AACN News—May 2001—Opinions

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Vol. 18, No. 5, MAY 2001


President's Note: Make Waves: Find the Courage to Manage Change

Denise Thornby, RN, MS
President, AACN

Change is difficult, partly because dealing with it requires courage. I chuckle when I read the cartoon tacked to the bulletin board in my office, which says, “If change is so good…you go first!”
This summer, I face a number of personal and professional changes. I am excited about some. I am uncertain about others. Not only will I leave the AACN Board of Directors after six years, but I will also leave a volunteer role that has been the highlight of my professional career—serving as your president. However, to keep things interesting, I recently assumed a new position as manager of my department and my only daughter, Sarah, is graduating from high school. All of these changes are exciting and positive. They will give me a chance to grow and explore new opportunities, though they also involve some loss or uncertainty.

Although I enjoy challenges and opportunities, I am uncomfortable making the transition from what I know and am comfortable with to a new, unknown or uncertain place. Whether change involves a shift in job responsibilities, patient populations, technology or the people I work with, I always mourn the loss and feel somewhat unsettled by the new.

In this century, each of us will face an escalating level of change. To be successful in our roles and serve as leaders in healthcare, we must act with courage and ride the waves of transition. Writer Raymond Lindquist said it well, “Courage is the power to let go of the familiar.” Much of what is familiar to us in healthcare will change and, in fact, needs to change if it is to become a system driven by the needs of patients and their families. Our workplaces must change—in the roles we each play, in how we work together, in how we staff, in how we manage our work—to create safer, healthier environments that will support our optimal contributions to the healthcare system.

Sometimes, we deny or resist change. Early in my career, I experienced my own resistance to new technology, which has always served to remind me how I must move past my comfort level to learn, grow and adjust with the times. I was working in a cardiac surgery ICU and preparing for the admission of a heart transplant patient. This was in the early ’70s and we were using a primitive IV pump with tubing that stretched around a roller mechanism to regulate the flow of the fluid. Because we were obsessive about protecting transplant patients from infection, we sent everything to be autoclaved. As I was setting up the room and preparing the IV fluids, one of my coworkers suggested I use one of the new IV pumps, on which we had just been inserviced. However, I declined, because I didn’t quite “trust” those pumps yet. Instead, I took the “old” pump, secured it to the IV pole using tape that had been autoclaved (though, unknown to me, it had lost some of its adhesiveness) and prepared the isoproterenol drip that

the patient would need on admission. Shortly after the patient was admitted, the tape gave way, the pump headed for the ground, the IV tubing popped off and, as you can guess, my patient got a full bolus of isoproterenol. Yikes! The resultant V-Tach was heart stopping—for me! Fortunately, the patient was fine. I was mortified that I had let my uneasiness keep me from using a better pump, where a clamp prevented the tubing from coming off. Looking back, I realize that it was silly to have resisted using the new pump. I was being overly cautious and reluctant to move from my clinical comfort zone.

I know that some of you face changes with the same fear and resistance I experienced. Yet, we must not let fear keep us from changing or taking the risks to move our practice forward. It does not matter whether that change involves a new way of assigning work, a new patient population to be cared for or new technology. If we are to achieve improved outcomes for our patients, we must acquire the information we need to go forward and step out of our comfort zone.

This fear of change also keeps us from making changes for ourselves. Whether that is taking the risk to become certified, to go back to school, to become involved in public policy, to change units or to change roles, fear and uncertainty can keep you from achieving your potential. Another writer, Frank Scully, said, “Why not go out on a limb? Isn’t that where the fruit is?” The fear of failure or the fear of not being perfect keeps many of us from making needed changes, even in the face of dissatisfaction. We become complacent, or act as if we are powerless to change our own condition.

The reality is that our work, our patients, our profession and the healthcare system itself will continue to evolve and change. We will also experience change within our personal lives as we continue our life journey. What a mess! What a challenge! What an opportunity for growth, if we manage the change and transition well.

We have the power to change—to change our perception, to change our understanding and to change our choices. We must challenge our thinking and perceptions so that we can see the choices available to us—the choice to take the high road, the choice to gain new knowledge or the choice to voice our concerns.

Exercising our choices empowers us. When you are frightened or uncertain about a new procedure or patient population, make the choice to gain the knowledge or seek the mentoring you need to become more competent and confident. When you are concerned about the staffing ratios in your unit, make the choice to acquire the skills to be articulate and communicate your concerns to those who manage staffing decisions. When your unit needs to hire new graduates, make the choice to support them and provide them with the needed education and experiences to be successful. When you are unhappy with your current role and current unit, make the choice to advocate for needed changes or make the decision to leave.

Managing change and transition is not easy, even when the change is positive. William Bridges, in his book Managing Transitions, described three phases we all experience in making changes:
• The ending phase, where we experience the loss of what changed
• The neutral zone, where we are in the midst of the change and feel unsettled
• The new beginnings, where we have begun the “new” way or experience

We travel through all three phases every time we are faced with changes. What the change is and how significant and meaningful it is for us determines the course of the journey. The important point is to realize that, before you can make the transition, you must leave your comfort zone of what was, travel through a time of creating the new that is coupled with an unsettledness and then, finally, arrive at a new beginning. Recognizing that this journey can be stressful, Bridges suggests several strategies:
• Recognize the symptoms of the neutral zone. These are normal and are characterized by mixed messages—one step forward and one step back movement. You often feel as if the change will never end, and you just want to get away from it all. (Sound familiar?)
• Take timeouts. Make time for a break in your routine. Spend more time taking care of yourself and making sure you have the energy to manage the transition.
• Use the neutral zone as a time to reflect and take stock. Use this time to decide what path you want to take and where you can find your satisfaction and significance.
• Do things differently. Force yourself to get out of the pattern of your routines and do something different. For example, take a different route to work, volunteer for something you wouldn’t do normally or take up a new hobby. As author Ellen Glasglow said, “The only difference in a rut and a grave…is in their dimensions.”
• Stay proactive. Read, explore and be involved. Be prepared for what the future might bring. Don’t wait to gain the needed information or skills that will position you for success. For those of you who have not learned to surf the Internet, now is the time!
• Spend time with those who nourish you, who empower you to be the best you can be—those who help you make the right choices in your life and travel the high road.

Most of all, join with others who are on the same journey. AACN will be your partner. AACN has always been there for me, and I know you will find the association a worthy companion. Lastly, I offer some simple rules to help navigate the chaotic waves that are present in healthcare today: Show up. Be present. Tell the truth. Keep the vision as your beacon. And, make waves!
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