I have just returned from the United Kingdom after having spent the last month  there on vacation. Spring comes earlier in England and Scotland than it does here in most parts of Canada. The flowers were in full bloom and the lambs were frolicking happily in the green fields as we drove through the rolling countryside. It was a very relaxing vacation and it caused me to think about the work we do as critical care nurses. Having been a nurse for thirty years I am still amazed at how many new things I learn and deal with working in critical care every year.

Just as spring is a time of renewal and rejuvenation in nature, likewise so is a vacation when new experiences are around every corner and new routines take over each day. I find both spring and vacation to be personally uplifting which  energizes  me, translating into a positive attitude that then becomes  a feeling that I CAN make a difference and I LOVE what I do.  And so, I have returned from my vacation ready to make a difference in the lives of  my patients and their families with this  abundant  energy combined with  a renewed focus to push myself  to  provide exceptional care.

I think it is fitting that Florence Nightingale was born in the spring; this allows us to celebrate nursing and the contributions that critical care nurses make in sustaining life at a time of year when Mother Nature renews life.  I hope that all of you took time to celebrate your achievements and contributions to excellence in critical care last week as the country recognized National Nursing Week.

It is important to take the time in “our” week to reflect on the difference we make in the lives of our patients and their families. It is not just during one week a year that we should think about the energy and passion we bring to work every day.  This makes a significant difference in how our patients respond to surviving an illness or catastrophic injury.  It is with pride and a sense of satisfaction we should recognize and celebrate the excellent care we deliver daily in critical care units across the country.

It is my privilege to witness the excellence in care provided by  the  critical care nurses I work with in my unit who are always striving to achieve better care every day for the patients and families they serve. I know what passion looks like when I watch them in action. They are constantly advocating for their patients by recommending changes in nursing practice based on the latest evidence.  Daily, I see examples of the depth of their knowledge as I watch them drawing upon their understanding of physiology, applying it to their patient’s condition and then making minute to minute adjustments  to the patient’s treatment plan. I see the compassion and empathy they have for both the patient and their family in this most stressful and vulnerable moment of their lives.  I take comfort knowing  that what I see in my unit  is something that is repeated in every critical care unit across the country.  Yes…it makes me proud to be a critical care nurse.

I would like to leave you with this quote from an anonymous source that I received in time for nursing week.  

To some special nurses.
 
About NURSES:   Somebody asked: “You’re a nurse?!? That’s cool, I wanted to do that when I was a kid. How much do you make?”

The nurse replied: “HOW MUCH DO I MAKE?” … I can make holding your  hand seem like the most important thing in the world when you’re scared… I can make your child breathe when they stop…I can help your father survive a heart attack…I can make myself get up at 5AM to make sure your mother has the medicine she needs to live…I work all day to save the lives of strangers….I make my family wait for dinner until I know your family member is taken care of…I make myself skip lunch so that I can make sure that everything I did for your wife today is charted…I make myself work weekends  and holidays because people don’t just get sick Monday thru Friday. Today, I might save your life. How much do I make? All I know is, I make a difference.”

The CACCN Board of Directors is proud of our members and critical care colleagues across the country for the difference that they continue to make to the patients and families that they care for every day. We hope that you had a happy nursing week and that you took time to remember and to celebrate the difference you make to so many lives every day you come to work.

Take care

Teddie Tanguay
President

* Top Photo from : http://www.bbc.co.uk/glasgowandwestscotland/content/image_galleries/spring_gallery.shtml

Over the last number of years CACCN has evolved in how we reach out to connect with members and how we connect members with each other.  The CACCN website not only has a wealth of information at your fingertips but it has also created opportunities to link with like-minded individuals across the country who share a passion for critical care nursing by the discussions made possible in the members-only area “Forum” to pose a practice question you may have or to share expertise that you have with others. The platform is there to use… and to borrow the American Association of Critical Care Nurses (AACN) Mary Stahl’s President’s theme this year; we will be “Together. Stronger. Bolder ” by finding meaningful ways to connect.

For anyone who uses social media tools like Facebook or LinkedIn or others, there is an appreciation of the on-line relationship you can develop with your “friends” and the ability to ask and receive “just-in-time” answers to questions or to share your experience, thoughts and feelings in a timely manner. And so it is with the discussion forums for members on the CACCN website. It is a much more private and focused place to pose the questions you have on practice issues or questions you may have and to find out what others are doing across the country or internationally. There is a great opportunity to use the resources of CACCN to harness the power and experience of 1200 critical care nurses by linking within the discussion forums.

For example in the Cardiovascular discussion forum, a question posted on April 20, 2012 by a member seeking information about ST Monitoring practice was replied to by Tannis S from Winnipeg who shared her practice from her area of the country. How helpful to know what is happening elsewhere when you want to know if your unit is up to date in the latest practices! Want to know more on cooling of patients? Then go look at how the discussion in the Neuro forum is evolving since Pam C first posed it when she asked about cooling beginning in the Emergency Department which then prompted Jennifer P who is from a rural community in BC to seek further information on current practice as it relates to pre-transfer to a tertiary care centre illustrating nicely that no matter where you live when best practices are needed for critical care, we all need to know what that is to get the best outcomes for the patients we care for. I initially answered both these members sharing my own experience from an acute care adult centre in Edmonton but I was so pleased to see that the information has recently been updated by VininderKour B who provides a succinct summary on the current research findings from post-cardiac arrest hypothermia. Thank you to all of you for “Speaking with Conviction” and posing the questions you have, because if you have them…so does someone else…and so does someone else have an answer or something to share. It is about giving and getting when we share within a community of practice on-line.

Kirk Dawe, the CACCN Director responsible for the website has posted in the “Miscellaneous” forum, asking for your assistance, input and thoughts on additional items you would like to see on the website.

If you have forgotten or misplaced your user name and password, use the Password Retrieval to have the information sent to your email address. If you have forgotten how to access the Members only area of our website, then contact Christine Halfkenny-Zellas at CACCN National office for assistance.

The National Board of Directors is committed to serving our community of critical care nurses and we need to hear from you to align the goals of the organization with your needs. 

Reach out to others with a question you may have. Reach out to others to share your experience and your practice. We are a community after all.

Yours truly in critical care nursing,

Teddie Tanguay
President

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I am very pleased to be assuming the role of President for the next two years and welcome two new members, Kirk Dawe from Newfoundland / Labrador and Barb Fagan from Nova Scotia. Unfortunately our third new board member, Lissa Currie from Manitoba regretfully informed us in February that she was unable to fulfill her BOD position starting April 1, 2012.   As a result the BOD has extended the term of current Board member Tricia Bray for one additional year (and we thank her for accepting this).  Elections for the position will be held in the fall.  The Board also said goodbye to Treasurer, Joanne Baird and President, Kate Mahon. Rounding out the current BOD is Karen Dryden-Palmer and Ruth Trinier from Toronto; Celine Pelletier from the North West Territories and me, from Edmonton.  Christine Halfkenny-Zellas remains as the Chief Operating Officer, working from our home office in London.

Building on past President Kate Mahon’s theme of “Find Your Voice” I would like to introduce you to my President’s theme for the two years of my term.  Now that we have found our voices at CACCN, I thought that it was very appropriate that we bring our voices up a notch and begin to “Speak with Conviction!“.

As critical care nurses we have so many stories to speak about.  Stories of caring, stories of personal courage…ours and our patients…and stories of the kind of knowledge, experience and skills we bring to patient care that keeps our patients safe and alive in the hour by hour, minute by minute care we provide in intensive care units across the country. The BOD feels strongly that it is in our ability to speak about what we do and the knowledge we possess that we can articulate the role that critical care nurses play in a balanced way – one that focuses both on care and cure.

As critical care nurses we are positioned to speak on many topics where we have the kind of knowledge and experience that provides a unique perspective on issues impacting patient care. If we don’t speak up, others will speak for us and their point of view is not always ours.

So as the new BOD has just finished up three days of planning in our first meeting in London, we have aligned the goals we have identified with this new theme.  You will see us speaking “into” issues where we believe the independent voice of critical care nurses should be heard.  Sometimes this will take courage, but only because we do not get enough practice in doing this, and not because we do not have enough to say.  If you feel there is an issue that the national board should be speaking to, then we want to hear from you.  We also encourage you to take every opportunity that you may have in your area of the country to find your voice and to “Speak with Conviction!“.

Teddie Tanguay
President – CACCN

It has been a great five years for me on the Board of Directors and in the last two years as President I have come to appreciate how much energy there is in critical care nurses across the country. What I want to see is that same energy beginning to transform into nurses speaking up and speaking about what you do. As I write my last blog for CACCN, I would like to reflect on the President’s theme that I chose for my term of “Find Your Voice!” I chose this theme because I truly believe that the work that we “do” in critical care needs to be made visible by speaking about what we “do” every chance we can get.

Personally I am tired of the “guardian angel” theme that you hear so often when people describe nurses. Caring is a very positive virtue for nursing (and angels too!) but it is not all we “do.” In many of my blogs I have spoken about the caring aspect of nursing as an essential component of the therapeutic relationship we have with patients and their families, but equally important is the knowledge we acquire that enables us to diagnose what is happening with our patient and the technical abilities we must master to keep them alive. There will always be people who require acute care and intensive care and it concerns me that the focus of acute care hospitals continues to shift the emphasis (and resources) away from what is required to look after really sick people in the name of promoting primary health initiatives. It almost stigmatizes those that become acutely or critically ill, implying that they could have prevented an illness or injury and sadly it can minimize the contribution of Registered Nurses (RN’s) in making really sick people well again.

In the ICU we know what we have to “do” to make this a reality and it is those kinds of things that I think we need to speak about more often to ensure the full image of nursing is appreciated by the public and by those who determine resource allocation for services. I very much believe in primary health and injury prevention strategies, but it must also be recognized that people get sick…really sick and they should not bear any blame in that regard and it takes expert and knowledgeable nurses to look after them when they end up in an intensive care unit to make them well again or to allow them to die a peaceful death.

Across the country the role of the Registered Nurse is being challenged to describe it in terms of a cost/benefit analysis at these times of fiscal restraint. Can we afford the care that RN’s provide in the same numbers we have in the past? This question remains in spite of the abundance of research evidence that demonstrates repeatedly that patient outcomes are better and overall costs are less through reduced lengths of stays and decreased complication rates in those units and hospitals with a higher ratio of RN’s to other care providers (some unregulated). Increasingly there is a movement (often led by nurses themselves) to divide the patient into “tasks” that need to be completed and assign the tasks to various care providers, while the role of the RN is seen as best used as the coordinator and planner of care. In the Intensive Care Unit we need to be very cautious how this model of care “movement” impacts things like appropriate and safe RN:Patient ratios (CACCN is working on developing a position statement on this issue later this year) and the ability to have time to form therapeutic relationships with patients and families when there are no “tasks” that need to be done.

As an administrator myself for over 25 years in critical care, I have seen and been part of the development of nursing workload measurement systems from their infancy in the early 90′s that attempt to measure how long it takes on “average” for a nurse to perform certain tasks and functions for the patient. This data then gets analyzed and through mathematical formulas computes how many hours of care a patient requires per day. I have seen how these tools can do harm if not used by administrators with the appreciation of their limitations of what they actually measure in describing the time that nurses need to do their work. These workload tools never capture what the nurse was unable to “do” for her/his patient because there was not enough time to “do” everything that the patient and their family needed. The danger lies within these workload tools when administrators expect nurses to work to these “numbers” as if it was all the evidence they need to measure how well a unit is functioning or how hard the staff is working. I know as I have been challenged by senior hospital administrators to reduce hours per patient day based on this “numbers” game when I knew that the numbers were only a partial view of the PICU I managed.

Like the expert bedside clinician the expert administrator “knows” the unit she/he manages and what it takes to keep the staff motivated and the unit staffed appropriately to allow the RN’s to perform their job expertly and with job satisfaction to get good patient outcomes and satisfaction with the care they received. So working to achieve targeted hours per day to measure productivity might be ok if we were producing donuts but it is not ok when critical care is needed in a timely manner by knowledgeable and skilled RN’s at the bedside. The danger lies within when we come to believe that all patient care is “average” and the experience of the nurse and context of care in which she/he practices is the same every day, so the formula can be applied uniformly. These workload measurement systems seldom take into account the time that is needed for nurses to continually acquire new knowledge and update and practice new skills to keep patients safe. The real danger lies when administrators fail to listen to the voice of RN’s that they need more time, not less time to be with their patients. If we fragment RN care by delegation of tasks to other (let’s admit it)…cheaper staff, then the safety net around patient care is being weakened and may be developing some holes. There is a tipping point that will be reached if the drive to decrease costs overtakes the quality of care for the “whole” patient that the RN currently provides in many areas of acute care but probably the greatest impact being in the ICU.

But before you think I am against any different way of looking at collaborative models of care, I want you to know that I am totally supportive of any role that assists the work of the RN in critical care to enable the nurse to focus on the assessment and ongoing care of her/his patient. The continuity of hands-on-care in the ICU is what keeps patients safe. If tasks like baths are delegated to another type of care provider, then the bedside RN will fail to see the beginnings of skin redness, so that she/he can reassess nutritional requirements and have the discussion with the Dietician and Clinical Pharmacist about feeding and/or TPN before skin breakdown results or fail to see the subtle skin mottling that tells a story of decreased tissue perfusion that requires adjustment of vasoactive intravenous medications. When doing the bath, if the blood pressure and heart rate or intracranial pressure changes, these are all things the RN “puts together” to make adjustments to the care plan. It is often at these most intimate times that the RN forms the deepest therapeutic relationship with the patient as the conversation that takes place, although may appear superficial to others overhearing it, is really about finding out so much more about your patient as you perform the bed bath. It is a continuous assessment. This view cannot be fragmented without an impact on the coordination of care that is expected of the RN.

What I AM for, is support for nurses through appropriate and safe staffing levels that enables another person to assist the RN with the bed bath and turning the patient, and the bed change so she/he does not struggle to do this independently. What I AM for is the investment in safe “lift” systems by hospitals so that the nurse uses technology to preserve her/his back. Within the ICU there needs to be secretarial and ward aide support staff scheduled around the clock to take phone calls and perform cleaning tasks, restock supplies and do paperwork and not just on the day shift. We all know in critical care how many “tasks” we pick up from other professions (particularly physiotherapy or a clinical pharmacist) because they are not scheduled 24 hours. Those are the kinds of models of care we need to support the work of the ICU RN.

If we fail to “find our voice” and fail to describe what we “do” and leave the image of nursing focused only on the caring virtues of nurses then we have failed ourselves. If we can’t describe the work we “do” in more concrete terms to the public (who already trust us highly second only to firefighters) then RN:patient ratios will be determined by imperfect workload measurement systems and processes that are designed to find a cheaper way to deliver the “tasks” of care.

So as I leave the Board of Directors, I encourage a Call for Action where ever you may work…watch how the image of nursing and nurses is portrayed in your ICU, your hospital and in your province and have your voice heard in a meaningful way. We cannot be quiet about such things. You can tell your stories of extraordinary patient care that you deliver every day without violating patient confidentiality by focusing on the expert knowledge that you have in meeting the patient’s needs and by describing what you “do” every day as the ICU nurse to keep the patient alive. These are the images I want people to remember of critical care nurses…not the angel!

Stay tuned and watch this blog in a couple of weeks as your new President, Teddie Tanguay and the 2012-2013 Board of Directors announce an exciting new and action oriented President’s theme building on the theme of Find Your Voice!

It has been a privilege to serve critical care nurses in Canada in my time on the National Board and I am proud and honoured to have been your President for the past two years. I hope to cross paths with many of you in the months ahead.

Until then and as always…take care of yourself and each other,

Kate Mahon
President

The critical care environment is not one for those who are risk averse or for those who are more comfortable waiting for the physician to make a diagnosis before you act. Many of the policies that are within ICU’s across the country which enable the critical care nurse to “act” based on a nurse’s clinical judgement are unique to this environment because failure to act in a timely manner can often have more serious consequences. Therefore I was surprised and dismayed to hear that some senior nursing leaders in one large teaching institution identified a couple of ICU nursing practices as ones where “ICU nurses are working beyond their scope of practice.” The practice you ask? ICU nurses were ordering their own blood work and x-rays without first getting a Doctors order! Of course there are processes within each province/territory and organization that regulate practice and one must ensure this function is properly sanctioned, but can you imagine in the ICU if you did not have the freedom to act and instead you had to stop and get an order for every time you needed to do blood work or get an x-ray when your assessment indicated they were warranted? If there is a failure to appreciate these kinds of “scopes of practice” within a critical care unit by the nursing leaders who oversee practice within our organizations, it is difficult for the ICU bedside nurse to function autonomously without fear of reprisal by the very leaders who need to support and endorse their practice.

Nursing in critical care is not about just being good at a series of tasks and skills and working within protocols. The nurse who works in ICU must acquire an enormous amount of clinical knowledge, understanding and drawing upon the same kind of science-based information that physicians (and other disciplines) utilize and then be able to use this understanding to assess what she/he is seeing in a critically ill patient, while simultaneously (and often) directing and teaching less experienced medical learners. The journey of learning in the ICU is not an easy one for the nurse when you first enter critical care. It takes a commitment to learning often going back to review your university science courses to draw upon general chemistry, biology, nutrition, microbiology, anatomy and physiology to truly appreciate what is happening to the patient you are caring for today who is in multi-system failure.

As organizational cutbacks have been steadily eroding the time that is provided for staff to attend in-services, teaching sessions, conferences and other learning opportunities, the ICU nurse has had to become more self-directed. Roles like the clinical nurse specialist were introduced in the 80′s and 90′s to advance the nursing practice of all nurses by particularly supporting the bedside nurse and by building capacity within nursing to care for the complex patient and family. It is therefore unfortunate that these positions are being considered a “luxury” in the critical care unit, rather than a necessity during times of fiscal restraint.

As a critical care nurse, not only must your knowledge be extensive, but your ability to perform many technical skills and cope with an enormous amount of technology “attached” to your patient must be mastered to enable you to competently work in the ICU. Organizational skills, multi-tasking ability and capacity to prioritize based on a multitude of competing demands are hallmarks of any nurse but probably demonstrated at a high intensity level in the intensive care unit. I am still amazed when I walk into the PICU and see the nurse quietly and efficiently caring for a small patient who may be recovering one day post-op from a major cardiovascular surgery. On the left side of her bed there is a “tree” of 15 or more infusion pumps infusing life-sustaining medication; above the bed is the patient monitor reading out 6 or more vital sign parameters; to the right of the bed is the ventilator breathing for the patient… and sitting in rocking chairs are family who have become comfortable with all of this because of the constant, expert and confident presence of the nurse caring for their child. The nurse is always “busy” ( even when he/she may not appear to be) assessing, watching, looking for the subtle patterns of changes in the vital signs he/she is monitoring to alert him/her to take action to avert any deterioration in his/her patient, all the while providing emotional support to the ever present family. That is pretty awesome when you think about it, yet those are the routine days in the PICU (or ICU) where you work. Add ECMO or an LVAD or a Berlin Heart or dialysis and well…you just keep coping with it when you work in critical care.

So yes…we do like to be known for the “caring” aspect of being a nurse, but it is time to balance that with a recognition of the knowledgeable and expertly skilled practitioners we are and we need not hide that or apologize for it or be demure about it. We need to make it visible. We need to speak about it and describe it as much as we depict the caring aspects of what we do. We need to partner with media to get our message out when we should speak on issues as we “find our voice” and articulate what we “know” as expert critical care nurses. It is time to get out of any shadow that blocks that light. In the ICU the knowledge and skills of nurses in the constant minute-to-minute care are what keeps patients alive and on the path to recovery.

Yes we care…but we know a lot too!

As always…take care of yourself and each other,

Kate Mahon
CACCN President

Every once in awhile a patient will remind us of how important the work we do as nurses is and why what we do in the routine care we provide daily for our patients can make an intense difference in how a patient copes with an illness…that is anything but routine in his or her life. I received that reminder this week when I was sent a YouTube video link by my brother Kevin, about the amazing story of his brother-in-law, Jim Mulcahy, age 63, from Antigonish, Nova Scotia, who was diagnosed with an aggressive form of lymphoma 10 years ago. I know Jim as well. He is a teacher by profession so it is only fitting that he uses a “teachable moment” to share with those of us in the medical profession his personal experience in what makes a difference in his ability to cope with his lymphoma diagnosis and his numerous hospitalizations.

In the video Jim shares some very personal insights about his individual cancer journey and the impact it has had on him and his family. Listen as he speaks about the difference that nurses can make when they demonstrate caring in a personal way, recognizing that the person in the bed is much more than the diagnosis we read in the chart. This is a beautiful and moving story that speaks for itself and will remind you of why you became a nurse. I encourage you to watch it for 15 minutes and after you do, to take the time to reflect on the lessons that Jim gives to each of us as a “gift” to remind us of the profound opportunity we have every shift to make a difference for those we care for and care about.

Watch the video now at A Story about Care .

In the Intensive Care Unit our patients are surrounded by life-sustaining technology and we are very proficient in the skills we have to competently “do” all the tasks we carry out to keep patients alive minute by minute. Yet it is in those quieter moments when you are one-on-one with your patients that some of the most meaningful connections are made.

As I write this, images of patients I have cared for vividly flood into my mind. When we see our patients as so much more than their diagnosis and we care about them as a “whole” person, it is then that we have learned the “art of caring.” We can never forget that fundamentally nursing is a profession of the heart. In my previous columns in the Dynamics journal I have spoken about these moments of “private victories” when you know that you have connected with the spirit of your patient and both of you have been moved because of it. Doctors, ever compassionate in their care for a patient, are necessarily focused on the diagnosis and the science of the disease, while nurses are focused on the human response to illness. This is the reason why I went into nursing and I suspect why you did too. It is not just a job. We have a privileged presence in the lives of the people we care for in their most vulnerable moments of living with a life threatening illness in the ICU and as we share that journey with them episodically shift by shift, we need to remember that a simple touch…a few words … can result in an act of grace and create yet another “Story about Care.”

Maybe you will be the “red headed nurse” that Jim remembers holding his hand or the “old” (I prefer to call them a “veteran”) nurse who kicked off her shoes, put her feet up on his bed and just talked to him in the “hollow of the night.”

Jim, thank you sharing your inspiring story, as a prompt to us all of the importance of not just caring “for”… but reminding us how important it is to our patients when we care “about” them. Teacher, your words have made an impression and will remain as a lasting legacy. I love you.

As always…take care of yourself and each other,

Kate Mahon
President

After almost three decades of the old logo serving the organization well, it was decided by the Board of Directors (BOD) in the spring of 2011 that it was time for a new, fresh and updated appearance.  

We asked members to send us your ideas and we were pleased that some people took the opportunity to share with us some very innovative, thoughtful and meaningful designs.  These designs were displayed at the fall Dynamics conference in London, ON for members to ponder.  There was no one design that was selected as submitted, but I am pleased to say that many of the elements that were in those submissions helped to shape the final version that we asked our graphic designer at Pappin Communications to create. 

The new logo maintains a link to our proud past and the founding organizations by incorporating the circle, maple leaf and red and black colour design.  Inside the circle there are now five figures holding hands signifying the interdependence and unity we have as critical care nurses around Canada, while also numerically corresponding to the five pillars of the CACCN Strategic Plan.

We also felt it was important that CACCN be “spelled” out so that it was clear who we are to anyone who may come across our logo, thus our full name is part of the new look, in addition to highlighting the first letter of each word in red, to make the acronym “CACCN“  stand out.

Over the coming weeks, you will see the new logo start to appear on  our visual materials.  We hope you like the fresh new look!

Thank you to the following individuals who sent in design ideas:

• Lissa Currie and Sarah Unrau
• Teresa Coughlan
• Josefa Inot
• Céline Pelletier
• Ariel Rogozinski
• Michael Wheatley

As always….take care of yourself and each other!

Kate Mahon
CACCN President

AI is about managing change in organizations by using an “appreciative”  process to discover (inquire) what is right about things, rather than focusing on what is wrong or what the problem is. AI is about finding the positive core strengths of an organization and building upon those, rather than trying to trace the root cause of problems. I think that is what I like so much about this approach as I have always found it personally draining to dwell on what is wrong with things. I prefer to spend my energy on building upon what is good, what is positive and what is already done well. 

In my 26 years in management I have been part of too many change management processes that took weeks, or months working to identify the problems (often bringing in high priced consultants to interview staff to tell them what the problems are), then look for the causes of problems (often ending up blaming people) and then spending more time to analyze why the problem exists before moving on to decide on actions needed to “fix” it. And then finally developing evaluation strategies to measure if the problem still exists (and being surprised when it does!).  Those approaches to bringing about change were energy draining because they are designed to dredge up everything that is wrong about the organization and the people who work within it. I have found that such processes are negative, are an obstacle to meaningful dialogue, demoralizing to people, they squash any sense of pride that people have in their past (or in their present for that matter), and fail to appreciate what the positive lessons from the past are that should be brought forward to use as a starting point to create a desired future.

AI on the other hand uses a strength-based approached  to find out what is good and what gives life to the organization (rather than focusing on problems and what takes life away from the organization) by utilizing an affirming strategy to “inquire” about: What is working well here? What are we good at? What are our strengths and best practices? What do we feel proud about? AI wants to know what is the best of what has been (the past) which allows people to tell their stories of their past experiences when they felt they were at their best.  It seeks to “appreciate” the strengths of an organization and its people. How liberating! How positive! What a great way to start people talking when you want to bring about change.

So let’s look at AI a little closer and I want you to think about the ICU  where you work as you read the next section and consider if AI is an approach that has potential to bring about positive change in your unit and elevate it to a new level of greatness.

Let’s face it…every unit has its issues and problems.  But fundamentally when we focus on what is wrong, what is negative, it becomes a self-fulfilling prophecy. You see MORE of what is wrong.  With AI you CHOOSE to focus on what is going right, what is positive and you therefore create a new destiny and discover new strengths of people and processes. You create a desired future with your colleagues as you believe in the best of you and the best of others. Synergy is the outcome. Greatness is the destiny. AI is about creating a future by building upon what already works, rather than fixing what we know doesn’t.

Cooperrider describes four phases to AI:

Phase 1 – Discovery: This is the phase when you engage everyone in your unit identifying “the best of what has been and what is.” Challenge one another to say (without being modest about it) what it is that your unit is good at from your past and in the present. A simple way might be to start a notebook at the desk called “What we are good at!”   And let people free lance any thoughts they may have. Write down your stories that illustrate what you do well. Then watch the positive energy that starts to come from reading what has been written by others. By doing this you are beginning to identify the positive core strengths of your unit.

Phase 2 – Dream: In this phase the purpose is to think about what you want for the future…to dream without restrictions. You want to liberate your thoughts and let go of the status quo.  Ask yourselves “What is the purpose of our unit? What is it that we want to do (or become)? What contribution do we want to make for the population we serve in this ICU? What is our calling?”

Phase 3 – Design: In this phase, building upon the positive core strengths at what you are already good at, you want to think about capitalizing on those strengths to formulate a plan to make your dream future a reality. Ask yourselves “What would this unit look like if we fully used our strengths to work towards achieving our dream? How can we take advantage of our current capacity and capabilities to create new capacity?”.

Phase 4 – Destiny: During this phase the execution of plans begins to happen but does not necessarily need formal action plans and implementation strategies to sustain momentum. It is important in this phase that people within your unit have opportunity to regularly but informally connect to share ideas (this could be face-face encounters or through virtual discussion forums or even gathering for tea-at-the-end-of-the-desk-in-the-middle-of-shift where positive discussion is the guiding principle of any conversations), to encourage and support one another and to mobilize the positive energy that comes from simply letting go of the negative past. As AI becomes a way of “being” in your ICU, a new culture of positive energy emerges and there is a natural alignment of the positive core strengths to achieve the dreams you have identified and reach the unit’s desired destiny.  (Cooperrider & Whitney, 2005).

Does this sound like a lot of work?  There is effort, but the work that it takes to stay entrenched in habits of negativity consumes much more energy than the work involved in using an appreciative inquiry approach to creating the kind of positive change you want in your ICU.  AI will lead you to appreciate what is the best in you and in others.  There are many trained professional AI consultants who could assist your unit in journeying through the AI process to reveal your strengths and creating the change you want for your unit. What destiny do you desire?

As always…take care of yourself and each other,

Kate Mahon
CACCN President

Reference:  
Cooperrider, D. L., & Whitney, D. (2005). Appreciative inquiry: A positive
         revolution in change. San Francisco, CA: Berret-Koehler Publishers
         Inc.

** There are many good websites on AI that can also be googled to read more on the subject.

There are many exciting things happening in units in Canada and abroad, that need and should be showcased.  Dynamics offers you the opportunity to share these great things (stories, innovative ideas, etc) with your critical care colleagues.

I can still remember the very first time I presented at Dynamics. It was back in 1993 in Vancouver (what a coincidence!) and my topic was “Can Critical Care Nurses Meet the Challenge of the 90′s?” (Guess we did as it is all history now!!) I submitted the abstract not thinking it would ever be good enough to be selected and when it was…I was both thrilled and nervous to think I would be standing up in front of people I did not know to talk about how critical care nursing was evolving so rapidly in the ICU in the early 90′s as technology in particular was changing how care was delivered and in fact which patients could actually be saved. (Think first generation IV infusion pumps, new ventilator modes, ECMO etc).

That first presentation for me went well and in subsequent years I continued to find topics that I could speak about and found myself presenting at many Dynamics since then. I gained my confidence and found my voice. I was so proud when staff from the PICU I managed began to find their voice and they too became presenters year after year. One year (2002), our unit won the (then) Johnson & Johnson Innovative Project award on the same topic we presented at Dynamics which was about “Developing a web-based orientation program to the PICU”.

I KNOW there have been many unique experiences that have happened in your ICU over the past year that are worthy to be submitted. I encourage you to think back over the past year or so and remember the interesting patient and family that were admitted to your unit and how it challenged you and your team. Tell that story, mixing it with how the ICU confronted the situation and provided exemplary care while you add in teaching points about the pathophysiology of the patient’s condition. And voila! You have a full presentation that people will enjoy.

When we share our stories (which we all love to hear!) we teach one another…and are in service to one another by doing so. Servant leadership again (see my column in the Winter 2011 issue of Dynamics).

The easy thing right now is that all you have to do is write your abstract which in fact is quite short to do (about 3-4 paragraphs or 2000 characters maximum describing what you intend to present)….you have lots of time (6-7 months) to get the presentation together and refine your thoughts AFTER you find out that you have been selected. Have a look at this year’s theme and link that to your abstract. Come up with a catchy or intriguing title and you have done it!

Once your abstract is submitted electronically, it will be forwarded to a selection committee who will conduct a blinded review process ( i.e. they will not know who submitted the abstract). Once they have completed this process you will be notified in March 2012 whether you have been accepted. As the Staples commercial says…”That was easy!”

The abstract submission information and requirements are available on the website and as the brochure describes:

Leadership is part of everyday critical care nursing practice. Leadership is required to provide excellent care for patients and families, to support healthy workplaces and healthy nurses. Using our voices to promote excellence in critical care is leadership in action. Dynamics 2012 is the place for you to give voice to your convictions. Lead from where you stand. We invite submissions for oral and poster presentations in the general topic areas of clinical practice, education, research and leadership.

Make it part of your New Year’s goals to become a presenter at Dynamics and this year make it a point to “Voices of Conviction from Sea to Sky. Speak Up, Speak Out, Be Heard“.

As always…take care of yourself and each other,

Kate Mahon, President

Note:

• Dynamics 2012 Online Abstract Submission
• Deadline: January 31, 2012 at 2359 EST
• ONLY Abstracts submitted online through the CACCN/Dynamics Abstract Submission Process will be accepted;
• Abstracts submitted in a manner other than the CACCN / Dynamics Abstract Submission Process will not be considered;

For me the past year was one of great personal change in my family some of which represents an ending, as in the death of my father,  not to mention that my career path was significantly altered when my job ended and I left the organization where I had worked for over 28 years. As you reflect on your past year, you probably have similar and different experiences that represent an ending.  Somehow though when a new year begins it is full of promise because it is a fresh “start” and if you are like me, I like to think only positive thoughts about what I will accomplish in the next 12 months as January begins.  I am full of optimism that my future is in my hands and will be guided by the choices I make in how I decide to respond to anything I am presented with in the months ahead, confident that I will succeed. 

With this in mind, I just finished reading a wonderful book called “The Happiness Advantage” (2010) by Shawn Achor which outlines seven principles from the research completed on positive psychology that fuels success and performance at work.  What I really liked about this book is that it identifies specific, actionable and proven patterns that predict success and achievement in individuals who display these behaviours and traits. He emphasizes that happiness causes success and not the other way around. 

Achor’s research in the field of positive psychology is particularly interesting, as he points out that rather than getting our brain stuck on noticing what is wrong with something or focusing on what stresses us out, whether that is negative people (or our own negativity and pessimism that “things will never change around here”) or dwelling on failures, rather his work has proven that you can retrain your brain to actually “spot patterns of possibility, so we can see and seize the opportunities wherever we look”.  He describes in detail through each principle how you can choose to react differently to what life has in store for you over the next year.  He concludes by saying “Together these 7 principles help people overcome obstacles, reverse bad habits, become more efficient and productive, make the most of opportunities, conquer their most ambitious goals and reach their fullest potential”.  Now THAT is powerful to consider. So how will you choose to pattern your brain in the year ahead?

2012 is also the Year of the Dragon in the Chinese zodiac calendar starting on February 4th.  In Chinese astrology, a person born under the sign of the dragon is special and they stand out from others as powerful and wise. They are not shy and they have an ”aura” about them that demands attention and respect. They are “doers” and they achieve power by getting things done. It also cautions however that like a dragon who can breathe fire, a person born under this sign can have a temper if riled and can be quite a confronting person on issues with the long reach of a dragon’s tongue. The dragon’s underbelly is also their soft spot and dragon people show a lot of compassion to people in need, even those that annoy them. Dragon people are driven, unafraid of challenges and willing to take risks. They are passionate in all they do.

I don’t know about you but I am thinking that a lot of critical care nurses may have been born under the sign of the dragon! Just some fun things to think about as the new year begins.

With these thoughts in mind I wanted to first wish you all a Happy New Year… as your happiness will give you the advantage to be successful in all the goals you choose for yourself in the coming year.

As always…take care of yourself and each other!

Kate Mahon, President

Reference: 

               Achor, S. (2010). The Happiness Advantage – The Seven Principles of Positive Psychology that Fuel Success and Performance at Work. Crown Publishing Group. New York

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PS  I would still like to urge all of you to read the information on the special web page we have linked from the CACCN home page (and my blog from two weeks ago) to update yourself on the Call to Action issued by CACCN on the issue of the decision by 10 of Canada’s nursing regulators to use the American National Council of State Boards of Nursing NCLEX-RN exam for new nurses in Canada for the purposes of licensure over the bid submitted by the Canadian Nurses Association and other providers to develop a similar computer-adaptive exam.  Please take the time to become informed and decide for yourself where you stand on this important issue for Canadian nurses.  Be sure to vote in the poll on the CACCN home page.  Bring out the dragon in you on this one!