PRESIDENT'S MESSAGE
Introduction
I began my term as President of STN on April 2, 2014, at the annual conference in New Orleans. I am extremely grateful to Karen Doyle, STN President and the STN board and members for this opportunity. This past year has realized numerous opportunities and successes through Karen's leadership.
This is the first of several messages that I will write as your STN President. For my first message I chose to reprint a guest editorial that I wrote several years ago. I thought it was appropriate as an adjunct to one of this year's annual conference themes, "If not now when, if not you who?" In addition, each year in May, we all celebrate National Nurses Week. I am always amazed at the accomplishments and influences of Florence Nightingale. She even influenced my birth and my profession. I was born in the Florence Nightingale Maternity Hospital at Baylor University Hospital in Dallas, Texas!
Over the years, job titles may change and you may think this message should now have Trauma Director or Trauma Program Manager in the title. Despite that, the issues and responsibilities of the role and program remain the same and demand the same attention.
-Kathi Ayers, MSN, RN, NP
THE NIGHTINGALE PLEDGE
"I solemnly pledge myself before God and presence of this assembly; to pass my life in purity and to practice my profession faithfully. I will abstain from whatever is deleterious and mischievous and will not take or knowingly administer any harmful drug. I will do all in my power to maintain and elevate the standard of my profession and will hold in confidence all personal matters committed to my keeping and family affairs coming to my knowledge in practice of calling. With loyalty will I endeavor to aid the physician in his work, and devote myself to the welfare of those committed to my care."
It was 33 years ago that as a "probie" I took a pledge named after Florence Nightingale. The ceremony remains in my memory as if it was yesterday and I continue to revere my official school cap that I received that night. Now, after a 30-year career, nearly all of it in trauma nursing, I am still passionate about the specialty of trauma nursing but question if I should continue as a trauma coordinator. Am I stale or a little "fried around the edges"? Do I need a role change, an attitude adjustment, a vacation, a few more FTE's or a maybe just a few less site surveys? Perhaps I need to reconnect with the reasons I became a nurse and later Trauma Coordinator. For whatever reason, I decided to read some of the historical information written about Florence Nightingale. As I read excerpts from her writings and biographies, the similarities of her role and the issues she dealt with and that of today's Trauma Coordinator seemed strikingly similar! How did she survive? Here are some comparisons of her philosophy and actions with similar challenges and resulting questions facing the modern Trauma Coordinator.
ADMINISTRATOR/LEADER
Florence Nightingale was born into wealth and privilege. She was well educated in the arts. Her father planned for her to travel and to live the life of an aristocrat. In that era, nursing was far from a respectable or safe profession for women. Determined to do something of value with her life, she was willing to break the rules established for women of her day. There were few nurses and she worked tirelessly to develop, recruit and retain the quality and quantity of women into the nursing profession.
As it is true for all of nursing, Trauma Programs throughout the country are experiencing a trauma nursing shortage. Do you know why nurses are attracted to trauma nursing? When you hire personnel do you have a profile of the nurse best suited for trauma nursing? Do you have a plan to retain nurses for the trauma program? Are you willing to serve as a mentor and coach? Does the hospital collect and provide you with the information that identifies why trauma nurses are leaving? Do you have a plan to provide the trauma nurse with the diverse clinical skills to deal with the challenges and chaos of trauma nursing? We must do our best to recruit and retain trauma nurses. Nurses should remain because we have instilled the love of trauma nursing as specialty, not because it is familiar or comfortable.
LIAISON
Ms. Nightingale respected the chain of command and believed in doing things quietly, working behind the scenes on conflicts, rather than airing them in the presence of many others. Although at times she was described as a "turbulent" character, her goal was to be a person who facilitated conflict resolution.
The trauma program is often known as a "disruptive service." Other services may refer to the program as "the fair-haired child that causes sibling rivalry." Are you using wisdom and stamina to guide the program effectively? Do you have the courage to delegate when it is not popular, admit defeat or profess your humility? Are we doing our best to acknowledge others when they play a role in promoting the Trauma Program? Do you have a recognition program for "trauma MVP's"? Do the nurses have the communication skills to deal with the conflicts that arise with even the simplest things like needing a bed-now? Do you have committees in place with the appropriate representation to resolve process issues that need changing?
EXPERT CLINICIAN
Ms. Nightingale is quoted as saying, "If you cannot get the habit of observation one way or other, you had better give up being a nurse, for it is not your calling, however kind and anxious you may be." She not only nursed adults, but children as well. Her initial experiences came from working in the battlefields of the Crimean War where her patients were mostly young males injured from penetrating trauma. She worked in a war zone with minimally trained nurses with limited experience. Sound familiar? She studied diligently to develop her skills in observation and assessment. She believed that until pain and suffering controlled, the patient could not accurately be evaluated. She also recognized necessity of good nutrition for healing the need to be compassionate yet controlled in the face of suffering. To her, light was important in the patient's recovery. It is interesting that JCAHO now mandates the solutions to problems that have been recognized for over a century. For example, Intensive Care Units are now required to have windows that help to deter sensory deprivtion.
Do your trauma clinicians incorporate all aspects of the patient into their care? Do they focus on the technology and not touch? Is mouth care as important as A-line calibration? When the patient is in the trauma room, do you pain medicate as soon as possible? Do you have a bereavement program? Are multidisciplinary rounds a part of the patient's care planning? Do you make time to keep the family informed of the patient's plan and progress? Have you reviewed the literature for best practice models?
EDUCATOR
She wrote, "... nor nurses of hospitals are taught anything about those laws assigned to the relations of our bodies with the world." Florence Nightingale was student of the disease process and believed necessary that the nurse be educated. She used her influence to convince hospitals to improve the training of the nurses. Trauma Coordinators today are urging administrators to maintain the education budgets for trauma nurse education. In an effort to further standardize the education of trauma nurses across the nation, the Society of Trauma Nurses developed Advanced Trauma Core Nursing (ATCN(R)). Do you have an educational reimbursement program or do you offer scholarships for nurses interested in trauma education programs? Are you willing to be a preceptor for schools of nursing or other health care professionals? Are you willing to publish articles in your area of expertise? Have you met with the trauma nurses in your facility to assess the educational needs and professional growth opportunities? Do you realize that every nurse that touches the patient is a trauma nurse? Do you have have succession planning built into your position?
QUALITY/RESEARCHER
She stressed, "Whereas, if you could but arrange that the thing should always be done whether you are there or not, then he (the patient) need never think about it." In other words, there should be standards of practice, policies and procedures, and a systematic way of doing things. Ms. Nightingale was an innovator in the systematic collection, tabulation, interpretation and trending of data. She was able to graphically display her statistics and is known for developing the pie chart!
On return from the Crimean war she collected data that demonstrated a high mortality rate from preventable disease. Through her tireless efforts to improve the art of nursing, the mortality rate among the sick and wounded was reduced from 420 per thousand to 22 per thousand.
She understood how room ventilation was key to the patient's return to health. In fact, the nurses were taught to raise the windows for ventilation and the physicians would come by and close them! Maybe this was the beginning of the first trauma coordinator and trauma medical director" I told you so." As we budget for negative airflow rooms, and work to prevent infection and the unnecessary use of antibiotics, I marvel at her foresight.
Her writings contained comments on prevention of pressure ulcers through placement of pillows and turning the patient frequently. It is told that she once expressed that even one pressure ulcer was too many and the development of a pressure ulcer was a direct reflection of the nursing care received. You go, Flo!
Skin care has been my personal soapbox since my diploma nursing school days. Several years our facility developed a trauma patient profile for those at risk for pressure ulcers. Do you have documentation standards regarding backboard times? Does the OR have standards of care for padding trauma patients? How many of you have incorporated issues as a part of daily trauma rounds? Do nurses recognize the importance of the bath as a means to assess and cleanse the skin? Do you review the literature for evidence based practice models? Does your Library have publications such as the Journal of Trauma Nursing? Are the nurses encouraged to be involved in research projects?
FINANCE
Ms. Nightingale believed in being thrifty. It is a well-known fact that trauma care is expensive and is a target for cost cutting. Each year the budget planning process becomes more difficult. Sources of funding are scarce. Is there a trauma utilization facet to the your trauma program? Is the program being as cost effective as possible? Are you working to pursue alternative revenues or sources of funding for program opportunities? Do employees have performance improvement standards for cost containment as a part of their annual performance evaluation? Do the trauma surgeons take part in the discussions regarding cost containment. Do you have reports that are easily interpreted and useful for cost containment?
ADVOCATE
Through her advocacy, the stature of nursing was raised to a medical profession with high standards of education and important responsibilities. She was adamant that nursing be placed entirely under the direction of the physician. Okay, so she didn't have the vision for advanced practice nurses! She believed strong female leadership and discipline would protect the nurses from sexual harassment by the physicians, male patients, and other male employees. She was responsible for obtaining the respect the nursing profession deserved.
How many of you are working on a policy for physician behavior standards or have been to human resources due to the sexual harassment of a nurse? Have we created the mutual respect and collegial relationships necessary to be seen as an equal voice with our physician partners? At this time the Society of Trauma Nurses collaborates with the American College of Surgeons and other professional organizations to further the cause for trauma systems, patients, and health care professionals. Are you a member of your professional organization?
COMMUNITY SERVANT/VOLUNTEER
Ms. Nightingale did not receive a salary for much of the work she did during her career. After serving her country with the military in the Crimean War, it is believed she suffered from Post Traumatic Stress Disorder. In spite fo being bedridden most of her later life, she always seized the opportunity to use her influence and writings for change.
Do you volunteer to help in your community even for both trauma and non-trauma events? Does the community understand the concept of trauma programs and systems? Are you able to get community support for issues impacting the trauma program? Do you work with the media in your area to highlight prevention education topics or legslative issues? Are you a member of a speaker's bureau?
BALANCE
"The most devoted nurse cannot always be there. Nor is it desirable that she should be." Florence Nightngale taught the importance of the nurse to fully recognize the fact that she could not always be with her patient and that it was greatly to the advantage of the patient that the nurse keep in good health. She instructed it was incumbent upon the nurse to arrange for proper rest and exercise.
In the mid-nineties, hospitals were downsizing, rightsizing and capsizing. Now, we are asked to address the issues of downshifting. We are all trying to go at a slower pace, stop to smell the roses, realize there is more to life than work, or understand that our younger personnel want quality of life. We must address employee satisfaction. Can we change our processes and still maintain the integrity of the program? Have you read any of the books that discuss workaholics or finding balance? Have you taken courses in being organized, delegating, or setting priorities? Do you use available technology to make your life easier? Do you realize that taking time off many increase your productivity?
SUMMARY
What I have learned through my journey of the Nightingale literature is that I still love the challenge, the chaos, the crisis, and the conflict that comes with and draws me to the trauma coordinator role. I laugh when I think that I once pictured myself as a hamster on a wheel. If I just worked faster. I could get ahead. Recently I spotted a T-shirt with the phrase "the hamster is dead." Now that was a rude awakening! There is still work to do. This role didn't kill Florence so I guess it won't kill me. But, I now see that I need a little more fresh air, sunlight, a healthier diet, exercise, time off and a warm cleansing bath. There, now Florence would be proud.
REFERENCES