Rethinking the critical care environment: luxury or necessity?
Rethinking the critical care environment, an implicit call to change, can catalyze a return to nursing's intellectual roots. Healing environments, as envisioned by Florence Nightingale, involve system-level changes that require effective negotiations on behalf of our patients and ourselves. The nurse-patient relationship is central to the patient's environment and requires a comprehensive understanding of healing. Only nurses can articulate the changes necessary to ensure quality nursing care, and our collective "silencing" must be confronted if it is to change. Nurses' tendency to avoid, accommodate, or compromise when faced with conflict also must change. Giving voice to nursing concerns itself becomes a call to excellence, and those unwilling to change are best excluded. Although all of this is difficult, it is no more difficult than the nonhealing environments where we now work, and at least gives promise of more positive outcomes.