BE THE CHANGE IN HEALTHCARE

Instructor: Maralon Bevans RN MN

PRO-ACTION
Questions to consider before proceeding:
Is it important that you act?
Will your definition of the problem or
issue be accepted as correct?
If your first choice of action fails, are you
prepared to carry this issue further?
Is NOW the right time to act?
Will action be relatively safe for you?

THE INVISIBILITY OF CARING

Caring: Integral to the RN Role

Viewed through many different lenses in health

care and within the profession of nursing itself

Especially in round tables making decisions

about who is the most cost effective care
provider to fulfill the mandates surrounding
public accessibility to healthcare and services

NURSING WORK
Invisibility of Skills
The invisibility of skills in nursing work has been taken
for granted largely due to nurses inability to articulate
well:
What it is that they do
Relevance to achieve quality patient care outcomes
Even to get government and administrators to
acknowledge the definite connection with patient care
outcomes
What becomes visible when it disappears?
The essential role of nurses in the Healthcare System.

WHAT ARE YOUR THOUGHTS?

Much of nursing work remains invisible and
undervalued.
New management schemes are apparent in basing
their restructuring plans on the notion that what
counts is what can be counted which reinforces this
invisibility and undervaluing of the work nurses do.
Many job related skills are not treated as skills by
evaluators, but rather as qualities intrinsic to being a
woman and therefore not comprehensible. Many
compensation systems have made invisible the skills
and responsibilities required for womens work
(Armstrong & Armstrong, 1996).

WHAT IS CARING ABOUT?

For Nurses
Caring involves more than a feeling response. It
includes those assistive, supportive or facilitative
acts directed towards another, in order to improve or
to maintain a favourable healthy condition of life...
Caring means learned capacities such as
communication skills required to deal with seriously ill
or infirm patients, those in drug induced states or low
functioning clients; patience, caring and listening
skills in dealing with patients or grieving families, as
well as a patient advocate, and to build trust...

CARING...
Caring means...

Knowing how to provide support and comfort in relation to

the specific, medical acts that are prescribed;

Being able to answer questions about the physical and

psychological impact of treatment, in relation to themselves
and their relatives;

Constantly interacting and reassuring on the basis of

Nursing Process (ADPIE), technological knowledge and
skill, not simply on the basis of caring about the individual.
Similarly, bathing a patient involves a complex of skills.

CARING...
Caring in Nursing is not about becoming a close
personal friend but about the assumptions and
skills of professional practice. (Armstrong & Armstrong,
1996).

Caring is about being there and being

present!

Is this how you practice? If not, what are the

barriers? Are they influenced by individual,
social, political, &/or economic environments?

GROWING TRENDS:
To fragment or compartmentalize nursing work
Deskilling placing emphasis on body parts and
the assumption that care can be divided up into
easy learned specific tasks based on a curative
model
Unregulated workers are being sort and utilized
to replace regulated care providers to perform
these viewed less complex care tasks

TRENDS ...
One such news headline suggests...
Nurses are too expensive to care for you

...implying that knowledge work in nursing is only

involved in those dimensions of practice that are
not associated with care of the person, or more
narrowly with the persons body.
Thus, the care of body is understood as natural
and unskilled while technical practices are
skilled and based on knowledge.

SHIFT IN THINKING CONSCIENCE RAISING

For Nurses to do basic nursing care is being
viewed as doing NON-essential work that
LESS -expensive workers can do
unregulated at that!
Any further comments ...

What do we need to do the educate those

involved in restructuring and redesign to
rethink and prevent going down this road?

WHAT CAN WE DO?

There is a substantial shift in nursing away from
basic nursing care and the promotion of roles
considered advanced practice in which the
nurse engages in less direct patient care and
acts as a consultant or advisor to others.
These roles tend to leave basic nursing care to
the least qualified worker and emphasize or give
priority to the talking and psychosocial
dimensions of care.

WHAT ROAD ARE WE ON?

ResultsNursing work and the work of caring is becoming bifurcated and
increasingly defined as with doing or talking, with the later
seen as more skilled and of higher status.
Example:
Case Management RolePossibly leading to increased status for the nurses but resulting in
fragmented and inferior care for patients, and that basic nursing
care is being abandoned for cheaper workers or limits are
imposed in the care system where nurses work is being
substituted for cheaper workers inplace of more expensive and
skilled workers (Nelson & Gordon, 2006).

WHAT ROAD DO WE WANT TO BE ON?

We pride ourselves as having one of the best
Healthcare Systems in the world but are we
on the right road to sustaining or achieve this?

What signs are there that indicate

otherwise?

Restructuring human resources may have saved

some $ initially but has the cost saving tactics
been worth it?

DEBATE:
Question:
By redefining nursing work, professionally, are
we on the road to distinction or extinction as
Registered Nurses?

Can you determine which state we are in

from
the current literature? Provide evidence
to
show which road we are presently on.

PRO-ACTION

What can we do to raise awareness to

move forward together on the Right
road?

What pro-action can you as nursing

students do to change this shift in
thinking and move forward together out
of the shadows and reclaim registered
nurse practice as it is intended to be.

NO MORE SHADOWS!
Only when nurses become more empowered
to engender the vastness of their potential and
roles, will they move from the shadows to find
and reclaim the voice of nursing in Healthcare.

It will require each nurse to individually and collectively build capacity to

know, sense, and believe in their inherit self-worth and presence.

Empathically knowing who they are, and what they bring to, in providing
service to individuals, families and communities.

Knowing and realizing their true identity and purpose, allows nurses to
be more useful and effective within the realm of Healthcare.

FINDING VOICE:
Your brand of leadership; as you wish it to be, and
the perceptions of what people have of you
must match for the relationship to succeed
(Keerfoot, 2002).

Our brand, who we are, our competencies,

standards, our style or philosophy, is how we
practice and negotiate our services and makes
us distinct and different, essential, and vital as
service providers/agents.

What is your leadership brand? Does it

enable your practice?

REFERENCES

Nelson, S., Gordon, S. (2006). The complexities of care.

Nursing reconsidered. Cornell University Press.
Armstrong, P., Armstrong, H. (1996). Wasting away. The
undermining of the Canadian healthcare. Oxford
University Press, Don Mills, Toronto.
Fahy, K. (1992). Advocacy? Reflections on the risks and
rewards. The Australian Nurses Journal. Vol. 21, No. 11.
Keerfoot, K. (2002). Creating your own leadership brand.
Pediatric Nursing. Vol. 28, Iss, 5.
Wakefield, M. K. (2001). What becomes visible when it
disappears? Answers: The essential role of nurses in the
health care system. Nursing Economics. Vol. 19, Iss. 4.