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Vol. 23, No. 6, JUNE 2006

President’s Note
Engage and Transform
Achieving Our Preferred Future

Following are excerpts from the keynote address delivered by AACN President Debbie Brinker, RN, MSN, CCRN, CCNS, at the opening session of the 2006 National Teaching Institute and Critical Care Exposition in Anaheim, Calif. The full text with references is available online at www.aacn.org > NTI or by calling (800) 899-2226. Request Item 006107.

We must be the change we wish to see in the world
—Mahatma Gandhi

What would your work environment be like if you designed it yourself to meet your exact specifications? How is this vision different from your current reality? How can you become engaged to move closer toward your vision?

I’ve learned so much in the past year serving as president of AACN. I’ve learned about individual and team excellence from the hundreds of nurses I’ve had the honor of engaging with across the country. I’ve learned what organizational excellence looks like from my fellow board colleagues and AACN staff members. And I’ve learned that organizational excellence begins with setting the kind of vision I’ve just asked you to think about. In our planning work at AACN, we call this vision the desired or preferred future.

We must have a clear picture of the destination before we can draw the map to get there. Let’s create this destination we call our preferred future. Does your vision look something like this?

• Nurses and all healthcare professionals insist on working only in healthy work environments, those where evidence-based practice is the norm, where systems are truly driven by the needs of patients and families, and where all team members make their optimal contributions.
• All team members are as proficient in communicating as they are in their clinical skills.
• Collaboration is not optional, and those who choose not to collaborate are not tolerated and are not welcome in patient care.
• Our priorities are elevated so that clinical outcomes like ventilator-associated pneumonia become an exception—a landmark event where we investigate every detail to determine what went wrong because our competence and systems are so optimal that such a complication in our hands is unheard of.
• Errors are discussed openly and colleagues who make them are supported, because we know that patients are not the only ones who suffer when mistakes are made—healthcare providers do too.
• Our work calls to us and rekindles the passion we still have deep inside for this important work that we still love to do.

This is not an impossible future scenario. Many are already on the journey and are demonstrating that it is within reach. I believe we can create this future when we seriously engage and commit ourselves to ensuring that three fundamental components—individual competence, team competence and organizational competence—are always present in our work environments

Individual Competence
Each of us must be accountable and answer for our own practice. We must work on ourselves first, transforming ourselves to become exceptional in our communication and collaboration skills while we sustain and extend our clinical competence. Just as you and I know how to quickly troubleshoot a malfunctioning pacemaker, we must become expert in communicating in difficult situations with physicians, families, respiratory therapists, pharmacists and anyone else in our daily work who impacts the care of our patients.

And in the same way that each one of us is responsible for acquiring the latest clinical knowledge and applying evidence-based standards in the care of our patients, we must also hone these critical communication and collaboration skills.

Team Competence
Healthcare is a team sport—an extreme sport, really. If we are not competent as a team, we suffer, and our patients and families suffer. Masterful communication and collaboration are not optional because patient care is too complex; none of us acting alone could ever meet those multifaceted needs.

The preferred future we are driving toward is rich with mutual respect and meaningful recognition that cannot be achieved in systems rife with hierarchies, traditions and power struggles. The days of not questioning our colleagues—including physicians and administrators—when we think something’s wrong cannot continue if we are committed to error-free, safe environments where patients feel confident in our care. Similarly, the practice of nurses mistreating their own—including new nurses to our units—must be eliminated if we want to produce transformed environments.

My preferred future is a place where patients and families are an integral part of the team—and I think most of us believe in this essential principle. Yet we are still annoyed when a family member grills us about the appropriateness of medications and other treatments and procedures. Imagine if we reframed our thinking to appreciate a family member who takes the time to verify that a medication is correct. How often do we see this as a value-added step in our patient safety system?

Organizational Competence
In order for our hospitals and healthcare systems to be truly transformed—to live up to that vision we call the preferred future—we must be leaders in redesigning our systems to produce outstanding results in patient care and in the experience of those who care for patients. We must reinvent the cumbersome systems we work in, and often work around. Did you know that approximately 50% to 60% of staff’s time in hospitals is spent working around problems that occur repeatedly? Is that a sign of a competent system?

What steps will you take to further the competence of your team and your organization? Imagine what progress we could make if each of us committed to taking these three actions to promote individual competence, team competence and organizational competence:
• Hold yourself and your teammates accountable for applying evidence in your practice using AACN’s practice alerts
• Discuss the importance of team competence in your next staff meeting and lead the group in creating your own definition of team competence and the outcomes that you will strive for as a competent team
• Immediately engage by identifying the one organizational system that needs the most improvement and participate in developing solutions that will transform this system into one that supports, rather than inhibits, your organization’s competence

This requires our best energy, but I believe this engagement will return our energy to us a hundredfold as we and our patients reap the benefits of organizational excellence. Excellence will inspire and energize teams of professionals who become reconnected with their passion—the passion that you and I recognize as the reason we chose to do this work in the first place.
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