Letter to the Editor by Anderson on "Nurse Safety: Have We Addressed the Risks?"

Nurse Safety: Have We Addressed the Risks?

March 30, 2005
by Calene Marie Anderson in response to topic Nurse Safety: Have We Addressed the Risks? (Sept. 30, 2004)

Dear Editor:

I share in this letter two standard operating procedures, drawn from the field of aviation that have implications for nursing. One procedure, that of using the parachute, can serve as a metaphor helping to explain the stresses of nursing; the other, that of the oxygen mask, is a metaphor to help nurses deal safely with these stresses.

Growing up as an Air Force child, I learned all about parachutes. The parachute is the last resort for a pilot and crew before an ultimate crash and burn. Even though losing a multi million dollar bird is something our Armed Forces frown upon, in the final synopsis, the plane is expendable, and bailing out is an option.

However, unlike an aircraft having a parachute with which to bail out, there is no bailing out in health care. No matter how hot the pressure may get, it is always our role to stay the course and fly without a parachute. There is no leaving the ship for us. Once you become a nurse, you do your best to land the craft no matter how difficult attitude control may get. Hit the emergency alarm and all hands on deck. It's a call to duty to preserve life, a calling that has its stresses.

Catching the red eye, I was pondering this aviation metaphor while waiting in queue for takeoff. Have you ever noticed how there's not much to do on short flights but think, pass the time with pleasant conversation, or read? I was thinking, sadly I might add, that our vacation was nearing its conclusion - reality was colliding in on me - that mixture of relief and post vacation blues. Next stop was home and back to the real world, put on the game clothes, and hit the floors.

Taxiing on the runway in the Atlanta Airport, the engines droned as flight attendants went through their preflight rituals, including the usual showing of the emergency lights, exits, how to secure your seatbelt, and what to do should the plane lose cabin pressure, a routine I, like most experienced flyers, have grown oblivious to. Maybe being oblivious to their instruction is simply my way of not wanting to think of earth coming at me at near speed of sound.

One instruction that did get my attention, though, was the attendant's explanation that if the cabin pressure dropped and the oxygen mask fell down, those with infant children were to give themselves oxygen first. What an interesting parallel for nurses, I thought. If we care givers don't take care of ourselves first, we can be of little benefit to our patients.

It's been ten years for me since nursing school. I am no longer the naive student. Time and experience have hardened me to the harsher realities we nurses all confront. It does interest me the many ways our profession has changed in only a decade. This virtual explosion of changes includes uniforms, which now look different; more male nurses; a team-oriented, rather than a then top down, management style; and, more than ever, patient satisfaction as a primary goal. We nurses must now be public relations people because patients and physicians have a smorgasbord of hospitals to choose from. We must become business savvy because without money to care for patients the hospital would be only an empty building. Yet we must still provide consistent, quality care because we live in an increasingly litigious society, thus demanding ever more flawless execution of nursing activities.

Getting back to the oxygen mask then, I see another metaphor for nursing. We are taught to be care givers, to meet the needs of our patients and our hospitals. But if we do not give ourselves permission to take care of ourselves, to give ourselves the same good care we give our patients, we will most certainly be in peril. It's important every week then to devote time just for ourselves. A brisk walk, drinking more water, healthier diets, and yes, resolutions we actually stick to. Remember, the four food groups are not nicotine, sugar, alcohol, and starch. As nurses, we must never forget the importance of the whole person within ourselves; we must find healthy alternatives for dealing with the pressures of our career and its intolerance for imperfection. Doing so is vital both to us and our employers. As my mother used to say, "Practice what you preach."

Yes, nursing is kind of like flying without a parachute, an abundance of instruction should something go wrong a mile high in the sky, but never the option to bail out. Just stay the course and remain calm, so others will not panic. My professors always said that if we wanted to be in health care, we had better learn to handle pressure. That is why taking care of ourselves is more important than ever before. We need to teach ourselves the class we didn't have in school - the class that motivates us and directs us how to care for ourselves. We need to do this both for our own sakes and for the sake of our patients.

Flight attendants, please take your seats.

Calene Marie Anderson, RN, BSN
Norton Audubon Hospital
Pain Management and Patient Satisfaction Committee
Louisville, KY