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PERIANESTHESIA CULTURE Happiness in the Work of Nursing Maureen V. Iacono, BSN, RN, CPAN THE WORKPLACE IS CHANGING. Perianesthe- sia nursing is not excluded from change, as change is fast paced, and all encompassing. There is no ‘‘bubble of protection’’ or isolation from the insti- tution, as may have been the case in the past for postanesthesia care units. Some of the changes have to do with the workforce itself and the work of nursing. Other changes, and perhaps increased pressures, stem from forces outside our units or the immediate staffing matrix within the unit. There can be a sense of frustration, and loss of control over nursing practice for the indi- vidual nurse. There are often laments, spanning the issue from the pressures and workload expec- tations in individual nursing units, to the more broad concerns of administrative decisions and dictates. Some of these decisions seem out of touch, questionable, and even quite ridiculous. Some of the dictates are generated because regula- tory bodies change requirements and conditions of participation, and institutional compliance be- comes mandatory. The steps toward compliance and enforcing necessary changes can be tedious and problematic based on the existing culture of the workplace. Additionally, there is an increas- ingly commonplace practice in hospital systems to spend sums of money to hire ‘‘experts’’ from outside to direct changes that make little sense to the front line staff. With mounting frustrations, the question of happiness at work is a sobering one. Can the nurse find happiness, or create happi- ness, in the workplace and in the work of nursing in particular? We work for many reasons. We earn money and make a living, accomplish goals, and may or may not experience personal validation. Health and well-being in work life also includes how we are treated, what kind of strength and support exist in work-based social networks, and what ability we have to achieve balance for ourselves. Work- life balance is essential to support the person we bring to work, and the person we want to be outside of work. Despite multiple challenges, each nurse has the ability to decide how to live his or her life, and the power to improve the qual- ity of life experiences. We owe it not only to our- selves but also to the people we care about, to maximize joy and contentment. It is helpful to return to the work of Florence Nightingale; to reconsider the impact she had on the origins of nursing practice and the implica- tions for us today. It is further beneficial to apply Nightingale’s teachings to the meaning of nurs- ing’s work, and to focus on what really matters. Nightingale taught that the profession of nursing required a sense of calling and of service in heal- ing. She asked for a personal commitment to the work of nursing in the world. She encouraged nurses to reflect and to know that there is deep meaning and purpose in real nursing work. The work itself, and the dedication to that work, would provide insight to the highest level of ethical choices and possibilities. She taught that nurses need to be role models, in word and action. Role modeling portrays self respect and dignity; it’s a simple message. She stressed that nurses facilitate healing, using knowledge, skill, experience, in- stinct and intuition. Nurses showcase this partic- ular esthetic through conduct, attitudes, narratives, and actions. The provision of care for patients, their families, and colleagues is what nurses do. It is worthwhile to get back in touch with the why in nursing and to reconnect with the fundamental awareness of the joy in meaning- ful work. With serious, intentional thought to the actual work of nursing, there is a happiness to be found everyday. This is not to say that inequities in the workplace and struggles to make sense out of administrative Maureen V. Iacono, BSN, RN, CPAN, is a PACU Nurse Man- ager, St. Joseph’s Hospital, Syracuse, NY. Conflicts of interest: None to report. Address correspondence to Maureen V. Iacono, St. Joseph’s Hospital, 301 Prospect Avenue, Syracuse, NY 13202; e-mail address: [email protected]. Ó 2014 Published by Elsevier Inc. on behalf of American Society of PeriAnesthesia Nurses 1089-9472/$36.00 http://dx.doi.org/10.1016/j.jopan.2014.09.003 Journal of PeriAnesthesia Nursing, Vol 29, No 6 (December), 2014: pp 511-513 511

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Page 1: Happiness in the Work of Nursing

PERIANESTHESIA CULTURE

Happiness in the Work of NursingMaureen V. Iacono, BSN, RN, CPAN

THE WORKPLACE IS CHANGING. Perianesthe-sia nursing is not excluded from change, as change

is fast paced, and all encompassing. There is no

‘‘bubble of protection’’ or isolation from the insti-

tution, as may have been the case in the past for

postanesthesia care units. Some of the changes

have to do with the workforce itself and thework of nursing. Other changes, and perhaps

increased pressures, stem from forces outside

our units or the immediate staffing matrix within

the unit. There can be a sense of frustration, and

loss of control over nursing practice for the indi-

vidual nurse. There are often laments, spanning

the issue from the pressures and workload expec-

tations in individual nursing units, to the morebroad concerns of administrative decisions and

dictates. Some of these decisions seem out of

touch, questionable, and even quite ridiculous.

Some of the dictates are generated because regula-

tory bodies change requirements and conditions

of participation, and institutional compliance be-

comes mandatory. The steps toward compliance

and enforcing necessary changes can be tediousand problematic based on the existing culture of

the workplace. Additionally, there is an increas-

ingly commonplace practice in hospital systems

to spend sums of money to hire ‘‘experts’’ from

outside to direct changes that make little sense to

the front line staff. With mounting frustrations,

the question of happiness at work is a sobering

one. Can the nurse find happiness, or create happi-ness, in the workplace and in the work of nursing

in particular?

We work for many reasons. We earn money and

make a living, accomplish goals, and may or may

Maureen V. Iacono, BSN, RN, CPAN, is a PACU Nurse Man-

ager, St. Joseph’s Hospital, Syracuse, NY.

Conflicts of interest: None to report.

Address correspondence to Maureen V. Iacono, St. Joseph’s

Hospital, 301 Prospect Avenue, Syracuse, NY 13202; e-mail

address: [email protected].

� 2014 Published by Elsevier Inc. on behalf of American

Society of PeriAnesthesia Nurses

1089-9472/$36.00

http://dx.doi.org/10.1016/j.jopan.2014.09.003

Journal of PeriAnesthesia Nursing, Vol 29, No 6 (December), 2014: pp 511-51

not experience personal validation. Health and

well-being in work life also includes how we are

treated, what kind of strength and support exist

in work-based social networks, and what ability

we have to achieve balance for ourselves. Work-

life balance is essential to support the person we

bring to work, and the person we want to beoutside of work. Despite multiple challenges,

each nurse has the ability to decide how to live

his or her life, and the power to improve the qual-

ity of life experiences. We owe it not only to our-

selves but also to the people we care about, to

maximize joy and contentment.

It is helpful to return to the work of FlorenceNightingale; to reconsider the impact she had on

the origins of nursing practice and the implica-

tions for us today. It is further beneficial to apply

Nightingale’s teachings to the meaning of nurs-

ing’s work, and to focus on what really matters.

Nightingale taught that the profession of nursing

required a sense of calling and of service in heal-

ing. She asked for a personal commitment to thework of nursing in the world. She encouraged

nurses to reflect and to know that there is deep

meaning and purpose in real nursing work. The

work itself, and the dedication to that work, would

provide insight to the highest level of ethical

choices and possibilities. She taught that nurses

need to be role models, in word and action. Role

modeling portrays self respect and dignity; it’s asimple message. She stressed that nurses facilitate

healing, using knowledge, skill, experience, in-

stinct and intuition. Nurses showcase this partic-

ular esthetic through conduct, attitudes,

narratives, and actions. The provision of care for

patients, their families, and colleagues is what

nurses do. It is worthwhile to get back in touch

with the why in nursing and to reconnect withthe fundamental awareness of the joy in meaning-

ful work. With serious, intentional thought to the

actual work of nursing, there is a happiness to be

found everyday.

This is not to say that inequities in the workplace

and struggles to make sense out of administrative

3 511

Page 2: Happiness in the Work of Nursing

512 MAUREEN V. IACONO

decisions and mandates require less than thought-

ful, rigorous attention. Nightingalewas famously at

odds with administrative layers and continuously

battled bureaucracy to champion causes for pa-

tient care, institutional improvements, and theprofession of nursing. Nightingale spoke to ethical

issues and criticized existing hospital systems. She

knew nurses were held back from doing the right

thing at times, particularly regarding unsafe prac-

tices and serving as patient advocates.

However, equal attention ought to be given to the

meaningful work and contributions of individualnurses, and for this column, perianesthesia nurses,

everyday, with dedication, insight, thoughtfulness,

and expertise. It is much more difficult to control

or even make sense of the forces outside your

own unit and can be draining and discouraging.

So take some time to focus on yourself, your

work, and the importance and value of the accom-

plishments of perianesthesia nurses. It may help toregain perspective related to the joy which can be

found in perianesthesia nursing.

Nightingale believed that nursing is a calling; she

asked for nurses to do the right thing, and to

perform nursing to the ‘‘best of one’s ability.’’ It is

certainly noble and worthy of consideration.

Nursing is worthwhile, profoundly importantwork. The specialty you have chosen requires

attentiveness, critical thinking, clinical reasoning,

and swift action. Perianesthesia nurses have

frequent reminders that vigilance is not merely a

word used in orientation, but a very real and neces-

sary attribute to provide astute care to very vulner-

able patients. It can set us apart, make all the

difference in patient outcome, and preempt emer-gent situations or potential patient decline. So, it is

a calling. We are called to provide expert care and

prevent harm, assess patients critically and smooth

their recovery, communicate accurately, provide

safe transitions of care, and follow through on

many details to do the right thing and to be the

best. It is an amazing calling. It is an amazing priv-

ilege. In addition to the technical aspects of patientmonitoring, perianesthesia nurses are attuned to

the nuances of patient safety, comfort, energy

level, and emotional and spiritual needs. We are

mindful of the difference made by well-chosen

words, simple touch, nursing presence, calmness,

and confidence. Nurses sustain caring with actions

and words.

How does the consideration of Nightingales’ leg-

acy promote the recognition of joy and happiness

in our work? The first step is that nurses ought to

thoughtfully review what nursing work means to

the individual—to the nurse, and the patient. Itis easy to underestimate the power of this work,

and the impact. So, first, recognize the impor-

tance of the work of nursing. Seek every opportu-

nity to refocus, and to again find meaning

in meaningful work. Provide support for one

another, for nurses, in the work of nursing. We

are at the front line of the provision of nursing

care. It is important for this work to be high-lighted and valued. We need to honor our work

and contributions. When we speak of our work,

we ought to speak with pride and intelligence.

We ought to question why, seek evidence to pro-

mote best practices, and share the answers to the

questions with colleagues. We ought to seek an-

swers to difficult questions, and reframe the ques-

tions when we are not heard.

Nurses can highlight the beauty and unique contri-

butions of individual nurses (self and others) at

work. In fact, it is inspiring and uplifting to recog-

nize and celebrate colleagues in the work of

nursing. Simply writing exemplars about nursing

care in your unit has a profound effect on esprit

de corps. Submitting nominations for nursing prac-tice and leadership awards within the institution

or through professional nursing societies speaks

volumes about the respect for our specialty prac-

tice. Perianesthesia nurses can survey patients

for their perceptions of care in our units, as our

specialty is underrepresented in formal survey

questionnaires. The patients and their families

bear witness to the stamina and excellence ofnurses; and they are very honest. I am often

delighted and encouraged to have my nursing staff

mentioned and thanked for expert care from grate-

ful patients and their families. Patients are often

frail and uniquely needy. They depend on dedi-

cated nurses for their care and sometimes their sur-

vival.

Take control of your inner dialog, particularly

when multiple factors affect your happiness at

work. The factors, and their related events can

be challenging. But the manner in which we

react to these factors can make a critical differ-

ence in the power they hold. Do not get stuck

in the negativity. Remember that negative people

Page 3: Happiness in the Work of Nursing

PERIANESTHESIA CULTURE 513

can be like sponges and drain joy from others.

Make a conscious effort to move in a positive di-

rection from wherever you are at the moment.

Change the focus of the words you say to yourself

and look at troubling situations in a nonjudg-mental way. Seek ways to understand the impact

of outside events, and choose to focus on what is

still okay and what is still good in the workplace,

to stay in the moment, and find your happy.

Seek to clarify goals and expectations when confu-

sion or conflict arises in the workplace. Support

nursing autonomy to achieve these goals, as eachnurse can have creative solutions to work chal-

lenges. Expect, and when necessary, demand re-

sources to enable nurses as individuals and as a

team to accomplish the work that is required.

Work toward a culture in your units that provides

a mechanism to support and learn from mistakes.

Foster the respect and recognition of excellence

in nursing care delivery. Encourage colleagueswhen the going gets tough, and share emotional

support when needed. Try to avoid the drama of

consistently needy nurses and focus on developing

a cohesive, positively focused work team.

It takes courage to rise above the troubles and trials

of work pressures and inconsistencies. It is pru-dent to understand that your work is hampered

when your outlook is narrow and uninspired. Do

not allow the troubles to overwhelm you. Choose

instead to focus on what is good and noble in the

work of nursing. Choose to believe that nursing

is a calling, and that we are fortunate and blessed

to be able to provide expert and essential care at

fundamentally important moments in the lives ofothers. It is a sacred trust, one to which we have

a duty. Be the best you can be; commit to the

work of nursing and to the belief that this chosen

professional holds awesome rewards and responsi-

bilities. Seek to find inspiration and awe in peria-

nesthesia nursing. If, at times, happiness seems

to be an obscure goal strive instead for optimism.

As long as we stay in the profession, take positiveactions to ensure that your contributions matter

and that you find joy when you can.

Suggested Readings

1. Dossey B, Selanders D, Beck D, Attewell A. Florence Night-

ingale Today: Healing Leadership Global Action. Silver Spring,

MD: American Nurses Association; 2005.

2. Locsin R, Purnell M. A Contemporary Nursing Process:

The (Un)Bearable Weight of Knowing in Nursing. New

York, NY: Springer Publishing Company; 2009.

3. McAllister M, Lowe J. The Resilient Nurse: Empowering

your Practice. New York, NY: Springer Publishing Company;

2011.