JONA Volume 45, Number 3, pp 130-132 Copyright B 2015 Wolters Kluwer Health, Inc. All rights reserved.

Advancing Leadership Education and Research

Pioneering Through Chaos Nora E. Warshawsky, PhD, RN, CNE M. Lindell Joseph, PhD, RN Debra L. Fowler, PhD, MBA, RN, CNE, NEA-BC Cole Edmonson, DNP, RN, FACHE, NEA-BC Heather V. Nelson-Brantley, BSN, RN, CCRN Karren Kowalski, PhD, RN, NEA-BC, FAAN The 2014 International Nursing Administration Research Conference, ‘‘Pioneering Through Chaos: Leadership for a Changing World,’’ was held at the Texas Woman’s University in Dallas, Texas, in the fall of 2014. The program drew more than 100 attendees from 4 countries. The conference informed attendees from both academe and practice about the role of nursing administration in navigating the dynamic healthcare climate. This article will report on the insights from the conference presenters. Virginia Trotter Betts, MSN, JD, RN, FAAN, challenged nurses to lead health policy as health affects Author Affiliations: Assistant Professor (Dr Warshawsky), College of Nursing, University of Kentucky, Lexington; Assistant Professor, Clinical (Dr Joseph), College of Nursing, University of Iowa; Assistant Professor (Dr Fowler), School of Nursing, University of Texas, Houston; Executive Fellow, Robert Wood Johnson Foundation, and Chief Nursing Officer, Texas Health Presbyterian Hospital Dallas, Texas (Dr Edmonson); Clinical Instructor, Jonas Nurse Leader Scholar, PhD Student (Ms Nelson-Brantley), University of Kansas School of Nursing; CGEAN President, President & CEO (Dr Kowalski), Colorado Center for Nursing, Fort Logan. The authors declare no conflicts of interests. Correspondence: Dr Warshawsky, 557 College of Nursing, University of Kentucky, Lexington, KY 40536-0232 ([email protected]). DOI: 10.1097/NNA.0000000000000171


all aspects of our lives. Healthcare reform is well underway and focusing attention on improving the cost, quality, access, and equity that have plagued the current system. According to Betts, the greatest issues facing the United States are the lack of attention to mental health services and the social determinants of health. Betts suggested that it is too early to expect impacts on actual health outcomes; however, a significant increase in screenings and increased use of mental health benefits by 15- to 19-year-olds may be early indications of improving health services. For the Affordable Care Act1 to be successful, everyone has to participate. We will soon see an additional 9 million covered lives through increased enrollments via the health insurance exchanges and the addition of 3 states expanding Medicaid coverage using a private exchange model. Nurses are well respected and positioned to influence health policy at national and state levels but need to become educated about the issues, make the necessary connections, and get involved. Educate and raise awareness of the benefits of health insurance. Sign up to volunteer in your state to help people sign up

for the programs available to them. Learn more about how you can support the new Guiding Coalition for Health.2 Get involved in developing new models of healthcare teaching that emphasize interprofessional competencies and teams led by nurses. Betts concluded by challenging nurses to become political activists and then policy makers.

Leading at the Speed of Change Major General (USAF, Ret) Kimberly Siniscalchi, RN, MSN, described her experience of strategic nursing leadership in a time of war. According to Siniscalchi, although the military develops every member as a leader, you are not truly prepared for leading amidst the chaos of war. Strategic leadership is easiest in a stable, familiar environment. The wars in the Middle East challenged military health leaders to transform a healthcare delivery system in a ‘‘white water world’’ of rapid change and upheaval. She set specific strategic priorities: deliver evidence-based, agile, patientcentered care in a global healthcare system; transform the rapid response capability of the air expeditionary medical service; and enhance aeromedical evacuation and patient

JONA  Vol. 45, No. 3  March 2015

Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.

Perspectives Advancing Leadership Education and Research

movement throughout the continuum of care. The most common injuries were traumatic brain injuries and multilimb amputations. Because the best available care was in the United States, the wounded needed to reach American treatment centers within 48 hours of injury. Evacuation from the battlefield to the combat surgical center was accomplished in 20 to 45 minutes by deploying tactical critical care teams of physicians and nurse anesthetists to provide intensive care at the point of injury. DC-10 military aircraft were transformed into flying critical care units to make the journey from Europe to the United States. Casualty transfers from battlefield to definitive treatment in US medical centers were reduced from 8 days during Desert Storm to G3 days with a 98% survival rate from Afghanistan today. Investments in technology, education and training, and research were essential to achieve these remarkable accomplishments. Advancements in nursing education included transition programs for new nurses and advanced flight nurse training. Research teams analyzed care delivery and guided the development of core trauma competencies and care guidelines. Major General Siniscalchi concluded that successful strategic planning and transformation of military healthcare required ‘‘leading at the speed of change.’’

Leadership Preparation in a Chaotic Healthcare Environment Dr Marian Broome, dean, Duke University School of Nursing, and dean emeritus of Indiana University School of Nursing, shared lessons learned in her academic leadership roles. She applied these lessons to the preparation of practice leaders, particularly in today’s chaotic

events. She stressed the criticality of effective nurse leaders and their responsibilities, especially the need to address the gaps in humanness of some of the transformational practices such as the focus on the rapidity of change in the foreseeable healthcare future. In addition, the nurse leader must advocate for the nursing staff who are struggling to deal with information technology and technological advances and overload, acutely ill patients, and the massive changes in the delivery of healthcare. This leader must also advocate for patients and families who expect that the registered nurse will lead any team who cares for them. Nurse leaders are charged with solving ‘‘wicked problems’’ or those for which few, if any, answers are available such as issues that defy clear identification or definition; problems for which inadequate time, money, or energy exist; and those for which attempted solutions actually change the structure of the problem. Dean Broome shared thoughts about complexity and in doing so engendered a ‘‘ray of hope’’ for us. She identified that neither the system nor its external environment will ever be constant. Uncertainty and paradox are inherent within the system, problems that cannot be solved can be moved forward and small changes can have big effects. The successful leader must be both self-aware and reflective because these activities lead to ‘‘learning in the moment.’’ Leaders must be less self-focused and more focused on others. They learn from their failures and see what ‘‘can be,’’ not just what is.

the future of health if they are intentional and proactive in their programs of research, strategic planning, and mentoring roles. According to the Institute of Medicine,3 populationbased prevention efforts can improve Americans’ health more efficiently than clinical care alone. The health system’s failure to develop and deliver effective preventive strategies continues to take a growing toll on the economy and society. Paterson stated that 1 way to position our institutions and students is to ensure that dissertations and projects use big data designs. Specifically, ensure that studies use volume, variety, velocity, and veracity in data sets. This approach will provide decision makers with robust findings for quick decision making in a variety of settings and various contexts. Findings can then contribute to population health versus clinical care. Dr Paterson referenced the work of Bekemeier,4 who advocates for upstream approaches to research, specifically focusing studies on primary prevention and addressing root causes of disease and disability. She stated that the healthcare industry is the consumer and nursing is ethically and professionally responsible to serve those who need care. Therefore, advocating for large data sets within projects and dissertations will save the US government millions of dollars, our primary funding source. Dr Paterson called for nurse researchers to design impactful studies that will inform nursing, health, and policy.

The Art of Governance Nursing Research on Population Health According to Mary Paterson, PhD, RN, nurse leaders, researchers, and faculty are positioned to influence

Leading the transformation of healthcare will require nurses to expand their roles from caregiving and care management to serving as full partners on healthcare boards.5

JONA  Vol. 45, No. 3  March 2015

Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.


Perspectives Advancing Leadership Education and Research

Stephanie Woods, PhD, RN, associate dean for Texas Woman’s University and Parkland County Hospital Board member, offered a pioneering perspective that academic nurse leaders are a perfect fit for hospital boards. She explained that they come to the table with no conflict of interest, which enables them to openly offer a wealth of healthrelated information and expertise. Dr Woods recommended that nurses always hold open the door to accept risk, encouraging nurses to put themselves in places they might find out of reach or unfamiliar and understand that chance encounters matter. Pioneering through chaos demands nurses serve in an array of hospital, corporate, community, and nonY health-related boards to bring leadership to a changing world. Terrie Sterling, MSN, MBA, RN, chief operating officer of Our


Lady of the Lake Regional Medical Center and board member of the Federal Reserve Bank of Atlanta, New Orleans Branch, reminded nurses to always be cognizant when they walk in the room as board leaders, that they represent 3 entities: themselves, the profession, and, even greater, an industry in which people are mystified. Sterling emphasized that nurses understand the DNA of healthcare and demystify its intricacies for others by being at the table. She stressed that nurses must make time to serve and must hold themselves accountable to holding open the door for future pioneering nurse leaders.

Conclusion Throughout the conference, participants were stimulated by the thoughtprovoking conversations. As the conference closed, participants re-

turned to their roles inspired and ready to advance nursing administration practice, education, and research. REFERENCES 1. The Affordable Care Act. 2010. http:// index.html. Accessed December 12, 2014. 2. Institute for Healthcare Improvement. New Guiding Coalition for Health unites to improve the health of millions. 2014. 100MillionHealthierLives/Pages/GuidingCoalition.aspx. Accessed November 24, 2014. 3. Institute of Medicine. For the Public’s Health: Investing in a Healthier Future. Washington, DC: National Academies Press; 2012. 4. Bekemeier B. Upstream nursing practice and research. Appl Nurs Res. 2008;21: 50-52. doi:10.1016/j.apnr20007.11.002. 5. Institute of Medicine. The Future of Nursing: Leading Change, Advancing Health. Washington, DC: The National Academies Press; 2011.

JONA  Vol. 45, No. 3  March 2015

Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.

Pioneering through chaos.

The 2014 International Nursing Administration Research Conference, "Pioneering Through Chaos: Leadership for a Changing World," was held at the Texas ...
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