There is no doubt that change is continuous. This is especially true in nursing. Nurses are increasingly expected to take care of complex patients and work in complex environments. Nurses are expected to use evidence to guide nursing practice and work effectively as team members. When you look around your unit, what do you see? What changes do we need to make today to make our work more productive, safer, and more enjoyable?

Involve the Family

Much has been published about family-centered care in NICU. Most recognize the need for families to be actively involved in the care of their infant. Parents note that communication with the nurse is central to their comfort level in the NICU environment, and they depend on the nurse for information and support.1 Parents also note that consistency in care is essential to forming partnerships with staff in the care of their infants.

While we have made great strides in providing family-centered care, we have a ways to go. It is not just about having a good relationship with families or implementing primary care, although those things help. It is about involving families in the decision-making process regarding the care of their infant. Parents should be involved in policy making and should have an active role in the planning of care for their infant.1 When is the last time you sat down with a family and reviewed the plan of care, let alone asked for their input? Do you know which problems the family considers the most important? How can you work with them in setting outcomes and evaluating results of interventions?

Fix the Root Cause of Problems

A study a few years ago looked at hospital systems and failures in care delivery.2 The author found that most operational failures occurred because of breakdowns in supply of materials or in breakdown of communication or information in the system. In the study, nurses quickly compensated for this lack of supplies or information in very innovative ways. While this gets the work done, the result is that organizations may not recognize that a problem exists or may not consider it important.2 The result is that the problem persists.

Nurses readily assume that they cannot have the equipment they need or that they have to make do with less. If we do not speak up, we cannot get what we need. Do not assume that the powers that be know what is happening. I have, on more than 1 occasion, witnessed nurses working without an essential piece of equipment while management was unaware that they did not have it. Once the problem was brought to the director's attention, it was quickly remedied. It only required someone to ask. No one can fix a problem that they do not know about. You are the one at the bedside; it is up to you to bring it to someone's attention.

Take a Stand Against Workplace Bullying

Lateral violence (bullying of nurses by peers) is a significant problem, resulting in nearly 60% of new nurses leaving their first job within a year.3 Despite much discussion in the nursing literature in recent years, the problem persists. In addition, nurses put up with bullying behavior from others, including physicians, ancillary personnel, and sometimes, their direct supervisor. The result is an environment that is not only unsafe for nurses but also for patients. No one can give good patient care if they are afraid to ask for help from a peer, call another department for test results, or report changes in patient condition to a physician, neonatal nurse practitioner, or other provider.

We can certainly learn to control our own behavior. How do you treat others in the workplace? Think especially about how you interact with new nurses and students. We must also learn to stand up to bullying behavior in others. Only when we learn to handle this behavior by stating clearly that we will not tolerate it, and reporting it to those who can do something about it, will change happen. In addition, we cannot stand by and not intervene when we see it happening to others. Speak up.

Let Go of "How We Do It Here"

Despite the avalanche of information regarding evidence-based practice, much of what we do is still based on tradition or how we are used to operating. This is partly because, for much of what we do, the evidence is still unclear or lacking. This does not mean that we are doing it correctly. We must constantly take time to think about what we are doing and why. We have to continually ask ourselves whether it makes sense. Intensive care nurses are typically great at attending to details, executing procedures and tasks precisely and quickly, and reacting to emergencies.4 However, we are not always good at thinking out of the box or being creative. Nurture those right-brained colleagues who are floating around. They are our best friends when thinking about how to make our work more productive and efficient. When someone transfers into your unit from another state, instead of making her prove she can fit in, find out what she did and where she came from. Chances are that there are some practices that will make things run better.

Keep Learning

Gone are the days when you could graduate from school, obtain a job in your desired specialty, and spend the next 20 years showing up and going home. Indeed, those days probably never existed, although you can probably think of colleagues who operate that way. If you are not reading the nursing literature, attending conferences (local is fine), and seeking out the latest evidence, you are a danger to your patients and a hindrance to your coworkers. Nursing and medicine change quickly and you cannot depend on others to spoon feed the information to you. Evidence-based practice depends on constant review of evidence and research and critically evaluating what practice changes should be implemented.5 This requires everyone to be involved or, at the very least, paying attention. What articles have you read recently?

Consider That Nursing is a Profession, Not Just a Job

Nurses have to be involved. We need to belong to our professional associations. We must participate in how the unit and the hospital operate. We have to take advantage of opportunities to sit at the table where these decisions are made. We have to think about what is best for the profession, the organization, and our coworkers and not just ourselves. How many hospital committees lack a representative from NICU? How hard is it to get someone to volunteer for projects? While the current economic climate has created difficult climates for hospitals and nurses, it is an opportunity for nursing to participate in important changes.6 Health care reform is happening, despite anything, congress may do or not do. Nursing has an opportunity and responsibility to be at the forefront of how patients are cared for in the future. We must not waste it. Get involved, even if you can do only a little bit. Every small step counts.

This is by no means an exhaustive list. Nursing will be called upon in many ways over the next few years to step up and institute and implement change. We cannot avoid it, but we can have a significant impact on how that change happens. The key is to be an active participant, not to wait until someone else tells us what to do.

References