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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
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
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.