"Nurses Leading Care Innovations," the theme for 2009 International Nurses Day, certainly makes this issue of Nursing Administration Quarterly (NAQ) timely and globally meaningful. Of course, when we have visionaries such as Tim Porter O'Grandy and Kathy Malloch as coeditors of this issue, we can expect nothing less than relevant and stimulating articles. Dr Tim Porter O'Grady's recent issue (NAQ 33:2), "Elements of Leadership Excellence," set the stage for the progressive development of sharing the best in leadership from among today's authors. His credentials, although known to most nurse leaders, are found in the editorial for that issue. Dr Kathy Malloch also needs no introduction because she has edited the most recently published issue (NAQ 33:3), "Innovation in Transforming Organizations," and has been introduced in the editorial for that issue. Kathy and Tim are the team par excellence, making their mark on organizational transformations nationally and internationally as visionary consultants, speakers, and authors.
Nurse executives may find themselves confronting painful and challenging organizational transitions. Oftentimes, the long-term nurse executive is asked to seek another position when a new chief executive officer (CEO) is brought on board, thus displacing the nurse leader. Sometimes, the nurse executive is considered for the CEO position and steps up to the plate with enthusiasm and proven leadership skills and abilities. Whatever the situation, challenges bring about innovation and transition from past organizational vision to transformation in an optimistic futuristic model. New partnerships of innovation are formed with nursing, physicians, business leaders, and healthcare administrators. Complex policy changes and unique communication modalities afford the creative leader with multiple sources of knowledge management.
Education for innovation is a key to developing models to transcend the ages, which evolve from the industrial age to the high-level information technology age of tomorrow. Innovation stems from creativity in approaching whatever new forms of activities seem to be a solution to a challenge in any environment. Creativity is frequently expressed as the generation of ideas, which can be in music, dance, writing, and various art modalities and in any professional endeavor. Creativity adds to a body of knowledge in every field and enhances the growth of an individual as well as an organization and society at large. What is necessary is freeing oneself of past barriers and "can't be done" attitude to allow free-flowing exploration of new ways of doing things. It is taking a problem or challenge or obstacle and turning direction into an opportunity for change.
An adventuresome spirit and mind will consistently challenge any assumption about what most people think is true. Bold thinkers in nursing are always looking ahead to create new pathways of learning and doing, and they strive to create an environment conducive to the challenging of assumptions. Recognizing similarities and differences, and respecting each idea as one worth testing, begins in the practice arena. Research into new ways of providing care and evidence-based practice is consistently paving the path to improved healthcare systems. As we learn to see in new ways, the commonplace of nursing is being transformed. Nursing is the most creative of the arts, "the finest of the fine arts," as stated by Florence Nightingale in our rich history.
Innovation stretches our thinking to bring together seemingly unrelated ideas and relationships and enables a "can't do" to become a "do it." An example of this is when I was told that home healthcare was "not possible" in Saudi Arabia because of cultural restrictions, we assembled a multidisciplinary team to address the problem of no beds for cancer treatment protocol patients due to full occupancy. We planned a longitudinal study of terminally ill cancer patients being cared for in their homes so that beds could be used for other patients who might be treated. Without detailing the study, it is significant that today there is a viable home healthcare system in place at the King Faisal Specialist Hospital in Riyadh, Saudi Arabia. But sometimes, proceeding with a new idea can be risky because daring to try new ideas with no control over the outcome can result in being wrong. A creative leader and innovator must be willing to take risks and cannot be afraid of being wrong. Although it is very difficult to be in a position of authority, responsibility, and accountability, it might occur to the nurse leader that the new direction could lead to the removal from that position. There is no other way for an effective nursing administrator and executive to practice.
Often the unexpected opportunities provide time and circumstances to take a new direction. The networks made in establishing relationships that enhance patient care and the professional practice environment lead to renewed energy and enrich the lives of successful nurse leaders. With the increasing concern over a global nursing shortage and its impact on healthcare, we will have constant pressure to do more with less. The International Council of Nurses (ICN) has published "Delivering Quality, Serving Communities: Nurses Leading Care Innovations" and is asking that anyone, individual or group, with a nursing innovation, simple or complex, submit to the ICN Innovations Database at http://www.icn.ch/innovations/about.htm (International Council of Nurses, 3 place Jean-Marteau, 1201 Geneva, Switzerland). The stated criteria for the innovation must meet the following:
* The innovation has resulted in improvements in a service, program, structure, product, and/or system.
* For an innovation not yet implemented, the innovation has the potential to generate improvements in a service, program, structure, product, and/or system.
* The innovation must be current (generated between 2003 and 2009).
* The innovation has had the significant nurses' involvement and leadership from inception to development and implementation.
* The innovation has not been funded or supported by a manufacturer of tobacco or alcohol products.
Certainly, there are such innovators in nursing administration who could add to this database. Workforce innovations and organizational transitions in caregiving will be essential to addressing the continuing shortage of professional nurses. Even as we have sufficient numbers of people wanting to enter the nursing profession from other career pathways, we are dead in the water if we do not have faculty to prepare the workforce of the future. But can we change the way we work, using technology, and still keep the "caring" of the individual as our primary mission?
A recent experience with hospitalization of 2 family members, after a motorcycle accident, and 2 intensive care units (ICUs), with transition to floor before discharge, leads me to believe that we are in serious trouble. While the ICU care of both was exemplary, the post-ICU care was less than caring. Fortunately, the patient advocacy role came into play as the legal form was signed to allow all information sharing with a knowledgeable family member. I would hesitate to be in such a situation again without an assigned patient advocate.
Maybe we need "caring advocates" or tutors to ensure that nurses have time and abilities to "care." The willingness may be there, but the spirit of human caring may have been temporarily set aside with all the technology and less than human response to the pain and suffering experienced. Why did we become nurses in the first place? Why are we designated as nurse leaders? How can we ensure that each person and family will be the center of our redesign of organizations and healthcare systems? Is our vision so hampered by the continuous economic constraints that the future of nursing as "the caring profession" is at risk? Whatever healthcare environment in which you find yourself as a leader, the vision and mission of professional nursing caring will be the driving force for innovation and organizational transitions.
Barbara J. Brown, EdD, RN, CNAA, FAAN, FNAP
Editor-in-Chief, Nursing Administration Quarterly