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Reclaiming our priorities.

Last fall three babies were born at an American hospital. They died shortly after from a wrong dose of medication.

These fatal incidents made national news and stopped me cold. How could this happen? Safety, the very thing we work for, vanished. These babies were harmed while they were in our care. Yes, our care. Because, unfortunately, this happened where I work.

I was proud of how my organization responded, doing the right thing in public and in private. Despite media pressure to single out one individual for blame, we recognized this was a system error. So we thoroughly examined every step of our processes to uncover and change the vulnerable spots. That experience has also become the seed for my theme as AACN's next president: Reclaiming Our Priorities.

What led me from such a devastating tragedy to a theme about reclaiming priorities? Does reclaiming mean that I believe we've missed the boat? Absolutely not. We'll have dark and stormy days even in the best of times. Reclaiming means much more than that.

It means making useful again. It means transforming from an uncultivated state. Reclaiming is about quality and efficiency. It is about thinking and working smarter. And especially about making the right decisions.

Reclaiming implies asserting and demanding. Sometimes it means demanding something of others. But it always means demanding something of ourselves. That part is never optional. To demand that we reclaim our priorities, we must be clear on what they are. But we'll never be able to do that until we define our core values. Without core values, our priorities will shift with the wind, just like they're doing now. Core values endure. They must never be jeopardized or violated. They cannot be renegotiated, reordered or traded.

I believe we share three non-negotiable core values in our professional life as acute and critical care nurses.

Patients and families is our first core value. Safety is the second. Reliability is the third.

Patients and families must come first.

In the foreword to the book, Critical Care Nursing: a History, Barbara Siebelt and Gladys Campbell point out that AACN's work has centered on patients and families since we were founded in 1969, even though it wasn't until 1992 that AACN's vision, of a healthcare system driven by the needs of patients and families, was formalized.

Patients and families are the fundamental reason for nursing's contract with society. Why is it, then, that the demands of our work often distract us from our purpose? Our shared commitment to patients and families inspires us and gives us strength.

Safety is our second core value.

AACN's founders and their physician colleagues challenged traditional care because of unsafe situations arising in the new critical care units of their day. I'm not sure whether to be appalled or reassured that, nearly 40 years after AACN was founded, safety is still a critical concern. But then, Florence Nightingale was also concerned about patient safety. And that was 150 years ago.

Our third professional core value is reliability.

Reliability means that we are trustworthy and dependable. It means that patients and families trust that we will be accountable for our contract with society.

Now that we have identified patients and families, safety, and reliability as our core values, let's take a look at our priorities. Unlike core values, priorities can be traded, renegotiated or reprioritized. Sometimes just for the moment. Sometimes indefinitely.

We don't need anyone's direction or permission to do this. We don't need for anyone to empower us, so long as the change does not cause us to deviate from our core values. Reclaiming our priorities doesn't need to be complicated.

One way to accomplish this is to stop something before starting anything new. New activities steal time and attention so we need to intentionally free up energy and resources, often eliminating existing rules, regulations and other infrastructure. For example, we monitor a patient for sepsis then start to monitor for ventilator associated pneumonia without asking whether we should still monitor for sepsis.

A second way to reclaim our priorities when we start a new project is to consider how each step will help achieve the project's purpose. Often we add steps that really don't help us reach our intended goal, just like the project planning approach called, "Fire. Ready. Aim."

Planned neglect can be a third way to refocus our priorities. Even after careful prioritizing, it's usually impossible to pursue everything we consider important. Temporarily suspending action on some things--maybe for a few months--can help to focus our energy. Like not pushing out a new paper form when, in 12 weeks, our documentation will be online. Two cautions if we use planned neglect. First, our decision will always involve other people, so we can't make it alone. Second, if something is truly a priority, the desired outcome may be repeatedly overlooked and never achieved.

Learning from our failures is a fourth way. Because nurses are encouraged, and even rewarded, when solving problems independently, the impact on the system may be ignored. Elaborate workarounds rob valuable time and make us crazy because these pseudo-systems become the norm. Like the clever ways we work around broken systems because we're missing medications, can't find essential equipment or don't have enough linen.

Our three core values of patients and families, safety and our reliability as nurses will drive our priorities. But the exact priorities will depend on what else is involved at the moment. My patient. My shift. My unit. My hospital. My chapter. My association. My profession. My community. My personal life.

My journey this year will start with identifying the priorities that compete for my attention. I already know there are far too many. My personal goal will be to think smarter and work smarter so I can use my energy to serve our core values, instead of squandering it on irrelevant and peripheral activities.

I challenge you to do the same right along with me and to be my partner on this journey. Which of your priorities directly or indirectly support our core values? Which ones get in the way and distract you? Is there one priority of your work that is being overshadowed by competing priorities?

What competes for your time and attention when you are involved with your patient? Your shift? Your unit? Your hospital? Your chapter? Your association? Your profession? Your community? Your personal life?

I would like to know your answers as we reclaim our priorities together. E-mail me at priorities@aacn.org.

Editor's Note: Hanson's complete speech from NTI 07, excerpted above, is available online at www.aacn.org> NTI > Past NTI Web Sites > Atlanta, GA > President-Elect's Speech.

Dave Hanson,

RN, MSN, CCRN, CNS
COPYRIGHT 2007 American Association of Critical-Care Nurses
No portion of this article can be reproduced without the express written permission from the copyright holder.
Copyright 2007 Gale, Cengage Learning. All rights reserved.

Article Details
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Title Annotation:President's Note
Author:Hanson, Dave
Publication:AACN News
Article Type:Speech
Geographic Code:1USA
Date:Jul 1, 2007
Words:1116
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