1. Section Editor(s): Raso, Rosanne MS, RN, NEA-BC

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"Courage is resistance to fear, mastery of fear, not absence of fear."Mark Twain

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Do you think of yourself as the Cowardly Lion when you're faced with difficult issues? If so, you aren't alone. Experiencing fear doesn't mean you can't be brave-a lesson all of us should take seriously. It's our responsibility as leaders to act courageously.


We frequently hear that having moral courage is an important part of our practice. This basically means that we speak up and act for what's important to us, for what's right. The organizational values that are posted on message boards and dangling from your ID badge are meant to be more than wallpaper. Be clear about your values. At times these values are in conflict with organizational direction. Excessive punishment for mistakes, staffing levels that don't meet patient needs, lack of transparency, and tolerance of disrespect are just some examples of the issues that can fuel moral distress among staff and managers. We may even experience situations that defy true patient-centeredness. It's an awful feeling.


Sometimes it's easier not to make a decision, stay silent on an issue, or even let our team be unduly criticized. Although it seems neutral at the time, the effects of inaction are often negative. Yes, fear can be paralyzing if you let it. Your staff members look to you to provide the moral compass and advocate for them and their patients. You may regret hesitating to act for what's right. However, we aren't always faced with a clear "right" versus "wrong." Both are relatively dynamic terms that can be defined by the situation and individuals involved. It helps to use a systematic process to understand and clarify issues, including any important hurdles in the way of acting bravely. It's up to us to get help along the way and to help each other. Fear is normal! We can all use encouragement and guidance in this respect.


There are resources out there to assist in managing fear and being true to our values. We teach our staff members the Agency for Healthcare Research and Quality's well-known TeamSTEPPS communication strategies to improve their confidence in dealing with tough issues at the bedside. We can and must use the same techniques, as well as others, to tackle difficult management concerns. Our support systems help prevent us from acting brashly or "crying wolf," which may result in lost credibility-something to avoid-although we also learn lessons from initial disappointments. There's no shame in it.


Celebrate courage. The OR staff nurse who "stops the line" when there's a discrepancy in laterality. The med-surg charge nurse who makes an assignment contrary to normal unit practice to meet patient needs and who stands up to the protesters. The manager who advocates for needed resources when his or her team is stretched to the limit. The director who doesn't settle for "we've always done it this way." The CNO who speaks up for nurses practicing at the top of their license. You know it when you see it and have that "right on, go for it" feeling.


I wrote about leaving your comfort zone last summer. Being courageous may feel that way to you and, if so, I urge you to develop your comfort with courage. The Cowardly Lion did it and we can, too. It's a moral imperative for nurse leaders who are striving for greatness.



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