AACN News—July 2005—Opinions

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Vol. 22, No. 6, JUNE 2005

President's Note: Engage and Transform
Commit to Healthy Work Environments

By Debbie Brinker, RN, MS, MSN, CCNS, CCRN,
President, AACN

Editor’s Note: Following are excerpts from the President-Elect speech delivered by 2005-06 AACN President Debbie Brinker, RN, MS, MSN, CCNS, CCRN, on the final day of the 2005 National Teaching Institute and Critical Care Exposition in New Orleans, La. Her theme for the year is “Engage and Transform.” The full text of this speech as well as references are available online at www.aacn.org > NTI > Past NTI Web Sites > New Orleans, La. > President-Elect’s Speech.

How would the environment where you practice look if you had the power to design it to your own specifications? I assert that we do have the power to change our workplaces so that they meet our needs as healthcare team members and individuals who care for the most vulnerable patients.

Over the last year, a group of nurses dared to imagine what our workplaces would look like if they were built to the specifications of our dreams. That group then wrote down those specifications in what became the AACN Standards for Establishing and Sustaining Healthy Work Environments.

This ideal environment is characterized by six essential elements that lead to excellence: skilled communication, true collaboration, effective decision making, appropriate staffing, meaningful recognition and authentic leadership.

What if nurses and their colleagues were as proficient in communication skills as they are in their clinical skills?
What if nurses were relentless in pursuing and fostering the kind of collaboration that is needed to efficiently and effectively care for patients?
What if nurses were valued and committed partners in making policy, directing and evaluating clinical care, and leading organizational operations?
What if there were always an effective match between patients’ needs and nurses’ competencies?
What if nurses were recognized and recognized others for the value each brings to the work of the organization?
What if nurse leaders fully embraced the imperative of a healthy work environment, authentically lived it and engaged others in its achievement?

Nurses are, by far, the largest group of individuals in the hospital environment. How is it possible then that we are not complicit in what is wrong with our environments?
Isn’t it possible that by working together toward a common goal, we could succeed in transforming where we work? Doing so will require our sustained engagement in identifying what needs to be transformed and in driving the transformation itself.

Recalling our past presidents’ themes, you might think that “Engage and Transform” sounds familiar. I hope so. Although the view that I have is distinct, the underlying call to action is the same. When the message is right, it cannot waver. We can’t switch gears until the change we wish to see is realized.

By engagement, I mean commitment, tenacity and the dogged determination that nurses can have when they are driven by a vision that calls to them from the inside out. The kind of being engaged I’m calling for brings us to a whole new level of commitment—of being willing to be accountable, for the environments in which we practice and the outcomes we produce.

What does a “transformed” environment look like? It is an environment where nurses are truly as skilled at communicating as they are in their clinical skills. It is a workplace where true collaboration is not optional, and where those who choose not to collaborate are neither tolerated nor welcome in the care of patients. It is elevating our priorities so that clinical outcomes, like ventilator-associated pneumonia, become an exception. A landmark event where we investigate every detail of what went wrong because we run a ship so tight that such a complication in our hands is unheard of.

It is a hospital where errors are discussed openly and colleagues are supported when they occur, because we know that patients are not the only ones who suffer when mistakes take place. Healthcare providers do, too. It is a workplace that calls to us again and rekindles the passion we still have deep inside for this important work that most of us still love to do.

The acts of engaging and transforming cannot be achieved in isolation. Being engaged is about involving ourselves, about participating, about investing in what we value. It is about acting on what we know should not continue because it is not right. Unless we engage, transformation will happen, but it will happen to us, not because of us.

To sustain ourselves, we must concentrate on our strengths, what we uniquely bring to critical care patients and their families. We must spend time doing work that energizes rather than drains us. This means actively engaging in repairing systems rather than perpetuating workarounds. It means being a willing and productive participant—not a disgruntled spectator—in making it possible for nurses like us to concentrate our focus on actual care delivery.

It is risky and unethical not to engage.

As nurses, our individual spirits and our collective code of ethics compel us to be engaged. Few occupations can afford people who are not engaged. But healthcare is downright dangerous when we are not.

Transforming ourselves is a lifelong engagement. Changing our environments will also be a long-term commitment.

There is a rhythm or progression to transformation. Some brave soul engages. Takes a risk to change the status quo. Isolated good outcomes are observed and word spreads. These outcomes get documented as evidence-based practice. And then the right thing becomes second nature.

We transform and get transformed all the time if we’re engaged. The trick is to recognize when we are doing things that feed our soul and improve the environment for ourselves and those around us.

Our individual engagement grows into collective engagement. This is where transformation gains momentum. Our collective engagement through professional organizations like AACN can be transformational on a grand scale.

Transformation begins with you. By transforming yourself, you create powerful new opportunities for yourself, your relationships and your workplace.

My wish is that each of us commits to engaging in the transformation of our workplace cultures. That we live powerfully. That we take responsibility for our experience and generate greatness in our lives.

Consider these questions:
• What would you attempt if you knew you could not fail?
• Who are “they” who hold so much power over our lives?
• If your workplace was exactly as you wanted it, what would it be like?
• What is your unrelenting passion?
• If not now, when?

If each of us engages in growing into the answers to these questions and transforming our work environments into healthy places, we can see our dream become reality.

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