When I was a college freshman I learned about the concept of internal and external locus of control. The metaphor used by David Riesman in his book The Lonely Crowd was radar people and gyroscope people. Gyroscope people have their own internal navigation system, while radar people are flying on a beam created by someone or something else. On college campuses in the 60s, the gyroscope people were considered to be the good guys, far superior to and vastly more evolved than radar people. I knew even then that it wasn’t that simple, but the concept made a lot of sense to me.
I began my nursing career in the Army. With military nursing’s strong history as an independent discipline, I experienced more professional autonomy, even as a new graduate, than most of my civilian counterparts. After the Army I worked in neonatal intensive care in a teaching hospital where we nurses often knew more about what to do and what not to do than the interns (especially in July). With Primary Nursing as our care delivery model, I was again able to use my whole self in giving care; the only limits to practicing as I wished to practice were ones I placed on myself, out of fatigue or lack of knowledge.
In my career I have worked side by side with hundreds of humane, insightful nurses who experience the same joy of using their whole selves, of life-long learning, of touching the lives of people in some of the most vulnerable moments of their lives. I have also worked with some nurses who use only parts of themselves, who figure they have learned enough for this lifetime, who keep their distance from patients and families – not the healthy boundaries we need in order to care for ourselves, but the distance of intolerance and stereotyping and even disgust.
It was this subgroup of co-workers who also seemed very comfortable in the role of victims – victims of heartless, stingy health care bureaucracies; arrogant physicians; thoughtless patients and families; unmanageable technology; and the younger, less saintly generation of nurses. As I worked with more and more nurses, most of them exemplary but some not, my informal data base grew, and with it my understanding of the significance of locus of control.
This understanding has been greatly expanded thanks to the opportunities I am fortunate to have in communicating with thought leaders in my role as editor of Creative Nursing: A Journal of Values, Issues, Experience and Collaboration. From Marie Manthey, in her article, “A Brief Compendium of Curious and Peculiar Aspects of Nursing Resource Management” in Creative Nursing 15 #2, I learned about how nurses, individually and as a profession, need to transform our thought process from an entitlement mentality (“Hospitals want us to give the best care to patients, and therefore they owe us consistently ample staffing to achieve that goal.”) to entrepreneurial thinking (“Nurses have the right and the responsibility to decide what to do and what not to do when there is more work to do than time available.”).
From Tim Porter-O’Grady, who literally wrote the book on Shared Governance and who is our guest editor for the November issue of Creative Nursing, I learned that while the other predominant professions developed horizontally-structured, accountability-grounded partnerships, the nursing profession has developed as a subset of hospital organizations or public health systems. He writes that “the professional owns the accountabilities for practice, quality, competence, and the generation of knowledge” and that “when this accountability moves away from its legitimate locus of control, it ceases to meet the legitimate requisites and obligations for its expression, negatively affecting the potential for achieving and sustaining the related outcomes.”
From historian and social theorist Riane Eisler, author of The Chalice and the Blade: Our History, Our Future and The Real Wealth of Nations: Creating a Caring Economics, I learned about the difference between domination systems and partnership systems, and their relationship to necessary hierarchies. In an interview with Creative Nursing, she makes a distinction between hierarchies of domination, in which accountability, respect, and benefit only flow from the bottom up, and hierarchies of actualization, in which these elements flow both ways.
And from futurist Joel Barker, guest editor of our upcoming issue on Futures Thinking (Creative Nursing 19 #1, due out in February 2013), come these wise words: “You can and should shape your own future, because, if you don’t, someone else surely will.”
Are nurses, individually and as a profession, flying on a beam that someone else has created? As individuals, the meaning we make of what we do for a living comes from our deepest selves – We do what we are. As a profession, we need to name and claim what Marie Manthey calls The Nursing Imperative – expertise and relationship – and make it our own navigation system.