The Castledine column
Nurses must learn to take risks George Castledine, University of Central England in Birmingham
t the recent British Journal o f Nursing Wound Care Confer ence, a leading physician declared that ‘nurses are no longer the handmaidens to doctors’. He is right. Now is a time of great up heaval and change in the British healthcare system; many questions are being asked about quality and the role of the professional nurse. Today’s decisions and actions, with all the ramifications regarding nursing education, practice and re search, will help to decide nursing’s role and power in the healthcare de livery system of tomorrow. If we are to be taken seriously as independent, accountable practitioners, then not only knowledge, technical expertise, and compassion, but also courage, strength and risk-taking ability are going to be crucial. Risk-taking occurs in situations where individuals proceed on a course of action that seems hazard ous and exposed to mischance or peril. Recently, in the Olympic Games, it seemed that gold medals were won or lost on this basis. To compare sport with serious profes sional decision-making may seem odd, yet Olympic sportsmen and A
women take their decisions as seri ously and are as dedicated and com mitted as any healthcare profes sional. We now live in an age where we must ask ourselves, ‘are we brave enough to be in nursing today?’ This is a key question. It is going to take the strength and courage of each and every one of us, individually and collectively, to confront the issues and problems facing nursing. A risktaker takes action even though the outcome is uncertain; in contrast, someone who does not take risks is very sure of the outcome before tak ing action. Throughout our early profes sional nursing careers we are taught to be safe and sure of our actions. Traditionally nursing has been characterized by its unwillingness to take risks or make decisions auton omously and independently of others. Rules and regulations have often restricted nursing develop ments, not only in practice but also in education and management. Risk-taking in a positive sense means taking deliberate action when the consequences are uncertain, even though the possible or predicted outcomes have been identified and weighed up. It means accepting the possibility of failure, ridicule, and,
in some cases, ostracism (Stanton, 1987). It takes guts to make a deci sion based on one’s knowledge and careful weighing up of a situation when there is uncertainty as to the outcome. In nursing, professional risktakers are usually very experienced and educated individuals. In my studies of nursing specialists I have found that such individuals are at the forefront of nursing developments and innovations. It is difficult to be too precise about the criteria needed to become a risk*-taker, but some of the characteristics are shown in Table 1. In my opinion, risk-taking is dif ferent from ‘whistle blowing’, which can involve any nurse — at any time and at any stage in his/her career — speaking out about injustices and matters related to the public’s inter est. Proposed risk-taking is usually performed by a specialist or ad vanced nurse who is in a situation that demands professional decision making based upon experience and knowledge. In stating this definition I do not wish to exclude the experienced, knowledgeable primary nurse work ing in a staff nurse position. There is no doubt that some risk-taking behaviour starts to develop at an
Table I. Some of the criteria necessary to be a risk-taker Commitment and dedication to nursing and the patient/client Knowledge of a specific nursing specialty_____________________________ A broad experience of life and nursing based on sound practice and research The ability to look ahead____________________________________________ Reasoned judgm ent________________________________________________ Individuality and a desire to be different_______________________ Realistic, flexible and pragmatic outlook__________ ____________________
Professor Castledine is Head of Department of Nursing and Community Health, Univer sity of Central England in Birmingham, Perry Barr, Birmingham B42 2SU
460
A willingness to be adaptable and interdependent; to move with the times Acute powers of perception and good communication skills
Downloaded from magonlinelibrary.com by 129.215.017.190 on March 13, 2020. British Journal of Nursing, 1992, Vol 1, No 9
Nurses must learn to take risks early stage in every nurse’s career. It is important to encourage such freedom of expression and intellectualization of healthcare de cisions, particularly those relating to nursing judgments and decision making. The opposite of risk-taking is timidity; a reluctance to get involved with the professional decision-mak ing process. Timidity restrains and constrains nurses, and is often en couraged in nursing situations where professional hierarchies and status still exist. There is no doubt that the move to the primary nursing model of more responsible and accountable
care is encouraging staff nurses to become more involved with and ad venturous in their decisions about patient care. If we are to develop de volved decision-making in nursing care, then the principles of profes sional risk-taking must also be ex plored and encouraged. Physicians often make choices for patients and their families without exploring the alternatives. What is more, many physicians still expect nurses to agree with these decisions. The practice of keeping silent and avoiding any involvement in the in tellectual discussion of why a deci sion has been made leaves the pa
tient, as well as the nurse, in a vul nerable position. If we are to improve this situation we must encourage specialist and ad vanced nurses to lead by example and be more easily accessible to in experienced and junior staff. Con sultation between expert nurses and primary practitioners is vital to the future of professional risk-taking behaviour in nursing.
Stanton M (1978) Politics, power, risk-taking and nursing. In: Williamson JA, ed. Cur rent Perspectives in Nursing Education. CV Mosby, St Louis: 22
INSTRUCTIONS TO AUTHORS All material submitted for publication should be sent to Joy Notter/Paula McGee, The Nursing Editors, De partment of Nursing and Community Health, Faculty of Health and Social Sciences, University of Central England in Birmingham, Perry Barr, Birmingham B42 2SU. The material must be typewritten on A4 paper, double-spaced with reasonable margins, on one side of the paper only. Three copies of the manuscript are required. Tables should be typed on separate sheets at the back along with references.
Unsolicited review articles Authors wishing to submit a review article to the jour nal must first write to Joy Notter/Paula McGee, the Nursing Editors at the above address, outlining their suggestion and the topics to be included in their re view in about 200 words and indicating the relevance of the review to the journal. Once their idea is ap proved they will be sent a full set of instructions to authors.
Length of articles In general, review articles are about 2000 words with the number of references not usually exceeding 20. All review articles should include an introduction of 35-40 words to be set in bold as a standfirst and details of the current appointments of each author.
British Journal ol Nursing, 1992,Vol I, No 9
Authors must also supply 5-10 key facts summar izing the major themes of the paper, and these will appear in a box at the end of the article.
References It is imperative that references are in the Harvard style, that is, with authors’ names and dates in the text, and the reference list arranged alphabetically. Article title and first and last page numbers must be included. All authors’ names should be given un less there are seven or more, in which case the first three should be given, followed by et al. Reference lists must by typed double-spaced.
Care studies Care studies should describe the planning, imple mentation and evaluation of the nursing care of a particular client with special reference to any prob lems that arise during the delivery of care. They should have a maximum of five references and one or two pictures.
Reproduction permissions Authors must gain the necessary permission to re produce figures/tables/artwork from other journals or books before submitting their manuscripts. A27.50
461 Downloaded from magonlinelibrary.com by 129.215.017.190 on March 13, 2020.
Nurses must learn to take risks George Castledine, University of Central England in Birmingham
t the recent British Journal o f Nursing Wound Care Confer ence, a leading physician declared that ‘nurses are no longer the handmaidens to doctors’. He is right. Now is a time of great up heaval and change in the British healthcare system; many questions are being asked about quality and the role of the professional nurse. Today’s decisions and actions, with all the ramifications regarding nursing education, practice and re search, will help to decide nursing’s role and power in the healthcare de livery system of tomorrow. If we are to be taken seriously as independent, accountable practitioners, then not only knowledge, technical expertise, and compassion, but also courage, strength and risk-taking ability are going to be crucial. Risk-taking occurs in situations where individuals proceed on a course of action that seems hazard ous and exposed to mischance or peril. Recently, in the Olympic Games, it seemed that gold medals were won or lost on this basis. To compare sport with serious profes sional decision-making may seem odd, yet Olympic sportsmen and A
women take their decisions as seri ously and are as dedicated and com mitted as any healthcare profes sional. We now live in an age where we must ask ourselves, ‘are we brave enough to be in nursing today?’ This is a key question. It is going to take the strength and courage of each and every one of us, individually and collectively, to confront the issues and problems facing nursing. A risktaker takes action even though the outcome is uncertain; in contrast, someone who does not take risks is very sure of the outcome before tak ing action. Throughout our early profes sional nursing careers we are taught to be safe and sure of our actions. Traditionally nursing has been characterized by its unwillingness to take risks or make decisions auton omously and independently of others. Rules and regulations have often restricted nursing develop ments, not only in practice but also in education and management. Risk-taking in a positive sense means taking deliberate action when the consequences are uncertain, even though the possible or predicted outcomes have been identified and weighed up. It means accepting the possibility of failure, ridicule, and,
in some cases, ostracism (Stanton, 1987). It takes guts to make a deci sion based on one’s knowledge and careful weighing up of a situation when there is uncertainty as to the outcome. In nursing, professional risktakers are usually very experienced and educated individuals. In my studies of nursing specialists I have found that such individuals are at the forefront of nursing developments and innovations. It is difficult to be too precise about the criteria needed to become a risk*-taker, but some of the characteristics are shown in Table 1. In my opinion, risk-taking is dif ferent from ‘whistle blowing’, which can involve any nurse — at any time and at any stage in his/her career — speaking out about injustices and matters related to the public’s inter est. Proposed risk-taking is usually performed by a specialist or ad vanced nurse who is in a situation that demands professional decision making based upon experience and knowledge. In stating this definition I do not wish to exclude the experienced, knowledgeable primary nurse work ing in a staff nurse position. There is no doubt that some risk-taking behaviour starts to develop at an
Table I. Some of the criteria necessary to be a risk-taker Commitment and dedication to nursing and the patient/client Knowledge of a specific nursing specialty_____________________________ A broad experience of life and nursing based on sound practice and research The ability to look ahead____________________________________________ Reasoned judgm ent________________________________________________ Individuality and a desire to be different_______________________ Realistic, flexible and pragmatic outlook__________ ____________________
Professor Castledine is Head of Department of Nursing and Community Health, Univer sity of Central England in Birmingham, Perry Barr, Birmingham B42 2SU
460
A willingness to be adaptable and interdependent; to move with the times Acute powers of perception and good communication skills
Downloaded from magonlinelibrary.com by 129.215.017.190 on March 13, 2020. British Journal of Nursing, 1992, Vol 1, No 9
Nurses must learn to take risks early stage in every nurse’s career. It is important to encourage such freedom of expression and intellectualization of healthcare de cisions, particularly those relating to nursing judgments and decision making. The opposite of risk-taking is timidity; a reluctance to get involved with the professional decision-mak ing process. Timidity restrains and constrains nurses, and is often en couraged in nursing situations where professional hierarchies and status still exist. There is no doubt that the move to the primary nursing model of more responsible and accountable
care is encouraging staff nurses to become more involved with and ad venturous in their decisions about patient care. If we are to develop de volved decision-making in nursing care, then the principles of profes sional risk-taking must also be ex plored and encouraged. Physicians often make choices for patients and their families without exploring the alternatives. What is more, many physicians still expect nurses to agree with these decisions. The practice of keeping silent and avoiding any involvement in the in tellectual discussion of why a deci sion has been made leaves the pa
tient, as well as the nurse, in a vul nerable position. If we are to improve this situation we must encourage specialist and ad vanced nurses to lead by example and be more easily accessible to in experienced and junior staff. Con sultation between expert nurses and primary practitioners is vital to the future of professional risk-taking behaviour in nursing.
Stanton M (1978) Politics, power, risk-taking and nursing. In: Williamson JA, ed. Cur rent Perspectives in Nursing Education. CV Mosby, St Louis: 22
INSTRUCTIONS TO AUTHORS All material submitted for publication should be sent to Joy Notter/Paula McGee, The Nursing Editors, De partment of Nursing and Community Health, Faculty of Health and Social Sciences, University of Central England in Birmingham, Perry Barr, Birmingham B42 2SU. The material must be typewritten on A4 paper, double-spaced with reasonable margins, on one side of the paper only. Three copies of the manuscript are required. Tables should be typed on separate sheets at the back along with references.
Unsolicited review articles Authors wishing to submit a review article to the jour nal must first write to Joy Notter/Paula McGee, the Nursing Editors at the above address, outlining their suggestion and the topics to be included in their re view in about 200 words and indicating the relevance of the review to the journal. Once their idea is ap proved they will be sent a full set of instructions to authors.
Length of articles In general, review articles are about 2000 words with the number of references not usually exceeding 20. All review articles should include an introduction of 35-40 words to be set in bold as a standfirst and details of the current appointments of each author.
British Journal ol Nursing, 1992,Vol I, No 9
Authors must also supply 5-10 key facts summar izing the major themes of the paper, and these will appear in a box at the end of the article.
References It is imperative that references are in the Harvard style, that is, with authors’ names and dates in the text, and the reference list arranged alphabetically. Article title and first and last page numbers must be included. All authors’ names should be given un less there are seven or more, in which case the first three should be given, followed by et al. Reference lists must by typed double-spaced.
Care studies Care studies should describe the planning, imple mentation and evaluation of the nursing care of a particular client with special reference to any prob lems that arise during the delivery of care. They should have a maximum of five references and one or two pictures.
Reproduction permissions Authors must gain the necessary permission to re produce figures/tables/artwork from other journals or books before submitting their manuscripts. A27.50
461 Downloaded from magonlinelibrary.com by 129.215.017.190 on March 13, 2020.
