Are there times when you’d like to speak up, take action, or create change in your work setting—but you think the risk is too great? Do you tolerate circumstances you don’t like, hoping things will get better?Most often, we equate courage with feats of daring or fearlessness. But overcoming everyday challenges—escaping failed relationships, admitting we can’t do it all, confronting abuse, speaking out, saying no—also requires great courage. Many of us undervalue our inner strength when dealing with these ordinary issues.

Where does courage end?
A few years ago, I attended an oncology nursing symposium. After a day of presentations on cancer treatment advances, my friend Kolleen ended her portion of the program by discussing 12 self-care steps for nurse caregivers. Then she asked for questions.
A young nurse I’ll call Jessica stood up. In front of more than 600 people, she challenged the notion that stopping to smell the roses, being optimistic, or using humor could counteract the day-to-day stressors nurses face. She suggested that these simple techniques don’t work in the complex, difficult arena of nursing, with its seemingly impossible staffing patterns, unrealistic demands, lack of respect, and inability to produce change.
In less than 2 minutes, Jessica had voiced the sentiments of many nurses in the room. She was feeling hopeless and victimized by factors beyond her control.
I admired her personal courage in standing up and speaking out. That’s not easy. But is that where courage ends? Preaching to the choir is one thing. Translating frustration and helpless feelings into positive, courageous action is another. Why is this hard for us to do?

Playing the victim
As nurses, we often get caught up in the role of victim. We may feel powerless, without a voice, underappreciated, overworked. We become angry, burned out, and uninspired. Negativity can spread faster than a California wildfire, leading to increasing stress, dissatisfaction, and turnover. These effects can lead to more problems. Some studies have shown that the quality of patient care may be compromised and caregivers may become ill if they experience lack of trust, autonomy, and respect in the workplace.

Banishing the victim mentality

How do we break away from seeing ourselves as victims? It’s not easy. Our behavior patterns are responses to long-held beliefs about ourselves and our profession—responses to the little voices in our heads that whisper, “You can’t handle conflict. Don’t rock the boat.”
We all make vows with ourselves to cope with our internal and external environment. These vows create our patterns—the “buttons” that control our behavior. We push them. We let others push them. According to Carolyn Myss in her book Sacred Contracts, the key to refusing the victim role is to answer this question: “Is it worth giving up your own sense of empowerment to avoid taking responsibility for your independence?”
Understanding and gaining control takes courage and hard work. But we can make change in the workplace if we practice courageous behaviors. Let’s look at some helpful strategies.

Strategy #1: Cultivating the courage of self-reflection
Embarking on the self-discovery process is a courageous act in itself. It takes courage to confront what comes to you as judgment and criticism, to face the little voice that keeps saying, “You’re not good enough.” It takes courage to discover who you really are.
In his book On Becoming A Leader, Warren Bennis describes the self-reflection process this way: “Figure out whose borrowed clothes you’re wearing, understand why and then change into your own.” Knowing yourself allows you to live authentically, to grow personally and professionally. It helps you understand and define your personal boundaries—the rules you choose for interacting with others.
It’s hard to let go of what isn’t working and find new ways to respond to situations. The key to doing this is to reframe your viewpoint. At the oncology conference, my friend Kolleen provided a poignant example. After Jessica had finished her remarks, Kolleen asked her to remain standing, and began to describe in graphic detail a smelly, dripping ball of rotting garbage that she held (figuratively speaking) in her hands. Without warning, she suddenly “tossed” this imaginary ball to Jessica, who instinctively moved away to avoid getting hit. Then Kolleen posed these questions: Why don’t nurses get out of the way when people or situations are hurling negativity their way? Why do nurses stand there with arms outstretched saying, “Hit me”? Why don’t they just move aside, as Jessica did?
Too often, we accept whatever comes our way. We may not like it, but somehow we feel required to endure it—then we complain about it later. We end up wearing the “smell” from the encounter all day, feeling angry and resentful or embarrassed and humiliated. Sometimes, we even toss the “stuff” on ourselves.
Changing this isn’t easy, and it doesn’t happen overnight. Letting go of being a victim in favor of seeking new self-definitions and ways of being and acting can bring resistance—both internal and external. Such resistance keeps us from creating our own destinies.
Practice the courageous behaviors of reframing, forgiving, letting go of what you believe (or have been told) is true about yourself. You’ll find this leads to authenticity and the ability to speak up with confidence and grace.

Strategy #2: Cultivating the courage to broaden your perspectives
When you can appreciate who you are and why you react the way you do, you’ll be able to look at yourself with compassion for being imperfect. This will allow you to practice the courageous behavior of seeing beyond your own viewpoint.
When Kolleen leaned on her cane and walked to the podium, she was pale and emaciated, bald as a billiard ball, without eyelashes or eyebrows. But Jessica seemed oblivious to this; I sensed her frustration was so great that she’d lost her capacity to recognize Kolleen’s situation. To a room full of oncology nurses, it was obvious Kolleen was terminally ill with cancer. Like Jessica, we can become so self-absorbed in our own issues that we lose sight of the forest for the trees.
It takes courage to look beyond ourselves and our own pain to truly “see” where others are coming from. It takes courage to give up being “right” or feeling “wronged.” It takes courage to walk in others’ shoes—physicians’, coworkers’, managers’, and patients’. Being comfortable with who you are allows you to appreciate others’ perceptions and opinions without feeling threatened.

Strategy #3: Cultivating the courage to change direction
By growing, letting go, and building community, you can more easily create new options and make change happen. To do this, you’ll need the courage to challenge assumptions, be flexible, listen to others, and learn lessons from life’s mistakes and triumphs. Working together, you and your colleagues can form a vision of change with empathy and cooperation, instead of functioning in fear and intimidation.
Nurses must speak out for safe staffing patterns, improved recognition, a just and fair environment, and a greater voice in healthcare issues. But we also need to learn about the bigger healthcare picture, such as the how’s and why’s of budgets, third-party payers, and physician issues. To become a more respected voice in the decision-making process, we need to understand how we fit into the bigger picture. Being an informed part of the solution eases feelings of victimization and conflict.

Joining the cadre of courageous nurses
Translating these strategies into action takes a lot of courage. You’ll need to take risks, and sometimes you won’t be able to side-step the garbage balls. But you can choose how you want to go through your day.
That day at the symposium, Kolleen suggested that when the balls start coming, imagine you’re wearing a yellow rain slicker—the kind little kids wear to school. When the garbage of negativity comes your way, keep a mental picture of it hitting your raincoat and sliding off as easily as raindrops.
Kolleen died not long after the symposium. But she left a legacy of personal courage for all who attended that day. Our profession has a rich history of nursing pioneers and activists who made courage a part of their everyday lives—Susie Walking Bear Yellowtail, Lillian Wald, and others. We need to follow their example and practice courageous behaviors that can lead to new ways of doing things.
Nurses often speak out and act selflessly on the patient’s behalf—but we need to do that for each other and ourselves, too. We need to empower ourselves. We don’t have to feel like victims. We can influence our work culture. Organizations are built on the acts of its employees, minute by minute, day by day.

Selected references
Klein M, Napier R. The Courage to Act: 5 Factors of Courage to Transform Business. Mountain View, Calif: Davies-Black Publishing; 2003.

Myss, C. Sacred Contracts. New York, NY: Bantam Books; 2001.

O’Brien-Pallas L, Hiroz J, Cook A, Mildon B, for the Nursing Health Services Research Unit. Nurse-physician relationships: Solutions & recommendations for change. Comprehensive report for the Nursing Secretariat of Health and Long-Term Care Research Unit. University of Toronto, Toronto, Ontario. Available at: www.nhsru.com. Accessed July 27, 2006.

Walston S. Courage: The Heart and Spirit of Every Woman. New York, NY: Broadway Books; 2001.

Jacklyn Shaffer, RN, MS, is President of INLight Associates in Columbus, Ohio.