1. Triolo, Pamela Klauer PhD, RN, FAAN

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After nearly 3 decades of watching the issues that continue to swirl around nursing, I begin to wonder if we actually experience repetitious cycles of challenges, like the seasons that come and go. From Anne Fisher writing in Fortune magazine about How to Battle the Coming Brain Drain, to every nursing journal with articles addressing safety in the workplace, the nursing shortage, and leadership development, one cannot help but pause and remember that 10 years ago, these same topics were the news.1


One questions what we as leaders have done to interrupt the cycle and reinvent healthcare. How have some of our short-term solutions to the problems, like using agencies to combat the shortage or sign on bonuses for recruitment, resulted in a whole host of new issues? What type of meaningful, long-term solutions have provided some semblance of stability yet created growth in health delivery systems and professional practice? How have we created new realities for nursing practice that have really taken us to the next level?


Due to the tremendous pressures of every day organizational life, administrators may be tempted to take the easy way: adjust the organizational chart without planning, cut costs through across-the-board reductions, increase compensation with no expectation that behavior will change or consequences if it does not, or indiscriminately hire anyone for a quick fix that actually ends up compounding the climbing vacancy rate. We too often address symptoms of problems rather than taking the time to explore and address the root causes with new management strategies.


Also, we sometimes forget in our frenzy to fix something that there are formulas for successful organizational and people performance available to us. In general, we would not begin a road trip without a map, build a house without a blueprint, or bake a cake without a good recipe. And although there is no single formula that we should turn to and expect results, models and methods can be combined, like a good chief takes a basic recipe and transforms it into a gourmet delight. Nurse administrators, with their tremendous knowledge of the working business, can take what we know and apply some of these time-tested models that are the foundation of quality.


Remember Avedis Donabedian? In the 1960s, his formula for quality2 began to transform healthcare as we considered his triangle: structure, process, and outcome. How often do we focus on structure and process without measuring our outcomes, creating our scorecard, tracking, trending, and benchmarking our results? A quick look at the Baldrige Criteria for Health Care3 and the scoring criteria reveal that of the 1,000 points, 550 cover structure and process criteria and the remaining 450 on outcomes. Every single organizational development model from the Forces of Magnetism4 to the Burke-Litwin Organizational Development cycle5 is driven by the component of leadership and considers the environmental context. Yet rarely do we see the science of organizational development taught in nursing programs or presented at our national meetings.


One of my favorite quotes by Albert Einstein is the definition of insanity as "doing the same thing over and over again and expecting different results." Another by Arthur W. Jones is, "All organizations are perfectly aligned to get the results they get." From personal weight loss to retention of staff, change is required, at all levels of the organization, to realign and achieve different results. And the kind of change that is needed in nursing and healthcare transcends the unit and the healthcare organization and must involve the business community, patients, and families we serve, our academic partners, and our governing bodies at the state and federal level.


In this issue, you will see the work of a variety of nurse leaders and business leaders who have created new partnerships to address shortage issues beginning in elementary school to new funding for faculty through government and foundation support, leaders who are working on safety issues, as well as evidence-based development for future nurse leaders. Another article addresses the issue of residency programs for our new graduates who we continue to plunge into what we know is a stressful and dynamic work environment, often without considering the reinvention of our basic nursing education to better develop the new nurse for the world of work.


When I am asked if someone should become a nurse, my response is, "This is the best time in our history to become a nurse." The visibility of nursing, the public trust of the profession, the rising grade point averages of applicants, the zeal for excellence in practice, the wide open opportunities for career growth, and the value of advanced education are just some of the few reasons why this is the moment for nursing. Let the challenges continue and leaders will step up to the plate.




1. Fisher A. How to battle the coming brain drain. Fortune. 2005:121-128. [Context Link]


2. Donebedian A. Evaluating the quality of medical care. Milbank Mem Fund Q. 1966;44:166-203. [Context Link]


3. Baldrige National Quality Program. 2005. Available at: Accessed July 19, 2006. [Context Link]


4. American Nurses Credentialing Center. ANCC Magnet Recognition Program. Available at: Accessed July 19, 2006. [Context Link]


5. Burke WW, Litwin GH. A causal model of organizational performance and change. J Manage. 1992;18(3):523-545. [Context Link]