NEW YORK NURSE: July/August 2008
In the “Leading Voices” column in the April 2008 issue of New York Nurse, Susan Casadone describes a nurse who is overworked and under-appreciated. Working 15-hour shifts and taking no satisfaction or pride in her job, this dedicated nurse is on the verge of tears, claiming achy joints and exhaustion as her only “rewards” for years of service.
Although this picture of the burnt-out nurse is becoming overly familiar in the midst of our current shortage, implying that collective bargaining is the only way to bring about positive change is misleading.
Ms. Casadone presents several statements with which we agree:
“Corporate mentality cannot direct the healthcare profession without the contribution of those who must deliver it,”
“…the well-being of the people in our care” is most important,
“we need to work in concert (with management) to find a way to deliver optimal care to the many and to do it economically,” and
“This collaboration can only succeed with contributions from both sides of the table.”
Our opinions diverge, however, when she comments that at unrepresented facilities:
“Staff nurses are not encouraged to bring forward their concerns or ideas for problem solving.”
“Decisions are made unilaterally without input from those who must implement them.”
“Change comes from people who sit behind desks and not those who stand at the bedside.”
Ms. Casadone writes that a nursing organization where nurses are represented for collective bargaining is closer to a “perfect work environment” than organizations that are not unionized.
With this said, we’d like to present an alternative viewpoint. The hallmark of the professional nurse is the ability to practice in a self-determined manner while adhering to ethical and professional practice standards. This can be accomplished where both management and nursing staff are committed to the principle of shared governance.
Shared governance, which is a dynamic interchange between management and nursing staff, is the structure through which professional nurses can work to make decisions regarding practice standards, quality improvement, and professional development. It is the platform that not only promotes, but also expects, the voice of nurses to be heard - from direct service decisions, to the organization’s strategic directions. Solid evidence demonstrates that shared governance is effective at satisfying and retaining the nurses who are central in assuring favorable patient outcomes.
At our hospital, shared governance has been a part of our nursing culture for decades and we have never been organized for collective bargaining. Our staff nurses have the power and responsibility to recognize when things are not right, to suggest alternatives, and effect change.
We would never claim our work environment to be perfect. The overworked and under-appreciated nurse is going to be present regardless of the practice culture. However, the imperfections are our responsibility as well as the responsibility of management. Our nurses have the tools to suggest and bring about change. They take pride in their work and feel empowered in their decision-making roles.
Annette M. Alexandrea, BS, RN
Staff nurse, Pediatric Unit
Bassett Healthcare, Cooperstown, N.Y.Maureen Fitzgerald Murray, MS, RN, NE, BC
Director, Professional Nursing Practice
Bassett Healthcare, Cooperstown, N.Y.