The Values Conversation
The Values Conversation
As a Registered Nurse with special interest in care delivery, I pursued a board specialty in Nurse Coaching early on. The conditions of my work environment at the time prompted me to look at larger, structural issues and the impact they had on our interpersonal relationships, communities, politics, and how we could ultimately approach our patients with safe and effective nursing care.
At that time I was a traveling psychiatric nurse, and social determinants played a big part in my nursing discipline. No matter what state or location I was in, the common theme was an overriding powerlessness and frustration. Patients did not seem to be getting better and would return for inpatient psychiatric services multiple times even in the short span of my 13-week contracts. At that time, structural changes were only being hinted or buzzed at - and literature on values-based care was non-existent. Patients were experiencing shorter hospital stays, and Epic was just getting established.
By 2012, the Affordable Care Act had been around a couple of years. The word value was being used in regards to healthcare. I was steeped in Nurse Coaching theory and holistic/ integrative nursing study. The very term "Values Based Healthcare" was curious to me. It seemed ambiguous. My first thought was of empowering my clients within a system where they experience repeated defeat and powerlessness. So I applied the holistic Nurse Coach lense and the early questions that I asked myself looked like this:
- Who is determining the value? In other words, who is determining what is important?
- Is it implicit or explicit?
- What is their perception of health value? (Not everyone cares about health as a motivator)
- When would they be willing to consider opportunities for development - if ever?
- Why would they want to?
As a Nurse Coach, I took notice that client values are not a constant - but are subject to change and influence in perspective. So why and how was this equivocal idea determining health care policy? Those questions have proven key in my assessment and implementation of coaching values.
The values conversation offers a powerful and useful understanding to serve our interests as Nurse Influencers for health partnerships and alliances. The values conversation is the elemental piece of a broad conversation that occurs each time a Nurse Influencer asserts human-centered values in any number of interactions. It can happen with clients dealing with specific health concerns, community organizations tending to specific geographic concerns, organizations, or even in the political arena.
The nature of the values-based approach is to transform U.S. healthcare strategy with continual refinements and quality improvement (Ballard, 2019). That being said, there are a few key assumptions to apply as a Nurse Influencer approaching healthcare value:
- Quality is not the same thing as value
- Value is governed by perception
- Perception is not static, but ever-changing
- Negotiation is merely a way of reconciling values
-(Carter, Davis, & Schaub, 2015)
When the nursing vision is opened to greater possibilities for participation, then we see that Nurse Influencers stand in their power to practice at full scope and in full partnership with their colleagues. The values conversation occurs as you perform your due diligence in nursing practice, networking, and job or other contract negotiations. It doesn't come without its challenges, as nurses have lost a significant amount of their voice in day-to-day processes and tasks.
Nurse Influencers take an expansive approach. If population health is to improve as directed by initiatives like Healthy People 2020 and The Nightingale Initiative on Global Health, then Nurse Influencers will have to have more of these conversations. The integrity of our communities depends on nurses asserting their place as advocates, coaches, community leaders...etc.(Barker & Barker, 2011) Nurse Influencers come with purpose and a clear mind that paves a way for sacred service and human centered care as a core value.