What is a culture of nursing engagement and how does a nurse leader begin the creative process in changing any environment of practice? These questions are key to the leadership challenge in any setting. Oftentimes we think of the word "culture" as meaning someone or some group of a different ethnic and societal background with mores and rituals considerably different from our own. Or, in the gardening sense, we weed, cultivate, fertilize, and try to enhance the growth of flowers, fruits, and vegetables. We cultivate toward enhanced growth.
Therefore, a nurse leader who is able to lead the creation of a culture of nursing engagement has the responsibility of refreshing, revising, reclaiming, and even reorganizing the professional practice environment if there is a wide discrepancy between the missions of family- and patient-centered care and professional nursing practice. Developing partnerships with patients and their families, as well as the nursing workforce, with a passion for the value of nursing care is an essential tool for engaging the key players in creating a renewed vision for quality patient care. In most settings, the gatekeepers to the gardens are the medical staff, so unless there is a strong partnership and meaningful collaborative relationships with the medical staff and hospital administrative team, there is little hope of creating a culture of nursing engagement.
Patricia S. Yoder-Wise, EdD, RN, NEA-BC, ANEF, FAAN, Professor of Nursing, Texas Tech University Health Sciences Center and Texas Woman's University in Houston, is the issue editor for this refreshing look at Creating a Culture of Nursing Engagement. Dr Yoder-Wise has been foundational in motivating graduate students and practicing nurse leaders through her visionary leadership. She has served as the Chair of the American Academy of Nursing's Institute for Nursing Leadership and is the immediate past president of the American Nurses Credentialing Center. She is the author of Leading and Managing in Nursing and the coauthor with Karren Kowalski of Beyond Leading and Managing. She is also editor-in-chief of The Journal of Continuing Education in Nursing: Continuing Competence for the Future. She is a role model in promoting changes in nursing practice and creating environments that engage the nursing workforce.
As I reflect on so many challenges in practice environments, including 2 practice settings acknowledged in the original Magnet study, Family Hospital, Milwaukee, Wisconsin, and Virginia Mason Hospital, Seattle, Washington, it is interesting to note that the process for change and creating a culture of nursing engagement has been enriched substantially through research and evidence-based practice. However, the overall leadership of moving from hierarchical to shared leadership with workforce engagement holds true. Understanding shared governance models, using best practices, and developing collaborative relationships with key players in the organization with the role of the nurse at the table lead to a renewed respect for nursing practice.
Because change is a process of reinvention, I am reminded of the first self-governance nursing bylaws I discovered in the archives of Virginia Mason Hospital. Miss Marie Mansberger, a previous long-time nurse leader there, had developed bylaws in 1954, a year before I graduated from nursing school. What a marvelous visionary. However, when I stated it was an expectancy that I attend medical executive committees. In the 1970s and 1980s, many physicians were not very receptive in those practice settings. If nurse leaders are not at the table, how can we be effective in developing a culture of nursing engagement? A most important insight is to acknowledge that each of us brings to the table problem-solving skills that have enabled progress in several different situations. The establishment of collaborative relationships requires mutual give and take between nurses, physicians, and administrative team members. The benefits to be gained are many, which will lead to a better and improved healthcare system for tomorrow.
Developing a cost-effective healthcare system of coordinated care, health promotion, and consumer education and empowerment will require the best nursing has to offer as the most trusted of the healthcare professions. This presents a formidable challenge as the nursing workforce diminishes with retirements of existing nurses and insufficient numbers of prepared faculty to teach nursing and replenish the nurse pipeline. The looming nurse shortage mandates the most creative leadership possible and collaborative efforts among all healthcare leaders and advocates.
The culture of nursing engagement must extend beyond any specific setting and the designated professional organizations. Without extensive and expansive worldwide partnerships in healthcare reform and multidisciplinary engagement, nursing practice may suffer from boundary protection and turfdom. If the profession of nursing's values and visions are truly shared with patients, families, and all healthcare professionals, we can be the shining light of so many possibilities. Every nurse leader has a responsibility to take the time to make a difference and know that every day presents an opportunity to create a culture for nursing engagement.
Editor's note: A new column, "News From the Front," is initiated in this issue by Victoria L. Rich, PhD, RN, FAAN, Chief Nurse Executive, Associate Professor, Pennsylvania School of Nursing, Penn Medicine, Hospital of the University of Pennsylvania. Dr Rich will lead NAQ readers in some pertinent updates from national forums and healthcare issues.
Barbara J. Brown, EdD, RN, CNAA, FAAN, FNAP
Editor-in-Chief, Nursing Administration Quarterly