Being involved in Careful Nursing has given me the opportunity to be part of a journey which engages the tradition and fundamentals of nursing and its contribution to patients' health and wellbeing. I think about how we deliver patient care in the current context and compare it with the stories of the nurses in the 1900s who were pioneers in setting up and managing hospitals to address the health and nursing needs of the population. This has led me to reflect on the management and leadership skills they employed as nurses to navigate the harsh socio-economic realities of their day. I ask myself what is different for a senior nurse manager today and what can be taken from their contributions of yore that can stabilise and steer the provision of care in contemporary times. 

Contagious calmness and professional authority

Two aspects of their leadership and management which I particularly note are fundamental concepts within Careful Nursing: contagious calmness and professional authority. In helping to facilitate a Therapeutic Milieu workshop, I help staff nurses explore these concepts and how they relate to them in their own practice. Those nurses of over a century ago were observed to bring a sense of calm to their surroundings and sustain it despite the continuous chaos and deprivation that surrounded them. 

Their calm poise reflected their competence and capability and their deep engagement with professional authority. I imagine that this must have brought a great sense of safety and security to their patients and to those working with them in providing and managing care. Although the care of patients has moved into the twenty-first century, first-world context, the challenges experienced in relation to demand and capacity in principle haven't changed. Today's patients also expect to experience safe and secure care.

Health systems are in ongoing change, testing and implementing new ways to address the above challenges and ultimately improve the ways care is provided to patients. The administration of nursing care in this context can be challenging. Careful Nursing draws out and defines concepts such as contagious calmness and professional authority as what we aspire to and require within nursing and organisations to ensure the provision of safe patient care in the challenges and changes within health systems.

Interestingly, I recently read about Hillary Clinton's run for the presidency of the United States and about her new election campaign manager, Robby Mooks. Little is written about Mr. Mooks. But, what is written identifies him as a low-key but formidable political operative with great ability to instil in-house calm and keep the team focused. It has been noted that these are some of the attributes that found him in one of the most challenging jobs in the United States electoral campaign. Perhaps he, too, knows contagious calmness and having a quiet sense of professional authority.

Coming back to the hospital environment and how one can achieve contagious calmness. Certainly, there are individuals who will always convey calmness; however that isn't everybody's natural disposition. During the Senior Nurse Manger handover we utilise the word "calm", it's a barometer of what it's like around the house; "around the house is calm", "ED is calm", "the place feels calm", or "its busy but its calm". 

So how is a place calm?

To me the place is the people. So what is happening between people when "it's busy but calm" and "not busy and not so calm" and how is that experience for patients? A key person in creating calm is the nurse. Professional authority has many facets: competence, responsibility, self-confidence and visibility. Professional authority creates a powerful and empowered space for the nurse, patients and the people they work with in the delivery of care. Into that space comes calmness, despite the activity and surrounding challenges.

Calmness cascades and is contagious. Careful Nursing creates and provides the structure for nurses at all levels to engage and reflect on their practice and what they bring to calm the experience of patients, whatever is happening to them. I think of myself in a senior nurse manger position and being conscious about how I am in the administration of my role, calmly and with professional authority.

The 19^th century nurses were noted for calmness and a quiet sense of authority by artists and commentators of their day. Many were members of religious communities which engaged in contemplative practices and this is thought to have influenced their inner calm and created for them a space for reflection. Careful Nursing endorses this practice and considers a 5-minute time of stillness each day to be fundamental for all nurses whether in administration or clinical practice. They can achieve this in whichever way best suits them, for example, mindfulness, meditation, silence, or prayer. I try to make this part of my daily routine and engage in mindfulness, a practice which is now being widely advocated throughout the health system across patients and professional groups.

Sinéad Brennan