- Email: [email protected]
Letter from the leadership
JUNE 2004
LETTER FROM THE LEADERSHIP
The following is the text of the President’s Address delivered by AONE president Karen Haase-Herrick during the Opening Ceremony of the 2004 AONE Annual Meeting and Exposition. During my President’s Address this morning, I would like to share some thoughts with you about roots, possibilities, and community. Roots When my parents left me at Ohio State University at the beginning of my freshman year, they departed with this message, “Remember your roots.” Yes, in those words I heard “Get back home to Napoleon once in a while,” but there was also a bigger message. They wanted me to remember who I was, my values and my heritage. I was part of them! As nurse leaders, we need to “remember our roots.” AONE board members began their first meeting this year by “remembering.” Each recalled a cherished memory from their days of bedside nursing. They were poignant stories, tenderly and elegantly blending the art and science of our chosen profession. What was striking about them was that each of them related to an act of caring, firmly grounded in the core values of our profession. Such memories serve a very critical
June 2004
purpose. They anchor us. They allow us to grow and spread our roots as our career journeys along in our lives. They evoke our passions and remind us of why we chose, and stayed, in nursing. Such enlarged roots remind us of the times when we each knew, for certain, that we made a difference in someone’s life and such roots deserve our mindfulness. We bring these memories, our root heritage, with us today. In our present roles, they serve as touchstones for us as we seek to enhance and strengthen the settings in which we serve as leaders. In remembering our roots, we can frame and ask such questions as: Do the nurses here have the same opportunities to store cherished memories as I did? Do they get to experience the same sense of community with their colleagues that I did? How can we create a setting in which they, as we did, can say, “I am making an important difference? How can the nurses in my organization feel the same joy in their profession as I have felt in mine?” Remembering our old roots also involves staying true to those values we learned in expanded in our nursing education: basing our care on the needs of the patient, allowing the patient a say in his/her care, respecting the uniqueness of each patient, Continued on page 20
Nurse Leader 15
VOLUME 2, NUMBER 6
JUNE 2004
TM
Voice of Nursing Leadership is published monthly by the American Organization of Nurse Executives, a subsidiary of the American Hospital Association. All opinions expressed in Voice TM of Nursing Leadership are those of the authors and not necessarily those of AONE or the institution with which the authors are affiliated, unless expressly stated. Naming of products or services does not constitute an endorsement by AONE. © 2004 AONE. All rights reserved. EDITOR DAVID A. STRICKLAND MARKETING COMMUNICATIONS COORDINATOR KIMBERLY CAVALIERO AMERICAN ORGANIZATION OF NURSE EXECUTIVES EXECUTIVE OFFICE: Liberty Place 325 Seventh Street, NW Washington, DC 20004 (202) 626-2240 (telephone) (202) 638-5499 (facsimile) OPERATIONS/MEMBERSHIP:
2004 AONE OFFICERS PRESIDENT
One North Franklin Street Chicago, IL 60606 (312) 422-2800 (telephone) (312) 422-4504 (facsimile) [email protected] www.aone.org KAREN S. HAASE-HERRICK, MN, RN Executive Director Northwest Organization of Nurse Executives Seattle, WA
PRESIDENT-ELECT
MARILYN BOWCUTT, MSN, RN Vice President, Patient Care Services University Hospital Augusta, GA
PAST PRESIDENT
RITA TURLEY, MS, RN Consultant Robert Wood Johnson Foundation Billings, MT
CHAIR, FINANCE COMMITTEE
DONNA M. HERRIN, RN, MSN, CNAA, CHE Senior Vice President and Corporate Nurse Executive Methodist Healthcare Memphis, TN
SECRETARY/TREASURER
PAMELA A. THOMPSON, MS, RN, FAAN Chief Executive Officer American Organization of Nurse Executives Washington, DC
2004 AONE DIRECTORS REGION 1
VERONICA T. HYCHALK, MS, RN Vice President, Professional Services Northeastern Vermont Regional Hospital St. Johnsbury, VT
REGION 2
DENISE LUCAS, MSN, RN, CNAA Vice President, Patient Services/Chief Nursing Officer DuBois Regional Medical Center DuBois, PA
REGION 3
MARY TONGES, PhD, RN, FAAN Senior Vice President/Chief Nursing Officer The University of North Carolina Hospitals Chapel Hill, NC
REGION 4
PATRICIA CONWAY-MORANA, MAd, RNC, CNAA, FACHE Vice President/CNE Columbus Regional Medical Center Columbus, GA
REGION 5
CHERYL L. HOYING, PhD, RN, CNA, BC Administrator for Patient Care The Ohio State University Medical Center Columbus, OH
REGION 6
LINDA KNODEL, MHA, CNA, BC, RN, FACHE Asst. Administrator/Director of Nursing St. Alexius Medical Center Bismarck, ND
REGION 7
LINDA K. DAUM, MBA, RN McAllen, TX
REGION 8
ELAINE COHEN, EdD, RN, FAAN Director of Case, Utilization Management, Quality and Outcomes University of Colorado Hospital Denver, CO
REGION 9
KATHLEEN D. SANFORD, DBA, MA, RN, FACHE Vice President, Nursing and Administrator Harrison Memorial Hospital Bremerton, WA
16 Nurse Leader
AONE CALENDAR June 24-26, 2004 AONE Seminar If Disney Ran Your Hospital: 9fi Things You Would Do Differently Orlando, FL www.aone.org
June 25-26, 2004 Florida Organization of Nurse Executives (FONE) Educational Conference and Tradeshow Orlando, FL www.fonexo.com or (407) 277-5515
September 17-19, 2004 AONE Seminar Mediative Behaviors for the Nurse Leader: The Nurse as Health Care System Diplomat Mount Washington Conference Center, Baltimore, MD www.aone.org or (312) 422-2800
October 17-19, 2004 New York Organization of Nurse Executives Annual Meeting and Exhibits Hotel Thayer, West Point, NY www.nyone.org or (518) 431-7700
November 4-5, 2004 AONE Conference Getting It Right: Foreign-Educated Nurse Recruitment Millennium Resort, Scottsdale McCormick Ranch, Scottsdale, AZ www.aone.org or (312) 422-2800
Continuing education events of interest to nurse leaders and sponsored by non-profit organizations will be included in this calendar. Send event information to [email protected]. AONE reserves the right to determine the contents of this calendar.
June 2004
Scenes from the 2004 AONE Annual Meeting and Exposition
The Phoenix Civic Plaza welcomes attendees to the 2004 AONE Annual Meeting and Exposition.
A Hopi Indian dancer entertains Opening Ceremony attendees with a traditional Hopi dance.
June 2004
Nurse Leader 17
AONE president Karen Haase-Herrick outlines her vision of AONE in 2004 during her President’s Address.
Brigadier General (ret.) Clara Adams-Ender shares key leadership lessons during her keynote address.
More than 200 exhibitors were on hand to present and discuss the latest products and services in patient safety, information technology, staffing, and other important areas.
18 Nurse Leader
June 2004
Attendees enjoy the beautiful Arizona sunshine during an Annual Meeting refreshment break.
AONE members strut their stuff at the “AONE Idol” contest.
AONE members vote during the Annual Business Meeting.
June 2004
Nurse Leader 19
Continued from page 15 ensuring safety for the patient or client, ensuring quality (remember those 20page care plans we all did to ensure that we identified all real and potential problems), and assessing and caring for the whole patient, not just their medical diagnosis. Coupled with our fiscal and business values, these nursing values are quite simply part and parcel of everything we do as nurse leaders. They inform our actions and our relationships. They broaden our work of direct organizational operations to see the “whole” of healthcare. To our own organizations, be it within or external, we are empowered by these values to ask a most pertinent question: “What about the patient?” Our roots then are the crux of the unique skills and competencies we bring to healthcare leadership. Possibilities Remembering our roots, we are in position to now envision the possibilities. The theme for this year’s AONE Annual Meeting and Exposition, “Rising on the Wings of Change,” and our location here in Phoenix could not be more appropriate. The legend of the phoenix exists across many cultures–Egyptian, Greek, Native American. It is a story of rebirth, renewal, and the capacity to rise up with renewed strength. It is, in short, a legend about possibilities. Our job, then, is to bring those possibilities to reality. It’s to create, manage, and sustain the environments in which nurses practice. Environments in which they can realize their contributions and leave every day knowing and believing they have made a difference in the lives of their patients. We have made significant strides in improving the work environments for nurses. In many areas of the country, nurses are beginning to return to the workplace and vacancy rates are dropping. Not all of this is because of the economic downturn of the past five years. Much of it is due to the hard work healthcare organizations have
20 Nurse Leader
invested in improving the work environment not just for nurses, but for all employees. And yet, public testimony and surveys indicate that nurses remain less than totally enthralled with their work environments. They continue to cite caring for too many patients. They cite the lack of safety. They cite continuing overtime. As new graduates, they continue to be frustrated by the reality of the workplace as opposed to what they learned in their educational programs. The inroad to truly making continuing and ever more significant improvements for today lies in asking new questions for this chronic issue–questions that will open us up to possibilities in creating positive and healthy work environments. The genesis of the questions lies in mindfulness to our roots. Simply changing the question from “Are you happy with your work?” to “Tell me about a day in which you went home from your shift truly proud and glad that you are an RN” can yield dramatically different answers. The first question begs the nurse leader to “make it happen.” It gives us opinion-based data. The second question gives us rich and specific data upon which to base new questions for further discovery or new strategies. AONE has published two idea-rich monographs on positive and healthy work environments that lift up the voice of successes of our members. The recent IOM report, Keeping Patients Safe: Transforming the Work Environment of Nurses, also cites many recommendations on the work environment for nurses. Boards of trustees across the country now include dashboard items on retention and vacancy rates by which to assess the health of the work environments for which they have governance responsibilities. With all the current interest in the work environment, the possibilities are truly exhilarating. To realize these possibilities, however, we must “do our homework.” We must engage in root cause analyses of our staff satisfaction and dissatisfaction
with the same intensity with which we address sentinel events. And then we must act on our findings–actions of sustaining the positives that are already there as well as developing plans to address the changes indicated. We must work in new ways with our leader colleagues in education so that new graduates come to us with the requisite beginning competencies as safe practitioners so that we can help flourish as practitioners. We must also work with educators so that new graduates are socialized into the realities of the current practice environment and not educated to believe that they will have the time to establish rapport with and complete a theoretical plan of care for each patient they serve. And, finally, we must, and we can, work with all our nurse colleagues to create environments of practice that may not be perfect but will at least allow nurses to be as passionately committed to and rewarded by their chosen profession as are we. As much as we need to focus on the work environments for the nurses and other employees in our organizations, we need to turn some attention and intentionality to our own work environments. Several years ago, AONE Strategic Planning Committee members spent a dinner discussing “leadership dream teams.” The dream teams were so exciting, so empowering that the organizations were undeniably successful. Some common elements emerged from this conversation: 1) “dream team” members had an unwavering clarity about the mission and the core competence of the organization; 2) team members trusted one another; 3) they worked together collaboratively and interdependently; 4) they acknowledged the strengths and weaknesses of one another and built a stronger whole as a result; 5) the team had a ‘can-do’ attitude; 6) the team members were visible to their staff; 7) nursing was highly respected; 8) the focus was on the patient, but fiscal performance was also monitored; and 9) they used humor. One of the committee members
June 2004
described working with her dream team as one of the most invigorating experiences she had ever had. Can you say that about your current work environment? Can your nurse managers say that about theirs? If not, what are the conversations that are needed to evoke the possibilities of creating a “dream team” in your organization? Even though we are focusing almost all available energy on the work environments of today, the possibilities of the future cry out, “Me, too.” Many of the changes that have created havoc in today’s work environments are beginning to converge to create a tsunami effect for future care delivery models. What do we know, or think we know, about the future? Here are just a few: Much of the interventional work now done in acute care will shift to pharmacologic or genetic work done in the ambulatory sector. The acuity of patients cared for in acute care hospitals will increase. The frail elderly will continue to seek additional means by which to live independently. Robotic, wireless, and other technology will enable us to intervene “from a distance.” We are going to have a total workforce shortage, not just a healthcare workforce shortage. What this means for the profession of nursing and for our organizations has yet to be clearly defined. Our possibilities will require our steadfast commitment to leadership for on-going research in administrative practice: continuing analysis of ongoing changes in the healthcare workforce, replication of Dr. Linda Aiken’s nursing workforce research, evaluation of new patient care delivery and staffing models, and expanding the “failure to rescue” construct so we can study outcomes in ambulatory and community-based practice. Evidence-based practice will provide the foundation of the fiscal case we make for innovations for today and transformations for the future. AONE’s strategic plan includes an important initiative focused on developing future care models for this very reason. We have a task force working to
June 2004
develop guiding principles for future care models. However, the real work for us as innovative leaders in healthcare is to craft the questions to stimulate conversations about the future that will realize new possibilities–for nursing and for healthcare. Here are a few questions to ponder: How will we engage all our colleagues in nursing in the conversations about the future of nursing care delivery so that we, as a profession, are excited by the possibilities and not left more saddened by “what used to be?” How will we collaborate with our education colleagues to create new models for nursing education that are based on the future needs of populations and patients while also continuing our current focused dialogue on meeting today’s needs? What conversations are needed in our communities to better understand their projected needs and that align our care delivery plans with the diverse health belief models of those communities? How will we define the caring work of nursing in the future–a future filled with robotics, wireless communication, and telenursing? What will be the unique and critical work of nursing in the future? There are more questions to be asked and more will emerge as conversations about the future unfold. Let us, therefore, step up to the plate, so to speak, and begin those conversations–with our communities; with our nurse colleagues across the continuum of care, across specialties, in education; with our partners in healthcare leadership, and within our community of nurse leaders. Community We live in community: where we live, our work places, where we feed our spiritual lives, among our families and friends, and those to which we call our fellow professionals. I want to tighten down this focus to the community we know as AONE. Whether we are longtime members, newcomers, or potential members, we are connected to it through our shared commitment to nursing leadership.
As an organization, AONE is a collaborator and a convener with an engaged and energized membership. It is opportunistic, innovative, and committed to evidence-based practice. It can be a provocateur, even approaching “the lunatic fringe” at times to see the possibilities for innovative leadership. AONE has well-delineated core businesses: education and leadership development, mentoring and career development, information resources, research, and local chapters. Public policy advocacy and diversity are strategic foci that AONE uses in all its work. And, as an organization, AONE has three stated strategic directions at this time: Creating positive and healthy work environments, creating future patient care delivery models, and stewards of leadership. But, the “community” of AONE is also us–it is a composite of our factual history, our stories, our legends, our hopes, our dreams, our sorrows, our beliefs, our traditions, our roots, and our community get-togethers. The AONE community is a lattice-work of networks among us that are reinforced continually at our Annual Meeting and many other intentional and chance interactions throughout each year. The support we share within our community is boundless. When one of us confronts a tough career decision, others step forward to share their stories and help sustain the decisionmaker. When one of us decides to take our career in a new direction, others step forward to support but also to learn from the innovator. Our past presidents remain engaged in the wellbeing of our community. In short, the community that is AONE is teeming, bustling, resilient, hardy, and professional. As members of the AONE community, each of us has a responsibility to be good stewards of leadership. Each of us needs to articulately describe the role of nursing leadership: the exquisite blending of the management of fiscal and environment needs and the unique contribution we bring to healthcare leadership in all provider settings.
Nurse Leader 21
Continued from page 21 Our work is to lift up the stories of our leadership that clearly demonstrate the efficacy of our presence on the executive leadership teams of acute care facilities, ambulatory care facilities, long term and continuous care facilities and other practice settings. The voice of nursing leadership is also needed in boardrooms to contribute to healthcare decisions at the governance level. One intriguing possibility lies in work within our AONE community to share learnings that will lead to increased appointments for nurse leaders as voting members of governing boards of healthcare organizations. For any community to thrive, it must renew and replenish itself. To that end, the AONE community is actively engaged in the development of our future nurse leaders. As we move forward with this work, a matrix of skills, work experience, and competencies across the life span of a nurs-
22 Nurse Leader
ing leader and across provider/practice settings will evolve. Any current or future leader can use the matrix to guide their career development plan. And mentors can use the guide to support their work with these current and aspiring leaders. We’ve done much work on this. Templates and success stories are already being shared throughout our community. We will engage the wisdom of our elders, the wit of our storytellers, the energy of our youth, and the passions of all of us to achieve this community renewal. I encourage each of you to engage in a very intentional process by which we secure the future of nursing leadership. A process by which we recognize early those with potential for and who aspire to nurse leader roles. A process by which we tend to diversity so that nursing leadership reflects the communities we serve and the settings in which care is delivered across our health care system. Tell your stories of how and why your passion for nursing
and your talents brought you on a journey of nursing leadership. And, in the process, bring these future leaders into our AONE community. In so doing, each of us will have contributed to our community’s on-going renewal. We will be able to assume ‘elder’ roles and delight in the possibilities brought to the community by the new members. As the community of AONE, our heritage is that of our successes and our roots. Our present is alive and vibrant. Our legacy is the possibilities of our vision. Our ability to shape the future of healthcare through innovative nursing leadership is supported by our roots as nurses, fed by the renewal of possibilities, and sustained through the community that is AONE. Along with my colleagues on the Board of Directors and the staff of AONE, I invite you to experience all three during this year’s Annual Meeting and return home joyfully buoyed and “rising on the wings of change.”
June 2004
LETTER FROM THE LEADERSHIP
The following is the text of the President’s Address delivered by AONE president Karen Haase-Herrick during the Opening Ceremony of the 2004 AONE Annual Meeting and Exposition. During my President’s Address this morning, I would like to share some thoughts with you about roots, possibilities, and community. Roots When my parents left me at Ohio State University at the beginning of my freshman year, they departed with this message, “Remember your roots.” Yes, in those words I heard “Get back home to Napoleon once in a while,” but there was also a bigger message. They wanted me to remember who I was, my values and my heritage. I was part of them! As nurse leaders, we need to “remember our roots.” AONE board members began their first meeting this year by “remembering.” Each recalled a cherished memory from their days of bedside nursing. They were poignant stories, tenderly and elegantly blending the art and science of our chosen profession. What was striking about them was that each of them related to an act of caring, firmly grounded in the core values of our profession. Such memories serve a very critical
June 2004
purpose. They anchor us. They allow us to grow and spread our roots as our career journeys along in our lives. They evoke our passions and remind us of why we chose, and stayed, in nursing. Such enlarged roots remind us of the times when we each knew, for certain, that we made a difference in someone’s life and such roots deserve our mindfulness. We bring these memories, our root heritage, with us today. In our present roles, they serve as touchstones for us as we seek to enhance and strengthen the settings in which we serve as leaders. In remembering our roots, we can frame and ask such questions as: Do the nurses here have the same opportunities to store cherished memories as I did? Do they get to experience the same sense of community with their colleagues that I did? How can we create a setting in which they, as we did, can say, “I am making an important difference? How can the nurses in my organization feel the same joy in their profession as I have felt in mine?” Remembering our old roots also involves staying true to those values we learned in expanded in our nursing education: basing our care on the needs of the patient, allowing the patient a say in his/her care, respecting the uniqueness of each patient, Continued on page 20
Nurse Leader 15
VOLUME 2, NUMBER 6
JUNE 2004
TM
Voice of Nursing Leadership is published monthly by the American Organization of Nurse Executives, a subsidiary of the American Hospital Association. All opinions expressed in Voice TM of Nursing Leadership are those of the authors and not necessarily those of AONE or the institution with which the authors are affiliated, unless expressly stated. Naming of products or services does not constitute an endorsement by AONE. © 2004 AONE. All rights reserved. EDITOR DAVID A. STRICKLAND MARKETING COMMUNICATIONS COORDINATOR KIMBERLY CAVALIERO AMERICAN ORGANIZATION OF NURSE EXECUTIVES EXECUTIVE OFFICE: Liberty Place 325 Seventh Street, NW Washington, DC 20004 (202) 626-2240 (telephone) (202) 638-5499 (facsimile) OPERATIONS/MEMBERSHIP:
2004 AONE OFFICERS PRESIDENT
One North Franklin Street Chicago, IL 60606 (312) 422-2800 (telephone) (312) 422-4504 (facsimile) [email protected] www.aone.org KAREN S. HAASE-HERRICK, MN, RN Executive Director Northwest Organization of Nurse Executives Seattle, WA
PRESIDENT-ELECT
MARILYN BOWCUTT, MSN, RN Vice President, Patient Care Services University Hospital Augusta, GA
PAST PRESIDENT
RITA TURLEY, MS, RN Consultant Robert Wood Johnson Foundation Billings, MT
CHAIR, FINANCE COMMITTEE
DONNA M. HERRIN, RN, MSN, CNAA, CHE Senior Vice President and Corporate Nurse Executive Methodist Healthcare Memphis, TN
SECRETARY/TREASURER
PAMELA A. THOMPSON, MS, RN, FAAN Chief Executive Officer American Organization of Nurse Executives Washington, DC
2004 AONE DIRECTORS REGION 1
VERONICA T. HYCHALK, MS, RN Vice President, Professional Services Northeastern Vermont Regional Hospital St. Johnsbury, VT
REGION 2
DENISE LUCAS, MSN, RN, CNAA Vice President, Patient Services/Chief Nursing Officer DuBois Regional Medical Center DuBois, PA
REGION 3
MARY TONGES, PhD, RN, FAAN Senior Vice President/Chief Nursing Officer The University of North Carolina Hospitals Chapel Hill, NC
REGION 4
PATRICIA CONWAY-MORANA, MAd, RNC, CNAA, FACHE Vice President/CNE Columbus Regional Medical Center Columbus, GA
REGION 5
CHERYL L. HOYING, PhD, RN, CNA, BC Administrator for Patient Care The Ohio State University Medical Center Columbus, OH
REGION 6
LINDA KNODEL, MHA, CNA, BC, RN, FACHE Asst. Administrator/Director of Nursing St. Alexius Medical Center Bismarck, ND
REGION 7
LINDA K. DAUM, MBA, RN McAllen, TX
REGION 8
ELAINE COHEN, EdD, RN, FAAN Director of Case, Utilization Management, Quality and Outcomes University of Colorado Hospital Denver, CO
REGION 9
KATHLEEN D. SANFORD, DBA, MA, RN, FACHE Vice President, Nursing and Administrator Harrison Memorial Hospital Bremerton, WA
16 Nurse Leader
AONE CALENDAR June 24-26, 2004 AONE Seminar If Disney Ran Your Hospital: 9fi Things You Would Do Differently Orlando, FL www.aone.org
June 25-26, 2004 Florida Organization of Nurse Executives (FONE) Educational Conference and Tradeshow Orlando, FL www.fonexo.com or (407) 277-5515
September 17-19, 2004 AONE Seminar Mediative Behaviors for the Nurse Leader: The Nurse as Health Care System Diplomat Mount Washington Conference Center, Baltimore, MD www.aone.org or (312) 422-2800
October 17-19, 2004 New York Organization of Nurse Executives Annual Meeting and Exhibits Hotel Thayer, West Point, NY www.nyone.org or (518) 431-7700
November 4-5, 2004 AONE Conference Getting It Right: Foreign-Educated Nurse Recruitment Millennium Resort, Scottsdale McCormick Ranch, Scottsdale, AZ www.aone.org or (312) 422-2800
Continuing education events of interest to nurse leaders and sponsored by non-profit organizations will be included in this calendar. Send event information to [email protected]. AONE reserves the right to determine the contents of this calendar.
June 2004
Scenes from the 2004 AONE Annual Meeting and Exposition
The Phoenix Civic Plaza welcomes attendees to the 2004 AONE Annual Meeting and Exposition.
A Hopi Indian dancer entertains Opening Ceremony attendees with a traditional Hopi dance.
June 2004
Nurse Leader 17
AONE president Karen Haase-Herrick outlines her vision of AONE in 2004 during her President’s Address.
Brigadier General (ret.) Clara Adams-Ender shares key leadership lessons during her keynote address.
More than 200 exhibitors were on hand to present and discuss the latest products and services in patient safety, information technology, staffing, and other important areas.
18 Nurse Leader
June 2004
Attendees enjoy the beautiful Arizona sunshine during an Annual Meeting refreshment break.
AONE members strut their stuff at the “AONE Idol” contest.
AONE members vote during the Annual Business Meeting.
June 2004
Nurse Leader 19
Continued from page 15 ensuring safety for the patient or client, ensuring quality (remember those 20page care plans we all did to ensure that we identified all real and potential problems), and assessing and caring for the whole patient, not just their medical diagnosis. Coupled with our fiscal and business values, these nursing values are quite simply part and parcel of everything we do as nurse leaders. They inform our actions and our relationships. They broaden our work of direct organizational operations to see the “whole” of healthcare. To our own organizations, be it within or external, we are empowered by these values to ask a most pertinent question: “What about the patient?” Our roots then are the crux of the unique skills and competencies we bring to healthcare leadership. Possibilities Remembering our roots, we are in position to now envision the possibilities. The theme for this year’s AONE Annual Meeting and Exposition, “Rising on the Wings of Change,” and our location here in Phoenix could not be more appropriate. The legend of the phoenix exists across many cultures–Egyptian, Greek, Native American. It is a story of rebirth, renewal, and the capacity to rise up with renewed strength. It is, in short, a legend about possibilities. Our job, then, is to bring those possibilities to reality. It’s to create, manage, and sustain the environments in which nurses practice. Environments in which they can realize their contributions and leave every day knowing and believing they have made a difference in the lives of their patients. We have made significant strides in improving the work environments for nurses. In many areas of the country, nurses are beginning to return to the workplace and vacancy rates are dropping. Not all of this is because of the economic downturn of the past five years. Much of it is due to the hard work healthcare organizations have
20 Nurse Leader
invested in improving the work environment not just for nurses, but for all employees. And yet, public testimony and surveys indicate that nurses remain less than totally enthralled with their work environments. They continue to cite caring for too many patients. They cite the lack of safety. They cite continuing overtime. As new graduates, they continue to be frustrated by the reality of the workplace as opposed to what they learned in their educational programs. The inroad to truly making continuing and ever more significant improvements for today lies in asking new questions for this chronic issue–questions that will open us up to possibilities in creating positive and healthy work environments. The genesis of the questions lies in mindfulness to our roots. Simply changing the question from “Are you happy with your work?” to “Tell me about a day in which you went home from your shift truly proud and glad that you are an RN” can yield dramatically different answers. The first question begs the nurse leader to “make it happen.” It gives us opinion-based data. The second question gives us rich and specific data upon which to base new questions for further discovery or new strategies. AONE has published two idea-rich monographs on positive and healthy work environments that lift up the voice of successes of our members. The recent IOM report, Keeping Patients Safe: Transforming the Work Environment of Nurses, also cites many recommendations on the work environment for nurses. Boards of trustees across the country now include dashboard items on retention and vacancy rates by which to assess the health of the work environments for which they have governance responsibilities. With all the current interest in the work environment, the possibilities are truly exhilarating. To realize these possibilities, however, we must “do our homework.” We must engage in root cause analyses of our staff satisfaction and dissatisfaction
with the same intensity with which we address sentinel events. And then we must act on our findings–actions of sustaining the positives that are already there as well as developing plans to address the changes indicated. We must work in new ways with our leader colleagues in education so that new graduates come to us with the requisite beginning competencies as safe practitioners so that we can help flourish as practitioners. We must also work with educators so that new graduates are socialized into the realities of the current practice environment and not educated to believe that they will have the time to establish rapport with and complete a theoretical plan of care for each patient they serve. And, finally, we must, and we can, work with all our nurse colleagues to create environments of practice that may not be perfect but will at least allow nurses to be as passionately committed to and rewarded by their chosen profession as are we. As much as we need to focus on the work environments for the nurses and other employees in our organizations, we need to turn some attention and intentionality to our own work environments. Several years ago, AONE Strategic Planning Committee members spent a dinner discussing “leadership dream teams.” The dream teams were so exciting, so empowering that the organizations were undeniably successful. Some common elements emerged from this conversation: 1) “dream team” members had an unwavering clarity about the mission and the core competence of the organization; 2) team members trusted one another; 3) they worked together collaboratively and interdependently; 4) they acknowledged the strengths and weaknesses of one another and built a stronger whole as a result; 5) the team had a ‘can-do’ attitude; 6) the team members were visible to their staff; 7) nursing was highly respected; 8) the focus was on the patient, but fiscal performance was also monitored; and 9) they used humor. One of the committee members
June 2004
described working with her dream team as one of the most invigorating experiences she had ever had. Can you say that about your current work environment? Can your nurse managers say that about theirs? If not, what are the conversations that are needed to evoke the possibilities of creating a “dream team” in your organization? Even though we are focusing almost all available energy on the work environments of today, the possibilities of the future cry out, “Me, too.” Many of the changes that have created havoc in today’s work environments are beginning to converge to create a tsunami effect for future care delivery models. What do we know, or think we know, about the future? Here are just a few: Much of the interventional work now done in acute care will shift to pharmacologic or genetic work done in the ambulatory sector. The acuity of patients cared for in acute care hospitals will increase. The frail elderly will continue to seek additional means by which to live independently. Robotic, wireless, and other technology will enable us to intervene “from a distance.” We are going to have a total workforce shortage, not just a healthcare workforce shortage. What this means for the profession of nursing and for our organizations has yet to be clearly defined. Our possibilities will require our steadfast commitment to leadership for on-going research in administrative practice: continuing analysis of ongoing changes in the healthcare workforce, replication of Dr. Linda Aiken’s nursing workforce research, evaluation of new patient care delivery and staffing models, and expanding the “failure to rescue” construct so we can study outcomes in ambulatory and community-based practice. Evidence-based practice will provide the foundation of the fiscal case we make for innovations for today and transformations for the future. AONE’s strategic plan includes an important initiative focused on developing future care models for this very reason. We have a task force working to
June 2004
develop guiding principles for future care models. However, the real work for us as innovative leaders in healthcare is to craft the questions to stimulate conversations about the future that will realize new possibilities–for nursing and for healthcare. Here are a few questions to ponder: How will we engage all our colleagues in nursing in the conversations about the future of nursing care delivery so that we, as a profession, are excited by the possibilities and not left more saddened by “what used to be?” How will we collaborate with our education colleagues to create new models for nursing education that are based on the future needs of populations and patients while also continuing our current focused dialogue on meeting today’s needs? What conversations are needed in our communities to better understand their projected needs and that align our care delivery plans with the diverse health belief models of those communities? How will we define the caring work of nursing in the future–a future filled with robotics, wireless communication, and telenursing? What will be the unique and critical work of nursing in the future? There are more questions to be asked and more will emerge as conversations about the future unfold. Let us, therefore, step up to the plate, so to speak, and begin those conversations–with our communities; with our nurse colleagues across the continuum of care, across specialties, in education; with our partners in healthcare leadership, and within our community of nurse leaders. Community We live in community: where we live, our work places, where we feed our spiritual lives, among our families and friends, and those to which we call our fellow professionals. I want to tighten down this focus to the community we know as AONE. Whether we are longtime members, newcomers, or potential members, we are connected to it through our shared commitment to nursing leadership.
As an organization, AONE is a collaborator and a convener with an engaged and energized membership. It is opportunistic, innovative, and committed to evidence-based practice. It can be a provocateur, even approaching “the lunatic fringe” at times to see the possibilities for innovative leadership. AONE has well-delineated core businesses: education and leadership development, mentoring and career development, information resources, research, and local chapters. Public policy advocacy and diversity are strategic foci that AONE uses in all its work. And, as an organization, AONE has three stated strategic directions at this time: Creating positive and healthy work environments, creating future patient care delivery models, and stewards of leadership. But, the “community” of AONE is also us–it is a composite of our factual history, our stories, our legends, our hopes, our dreams, our sorrows, our beliefs, our traditions, our roots, and our community get-togethers. The AONE community is a lattice-work of networks among us that are reinforced continually at our Annual Meeting and many other intentional and chance interactions throughout each year. The support we share within our community is boundless. When one of us confronts a tough career decision, others step forward to share their stories and help sustain the decisionmaker. When one of us decides to take our career in a new direction, others step forward to support but also to learn from the innovator. Our past presidents remain engaged in the wellbeing of our community. In short, the community that is AONE is teeming, bustling, resilient, hardy, and professional. As members of the AONE community, each of us has a responsibility to be good stewards of leadership. Each of us needs to articulately describe the role of nursing leadership: the exquisite blending of the management of fiscal and environment needs and the unique contribution we bring to healthcare leadership in all provider settings.
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Continued from page 21 Our work is to lift up the stories of our leadership that clearly demonstrate the efficacy of our presence on the executive leadership teams of acute care facilities, ambulatory care facilities, long term and continuous care facilities and other practice settings. The voice of nursing leadership is also needed in boardrooms to contribute to healthcare decisions at the governance level. One intriguing possibility lies in work within our AONE community to share learnings that will lead to increased appointments for nurse leaders as voting members of governing boards of healthcare organizations. For any community to thrive, it must renew and replenish itself. To that end, the AONE community is actively engaged in the development of our future nurse leaders. As we move forward with this work, a matrix of skills, work experience, and competencies across the life span of a nurs-
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ing leader and across provider/practice settings will evolve. Any current or future leader can use the matrix to guide their career development plan. And mentors can use the guide to support their work with these current and aspiring leaders. We’ve done much work on this. Templates and success stories are already being shared throughout our community. We will engage the wisdom of our elders, the wit of our storytellers, the energy of our youth, and the passions of all of us to achieve this community renewal. I encourage each of you to engage in a very intentional process by which we secure the future of nursing leadership. A process by which we recognize early those with potential for and who aspire to nurse leader roles. A process by which we tend to diversity so that nursing leadership reflects the communities we serve and the settings in which care is delivered across our health care system. Tell your stories of how and why your passion for nursing
and your talents brought you on a journey of nursing leadership. And, in the process, bring these future leaders into our AONE community. In so doing, each of us will have contributed to our community’s on-going renewal. We will be able to assume ‘elder’ roles and delight in the possibilities brought to the community by the new members. As the community of AONE, our heritage is that of our successes and our roots. Our present is alive and vibrant. Our legacy is the possibilities of our vision. Our ability to shape the future of healthcare through innovative nursing leadership is supported by our roots as nurses, fed by the renewal of possibilities, and sustained through the community that is AONE. Along with my colleagues on the Board of Directors and the staff of AONE, I invite you to experience all three during this year’s Annual Meeting and return home joyfully buoyed and “rising on the wings of change.”
June 2004