- Email: [email protected]
Power: An elusive franchise
Caroie A. Anderson,
fhD,
RN, HAN
POWER: AN ELUSIVE FRANCHISE
A
s I write this editorial, the public is being bombarded by newspaper and television accounts of the troubled marriage of an American folk hero, 0. J. Simpson, and the violent deaths of his wiie, Nicole, and her friend. What we are learning is that Nicole (beautiful, rich, and privileged) lived a life of qui.et desperation. She, like thousands of other women, was a battered wife. My reaction to the tragic details of this relationship is one of profound sadness-sadness derived from confronting the harsh reality that not enough has changed in the 30 years that women have struggled for equal rights that include the right to be protected under the law. In the face of this high-profile tragedy, there are attempts to reassure, such as a report in the newspaper before me stating that the number of women killed by their partners has decreased, even though the incidence of spousal abuse has inNURS OUTLOOK Copyright 0 1994 0029-6554/94/$3.00
1994;42:205-6. by Mosby-Year Book, + 0 35/39/58618
NURSING OUTLOOK
Inc.
SEPTEMBER/OCTOBER
creased. Are we to conclude that this tion of cultural conditioning, social change is enough? Clearly it is not! expectations, and systems responsive In 1978 I worked with a group of only to the most powerful operate to women in a community to establish a keep women from taking action to imshelter for battered women-a first for prove their lives. Today, many nurses that community. We worked hard and (the vast majority of whom are women) were successful. The shelter was just feel that same way about their profesone part of a comprehensive plan of intervention. We promoted public education, we consulted with emergency The problem of room nurses and physicians, and we spousal abuse is just worked with the criminal justice system to bring about change. We were one example of the hopeful. We hoped that by bringing many ways in which the “dirty little secret” of family life women do not feel into the open, the violence would stop. But it hasn’t; it wasn’t enough. Too empowered to many women have, for too long, lived change their lives. in terror, deathly afraid of someone they love because, for a variety of complex reasons, men beating women is still tolerated. But what has this to do sional lives. They look around at what is happening in health care reform and with nursing? Quite simply, the problem of spousal feel as if they are being squeezed out. Because hospitals are downsizing and abuse is just one example of the many ways in which women do not feel em- patients are being discharged more powered to change their lives. The rea- quickly, staff nurses are being laid off, vacant positions are not being filled, sons for this are many. Some combina1994
Anderson
205
and unlicensed personnel are hem): substituted for RNs. Most nurses feel quite helpless about these happenings. They do not feel ahle(i.e., cmpowercd t to change their circumstances. But, rl’alisticaliy, what can they do: First, nurses can learn as much ,.ts possible about health care reform and carefully think through what new opportunities and roles there are or can hc for nurses in a reformed system. TheII, they need to ask themselves if they arc prepared to assume these new roles. it may be the case (I believe it will be the case) that many nurses will need more or different education to compete for and function effectively within these roles. Roles are emerging that include assuming responsibility for directing the work of a “mix” of personnel, coordinating care and services, and providing care in nontraditional ways and places. Furthermore, there is increasing pressure to link explicit measures of accountability into the new roles and responsibilities, and then to make the results of these outcome measures available for discussion and for use in further decision making. Clearly, the system is changing quickly. Yet, I hear nurses say that things will “cycle back.” They think RN positions in acute care settings will be restored. It may he true that the changes we are now witnessing will go too far and cut too deeply into the quality of care. But things will not go back to the way they were. Things rarely do. Nurses must prepare for a different culture of health care. Nurses with advanced preparation are also being affected by the changes. Traditional clinical specialist positions
are in jeopardy. Why? Because with till new emphasis on reducing costs, poti! tions that involve significant time spen I in indirect cal-c ;If-.1 ciiapensabir 1.11 fortunately, 1%~Jo not have good (LX I to document the> ]YJsitive Impact t/iii: clinical specialists have had on pattcnt care, ho those positions are vulnerabL Yet in the ml&t of all of this thc.rc is enormous opportunity for nurse\ to look syuarcly into the eye of ch.lngc and ask themselves. “What do these changes mean ior me?’ and turthrr. “What am I going to do, for my cLlrccI and for my own satisfaction?” Havmg answered these questions, then a goal can be set. Once a goal is set, then the challenge becomes finding the mcans to fulfill it. Hcreln lies another challenge that otten takes the form ot 11drlemma. Will ,I ilursc consider her wants, her ambitions, her goals, her career to be ;IS important as those of others in the ~am~lyl Will her “plan ’ have a high priority or will it take J back seat to the ileeds of others? If the latter happens, then this nurse has iittle recourse but to tee1 like a victim, to become disgruntled, disenchanted. demoralized, and watt for the inevitable to happen. Of course, actualizing this kind of personal plan ia not easy. The psychological and sociological literature of the past three decades is replete with explanations oi why it is so difficult for women to feel empowered, to feel that they are in charge of their own destiny. We cannot change history or wave a magic wand to change society. But we can hope, and each of us, in our individual way, can ensure that the profession itself-the leadership, our col-
The rcalit) is that no one will freely give away power; it ib difficult to give author Ity to someone (l.c., empower) who dots ni)t want it or dots not feet it, Individuals have to work to feel the abilitv to do, to act, to take charge of thclr lives. We all must aupgort and encourage these efforts that will ultimately reduce the number of victims created by the wave of any change Nicole Sirnpson was a victim. If any good 15 to come of this tragedy, I hope it i:, that every woman ,ilid nonviolent man assume responsibility for ending thi> type oi violence. Sirnilariy, every nurse should work toward taking charge of his or her protesslonal life, and supporting colleagues ii1 taking charge of their livea, their future.---to change! n
Authorization to photocopy items for internal or personal use is granted by Mosby for libraries and other users registered with the Copyright Clearance Center (CCC) Transactional Reporting Service, provided that the per copy fee stated on the first page of each article is paid directly to CCC, 222 Rosewood Dr., Danvers, MA 01923. The U.S. Government retains a nonexclusive, royalty-free license in and ttiany copyright on articles authored by government employees.
206
Anderson
VOLUME
42 * M-f?
5
NURSWG
OUTLOOK
fhD,
RN, HAN
POWER: AN ELUSIVE FRANCHISE
A
s I write this editorial, the public is being bombarded by newspaper and television accounts of the troubled marriage of an American folk hero, 0. J. Simpson, and the violent deaths of his wiie, Nicole, and her friend. What we are learning is that Nicole (beautiful, rich, and privileged) lived a life of qui.et desperation. She, like thousands of other women, was a battered wife. My reaction to the tragic details of this relationship is one of profound sadness-sadness derived from confronting the harsh reality that not enough has changed in the 30 years that women have struggled for equal rights that include the right to be protected under the law. In the face of this high-profile tragedy, there are attempts to reassure, such as a report in the newspaper before me stating that the number of women killed by their partners has decreased, even though the incidence of spousal abuse has inNURS OUTLOOK Copyright 0 1994 0029-6554/94/$3.00
1994;42:205-6. by Mosby-Year Book, + 0 35/39/58618
NURSING OUTLOOK
Inc.
SEPTEMBER/OCTOBER
creased. Are we to conclude that this tion of cultural conditioning, social change is enough? Clearly it is not! expectations, and systems responsive In 1978 I worked with a group of only to the most powerful operate to women in a community to establish a keep women from taking action to imshelter for battered women-a first for prove their lives. Today, many nurses that community. We worked hard and (the vast majority of whom are women) were successful. The shelter was just feel that same way about their profesone part of a comprehensive plan of intervention. We promoted public education, we consulted with emergency The problem of room nurses and physicians, and we spousal abuse is just worked with the criminal justice system to bring about change. We were one example of the hopeful. We hoped that by bringing many ways in which the “dirty little secret” of family life women do not feel into the open, the violence would stop. But it hasn’t; it wasn’t enough. Too empowered to many women have, for too long, lived change their lives. in terror, deathly afraid of someone they love because, for a variety of complex reasons, men beating women is still tolerated. But what has this to do sional lives. They look around at what is happening in health care reform and with nursing? Quite simply, the problem of spousal feel as if they are being squeezed out. Because hospitals are downsizing and abuse is just one example of the many ways in which women do not feel em- patients are being discharged more powered to change their lives. The rea- quickly, staff nurses are being laid off, vacant positions are not being filled, sons for this are many. Some combina1994
Anderson
205
and unlicensed personnel are hem): substituted for RNs. Most nurses feel quite helpless about these happenings. They do not feel ahle(i.e., cmpowercd t to change their circumstances. But, rl’alisticaliy, what can they do: First, nurses can learn as much ,.ts possible about health care reform and carefully think through what new opportunities and roles there are or can hc for nurses in a reformed system. TheII, they need to ask themselves if they arc prepared to assume these new roles. it may be the case (I believe it will be the case) that many nurses will need more or different education to compete for and function effectively within these roles. Roles are emerging that include assuming responsibility for directing the work of a “mix” of personnel, coordinating care and services, and providing care in nontraditional ways and places. Furthermore, there is increasing pressure to link explicit measures of accountability into the new roles and responsibilities, and then to make the results of these outcome measures available for discussion and for use in further decision making. Clearly, the system is changing quickly. Yet, I hear nurses say that things will “cycle back.” They think RN positions in acute care settings will be restored. It may he true that the changes we are now witnessing will go too far and cut too deeply into the quality of care. But things will not go back to the way they were. Things rarely do. Nurses must prepare for a different culture of health care. Nurses with advanced preparation are also being affected by the changes. Traditional clinical specialist positions
are in jeopardy. Why? Because with till new emphasis on reducing costs, poti! tions that involve significant time spen I in indirect cal-c ;If-.1 ciiapensabir 1.11 fortunately, 1%~Jo not have good (LX I to document the> ]YJsitive Impact t/iii: clinical specialists have had on pattcnt care, ho those positions are vulnerabL Yet in the ml&t of all of this thc.rc is enormous opportunity for nurse\ to look syuarcly into the eye of ch.lngc and ask themselves. “What do these changes mean ior me?’ and turthrr. “What am I going to do, for my cLlrccI and for my own satisfaction?” Havmg answered these questions, then a goal can be set. Once a goal is set, then the challenge becomes finding the mcans to fulfill it. Hcreln lies another challenge that otten takes the form ot 11drlemma. Will ,I ilursc consider her wants, her ambitions, her goals, her career to be ;IS important as those of others in the ~am~lyl Will her “plan ’ have a high priority or will it take J back seat to the ileeds of others? If the latter happens, then this nurse has iittle recourse but to tee1 like a victim, to become disgruntled, disenchanted. demoralized, and watt for the inevitable to happen. Of course, actualizing this kind of personal plan ia not easy. The psychological and sociological literature of the past three decades is replete with explanations oi why it is so difficult for women to feel empowered, to feel that they are in charge of their own destiny. We cannot change history or wave a magic wand to change society. But we can hope, and each of us, in our individual way, can ensure that the profession itself-the leadership, our col-
The rcalit) is that no one will freely give away power; it ib difficult to give author Ity to someone (l.c., empower) who dots ni)t want it or dots not feet it, Individuals have to work to feel the abilitv to do, to act, to take charge of thclr lives. We all must aupgort and encourage these efforts that will ultimately reduce the number of victims created by the wave of any change Nicole Sirnpson was a victim. If any good 15 to come of this tragedy, I hope it i:, that every woman ,ilid nonviolent man assume responsibility for ending thi> type oi violence. Sirnilariy, every nurse should work toward taking charge of his or her protesslonal life, and supporting colleagues ii1 taking charge of their livea, their future.---to change! n
Authorization to photocopy items for internal or personal use is granted by Mosby for libraries and other users registered with the Copyright Clearance Center (CCC) Transactional Reporting Service, provided that the per copy fee stated on the first page of each article is paid directly to CCC, 222 Rosewood Dr., Danvers, MA 01923. The U.S. Government retains a nonexclusive, royalty-free license in and ttiany copyright on articles authored by government employees.
206
Anderson
VOLUME
42 * M-f?
5
NURSWG
OUTLOOK