It's 2014. Do you know what the future holds?

As we begin a New Year, thoughts turn from what was to what will be or could be! Imagining and creating the future is especially important in the context of President Hester Klopper’s 2013-15 presidential call to action: Serve locally, transform regionally, lead globally. Klopper’s request to provide input and respond to the work of the Global Advisory Panel on the Future of Nursing (GAPSON) calls for development of futures literacy among nurses around the globe.

Improve your futures literacy and help transform health care.

Consider that, in 1997, the International Council of Nurses (ICN), on the occasion of their 100th anniversary, partnered with the Institute for Alternative Futures to create the Guidebook for Nurse Futurists. The World Future Society is home to a number of resources that educators, clinicians, and administrators can use to exercise and influence the development of future-thinking skills. Perhaps, in 2014, it is time to renew and resurrect our learning about futures thinking, research methods, and the creativity associated with design-thinking about the future we want to create.

Intentional use of futures thinking and the application and evaluation of futures-related research methods is a chance to inspire agency in the face of uncertainty. How will you use these resources to anticipate, forecast, and respond to future trends and scenarios that have cascading consequences? What future do you want to create for yourself and the nursing profession at large?

Riel Miller, PhD, argues that futures literacy involves dynamic interactions between narrative capacity, our collective interactive sense-making intelligence, and our capacity to reframe situations. Nurses are very good at sense-making and, if provided the time, space, and resources, we excel at activating our collective intelligence and reframing situations with a greater good in mind.

In addition to Miller’s work, the ideas and insights of Margo Greenwood, PhD, and colleagues provide a road map for developing agency in the face of uncertainty. It is useful, they suggest, to reflect on the cross-impact of two variables: locus of control (to what degree do we see our response to the future in our own hands or the hands of others) and certainty versus uncertainty about the future. Such a 2-by-2 reflection reveals four positions. As you consider the positions below, discern what stance best represents the perspectives of your organization, colleagues, and your own personal or professional opinions.

• Position 1, Building site: People assume the future is open and undetermined, and they have control determining the way forward into possibility.
• Position 2, Route map: People are confident of a particular future coming to pass, and they have control over their path to that future.
• Position 3, Carried along: People are confident of a particular future coming to pass and do not see themselves having control over their path to that future.
• Position 4, Into the mist: People assume the future is open and undetermined, and they do not see themselves as having control over determining their way forward in relation to possibilities.

Is it possible to change peoples’ opinions, beliefs, and points of view? I believe it is, and An Educator’s Guide: Realistic and Creative Strategies for Thinking About the Future, is a wonderful resource that supports development of futures literacy skills and helps people see a way forward. The exercise included in this resource helps people explore and unpack tacit beliefs, values, and positions and nudges people toward more proactive insight and understanding of the need for agency and action.

As you think about your engagement with the Honor Society of Nursing, Sigma Theta Tau International, over the next biennium, consider how you can develop your futures literacy. Explore and experiment with some of the references, tools, and resources cited in this post. Share your learning and discoveries with others. Consider how exerting nursing-leadership influence can shape the future and contribute to the positive transformation of a 21st-century health care system. Move beyond the fear of uncertainty to agency and action.

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

Time, change, and transformation

Many in the United States are familiar with the Future of Nursing: Campaign for Action, an initiative of AARP, the AARP Foundation, and the Robert Wood Johnson Foundation. Participants at the Future of Nursing: Campaign for Action Summit 2013, held in Washington, D.C. early this year, used Liberating Structures to create action plans that advance Campaign for Action goals and objectives. Liberating Structures support change and transformation, and they provide leaders with new and creative ways to engage people in complexity change and transformation efforts.

The 2013 Summit, Transforming Health Care Through Nursing, produced some interesting results and action plans. Consider supporting efforts in your state or region related to the recommendations developed by Action Coalition participants. If nurses are to transform the future of nursing rather than change it, we need to become more conscious and reflective about differences that make a difference between change and transformation.

Transformation is what creates the butterfly's future.

Chris McGoff makes important distinctions between change and transformation. McGoff observes change fixes the past, whereas transformation creates the future. He notes that change is the work of managers, and transformation is the work of leaders. His observations suggest that, when it comes to issues of change and transformation, it is essential that people become more conscious of their perspectives on the nature of time and whether they are interested in a “fix” or a “creation.” There is a secret power to time. How might nurses become more conscious of and insightful about how time perspectives influence thinking, doing and acting in service of change and transformation?

Philip Zimbardo and John Boyd, authors of The Time Paradox: The New Psychology of Time That Will Change Your Life (2008), suggest that one’s time perspective is the nonconscious personal attitude that each of us holds toward time. Our attitudes toward time are bundled into time categories that help to give order, coherence, and meaning to our lives. Zimbardo and Boyd have identified six time perspectives: 1) past-negative, 2) past-positive, 3) present fatalistic, 4) present hedonistic, 5) future, 6) transcendental future. If nurses are to transform the future and advance health, what time perspective do you think is most valuable in service to a transformed future goal?

In future blogs, I plan to touch on the topic of futures literacy and its importance for next-generation nursing leaders. Meanwhile, I invite you to discover your own time pattern perspectives and engage in some reflection around how the pattern that emerges for you supports or inhibits your sense-making in terms of the work you do.

Complete the Zimbardo Time Perspective Inventory. How does your pattern of time influence your thinking, feeling, doing? As you learn more about the six time perspectives, how does this knowledge and insight help you understand those in your care or work world? If you had to conjecture the time pattern of professional nurses as a group, what would you conclude? How does one’s pattern of time influence perspectives on change and transformation? To what degree is it possible to reset one’s psychological time clock?

Becoming aware of one’s time perspective influences the development of one’s leadership capacity and sets in motion different dynamics, based on the challenges of change and transformation. If nurses are to transform the future and advance health, then paying attention to the influence of time perspectives and the differences between change and transformation becomes an essential variable in the equation.

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

The hero~heroine’s journey

Recently, I relocated from Indiana University School of Nursing to the University of Minnesota School of Nursing. Personally and professionally, I had to engage in deep reflection about this career move. I decided to answer the call and begin a new life chapter.

When we are called to something, we frequently embark on what Joseph Campbell describes as the hero’s (heroine’s) journey. Basically, there are eight steps to the journey: 1) Hearing the call, 2) committing to the call (overcoming refusal), 3) crossing the threshold (initiation), 4) finding guardians, 5) facing and transforming demons, 6) developing inner self and new resources, 7) the transformation, and 8) returning home with the gift.

From time to time, I believe it is important to reflect on the degree to which each of us answers his or her call. John Schuster’s book, Answering Your Call, Berrett-Koehler, San Francisco, CA (2003) is a wonderful invitation and guided reflection on the nature of calls as a push and pull into a purpose-driven future vision. Certainly, nurses and other health care providers hear a call, commit to it, are initiated, find guardians, face and transform demons, develop inner resources, are transformed and realize gifts. To what degree have you revisited or reflected on your personal and/or professional calling?

Stephen Gilligan and Robert Dilts in their book: The Hero’s Journey: A Voyage of Self Discovery, Crown House Publishing, Bethel, CT (2009), provide some provocative questions for people to consider in regard to reflecting on the nature of their calls and where they themselves in the context of their journeys. These questions include the following:

• What is the call?
• How do you know your calling has been fulfilled?
• When did you first hear the call? What were subsequent events, both positive transcendent and negative?
• In what ways have you refused the call? What have been the consequences of the refusal?
• What people are models/ancestors/sponsors for your call?
• Which people are negative examples/warnings?
• What are the demons that block your path (inner states/habits or addictions/external associations)?
• What are the resources that support/nurture/motivate your path?
• What will allow you to deepen your commitment to the hero’s journey?
• How do you create action agendas and find guardians?
• What is/are the demons/challenges you are currently facing? What is a situation in which you feel more of a victim than a hero?
• What is your “threshold?” What is the unknown territory, outside of your comfort zone, that either (a) the challenge is forcing you into or (b) you must enter in order to deal with the challenge?
• Given the demon you are facing and the threshold you must cross, what is the “call to action?” What are you being called to do or become? It is often useful to answer this question in the form of a symbol, or metaphor, e.g. I am called to become an eagle, warrior, magician, etc.)
• What resources do you have and which do you need to develop more fully to face the challenge, cross your threshold and accomplish your calling?
• Who are (will be) your guardians for those resources?

I believe most nurses are called to nursing because they are purpose-driven to care and serve, and make a difference in the world by sharing their strengths, gifts and talents. Periodically recalling and reviewing one’s call is an important aspect of personal and professional renewal.

A new book by John Schuster, The Power of Your Past: The Art of Recalling, Reclaiming and Recasting (2011), was a great resource to me as I contemplated my career move. The book provided a systematic way for me to reflect and reframe my past in light of future aspirations. At the same time, the book helped me develop an action agenda related to discernment about the call to change. Through a series of self-reflective exercises, Schuster leads and coaches you into recalling, recasting and reclaiming life experiences.

Recalling stories and images from one’s past is grist for reflecting on how the images and early life stories compress or expand life and learning. Recasting past images and identifying and analyzing what the image evoke and what is/was the impact of that evocation helps us reframe old experiences in new ways. Such reframing supports wisdom making. Reclaiming allows one to apply the lesson derived from reflection and reframing to a current setting. Schuster’s work helped me on my hero-journey path. Recalling, reclaiming and recasting my past helped me realize that there were elements of my calling that still needed attention and activation. Such reflection also helped me realize that I had the inner resources to respond to the call with an affirmative voice.

Perhaps you are happy and content with your current calling? Perhaps you have successfully navigated the steps of the hero’s~heroine’s journey? If so, compliments to you. If, however, you are at a crossroads in your journey and you feel somewhat restless with your current calling, I invite you to explore and reflect on some of the questions offered by Gilligan and Dilts (2009), as well as John Schuster’s (2003, 2011) work. Such reflection may help you uncover new resources that will support you as you continue with the personal transformation associated with your own hero’s~heroine’s journey.

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

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.

The Future of Nursing, Part I

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.

The Future of Nursing, Part II

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.

The Future of Nursing, Part III

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.

The ingredients of well-being: PERMA 2051

I have followed the work of Martin E.P. Seligman, PhD, for about 36 years! I first became aware of his work when I was getting my master’s degree in psychiatric mental health nursing at the University of Texas Health Science Center in San Antonio. Seligman is often referred to as the father of positive psychology. Early in my career, I was interested in his theory of “learned helplessness” as a model for explaining depression. Over time, Seligman shifted his focus and began to study and create theories of optimism and authentic happiness.

Recently, he has refined and amalgamated his thinking and created a theory of well-being, which he explains in a new book titled Flourish. In this work, he proposes that well-being involves five measurable elements: Positive Emotions (P), Engagement (E), Relationships (R), Meaning (M) and Achievement (A), or PERMA.

Working with colleagues and students at the University of Pennsylvania, Seligman has developed a number of measures and interventions to support positive accomplishment, resilience and well-being. Listen to his remarks as he shares how he is using knowledge created to influence and stimulate change in education and therapy, including military settings. I particularly like his notion of the complementary pair of post-traumatic stress ~ post-traumatic growth syndrome. I also admire and appreciate his visionary goal that, by the year 2051, 51 percent of the people of the world will be flourishing.

Personally, after reading the book, I have decided to take up the practice of two evidence-based exercises that seem to influence and support one’s well-being: the Gratitude Visit and the Three Blessings Exercise.

The Gratitude Visit involves conjuring up an image of someone still alive who did or said something that changed your life for the better, and you never properly thanked him or her. The task is to write a 300-word letter of gratitude to that person with specific details about what they did and how it affected your life. Once you have written the letter, surprise him or her with a visit and personally deliver the letter. Read it out loud to and then discuss the content and your feelings for each other.

The Three Blessings Exercise is also a useful practice to develop. This involves reflection and appreciation. Every night, set aside 10 minutes before you go to sleep to write down three things that went well today and why they went well. Writing about what went right rather than what went wrong is likely to support your PERMA and increase your feelings of well-being.

I believe nurses around the world already understand the importance of PERMA for health and well-being. Seligman has provided specific measurements, tools and resources that may help and support the work nurses do to develop resilience and promote well-being in themselves and for those for whom they care. With the support of nurses who flourish, I believe his 2051 PERMA Vision will be realized.

Reference:

Seligman, M. (2011). Flourish: A Visionary New Understanding of Happiness and Well-Being. (New York: Free Press).

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

Self as coach: Professional renewal through strength and character

One of the most significant challenges leaders face is how best to maintain optimism, hope and a sense of renewal when confronted with competing commitments, conflicts and struggles that are a part of leadership responsibilities. Nurse leaders need to engage inner work in order to more effectively provide outer service (Pesut, 2001). Renewal is accomplished by clarifying one’s strengths, values, gifts and talents—and using them with intention. A strengths and character-based approach to personal and professional renewal helps people appreciate and value their signature themes and natural talents. Knowing what one’s signature strengths and values are promotes personal mastery and self-management in the creation of a purpose-driven life.

Some leaders choose to work with professional coaches to discern their strengths and learning edges. Others believe there is value in developing self as coach, through deliberate inquiry and practices connected to personal and professional renewal efforts. I encourage leaders I know to use two assessments to obtain information about signature and character strengths. The first is the VIA Survey from the VIA Institute on Character. This instrument assesses strength in character. Based on responses to a series of questions, the instrument rank orders 24 character strengths and then groups them by the virtue categories of wisdom, courage, humility, justice, temperance or transcendence. Knowledge of character strengths and learning edges promotes insight, action and development.

Another resource I think is most valuable for nursing leaders is the book, Strengths Based Leadership, by Tom Rath and Barrie Conchie (Rath & Conchie, 2009). This book provides access to the Gallup Corporation StrengthsFinder assessment tool. Knowing what your top five signature strengths are gives voice to your talents and skill mix. Even more valuable, this reference and resource provides specific strength by strength-based strategies to help a leader master most of the characteristics that followers want in leaders: trust, compassion, stability and hope. The best thing nursing leaders can do to strengthen the profession is to know what values support and sustain individual character and how to support followers through intentional activation of personal strengths and virtues.


References and Resources:

Pesut, D.J. (2001). Healing into the future: Recreating the profession of nursing through inner work. In N. Chaska (Ed.), The nursing profession: Tomorrow and beyond (pp. 853-867). Thousand Oaks, CA: Sage.

Rath, T., & Conchie, B. (2009). Strengths based leadership. New York, NY: Gallup Press.

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

Join the 100 Top Squiggles of Nursing project

In my July 12, 2010 Meta-Reflections post, I commented on the squiggle sense and the complementary nature of nursing phenomena. I was delighted and surprised when David A. Engstrom, PhD, creator~designer of The Squiggle Sense blog and co-author, along with J.A. Scott Kelso, PhD, of The Complementary Nature, contacted me and invited me to be interviewed! We exchanged many an e-mail and now that interview is posted on the Squiggle Sense blog!


Dr. Engstrom also posted a comment to my July blog post, in which he extended an invitation to the nursing community to participate in the 100 Top Squiggles of Nursing project, part of his effort to gather the 100 top squiggles in a variety of disciplines. I think this would be a very interesting exercise that would add to our understanding and appreciation of the complementary nature and dynamics nurses negotiate on a daily basis.


So, here is the plan. I invite all my nursing colleagues to use the comment feature provided at the bottom of this blog post (click on the word “comment”) or send directly to me (dpesut@iupui.edu ) a list of squiggles you notice in your practice, education or research contexts. I, in turn, will pass them along to Dr. Engstrom, and we will slowly but surely build a list of the top 100 squiggles in nursing! For example, a few of my candidate squiggles of nursing are: nursing~negligence; suffering~succorance; health~illness; mindfulness~mindlessness.


What complementary pairs or “squiggles” has your squiggle sense perceived and acted upon? Participating in this project is easy. All I need are your squiggles, but if you care to spend a few minutes to let us know why you chose your particular candidate(s), please do so.

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