1. Pickler, Rita H.

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This recent (and still current as of this writing in mid-April) pandemic has gotten me thinking about the interruption of some of our most important scientific work, work focused on the health and wellness needs of those for whom we provide care. My hope is that, by the time this editorial is published in July, our laboratories will be functioning at full capacity again and our critical data collection in hospitals and communities will have restarted. Without a doubt, important research has halted or slowed over the last few months. In some cases, we will probably never know what scientific discoveries might have occurred because experiments will have been abandoned or researchers will have moved on to other ideas, and unfortunately, some researchers may not have lived. In any event, calculating the costs of lost knowledge probably is not the most useful thing to do. Frankly, there are going to be many costs related to the COVID-19 pandemic; lost research is just one line item on a long list.


However, I will admit that, even before the pandemic, I had concerns about our, that is, nursing's, retreat from the science of human health. More pointedly, I was becoming concerned with the continued focus of research on us and, specifically, our "psyche." I acknowledge the imperfect if not often terrible working conditions in which nurses around the world labor, even in the best of times. Still, I think there has been overattention to studying ourselves and our problems. I think it is time to stop navel-gazing.


Navel-gazing, or omphaloskepsis, is an ancient practice, originally considered an aid to contemplation and still part of some religious practices. It is also a term that has come to mean engaging in self-absorbed behavior, perhaps bordering on the narcissistic. Frankly, I find some of nursing's current research focus to fall into the category of navel-gazing, for example, the avalanche of studies about nurse depression or burnout or anger. I do not deny the existence of these conditions nor their potential genesis in unhealthy working conditions. My concern is that focusing on ourselves does not advance nursing science, the development of knowledge to improve care, manage health conditions, prevent illness, and maintain health. Perhaps there are relationships between work conditions in healthcare settings and the outcomes of nursing care. Perhaps there are relationships between nurse fatigue, burnout, or depression and the outcomes of nursing care. In fact, those relationships likely exist, and we should study them, just as we would study the effects of any health determinant on health outcomes. In other words, we must be scientifically interested in the effect on patient outcomes related to the effects of nurses' work conditions on nurses.


I acknowledge that there are many concerns with healthcare settings and that many nurses struggle with what they see, hear, and do every day and particularly in situations where work environments are difficult. I acknowledge that most of us, at least at times, want "more" from our work environment than we get (i.e., satisfaction, comfort, praise). I acknowledge that many nurses expect bad work environments to be fixed. I agree; they should be. I am particularly cognizant that the conditions of working in hospitals during the COVID-19 pandemic were and perhaps still are horrific.


As the pandemic ends, however, we cannot allow continued neglect of nursing science. We cannot divert our time, energy, and funds on research directed at, essentially, helping nurses to reappraise bad work environments. Reappraisal will not solve the problem of poorly resourced healthcare facilities. Rather, funds should be spent on studying the effects of redesigned work environments on patient outcomes; effects of these redesigned environments on nurses' well-being may mediate the primary goal of improving patient outcomes. Perhaps one upside to the pandemic will be translation of our creativity in managing the physical and psychological aspects of providing care to many more patients than we thought we could under conditions we never anticipated, to less difficult situations. We can certainly hope that, from this terrible crisis, we will learn something about care delivery and support of care providers that will be translatable to our future.


In any event, I hope by the time this editorial is published that it will finally be time to get back to science. Specifically, I hope it is time to get back to the scientific work that will advance health and well-being of the people who need us most.


Rita H. Pickler, PhD, RN, FAAN