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Vol. 23, No. 7, JULY 2006

President's Note
Powered by Insight

Editor’s Note: Following are excerpts from the President-Elect speech delivered by 2006-07 AACN President Mary Fran Tracy, RN, PhD, CCNS, CCRN, FAAN, on the final day of the 2006 National Teaching Institute & Critical Care Exposition in Anaheim, Calif. Her theme for the year is “Powered by Insight.” The full text of this speech as well as references are available online at www.aacn.org > NTI > Past NTI Web Sites > Anaheim, CA > President-Elect’s Speech.

By Mary Fran Tracy, RN, PhD, CCNS, CCRN, FAAN
AACN President

Does it seem to you like healthcare in this country has no clear direction? That’s how it seemed to me when I started to think about the right theme to illuminate and guide AACN’s work for the coming year. Then this quote by the author Henry Miller caught my attention: “One's destination is never a place,” he said, “but rather, a new way of looking at things.” That’s the power of insight.

The concept of insight isn’t foreign to us. What might be unfamiliar is the notion of looking for insights. I’m convinced that each of us will benefit in surprising ways when we start to intentionally seek insights, and then make use of them.

Out of insight come those “Aha!” moments that catch us by surprise. They can be moments of inspiration, or joy, or resolution. Or just plain relief that something finally makes sense. In reality, our mind probably registered a string of discrete moments—like pieces of a puzzle or connecting dots. One day, that final piece locks into place and the dots connect.
Where do insights come from? Typically, they don’t develop the first time we encounter new information. That’s when we acquire knowledge and learn facts. Our challenge is to turn information into insight. Here’s how:

Look for Connections
We often find insight when we revisit something we’ve already learned, seeking connections and probing for relationships and meanings we missed the first time around. William Byron said that insight requires excavation; it takes lots and lots of digging to discover new meaning and unearth additional connections.

Do you remember what it was like to be a brand new graduate? What about a year later? Five years? Ten? Don’t be surprised if you can’t remember. Experience changes the view. When we were new graduates, didn’t it seem like there was so much to keep track of? All of it was black and white then. Add the insight that comes from experience and there are just as many things to notice, but they come in many shades of many colors.

Learn From Mistakes
Making a clinical error can be a powerful source of insight – errors, such as administering an incorrect medication that caused permanent harm or preparing a patient for the wrong procedure. “That would never happen to me,” we say. Until we find ourselves working in a broken system and it does happen to us. Talk with a person who has successfully transcended the personal shock of making that error, and you’ll find someone who now uses the insight gained from a devastating experience as a powerful guide for practice – someone who has intentionally sought insight by using self-motivation to mobilize self-inquiry and self-reflection.

Hunt for Clues
Insight requires examination from a big-picture perspective, yet it also requires zooming in on the details to gain clarity. For example, at work it’s so easy to focus on the minute-to-minute details of caring for someone who’s critically ill. Unless we put the details into a critical synthesis of the patient’s overall condition and how they’re progressing, we’ll miss significant clues that are vital.

See New Perspectives
Insights of every kind generate their own energy. By forging our knowledge and our experience into something new, insight generates within each of us the power to grow individually as we uncover intelligent new solutions—and, often, new questions—for the thorny issues that confront us. Even so, why bother making the effort to gain insight? Isn’t it enough that we work hard and care deeply about the patients and families we provide for?

Consider the difference that acting on insight made for one staff nurse struggling in a busy ICU. He never got challenging assignments and felt so disconnected and devalued that he considered finding another job. What he didn’t know was that people saw him as pessimistic and definitely not a team player. The manager guided this nurse in how to explore his frustration by talking to some coworkers. It took courage to approach them. Just like it took courage for the coworkers to give him honest feedback about how he came across and his effect on everyone’s work. In the end, everyone gained insight. The nurse decided to own his part of the frustration and eventually became a contributing team member.

Or the difference insight can make when a nurse finds families intrusive and excels in pushing them away, only to have his or her own loved one hospitalized. Being on the other end of care is so different, isn’t it? Don’t be surprised when that nurse is forever changed into one of your unit’s most powerful family advocates. And we all know that no one has as much passion and energy as a new convert. Marshall McLuhan, the famous Canadian media scholar, warned that "a point of view can be a dangerous luxury when substituted for insight and understanding."

Our next step is to dig for insights by asking ourselves some hard questions. Why is a particular situation challenging? Is it the situation or how I’m approaching it?

We also need to ask: Am I paying attention to the big picture but missing critical details? When I start to notice new patterns, do I try to better understand them or do I withdraw because they’re unfamiliar and unsettling?

Asking Questions
Once I gain insight into a situation, how do I contribute where it will benefit most? Someone once said that conversations are action. So I’ve decided to do two things and challenge you to do them with me. At work, I’m going to ask two questions: What’s going well? (Or what have I done well?) What could be done better? (Or how could I serve you better?)

I’ve made a list of who I’m going to ask and I know I’ll keep adding to it. My list includes patients and families, some of my colleagues—especially the ones I don’t see eye-to-eye with, the person I report to, and physicians. Oh, and some of the housekeepers. They know everything, don’t they? If I were a manager, I also would ask the people who report to me, being sure to include the complainers. While I’m on the road this year, I’ll ask people in the audience whenever I speak. Insights will inevitably start to form.

Sharing Answers
The answers I receive should draw my attention to things I might be ignoring. Maybe I’ll begin to see patterns and relationships that I never noticed. So besides asking the two questions, we need to tell one another about new insights prompted by the answers. I’ll do this in my column each month. You can do it by writing to me at insights@aacn.org.

The Journey Ahead
I need new traveling companions during my year as president—people who are willing and able to join me on this journey where finding insights will not be left to chance. And where, once the insights are found, they become new energy sources for us as individuals, as teams and as an association. We’ll be seeking new ways to understand problems, new ways to ask old questions and new ways to solve challenges.

The actress Bette Davis once said that, without wonder and insight, acting is just a trade. With wonder and insight, it becomes creation. Couldn’t we say the same thing about nursing?

I need people who will join me in discovering insights and their power, who will share their insights with me and help me discover new ones of my own. I need people who will become partners in making use of our new insights as we transform nursing from trade to creation.

I’m counting on you to travel with me.

A Special Message to Our Heroes Along the Gulf Coast

Throughout this issue of AACN News is coverage of AACN’s recent National Teaching Institute & Critical Care Exposition in Anaheim, Calif. Included is information about a chapter-led effort to bring members of the Greater New Orleans Chapter, which hosted the 2005 NTI, to Anaheim following the devastation of their city from flooding in the aftermath of Hurricane Katrina. AACN wants all nurses in the hurricane-ravaged Gulf Coast area—Alabama, Florida, Louisiana, Mississippi—to know how much we admire your courage and dedication to caring for others throughout the ordeal, from which the recovery continues today. Please continue to let us know your needs, personal and professional. You are in our hearts always, and we want to know how you are doing. E-mail us at aacnnews@aacn.org.
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