The weather forecast for the nursing profession continues to be cloudy, with increasingly blackened skies and impending tumultuous, potentially unnavigable storms. We have tied down the main beam, tightened the main sail into a storm trisail, and the sea anchor is out as the genoa sail is billowing beneath the 12-ft high waves. The spreader lights are lit on the 60-ft mast so that freighter ships, HealthCare Systems, can see the 50-ft sail boat, Nursing Hope, tossing about at the mercy of the storm. There are only 4 crew members on board, including the captain, and they are ready for retirement. With no crew coming to assist, the situation is dire. The auxiliary gas tanks have washed overboard, so there is no engine power. Reaching shore is too dangerous until daybreak because of the depth of the boat draft and rocky breakers at the distant harbor. The seas are too rough to see the beckoning harbor lights. So how does Nursing Hope plan to survive? The Perfect Storm: 4:1 ratio, ready to retire, and limited newly educated and seasoned replacements.
As I am writing this, preparing to leave for the Hawaiian Islands in the morning, another storm is occurring. The largest earthquake since 1989 has happened in Hawaii and the hospital there has been evacuated. Yet, I will leave as scheduled and see for myself what has happened. None of us can be certain at any time when nursing meets the inevitable turbulent future. However, when we have important leaders, who are visionaries and anticipate the oncoming waves of uncertainty, then we can be ensured that our future is bright and we will weather this impending storm. Linda Burnes Bolton and Roy Simpson, coeditors for this issue, are such leaders.
Linda Burnes Bolton, DrPH, RN, FAAN, is Vice President for Nursing and Chief Nursing Officer and Director of Nursing Research at Cedars-Sinai Medical Center in Los Angeles, Calif. She is one of the principal investigators at the Cedars-Sinai Burns & Allen Research Institute. Her research, teaching, and clinical expertise include functional health literacy for African Americans and other ethnic and racial communities, quality of care in racially and ethnically diverse communities, cultural diversity in leadership, eliminating structural and racial barriers as a solution to eliminating health disparities, and cultural diversity and healthcare overall.
Dr Burnes Bolton is the current President of the American Academy of Nursing and is a member of the American Nurses Association, the American Organization of Nurse Executives, the Association of California Nurse Leaders, the Center for Nursing Leadership, the National Black Nurses Association, and the National League for Nursing. She believes that the impending storm can be partially calmed by partnering nursing with industry in developing new technologies for nurses to conserve energy, save time, and provide safer patient care. The education system needs to prepare nurses to work with biometric systems to analyze and synthesize data and enhance the knowledge worker capability of nurses.
Roy Simpson, RN, CMAC, FNAP, FAAN, Vice President of Nursing Informatics, Cerner Corporation, has dedicated his career to leading nursing in informatics and technology. In 1999, Simpson received the Rutgers University Informatics award for pioneering efforts in the field of nursing informatics. He is responsible for strategic sales and planning for the patient care enterprise as well as industry related to Cerner's professional practice. He has more than 30 years of experience in nursing informatics and executive administration. His present executive research focus pioneered the development and funding of the Nursing Minimum Data Set, which is a minimum set of nursing data elements with uniform definitions and categories, including nursing problems, diagnosis, interventions, and patient outcomes, approved by the American Nurses Association.
Simpson serves on the board of trustees for Excelsior College, formerly Regents College, at the State University of New York. He has held board and committee appointments with the American Academy of Nursing, the National League for Nursing, the American Organization of Nurse Executives, and the American Nurses Association, along with other national and state professional organizations. He also served as distinguished professor at the University of Wales during the European Summer School on Nursing Informatics in 2002. Simpson lectures extensively around the world and has published more than 600 articles on nursing informatics and sits on 12 editorial review boards. As a world expert in nursing informatics, Roy Simpson faces the impending world crisis in nursing, considered to be the worst shortage of nurses to date, has his sights on the blending of technology and the practice of nursing as bridging the increasing gaps in workforce availability and the preparation of nurses and nursing leaders for the future.
The current thrust of potential dichotomy between the knowledge worker and technology and the nursing "caring" domain may create a vortex centering around ratios, and entry into practice as more faculty and nurse practice leaders retire.
The nursing practice environment has been changed from mostly autocratic, patriarchal, and physician domination to one of collaborative practice, nurse empowerment, and patient and family advocacy. A redistribution of power has changed the roles of physicians and nurses and has created new missions for healthcare systems. The national impact of Magnet Hospitals has enriched the overall way in which organizations are governed with significantly more staff nurse participation. However, many strong nurse leaders have fallen by the wake of the storm as new, energetic, healthcare executives decide the seasoned nurse leader is too strong to allow for dividing up the nursing workforce. While the nursing mandate is evidence-based practice, placing the patient foremost in a high-technology, stressful environment, with a sense of calmness, serenity, caring, and gentleness, financial and organizational productivity frequently create untenable barriers to the "caring" mission of nursing.
In addition, there is greater emphasis placed on science and knowledge-based nursing education without sufficient caring and touch. Can and should both caring and science be balanced in an autodynamic equilibrium on behalf of the caregivers and those they care for? Where will the future educators and leaders come from? Who is preparing sufficient knowledge-based nurse executives to weather this impending storm? With many new nurses coming from other careers into nursing, mostly mature and life experienced, the potential for building a stronger nursing workforce, including faculty and managers, is greater than ever. The advancement of nursing practice is directly related to the knowledge-based advanced practice capability of nurse executives, along with technology and administrative science, including financial management sophistication. Healthcare systems are like small cities and need politically seasoned and well-educated nurses who are adept communicators in order to continue to be the captains of the ship, Nursing Hope.
Barbara J. Brown, EdD, RN, CNAA, FAAN, FNAP
Editor-in-Chief, Nursing Administration Quarterly