Two separate but related “undercover boss” writings by former senior nurse executives recently caught my eye: Rose Sherman's blog late last year about a CNO colleague's stint as a travel nurse and an insightful poem by an associate CNO who returned to the bedside published in this month's issue (see Letters, p.6). Both end with the concept of needing a revolution. Both were centered on medical-surgical nursing, an undervalued practice area. What a difference it makes to be on the other side, the bedside, of care delivery.
On reflection, you realize that the seemingly enlightened nurse leader, who thinks they keep their finger on the pulse of practice, might need a stronger dose of reality. Myself included. This is especially applicable regarding med-surg, which is sometimes seen as a stepping stone to specialized practice, where “just one more patient” assignments are the norm. If only it was that easy at the bedside. Today's acuity and workflows challenge the most experienced nurse and, until something bad happens, we rarely do deep dives into processes to simplify and improve. We think it's easier and more foolproof than it is, and then we get preachy about “compliance,” time management, and patient experience even when workloads are tough. And we wonder what happened to trust and respect.
When you read the poem, you'll be surprised how it straddles both perspectives–seeing how the leader tries and unfortunately how the clinical nurse doesn't see it and struggles with frustration. It's a call to action. What does it take work together? There are certainly nurse managers and senior leaders at every level who are adored by their staff. That staff is on board with cultural expectations, feels valued and appreciated, and enjoys coming to work. Why? Is the workload different? Perhaps.
Even more likely, there's a palpable effort to improve and advocate, and our poet adds the need for staff to see and feel change and a vision for the future. She also implores us to do it together, in a revolution against what doesn't work, toward a compelling vision of what could be. Haven't we been talking about needed change since the first pandemic wave? What's holding us back? It's been 3 years already.
In our world of complex healthcare dynamics, conditions for revolt are ripe. I don't mean a revolt against each other; I also see it happening together. There's a lot at stake; patient care and nurse engagement sharing the primary focus. Nursing provides immense value along every step of the continuum of care, central to healthcare. Reimagining the work and the work environment, and positioning ourselves as value-driven, are win-wins.
A disconnect with real practice and ineffective leadership are the last things we need right now. Round more. Listen more. Ask more. Maybe we should all take a shift at the bedside. At the very least, we must acknowledge the challenges. Active mutual engagement in fixing them is better, with constant closed-loop communication, humility, and a steadiness toward clearly articulated goals.
We all have periods of feeling ineffectual to identify the path forward and make needed changes happen. Complex environments aren't easy, especially when the future calls for new models. Using views from “the other side,” we should be energized to propel forward. Together, anything is possible.