1. Alexander, Mary MA, RN, CRNI(R), CAE, FAAN

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The following speech was delivered at the INS 2012 Annual Convention and Industrial Exhibition in Las Vegas, Nevada, on April 30, 2012.

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Good morning. It is a pleasure to be with you all this morning.


Each year I am honored to stand before you and share the many wonderful moments that INS has enjoyed during the past year. As I prepare my thoughts and words I am constantly reminded of the impact we have on the daily lives of our members and their patients. The work you do as infusion nurses is gratifying in many ways. The work that INS does on behalf of our members is equally gratifying.


The year 2012 represents a special time for me, as it marks my 15th year as chief executive officer of INS and INCC. It has been a tremendously rewarding experience, both personally and professionally. I have enjoyed watching our organizations' growth, the growth of our specialty, and the growth of our individual members.


As I looked back on the last 15 years, I could not help but draw comparisons to the book Great by Choice, by renowned business management consultant and author Jim Collins. Mr. Collins also wrote the worldwide bestseller Good to Great, which studied how some companies were able to transform themselves from good companies into truly great companies.


In his new book, Mr. Collins, along with coauthor and researcher Morten Hansen, studied the question of why some companies thrive despite uncertainty, chaos, and even luck. With a team of more than 20 researchers, Mr. Collins and Mr. Hansen studied companies that rose to greatness over a 15-year period in an environment characterized by big forces, rapid shifts, and unpredictable conditions. As I read each page and digested the information being presented, I could not help but make the case that INS exhibited many of the traits of the companies listed in the book.


The first chapter in the book is entitled "Thriving in Uncertainty." Is there any better word to describe the health care arena in general, and nursing in particular, than uncertainty? The first sentence in the book is simple but profound: "We cannot predict the future. But we can create it."1(p1) The authors continue: "None of us can predict with certainty the twists and turns our lives will take. Life is uncertain, the future unknown. This is neither good nor bad. It just is, like gravity. Yet the task remains: how to master our own fate, even so."1(p1)


Our specialty has been filled with uncertainty over the past 15 years. Downsizing, rightsizing, consolidating, and outsourcing are some of the many buzzwords that echoed throughout the infusion nursing landscape. Most of these items presented themselves as challenges to the way we were accustomed to doing things. Change was happening at lightning speed. But much like the companies listed in the book, INS understands that we "face continuous uncertainty and that [we] cannot control, and cannot accurately predict, significant aspects of the world around [us]."1(p19) And much like these companies, INS has rejected "the idea that forces outside [our] control or chance events will determine [our] results; [we] accept full responsibility for [our] own fate."1(p19)


Discipline is a major reason for the success that we have enjoyed. As described by the authors, "discipline, in essence, is consistency of action-consistency with values, consistency with long-term goals, consistency with performance standards, consistency of method, consistency over time."1(p21) For a truly successful company, "true discipline requires the independence of mind to reject pressures to conform in ways incompatible with values, performance standards, and long-term aspirations."1(p21) So when health care facilities are looking to eliminate infusion teams, INS instead created a task force that will ultimately show, in concrete financial ways and in positive patient outcomes, the importance of the infusion team structure. When health care facilities began cutting back on reimbursement for membership in professional organizations, INS held the cost of its membership dues at the same level it has been since 1996. When health care facilities make decisions based on the bottom line instead of what's best for the health of the patient, INS continues to adhere to its mission by advancing the specialty through evidence-based practice and research and by advocating for the public.


It has been easy for INS to adhere to this discipline because of the allegiance that our membership has shown to our organization and to our mission. Your values and your standards advocating for your patients and your specialty are what motivate us to continue the important work that we do. We are committed to providing the resources and information that is critical to your success. Revisions to important resources like the Infusion Nursing Standards of Practice and Policies and Procedures for Infusion Nursing and the development of the INS Knowledge Center are just a few examples of our commitment to you and to setting the standard for excellence in infusion nursing.


While it seems as though the years have passed very quickly, our growth and influence within the infusion community has been steady and measurable. With each resource, each educational meeting, each position paper, each publication, each new chapter and international affiliate, the INS brand becomes stronger. The number of people and organizations who seek our advice and expertise continues to grow. We have expanded our reach and influence well beyond the borders of this country. The 8 international affiliates who are now associated with INS are testament to that influence.


INS' steady growth over the years is similar to the book's chapter entitled "20 Mile March." The authors paint a scenario in which they ask the reader to envision themselves making a 3000-mile march from San Diego to the tip of Maine. The march is conducted by traveling 20 miles per day-no more, no less. When the weather is good, you resist the urge to go further so that you can conserve energy to march 20 miles on the days in which the weather is not as good. By sustaining your pace and marching 20 miles each day, you will eventually get to Maine. It is the prototypical example of "slow and steady wins the race."


The authors of the book describe their march as follows: "The 20 Mile March is more than a philosophy. It's about having concrete, clear, intelligent, and rigorously pursued performance mechanisms that keep you on track. The 20 Mile March creates two types of self-imposed discomfort: (1) the discomfort of unwavering commitment to high performance in difficult conditions, and (2) the discomfort of holding back in good conditions."1(p45)


INS has conducted its own 20 Mile March over the past 15 years. We have been consistent in our beliefs and how best to reach our goals. We are fully cognizant of the challenges that are presented to us, but our commitment and high performance see us through to our goals in both good and difficult conditions. In addition to our consistency in our beliefs, we have been consistent in our performance. Our incredible growth in membership and the development of numerous educational resources are examples of our accomplishments. Doing this over time marks our consistency. We have made the journey espoused by the authors: "A good 20 Mile March must be achieved with great consistency. Good intentions do not count."1(p49)


There is an old adage that "change is hard." Mr. Collins and Mr. Hansen disagree with this premise. For them, "far more difficult than implementing change is figuring out what works, understanding why it works, grasping when to change, and knowing when not to."1(p134) We are in full agreement with their assessment. Change can be challenging, but if implemented correctly and timely it can provide defining results. A look over our past gives us a vision of a clear path of defining results for INS.


One of the final chapters in the book exemplifies a concept that INS likes to adhere to. It is called SMaC and stands for Specific, Methodical, and Consistent. The authors advise that the "more uncertain, fast-changing, and unforgiving your environment, the more SMaC you need to be."1(p147) We could not agree more. INS has repeatedly resisted the temptation to make decisions based on the latest fad or whim. We try to be specific and consistent in our decision making, as we believe this generates the best results. Our work over the past 15 years is testament to that belief.


Despite the many challenges and changes that have occurred over the years, the one constant that has existed is the support and dedication of the INS membership. We did not make our 20 Mile March alone; we made it with you. During that march we were faced with numerous challenges and obstacles, but they provided us with determination and inspiration to do the right thing. We developed an SMaC recipe and remained loyal to it because we wanted to make a lasting contribution to our membership. You were not interested in any short-term stop-gap measures but, rather, long-term solutions.


We believe through all the uncertainty, chaos, and even luck, INS has thrived. It has been a thoroughly enjoyable journey and one that we are honored to have shared with each of you. As we look ahead to the next 15 years, we do so with a commitment to our united and dedicated membership. We invite you to continue the journey with us and help INS continue to serve as the global authority in infusion therapy.


Thank you.




1. Collins J, Hansen MT. Great by Choice. New York, NY: HarperCollins; 2011. [Context Link]