Nurses in community service:

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During his State of the Union address last year, George W. Bush encouraged all Americans to give at least 2 years or 4000 hours of service during their lives. To help citizens meet that goal, he announced the establishment of the USA Freedom Corps to foster a culture of service, citizenship, and responsibility. Little does he know, he is about 30 years too late for most of today's emergency nurses who live and breathe community service. I wish I had a nickel for every life impacted by a bike helmet, car seat, seat belt, safe driving practice, smoking cessation, relaxation technique, healthy lifestyle, breast check, colon screening, women's or homeless shelter, fall prevention, first aid, child rearing, or playground safety event (to name a few) that was initiated or staffed by an emergency nurse out of the unselfish desire to make his or her own community a better place to live. It is no wonder why nurses have consistently remained at the top of the poll as the most trusted professional since nurses were first included in the rankings reported by the Gallup Organization in 1999.

In an unscientific survey of colleagues throughout my tenure with the ENA Board of Directors, I have found mixed views on whether nurses feel respected by their own administration in performing as the nation's most trusted professionals. Those who are most satisfied unequivocally reference a manager or supervisor who (1) treats them fairly, (2) listens empathetically, (3) empowers them to find solutions to problems, (4) supports them in their professional activities, and (5) shares their passion for nursing. When you find someone who is leaving a job or the profession, you will hear remarks like “treated like just another warm body,” “not one of the manager's pets,” or “didn't give me credit for the things I know,” and “lack of support.” I have experienced both ends of this professional spectrum, and in a matter of seconds I could name 4 colleagues who left or lost jobs because of their participation in activities related to ENA. When they started talking in their department's lunchroom about current legislation, teaching advanced nursing courses, having access to staffing formulas, ED benchmarking materials, policies, and position statements, they report that certain managers implemented barriers to interfere with their ability to participate in local or state meetings, including injury prevention and related activities—all actions that would fall into President Bush's description of citizen service. How well I know. I worked at the same facility for 22 years and resigned my position when, in my opinion, administration implemented rules and schedule changes that effectively prevented my continued participation in community service activities which included my current role as ENA president.

It was not the end of the world. The experience of reorienting as a new nurse in a new hospital was intimidating. It had been 22 years since I had to demonstrate intravenous line proficiency, dressing changes, and knowledge of medications to someone I did not know. I had to be “signed off” all over again on Foley catheters and nasogastric tubes and get used to a whole new system of paperwork. Once more I endured those saccharine exercises as I was fit-tested for my mask and had all new passwords to memorize because you cannot just transfer that kind of stuff with you to a new place! All in all, it was a humbling experience and I thank Darlene Rowe, RN, and the staff at Evangelical Community Hospital for putting up with me during that difficult time! I learned more about the Magnet Recognition Program because that facility was considering an application. The Magnet Recognition Program, established by the American Nurses Credentialing Center (ANCC), is an application and appraisal process for recognition that demonstrates a health care organization's attainment of nursing excellence. In one published study Havens and Aiken¹ wrote,

Studies of Magnet hospitals highlight the leadership characteristics and professional practice attributes of nurses within these organizations…. Hospitals selected met the following criteria: (1) nurses within the hospitals considered them good places to practice nursing, (2) the hospitals had low turnover and vacancy rates, and (3) the hospitals were located in areas where there was significant regional competition for nursing services.

During a recent luncheon with Linda Urden, DNSc, RN, CNA, FAAN, Chairperson of ANCC's Commission on the Magnet Recognition Program, I had an even greater opportunity to learn about the program, and I commend ANCC for the process and the high outcomes it achieves. However, in a visit to several Web sites of Magnet facilities, it is clear that nursing still does not receive the same visibility or prominence as our colleagues in medicine. One university hospital advertises “24 specialists board certified in emergency medicine with 29 emergency medicine residents,” and another notes “board certified emergency physicians supported by 24-hour radiology and lab services.” Yet there was no mention of the high quality, board certified emergency nurses who are their hallmark of excellence in emergency care. They did not reference the thousands of car seat checks or drunk driving lectures their nurses gave to prom goers, nor the presentations on domestic violence to community groups that have gotten hundreds of silent victims into safe homes, the unintentional shooting prevented by gun locks given away during safety education programs, hours spent with the local ambulance service, the health histories and vital sign checks administered at community blood drives, or the numerous volunteer committees on which their nurses serve—because most hospitals provide very little in the way of support for these activities. It would be interesting to know how many institutions provide “CME time” to physician colleagues that serve on outside boards, whereas nurses serving in a similar capacity are required to utilize their vacation time to attend meetings, a common hospital occurrence in my experience.

According to a report released by the Joint Commission on Accreditation of Healthcare Organizations,² there are 126,000 nursing positions unfilled in US hospitals nationwide. With the aging of the nation's baby boomers and the nurses themselves, the report estimates the nursing shortage will reach 400,000 by 2020.

The emergency nurses I know use their ENA connections to influence work and impact communities in a positive way. The cost versus societal benefit of these activities is immeasurable in regard to prevention of death and disability, quality of care, and the professional satisfaction that will attract and retain nurses. When hospital administrators evaluate the nursing shortage and how time spent away from work affects departmental budgets, someone needs to tell them it is not always about money.

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Acknowledgements 

I would like to thank my friends Sue Sheehy and DiAnne Leonard for their love and support during this difficult time in my life.

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References 

References
1. Havens DS, Aiken LH. Shaping systems to promote desired outcomes: the magnet hospital model. J Nurs Admin. 1999;29(2):14–20
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2. Joint Commission on Accreditation of Health Care Organizations. Health care at the crossroads: strategies for addressingthe evolving nursing crisis [online]. 2002. Available from:URL: http://www.jcaho.org/about+us/public+policy+initiatives/health+care+at+the+crossroads.pdf.
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