Team: a concept of individuals working together to accomplish a defined mission.

As society changes and time inevitably passes, our healthcare system evolves. There is change, and change is good-right? Well maybe, but this is not an absolute.

Recently, we have noted a change in healthcare practice, what we choose to define as the "shift mentality." Healthcare professionals, regardless of patient or team members' needs, conduct the handoff, which equates to, "I have done all that I can do during my predetermined hours." (Mind you, we are not describing walking out of an imminent crisis.) However, we are seasoned professionals (sounds better than old), with perhaps too strong a work ethic, who have always believed you were finished when the job was done, the patient was comfortable, the consultations were completed, and needed tasks were accomplished. This work ethic seems to be going the way of the dinosaurs. Is this a good thing? Well, yes and no.

Admittedly, most of us work too hard and we never seem to have enough time or resources. Administrators may be pushing some staff home to avoid overtime, as with the medical staff residencies' hour limitations, which is not necessarily a bad thing. This push, however, may be promoting the handoff mind-set.

Regardless, the patients and their families just keep coming at larger volumes. They are more seriously ill and have greater needs. We nurses work long hours, often with no added benefits other than personal satisfaction for our troubles, while home and family miss our presence. But we have supported our colleagues, promoted our healthcare system, and hopefully improved patient and family outcomes.

The reason for the shift mentality may simply be survival. Our families, our generation, have witnessed their loved ones work excessively, and what this new generation has learned from our examples is this is not what I want my life to become! This same etiology may be the reason that professional associations are finding fewer volunteers to accept leadership opportunities. Essentially, the mind-set has become "when I am done work I want no perceived work-related activities."

So where do we go from here? Hard to say, but the future is today and, at times, does not seem bright. The population is aging (which includes a large percentage of current healthcare professionals), compounded by a nursing and physician shortage and fewer healthcare dollars, which are all reasons for concern. How can we regroup, move forward, support each other and "our teams" and survive?

We need to come back and fight another day for our patients, our families, and ourselves. We must find a balance in our own lives; this is truly the challenge (which, perhaps, the younger generation has solved). Achieving this goal may require advocacy for our peers and ourselves, even as we seek this balance.

We really do not know the answers; we merely pose the questions in the search for this grail. Exploring our next steps is critical and must occur now.

Our teams, and we, must persevere.

Contributed by:

Patrick J. Coyne, MSN,

Clinical Director,

Thomas Palliative Care Program,

Virginia Commonwealth University, Rockville, VA