Editor's
Note
Take back the
power
Give
nurses control over their practice
Carol Bradley, MSN,
RN, California Editor
November
6, 2000
In the
1970s and 1980s, a lot of nursing leadership’s focus was
centered on creating professional practice models within
the work environment of nurses. Participative governance
models that required staff involvement, such as shared governance,
were popular and successful. These models recognized the
need for nurses to have control over their practice, to
engage in peer evaluation and to be accountable for the
outcomes of nursing care. While some of these models suffered
from poor implementation or lack of leadership commitment
to the principles, the basic idea was a good one.
I saw
many nurses blossom within an environment of open communication,
shared decision making and professional accountability.
Bedside nurses had the opportunity to cultivate important
leadership skills as they participated in guiding and leading
their own profession within an organization. Organizations
have to support an environment of trust and respect for
the wisdom of caregivers for this type of model to be successful.
Unfortunately,
the health care environment of the ’90s created such a singular
focus on financial survival for many health care organizations
that much of the progress in professional autonomy and control
over practice that nursing had achieved evaporated at the
hands of restructuring and cutbacks.
As I
talk to staff nurses today, listen to their level of frustration
and observe the state of the work environment, it seems
that a contemporary interpretation of these enduring principles
could help nurses reclaim control of their practice and
help address many of the challenges relative to recruitment
into the profession.
As the
nursing shortage increases and employers become more desperate
to retain existing staff and fill vacancies, nurses will
realize the new and heady power of being in great demand
once again. For demographic reasons, this demand for nurses
will be sustained for many years. It will challenge all
of us and become the most compelling problem within the
industry, making the Balanced Budget Act of 1997 pale by
comparison. It will require us to rethink how we view nursing,
how patient care is delivered and by whom.
Let’s
make sure that our newfound power and influence is used
for the betterment of patient care and the long-term viability
of our profession. It should not be used to meet the short-term
selfish needs or political aims of a few. It is time for
nurses to reclaim their legitimate voice in the health care
delivery system. However, it can be a voice of intelligent
reason, of collaboration and understanding, vs. anger and
strident opposition to an unknown future.
It also
is time to recognize the importance of nurses in helping
the profession respond to the needs of the delivery system
and our patients in fundamentally new and different ways.
Wherever you work, in whatever setting you practice, make
sure you are a positive force for change that serves patients,
our profession and whoever signs your paycheck. Perhaps
someday nurses will be the ones to sign their own paychecks.
Now that is the ultimate degree of accountability.
