| Uniting
Voices: A New Nursing Vision of Our Own
A Report of Nursing's Whole-Scale Change Event
May 14-15, 2002
by Lynn Hamilton, MSN, RN, C
"Hopeful."
"Challenged." "Enthusiastic!" "Skeptically
hopeful." Participants described their moods at the end of
initial and final days of the long-planned "Nursing Whole-Scale
Change Event," May 14 - 15, 2002, which achieved its purpose
to work together to co-create a vision for nursing and the beginning
steps to transform nursing's future at the University of Michigan.
Some 250 persons
in all, an unprecedented cross-section of nursing services hospitals-wide,
combined with an array of multidisciplinary representatives integral
to the delivery of patient care. Interspersed at tables of nine
were nurse managers, some 60 Clinical Nurse I's and II's, and some
28 Clinical Nurse III's and IV's, over 20 faculty and students from
the School of Nursing, as well as a smattering of physicians, pharmacists,
respiratory therapists, physical therapists, assistive personnel,
clerks, and yes, patients!
In two days
of highly structured, intensely interactive work, this microcosm
of UMHS nursing and its many customers represented all the organization's
voices to become "one powerful voice to advance the art and
science of Nursing and revolutionize leadership, education, research,
and transform patient care." A highly visible partnership between
service and education became evident in the co-leadership of Marge
Calarco, Chief of Nursing Services and Ada Sue Hinshaw, Dean of
the School of Nursing. The ultimate issue is "to create a dialog
among us," Marge Calarco reminded everyone, "not just
now, but over the months and years to come." And plenty of
dialog did occur, through alternating small and whole group interactions,
a trademarked process used to a similar effect in a UM Heart Care
Program event of past years.
Massive in
scale and scope, yet extraordinarily efficient and effective in
maximizing the time, the process of engaging so many people purposefully
with one another throughout the day--allowing them to absorb new
information, react thoughtfully, analyze next steps, and brainstorm
plans and direction-didn't happen automatically. Six months of preplanning
by an event planning team laid the groundwork. Every aspect of the
process was carefully choreographed down to the last detail of when
to move in and out of large and small groups; directions about how
to proceed; how to report out results, and how many flip charts,
handouts, and markers would be necessary. A small army of volunteers
acted as a logistic team, tool belts full of masking tape, Flair
pens, and everything else needed to allow participants to concentrate
on their task.
Everyone had
the chance to speak and to listen to each other's particular truths
and diverse views about their world at work. They began by sharing
what made them proud of their work, as well as their sorrow or frustrations,
something they yearn for others to join them in doing differently,
and what would make these two days worthwhile. Learning this from
each other was very different from more traditional, top-down approaches.
First-hand
knowledge was enhanced further with additional information. Current
employee and patient satisfaction data, as well as a snapshot of
the cultural climate in Nursing Services, made the "business
case for change." Of course, not everyone there had been previously
exposed to such data, and it was certainly not comfortable to contemplate.
Beyond doubt, there are a lot of "opportunities for improvement."
The frankness with which the data was confronted became further
example of Marge Calarco's exhortation, "We must be up front
with each other, to speak of and struggle with what we must."
Answers and solutions lie within us and among us. That this is a
tremendous paradigm shift in itself became clearer in some early
questions put to the leads. Just what was their plan? How would
they bring it back to the rest of the hospital? What were their
implementation plans? Such queries were met with a gentle yet clear
push back, helping participants begin to realize that top-down control
was no longer the order of the day, but that, the answers were within
ourselves, individually and collectively. The wishes and efforts
of some to thrust on others the traditional hierarchical role in
determining vision and direction was politely declined.
Now and for
the future, we are invited to look to ourselves rather than to the
supposed "powers that be" to identify our issues and take
initiatives to solve them. "Ada Sue and I could make plans
and strategies," commented Marge Calarco. But "systems
don't change unless and until people do." Gently she nudged
participants to look to their own responsibilities and accountabilities,
and in so doing, to recognize the power and potential that nurses
and nursing have.
And change we must. Nursing talent in the room was acknowledged
as second-to-none, yet much of it remains untapped. Opportunities
abound to "broaden our potential impact on the world."
"The question is not, 'Can we change the world?' Rather, it's
'what is the world that we want?'" "To alleviate the nursing
shortage, we must change the work environment," asserted Dean
Hinshaw, underscoring the integral interests of education and service.
Especially
poignant and appreciated by those assembled was the panel of patients,
who spoke about their experiences with UM nursing, both good and
bad. In follow up, participants engaged each other, as throughout
the day, to discuss what they had just heard; to react; and to formulate
more questions. Each effort distilled more essentials. An equally
moving panel of physicians vied with the patients for some of the
most touching moments of the day.
Sure enough,
the energy steadily accrued. Building on every dialog and analysis
in which they'd engaged, the group's work on the first day was a
final step toward a vision for nursing: a collection and synthesis
of their greatest hopes and dreams for nursing. Participants left
feeling "hopeful," "skeptical but hopeful,"
"challenged," "energized," "enthusiastic,"
and combinations thereof! The planning group was left with the captured
data on which to draft a vision that very evening.
Unveiling nursing's new vision first thing in the morning, culled
from the previous day's work, dramatized the uniting of many voices.
Now the more focused work began: fleshing out the bones of the statement
with potential directions and actions to make it come alive. A "panel
of possibilities" presented an intriguing array of concepts,
from "collaboratories," a special education/practice partnership
of the University of Iowa, to "Magnet Hospitals," whose
qualities attract and keep nurses, to "relationship-centered
care," to patient educative and technological innovations in
care. Once again, small groups merged to consider; react; and question.
Asked to dream
big, they engaged in "Preferred Futuring," responding
to the question:
"It's May 15, 2004... We are all gathered together in celebration
of how we have made progress toward our vision for nursing. What
are people saying? What is the feedback from patients, families,
staff, faculty, students, other sources that tell us we are making
tremendous progress?"
Within the
context of nursing's areas of interest (research, education, leadership
and clinical practice) small groups brainstormed steps, then sifted
as a whole to identify those that were achievable, significant,
and of interest to work on. Particular ones were identified by leads
as significantly "big hitters" in making a difference.
Next steps in determining the structures and resources to support
initial actions will occur June 10 in a re-grouping of the planning
team.
Continuing
the momentum, each participant capitalized on the positive energy
continued the momentum in a number of ways: creating personal statements
of commitments; signing those on which they wished to work; even
initialing and thumb printing the vision! Not only did the diverse
stakeholders "buy-in"; they themselves had created the
vision and proposed the actions.
Moreover, throughout
the entire process, they were acutely aware and concerned for the
thousands more staff that remained back at work in the clinical
setting. In the end, they vowed to take back and discuss with others
the process, the vision, and the directions to date. There was a
sense of eagerness to begin anew, to demonstrate to everyone at
work the promises of the vision:
"We, the members of the Nursing community at the University
of Michigan, will each make a difference by partnering with colleagues
to provide world-class patient/family-focused care and create an
environment that advances:
· Collaboration
· Respect
· Innovation
· Research
· Evidence-based practice
· Personal and professional growth." |
