1. Schaffner, Marilyn MSN, RN, CGRN

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As I stepped out for an evening walk, my eyes were drawn to the sky full of beautiful cumulus clouds against a dark blue sky. Fair-weather cumulus clouds are fueled by buoyant bubbles of air that rise upward from the earth's surface. As they rise, the water vapor within cools and condenses, forming cloud droplets. Young fair-weather cumulus clouds have sharply defined edges and bases, whereas the edges of older clouds appear more ragged (Fair-weather cumulus clouds, 2003). Imagine my thrill when I looked up and saw a nicely formed esophagus and stomach!


I was quickly drawn back to my youth. My brothers and I would lie on the grass watching the clouds roll by and call out the shapes we saw in the clouds. The greatest excitement came when one of us could identify the shapes seen by the others. Seeing the shapes in the sky was a gentle reminder for me to see the possibilities in my life.


Recently, a friend reported yet another staff cut because of decreased funds for the state-run clinic she manages. Despite decreases in funds, patient visits continue to increase. The pressure is on to build cash for funding a new endoscopy unit, or perhaps a new hospital. The patient's length of stay continues to shrink, putting large burdens on the staff nurses to educate the patients and their families so they can comfortably and safely care for themselves or their loved ones upon discharge.


There is a focus on productivity, but at times we feel the wheels are spinning, taking us nowhere. There is a fine line between living in the moment, not worrying about what may never be, and creating a vision that provides staff with a hope of what can be. Work stress adds to the complexity of finding that balance. How do we as leaders ensure that we do not develop ragged edges like the "older clouds"? How do we maintain the ability to create a vision for a better tomorrow?


I asked some colleagues how they maintain hope and a vision for tomorrow amid the daily adversities. One colleague said, "I am able to maintain hope because of all the other stuff besides the adversities-the good stuff." Another colleague said, "We are doing 95% of things well, and the 5% is getting better." Still another said, "I am able to maintain hope because I witness the leaders making decisions based on what is best for the patient."


Now, more than ever, leaders must be purveyors of hope. Hope is a vital psychological resource in our lives, and it arises from a strong desire to change a situation and from the impression that this change is possible (Lazarus, 1999). Leaders must see not only the current reality, but also what possibilities can be achieved (Thornton, 2003). They must help others see the possibilities.


Elias Zerhouni, director of the National Institutes of Health (NIH), says that as a leader, one must first have a big heart. Having a big heart means that one has a passion-a belief deeply set in one's core values. Leaders describe what is possible with passion-passion that comes from a belief in a better future (Thornton, 2003).


Second, leaders must have a spine, which means they stand up for what they think and take risks for the things they feel are important (Lauer, 2003). Leaders must have the courage to challenge the status quo, to be different, to speak out, and to go in a new direction (Thornton, 2003).


Third, leaders must have "brains." Zerhouni, however, believes a big heart and a strong spine are more important than brains (Lauer, 2003). It is with a big heart and a strong spine that trust relationships can be built. Trust is the lubricant for all successful relationships, whether it is the bond between managers and directors or between practitioners and their patients (Spath, 2003). With trust relationships, leaders can build a better tomorrow.


As leaders, we must maintain self-awareness when our edges are becoming ragged. We must find techniques that work to help keep us fresh and able to envision a better tomorrow. For instance, sitting in my windowsill is a bendable nurse holding a smooth cobalt blue stone with the inscription "hope." Merely glancing at the word "hope" or caressing the stone can help refresh my spirit. At other times, a playful approach is best. I have a small magnetic dartboard hanging in my window that has the phrase "challenge of the day" as its bull's eye. I envision the current challenge and throw the darts. Sometimes, I insert my favorite soothing compact disk and light an aromatherapy candle while reading emails.


Make a list of the good things going on in your work life. Create boundaries that separate work from home and family. Recognize when you need a few days off. Finally, ensure that you have someone with whom you can talk when your hope is dwindling.


Last week, someone was relaying to me that she had cable installed at her home. When the cable man came to the door, she greeted him and asked how he was doing. The man answered, "I am too blessed to be stressed." I am tucking that one away to be pulled out when, as a leader, I am letting stress cloud my sight of possibilities!




Fair-weather cumulus clouds. Retrieved August 10, 2003 from. [Context Link]


Lauer, C. S. (2003). Glad this doctor is in NIH's Zerhouni: An example of unconventional leadership that works. Modern Healthcare, 33( 30), 22. [Context Link]


Lazarus, R. S. (1999). Hope: An emotion and a vital coping resource against despair. Social Research. Retrieved August 10, 2003 from [Context Link]


Spath, P. L. (2003). Sharing the knowledge. Health Forum Journal, 46( 2), 16, 18-19, 47. [Context Link]


Thornton, P. B. (2003, July). The triangle of possibilities. Executive Excellence, 20( 7), 7. [Context Link]