AACN News—May 2007—Opinions

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Vol. 24, No. 5, MAY 2007

Creating Intentional Slack

Mary Fran Tracy, RN, PhD, CCNS,

Without curiosity, insight can be tough to come by. Asking questions is foundational in finding enduring solutions to improve our patients’ quality of care. But have you noticed how asking questions to gain certainty and knowledge usually leads to uncertainty and more questions? It reminds me of that old saying, “The more you know, the more you know you don’t know.”

Sometimes this gnawing uncertainty frustrates me and makes me anxious. Why can’t I just find the answer, I ask myself. I didn’t bargain on needing to develop an entire project just to find a simple answer, I tell myself. Times when there’s a lot going on can be overwhelming. It may seem easier and less stressful to turn off our curiosity and keep doing things the same way we’ve always done them. It’s a convenient fix, but not very practical in the long run.

Cultivate “Confusion Endurance”
Developing a high tolerance for ambiguity has become essential in a healthcare environment of constant change. Last month I mentioned “How to Think Like da Vinci,” an enjoyable book by Michael Gelb. He calls it the need to develop confusion endurance—the ability to explore paradox, embrace it and use its creative tension to catapult us to a new level of solutions. As nurses caring for high acuity and critically ill patients, we live in the land of ultimate paradox, where the omnipresent reality of death casts a unique spotlight on the quality of life.

Cultivating confusion endurance requires time and space to encourage curiosity and explore contradictions. In the units where we work, time and space are both in very short supply. Karlene Kerfoot, a veteran nurse executive well known to AACN for her creative vision, writes about the busyness of our workplaces and how it hinders the creative thinking nurses and managers need to have to address vital problems they know must be solved.

Build in Slack
Paradoxically, busy units may be more efficient from a financial, bottom-line perspective. The shortsightedness occurs with the assumption that financial efficiency is the only critical measure of a productive, quality care environment. What happens when there is a lull in a busy unit’s activity? Typically, its nurses are floated to support busyness in other units. Or those nurses are sent home. Helping each other in times of dire need is one thing. But mindlessly institutionalizing the practice and cheating every unit from essential time for creative thinking and problem solving harms all of us. It reminds me of another familiar saying, “The more things change, the more they stay the same.”

Kerfoot challenges organizations to intentionally build in slack so nurses and leaders have the opportunity to generate ideas and rethink current processes to improve patient care. How will we create our preferred future without taking time to envision what it should be or how we’ll get there? The obvious quandary is how to create slack in cultures where thinking time is equated with idleness. One way is to do it by stealth. Find less visible, but equally useful ways like taking 5 or 10 minutes from an already scheduled project meeting to deliberately talk about what ifs. For example, what if we wiped the slate clean and could redesign our work any way we wanted? You’d be surprised at how quickly that can jump-start creativity.

Tapping Those Who Know
Unrelenting change, 100% constant productivity and no allowance for nurses to use their considerable expertise beyond task completion is already dulling, even eroding, our creativity and curiosity. These things dampen genius and promote mechanistic, rote routines. Kerfoot recounts the story of the factory worker who is lauded at a retirement dinner for 40 years of dedicated and quality service to his company. With nothing to lose, the worker poignantly described year after year of new management mandated initiatives. Many of them failed because they weren’t aligned with what would work in reality. The work of his hands may have been valued, but his mind and ideas remained untapped.

Nurses at the bedside can tell us how to develop processes that will actually work. Some have decades of wisdom and insight. Others are new to the environment and see the familiar from a fresh perspective. What they need is intentional slack time to unleash their creativity.

When I first became AACN president, I didn’t deliberately plan to create a space in my life for confusion endurance or intentional slack. But reflecting on this year I now realize it’s exactly what I did. Visiting with many of you, I was inspired by the paradox of your enthusiasm and creativity even in the face of unrelenting change. I marveled at the solutions you might uncover if afforded the time and support to do so. I recognized how developing insight requires deliberate time and so began noticing opportunities to create the slack that Kerfoot suggests. Those insights have been your gifts to me and I cherish them with deep gratitude.

Have you developed confusion endurance and successfully created slack where you work? I invite you to share your experiences with me at insights@aacn.org.

What do you see?

See something a new way and you’ll never see it the old way again. Each of my columns this year will feature a different graphic so we can share a different dimension of seeking insights. —MFT

What is da Vinci painting?

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