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In Touch
A forum to discuss the latest news and ideas in nursing and healthcare.
Tuesday, September 01, 2015
One thing will always turn a bad situation into something much worse: lying about the bad situation. As humans, we’re all capable of making mistakes and errors in judgment. Because none of us is immune, most people can ultimately move forward and chalk up an event as a learning or growth opportunity. But when the person involved doesn’t demonstrate integrity in owning the mistake, an entirely different set of potentially serious and long-ranging consequences may follow.
Integrity is the foundation of our judicial system and a core expectation of professional nursing practice. It’s intrinsically connected to personal ethics and manifested through accountability for one’s actions. Integrity requires the courage to be honest no matter what the situation. I’ve come to believe that although nursing skills and knowledge can be taught, integrity stems from deeper lessons learned about morality that originate in a person’s upbringing and character development.
Patient safety depends on professional integrity. When an error involving a patient is recognized, it must be immediately reported and addressed to protect the patient. It also must be disclosed to the patient or the patient’s family and sometimes even to regulatory bodies, such as The Joint Commission, according to institutional policies and procedures. These aren’t easy conversations to have, but they’re essential to preserve trust, to intervene effectively, and to objectively discern preventive actions to avoid future occurrences. But if someone attempts to alter the facts and that breach of integrity is discovered, a whole host of negative consequences are likely, including significant damage to one’s reputation, possible termination of employment, and perhaps even sanctioning by the professional regulatory board. Clearly, there are personal, professional, and employment repercussions to any attempt at a cover-up.
Practicing with integrity is a conscious choice. No matter how scary or difficult the situation, honesty is always the best policy. As a leader, I think we need to proactively talk about this subject a lot more on nursing units and within healthcare teams. Being honest won’t always protect a nurse from having to face consequences, but it will serve as the best way to protect the nurse’s professional reputation and moral character as well as the patients in his or her care.

Thursday, July 30, 2015

I came across notes to a speech I delivered a few years ago to a group of nursing mentors, preceptors, and educators. My inspiration came from an album by The 5th Dimension (circa 1969) buried in my closet entitled “The Age of Aquarius.” The title song speaks of peace, love, understanding, and living in harmony. How do these lyrics relate to nursing? Stay with me here: Think for a moment about the nurses who helped shape your career—the ones who truly made an impact on you.

First, I’m sure you recall the nurses who nurtured you when you were a new graduate or as you went through a career transition. These special people educated you, coached you, and helped you achieve your personal best. And then there were the bullies who provided a living example of how not to behave—the ones who were insensitive and highly critical to the point of cruelty. They took pleasure in tearing you down as a way to build themselves up.

Being a catalyst for positive change takes courage and strength of character to confront the intimidators and critics who erode efforts to create a workplace environment that nurtures us, feeds our spirit, raises our self-esteem, and promotes a culture of safety and clinical excellence.

No doubt intelligence and skill are critical for success in nursing, but these qualities alone aren’t enough anymore. Excellent core values that help us work well together and in interdisciplinary teams are essential. Nurse leaders must actively address destructive behaviors and mentor staff to develop kinder, gentler, but far more effective approaches to educating and supporting new and seasoned colleagues. These are tough discussions, especially when individuals who are exceptionally talented clinically act as professional saboteurs. Over the long term, these nurses sabotage their own careers because people remember their caustic manner.

We spend so much time at work. We each have the power to make our relationships highly functional and supportive.

Although astronomers don’t agree on when the Age of Aquarius will start (or if it’s already begun), there’s no time like the present to be the catalyst for peace, love, understanding, and living in harmony. Our planet and our profession need it more than ever to assure our survival!

Tuesday, June 23, 2015
When I think about moral distress, I’d describe it as a gnawing, distraught feeling born of perceived injustice. The underlying catalysts are highly variable and include lack of essential resources necessary to provide the standard of care to patients, interpersonal or inter-professional conflict, especially involving ethically challenging situations with patients, families, providers, or co-workers, as well as errors and disturbing treatment decisions. It encompasses a constellation of emotions that nurses have likely felt since the dawn of our profession. If left to fester without effective intervention, moral distress can lead to disillusionment, disenchantment, and even disengagement with the nursing profession. 
Over 30-plus years of practice, I’ve not only observed moral distress in colleagues, but have experienced it personally on several occasions. Until relatively recently, I didn’t have a name for it. My earliest memories of what I’d now term moral distress typically stemmed from being a party to treatment decisions that I simply couldn’t fathom--they involved care that was either too aggressive (and seemingly abusive) for patients who had no hope for any type of recovery, or care that wasn’t aggressive enough for patients who did. These were the days before evidence-based care pathways or palliative care services existed. I felt outraged that the hospital I worked for at that time didn’t seem to address these issues with the medical staff.
A nurse, seasoned and hardened by her own years of enduring ethically challenging assignments, brushed off my distress as reality shock. “Just do what’s ordered; that’s our job,” she advised. But my own professional framework wouldn’t allow me to be satisfied with that advice because I felt the patients deserved so much more.
As this situation recurred repeatedly, I felt something had to change, but I didn’t know how to effect change at that point in time. Simply being mad wasn’t constructive.
Sadly, the way many nurses, especially those in their formative years, handle this type of challenge by jumping ship in their search for calmer seas or greener pastures. The true reality shock, in my opinion, is that no sea is always calm or pasture always greener. The challenge is learning how to cope with resilience and fortitude, and at the same time, derive effective strategies to tackle the root causes of the situations that lead to moral distress. 
Mentoring and supportive relationships are essential among colleagues, nursing educators, and leaders to help individuals in the throes of moral distress to sort out their feelings, identify the causative factors, plan the resolution, and regain their own healthy emotional balance. Sometimes employee-assistance programs are the best options to help nurses deal with the emotional toll in highly sensitive and confidential matters when discussions with colleagues or leaders wouldn’t be conducive to the open dialogue needed to sort out feelings and develop potential solutions.
For nurse leaders, listening and observation skills are key to identifying problem situations and the impact they have on the staff. Ongoing vigilance and diligence are necessary to deal with the issues in our healthcare facilities that cause moral distress in nurses.
Frankly, these issues should be very visible in the priority scheme of all healthcare leaders. The solutions aren’t always straightforward, quick, or easy, but they’re essential to preserving quality and safety in patient care--as well as nursing itself as a long-term career choice.

Tuesday, May 19, 2015
Have you ever worked with someone whom you counted on to complete a task or project only to discover that the person totally dropped the ball, leaving you to pick up the pieces? It’s even worse when that individual isn’t up-front about it, doesn’t seem to care, or refuses to discuss the matter.
My guess is that this scenario resonates with most of us as a result of similar distasteful experiences in our personal or professional lives. These types of incidents can leave a trail of destruction–tempers flare, relationships are strained or broken, and reputations suffer potentially long-term consequences.
Not surprisingly, some nurses in our ranks dislike working in groups and prefer to be accountable only for themselves because they’ve been burned at some point by a ball-dropper. But more often than not, working in healthcare is a team sport. It’s awfully hard to go it alone without the cooperative efforts of team members to share the workload.
To prevent these unfortunate experiences, consider using a few tried-and- true project management strategies. First, openly discuss the task or project with all members of the work group. Assure clarity around expectations, including individual responsibilities, timelines, deadlines, the specifics about the work product to be completed, resource availability, and the consequences of late or incomplete deliverables. Set up touch points for status updates or progress reports to enable timely action to get the assignment back on track if needed. Consider formulating a “Plan B” as a fail-safe if you experience significant barriers with the original approach.
What if you find yourself in the difficult position of not being able to follow through on a commitment? Everyone has had times when life takes an unexpected turn, such as a health or family crisis. Let the parties involved know that you can’t deliver as early as possible. Offer to help problem-solve or suggest resources to assist those left to accomplish the work.
It’s best to always remain self-aware about how much you can realistically take on given your current obligations. Rather than saying yes when you’re overextended because you feel guilty about saying no, politely turn down projects rather than overcommitting and then coming up short. Honest communication is key. Don’t fumble or make an error–keep your eye on the ball!

Tuesday, April 28, 2015
Deprivation and suffering--do these words describe the thoughts that people harbor when we educate them about healthy diet and exercise? There’s a very good chance the answer is yes more often than not. That doesn’t bode well for success. Advising individuals to consider a change in the foods they consume and to increase their activity level has deeply personal implications. Yet, with the national focus on improving population health, these are the cornerstone strategies for developing a healthy population culture.
Personal choices about lifestyle, food, activity level, and habits are key determinants of health. But how do we motivate people to change embedded patterns of behavior and personal beliefs that may have childhood or even cultural roots? They’re the blockades in the tough road ahead that we must successfully navigate to achieve desired population health outcomes.
The popular media doesn’t make our job any easier. It’s actually part of the problem. You can’t thumb through a typical magazine or newspaper without seeing ads for weight loss products that promise dramatic results without dietary changes or exercise. How easy it is to believe that simply taking a pill will somehow neutralize all detrimental lifestyle choices.
The big commercial food industry, including the fast food chains, isn’t an innocent bystander either. The abundance of cleverly packaged convenience foods labeled “healthy” is often anything but. Low fat doesn’t always equal low calorie. Many popular processed foods sport a lengthy list of chemical food additives, too much salt, and added sugars. These “foods” also may lack the beneficial micronutrients and antioxidants that real food provides. Unfortunately, a lot of people have forgotten (or never learned) what a diet containing real food looks like. Here’s a hint: Garden-fresh fruits, vegetables, grains, nuts, and legumes form the foundation (with appropriate modifications, of course, for food-allergy sufferers).
The work we need to do as nurses is multifaceted. It includes discovering more effective approaches to health education that motivate healthy lifestyle choices in children and adults; making low cost, healthy foods available to low-income communities; and influencing the food industry to remove harmful additives and improve the nutritional value of processed foods. Yes, we have a heavy lift, but what other choice do we have? The scales are definitely tipped in the wrong direction!
What do you think? Share your thoughts below!
About the Author

Linda Laskowski-Jones
Linda Laskowski-Jones, MS, RN, ACNS-BC, CEN, FAWM, is editor-in-chief of Nursing and vice president of Emergency, Trauma, and Aeromedical Services at Christiana Care Health System in Wilmington, Delaware.