Nursing’s Sweet Spot Amidst The Chaos

Happy 2018 to you!  I hope your first 5 days have been ones of contemplation for what is to come in your new year.

For me, I know that this is going to be a big year for me and Saving Nurses.

I have mentioned before that I have been writing a book, A Memoir, Getting Real About Caring in Healthcare.  Interestingly, in this process, I have identified the core meaning of my website’s name, Saving Nurses.  Up until now, I didn’t really know why I chose this name.  Now, it is self evident.

Here is a sneak peak in one of my book’s chapters.

Our 21st Century Story – Saving Nurses

We know that the essence of nursing is authentic caring. We also know that if we nurse leaders want nurses to focus on authentic caring, then we have to focus on it. The one story that puzzles me is the pervading silence of a collective voice about real caring from nurse leaders in the healthcare industry. Had there been a clear collective voice from nurse leaders in the industry standing equal with medicine and business, sounding what caring is, its science and research, its reach, its range of impact on people’s lives, its source and how it is cultivated, I would have followed that beacon and jumped sooner. And now, the shift in society’s wellness consciousness and the monetization of caring are demanding it with the escalating recognition that it is nurses to whom patients turn for real connection, which means that the solution lies within nurses.

Understanding these contextual forces brings us to a new territory, one of preservation of nurses, above all else. If we do not help nurses thrive in nursing as our number one priority for the sake of nurses, patients, healthcare and society, despite all the other worthy priorities nurse leaders are consumed in, they won’t matter. We cannot continue to sidestep this looming obligation. Not only do we have ethical and professional responsibilities to lead caring in healthcare for patients, we have the same obligation to nurses. This is the gift of authentic caring. Caring Science shows us that authentic caring provides deep meaning for both patients and nurses. It has a reciprocal nature; both the patient and nurse benefit. Authentic caring moments can impact patients’ lives in lasting ways and renew nurses’ commitment to their work. This is our nurse leader legacy.

We know that most nurses yearn to connect more often with patients on meaningful levels. The more real conversations we have with nurses, the more we know this. They entered the profession to be a part of something larger than themselves. Daniel Pink, in his book Drive: The surprising truth about what motivates us (2009), describes a vast disconnect between the science behind motivation and what businesses are currently doing in how we manage 21st-century individuals. He explains that unlike other generations, it is intrinsic drivers that motivate the 21st-century individual: a sense of purpose, mastery and autonomy. We of all leaders should be paying attention to this motivation science. Is there another profession more intrinsically motivated than nursing?

The journey to authentic caring is unique. Nurses are propelled to engage in authentic caring by their internal resources. “These connections originate within the nurse, spark from a connection between the nurse and other, are nurtured by the nurse’s internal resources, and can only be sustained by the nurse” (McClendon, 2017, p.39). Nurses come to nursing with a desire to help people, and in nursing school they start cultivating their caring consciousness. But once employed in healthcare, acknowledgement and support of authentic caring cultivation virtually suspend.

Nurse leaders focusing on authentic caring practices with the intention to grow caring conscious work environments can change this work place trend. The problem is the collective acceptance that compassion fatigue and burnout are unavoidable work hazards in nursing given the pace and complexity of nursing tasks. The solution lies in how we care while doing these tasks, but this is where it stops for nurse leaders mired in the industry. If we as nurse leaders collectively accepted the evidence that the very connection that patients are seeking from nurses is the same connection that renews nurses’ commitment to nursing, we will have found nursing’s sweet spot within the healthcare chaos, a work safeguard for nurses. The evidence exists. Patient experience evidence shows us that patients are turning to nurses for authentic connections while receiving healthcare, and there is evidence that these same connections of authentic caring prevent compassion fatigue and burnout, and improve nurses’ health, resilience and commitment to nursing.

It is true that nurses’ desire to authentically care is often greater than their inner resources, but these can be restored and cultivated by self-care and health practices. Health promotion behaviors have been shown to impact compassion fatigue, compassion satisfaction, and burnout (Neville & Cole, 2013). In addition, evidence supports that caring behaviors and job satisfaction are correlated. Nurses find harmony and wellbeing through caring behaviors (Amendolair, 2012). While it was confirmed that stress and salaries impact turnover and retention, the same study underscored the importance of autonomy, opportunities to express altruism and congruence of values between the organization and nurse in intention to stay in the profession (Tucker et al, 2012 & Dotson et al, 2014).

Caring relationships are what unites and transforms us as leaders. “Caring and resiliency are intertwined and could be the undergirding concepts necessary for nurse leader success in the 21st century” (Dyess et al, 2015). Authentic connections lead to the highest level of caring—biogenic caring—related to healing, wholeness, and transpersonal caring relationships; they have a reciprocal nature between the patient and nurse, restoring trust, faith and hope (Watson, 2012 & Halldorsdottir,1991). Jean Watson (2016) has made clear that burnout doesn’t happen because we care too much, it happens because we wall ourselves off from human connectedness, sustaining nourishment, and love. Becoming our authentic selves as nurse leaders leads us to human connectedness, a caring conscious culture, and saving nurses.

Do we not have a moral duty to make standard that which we know creates resilience for many nurses? We know the healthcare industry is a beast to work in, caring fatigue is on the rise among nurses, real caring connections heal, and the remedy lies within nurses. We also know that there is a science behind the remedy, and that it is nurse leaders who are the ones with the most access and influence with nurses. So how can we nurse leaders not act with a sense of purpose and urgency?  The solution lies in tapping into nurses existing intrinsically motivated caring practices.

Nurse leaders within the healthcare industry are nurses’ best hope. Nursing theorists, academicians, thought leaders and educators have been sounding Caring Science theory, research and knowledge for decades. But the seas are too rough and the noise is too loud. Nurse leaders, from within the organizations, who are on their own caring consciousness journeys, however slight, are in the best position to translate such a disruption amidst the chaos. Caring consciousness and language is the path that can trigger nurses’ intrinsic drivers to authentic care. By sharing their own consciousness, nurse leaders can tap into nurses existing caring practices and cultivate growth in each nurse, create a caring conscious culture and become the leader of caring in organizations. Nurses are nurse leaders greatest asset. This is not an asset to control and protect, but an asset to grow beyond its current boundaries within the chaos. This is our 21st century story. We can turn the tide of real caring in healthcare and save nurses.

Amendolair, D. (2012). Caring behaviors and job satisfaction. Journal of Nursing Administration, 42(1), 34-39.
Dotson, M.J., Dave, D.S., Cazier, J.A., Spaulding, T.J. (2014). An empirical analysis of nurse retention. Journal of Nursing Administration, 44(2), 111-116.
Dyess, S.M., Prestia, A.S., Smith, M.C. (2015). Support for caring and resiliency among successful nurse leaders. Nursing Administration Quarterly. 39(2), 104-116.
McClendon, P. (2017). Authentic caring: Rediscover the essence of nursing. Nursing Management, 48(10): 36-41.
Neville, K., Cole, D.A. (2013). The relationships among health promotion behaviors, compassion fatigue, burnout, and compassion satisfaction in nurses practicing in a community medical center. Journal of Nursing Administration, 43(6), 348-354.
Pink, D.H. (2009). Drive: The surprising truth about what motivates us. New York: Riverhead Books.
Tucker, S.J., Weymiller, A.J., Cutshall, S.M., Rhudy, L.M., Lohse, C.M. (2012). Stress ratings and health promotion practices among RNs: A case for action. Journal of Nursing Administration, 42(5), 282-292.
Watson, J. (2012). Human caring science: Theory of nursing. (2nd Ed). Sudbury, MA: Jones & Bartlett Learning.
Watson J. (2016). Caring science and caritas processes. Presentation in online class: Caring Science, Mindful Practice. Canvas Network. January.
image courtesy of Igor Ovsyannykov,

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