By Don Sadler
Published in 2010, the “Future of Nursing Report: Leading Change, Advancing Health” explores how nurses’ roles, responsibilities and education need to change to meet the increased demands for health care and advance improvements in the nation’s complex health system.
One of the report’s key messages is the need to transform nursing leadership.
“Nurses should be full partners with physicians and other health professionals in redesigning health care in the United States,” says the report.
Transforming leadership translates more broadly to the health policy arena, where nurses should have a voice in health policy decision making.
“Nurses also should serve actively on advisory committees, commissions and boards where policy decisions are made to advance health systems to improve patient care,” states the report. “Yet a number of barriers prevent nurses from serving as full partners.”
Advancing Health Quality for All
Renae Battié, MN, RN, CNOR, FAAN, vice president of nursing for the Association of periOperative Registered Nurses (AORN), points out that the nursing code of ethics states that perioperative nurses are to collaborate with others in advancing the quality of health for all.
“Use of the title RN carries with it the individual’s responsibility to act in the public’s best interest and to promote social justice by advocating for patients,” says Battié. “To do this, perioperative nurses need to stay connected to broader nursing initiatives.”
One example is the affiliate ANA membership available to all AORN members. As an outcome of “The Future of Nursing Report,” AORN is also a member organization with Nurses on Boards and has more than 10,000 nurses serving on boards and actively matching nurses with needs. “This is an example of nursing being well-positioned for impact,” says Battié.
“Perioperative nurses need to engage with the nursing profession at large or we’ll be forgotten,” says David Wyatt, Ph.D., RN, NEA-BC, CNOR, FAORN, FAAN, chief nursing officer, University Hospital, UT Southwestern Medical Center, and AORN past president. “There’s a great opportunity now to shape the profession and ensure that we have a voice in where it is headed in the future.”
Wyatt says that AORN members have opportunities to serve on task forces and as subject matter experts with their ANA state nursing associations. “Reach out to your local chapter or the national headquarters to get involved,” he says.
“Many of the committees and board rooms in nursing where decisions are made do not have representation from perioperative nurses,” says Dawn Whiteside, DNP, MSN-Ed, RN, CNOR, NPD-BC, RNFA, director of education and professional development for Competency & Credentialing Institute (CCI). “So important decisions about patient care are being made without our expert input. Nurses are front-line caregivers so we need to have a seat at the table in order to influence change.”
Elaine D. Geroski, RN, MSN, CNOR, CSSM (E), assistant vice president of patient services at the WVU Medicine Grant Memorial Hospital, serves as the president of the CCI Board of Directors.
“Volunteer board service has helped me gain knowledge and network with other nurses throughout the nation,” she says. “And by volunteering as a subject matter expert, I’m helping lead change to increase patient safety and compliance of standards.”
Geroski recalls her first committee volunteer experience.
“I remember sitting across from a director of periop from a larger city and thinking, ‘How can I contribute from a smaller rural facility?’ ” she says. “But I learned that they prized diversity of regions, and I was probably picked based on my rural hospital’s location and size.”
Why Actively Lead Change?
Melissa R. Nosik, Ph.D., BCBA-D, ICE-CCP, SHRM-SCP, CEO of the CCI, lists a number of reasons why she believes perioperative nurses should take an active role in leading change in the nursing profession by serving and volunteering:
- Quality improvement – As frontline caregivers, perioperative nurses are well-positioned to identify areas for improvement in clinical practice, workflow efficiency and patient safety. “Nurses’ involvement in leading change initiatives can drive quality improvement efforts and enhance the overall standard of care,” says Nosik.
- Specialized expertise – Firsthand experience in the operating room gives perioperative nurses valuable insights into the challenges and opportunities within health care delivery.
- Collaboration and interdisciplinary care – Effective perioperative care requires collaboration among various health care professionals including surgeons, anesthesiologists and support staff. “Nurses who lead change initiatives can foster a culture of collaboration and interdisciplinary teamwork, resulting in better coordinated and more comprehensive patient care,” says Nosik.
- Professional development – Taking a leadership role allows perioperative nurses to enhance their professional development and contribute to the advancement of the nursing profession. “By engaging in initiatives such as research, education and policy advocacy, nurses can elevate the status of perioperative nursing and promote continuous learning and growth,” says Nosik.
- Patient advocacy – By taking a leadership role, perioperative nurses can champion initiatives that prioritize patient-centered care and improve outcomes.
- Adaptation to evolving practices – The health care landscape is constantly evolving with advancements in technology, changes in health care policies and shifts in patient demographics. “Perioperative nurses who actively lead change initiatives can help their colleagues adapt to these changes and stay abreast of best practices in surgical care,” says Nosik.
Educate and Influence Policymakers
Senator Gale Adcock (North Carolina State) is a family nurse practitioner and former chief health officer at global software company SAS, where she led the onsite primary care practice. Over the past three decades, she has been appointed to four different health-related state boards and commissions by three different North Carolina governors.
“These experiences have helped me become more comfortable asking tough questions, offering a minority opinion and handling conflict,” she says.
Policymakers, both inside and outside your workplace, cannot be experts on every issue they face.
“When no one at the decision-making table represents the views of perioperative nurses, there’s a risk that poor or even failed policies will be enacted,” she says.
Adcock says that nurses’ voices have no impact when they’re confined to grousing in the locker room or staff lounge.
“If a perioperative nurse cannot be one of the policymakers, then it’s up to them to educate and influence those who are,” she says.
One of the best ways to actively lead change is to join national and state organizations that speak for perioperative nurses.
“Many of these are responsible for proposing, monitoring and lobbying for and against bills impacting the work that perioperative nurses do,” says Adcock. “They hire professional lobbyists to ensure that nurses’ perspectives are heard and considered by state lawmakers.”
Adcock also urges nurses to seek appointments to advisory boards and commissions from their local, state and federal officials. “Search the website of your county, city and governor for information about existing boards and commissions, any board-specific qualifications, and how and when to apply,” she says.
Spearheading Surgical Smoke Legislation
Brenda C. Ulmer, RN, MN, CNOR, has been spearheading the charge to get surgical smoke evacuation and filtration legislation passed in states around the nation. She started her efforts way back in 1996 as the chair of AORN’s first multidisciplinary round table discussions on surgical smoke. She served on AORN’s Smoke Task Force in 2006, which resulted in the AORN Smoke Position Statement and Smoke Tool Kit.
“Because of a personal health experience, I knew how bad breathing surgical smoke is and that physical symptoms take a long time to develop,” says Ulmer. “I felt that advocating for smoke evacuation was the right thing to do.”
According to Ulmer, in the 15 states that have passed laws on surgical smoke evacuation, everything started when a nurse or group of nurses contacted state legislators and said this is a workplace hazard that needs to change. “Addressing the issue at the state level has demonstrated that when we work together, we have the power to make significant practice changes,” she says. “Our voices can and should be heard.”
Ulmer urges nurses to get to know their local and state legislators before they need to ask for something.
“In Georgia, we invited local politicians to one of our conferences, which allowed us to get to know them and they us,” she says. “We also partnered with our AST organization and with the Georgia Nurses Association.”
Nurses are rated as one of the most trusted professions year after year.
“This is something we can leverage as we publicly advocate for ourselves, our patients and safe working conditions,” says Ulmer.
Overcoming Challenges to Service
Most perioperative nurses lead busy lives, both professionally and personally. One of the biggest challenges is simply finding the time and energy to volunteer and serve in ways that help lead change.
“I understand these real-life challenges, but I urge nurses to do whatever they can,” says Ulmer. “There is no shortage of situations where you can make a difference.”
Wyatt acknowledges that the time commitment to serving and volunteering is a legitimate consideration.
“I encourage nurses to figure out how they can engage based on their current season of life,” he says. “Service won’t look the same for everybody, but I believe there’s an obligation for nurses to contribute to the profession in whatever way they can.”
Another common challenge to service is obtaining support from your primary employer, including the scheduling flexibility to devote to volunteer service.
“I gained support by emphasizing the return on investment,” says Geroski. “Volunteering for service with the CCI has allowed me to attend AORN events free of charge. Otherwise, my small facilities could not afford to send me to these conferences.”
Some nurses hesitate to serve because they don’t think they have the knowledge or skills to contribute to a board or committee.
“This is completely wrong,” says Geroski. “Diversity is valued among the committees and boards I’ve served on. Believe in yourself and the knowledge you bring to the table. You know more than you think you do.”
Battié concurs.“Lots of nurses don’t see their experience as valuable,” she says. “But periop nurses advocate every day for their patients when they can’t speak for themselves. That same voice can speak up as an advocate for improving health.”
Battié recommends starting out local – for example, serving on a school, church or professional board, like an AORN chapter.
“This will help you get used to the structure of board work and communications,” she says. “There are many resources for understanding how a board works and learning the language of a BOD.”
Ulmer says she sometimes hears nurses say, “Well, I’m just a nurse.”
“To me, this indicates that they think they have no power and can’t do anything except go to work and collect a check,” she says. “However, being a trusted professional gives nurses power that not all professions enjoy.”
From the outside, board service and advocacy can look mysterious and the process can be hard to understand.
“So, some nurses think service is only for those who are experienced in advocacy or active politically,” says Adcock “But this is far from the truth: Everyone starts somewhere, and every board member doesn’t have to have the same degree of prior board experience.”
How Nurses Benefit Personally
Actively serving to lead change will not only benefit the nursing profession as a whole, but nurses themselves may benefit personally in many different ways. “For me, it’s the personal satisfaction of doing a good job,” says Ulmer.
“Being somewhat of a nerd, I instantly go to the knowledge that you gain, which is invaluable,” says Geroski. “Another benefit is making life-long friends whom you have so much in common with.”
Battié says these kinds of experiences help grow leadership skills and can open doors of opportunity for influence and impact. “They look great on resumes, too,” she says.
Wyatt says he has never been one to sit back and wait for others to lead the charge. “There aren’t enough nurses stepping up right now and using their voices to lead change,” he says. “Important decisions will be made with or without our input.”
Nurses can’t complain about where things are headed if they’re not willing to get involved, says Wyatt.
“The more of us who step up and engage, the more likely we are to have solutions that produce positive outcomes for our profession,” Wyatt adds.
