Getting Comfortable With the Uncomfortable: Nurse Leader as Advocate—One Leader’s Story

Nursing advocacy serves as the bedrock for supporting problems affecting nursing practice, the nursing profession as a whole, and health care issues. Every nurse has a professional mandate to advocate for the profession and answer the call to action to be the voice in all issues affecting nursing and patient care. Dr. Nicolette Fiore-Lopez shares her personal insights by providing examples of political advocacy in the nursing arena and how one may overcome the fears of conversing with congressional leaders. She addresses the why, the how, and the interface between advocacy and nursing practice. Grounded in the advocacy mission of the American Organization for Nursing Leadership, Dr. Fiore-Lopez reminds us that advocacy is our responsibility as nurses, and we should be able to speak about our profession and the legislative issues that affect it.     

Advocating for nurses and nursing

Every nurse has the opportunity to make a positive impact on the profession through day-to-day advocacy for nurses and the nursing profession. In this article the author defines advocacy; describes advocacy skills every nurse can employ to advocate for a safe and healthy work environment; and explains how nurses can advocate for nursing as part of their daily activity whether they are point-of-care nurses, nurse managers, or nurse educators. The advocacy practices discussed are applicable whether advocating on one's own behalf, for colleagues at the unit level, or for issues at the organizational or system level.     

Martha E. Rogers: a life history

The 20th century in nursing has focused heavily on theory development. While theorizing about nursing--what it is, and what it is not--can be traced back to Nightingale, Martha E. Rogers' An Introduction to the Theoretical Basis of Nursing (1970) marked the advent of a new era in nursing science. With a view of nursing as a "learned profession," this landmark work staked out a substantive knowledge base for the discipline. The science of unitary human beings proposed by Rogers was a radical departure from all that had come before and is seen by many as pioneering the beginning of a paradigmatic shift within the profession. The purpose of this inquiry is to document the self-described events across the life span of Martha E. Rogers that she perceived as having influenced the development of the science of unitary human beings. A life history approach is utilized and the data are organized chronologically. This life story of Martha E. Rogers is essential to the current and future understanding of the evolution of the culture of nursing. Likewise, more is learned about the nature and process of theory development.     

When TikTok Is Not Enough: Engaging Nurses at All Levels in the Advocacy Process

Nurses took to social media at the height of the pandemic. They leveraged the popular app TikTok to share their experiences with the pandemic, educate the public, combat misinformation, and used it as a tool to advocate for the nursing profession. Although many nurses leveraged this platform to educate, others used it as a platform to challenge the system and highlighted the great divide within the nursing profession. With 4.2 million nurses in the United States, it is estimated less than 10% are members of professional organizations. These professional organizations are the primary groups advocating on behalf of the profession. How are we developing legislative agenda’s that meet the need of the profession if less than 10% of nurses are engaging and speaking up? There are multiple ways nurse leaders can engage frontline staff in the advocacy process. Levels of engagement can range from within the organization to local, state, national, and global efforts. The opportunities to engage are endless. We are 4 million strong, yet we struggle to have an aligned collective voice. Our divide begins with unions versus non-unions, mandated staffing ratios versus other staffing models, associate degree versus bachelor’s degree, and so on. How do we ever expect to be heard if we are not aligning our voices and coming to consensus on what is best for the profession as a whole? Social media is not getting us in front of the right people. As leaders, we must role model what advocacy looks like and provide avenues for our nurses to engage in this process.     

Contributions of Martha Rogers to the development of nursing knowledge.

Martha Rogers' greatest contribution may be her introduction into nursing of a questioning stance about the prevailing models of science, leading to increased acceptance of alternative paradigms, a variety of research methods, and explorations of topics such as existentialism and Eastern philosophy. Nursing is a richer, more diverse profession because of Martha Rogers.     

Perianesthesia Nursing Advocacy: An Influential Voice for Patient Safety

Perianesthesia nurses are called to advocate for their patients, promote a safe work environment, and contribute to the continued advancement of the nursing profession. Nurses must demonstrate vigilance in their nursing care to protect patients from harm. It is an ethical and legal responsibility to request physicians to review with patients their informed consents when they report they do not understand or have questions about the surgical procedure. Likewise, nurses need to alert managers and administrators when they experience unsafe work environments, such as actual or potential nurse staffing issues, unsafe nurse-to-patient ratios, medication errors, and nurse fatigue. This article focuses on the valuable role perianesthesia nurses play in patient advocacy by: (1) speaking out on behalf of the patient, (2) assuring a safe work environment, (3) assessing for nurse fatigue, and (4) advocating patient safety for the global nursing profession.     

The impact of utilization review on nursing

At first glance, nursing's role in UR appears to be of strategic significance to the profession. But there are several issues that nurse executives need to consider. First, since UR departments are seldom part of the nursing department, UR nurses are practicing outside the realm of nursing. What responsibility, if any, does the nursing department have to nurses practicing in the hospital, yet not in the nursing department? What can the nursing department do to help UR nurses maintain their identification with the profession and appreciate the strategic importance of their role, with its legal and financial ramifications? Second, UR is changing the established role of the primary care nurse. In your institution UR may already have taken the staff nurses' discharge planning function. It appears that several factors are contributing to this role change. Patient acuity has increased the time needed to administer physical care. The nursing shortage means more patients are assigned to each professional nurse and paraprofessionals are doing more patient care. There is less and less time left for the primary nurse to practice the professional attributes of nursing, primarily discharge planning. This function is shifting to the UR Department. Is discharge planning a function nurse executives wish to relinquish? Finally, we are entering another period of severe nurse shortages, where recruitment and retention of staff are paramount. Actively competing for our staff are the UR departments. Forty professional nurses work in three regional centers of the American Health Network, American Group Insurance Company (Dallas, Texas). In one hospital of 450 beds, nine nurses are employed by the UR department.(ABSTRACT TRUNCATED AT 250 WORDS)     

Do we really understand how to retain nurses?

AIM: To compare views of nurse executives with those of nurses who have left the profession on the importance of retention strategies. BACKGROUND: Although much has been written about nursing turnover, there continues to be dissonance among decision makers as to why nurses leave the profession and what the most crucial issues are for retention. METHOD: Factor analysis was undertaken to compare responses of nurse executives with those of nurses employed outside of nursing. RESULTS: Contract requirements represented the greatest discrepancy, 1.07, followed by legal and employer issues, 1.02; worklife/homelife balance, 0.91; external values and beliefs about nursing, 0.75; and professional practice, 0.29. CONCLUSIONS: A disparity exists between perceptions of nurse executives and those of nurses who have left the profession as to which issues are most critical in retention. We suggest that nurse executives ensure sufficient organizational support for nursing unit managers who are more likely to understand methods of retaining nurses at the clinical interface.     

The Medical‐Surgical Nurse Perspective of Advocate Role

Nursing advocacy for patients is viewed as a vital role for the nursing profession; however, there is little empirical research regarding nursing advocacy. PROBLEM. The medical‐surgical nursing specialty is the largest specialty in acute care settings, but few advocacy studies have focused exclusively on this specialty population. METHODS. The purpose of this study was to explore the nurse advocacy actions and workplace support for advocacy using written narrative responses to a mailed survey using a medical‐surgical nursing sample. FINDINGS. The responses help to illuminate the importance of the advocate role for this nursing specialty and provide preliminary information on the advocacy actions and workplace support as reported by the nurses. CONCLUSIONS. The resulting data provide a basis for examining the workplace environmental support for nursing advocacy, further delineate the actions of the nurse advocate, and clarify how nurse advocates follow patient desires regarding care. In addition, the results can be used in education, improving advocacy skills, and safety initiatives.     

Nursing leadership and health sector reform

The political, technological and economic changes that have occurred over the past decade are increasingly difficult to manage within the traditional framework of health‐care, and the organisation of health‐care is seen to need radical reform to sweep away many of the internal barriers that now divide one form of health‐care, and one profession, from another. Nursing must equip itself with skills in advocacy and political action to influence the direction the system will take. Nursing currently suffers from a weakness in self‐concept that goes hand in hand with a weakness in political status, and nursing leadership must build the foundations for both advocacy for others and self‐advocacy for the nursing movement. The profession faces tensions between different conceptions of its role and status, its relationship to medicine, and its relationship to health. Health indices are tightly linked to status, and to trust, hope, and control of one’s own life. Can nurses help empower others when they are not particularly good at empowering themselves? What will the role of the nurse be in creating the information flows that will guide people toward health? Nursing’s long history of adaptation to an unsettled and negotiated status may mean that it is better fitted to make this adaptation than other more confident disciplines.     

Mental health nursing consultation: a study of expectations.

Psychiatric nurses working in the field of mental health consultation to medical-surgical nursing units may find it useful to become more fully aware of what is expected of the mental health nurse consultant role and how they can best meet these expectations in their individual situations and setting. This study demonstrated that the medical-surgical nurses in one hospital do have specific expectations for the role of the mental health nurse consultant. To fulfill these expectations the mental health nurse consultant should identify her role in light of the above findings and attempt to integrate her job within the boundaries set forth by her hospital, the nursing team with whom she is working, and the patient's needs.     

Specialisation in nursing: are we ready for the year 2000?

The development of specialty nursing practice and nurse specialists in today's health care arena is a controversial yet growing force, fuelled by a complexity of factors from both within and external to the profession. By narrowing the focus on parts of the whole field of nursing, nurses have met the challenge of increasing technology, complexity of the health care system, and nursing care needs. Although the debate regarding nurse specialists continues to rage, the production of such nurses will push beyond the boundaries of the profession into the new millennium, in the interests of patient care.     

Communication. Improving RNs' organizational and professional identification in managed care hospitals

Nurse administrators are searching for an expanded repertoire of strategies to attract and retain qualified nursing staff in today's managed care environment. This study examined hospital registered nurses' interpretations of managed care and the effects of those views on nurses' identification with their employing organization and the nursing profession. Findings show that nurses held greater identification with their occupation than their organization. Significant factors influencing nurses' attachment to both of these reference groups included uncertainty about managed care changes, information received about managed care changes, and effects of managed care on the nursing role. Communication principles and strategies are presented to nurse leaders for use in fostering a stronger organizational affiliation among staff nurses while maintaining a strong identification with the nursing profession.     

Mental illness in the nursing workplace: a collective autoethnography

Many nurses are burned out, exhausted and have a high intent to leave their jobs. These factors, when experienced over a period of time, are consistent with the development of mental illness. This study takes a collective autoethnographical approach to mental illness in the nursing workplace by focusing on the stories of nurses who have experienced mental illness in clinical practice. It highlights three ways in which nursing and mental illness are connected; the nurse who is vulnerable to mental illness prior to entering the profession, the nurse who develops mental illness that is independent of her work but is nevertheless impacted by it, and the nurse who develops mental illness as a result of her work and/or role. This paper explores the hyphenated lives and bullying these nurses experience, and recommends strategies that the profession, employing organisations, and individuals can adopt to reduce nurses' progression from stress to distress and mental illness.     

Compassion: what history teaches us

Although the government and nursing bodies agree that patients have a right to be treated with compassion, reports such as the Health Service Ombudsman's Care and Compassion? Have criticised the NHS, and nurses in particular, for lacking this quality. This article considers how compassion has been characterised by nurse writers and educators throughout the profession's history and considers what lessons can be learnt by the profession today.     

Keeping nurses in nursing: the profession's challenge for today

Urologic nurses and the nursing profession face incredible challenges in caring for patients and their families after a trend of the continued decline in nursing school enrollment, the nursing shortage, and increasing staff nurse dissatisfaction with the current workplace environment. Is it possible to retain staff nurses during this current crisis? Many factors contribute to nurse dissatisfaction and subsequent turnover and burn out. In light of the current nursing shortage, it is essential and cost effective to retain nurses in their specific jobs and within the profession. There is no single, simple reason or solution for professional staff nurse turnover. Some of the current contributing factors to staff nurse dissatisfaction and satisfaction will be discussed in an effort to discern ways to promote staff nurse retention.     

护士长兼任糖尿病专科护士工作的实践与成效

随着医学的发展，专科护士已成为近年来护理专科迅速发展起来的新角色。某院于2005年起，由内分泌科护士长兼任糖尿病专科护士，其为了兼顾好病房管理和专科护士两方面的工作，通过科学管理好时间，有计划地安排工作；优化护理工作模式，实施“层级全责一体化护理模式”；以成立“糖尿病联络护士工作小组”的形式，培训和指导非内分泌科护士的糖尿病专科知识和技能等。经过两年多的工作实践，在护理管理、专科护理质量、糖尿病患者教育等方面均获得很好成效，科室没有投诉和纠纷，没有发生任何差错事故；提高了患者的糖尿病知识知晓率；患者的综合满意度达到95％以上；并能开展一些糖尿病护理研究。因此，在目前没有条件设立全职糖尿病专科护士岗位的情况下，由护理骨干兼任糖尿病专科护士，履行其职责及发挥其功能，对为患者提供高水平、高质量的临床护理同样起到很好的作用。     

Education purchasers’ views of nursing as an all graduate profession

The issue of whether nursing should be an all graduate profession is one of the most important questions currently facing the nursing profession. The literature indicates that there are differing views on this issue but that there is little research on the performance of graduate nurses in practice. Purchasers of education have played an increasingly significant part in nurse education since the advent of Working Paper 10 (WP10) (DOH 1989). Purchasers hold the resources for nurse education and can now decide whether to commission for diploma or degree level student nurses, therefore they will have a major influence on the outcome of this debate. The aim of this paper is to discuss the views of the purchasers of education about this issue. A purposeful sample of 34 key stakeholders involved in commissioning and contracting for education was selected and asked for their views on whether nursing will or should become an all graduate profession. Key areas that were focused upon were the problems that might emerge from an all graduate nursing profession, the advantages of graduate level nurses within the NHS, what graduateness is and what it might mean for nursing. The results indicated that purchasers were convinced of the importance of nursing graduates but only as part of the workforce. Alternative ways of increasing the percentage of graduates rather than in pre-registration education were preferred with pathways of education linked to continuing professional development. Significantly, the participants were able to articulate the attributes of a degree level education for clinical practice including leadership, assertiveness, and reflective, critical skills.