Question: What is the most well developed sphincter in a nurses body?

Ill bet you answered the one in our bladders no?1.

Well, actually I disagree, I think it is the one in our throats.
The one that stops us voicing our professional concerns over the many problems we see around us in the health system.
This muscle is held in a constant state of contraction by strong forces of stress.
Forces such as rear of reprisal, or suffocating organisational policies, or fear of breaching patient confidentiality, or the biggie….. the misconception that you are not senior enough, or not important enough, or not right enough to have a strong voice.

Here are some strategies to help you loosen up that ring of sphincter and turn it into a ring of engagement.

“Action is the antidote to despair.” ~Joan Baez

Engagement Strategy 1: Don’t stew on it….work on it.

This evening, turn off the TV and get out a pen and doodle-pad. Make a pot of tea. A glass of wine is also good.
Write down your issue(s) in the middle of the page.

Riff off those issues….that is, just write down whatever comes into your head without any analytical editorial-ship from your frontal lobes.
Problems. Causes. People. Equipment. Words that describe how you feel. Outcomes. Circle topics and make connections. Drop in a doodle.
Think about events that occurred as a direct result of your issue. Were there adverse outcomes? Is there a high risk of any?
Look at your thoughts and search for root causes.
Is your problem really the problem?

Or is it just a symptom, pointing to the problem.
When you think you have identified the cause, ask yourself why that is occurring. Drill down to the core.

Map it all out.
Nurses tend to be very visual animals. Now your problem is art.
……As in articulate.

Engagement Strategy 2: Choose your battles well.

OK. This is the important bit.
Ask yourself: How important is my problem?

Some guiding thoughts on this. Ask yourself:

  • In 3 months time will this problem still be significant? To me? To my patients?
  • Do I have a professional obligation to address this issue?
  • Do I have an ethical responsibility to try to resolve this problem?
  • Do I really want to try to fix this problem, or is it something that, well honestly, gives me a little sanctimonious satisfaction just to whinge about.

For some problems you should build a bridge (and get over it).
For others you should build a trebuchet (and get behind it).

But unless you are an expert in trebuchet construction and operation, you are going to probably need some help.

Engagement Strategy 3: Talk about it:


You can blame people who knock things over in the dark, or you can begin to light candles. You’re only at fault if you know about the problem and choose to do nothing.
: Paul Hawken ::

Talk about your issues with your colleagues. Try to get a sense of what other people actually feel about it. Get a discussion going over lunch in the tea room.

Or around the nurses station, or beside the pan sluice.
See what others really think.
Try to guide the conversation from just sliding into a complain-o-fest. Complaining about something comes from the surface layer of our brains. The sludge zone.

Is the problem an internal one, or is it coming from outside? Or is it a mix of internal and external influences.

What do others think should be done about it?

Engagement Strategy 4. Be strategic. Be tactical. Be professional. Be informed.


Chance favours the prepared.: Louis Pasteur

Never underestimate the power of a nurse with momentum and direction.

Be strategic: what exactly do you want to do?
Be tactical: What are is the next most skilful step you need to take to begin to develop some momentum?
How can you influence others to address the problem?

Tactics to generate influence include:

  • The direct request. Identify the person(s) who most responsible for the situation or problem. Contact them. Meet with them. Motivate others to do the same.
  • Capture by team: build a community of people who also feel strongly about the problem and are willing to help you voice your issues and work to change the status quo (and don’t just limit this to your colleagues. Explore the feelings of doctors, clerical staff and other allied health staff if relevant).
  • Outflank with influence: if you don’t think you are getting any results with the person(s) you are trying to engage with, consider making contact with people around them.

Be Bold: Go to the top. Go to the source. Build consensus. Mobilise resources. Motivate. Lead.

Be professional: Two important points of caution here:

1) Don’t ever make it personal.
Spare a thought for the people you think might be responsible for (or have a solution to) your problems.
Everyone is working from within their own constraints. From your unit manager, to the CEO of the Hospital, to the minister for health. Budget over-blows, organisational policies, political pressures, job security, personal problems….we are all in the system, we are all doing this tough.

2) Social media can be a very very strong agent of change and a powerful tool an assisting you to engage and empower. But proceed with extreme caution here. Be smart.

There are many other resources available to help you begin taking action to address your problem. Make sure you have systematically worked through all the procedures your own organisation has put in place for this as well as thinking outside the box.

Things like:

  • Meet with your unit manager or senior nursing leaders. Remember, all good nursing managers should be allies, not enemies.
    Oh yes, as a quick aside, ….have you ever heard a manager say “don’t just bring me problems, bring me solutions”? Well that’s just a little bit of managerial bollocks. What you do need to take with you is momentum. Momentum and direction.
    These people should be part of the solution not the gatekeeper for the solution.
  • Use your hospital’s own reporting pathways.
  • Talk to your union representative.
  • Workplace safety. Contact your local workplace safety representative.
  • eMail. Don’t forget good old email. These days it is pretty easy to get the email address of anyone you think needs to get your message.

Be Informed: Look to see there is evidence in the literature to support your arguments and put some real mass behind your momentum. There is some great work being done (often by nurses in academia and research fields)  these days examining many of the common problems that currently effect the health system. Read up to see if any others have struggled with similar issues.
Consider performing your own audits or studies to help support your direction.

So there are just a few ideas to overcome any inertia, build a little momentum and help you begin to find voice. Just open your mouth and engage.
For as every nurse knows…there is no sphincter in our throats.

The real sphincter is in our minds.

  1. The urethral sphincter refers to one of two muscles used to control the exit of urine in the urinary bladder through the urethra. The two muscles are the external urethral sphincter and the internal urethral sphincter. When either of these muscles contract, the urethra is sealed shut []

4 Responses to “Nurses engage!”

  1. These are excellent strategies. If more nurses would utilize their voices (productively), and management would heed our expertise…many problems/issues could be solved together.

  2. Brilliant strategies, Ian – though I’d add “and think about becoming a union rep and/or Health and Safety Rep yourself.” Not only does being a rep ensure there IS at least one in your workplace, the training gives reps education about rights and responsibilities, tools for resolution, and reinforcement that you’re not a lone voice in the wilderness.

  3. Some great ideas here! I would encourage many to follow the advice, and particularly ‘choose your battles’. Be careful how you expend your energy, use it wisely – but do use it! Be strategic in how you use it to get the bang for your bucks.

  4. Agree! Also be informed – read the literature relating to your issue, understand the evidence but also the clinical, organsational and political forces that may block that evidence being used in practice. The pen is mightier than the sword, write a discussion paper and put the issue out for broader debate and discussion.

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  • will soon be gone. (3)
    • Zeke said: Are you keeping an archive of this site on the nurse path site?

    • jelly said: Just work a few more hundred Sundays!

    • matgrad said: Bye Ian will miss the site but as you say everything has its day. Good luck for the future.

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