President's Column: Starting Now: Stepping Toward a Revolutionary Shift

Jun 05, 2023

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As AACN President Amanda Bettencourt finishes her term, she shares some closing thoughts on how Starting Now, "It’s time for nurses to carry out our own collective act of ethical visualization."

In May 2022, when I announced that Starting Now would be this year's AACN theme, it felt like the start of nurses' own revolution. A revolution of hope. Hope that we'd crack open many of the fundamental principles of our current healthcare system. Because it needs to look so different from what we have now. And hope that we'd take our first steps to repair broken pieces. To ruffle feathers. And to break new ground.

When our country's founders drafted the United States constitution on the heels of the American Revolution, they performed what has been called a “collective act of ethical visualization.” It's time for us to carry out our own collective act of ethical visualization. It's time to frame a new constitution so we can define for ourselves - and for others - that everything we do as nurses is rooted in what's important for our patients and their families. And important for our profession. But, maybe most of all, rooted in what's important for our well-being as individuals.

Now, what do you think of when you hear the words leader, leading or leadership? Being a leader does not necessarily mean it's time for you to become a manager or a charge nurse. Recognize that leadership comes in many forms, and once we accept our own power, we can demonstrate leadership every day by listening, supporting, mentoring and advocating, both in person and in our online communities.

I used to be a reluctant leader. I swore I'd never become a manager. But when a burn unit I worked in struggled to fill a manager position, I felt an obligation to my colleagues. After some conversations with trusted people and a lot of introspection, I interviewed for and ultimately took the position.

Those were some of the most difficult years of my career, but they were also some of the most rewarding. Seeing what we accomplished as a team energized me.

I also learned that nobody can lead alone. Reluctant leaders are competent and talented, but to unlock their potential, they need others to believe in them. That's where a first follower comes in — someone who recognizes another person's idea, creates momentum and brings others on board. Following someone and helping others rise together is another form of leadership.

Most change is incremental. We need our healthcare system to look radically different from what we have now, and that revolutionary shift requires us to take a first step, knowing many more steps must follow. Seeking solutions for inadequate staffing is an example of that incremental change.

AACN has advocated boldly for appropriate staffing for years. But over that time, staffing has become an even bigger issue. So with an eye on creating lasting and meaningful change, we convened a national task force. We purposefully invited bedside nurses, leaders and administrators with various perspectives because the best solutions arise when diverse voices are heard. We had passionate discussions and also disagreements at times, but we gathered around the priorities to put into action. A year later, we have a comprehensive framework of solutions that can be implemented to address the staffing crisis.

Even when we achieve appropriate staffing, however, it's abundantly clear that it's only one piece of the larger picture. AACN has identified six pillars of a Healthy Work Environment (HWE): skilled communication, true collaboration, effective decision-making, appropriate staffing, meaningful recognition and skilled communication.

Starting Now, we're taking bold steps toward implementing the HWE standards in individual units and hospitals. Change projects from AACN's Scene Investigator (CSI) Academy have resulted in significantly improved outcomes including reduced CLABSIs, CAUTIs and falls, with an estimated $84 million in hospital savings.

This fall, AACN plans to roll out 60 nurse-driven CSI teams to develop change projects focused specifically on implementing unit-based HWE standards. After that, we envision a multisite project of 45 hospitals to study how the health of the work environment impacts journeys across the continuum of care, including outcomes for patients, nurses and organizations.

Tennis great and humanitarian Arthur Ashe said it well: "Start where you are. Use what you have. Do what you can." In other words, start now.

A good first step is creating a personal manifesto, a statement that helps to focus the mind and remind you of priorities. When things become stressful, your manifesto can act as a north star to help keep your behavior aligned with your values. It becomes the foundation on which you build your professional life and a way to work toward change.

A personal manifesto can be something like this:

First and foremost, I prioritize my own well-being.
I approach every part of my life with care and attention.
I am guided by my values.
I nurture supportive and inclusive relationships.
I commit to inviting others in and seeking their diverse perspectives.
I am responsible for my actions.
I give credit to others for their contributions.
I am open-minded.
I commit to using my voice to speak truth to power.
I advocate, even when it means ruffling feathers.
I embrace joy and leave room for magic that transforms me.

The above is one nurse's personal manifesto. And backing them up is a team of fellow nurses, charge nurses, nurse educators, advanced practice nurses, students, colleagues from other professions, clinical leaders, nurse executives and hospital executives. And AACN is there supporting all of them.

I choose to be a nurse because I can visualize the endgame. I know we have to work through difficult times to get there, but I can see a healthcare system where we don't just survive. We thrive.

To create the future we hope for, we have to envision it as individuals and as a collective of professionals. That vision becomes the blueprint to guide us, to declare what we value today and what we believe about tomorrow. Starting Now.

If you have comments or questions about this Presidents' Video Chat, please email Amanda at