AACN News—July 1999—Opinions

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Vol. 16, No. 7, JULY 1999

President's Note: Pioneer in a World of Innovation

Editor’s note: Following is the speech delivered by 1999-2000 AACN President Anne W. Wojner, RN, MSN, CCRN, after accepting AACN’s vision from outgoing President Mary G. McKinley, RN, MSN, CCRN, at the closing session of the 1999 National Teaching Institute™ in New Orleans, La. Wojner’s theme for the year is “Pioneering in a World of Innovation.”

How can we bring back the good old days?” seems to be the million dollar question for the ’90s. Change is happening today at record speed. Looking back at what was is easy compared to trying to look forward—unless, of course, you enjoy the vertigo.

The pace of change is so fast that we can’t keep up with it by moving faster ourselves. Just as we cannot know with any certainty the exact position of an electron moving around a nucleus, we cannot really know where and when change will occur next. What we must accept is that this is the way it will be for some time, perhaps forever.

As people who thrive on control—control of our patient’s mean arterial pressure and intracranial pressure, control of pain, control of the rate of finely tuned infusions—critical care nurses are likely to find this pretty hard to swallow. However, as the pace of change accelerates, the less possible it will be to predict and plan for what lies ahead. Instead, we will need to be flexible and learn to adjust as we go. No, Toto, we are not in Kansas anymore.

I don’t know about you, but I find myself liking most of the changes going on around us. I like being able to order books on the Internet “24-7.” I like being able to send and receive e-mail from all around the world almost instantaneously. I like being able to drive through toll booths on my way to work with my “EZ” tag, so that I don’t have to stop to deposit money. Did you know that there is even technology being developed by oil companies that will identify your car as you drive up to the gas pump, so that you will never again have to swipe your credit card when you fill up the tank? I like that. You can’t escape the fact that the conveniences associated with all this change are phenomenal.

Twenty-one years ago, when I entered critical care nursing, things looked very different than they do today. For example, cost and length of stay were not issues that most nurses concerned themselves with. In fact, many of you may recall the days when we raided our unit’s central supply stock to send patients out the doors with all that they could possibly need, so that they wouldn’t have to bear the expense themselves after discharge.

While technology has complemented delivery of nursing care for some time, what existed 21 years ago was light years away from the sophistication of today’s patient-care systems. I remember the days when we hand-calculated hemodynamic variables, such as systemic vascular resistance. Now, our monitors do the work for us. The ability for these same monitors to capture, calculate and record patient data in real time would have seemed like rocket science in the mid-1970s. Yet, today we take these conveniences for granted.

No, it is certainly not like the good old days, but do we really want to go backward instead of forward? I don’t think so, and I would argue that each of us would resist giving up the conveniences we have come to enjoy because of all this change.

Often, our comfort level with the status quo gets in the way of our ability to embrace change. Whether it is implementation of new technology, which causes us to change our documentation methods, or the need to redesign care delivery systems to improve efficiency, we often find ourselves struggling to hang on to the past. However, change is nonnegotiable, and probably the only predictable factor in our work environments. Acceptance of this is fundamental to our ability not only to succeed in creating our future, but also to actively pioneer development of systems and technology that will enhance our ability to meet the needs of patients and families. Resisting the winds of change is dangerous, risky business that will cause us to tumble toward an unknown destiny. Instead, we must learn to flow with change and use its momentum to mold our future. This takes leadership, which many have defined as the art and science of producing effective change.

Leading incremental change or small improvements is an easy process. We know exactly where we are going and what to expect. However, what we are experiencing now is quantum change, or deep change, which involves a radical shift in course. Quantum change is always associated with the need to give up control, because its course defies prediction of upcoming events and long-term consequences. Living with periods of uncertainty and pain requires courage, but then we know this, given the massive amount of change we have experienced professionally just within the last 10 years. No matter who you are, quantum change is very difficult.

In Deep Change: Discovering the Leader Within, Robert E. Quinn says that we have a choice of either a slow, painful death from stagnation and denial or enduring and growing through the pain associated with quantum change. Some fall on their swords, becoming self-absorbed in their personal struggle with the change going on around them. Others have the courage to rely on their values to guide and lead with vision. What we must remember is that, when actions are driven by values and vision, a process larger than the power of one is unleashed, promoting synchronicity, commitment and direction. As Gandhi told us, “Do the right thing and resources will follow.”

Rapid evolution creates obsolescence overnight. Innovation makes what we know today obsolete tomorrow. Each of us must grasp the significance of our individual and collective contributions, so that we can flow with the current and not become obsolete.

Peter F. Drucker, head of the Foundation for Nonprofit Management, advocates adoption of a philosophy of abandonment as a preventative to obsolescence. Abandonment is the process of periodically challenging every product, policy and system by asking: “If we were not in it already, would we be going into it now?”

Abandonment differentiates the “need to haves” and the “nice to haves” for an organization. It identifies excess baggage that can be thrown overboard to prevent leaks that ultimately might cause the ship to sink.

As you can imagine, abandonment is not an easy process. As organizations grow, so does their corporate memory. In Competing for the Future, Gary Hamel and C. K. Prahalad call this corporate genetics. Genetic coding is very strong and resistant to change. Yet, an organization’s learning curve is equal to its forgetting curve. In other words, learning cannot take place unless there is forgetting.

Over the past few years, AACN has struggled with quantum change and our own corporate genetics. This year in particular, we re-examined who we are, what we do and where we want to be in the future. Guided by our vision and values, we have charted our course through these unknown waters, based on two key strategies: promoting the value of nursing and the continued development of state-of-the-science, world-class practice resources. Although the decisions we have had to make were not easy, the excitement that these strategies has unleashed is awesome. Yes, things look a little different at AACN, just as they do in your workplace, but we are learning to role model how to flow with the changes around us. We are also learning to enjoy the ride.

Our collective challenge is to become “change masters.” Our ability to succeed is tied to our ability to forget and let go of concrete processes, material objects and position status.

Instead, we must connect with our values of integrity, holism, creativity, humor, wisdom and love, and let them forge a way into the future.

Nurses are everyday heroes. Because of the regularity of our heroic acts, we tend to take them for granted, instead of acknowledging the significance of our contributions to society, and mankind. More than any other profession, nursing provides unparalleled opportunities for its members to improve the quality of life for their fellow human beings. The courage associated with what we do and who we are as critical care nurses is needed more than ever.

This year, we enter a new millennium. AACN is stepping out to lead the way for its members through unexplored territory. Each of us will contribute what he or she can as we journey into the future. Some will give everything they have; others will take a more balanced approach. However, as long as we are moving toward creation of our future as one, we must celebrate our progress and pull together, not apart. Each of us brings a gift to this expedition, and it sometimes takes getting lost on the journey to make that gift visible and valuable to others.

Our future will bring automated, dose-adjusted medication delivery systems; ventilators that sense and automatically adjust their settings to meet oxygenation, ventilation and weaning needs of our patients; and even more noninvasive technology than we can possibly imagine. As technology grows, we as nurses must recognize that elaborate machinery is of no help to us as we strive to build our professional image. In fact, technology may indeed be our death, if the intellectual and spiritual aspects of what we are about—our heroism and courage—are subordinated to mechanical structures.

What it comes down to is that nurses are, and always will be, the most essential component in the provision of patient care, while physicians and other interdisciplinary providers simply make up the ancillary treatment team. The value of what we do is priceless. Let’s showcase that value to our patients and families as we walk together down the trail to the future. I hope you will join with AACN as a pioneer in a world of innovation.

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