to the work of nursing and to the belief that this chosen professional holds awesome rewards and responsibilities. Seek to find inspiration and awe in perianesthesia nursing. If, at times, happiness seems to be an obscure goal strive instead for optimism. As long as we stay in the profession, take positive actions to ensure that your contributions matter and that you find joy when you can.
Suggested Readings 1. Dossey B, Selanders D, Beck D, Attewell A. Florence Nightingale Today: Healing Leadership Global Action. Silver Spring, MD: American Nurses Association; 2005. 2. Locsin R, Purnell M. A Contemporary Nursing Process: The (Un)Bearable Weight of Knowing in Nursing. New York, NY: Springer Publishing Company; 2009.
3. McAllister M, Lowe J. The Resilient Nurse: Empowering your Practice. New York, NY: Springer Publishing Company; 2011.
Happiness in the Work of Nursing Maureen V. Iacono, BSN, RN, CPAN THE WORKPLACE IS CHANGING. Perianesthesia nursing is not excluded from change, as change is fast paced, and all encompassing. There is no ‘‘bubble of protection’’ or isolation from the institution, as may have been the case in the past for postanesthesia care units. Some of the changes have to do with the workforce itself and the work of nursing. Other changes, and perhaps increased pressures, stem from forces outside our units or the immediate staffing matrix within the unit. There can be a sense of frustration, and loss of control over nursing practice for the individual nurse. There are often laments, spanning the issue from the pressures and workload expectations in individual nursing units, to the more broad concerns of administrative decisions and dictates. Some of these decisions seem out of touch, questionable, and even quite ridiculous. Some of the dictates are generated because regulatory bodies change requirements and conditions of participation, and institutional compliance becomes mandatory. The steps toward compliance and enforcing necessary changes can be tedious and problematic based on the existing culture of the workplace. Additionally, there is an increasingly commonplace practice in hospital systems to spend sums of money to hire ‘‘experts’’ from outside to direct changes that make little sense to the front line staff. With mounting frustrations, the question of happiness at work is a sobering one. Can the nurse find happiness, or create happiness, in the workplace and in the work of nursing in particular? We work for many reasons. We earn money and make a living, accomplish goals, and may or may Maureen V. Iacono, BSN, RN, CPAN, is a PACU Nurse Manager, St. Joseph’s Hospital, Syracuse, NY. Conflicts of interest: None to report. Address correspondence to Maureen V. Iacono, St. Joseph’s Hospital, 301 Prospect Avenue, Syracuse, NY 13202; e-mail address: [email protected]. Ó 2014 Published by Elsevier Inc. on behalf of American Society of PeriAnesthesia Nurses 1089-9472/$36.00 http://dx.doi.org/10.1016/j.jopan.2014.09.003
not experience personal validation. Health and well-being in work life also includes how we are treated, what kind of strength and support exist in work-based social networks, and what ability we have to achieve balance for ourselves. Worklife balance is essential to support the person we bring to work, and the person we want to be outside of work. Despite multiple challenges, each nurse has the ability to decide how to live his or her life, and the power to improve the quality of life experiences. We owe it not only to ourselves but also to the people we care about, to maximize joy and contentment. It is helpful to return to the work of Florence Nightingale; to reconsider the impact she had on the origins of nursing practice and the implications for us today. It is further beneficial to apply Nightingale’s teachings to the meaning of nursing’s work, and to focus on what really matters. Nightingale taught that the profession of nursing required a sense of calling and of service in healing. She asked for a personal commitment to the work of nursing in the world. She encouraged nurses to reflect and to know that there is deep meaning and purpose in real nursing work. The work itself, and the dedication to that work, would provide insight to the highest level of ethical choices and possibilities. She taught that nurses need to be role models, in word and action. Role modeling portrays self respect and dignity; it’s a simple message. She stressed that nurses facilitate healing, using knowledge, skill, experience, instinct and intuition. Nurses showcase this particular esthetic through conduct, attitudes, narratives, and actions. The provision of care for patients, their families, and colleagues is what nurses do. It is worthwhile to get back in touch with the why in nursing and to reconnect with the fundamental awareness of the joy in meaningful work. With serious, intentional thought to the actual work of nursing, there is a happiness to be found everyday. This is not to say that inequities in the workplace and struggles to make sense out of administrative
Journal of PeriAnesthesia Nursing, Vol 29, No 6 (December), 2014: pp 511-513
511
512
decisions and mandates require less than thoughtful, rigorous attention. Nightingale was famously at odds with administrative layers and continuously battled bureaucracy to champion causes for patient care, institutional improvements, and the profession of nursing. Nightingale spoke to ethical issues and criticized existing hospital systems. She knew nurses were held back from doing the right thing at times, particularly regarding unsafe practices and serving as patient advocates. However, equal attention ought to be given to the meaningful work and contributions of individual nurses, and for this column, perianesthesia nurses, everyday, with dedication, insight, thoughtfulness, and expertise. It is much more difficult to control or even make sense of the forces outside your own unit and can be draining and discouraging. So take some time to focus on yourself, your work, and the importance and value of the accomplishments of perianesthesia nurses. It may help to regain perspective related to the joy which can be found in perianesthesia nursing. Nightingale believed that nursing is a calling; she asked for nurses to do the right thing, and to perform nursing to the ‘‘best of one’s ability.’’ It is certainly noble and worthy of consideration. Nursing is worthwhile, profoundly important work. The specialty you have chosen requires attentiveness, critical thinking, clinical reasoning, and swift action. Perianesthesia nurses have frequent reminders that vigilance is not merely a word used in orientation, but a very real and necessary attribute to provide astute care to very vulnerable patients. It can set us apart, make all the difference in patient outcome, and preempt emergent situations or potential patient decline. So, it is a calling. We are called to provide expert care and prevent harm, assess patients critically and smooth their recovery, communicate accurately, provide safe transitions of care, and follow through on many details to do the right thing and to be the best. It is an amazing calling. It is an amazing privilege. In addition to the technical aspects of patient monitoring, perianesthesia nurses are attuned to the nuances of patient safety, comfort, energy level, and emotional and spiritual needs. We are mindful of the difference made by well-chosen words, simple touch, nursing presence, calmness, and confidence. Nurses sustain caring with actions and words.
MAUREEN V. IACONO
How does the consideration of Nightingales’ legacy promote the recognition of joy and happiness in our work? The first step is that nurses ought to thoughtfully review what nursing work means to the individual—to the nurse, and the patient. It is easy to underestimate the power of this work, and the impact. So, first, recognize the importance of the work of nursing. Seek every opportunity to refocus, and to again find meaning in meaningful work. Provide support for one another, for nurses, in the work of nursing. We are at the front line of the provision of nursing care. It is important for this work to be highlighted and valued. We need to honor our work and contributions. When we speak of our work, we ought to speak with pride and intelligence. We ought to question why, seek evidence to promote best practices, and share the answers to the questions with colleagues. We ought to seek answers to difficult questions, and reframe the questions when we are not heard. Nurses can highlight the beauty and unique contributions of individual nurses (self and others) at work. In fact, it is inspiring and uplifting to recognize and celebrate colleagues in the work of nursing. Simply writing exemplars about nursing care in your unit has a profound effect on esprit de corps. Submitting nominations for nursing practice and leadership awards within the institution or through professional nursing societies speaks volumes about the respect for our specialty practice. Perianesthesia nurses can survey patients for their perceptions of care in our units, as our specialty is underrepresented in formal survey questionnaires. The patients and their families bear witness to the stamina and excellence of nurses; and they are very honest. I am often delighted and encouraged to have my nursing staff mentioned and thanked for expert care from grateful patients and their families. Patients are often frail and uniquely needy. They depend on dedicated nurses for their care and sometimes their survival. Take control of your inner dialog, particularly when multiple factors affect your happiness at work. The factors, and their related events can be challenging. But the manner in which we react to these factors can make a critical difference in the power they hold. Do not get stuck in the negativity. Remember that negative people
PERIANESTHESIA CULTURE
513
can be like sponges and drain joy from others. Make a conscious effort to move in a positive direction from wherever you are at the moment. Change the focus of the words you say to yourself and look at troubling situations in a nonjudgmental way. Seek ways to understand the impact of outside events, and choose to focus on what is still okay and what is still good in the workplace, to stay in the moment, and find your happy. Seek to clarify goals and expectations when confusion or conflict arises in the workplace. Support nursing autonomy to achieve these goals, as each nurse can have creative solutions to work challenges. Expect, and when necessary, demand resources to enable nurses as individuals and as a team to accomplish the work that is required. Work toward a culture in your units that provides a mechanism to support and learn from mistakes. Foster the respect and recognition of excellence in nursing care delivery. Encourage colleagues when the going gets tough, and share emotional support when needed. Try to avoid the drama of
consistently needy nurses and focus on developing a cohesive, positively focused work team. It takes courage to rise above the troubles and trials of work pressures and inconsistencies. It is prudent to understand that your work is hampered when your outlook is narrow and uninspired. Do not allow the troubles to overwhelm you. Choose instead to focus on what is good and noble in the work of nursing. Choose to believe that nursing is a calling, and that we are fortunate and blessed to be able to provide expert and essential care at fundamentally important moments in the lives of others. It is a sacred trust, one to which we have a duty. Be the best you can be; commit to the work of nursing and to the belief that this chosen professional holds awesome rewards and responsibilities. Seek to find inspiration and awe in perianesthesia nursing. If, at times, happiness seems to be an obscure goal strive instead for optimism. As long as we stay in the profession, take positive actions to ensure that your contributions matter and that you find joy when you can.
Suggested Readings 1. Dossey B, Selanders D, Beck D, Attewell A. Florence Nightingale Today: Healing Leadership Global Action. Silver Spring, MD: American Nurses Association; 2005. 2. Locsin R, Purnell M. A Contemporary Nursing Process: The (Un)Bearable Weight of Knowing in Nursing. New York, NY: Springer Publishing Company; 2009.
3. McAllister M, Lowe J. The Resilient Nurse: Empowering your Practice. New York, NY: Springer Publishing Company; 2011.
