29 January 2012

PlexusCalls on The Future of Nursing

I had the good fortune of serving for the past seven years on the Plexus Institute board of trustees. In 2010-11, I served as chairman of the board. Plexus does great work! In service of my intention in writing this blog, "Meta-Reflections" (creating community and inviting action through reflection and sharing of personal, professional and public resources), I invite you to explore resources available to you at Plexus Institute. There are a great number of PlexusCall podcasts available free of charge at iTunes or by accessing archived PlexusCalls at Plexus Institute.

I want to particularly draw your attention to a series of calls, titled "The Future of Nursing," that were produced in the fall of 2011. (Thanks to Prucia Buscell of Plexus Institute for providing some of this information.) The Future of Nursing podcasts, Parts I, II and III, included nurses from across the country who explored the RWJF and Institute of Medicine Future of Nursing report and discussed how complexity principles could influence and inspire effective change and provide solutions to issues challenging nurses in education and practice settings. Below is a brief description of each part, linked to the appropriate podcasts. I hope these calls will provide you with new information and opportunities for reflection and action.

On the first call, Liana Orsolini-Hain, PhD, RN, CCRN, a Robert Wood Johnson Foundation (RWJF) Fellow from California, says nurses, as the largest portion of the health care work force, are in the best position to promote improved patient protections and increased access to care. Itemizing key messages in The Future of Nursing report, she emphasizes that all nurses should:
  • Practice to the fullest extent of their education and training.
  • Achieve higher levels of education and training through an improved education system revised to promote seamless progression.
  • Be full partners with physicians and other professionals in designing health care.
  • Work toward improved data collection and infrastructure that makes policy making more effective.
Orsolini-Hain says leadership is needed to shift focus from individual practices to the needs of national populations and the role of health care teams. The educational goals, she says, include increasing the number of nurses with bachelor’s degrees to 80 percent by 2020, and doubling the number of nurses with doctorates.

This series of calls features a description of how the complexity-informed processes of Appreciation, Influence and Control (AIC) were used to create, with the future transformation of nursing education in mind, an appreciation of the nursing culture. AIC, developed by William E. Smith, PhD, author and principal of Organizing for Development, was introduced to nurses at the 2009 Plexus “Nursing On the Edge” Conference. Building on work introduced in 2009, Smith partnered with Cynthia Hornberger, PhD, MBA, RN, ARNP, professor and special assistant to the president at Washburn University School of Nursing, and me, chair of Plexus Institute board of trustees (2010-11) and professor of nursing at Indiana School of Nursing, to use the AIC process with attendees at conference, held at Gonzaga University in Spokane, Washington, USA.

Using the AIC process, we asked participants what it would take to transform the future of nursing education. Analyzing the data we gathered, we developed power maps. A summary and implications of the AIC Appreciation of Nursing Culture are shared on the call.

Results suggest that we nurses, for the most part, go about our work in a very open, appreciative way. We listen, learn and discover. We rely more than most on our innate intuition and sensing capacities. Our first preference is for the use of appreciative power (47 percent). Secondarily, we rely on our ability to relate to other people (influence power), but this extends to our ability to relate to new ideas and technologies. Our preference level for the use of influence power is 38 percent. When we have to, we can also be directive, relying on our knowledge and experience. Our preference level for the use of control power is 15 percent. Ideally, preference levels for appreciation, influence and control should each be at 33 percent. The implications of this assessment? Nurses probably need to be more open to influence of others and, in turn, influence others more and act accordingly in supporting nursing values, ideals and purposes.

This series of calls features Phyllis Beck Kritek, PhD, RN, FAAN, an internationally known nurse scholar and writer who is frequently engaged as a facilitator by organizations and health care agencies seeking to create effective strategic changes. She is noted for her ability to create conceptual maps that assist individuals and groups grappling with challenges and dilemmas. She is the author of two books on conflict resolution and healing: Negotiating at an Uneven Table: Developing Moral Courage in Resolving Our Conflicts and Reflections on Healing: A Central Nursing Construct. She discusses the need for nursing leadership and how to build productive relationships that increase standards of care and improve organizational outcomes in complex environments. Individuals, she points out, need to move from toleration (where people do their work in silos) to cooperation (where they work together for mutual benefit) to collaboration (where they retain their autonomy but become skilled at facilitation, analysis, reframing issues, and working with others to overcome obstacles and achieve shared values).

Kritek discusses the importance of deep personal reflection and attention to the shadow work that is necessary to collaborate more effectively. Leadership and collaboration, she notes, requires people to assume they are operating in a complex adaptive system where they must adapt to uncertainty and emergence. It takes courage to act in the face of danger and rejection. “If that were easy, we’d all rush around being leaders,” she says.

Plans are being developed to launch a 2012 Nursing Learning Network Call Series. Plexus Institute invites your support and participation. Stay tuned! Stay engaged! What the future holds for you depends on what you hold for the future.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.