MAY 1989, VOL. 49, NO 5 AORN JOURNAL

The Award for Excellence in Perioperative Nursing

President Pat Hercules presents Linda Groah with the 1988 Award for Excellence in Perioperative Nursing at Opening Session.

The Sphere of Excellence

Linda K. Groah received the 1988 Award for Excellence in Penoperative Nursing. She said the award has a very special meaning to her because in 1988 she completed 25 years as a penoperative nurse. It resulted in her reflecting back over her career and looking to the future, wondering where she will take her career during the next 25 years. She presented the following address at Closing Session.

wing my reflections over my career, I found D something out about myself, something you may have surmised-I have been having a love affair. A love affair that has lasted for a quarter of a century. This affair has been with nursing and specitidly with penoperative nursing. Explamng

this love affair perhaps is like explaining poetry. Robert Frost said a poem “begins in delight and ends in wisdom.” So does the love for a profession.

All the theoretical frameworks cannot reverse this. We cannot begin with wisdom and finish in delight, and we must pay the price for wisdom. My career has not always been the way I would have perceived an ideal love affair. It has been fickle at times; it has been hurtful, frustrating, and sometimes even damaging to me. I have felt the throbbing, aching feeling of loneliness, the emptiness and frustration when a patient died in the operating room or when I had to dismiss an individual who could not meet the standards of work performance. But those feelings were always fleeting and a good night’s rest helped revitalize me and helped me look optimistically to renewing my love affair with nursing.

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The future of nursing and perioperative nursing is the responsibility of staff nurses and managers who work together. We, as members of this profession, must have an infectious optimism. We must be able to instill optimism about nursing in others.

How do you know if you are optimistic? When a case goes well do you say, “It was no big deal,” or do you accept a compliment and tell yourself, “I was well prepared, I studied the physician preference cards, and the extra effort really did

Optimism has been defined as the middle ground between two other attitudes. On one end you have naivete or viewing the world through rose-colored glasses. At the opposite end is pessimism or fatalism. Naivete and pessimism actually have the same origin-a belief that some outside force is totally in control of your life.

The optimist believes power or control comes from within and that we are ultimately responsible for our success. We know that positive illusions create self-fulfilling prophecies that will allow us to achieve success and excellence. Optimistic nurses work harder and longer, and their perseverance allows them to lead our profession to success. They are empowered and they empower others.

In contrast, a negative attitude imprisons us as individuals and professionals. If you think as a loser, you will lose. If you think as a winner, you will win. Your ability to convey an attitude of self-confidence will permeate your colleagues, and they will be infected with the same winner’s perspective.

Managers must appreciate change and see something motivating in the process. It is our responsibility as leaders to create the best possible reality even in very difficult circumstances. We must convert concerns and apprehensions into challenges and opportunities. To be successful in leading our departments, we must have the courage to be on the cutting edge. We have to risk being the first to implement new concepts such as self- scheduling, decentralization, clinical practice committees, flexible scheduling options, and joint professional practice committees to nurture professional relationships.

pay o r ?

We want nursing to be recognized by having RNs on medical committees. Why don’t we recognize medicine’s contribution to patient care by including physician representation on nursing committees?

Even more important, we must be willing to take the heat if our ideas do not work out. If we are willing to delegate and encourage our employees to take risks, we will promote optimism and excellence. When our employees feel good about themselves, they will have a sense of control over their careers, and they will develop a sense of loyalty and commitment to us, our departments, and our institutions.

How can you develop excellence as a clinical nurse? Set goals that you can achieve; when you reach them, set new goals. Always stretch yourself a bit further than you think you can. Five out of 10 people avoid setting goals because they are afraid of failure.

Don’t fight negative thoughts. Accept them and then move on. If you suppress negative feelings, you will carry them around as extra baggage, and they will resurface when you least expect it or they will haunt you until you deal with them.

As professionals, we can acquire a sense of control by doing our homework. This means we must know who our competitors are and who our supporters are. Before presenting a plan, we must know who is going to support the plan and who is going to fight it. A well thought-out plan with supporting data will provide additional enthusiasm for the goal or project.

Above all, do not expend energy on unimpor- tant issues. You do not need to play win-lose battles on every issue. Know when to dig in your heels and not give in. An example is when the quality of patient care is impacted adversely.

Anticipate success and fantasize about how winning will feel, what it will it taste like, and how it will look. Imagining yourself as successful is a powerful tool. Imagine yourself as next year’s Award for Excellence recipient-what would you say to your colleagues about success?

Successful individuals know that excellence means creating a psychological safety net. It’s much easier to be a risk taker if you know there is a safety net under you. Every time you try

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something new, imagine the worst possible outcome and have a solution or alternate plan ready. Having alternate solutions will give you a sense of control. Knowing that you can survive and that you can get through the most difficult situation will reinforce your self-confidence.

To assist in achieving excellence, be good to yourself. One of the most important things I have learned as a manager is to break projects up into small pieces. When I get a project that overwhelms me, I break it down into small pieces and work on one piece at a time. After I accomplish part of the project, I reward myself by going jogging, going shopping, reading, or playing with the computer. As professionals, we must have the ability to reward ourselves either internally or externally. The higher up in the organization you go, the fewer strokes you receive.

Managers-when was the last time a surgeon came into your office, sat down, and said, “Jane, I want you to know you run a great department”? It’s more like, “I don’t ever want that [nurse] to scrub for me again, she never pays attention,” or, “Your nurses won’t let me take the patient into the room until after they check the patient in.”

Clinical nurses-where you work is important. Search for an environment that values you as a professional and allows you to practice profes- sional perioperative nursing. Nonnursing functions should be performed by nonnurses. Take the time

In her address Session, Linda GI plains how nursa agers can achieve

at *oa i ai ex

Closing .h ex- nd man- cellence.

to look for the institution and the department that has philosophies similar to your own. Interview the head nurse or supervisor and ask to talk to members of the staff before you commit to a job. It is a seller’s market and you have a valuable commodity to sell.

Managers and senior staff nurses40 not be threatened by the crackerjack head nurse or new staff nurse. Enjoy the great job they are doing and appreciate that they are making you look good. After all, you hired and trained them.

In the sphere of excellence, keeping in good physical condition is very important. Exercise is an excellent way to keep the body tuned, to relieve stress, and to create a sense of well-being. How can we talk with patients about preventive health care when we don’t exercise, we carry salt shakers in our purses, and we cannot wait to get out of a case to have a cigarette?

Exercise causes the brain to release endorphins. This is a natural opiate that promotes good feelings and a sense of well-being better than any over- the-counter or under-the-counter drugs that are available. If your body is in good working condition, you can put in longer hours, function under increased stress, and still have energy left at the end of the day for other activities.

Nursing image has come a long way, and it is very important. A professional image communicates professional value. We are the most important sales

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force we have for our profession. Being well dressed and well groomed helps boost selfconfidence and the confidence others have in you.

Maintain broad perspectives and have interests other than your jobs. These interests will help you through tough weeks and give you something to look forward to. Having important roles outside of work reduces the anxiety of having all your “emotional eggs” in one basket.

Go to school and take a course in adult education, computers, calligraphy, or even basket weaving. Volunteering for organizational activities such as AORN, the American Heart Association, the American Cancer Society, or campaigning during an election will reenergize you. Many people have achieved excellence, and they have taken the time to develop well-rounded lives that include many positive areas. If they suffer defeat in one area, they can be sustained by success in another. Success and excellence are ego-building and provide the support and confidence to try new experiences and accept new challenges.

For managers, the power of personal presence, or “management by walking around,” is essential. You have to be where the action is. Participate directly, see with your own eyes and hear with your own ears. This is the only thing that will provide you an unfiltered, richly detailed impression of what is really going on in the surgical suite.

You’re probably thinking that you don’t have time for one more activity, but I would challenge you by saying, you can’t afford not to have the time to do it. Look at how you spend your time and what is important to you. Make an appointment to spend time with your staff. Block time out on your calendar to make rounds. We all know how calendars can fill up with outside priorities. Don’t be the manager whose staff says “the only time we see her in scrub clothes is when the Joint Commission is here.”

Be a role model for your staff and practice what you preach. Your staff members are boss watchers; how you interact with your staff will affect how they buy into your ideas and your concepts. Your responsibility as a leader is to make a lot of little things happen, the kind of small, perhaps revolutionary changes that add up to make

your department a better place to practice professional nursing. Place a high value on the clinical nurses in your organization. They are the individuals who make it happen day after day. They are the real core of perioperative nursing practice.

Financial decision making in hospitals will continue to contradict our professional values and beliefs. Nurses will continue to be concerned about decisions that they believe will jeopardize patient care in favor of cost. By providing support and a strong department, we as nursing leaders can, must, and will assist our clinical nurses in resolving some of these complex problems.

Get the clinical nurses involved. Let them help shape the future of your department and how care is delivered. We have opportunities now that we have never had before. Together we can develop great visions for a great profession.

I once had a boss who made me feel like I could accomplish anything. That attitude exerted a tremendous force on me, my career, and my interactions with the individuals with whom I worked. I found that motivators don’t do things for me-they give me the opportunity and the belief in myself to make things happen, to reach out, and to strive for excellence.

Clinical nurses have some responsibilities in this quest for excellence. You have the responsibility to communicate with your managers to let them know your thoughts, your concerns, and your ideas. Don’t bottle all this up and save it for the local pub or the locker room. The last time I checked, bar stools and lockers did not have much power to assist in resolving issues, but managers do. When you have a problem with nursing or nurses, talk to nurses, not physicians. Physicians control medicine, not nursing. Every time you discuss nursing problems with physicians, you undercut our profession and devalue your colleagues.

When conflicts arise with your colleagues, as they always will, be open and confront your peers assertively but gently. Remember, however, that being assertive cames with it the responsibility to know when to use the skill and to know the difference between being assertive and aggressive.

In looking back over my career, I realized that

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:rly Groah ratulates he] the closing

proudly ; mother address.

the most hurtful, demoralizing things I remember about nursing came from my colleagues. When I was a student, the OR nurses treated me like an albatross that they had to put up with. They obviously did not like students.

I remember being a new staff nurse and scrubbing with a senior staff nurse who told me just enough to do a case, but not enough to allow me to perform as well as she could. I also remember the time the team leader went on vacation and took the keys to the plastic [surgery] cupboard with her when I was going to be in charge of the service. I remember being a new staff nurse sitting in the lounge totally ignored by all the old timers.

We must stop these behaviors. We must stop putting nursing and nurses down and get on with the exciting things the future of our profession holds. I have a vision that nursing in the next decade will attract the brightest and most talented young people America has to offer. You and I will be the mentors. We are empowered to make the difference through our daily interactions with each other, with patients, with physicians, and with our consumers. We as nurses must support each other; we must look for positives not negatives in our

interactions. If one of our colleagues is getting beaten up, we should defend him or her. We must stop eating our young and start nurturing them, mentoring, and guiding them toward success.

My love affair with nursing has involved 25 years of loyalty, commitment, and a willingness to strive for excellence. It has involved a willingness to allow nurses to do nursing and to provide quality care to the surgical patient.

The theme of the 1989 Congress was “New Frontiers: Shaping the Future.” The future is in our hands individually and collectively. We must accept that challenge, make a commitment to each other and to our profession, or surely professional extinction will result. I would like to end with the following quote:

Only as high as we reach can we grow Only as far as we seek can we see

Only as deep as we look can we go, and Only as wide as we dream can we be.

LINDA K. GROAH, RN, BSN, CNOR, CNA DIRECTOR OF NURSING, OPERATING ROOM,

POSTANESTHESIA CARE UNIT UNIVERSITY OF CALIFORNIA

HOSPITALS AND CLINICS SAN FRANCISCO