Many nursing theorists, from Nightingale to Watson, and Henderson to Benner, describe the essential mission of caring as the foundation of nursing practice. The concept of caring in nursing practice is often thought of as a "given." There is an assumption that compassion and therapeutic relationships serve as the underpinning of all our intentions as nurses. Caring is "like motherhood and apple pie." Yet, in today's complex healthcare world, clinical nurses and nursing leaders are increasingly challenged to uphold an ethic of caring in practice environments laden with barriers and competing priorities. It is our hope that this issue of the Nursing Administration Quarterly will explore and challenge these assumptions while offering practical, inspiring strategies for supporting caring competencies in nursing leadership and clinical practice.
Maybe it is my New England worldview, but I have always seen caring competencies from a practical sense as carried out through effective relationships and communication skills, whether as a clinician or as a leader. It has fascinated me that while we spend some time learning the theory of caring and therapeutic relationships in nursing school, actual support for practicing and improving these skills-such as empathy, collaboration, communication, and conflict resolution-gets very little attention in the work setting. There is perhaps an assumption that nurses are innately gifted in relationship and communication skills rather than seeing these as competencies that require practice, coaching, and ongoing development.
Clinical nurses and nursing leaders work in highly complex, often-fractured, and risky work environments. Nurses are faced with extremely challenging relationship dilemmas unparalleled by many other professions, such as life and death situations, anger and frustration, intractable physical and emotional pain. These scenarios bring high emotions with patients, their families, and the rest of the healthcare team, and create many opportunities for relationship and communication breakdown. Other role dimensions, such as patient advocacy, "nursing the system," ethical dilemmas, and leadership and management practices, require effective communication and relationship skills to achieve successful outcomes.
So, what is the role of nursing leaders in promoting and creating an environment conducive to caring practice? In reviewing the articles included in this issue with this question in mind, interesting themes emerged.
* Attention to training, ongoing mentoring, and development is worth the effort to enhance communication and relationship skills of clinical nurses and nursing leaders. Emotional intelligence and personal reflection are essential to developing effective interpersonal relationships with patients, families, and colleagues. Caring is a practice.
* The work environment has a major impact on nurses' ability to care. Cultural transformation and organizational infrastructure are needed to build and sustain caring practices. Interdisciplinary collaboration is critical. Understanding the impact of organizational culture is an important principle in implementing and sustaining change. Barriers to care are real and plentiful in our healthcare environment.
* Nursing leadership matters. Nursing leaders are critical in setting a tone of support for clinical practice and removing barriers to care. Whether caring for patients, caring for nurses, caring for the health of our community or our organization, nursing leaders make a difference.
We are excited that this topic generated so much interest that there will be 2 issues devoted to caring competencies, and look forward to sharing more great articles on this subject in the next edition of the Nursing Administration Quarterly.
Lois Napier Skillings, MS, RN, CNAA, BC
Guest Editor, Vice President, Nursing and Patient Care Services, Mid Coast Hospital, Brunswick, Me