Agenda for Change
"If there is a single constant in today's complex, tumultuous, turbulent health care systems, it is the state of continuous change; alterations, mutations, permutations, variations, modifications, consolidations, modulations, deviations, innovations, shifts, turns, diversions, even breaks, and closures of hospitals, especially in rural areas. The challenge for nursing is to respond to change in a proactive, interactive, and collaborative way" from the Editor, Barbara J. Brown, Nursing Administration Quarterly, Vol 19:3, Spring 1994, "Change: The Challenge for Nursing."
So, what is different in today's health care reform era? Do we, as nurse leaders, have an agenda for change? And is this agenda workable and acceptable to those affected by the proposed changes? Fortunately, nurse leaders have been gearing up for changes with a solid agenda, and foremost is "The Institute of Medicine Report: The Future of Nursing: Leading Change, Advancing Health." Dr Linda-Burnes Bolten, vice chair of the committee, a long-standing member of the Nursing Administration Quarterly editorial board, and vice president for nursing and chief nursing officer, at Cedars-Sinai Medical Center, Los Angeles, said "Transforming the nursing profession is a crucial element in achieving the nation's vision of an effective, affordable health care system that is accessible and responsive to all."
When we think of transformational leadership, innovation, and change, these words are synonymous with Dr Tim Porter-O'Grady, who is the issue editor for "Agenda for Change." Tim has been involved in health care for 40 years and has held roles from staff nurse to senior executive in a variety of health care settings. He is senior partner of an international health care consulting firm in Atlanta, specializing in health futures, organizational innovation, conflict, and change, as well as complex health care service delivery models. He is noted for his work on shared governance models, clinical leadership, conflict, innovation, complex systems, and health futures. As associate professor and leadership scholar at Arizona State University, Program in Health Innovation, he has co-led the implementation of the new Master's and PhD programs in health innovation. He is visiting professor at the hybrid DNP Program at the University of Maryland and is an adjunct professor at Lakehead University, School of Public Health, Ontario, Canada.
Tim has published extensively in health care, with more than 175 professional journal articles and 21 books and is an 8-time winner of the AJN Healthcare Book of the Year Award. He has consulted internationally with more than 500 institutions and has lectured in more than 1000 settings internationally. He has held a number of offices in professional associations and national and community boards such as the vice chair of the governing board of Catholic Health East, governor with Sigma Theta Tau International, president of AID, Atlanta, and the STT International Foundation, just to name a few. Tim is well known to Nursing Administration Quarterly readers and has been a guest issue editor for several topics, so it is no surprise that he is the issue editor for "Agenda for Change."
Several years ago, when presenting to an audience of mostly staff nurses, in the Northwest, I placed a large poster board with sheets for nurses to answer the question: What changes would you like to see by the year 2020? I find it interesting to review those comments for changes needed and see where we, as a profession, have progressed toward these perceived needed changes. In no particular order and with some relevance to today's changes, I would like to share with you what nurses thought:
* Retirement benefits matching by employer.
* Better health benefits and ability to convert all sick leave to pay.
* Continuous health benefits after retirement.
* Profit sharing, better pay, and increase in wages and benefits such as pension plans.
* Home-buying benefits.
* Better nurse/patient ratios (and this is before mandated state ratios).
* Flexible scheduling/job sharing, like mother's hours.
* Rewards for long-term service. Keeping staff from burning out in the profession. Keeping seasoned nurses in the profession. Don't put old nurses out to pasture. Provide refresher courses.
* Reward seniority for clinical nursing; transferable seniority.
* Increased pay for faculty educators of nursing. Fairness in nursing schools.
* Recognition of the value of nursing. To be respected as professionals. (Gallup Poll "Nurses most trusted profession for the 11th year" 2011.)
* More support from nurse managers/administrators. More teamwork.
* Cultural diversity, more men in nursing.
* Less paperwork. Standardized chart forms. (Top 10 trends in 2011 include IT. Information technology underpins providers' ability to shift to new care models. See the "Informatics" column by Roy Simpson.)
* Helping our colleagues staying in love with the profession.
With more than 200 comments, I have tried to sort through the most salient changes for today's agenda. And the last one really says it all.
Are you still in love with the profession of nursing? I know I am, and I remember when I was traveling and speaking in so many states and other countries. One time a video photographer wore a sweater with Charlie Brown's Woodstock with flags cheering yeah team. He said: "You are the national cheer leader for nursing, so I wore this for you" as the program was being telecast to other cities in that state, in a 3-day series. I miss those opportunities to share my love for nursing in a personal way but you can. Your passion for nursing is so very important.
If every nurse leader today focused on the agendas for change in a unified way, the agendas of Magnet, the IOM, the ANA, the NLN, the AAN, the Accountable Care Organizations, your states, and individual organization agendas would all be possible to achieve, and nursing would be at the forefront of changing the health care system, no matter what happens to health care reform and nursing's role. If it unravels, we are good knitters, and know how the skeins of color and diversity can weave a pattern of positive, all-embracing health care to cover all. Embrace "Change."
-Barbara J. Brown, EdD, RN, CNAA, FNAP, FAAN
Editor in Chief
Nursing Administration Quarterly
-Tim Porter-O'Grady, DM, EdD, ScD (
h), FAAN
Guest Editor