At first glance, this research issue of The Journal of Nursing Administration may seem to be a simple and straightforward reporting of research findings from teams of American, Canadian, and Finnish nurse researchers. But beyond the sharing of important study results, the 7 articles open a window of opportunity for readers to reflect on the obligations of nursing as a profession, the realities of the practice environment of the new century, leadership within the nursing profession, and potential approaches for moving contemporary nursing from "good to great." Consider the following.
The research reports in this issue serve as a reminder that conducting research is one of the major obligations of nursing and of any profession. According to historical sources,1(p67) "a profession develops and uses spiritual and practical standards of conduct; has been entrusted with the fulfillment of duties; has acquired cultural knowledge and skills based on principles which have religious, social and professional foundations; has applied knowledge and skills toward the betterment of society; and entails continued study or research for advancement of status and standard." Thus, nursing research is not simply an adjunct to the nursing profession-it represents a significant professional obligation.
One of the articles in this issue takes us directly into the challenging realities of today's practice environment. Laschinger and Leiter have built upon the findings of the 2004 Institute of Medicine report on patient safety2 to further examine the critical connection between the nursing practice environment and patient safety in Canada. Three of the articles shift the unit of analysis to the individual nurse: Piazza et al assessed the effect of national certification on nurses perceptions of empowerment; Jalonen and her nursing colleagues from Finland identified the predictors of continued organizational commitment among nurses who were working on a temporary job contract; and Garon used storytelling to reveal how nurses engaged in acts of resistance to overcome difficult working conditions. The remaining 2 articles offer a view of 2 macro research techniques: Moore and Hastings discuss the use of an ambulatory nursing intensity tool to measure nurse workload, and Anthony and Higgins share their experience with concept mapping as a tool that can improve data capture in multi-institutional research.
This sampling of nursing research mirrors the organizational goals and strategies of the American Organization of Nurse Executives (AONE) for 2006-2008: the active involvement of nursing leaders in the design, implementation, and evaluation of safe, high-quality patient care delivery systems; the creation of positive, healthy working environments for nurses; and the positioning of nurse leaders as national voices for critical healthcare issues such as patient safety, quality, work force development, and information technology. Innovative nursing leadership, according to the AONE, is the link to an improved future for healthcare. Reports in the literature on healthcare reform3 agree that, in the complex healthcare environment of today, leadership from nurses and other healthcare providers is badly needed to make that improvement a reality.
As we search for that new and improved future in nursing, in the institutions we lead, and the entire healthcare industry, we nursing leaders could benefit from revisiting the work of Jim Collins, coauthor of the business classic Built to Last: Successful Habits of Visionary Companies4 and author of Good to Great: Why Some Companies Make the Leap and Others Don't.5 In a recent monograph published as a companion to Good to Great, Collins6(p1) suggested that "a culture of discipline is not a principle of business-it is a principle of greatness." Great organizations, he suggests, move through 4 distinct stages of "building," which are all built with discipline:
* Stage 1: Disciplined people. Great organizations need "level 5" leaders who are ambitious first and foremost for the cause, the mission, and the work-not themselves-and have the will to do whatever it takes to make good on that ambition. These are leaders who possess a paradoxical blend of personal humility and professional will. Says Collins: "They know how to make sure the right decisions happen, no matter how difficult or how painful-for the long term greatness of the institution and the achievement of its mission, independent of consensus or popularity".6(p11) From the research perspective, these level 5 leaders within the nursing profession must assure that national nursing research agenda is focused with laser-like sharpness on the most urgent research questions facing the profession. Just as important is assuring that the right people are on the research or leadership team. Collins reminds us that before we ask "what" we must do, we should identify "who" the right people are for the job.6(p34)
* Stage 2: Disciplined thought. Collins suggests that leaders must have the discipline to confront the brutal facts of the current reality while remaining steadfast to their belief that they will prevail in the end, despite difficult circumstances. For the nursing profession, this requires combining an honest appraisal of the critical nursing shortage and the current practice environment with the belief that the nursing profession will endure and triumph in these challenging times. Greatness, says Collins, comes from making good disciplined decisions driven by the right blend of passion for the work, the appropriate skills, and an understanding of the factors that drive the organization's resource engine. The AONE strategies for 2006-2008 reiterate this in their support for "evidence-based practice of nursing management and the importance of sound research in the development of future patient care delivery systems and practice environments." The AONE strategies also emphasize the importance of resources and the need for nursing leaders to secure the federal resources needed to ensure a sufficient nursing work force.
* Stage 3: Disciplined action. Collins suggests that great organizations promote a culture of discipline in which disciplined people engage in disciplined thought, which leads to disciplined action. The research teams cited in this issue represent this type of disciplined, collective thought and action. The teams also represent another of Collin's key concepts about great organizations: Greatness does not stem from one single grand program, innovation, or lucky break. Rather, as the research reports in this issue illustrate, momentum and progress in our profession are built 1 small step, 1 study at a time.
* Stage 4: Building greatness to last. According to Collins, "leaders in great organizations build catalytic mechanisms to stimulate progress and do not depend upon having a charismatic personality to get things done".6(p35) Progress is made in a context of an interesting duality, says Collins. This duality contrasts a relentless dedication to core values and a core reason for being that remain constant over time with a relentless drive for change in operating strategies and cultural practices that are needed in an ever-changing world. This duality is clearly evident in the research studies in this issue and in the AONE strategies for nursing in the years ahead. The core commitment of the nursing profession to providing high-quality, safe, cost-effective patient care is juxtaposed with the urgent need for the nursing profession to adapt to the complexities of the contemporary healthcare industry of the 21st century.
In conclusion, the nursing research reported in this issue represents the work of the nursing profession meeting its obligation to advance its professional knowledge base. As Jim Collins has suggested, the research represents the inherent leadership discipline within our profession to adapt to changing times. Nevertheless, the research leaves us with a final, compelling question: How will our profession leverage these and other research results for the maximum benefit for patients and for nurses?
Research7 has shown that leveraging knowledge is one of the most critical aspects of knowledge management, which is the intentional, disciplined organizational process of fostering knowledge for competitive advantage. This includes making information available so that reinventing the wheel becomes unnecessary, reusing and recycling knowledge, and sharing lessons learned. To achieve a vibrant knowledge exchange, knowledge management must transcend traditional organizational silos.
Leveraging or sharing knowledge makes good professional sense for nursing because it increases the value derived from it. Without efficient knowledge management, our profession risks the loss of new knowledge that has been created by the focused and passionate discipline of our nurse researcher colleagues. If we truly view nursing as a knowledge enterprise, then we must be committed not only to generating research findings but also to leveraging those results for the full advantage of the institutions we lead and the patients we serve.
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