AACN News—March 2008—Opinions

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Vol. 25, No. 3, MARCH 2008

President’s Note Reclaiming Our Priorities

Leaders. What about them?

Let’s take a different tack this month and do some free-range thinking about nurse leaders. It’s a topic I think about a great deal in my dual role as clinical nurse specialist and AACN president. One caution: If you generally think in a straight line, you won’t find the usual beginning, middle and end. I hope this nonlinear thinking doesn’t distract you.

Authentic leaders. “Nurse leaders must fully embrace the imperative of a healthy work environment, authentically live it and engage others in its achievement.” I’m sure you recognize Standard 6 of the AACN Standards for Establishing and Sustaining Healthy Work Environments. A familiar dictionary definition is that authenticity means conforming to fact and therefore worthy of trust, reliance or belief. An authentic leader genuinely understands what happens at the point of care and successfully translates his/her vision so it becomes relevant at the frontline.
Idle dreams. A wise leader knows that an untranslated vision and no committed team to make it happen means nothing more than idle dreaming. In its 2003 report Keeping Patients Safe: Transforming the Work Environment of Nurses, the Institute of Medicine identified transformational leadership as the best way to solve the leadership problems in healthcare. The IOM called it the essential precursor to patient safety, successful organizational change and an organization’s competitive position. Transformational leadership involves influencing the choices that individuals and groups make in order to achieve lasting and positive change.

Remembering to ask. Leaders are obligated to translate their vision so everyone in the organization can understand his/her part in achieving it. But why wait until you’re told? Why not schedule time with each of your nurse leaders—CNO, director, manager, advanced practice nurse—to inquire about their vision? They are nurses first and foremost, who ultimately want what you do. When you take time to learn more about them and their vision, I suspect you’ll discover you share more similarities than differences.

An informed culture. James Reason, a British human factors expert, proposes that a safe culture is an informed culture. An informed culture leads to an atmosphere of trust, which in turn creates a just culture where there is a clear line between acceptable and unacceptable behaviors. In a truly informed culture, information moves in every direction. Top down. Bottom up. Sideways. Consider inviting one or more of your nurse leaders to join you at NTI – especially if their background isn’t acute or critical care; it will expose them to the uniqueness of our specialty and the universality of nursing.

The eternal circle. In the leadership classic “Flight of the Buffalo,” James Belasco and Ralph Stayer remind us that business is a metaphor for life. They refer to the “eternal circle” of doing, learning and changing. Mistakes and fear are consistently two of the most effective teachers. Fearful leaders teach us what happens when we allow ourselves to become paralyzed. Leaders who make mistakes teach us how to move beyond fear. Warren Bennis and Robert Thomas take it further in a Harvard Business Review article by saying that adaptive capacity is the most critical essential skill to lead successfully. Adaptive capacity is the combination of grasping context—that is, being able to sort out a multitude of data to put a situation in perspective—and hardiness—the toughness of weathering a devastating experience without losing hope. They call it “an almost magical ability to transcend adversity,” coming out stronger on the other side. Have you known leaders skilled in overcoming adversity? Have you worked with leaders who truly viewed failure as their friend and not an enemy to be avoided at all cost?
It’ll be fun. How have nurse leaders you admire communicated their vision and influenced you? I fondly recall one leader whose ability to mobilize support across every level and discipline in an organization was legendary. She had the uncanny ability to equally zero in on everyday challenges—for example, how to safely transport a critically ill patient across three buildings during major construction—and a long-range vision—like how the “AACN Synergy Model for Patient Care” could become our formal nursing care model or even how our healthcare organization would be the first in the country to implement the AACN Standards for Establishing and Sustaining Healthy Work Environments. No matter the complexity and frustration, she authentically inspired us with a smiling “It’ll be fun, you know.”

If only I could be like … Even as an adult—maybe especially as an adult—do you find yourself wistfully thinking, “Someday I wish I could be like [insert name here].”? This wish is a powerful clue about how we view leaders and their behavior. It reminds us that we do indeed recognize and value talented leadership. Otherwise we simply wouldn’t want to emulate it. Think for a moment about the leaders you have known. Who are the authentic leaders you admire? What compels you to believe in them? I have no doubt there is at least one and possibly more you could recognize. Please share with me by writing to me at priorities@aacn.org.

Letter to the Editor

Dear Dave,

Since the beginning of your AACN presidency I have wanted to e-mail you. Each time I read your President’s Note in AACN News I would tell myself to e-mail you. As NTI draws near I realize so does the end of you presidency, so I’d better reclaim my priority and send this e-mail.
All of your opinions have touched my practice. However, your February article reminded me of the importance of what I do as a nurse and as a nursing faculty member. Whether it is when I am working a shift at the Heart Hospital of South Dakota, in the clinical arena with students or in the classroom, I cannot forget mindfulness. When you wrote that “although we do not carry the traditional weapons around like law enforcement officers do” you struck a powerful chord with me.

When I teach students medication administration and go through the six rights, I bring information to the classroom regarding medication errors; when we are giving or preparing the medications during clinical rotation I know how easy it is to become distracted. Now you have given me powerful words to use as I teach. From now on, I will use the metaphor of a gun and how our inattention to what we are doing at the moment and its subsequent effects can unleash hazardous and even fatal firepower.
Thank you for all the wisdom you have given AACN members during your time as president.

Teresa Jahn, RN, MSN, CCRN
Canton, S.D.

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