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You've had a lot of experience, both
as a nurse and as an administrator and nurse leader.
Can you talk about the direction of nursing in this
new century?
First of all, I truly feel we have to come together
and focus on the things we agree on, and where we can
agree is the care of the patient. If we focus on the
patient, we're never going to go wrong.
Second, and I don't mean it to come out negative, but
as nurses we need to get out of the victim mentality.
I think it's holding us back and hurting our ability
to shape the future.
Nursing needs to be at the table, at all levels and
at all institutions. Being vocal and being an effective
contributor involves problem-solving and proposing solutions,
instead of just talking about the problems.
Which is, in part, the work of AONE.
Yes, and what AONE tries to do is to provide tools
to the nursing leaders to facilitate their work, to
bring forward some of the best practices in recruitment
and retention and disseminate them, take success stories
and share them. We have a lot of talk about work environment
and we hear all the time how negative it is, but everyone
I talk to is doing work to improve this.
What are some of the particular challenges
of your own setting in South Dakota?
One of the things-and this is real consistent with
the literature-is the respect issue, and working with
our physician colleagues to create a collegial atmosphere.
We are working with the concept that to truly give the
best service to our customers, we have to create an
environment for our staff that is one of healing. So
we're working on ways to provide that compassionate
environment for people, because our goal is to be an
employer of choice.
But the greatest innovation we're pursuing is using
our staff-not just nursing, but all of our staff-because
frankly, we need to get out of our silos and truly work
as a team, because we nurses are only touching the patient
for a very small [point on the] continuum of their illness.
What would be your wish for the end
of the
century for nursing?
To focus on the health of the community. That's what
nursing's all about.
Who's best at chronic care of patients? Usually, what
those patients need is nursing care, not medical care.
Because we have an increased number of elderly, we're
going to have more chronic illness and a greater need
for nursing.
And who's best at education? If we focus on health
instead of illness, nursing's been doing that, and nursing
plays a vital role in that. We need to get out of our
medical model mindset.
When we talk about clinics and talk about hospitals,
we're talking about illness centers. If we're really
focusing on the health of the community, can't we have
some healing and wellness centers?
Are there good models for this type
of health care delivery system?
The best model I've seen is a model called integrative
health. To have truly integrative health, you need to
involve Western medicine and complementary and alternative
therapies, and you need to have a matrix for deciding
what makes sense.
For example, if someone comes in with an acute abdomen,
you're going to do surgery. However, if they come in
with some chronic illness, you're going to try some
other modalities.
What I envision is a center for the community where
you focus on education and wellness. A health care facility
needs to be actively involved in reducing violence,
in reducing crime. They need to be involved in the social
activities as well.
Now, the problem is that the reimbursement system doesn't
handle that; the reimbursement system only works if
someone comes through your doors, except in the case
of capitation.
So the larger question is, how do you
realize this?
You ask the most difficult question, one [that] nursing
has been struggling with for some time. We have traditional
Western medicine, with a lot of huge players, and you
can't just blow it up and start from scratch. It's going
to take a few years, and some pain.
But I think it will not come from the politicians,
it will come from the grass roots. Because if anything,
what I've learned within AONE is that change occurs,
not from the podium, but from the grass roots and the
people, the members. The role of the podium is to bring
those examples forward, so that everyone can see what's
occurring.
We need to promote the profession, fix the capacity
issues in nursing programs and continue to fix the workplace
environment issues, because if we don't, we're going
to lose nurses as fast as we get them in. I think that
we are down the road to fixing that, but I think in
some cases we have a long way to go.
In others, I think we're making great strides.
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