A nurse who is attentive, exudes confidence, and has a “Don't worry, I've got this” attitude makes patients and families feel safe. That was the message of Dana Woods, chief executive officer of the American Association of Critical-Care Nurses (AACN), who spoke at the AACN's annual meeting in Boston in May about her experience of having a family member seriously ill.
I've also experienced, as a family member, that feeling of safety in a confident nurse's presence. My first son was born five weeks early and was showing signs of mild respiratory distress. I became anxious when the pediatric resident in the delivery room was slow to act. He was awkward in his attempt to suction my son and had trouble connecting the oxygen tubing to the Ambu bag. To my great relief, a nurse saw what was happening, quickly approached the resident, and said, “Here, let me,” resolving the situation efficiently and effectively.
Amy Cuddy, who gave the opening keynote address at the AACN meeting, expanded on Woods's message about acting with confidence. Cuddy is a social psychologist and Harvard University lecturer, author of Presence: Bringing Your Boldest Self to Your Biggest Challenges, and presenter of a 2012 TED Talk that has garnered millions of views. She spoke about her research on the effects of “power posing,” that is, the universal stance that conveys power (think Wonder Woman or Superman: hands on hips, legs apart). She maintains that practicing expansive postures (shoulders back, head up, wider arm movements, making oneself “big”) versus inward postures (shoulders curving in, head down, constricted movements) creates physiological changes that instill confidence, even under stress. While some of her critics have raised questions about the rigor of the science underlying her work, Cuddy says recent research supports her findings that these pose-induced feelings of confidence and power are what enable people to act on behalf of themselves and others.
This message certainly resonated with the approximately 9,000 critical care nurses attending the AACN conference, and I think it's particularly germane to nursing. There have been many incidents in which nurses have felt empowered to advocate for patients in very stressful circumstances—think of Utah nurse Alex Wubbels who was arrested for protecting her patient's legal rights (see Ethical Issues, March), or ICU nurse Katie L. George, who challenged her hospital's hierarchy to insist on tests that proved her patient was not brain dead (see Profiles, October 2016).
These nurses’ actions are magnificent examples of patient advocacy. However, nurses don't always feel empowered to change the larger system. We can be reluctant to speak up, contribute at meetings, or offer suggestions.
Yet, more than anyone, nurses have the knowledge and insight to develop innovations to better meet patients’ needs and create a safer environment. Articles in this issue are good examples of that: Baumgartner and colleagues report on outcomes of a nurse-led protocol for using ketamine to provide better pain management in burn patients; Ehrhardt and colleagues developed a tool to identify patients at risk for difficult IV placement, changing policy so patients wouldn't have to endure multiple IV sticks; and three nurse ethicists write about their programs to create unit-based ethics champions to support nurses when they face ethical challenges. Clearly, these nurses and innovators were empowered by their knowledge, sense of professional duty, and willingness to put themselves and their ideas out there.
When I describe to new nurses the power imbalance that existed when we baby boomers began our careers—we were expected to stand when physicians entered the room and never question their instructions—they are incredulous. I don't think expansive postures would have helped in those days: nurses who were considered overconfident or out to change the system were often written up and seen as troublemakers.
Today, though more of us feel empowered to speak up and act with confidence, I still hear from colleagues who feel frustrated, defeated, and powerless because they feel ignored or undervalued by their organizations. Yet they soldier on, and amid the chaos of a normal day, may have shining moments of success that remind them of why we all chose nursing.
While the jury may still be out on whether power posing works, I say go for it. If anyone has a reason to stand tall, it's a nurse.