Recently (very recently), a young (very young) consultant was trying to convince me that my organization needed his company's services. His sales technique was to paint a dismal picture of the overwhelming odds faced by current health care leaders. He informed me that the transformation needed to move into the next era of health care, with its emphasis on the continuum of care, maintenance of health rather than hospital services, and (most of all) cost containment, is an unprecedented challenge. It was his contention that "Hospitals have never experienced this much change. We're calling it the perfect storm."
I surmised by the way he emphasized these last 2 words, that his own lack of experience led him to believe that his colleagues had coined a clever title for current realities and that the use of them was new to me. Of course, neither assumption is true. Since the 1997 book, and ensuing 2000 movie of the same name, a myriad of health care speakers and writers (including me), have borrowed author Sebastion Junger's1 severe (very severe) weather term to describe everything from overutilization of health care to our aging population, to the increasing cost of care, and to shortages of everything from health care professionals to medications.
I don't know if it is perfect, but I agree it has been pretty stormy for the last 15 years. However, I postulate that chaos and change in health care are not new phenomena. I base this assertion, not just on my own 40+ career years, but on the 40 years of nursing leadership articles I've been reviewing as part of Nursing Administration Quarterly's (NAQ's) 40th birthday. Among these, I found Luther Christman's 1982 book review in which he recommended that nurse leaders (in the midst of that decade's health care chaos) would benefit from reading Peter Drucker's2Managing in Turbulent Times. We were in a storm 34 years ago ... but anyone who has studied health care history is aware that we have faced tribulations and change for much longer than that. Yet, this profession and those who have chosen nursing management as their specialty have persevered.
Article after article in our NAQ archives paint a picture of resilient nurse leaders who, facing storms, rolled up their sleeves, tackled problems, and found solutions to best serve others. I don't share the pessimism of my young consultant friend. In fact, I am optimistic about the current environment. I believe we are making changes that will be better for individuals and communities, even if those changes are being forced on us by a storm. I believe we have talented (very talented) nursing leaders who will reinvent our profession and care models for the betterment of health care.
A psychologist friend tells me that the best indicators of future behavior and actions are past behavior and actions. He is referring to specific people, but I think it is true of professions as well. Nursing leaders persevere because we are skilled problem solvers who concentrate on the people we serve.
This edition is about the continuum of care, a hot topic as hospital leaders grapple with the concept of the hospital as part of a total range of health care, rather than its center. Nursing has always been practiced across the continuum, so this isn't so new to us. Enjoy the offerings that guest editors Mary O'Connor and Elaine Cohen have assembled. As always, they are presented to bolster and encourage you in your endeavors to make positive (very positive) change.
Thanks for choosing to lead.
-Kathleen D. Sanford, DBA, RN, FACHE, FAAN
Editor-in-Chief
Nursing Administration Quarterly
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