Health care professionals are experiencing the ancient Chinese curse "May you live in interesting times." Health care today is a constant battle between cost and compassion, and one group of health care professionals finding themselves in the middle of that battle is nurses. The following article is adapted from my customized keynote presentation on The Power of a Vision … The Nurse's Journey Through Health Care. This presentation was given to the Society of Urologic Nurses & Associates at their Annual Conference. Please check back to this page periodically for articles customized specifically for other health care professionals.

The Power of a Vision ... The Nurse's Journey Through Health Care

A man and a woman approached the pearly gates, their heads were bent and low. Softly, they asked St. Peter which way they should go. "What have you done?" St. Peter asked, "to gain admission here." "We've been urologic nurses for many and many a year." "Open the door" St. Peter cried as he loudly rang the bell. "Come right in" St. Peter said "you've had your share of hell." Isn't that the truth! This past year has given new meaning to the hell in health care and it looks like next year will be more of the same. (Mintzer, 2001).

With medical facilities downsizing, right-sizing and capsizing, workplaces are becoming very stressful environments these days. I asked a urologic nurse at a local hospital if all the changes in health care were bothering her. She said "Barbara, don't be silly. All these changes taking place don't bother me or stress me out at all. As a matter of fact, when I go to sleep at night I put my head on the pillow and sleep like a baby … I get up every two hours and cry, God do I cry." So if you are sleeping like a baby and getting up every two hours to cry, you are not alone. (Mintzer, 2001).

Change is rampant in health care today, and one of the biggest changes is the priority given to the BOTTOM LINE that all hospitals and medical facilities must adhere to. The hardest change nurses have had to make, is to expand their vision of the compassionate caregiver to include the bottom line business professional as well. If this feels schizophrenic to you, you are not alone. Health care is a constant battle between cost and compassion, and nurses are caught up in that battle.

I had the privilege of keynoting your 33rd Annual Conference in Orlando this past May, and I spoke to you about The Power of a Vision: The Nurse's Journey Through Health Care. This article is written to reinforce the strategies I presented to help you win the battle and move from "change-victim" to "change-maker." In order to become a change-maker, you must do something! To effect change on your team, it requires your willingness and ability to formulate and articulate a vision your team can work towards. It is YOUR enthusiasm, faith and conviction in the vision that will enable your team to create tomorrow's opportunities out of today's changes.

VISION STATEMENT

One of the most important facets of a vision is the power it has to unify people to strive towards a common goal. When the shared vision becomes more important than an individual's personal agenda, people rise above the "turf" issues and power struggles that can happen in the workplace. When team members have a vision of what they want to achieve, they start to gravitate to those activities that will lead them closer to the vision. The vision they hold becomes the compass that keeps them on track. On a personal level, a vision is the structure that gives life its meaning and purpose. It gives you a reason to get up in the morning and look forward to going to work. It gives you the opportunity to get out of your comfort zone and not only embrace change but initiate it. A vision allows you a view of what you can aspire to if you are willing to do the work to make it happen.

The following is a Vision Statement you may wish to share with your team. You can get feedback from the team and modify it any way you like so that you end up with a vision that everyone feels a part of and comfortable with. You get buy-in from your team when everyone takes responsibility for his/her part in making that vision a reality.

We are the hospital of choice in this community. Patient care is our highest priority, and we are responsive, effective and innovative in meeting and exceeding the expectations of our patients and their families.
Our team is knowledgeable, flexible and accountable for our performance, and we are committed to embracing change. We value those we serve and treat our patients AND each other with respect and compassion. We build relationships based on trust.

After you and your team have come up with a Vision Statement that everyone agrees to, the following is a powerful strategy to implement that will make your vision a reality. It is the 15-Minute Vision Meeting and its purpose is to make each team member accountable for the vision. However, this strategy will work only if you follow it exactly as it is written here. If you have any problems with implementing this strategy, or you have a unique situation on you team, e-mail me at: bmintzer@barbaramintzer.com and I will help you.

15-Minute Vision Meeting
(To Get Buy-in and Accountability From Your Team)

Every Friday morning you and your team meet from 9:00 till 9:15.

You meet at the same time, in the same room, everyone takes the same seat, and you always ask the same two questions of each member of your team:

1. What did you do that brought us closer to our vision?
2. What obstacles did you encounter that prevented you from getting us closer to our vision?

Once your team is actively supporting the corporate vision and everyone is working towards making it a reality, the next step is for you to take some time for individual reflection. What do you view as your strengths as a urologic nurse, and what areas need improvement? Where do you see yourself five years from now, and what will it take to get there?

Thinking Outside The Box

The following four questions will help you think "outside the box" as you look at urologic nursing from a broad perspective. The answers to these questions will give you insights into your present career and opportunities that may be available to you in the future. I will give you the questions and some answers that I have either researched on my own, or gotten from your colleagues whom I interviewed over the phone.

How can I add more VALUE to my work as a urologic nurse?

This question looks at the "value-added" component of your job function. What else could you be doing in your job that would be beneficial to the patients you serve, the people you work with and work for? The following are six strategies to implement that will substantially add value to the services you now perform as a urologic nurse.

1. Get involved in community outreach! I feel very passionately about this. Many of us have developed such a "lust" for technology, we forget that health care is a PEOPLE business. No health care professional knows that better than a nurse. This is my suggestion: Once a month, for example on a Tuesday evening from 7:00 to 8:30, open up a room in your hospital and hold a community lecture on a particular disease or surgical procedure. Have some coffee, punch and cookies and invite the community in for free. You could have three people on your team present a different perspective on prostate surgery, for example. You give your perspective as a urologic nurse and discuss what you do, the surgeon can discuss his or her perspective, and you can ask a patient who has been through the procedure if he would be willing to discuss his experience (provided it was a positive one, of course.) This community outreach lecture puts a humane touch to potentially frightening health care situations.
   I know this first-hand. My husband and I attended just such a lecture at a local hospital here in town last year. This past year he needed prostate surgery and had his choice of hospitals to go to. He picked the hospital we had gone to hear the lecture because he felt he "knew one of the nurses, he knew the surgeon" and he felt comfortable going there. Now he is an engineer who looks at things very clinically and non-emotionally, however, when it came to possible surgery his emotions took over. As a urologic nurse you can put a humane touch to embarrassing situations and your ability to reassure potential patients puts you in a powerful position. Use it to your advantage. Remember, health care is a business, and part of business is marketing. The hospital you work in would not be in business if they didn't have patients, and this face-to-face marketing gives wonderful visibility and credibility to you and your hospital.
   
   
2. Use technology to your advantage. If the hospital or medical facility you work in has a website, ask for a column on the website. Once a month write a short column on news of interest to the community. One month you could write an article on complications from diabetes; another month it could be on older women and bladder leakage. You add value and credibility to your profession when you give information to the public, both verbally and through the written word. You become a resource to your hospital as opposed to an employee. In tough economic times, hospitals will lay off employees but they rarely let a community resource go. You could vary this column from month to month with a Q&A column one month, perhaps one month have a feature called "In Their Own Words" and let a satisfied patient write of his or her experience at your hospital. Again, this is done to add value to the hands-on primary care you do.
   
   
3. If your hospital has a newsletter that they send out to the community, ask for a column in the newsletter and do the same things you would do on the webpage.
   This increases your visibility and credibility as well. This is particularly important in communities where people are not computer savvy and still prefer the newsletter that comes by mail. If you serve a population where English is a second language, perhaps you could have the column in both English and the native language of the culture you serve. It would be easier for people to read, and they can then pass the newsletter on to a family member or friend who may be interested in your column.
   
   
4. Continue your education in urologic nursing to stay current with new practices and procedures.
   Everyone has such a full plate today, it is hard to commit to one more thing. However, the pace of change going on in health care is breathtaking, and you need to stay on top of current practices and procedures to be of most value to your profession. When you educate yourself you are continually educating your patients.
   
   
5. Stay active in SUNA and attend the Annual Conference. It would be a very good idea to be active in your local chapters as well. We all need a place to go to where we can "vent" with people who understand what we are going through. When you become active at the local chapter level and you regularly attend the meetings, you meet kindred souls who can empathize with you. Of course, you also share knowledge, experiences and information. It is important for all urologic nurses to keep SUNA strong.
   
   
6. Lastly, recognize the uniqueness of your patients and tailor the procedures to their specific needs.
   If someone is getting chemotherapy, schedule the patient for a procedure when it is easier for him/her rather than easier for you. Empower the people on your team to be the best they can be and be flexible yourself. Always keep a professional approach; be a good listener and include the family. These are ways you can continue to keep the "care" in health care.

Where is the NICHE in urologic nursing that hasn't been developed?

Home Health Care
We have seen an explosion in home health care and it will continue. With hospital stays being shortened, and more outpatient surgeries, urologic nurses have a big part to play in the home health care setting. To begin with, you could write an educational pamphlet on what to do after a procedure that the patient can take home.
Believe me, when my husband came home after his prostate surgery, I could have used a pamphlet. I had to call the nurse at the hospital a number of times to ask some questions, and a pamphlet written in simple, lay terms would have been very much appreciated. The pamphlet should have concrete information (the blood should look like white wine) I could relate to. It could contain information on possible incontinence or impotence after prostate surgery and a phone number my husband could call to talk to you, if necessary. Sometimes it is easier to talk to the nurse than the wife and you can help the patient adjust and heal emotionally as well as physically.

Bilingual Skills
A very strong niche in health care is the bi-lingual nurse. A problem in nursing today is that we do not look or speak like the people we treat. In California where I live, many nurses serve in areas that are predominantly Hispanic, and these nurses are taking adult-education classes in Spanish to be better able to communicate with the patients they treat. A very good idea, and a very smart career move! Bi-lingual nurses are in demand throughout the United States, and if you ever have to relocate, it would be much easier for you to find a job if you know another language.

Entrepreneurship
A niche that is gaining momentum is the entrepreneurial nurse. A number of nurses that I talked to told me they are strongly considering going out on their own since they do not feel as secure in their jobs as they once did, and they want the freedom to choose the hours they work. The technology boom has changed the demographics of the United States. Today serving the "underserved" population could be in a beautiful small town in Colorado or Utah or any other area where people are deciding to move, laptop in hand, for a better quality of life. The health care facilities in these areas are not what they are in large cities.
You can work for one or more hospitals in a given area, or have a territory that you service much like a sales rep in a small town. You can do consulting work along with primary care, and set up the type of diversified job function you may want and can't get working for a hospital. To me this is very exciting. When I was a trainee selling drugs and pharmaceuticals for a drug wholesaler, they sent me to the small towns of northern Arizona for my training. It was a wonderful experience. I'm a Brooklyn girl originally, and have lived in large cities almost all my life, so this was a new experience for me. While I would not choose to live in such small towns permanently, I would not have given up that experience at all. It was wonderful, and I have fond memories of that year (1975) still.

What would urologic patients pay for if it was available?

Home Health Care Consultations
I believe patients would be willing to pay for home health care consultations on how to heal at home. More and more patients are reluctantly getting used to the idea that they will have to go into their own pockets to pay for certain health care practices and procedures. Insurance companies and corporate America are tightening their belts once more, and patients will have to pick up more of their health care costs, especially if they go beyond the usual scope of care. However, patients today want attention, assurance and more time with their health care provider. I strongly believe they would pay for this out of their own pockets if they could afford it. Urologic nurses could give these consultations and the hospital could bill for it. This may be additional income for you or it may become an integral part of your job description.

Respite Care
I believe respite care for families of patients with special needs will be another area patients and/or their families would pay for. The urologic nurse could come to the home for a specific number of hours to care for patients with special needs so the caregivers can have a break and go out for awhile. In today's stressed out society, this is a service people would pay for.

Language Hotline
A special line to call a health care provider who speaks the patient's native language if it is not English. If an emergency arises at home and a patient needs to speak to a health care provider and explain symptoms, etc., it is much easier and more comforting if they can do that in the language they are most comfortable with. If they can afford it, I believe patients would gladly pay for that service.

One-Stop-Shopping
Patients would pay for the convenience of a one-stop-shop where they can have their urology visits, CAT scans and intravenous injections all in the same place. Convenience takes on a high priority in today's full-plate lifestyle.

What is the future of urologic nursing, and what can I do now to prepare for it?

Geriatric Care
People are living longer today and urologic nurses will continue to address geriatric issues such as urinary oncology and incontenence. Nurses will also need to keep up with their education as new and improved procedures and techniques are developed to address the health issues of the aging. The emotional needs of the aging will be given more attention, as we have more interaction with people who may be angry, depressed and/or confused as well as sick. I believe in this coming decade the care of the aging will be the thrust of health care debate and legislation.

End of Life Care
Along with primary care of all patients, an issue that will be front and center for nurses will be end of life care. Nurses, in all care settings, spend more time with patients who are facing the end of life than any other member of the health care team. As care of the dying occurs across the life span, from pediatric to geriatric, nurses must learn to communicate effectively and compassionately with the patient, family and health care team about end of life issues. In the not too distant future I believe urologic nurses will have a strong niche in EOL care.

For urologic nurses who want to remain in health care, but want to do something other than primary care, there are a number of avenues to explore. I will give you a number of suggestions … see which one sounds like something you would like to pursue.

Research
Research is a wonderful place to be. With all the latest technologies coming out you can be on the cutting edge of new ways to save lives and increase the quality of life for patients today. Pharmaceutical companies are looking for educated, clinically qualified nurses for drug research.

Pharmaceutical Sales
I, of course, have a bias towards pharmaceutical sales since I was a sales rep myself for a major drug wholesaler back in the 1970's. At that time, very few women were in the sales end of the pharmaceutical industry and nurses were not even considered. However, that has changed dramatically. Today there is a strong representation of women on the sales forces of pharmaceutical companies, and what better person to have selling the drugs than someone who is familiar with the end use of the drugs on patients.

Teaching
There is a shortage of experienced nurses on the faculties of many nursing schools, and teaching would be a wonderful way of using your skills, talents, experience and expertise to send a new generation of nurses into the world. With the nursing shortage reaching critical proportions, this would be a wonderful way to help ensure that qualified, educated nurses will be filling the positions of the nurses who are now retiring or choosing areas of health care other than the primary care setting.

Lobbying/Political Office
Be a part of the system that urges the government to do something about the state of health care today. Nurses are a formidable group to deal with when you ban together for a cause. Nursing and politics go together. Congresswoman Lois Capps (Democrat -California) a registered nurse, authored the Nurse Reinvestment Act recently signed by President Bush. This landmark bill is designed to address the national nursing shortage and its provisions include: scholarships for nursing students; the institution of career ladder programs; the creation of nurse retention and patient safety enhancement grants; establishing comprehensive geriatric training grants for nurses; offers grants to nursing schools for faculty loan programs and provides for a Public Service Announcement campaign to promote the nursing profession. Many leading nurse and health care groups are supporting this bill. (Press Release from the office of Congresswoman Capps - July 22, 2002).

In the February, 20002 issue of Urologic Nursing, Volume 22 Number 1, your President, Jean Lewis, BSN, RN,C, CNP eloquently states "Too often we, as urologic nurses, do not realize the power we have. The health care system needs us! It needs our intellect and our competencies to provide quality urologic nursing care …. Without nurses there would be pandemonium in the health care system. Nurses are not dispensable; nurses have power!"

I couldn't agree more. My hope is that you read over this article a number of times. Re-read the four questions you need to ask yourself and see how many answers you can come up with each time you visit these questions. You are in a very exciting position now to make a difference in the health care system. It is easy to get discouraged and angry at some of the things you see happening in health care today. However, as we discussed in my talk, you must be able to tell yourself with conviction "I am not pushed by my problems … I am led by my dream." I admire and respect the vital, life-saving work you do, and wish you much continued success in all your endeavors.

In a future article for Urologic Nursing I will discuss the five inner core strengths we all can call on to help us create tomorrow's opportunities out of today's changes.

References

• Capps, L. (2002). Press Release from the office of Congresswoman Capps, July 22, 2002.
• Lewis, J. (2002). Situational anger and self-empowerment. Urologic Nursing, 22, 8, 47.
• Mintzer, B. (2001). Presentation to the American Occupational Health Conference, San Francisco, CA, April, 2001.