Barbara Peterson Sinclair, M N , RNC, OGNP, F A A N , is chair of the division of

health sciences at California State University,

Dominguez Hills, and editor in chief of

AWHONN Lifelines.

o you remember the old joke “Where D does a 1,200 pound gorilla sleep? Any- where it wants!”? As I think about the cir- cumstances of nurses today, I give great cre- dence to the gorilla story. The gorilla sleeps anywhere it wants because of the potential power it wields. Nurses have potential power-why can’t we “sleep” wherever we want? The answer is simple: We can’t do what we want because we don’t use our power!

Think about it. If we were to “hang to- gether,” there are enough nurses in the Unit- ed States to swing political elections, to in- fluence legislation, to control our own work environments, to impact access to and qual- ity of health care, to be recognized as major players within the health delivery system. Think about it. We should be involved in all of these, but at the very least, we should be able to have a strong voice about what we do in the workplace and the circumstances under which we do it.

The issues facing the health care system in general and nursing in particular are huge in number and complexity. It has been said that nurses are the critical glue that holds the fragile health system together. This is probably true, but at what expense to the nurse? If we are going to provide the quality care that is so needed by our patientdclients, we must take stronger positions on issues affecting work environments.

It is the inpatient locales that are facing the problems. Considerations include man- datory overtime; hours of work, for exam- ple, 12-hour shifts; staffing ratios; use and supervision of unlicensed personnel; and floating to unfamiliar clinical areas. Unfor-

tunately, staff nurses are often unheard and misrepresented on these issues. We must en- courage one another to voice opinions and concerns about the issues and to seek help when results are not forthcoming.

Nursing leaders in the workplace and from professional organizations and unions must strongly advocate for a safe and equi- table work situation for all of our nurses, including quality safeguards for patient care. I believe that we can accomplish this as professionals and without the need for governmental intervention or unilateral de- cision by management. Regulations and policies should not be maintained just be- cause they are politically or economically expedient.

are filled, it is not impossible to come up with flexible, simple guidelines that meet the needs of all concerned. These guidelines would take into account work schedules, pay practices, overtime, consecutive shifts, possible job sharing and patient ratios/ assignments. Handled creatively, such guide- lines could be cost-effective for the employ- er, could increase continuity and quality for the patient and could better meet the desires of nurses. They could be developed with rel- ative ease if nurses work collectively and support efforts for a team approach with management in working out differences.

I hope to share perspectives on other is- sues in future columns, and I would really like to hear from you about situations in which you are involved or would like to be. Remember, the gorilla really can sleep wher- ever he wants-and so can we if we do it together. +

Assuming that sufficient nurse positions

A W H O N N Lifelines 7