Decades ago, I joined a group of 10 nurses who met monthly to discuss "ideas and strategies" to improve nursing education and practice. Our meetings took place at the home of a member who lived deep in the woods, halfway between New York and Philadelphia. Anticipating the meetings was as stimulating as the meetings themselves including predicting who would make the most impassioned arguments. "How useful are the new models of nursing care?" "Do they make sense in this health care environment?" "Are nursing theories contributing to the evolution of practice and education?" "How is nursing research trending and what impact will it make on outcomes of care?"
We argued ideas passionately and debated divergent positions. Should hospitals or the home be the primary venue of care? Should nursing accrediting bodies "mandate" specific curricular design elements or should the faculty freely innovate? Should a nursing program subscribe to a specific nursing theory? What are the most effective staffing patterns for hospitals? Occasionally, the discussion was heated, even combative, particularly when, for some, ideas had hardened into rigid ideologies. The highest consensus we ever reached was that the discussions provided rich food for thought and the promotion of change back in our home institutions. Even those who had become "believers" of certain nursing theories or practices acknowledged the positions of others, agreed to disagree, and pledged to continue the discussion. There was no demeaning of ideas, no rolling of the eyes, and no negative silences or attribution of negative motives. Everyone offered food for thought that nourished continued discussion and food for refreshment that enhanced the meeting's atmosphere. The group remained intact for years with no factions, nor dropouts, and its singular consensus point was on the importance of open discussion.
Today, in nursing circles, a call for "consensus" might also be a disguised wish for conformity, a state in which we follow the same path, believe the same words, and create rules or norms that discourage deviation. Conformity prevents the clash of ideas, which, though uncomfortable, promotes the profession's evolution. Exchanging ideas to reach consensus, if only agreeing to disagree, is what leads to progress.
The pandemic has exacted a toll on the nursing profession, exposing it to unprecedented work pressures and to polarization. We need to mine the lessons of the past 2 years to create better prepared and responsive work environments, and more resilient nurses. Retreating to the woods to discuss and debate the issues, openly, respectfully and with good food, may help us prepare for the next crisis and move nursing forward.
-Gloria F. Donnelly, PhD, RN, FAAN, FCPP
Editor in Chief