Moving forward with vision and unity.

Abstract

Many challenges face nursing and emergency nursing, and the entire health care system in our nation today. These challenges can readily be seen as threats, but they also are proving to be brilliant opportunities as nursing increases its financial and political savvy and, most important, as it becomes more united and speaks with a single voice. One example of these opportunities concerns the financial picture of health care. I believe that there has been a pervasive and systematic exclusion of nurses from fiscal affairs. Historically, nurses have been given little information about the fiscal aspects of emergency care. We have been left ignorant and consequently powerless in the decision-making process, which affects the daily care we give our patients and ultimately affects our own profession. Thanks to the nursing shortage coming on the heels of a major health care fiscal crisis, many nurse managers have become more involved in money matters and have shown others how to run a cost-effective department. What we are finding in the process is that being on top of the financial aspects of our profession and taking the “bull by the horns” does not leave the doors of leadership and decision-making wide open for those who “work with numbers.” In another example the nursing shortage and widespread budgetary constraints are forcing us to demonstrate (even “prove”) that nurses provide responsible, cost-effective patient care and that the delivery and coordination of that care are well worth a price tag. We’re proving what we’ve known all along: nurses make and save more money for health care mstitutions than they cost them and nurses do make the difference. Many health care issues confront our nation today: fiscal constraints in health care, the nursing shortage, AIDS, the ever-increasing aging population, increasing patient acuity and longer waiting periods in the emergency department, care for the indigent, the cost of care, and access to care. These and many other issues will continue to have effects on each and every one of us. They will change our profession and how we perceive it. In this light, we need to join together with a new energy, come up with fresh ideas, and create a new presence for nursing. From my vantage point, nursing is meeting these challenges like a family. I know in my own large family that the children might be quite vocal in their differing opinions, but would invariably meet a challenge from outside with a unified front. Nursing is currently doing just that. At our Annual Meeting in New Orleans last September, so many nurses attended the practice/ professional issues forum that the doors and dividing walls were literally swung open and moved back to make more room. Participant after participant, many of them emergency nurse managers, stood up to briefly describe very impressive and creative solutions with which they had combatted everything from the nursing shortage to long patient waits in the emergency department to the AMA’s RCT proposal. It was exciting to watch that happen. You could feel the energy. What happened in that room with a few hundred nurses is happening across the country with thousands. Last fall two milestone meetings took place in which virtually all of nursing banded together to problem solve and empower nursing. in Chicdgo last October, the National Federation for Specialty Nursing Organizations convened at a national consensus meeting on the nursing shortage and the .AMA’s RCT proposal. ENA presented data that were collected in 1987 and 1988, concerning the impact of the shortage on our practices and shortand long-term strategies to resolve the problem. Other organizations also shared data and strategies. The conference was held in collaboration with the American Association of Colleges of Nursing, the American Nurses” Associd. tion, the American Organization of Nurse Executives, the National Council for State Boards for Nursing, Inc., and the National League for Nursing. All of these groups came together to address the shortage and other issues that face nursing today. All of nursing, it seems, is taking a giant step forward together. Also occurring last October was alother collab-