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Robert G. Hess Jr., PhD, RN, FAAN, is OnCourse Learning's executive vice president and chief clinical executive, and founder and CEO of the Forum for Shared Governance. As an editor for, Hess has penned several editorials on career topics. As a presenter at professional conferences, Hess often addresses participants on how to find the right job and steps for building a successful career.
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By Robert G. Hess, Jr.
PhD, RN, FAAN Executive vice president and chief clinical executive
critical care nursing
Who would have thought we would have moved from open visiting hours to in-room sleeping beds for family members and allowing families to be in the room when their loved ones were being resuscitated from cardiac arrests? The curricula for the CCRN exam has been hung on
the framework of AACN’s Synergy Model
since 1997, where “… the needs or characteristics of patients and families influence and drive the characteristics or competencies of nurses.” There they are — right in the descriptor — families. And the model, when realistically applied, can connect
patients and their families to nurse competencies
. Remember those hearing aids we couldn’t keep track of? The Synergy Model prescribes patients should be involved in their own care; but, in application, reminds nurses patients can’t participate in anything if they can’t hear. And it’s often the family who needs to bring hearing aids in so elderly patients can effectively participate in care decisions. The model also reminds us the significant others of elderly patients may be elderly and impaired themselves, so nurses may need to
include other family members
in decision making and care. I like to think family inclusion is rooted in the early days, when my colleagues’ and I were just hinting at the knowledge, skills, and abilities that would later define a competent critical care nurse and put that person to the test. Whether the work and practice of older nurses helped define critical care nursing and its current environment, it is what it is. Meeting the needs of the family, along with the patient, is ground zero for a competent critical care nurse.
I went to school be a psych nurse, but hours of roleplaying at a job interview squashed that. I didn’t like it. Instead, I found my way into critical care with a bulk pack of other new grads.
That first job was the stuff of legends — giving my first lidocaine bolus with a textbook open in front of me to confirm the offending dysrhythmia, coding patients with Legionnaires’ disease directly from Philly’s Bellevue-Stratford Hotel, and running antifungal agents on young men and then recovering them from the toxic agent’s effects to treat a disease we had not yet named (HIV). I’m one of thousands of nurses with these stories.

But nothing was more singular and terror-ridden for me at that point in my career than preparing to sit for the
American Association of Critical-Care Nurses’
certifying exam to become a certified critical care nurse. As one of the first applicants in an urban teaching hospital to sit for that test, I was terrified. I was the critical care supervisor on the day shift at the time, so the eyes of the entire staff were upon me. A friend asked me to help her study for the neuro section. When I asked why, she said, “Aren’t you an expert? You’re always carrying a neurology nursing book.” I answered, “That’s because I don’t know anything about it!” I subsequently found all of my angst was baseless because I had prepared appropriately, completed the exam comfortably and passed.
Becoming a CCRN
was one of the proudest moments of my career, and it was the hardest when I gave it up for another practice role (there was no inactive CCRN status at the time).
One of the issues the exam covered lightly was family. We knew these folks were part of our care, but we struggled with what to do with them. In those days, nurses’ focus on patients’ technical needs could cast the family as a nuisance. Wasn’t it enough that we were saving their loved one’s life? However, the further away I got from the bedside, the more I saw them as a necessary adjunct to care. As director of critical care departments in three job sequences, with a few personal family experiences to sway me, I expanded visiting hours every time I took a new job. In fact, I was so successful at arranging for family members to be around at any hour so they could regularly ambush physicians about their loved ones, one doc called me a weasel — my badge of honor. As I forced nurses and physicians to deal with the families at hand, I was perhaps too relentless and not always popular.

Revisiting critical care today, I recognize many of the same issues I and the expert staff with whom I was honored to work struggled with years before. I can see progress has been made with some issues, others have been eliminated and problems no one could have foreseen have emerged.
Susan Hassmiller, PhD, RN, FAAN,
Robert Wood Johnson Foundation’s
senior adviser for nursing, shares her personal story about her husband’s stay in an ICU had an impact on her views about creating a culture of compassion.

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