I have been trying to limit my watching of the Newtown, Connecticut events on television. I feel guilty about it, as those directly affected by the horrible massacre that occurred December 14th must face the tragedy every minute of every day. Like you, I am experiencing all sorts of feelings of sadness and anxiety and my thoughts and prayers are with the victims, their families, and the first responders.

I have not limited my reading though. I feel that by reading the stories shared by family members, I am getting to know the victims and in some small way, I am honoring them. I am reading the stories shared by the survivors and feeling that in some small way, by doing so I am helping them process the events by “listening.” I am reading the thoughts and feelings of how others are processing what happened, hoping to contribute to the discussion and let our voices be heard so that changes can be made to make our nation a stronger and safer place for ourselves and our children. 

Now I turn to the feelings of “How can I help?” and “What can I do?” I encourage you to see posts from our colleagues at AJN’s Off The Charts and Nursetopia for lists of resources and ways to help. Also, the American Nurses Association has assembled a list of more than 30 nursing organizations joining forces to call for change. 

“The nation’s nurses call on President Obama, Congress, and policymakers at the state and local level to take swift action to address factors that together will help prevent more senseless acts of violence. We call on policymakers to: 

• Restore access to mental health services for individuals and families 

• Increase students’ access to nurses and mental health professionals from the elementary school level through college 

• Ban assault weapons and enact other meaningful gun control reforms to protect society”

Nurses – we are the largest single group of health care professionals. We see the devastation caused by weapons and violence. We care for patients with mental illness and know there is need for improved services and access to treatment. It is time to take action.

I just spent a wonderful long weekend in Nashville, Tennessee at Nursing Management Congress 2012. What a great city, great venue (Gaylord Opryland Resort and Convention Center), and great event! I learned a lot, connected with lots of nurse managers and executives, and enjoyed my surroundings. I have lots to share with you over my next few blog posts, but I’m especially excited to share the following idea which was presented by one of the attendees and then shared by Sharon Cox, BSN, MSN during the opening session, titled “Nurse Managers: Adding Value in a Time of Volatility.”

During one of the preconference workshops, a discussion about staff recognition had begun, when one attendee (I wish I knew her name to give credit where credit is due) shared a means of recognizing staff members that has had positive results. Rather than recognizing a staff member with a pat on the back or a letter of recognition to be filed, this manager asks the staff member (and I’m paraphrasing here), “I’d like to let someone important to you know what a valuable asset you are to us. To whom could I send your letter of recognition?”  She then wrote a personal note to to the person selected. 

This manager said she’s written to parents, spouses, mentors, and children of her staff members and has gotten positive feedback from all involved. She even met one staff member’s parents at a wedding and was thanked in person for the note she had written about their daughter.  

What a great idea!

Last week I had the privilege of speaking with Carole Eldridge, RN, DNP, CNE, NEA-BC, Director of Graduate Programs at Chamberlain College of Nursing. This fall, Chamberlain is launching a new Masters of Science in Nursing Healthcare Policy Track and I was particularly interested in learning more about Dr. Eldridge, as I’ve been following her on twitter for years (@Nerdnurse), and about this new MSN track.

I was more than impressed when I asked Dr. Eldridge to share her nursing background with me. In a nutshell, after about 15 years in acute care (including critical care, post-surgical care, hemodialysis, and transplant), Dr. Eldridge and her husband moved to Africa for about a year to run a health clinic. When she returned to the U.S., she started a Home Health and Hospice Agency which grew into about 50 agencies in 4 states! After selling this business, Dr. Eldridge became interested in education and saw a need for training nurse aides. She started her own publishing company which developed training packets. After selling this company, Dr. Eldridge returned to school herself for her MSN in Leadership and Healthcare Business, and later her DNP. She taught for about 3 years, and since then has held various titles including Director of a Master’s program, Dean, and Campus President. Wow!

In her current role, Dr. Eldridge oversees all of the graduate programs at Chamberlain College of Nursing. As previously stated, this fall, a new Healthcare Policy track is available for MSN students. The development of this track is timely in the wake of the report from the Institute of Medicine – The Future of Nursing: Leading Change, Advancing Health – and as we approach a Presidential election here in the United States. An MSN in Healthcare Policy will prepare nurses to be active in bill and policy writing, foundations, education and training, academia and research, disease investigations, health services, and other positions where one can “Impart the voice of nursing to direct the path of healthcare policies that benefit patients, the community, our nation and the world.”

This particular program involves 6 core courses (foundational concepts, theory, informatics, leadership, research, and basic healthcare policy) and 6 specialty courses (healthcare systems, economics, global health, nurse leadership and healthcare policy, healthcare policy practicum, and a capstone project).  When asked for more details about the capstone project, Dr. Eldridge gave me several examples that students from similar programs have done, such as global health projects, legislative proposals, and oral testimony collaboration. The coursework is flexible, can be completed in 2 years, and is completely online.

My favorite part of our conversation had to be discussing the upcoming election. Dr. Eldridge reminds us that as nurses, we have a responsibility to be politically engaged in order to best advocate for our patients. In particular, we need to be alert to the following:

• Economics – how will healthcare be funded? 
• Affordable Care Act
• The aging population, including funding their care & medical devices
• “Equitable access”
• Epidemiology
• Vaccines
• Global Healthcare 

Remember, Florence Nightingale was our first political activist. As nurses, let’s remain educated about the issues and share our voice. We are more than 3 million strong – it’s important that we are heard!

Resources:

The Future of Nursing: Leading Change, Advancing Health 

Keeping Health Care Reform Healthy, Patients Informed (American Nurses Association) 

ANA’s Policy and Advocacy page 

ANA's Nurses Strategic Action Team (N-STAT)

It’s been almost 2 years since the Institute of Medicine (IOM) and the Robert Wood Johnson Foundation (RWJF) released Future of Nursing: Leading Change, Advancing Health and this landmark report is still being discussed and written about. This thrills me! People are hearing and learning about nursing. Other disciplines in healthcare have responded to the report. Nurses are making changes based on the report and sharing their plans and outcomes. Good things are happening!

We have a collection of articles and editorials all about the Future of Nursing Report and in the past few months several good reads have been published. Take a look:

Learn how the nursing staff at one New Jersey health system embraced the report and made changes to improve patient outcomes and satisfaction by reading Responding to Health Care Reform by Addressing the Institute of Medicine Report on the Future of Nursing (Nursing Administration Quarterly, September 2012).

In Nursing's future: What's the message? (Nursing Management, July 2012), the authors share the response of the Robert Wood Johnson University Hospital Division of Nursing, including “…creating opportunities within our hospital and our professional networks for honest conversation about the report and its implications, and then using strategic planning to design our action strategies.”

Read Wellness Promotion and the Institute of Medicine's Future of Nursing Report: Are Nurses Ready? (Holistic Nursing Practice, June 2012) and discover how the role of disease prevention and health promotion, or wellness, is a critical component for nurses in implementing the changes recommended in the IOM report. 

In the NACNS Position Paper: The National Association of Clinical Nurse Specialists Response to the Institute of Medicine’s The Future of Nursing Report (Clinical Nurse Specialist: The Journal for Advanced Nursing Practice, August 2012), the NACNS addresses several of the IOM recommendations with strategies and recommendations specific to clinical nurse specialists. 

The American Association of Neuroscience Nurses has also developed specific recommendations based on the report which were published in the Journal of Neuroscience Nursing (June 2012) – Integrating the Institute of Medicine Future of Nursing Report Into the American Association of Neuroscience Nurses Strategic Plan. 

There are over 35 editorials and articles that have been published in our journals since the release of the IOM report. All can be read online FREE --- be sure to check out Focus On: The Future of Nursing.  

What changes have you implemented in your practice or career plans? Have there been initiatives at your workplace since the release of the IOM report?

On December 2nd, Dr. Donald M. Berwick will step down as administrator for the Centers for Medicare and Medicaid Services (CMS). Replacing Dr. Berwick will be Marilyn Tavenner, who served as Berwick’s deputy principal administrator since April 2010. The first article I read about this development was last week on Reuters.com. Toward the end of the article, I read “Tavenner is a former Virginia health secretary and hospital chief executive. A nurse by training, she has been with CMS since February 2010, first as acting administrator and currently as principal deputy administrator." A nurse to head CMS? Yes!

Since last week, I’ve read more about the sequence of events leading to Dr. Berwick’s resignation as well as more about Marilyn Tavenner’s background and experience. In this blog post from the Washington Post, Tavenner’s path from ICU nurse to this nomination is chronicled in detail with comments from former colleagues describing her as respectful, quick-thinking, decisive, and hard-working. In an article on HealthLeaders Media, more former colleagues share their thoughts and feelings of Tavenner’s pragmatism, leadership experience, and decision-making skills. 

The American Nurses Association (ANA) has released a statement commending the White House for its decision to nominate Marilyn Tavenner, MHA, BSN, RN, to head CMS.  I’d like to join in on the commendation. Seeing a nurse take on such a prominent leadership role makes me feel proud – how about you?

There are certain words and phrases that are used frequently in nursing and medicine – sometimes so frequently that we lose our understanding of their true meaning. Or sometimes, we may not have really understood them at all.

For me, “shared governance” was one such phrase. In the past, if someone had asked me what shared governance meant, I would have had some difficulty explaining it in great detail. Sure, I would have answered that it’s a model for nurses to work together and manage themselves, but beyond that, I’d have been at a loss.

That is, until, I did some reading. Now I feel better prepared to discuss shared governance and its role in nursing. Here’s what I’d say now:

Shared governance is collaboration, whether in scheduling staff, educating new staff, or implementing evidence-based practice. It involves teamwork, problem-solving, and accountability, with the goals of improved staff satisfaction, productivity, and patient outcomes. It is working together to make decisions that affect nursing practice and patient care. It is working with other disciplines for the good of the patient. It is collaborating to improve nursing practice. 

Allow me to share the following excerpt which I found very enlightening:

The structure is shared governance; the process is professional nursing practice; the outcomes are positive productivity data.¹

Is a shared governance structure in place where you work? Have you been involved with implementing shared governance? I'd love to learn more; it sounds like the ideal working environment, but I'm wondering - does it truly exist?

1. Church, J.A., Baker, P., Berry, D.M. (2008). Shared governance: A journey with continual mile markers. Nursing Management, 39 (8).

What does it mean to be a leader? In the past, I would think of a nurse leader as any nurse in a management position or an advanced practice nurse. After reading Finding the Leader Within: Thoughts on Leadership in Nursing, my perspective has changed. Let me share the following words of the authors to help you understand why we all can be, and should be, nurse leaders:

…real leadership is less about a title or institutionally granted power, and more about how we “show up” in the myriad of moments that make up our days.

…leadership is an “in the moment experience”

…being a leader is basically about constantly trying to be a better person.

The authors’ work has focused on helping individuals find the “leader within” and developing behaviors to share their leadership with others. To do this, they identified five “skill-cepts”, that is, skills derived from leadership concepts:

1. Know your stuff - have the knowledge and be confident in it
2. Have a goal - know where you are going
3. Stay “in role” - focus on your goals and how to achieve them; avoid taking things personally (you really must read this part of the article in its entirety!)
4. Love the fight - recognize resistance as a sign that you are making an impact
5. Cultivate gratitude - remember there is always something positive to gain, even when you are faced with challenges

I hope you find this article as inspiring as I did. You can read it free online until 7/1/11 as it is from our current featured journal. Let me know what you think!

Reference: Gordin, P.C. & Trey, B. (2011). Finding the Leader Within. Journal of Perinatal and Neonatal Nursing, 25(2), pp. 115-118.