1. Gauthier, Peggy MS, BSN, RN, CGRN

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Society of Gastroenterology Nurses and Associates-The Link Between Practice and Care: Courage, Commitment, Collaboration is the Society theme for 2010-2011. This theme was chosen because these three words embody what it takes to take to be engaged in our profession. Nursing is a serious profession that requires a high level of commitment along with a dedication to lifelong learning. Nurses need to possess a full complement of skills-intellectual, interpersonal, and critical decision making. The future of nursing and our specialty will not just happen-engaged and committed nursing professionals will create it.

Peggy Gauthier, MS, ... - Click to enlarge in new windowPeggy Gauthier, MS, BSN, RN, CGRN

The original definition of courage comes from the French word corage, which means heart and spirit. Historically, nurturing and compassionate people have always acted from their heart. Bringing your heart and soul to your work is an essential requisite of nursing. Nowadays, the word courage is most often associated with heroics, and the heartfelt value of daily courage is almost nonexistent. If you ask a group of people to identify a "caring" profession, nursing most often will come to mind. But ask those same people to identify a "courageous" profession and they spout such professions as police work, firefighting, soldiery, and even race-car driving. Nursing is typically overlooked and in studies, ranks near the bottom of the list. This is unfortunate, because in reality, nursing is the embodiment of both care and courage.


It takes courage to fight for what is right for our patients and colleagues. It takes courage to decide on a course of action and stick to it. It takes courage to stand up for what you believe in, especially when it is not popular or easy. It takes a personal commitment to see things through. Everyday courage does not revolve around amazing acts of heroism, even though as a society, we pay tribute to those acts of heroism more than we practice or even notice everyday courage.


Why is courage so often unnoticed in the nursing profession? Most people do not regard courage as one the primary virtues for health care workers. People mistakenly believe that courage is relevant only during perilous times. They do not perceive comforting a person who has just received a cancer diagnosis, questioning a doctor's order, attempting a new procedure, or being a patient advocate as courageous workplace moments. They do not see nurses trying to change working conditions, long hours, or forced overtime as courageous. The courage of nurses is tested daily. We are often trapped between two different mindsets. Every day, we deal with declining reimbursements, staffing cuts, and being asked to do more with less. At the same time, we must balance these issues-they are real and are not going away-with the nurturing nature of our profession. Sometimes, the corporate culture within which we work directly contradicts the compassionate aspect of nursing, causing many to feel frustrated and emotionally drained.


Opportunities for nurses to display courage occur almost every day. It takes courage to speak up at a staff meeting, remind a coworker or physician to wash their hands, or advocate for a more concise procedure for cleaning and disinfection. It takes courage to stop the well-oiled machine of procedural areas to attend to the personal and particular needs of one patient. Do you ever find yourself at a work wondering whether or not to speak up in a meeting? You have an idea that you think might really make a difference, but you are unsure of how it will be received by your colleagues or, even more important, by your boss? As the seconds tick away, you debate with yourself whether your idea has enough merit to share it with the group. Does it take courage to finally share your idea? Yes! Courage is important every day. All of us are pulled in a variety of directions on a daily basis; our decisions may get questioned. Perhaps even our motives are second guessed and choices scrutinized. Our ideas are analyzed. And each new day, it takes courage to make new decisions, new choices, and share our ideas.


A lack of everyday courage can afflict anyone: the young person who worries that he might embarrass himself because he lacks experience or the veteran who has taken a few chances that have not paid off; they are now "gun shy" about putting themselves out there again. You must have the courage of your convictions. If you state a reasonable position, you have the right to defend it. You do not have to feel bad about having an opinion. You do not have to apologize for sharing your ideas. Just because someone has an opinion that is different from your does not make yours less valuable. You do not have to feel guilty about disagreeing with your colleagues. Stand up for what you believe in and know is right.


To be successful you have to have courage. You have to be willing to put yourself out there. You must be willing to take some chances. Oh, by the way, you would not always be successful. There will be times when you speak up and you will be flat wrong. You will have bad ideas. You will try things that would not work. No one, and I mean no one, is successful all the time. So, when you fail-and you will fail-is when courage will be most important and, likely, the most difficult to come by. That is when you need to summon your inner courage and continue on. You do not have to work in a profession that puts your life at risk to benefit from displaying courage. Dare to have everyday courage. Courage is contagious both to you and to those around you. "Whether you think you can or think you can't, you are right."-Henry Ford


Commitment and courage go hand in hand. You may have courageous thoughts and ideas, but you need to commit to them to bring them to actuality. Commitment requires an emotional investment. It means that we will act now and live with the consequences. We give up our wish for safety when we commit. Commitment can be a dangerous concept.


There are some assumptions when it comes to commitment: how much time is this going to take, what if no one will come along with me, how will this make me look, and what if I fail? If people have a hard time committing, it does not that mean they do not care. More often, it means that they are caught up in a process of doubt. Commitments contain unknowns. When we think about a new commitment, we climb onto a mental diving board. Do we jump or climb back down? If we just stay at the top, we become immobilized in pros, cons, and worries. Sometimes we just have to have the courage to jump. "Never be afraid to do something new. Remember it was amateurs that built the ark and professionals that built the Titanic."-Anonymous


We all must have the courage and commitment to care for our patients, each other, and ourselves during these turbulent times in health care. It takes a strong commitment to excellence and professionalism to stay in nursing, whether in a clinical, educational, or administrative role. Sometimes, we need to look deep within ourselves to rekindle the passion for nursing we once had. It has been said that "people won't care how much you know until they know you care." That is certainly true for us as we work with our patients and colleagues. The magic is not what we do, but how we do it. Create a memory with each contact no matter the length of time you are with that person.


If courage and commitment have eluded you in the past, now is the time to step up and make your daily activities a profile in courage-one that reveals your heart and spirit. Confront issues even when no one backs you. Stand up for your patients' rights. Stand up for what is right in nursing. Be vulnerable to admit when you have made a mistake. Take the initiative to update or validate your skills and knowledge. The year 2011 is the 25th anniversary of the American Board of Certification for Gastroenterology Nurses. Find the courage to take the certification examination and join your certified professional colleagues. Make a commitment to yourself to take the time to study and validate your knowledge. You will show others that they can follow the same path, that they also have everyday courage. To most of us, everyday courage does not come naturally. It is a skill that we learn as we practice it. To quote John Wayne, "Courage is being scared to death-but saddling up anyway."


Let me give you an example of how each of us can promote and encourage others to use everyday courage and make commitments. It all starts with commitment to respectful interpersonal relationships. As human beings, we do not live in isolation. We interact with others on a continual basis. We have girlfriends, boyfriends, families, coworkers, and other social groups. We depend on this personal group and they depend on us. You do not have to like or agree with every person you meet, but you must respect them as fellow humans. To be emotionally and physically healthy, one needs the touch (physical, mental, emotional) of another human being. Relationships are all there is. We have to stop pretending that we as individuals can go it alone. That is where collaboration comes in. The word collaboration implies working together for the greater good. Collaborative efforts must have shared objectives. Communication must be honest and respectful. Collaboration requires an understanding and appreciation and respect for what each person brings to the table. At the heart of collaboration is trust. It is the central issue in human relationships, both personal and professional. To build and sustain collaborative relationships, you have to trust others and they must be able to trust you. Trust is not just what is in your mind; it is also what is in your heart.


Nursing has a major role as well as an obligation to shape the health care system of tomorrow. We must challenge ourselves to advocate for patients, consumers, nursing colleagues, and other health care professionals. We must look forward. Exciting and challenging work lies ahead of us. How are we going to write our chapter of nursing history? What is our role at the local, national, or even international level? What germinating seeds are we going to leave for those who follow us? I challenge you to make a commitment to have a positive effect on something you are passionate about-to make a difference. "Twenty years from now you will be more disappointed by the things you didn't do than by those you did."-Mark Twain