Commentary

Lean In to Our Profession CATHERINE H. IVORY

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I Catherine H. Ivory, PhD, RNC-OB, is the 2014 AWHONN President. The author reports no conflicts of interest or relevant financial relationships. Address correspondence to: [email protected].

http://nwh.awhonn.org

It’s an exciting time for nursing. The release of the 2010 Institute of Medicine (IOM) Report, “The Future of Nursing: Leading Change, Advancing Health” (Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine, 2010) underscored the importance of our profession to population health; it’s hard to believe that the report is now 4 years old. The Future of Nursing: Campaign for Action, which is coordinated through the Center to Champion Nursing and is a joint initiative of AARP, the AARP Foundation and the Robert Wood Johnson Foundation (RWJF), coordinates national efforts to move the IOM report forward.

Within individual states, action coalitions are working on state-specific nursing priorities to increase nursing visibility. The campaign’s goal is ensuring that high-quality health care is available to all Americans, with nurses providing care to the full extent of their licensure and training. Nurses are so important that, prior to opening the health care insurance marketplace last October, the White House held a conference call for us, reminding nurses that our profession is the one that the American public turns to most with health care questions. I was proud that day when Vice President Biden told those of us on the call that “nurses are critically important” and “vastly underestimate what you

Abstract Nurses play a critical role in the delivery of high-quality, evidence-based health care. Nurses can “lean in” to our professional by voicing our opinions, contributing to decisions affecting health care practice and policy, and assuming leadership roles. DOI: 10.1111/1751-486X.12105 Keywords evidenced-based practice | leading change | nursing leadership

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After hearing the book, two things struck me. First, the principles Sandberg discusses in the book apply equally to both men and women and, second, Sandberg’s recommendations could help nurses, whatever your practice setting. It’s time to lean in to your own practice and into our collective profession. Using three of Sandberg’s main points, I offer the following suggestions.

It’s time to lean in to your own practice and into our collective profession do,” implying that nurses may not appreciate or promote our professional value. The public’s trust in our profession was validated again in 2013, when more than 80 percent of Gallup (Gallup® Politics, 2013) survey respondents rated nurses as “high” or “very high” in the categories of honesty and ethical standards, the 12th year that nursing achieved such designation. We care for women and newborns. Every woman and every newborn deserves excellent, evidence-based care, provided by competent and compassionate nursing professionals. To make sure that women and newborns receive the care they deserve, and that the nursing profession is the best that it can be, we need nurses who are willing to lead; nursing voices need to be heard in our workplaces, our communities and nationally. While on a road trip last year, I had the opportunity to listen to Sheryl Sandberg, the chief operating officer of Facebook, read her book, Lean In: Women, Work and the Will to Lead.

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To make her point, Sandberg recalled a meeting she hosted, attended by both experienced and more junior team members. Everyone was invited to join the meeting and sit at the conference table. While the table had room for everyone, the experienced members immediately stepped right up, while the junior members took seats around the perimeter. After the meeting, Sandberg pulled the junior members aside and assured them their voices were important and they too should have been at the table. A lack of confidence in the value of one’s contribution can keep one on the outside. We underestimate our abilities, a phenomenon Sandberg describes as “imposter syndrome,” which is the perception that we don’t know enough, regardless of our education or preparation. How many times has this happened to you in practice? Have you not spoken up because you believed your voice would not be heard because you are “just a nurse” or because you thought speaking up was someone else’s job? Every nurse’s voice is important. It may be easier for us to advocate for the women and newborns for whom we care than to advocate for our individual practice or our collective profession. However, speaking up for our profession also benefits our patients. Nurses should be sitting at all tables where decisions affecting our profession are made. Most of you are aware of opportunities to participate on nursing committees in your workplace; your contribution is valuable on these teams. In addition to being involved at your workplace, AWHONN needs every nurse caring for women and newborns to be involved in our

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Sit at the Table

It’s a Jungle Gym, Not a Ladder In her book, Sandberg notes that the most common metaphor describing professional advancement is a ladder. One can only go up or down on a ladder, yet the career path of most professionals today includes lateral moves as well as moves up

and moves down. The days of an employee staying at the same company for her entire career are rare. Thinking of one’s career path as being on a jungle gym, rather than a ladder, according to Sandberg, allows the freedom to explore different career paths, to move up, move over, move down or even move off the path for a time. Isn’t this true for nursing? Our profession offers multiple career opportunities. Even within our own specialty, nurses caring for women and newborns can work in a variety of both inpatient and outpatient settings, at the bedside, in nursing leadership roles, the community, academia, research and health information technology. We have the freedom to try more than one role and to move back and forth among them if we so choose. Our profession should also advocate for clinical advancement programs that reward creativity, innovation and nontraditional roles. My involvement in AWHONN has allowed me to network with professional colleagues in a variety of settings and roles, all committed to the health of women and newborns. I encourage you to take advantage of the networking and mentorship available to you within AWHONN as you navigate your own jungle gym.

Commentary

professional organization and every woman and newborn should have an AWHONN nurse! Other “tables” where the nursing voice is needed include hospital and health systems boards of directors, birth centers, and among lawmakers and in public health departments. There may be other tables that come to mind for you; the idea is to find out where they are and to find a seat. Many states now have active perinatal quality collaborative organizations that need and welcome nursing involvement. Evidence-based practice should be disseminated by nurses through both community and faith-based venues. I encourage you to explore what opportunities exist for you to bring your nursing voice to the tables in your own community to make our profession visible. AWHONN has been working hard to make sure the voice of our members is heard equally among the voices of our physician and other specialty colleagues, on issues such as quality measurement, staffing, preterm birth and maternal and neonatal morbidity and mortality, to name a few. Collaboration has never been better and working together can only help those we serve.

Seek and Speak Your Truth Open and honest communication is essential in any setting. According to Sandberg, there are two points of view in any conversation—your

Nurses should be sitting at all tables where decisions affecting Photo © Wavebreak Media / thinkstockphotos.com

our profession are made

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Commentary time to make the importance of highquality nursing care more visible point of view (your truth) and the other’s point of view (their truth). It’s no secret that nurses may have trouble speaking their truth, perhaps due to organizational culture or because they doubt whether their opinion matters. By not speaking up, nurses remain in the background and decisions that affect us are made without us. What is our truth in perinatal nursing? Our truth is the evidence that guides our practice as we care for women across the lifespan, support them through labor and birth and care for their newborns. We should always be speaking the truth, advocating for the best evidence-based care. We should be seeking our truth by measuring the outcomes of the care we provide. In today’s health care environment, it’s truly all about the data. Quantifying nursing outcomes provides the truth that what we as perinatal nurses do matters, that women and newborns cared for by us have better outcomes because of the evidence-based care we provide. AWHONN is well on the way to releasing our own set of perinatal nursing care quality measures by which we can measure and improve nursing practice. We also seek our professional truth by contributing to our body of evidence through research. In addition to evidence-based guidelines

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already published, and cutting-edge research published in AWHONN’s journals, AWHONN continues original research related to perinatal nurse staffing and maternal-fetal triage, and also has, among other projects, a multiyear research initiative underway to improve the management of maternal hemorrhage. These are just a few examples of the many projects underway at AWHONN and now, more than ever, it’s time to lean in.

Conclusion At a nursing conference last November, I learned that the Center to Champion Nursing adopted a slogan encouraging all nurses to step in to their profession and noted the similarities to Lean In, suggested by Sandberg. Whether you lean in or step in, find a seat at the table. There has never been a better time to make the importance of high-quality nursing care more visible, and it will take all of us to make this happen. NWH

References Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine. (2010). The future of nursing: Leading change and advancing health. Washington, DC: National Academies Press. Gallup® Politics. (2013). Honesty and ethics rating of clergy slides to new low. Nurses again top list; lobbyists are worst. Retrieved from www.gallup. com/poll/166298/honesty-ethics-rating-clergyslides-new-low.aspx Sandberg, S. (2013). Lean in: Women, work, and the will to lead. New York: Alfred A. Knopf.

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Issue 2

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There has never been a better

Lean in to our profession.

Nurses play a critical role in the delivery of high-quality, evidence-based health care. Nurses can "lean in" to our professional by voicing our opini...
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