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You take the high road, and I’ll take the low

Hypothetical Case

Natalie is a nurse anesthetist working on her DNP. Eager to obtain this credential she dove headfirst into coursework and discovered she enjoyed her courses, especially the camaraderie that quickly developed with her classmates. Now they are all trying to decide on areas of study for their DNP translational research projects. Natalie’s pet peeve has always been the way some surgeons and their teams treat obese patients — especially when they are under anesthesia. A large woman herself, Natalie is often uncomfortable with the disrespectful comments and laughter she hears but has never challenged the behavior. As she reflects on her experience she realizes that any anesthetized patient is fair game for some surgical teams and the operating room culture in some of the suites is characterized by loud rap music, jokes at the expense of patients and general disrespect. Talking with classmates about studying this culture for her translational research project she is surprised that most discourage her from choosing a topic where she won’t be able to effect change. “Don’t be naïve and think you are going to change what happens in the OR. The power brokers are the surgeons and they’ll eat you for lunch!” She shares this experience with the professor in charge of the research projects.

Code of Ethics

Provision 1 of the ANA Code of Ethics for Nurses (2015) obligates every nurse to practice “with compassion and respect for the inherent dignity, worth, and unique attributes of every person” (p. 1). Provision 3 obligates nurses to promote, advocate for, and protect “the rights, health, and safety of the patient” (p. 9). The Essentials of Doctoral Education for Advanced Nursing Practice (2006) include “Organizational and Systems Leadership for Quality Improvement and Systems Thinking” with the explicit goal of eliminating health disparities and promoting patient safety and excellence in practice. DNP graduates “must be proficient in quality improvement strategies and in creating and sustaining changes at the organizational and policy levels” (p. 10).

Scenario 1

Natalie’s heart is in the right place. She knows the operating room culture in her institution is disrespectful to patients. She has done well in course work on organizational theory and behavior, quality and performance measurement, and reflective leadership and ethics in healthcare systems. She wants to use her DNP translational research project to make a critical difference where she works, But human nature being what it is, she is cowed by the imagined roadblocks to sustainable change and realizes she can take an easier path. There has been a recent uptick in erroneous needle counts that have led to patients requiring more anesthesia time until scans can demonstrate that the missing needle is not in the patient. This research would also be important and a much easier “do.”

Scenario 2

Natalie reflects on her classmates’ wisdom and desire to protect her from the ugly side of being a change agent. She always has viewed nursing as a calling to help people. She believes that the disrespectful OR culture is reflective of a deeper problem, a lack of commitment to patients. She believes she now has the right knowledge and expertise to create and sustain needed change and decides to assume the challenge. Her professor supports her and together they do a quick SWOT analysis, internal strengths and weaknesses and external opportunities and threats. That evening, reflecting on her experience, Natalie opens her journal to a favorite quote: “Always in life an idea starts small, it is only a sapling idea, but the vines will come and they will try to choke your idea so it cannot grow and it will die and you will never know you had a big idea, an idea so big it could have grown thirty meters through the dark canopy of leaves and touched the face of the sky.’ He looked at me and continued. ‘The vines are people who are afraid of originality, of new thinking. Most people you encounter will be vines; when you are a young plant they are very dangerous.’ His piercing blue eyes looked into mine.’ Always listen to yourself, Peekay. It is better to be wrong than simply to follow convention. If you are wrong, no matter, you have learned something and you grow stronger. If you are right, you have taken another step toward a fulfilling life.” – Bryce Courtenay, The Power of One.

By | 2015-04-20T20:53:37-04:00 January 25th, 2015|Categories: Blogs, Nursing Careers and Jobs|Tags: |1 Comment

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    Kay Gremmels July 7, 2015 at 9:05 am - Reply

    I love this story. I can identify with its situation- writing a research paper for a class addressing an unpopular subject in nursing- The unemployment of older experienced nurses. These ethical and political issues are the driving force in today’s nursing culture and therefore are dictating practice. They are dilemmas because one knows that what is being observed and experienced is wrong, but also one also knows that speaking up can be personally detrimental to you future employment status. In real life nursing practice, it is very dangerous to address these issues. They are career/employment suicide. However in today’s nursing work environments these issues have reached the point where some one has to address them and they cannot be ignored any longer.I received barbs, harsh criticism, a lack of support from both the instructor and fellow nursing peers and a lower grade for my choice of a topic (Unemployment of older experienced nurses in today’s nursing workforce) Nursing has to start taking a stand against unethical and often times illegal behavior. Discriminatory actions in any setting, including nursing is against a person’s civil rights- whether it is in an OR exhibited against a patient or against a fellow nurse based on age. Nursing Its time you stepped up to the plate a do what is right and just.

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