The Futurists Among Us
I first heard the moniker "futurist" in 1980. My hospital had hired one of these self-proclaimed prophets to speak to our leadership group about what we could expect during our healthcare careers. I don't remember his name, but his predictions were so startling that I can recite several of them 24 years later.
Among the revelations we heard was the revolutionary idea that some time around the turn of the century most hospitals would have computers located in their patient care areas for documentation, order-entry, and communication between healthcare workers. Lab tests would be performed at the bedside. We learned that vehicles would someday be intelligent, with the ability to analyze blood alcohol from the driver's breath and then refuse to start for an intoxicated operator. Furthermore, the day would come when automobiles would not be capable of crashing into another object (or other car) because they would sense and stop before a possible impact.
Some of what left our management team incredulous two decades ago has become reality. Other predicted changes haven't happened [horizontal ellipsis] yet. The most important thing I've learned since I was exposed to my first futurist is that it's possible for educated and thinking people to research trends and then prognosticate with some success, but no one has a completely transparent crystal ball.
The authors in this journal may not have the ability to divine everything we'll be experiencing in the near and distant future. They are, however, educated and thoughtful researchers and nurse leaders who are presenting a variety of provocative thoughts about the time yet to come. Some also point out that what we do now will determine what will happen tomorrow. Today's research and proactive action to address workforce issues, technology, and information systems are as important as any forecasting in preparing for a preferred future.
Taking time to contemplate the future, and what we can do to ensure nursing and patient care thrive there, may seem like a luxury. Executives and managers are inundated with the challenges and crises of "right now." As leaders, though, we must look beyond the current. We are, in a sense, caretakers of the future. We must practice intergenerational equity by ensuring that the decisions we make today include consideration of patients and communities in the future.
I don't claim to be a futurist myself, but there's one thing I'm positively clairvoyant about: change is inevitable, and we will continue to need bright, caring, and articulate people who face it with enthusiasm, optimism, and courage. How fortunate we are that our profession produces nursing leaders with those very characteristics.
Building Engagement of Followers
The effectiveness and ultimate success of any leader hinges on one universally critical factor: the willing engagement and support of a critical mass of followers. These followers are the ones who support and provide the tangible action required to operationalize the vision of the leader. While much has been written about leadership and how it can be more effective, the role of the follower and, perhaps even more important, the quality and nature of the leader-follower relationship is often taken for granted or dismissed.
Given the significant challenges of our industry today, our effectiveness as nursing leaders will depend on our ability to strengthen and solidify our relationship with those we lead as we seek to inspire their commitment to tackle the significant challenges we are confronted with. Any progress we hope to achieve in improving the quality of patient care and the work environment in which care is delivered will depend on the quality of the relationship we have developed with the very nurses who deliver care to patients and dominate the work culture of our hospitals.
Despite past success with various staff participation models, changing characteristics of today's workforce create unique challenges for nurse leaders. There is an increasing reliance on temporary, transient nursing staff to provide care in our hospitals. Our workforce represents an ever-increasing diversity in values, cultures, work ethic, and education backgrounds. Highly competitive job markets lure nurses to leave established jobs to fill critical vacancies elsewhere. All these changes make it even tougher for nurse leaders to stay in touch with the changing needs and concerns of their staff.
Despite all the demands on the time and focus of nurse leaders, it has never been more critical to connect and dialogue with our workforce and ensure that we truly understand the challenges confronting our direct caregivers. Given the adversarial positioning that dominates the rhetoric of labor unions today, it is important that the essential connection of nurses and their leaders not be broken or degraded. It has also never been truer that nurses must have meaningful control over their practice and work environment.
In the midst of our busy and demanding days, nursing leaders must listen carefully to those we represent and must invest significant time and energy to build and sustain a positive relationship with nurses who we employ. Strengthening our clinical workforce remains a central focus in meeting the increasing expectations of our discerning customers and the public's demands for greater quality, service, and cost-effectiveness in our American healthcare system.
Kathleen D. Sanford, DBA, RN, FACHE
Vice President for Nursing, Harrison Memorial Hospital, Bremerton, Wash, Administrator, Harrison Silverdale, President-elect, American Organization of Nurse Executives
Carol Bradley, MSN, RN Chief Nursing Officer
Tenet California, Tenet Health System, Santa Ana, Calif