Mission not accomplished ... yet

It’s the final day of the conference. You attended plenary discussions, concurrent sessions, poster presentations, and had terrific interactions. Pack up, travel home, mission accomplished!

NOT SO! Your mission is accomplished only when you turn your take-home messages into action.

In today’s economic climate, participating in onsite conferences is a tremendous privilege. Limited financial resources result in close scrutiny of the cost of conferences. You were in Indianapolis for CHWE because of your agency’s belief that your attendance would directly impact important issues, or because of your belief that it would enhance your individual contributions to your work. The resources invested—time away from regular duties, cost of travel, hotel, registration, etc.—are carefully considered in these investments. Either way, the return on investment will be realized only through actions you take upon returning home.

If you have not yet “lived” the experience of the Apollo 13 events, please visit my 13 April post and view the 28-minute video clip of that crisis. Beginning with the crew’s announcement, “We had a pretty large bang …,” the urgency and problem solving associated with that crisis provide poignant lessons—a role model—we can take into our own mission of improving work environments.

In some ways, our perception of “Do we have enough to do it?” is just that—perception. It’s an issue of relativity. In the past year, I had the privilege of visiting NASA in Texas, for the purpose of connecting advances in patient safety with those of space safety. During our visit to the CapCom room, the host asked us to raise our smartphones in the air. He then informed us that we were holding in those smartphones more technological capacity than was available at the time we landed men on the moon!

Nurses have the capacity and resources to create healthy work environments. In fact, we have more resources than ever before. Recent emphasis on quality improvement and performance has raised awareness, thereby helping to catapult initiatives that promote healthy work environments. Stakeholders are interested and supportive of such initiatives.

Notice the present tense: We HAVE the capacity, knowledge, and resources needed to create healthy work environments. Today!

What is needed now is teamwork, constant communication, and courage to risk new solutions, together with adaptation and flexibility as each new challenge is recognized and faced.

Will we always feel safe along this journey? No.

Back to the video. Hear the mustering of support from astronauts, ground crew, and citizens of the world as they move forward step-by-step through great uncertainty: “Hang in there, it won’t be long.” “Lord, we ask that the astronauts come back safe.” “There were moments that I didn’t know … whether we could make it … you just keep going.”

So it is that each of us as conference attendees is charged to “just keep going.” In the opening session, we were asked to name three things that we will do when we return home—and to DO THEM!

On 17 April 1970, one headline announced: “They’ve made it! Gallant astronauts make perfect splashdown.” Members of the Apollo 13 crew expressed regret that they had not completed the mission of moon landing, but America’s president reminded them that, from the start, theirs was a high-risk mission. So it is for us: Creating healthy work environments is high-risk work. It is a hazardous adventure with no guarantee of success at every turn, but no failure is a failure if lessons are learned and heeded.

Those who venture forth to achieve healthy work environments will be recognized for their poise and skill under intense pressure and their efforts will benefit many. Every conference participant should stand tall and take actions that reflect the belief that the individual still counts; and, in crisis, that it’s the character of each person that will make the difference.

You’ve acknowledged the problem and explored creative solutions. Now, it’s your time to ignite the change.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.

Failure not an option

On this very day, 43 years ago, an urgent call was issued from the crew of Apollo 13: “Houston, we have a problem.”

  

In response, unprecedented activity began. NASA’s ground crew scurried into solution-development mode with a sobering deadline and two severe limitations in coming up with a solution: Only materials already in the space module could be used and, because this was a first-ever occurrence, the answer would have to be inferred or extrapolated from known scientific principles. The solution would have to be innovated on the “edge of knowledge.”

Failure to correct the space module’s malfunction would have dire consequences for the Apollo 13 crew and for America. Left uncorrected, the environment in the module would become so toxic it would not sustain human life, and the mission would be lost. Despite a situation that initially seemed to the NASA crew hopelessly futile, the commander proclaimed, “Failure is not an option!” With considerable ingenuity and working under extreme time and emotional pressures, the team successfully mounted the challenging task.

In this second day of the Creating Healthy Work Environments (CHWE) conference, I am struck by the similarities between the malfunctions of Apollo 13 and our work environments. The stakes are comparable and the challenges facing us analogous. Although our work environments are worlds apart from the confinement of the Apollo 13 space module, our situations are much the same: 1) Toxic environmental factors must be corrected to prevent harm to those aboard and those invested in the mission. 2) The well-being of health professionals, patients, and health care organizations depend on the actions we take.

Fortunately, the HWE initiative has an advantage over Apollo 13. We have the opportunity to draw knowledge, research, and practice-based evidence from the CHWE conference. To size up the status of our knowledge, a synthesis of the conference content seemed in order, at least to the “scientist” in me. The conference program contained 66 poster and podium presentations, along with three symposia, based on submitted abstracts. Realizing that knowledge begins with exploration and moves to intervention testing, I classified the projects into a) those that described the HWE issue and b) those that were doing something about it.

Roughly 60 percent of the projects fell into the first category. These projects defined concepts and showed relationships or developed useful metrics to quantify concepts. The projects reflected excellent work in identifying core HWE concepts, such as horizontal violence, moral distress, and organizational cynicism. The remaining 40 percent of the projects fell into the second category—solutions being tested. These projects evaluated initiatives, programs, and strategies to answer, “What strategies work to change the situation?” For example, projects tested new solutions and interventions to manage bullying, improve emotional work environments, evaluate collaborative care councils, build leadership, and increase conflict-resolution competence. This far-less-than-fully-scientific approach suggested to me that we are rapidly growing our understanding of “how” to solve the issues and achieve healthy work environments.

In creating these environments, we can learn from the ingredients that contributed to Apollo 13’s dramatic success: 1) Experts were willing to risk, to go beyond what had been tested. 2) Teamwork was used to co-create an effective solution. 3) Once a “fix” was devised, it was implemented through exquisite communication between ground and flight crews. 4) Courage flipped the switch to what was an untested solution. 5) Full devotion was given to saving the astronauts’ lives and the mission. In the end, the Apollo 13 malfunctions were corrected, the crew brought home safely, and the mission saved.*

For us, as with Apollo 13, FAILURE IS NOT AN OPTION! We must continue to invent, test, and put in place work-environment “fixes” that assure every nurse, every health care professional, every manager, and every person experiences joy in work—the joy that drew each of us into our careers. We must reduce into nonexistence the toxicities and hassles of our work environments so that we, our legacies, and the future workforce thrive and excel.

Nurses are at the head of the crew that will innovate and put in place the strategies, programs, and culture that create healthy work environments. In fact, from the interactions I enjoyed today, I conclude we already have begun!

*For an account of these events, see Charlie and Dottie Duke’s autobiography, Moonwalker (1990, Thomas Nelson, Inc.) and Charlie Duke’s website. He will present “Innovating on the Edge of Knowledge: A Walk on the Moon” on 11 July 2013 at the Summer Institutes on Quality Improvement.

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International. 

"Houston, we have a problem."

It is a privilege to be one of the 200-plus participants who gathered today at the “Creating Healthy Work Environments” conference in Indianapolis. Sponsored by the Honor Society of Nursing, Sigma Theta Tau International, our shared goal is to improve our organizations’ work environments.

Embedded in this goal are a number of requisite tasks: Problem identification, brainstorming solutions, action to create change, and challenging the status quo. We spent this day exploring a number of essential components of a healthy work environment.

So first, to refine our goal, a definition for healthy work environment (HWE). As some of us will confess to doing, I started my journey in this new thinking by consulting Wikipedia, only to find the comment, “The page ‘Healthy Work Environment’ does not exist.” I conclude that an entry in Wikipedia would be a valuable resource for any novice wanting to explore the subject. While not necessarily scientific, Wikipedia would provide us with a hub for this immensely important topic, pointing to the larger body of knowledge.

Undaunted, I moved on to an Internet search and located the advocacy initiative launched by the American Association of Critical-Care Nurses. AACN defines the essential components of HWE as skilled communication, true collaboration, effective decision-making, appropriate staffing, meaningful recognition and authentic leadership. Further, the components are outlined in the AACN Standards for Establishing and Sustaining Healthy Work Environments. Click here for the executive summary.

Throughout the day, the irony of the need to create HWE in our health care services was not lost on me. As nurses, we communicate, make decisions, work in staffed units, offer recognition and leadership … to patients. How is it that our work environments are not healthy? How is it that we don’t do this for each other? The importance of the issue was quickly validated by discussions that ensued throughout the day.

Reflecting on today’s discussions, I am struck by the active engagement of the presenters and members of the audience, who quickly moved to be active participants in this conference and were up at the microphone, sharing experiential knowledge. The stories offered by both the presenting experts and the audience, who ranged from clinical directors to educators to students, verified that the need for healthy work environments is urgent. Framing the discussion in Maslow’s hierarchy of needs, all were deeply passionate as they described incidents of incivility, lateral violence, bullying, threats to psychological and physical safety, and the need for skill-building to meet these challenges. Applause erupted multiple times as these common experiences were vividly articulated.

The described events conjured up images in my mind of challenges met by early explorers of the the New World when encountering hostile, uncharted environments. I muttered to myself, “Is this health care today? Can these problems be so far-ranging?” They are! No fewer than 20 testimonials validated this truth.

Discussions confirmed that there are solutions, strategies, and tools, derived from multiple fields—nursing, business, aviation safety—that are effective for creating healthy work environments. Some of the day’s lessons include:

• Policy means nothing without a culture that supports it.
• The beliefs, values, and actions of all health care professionals can be shaped to produce healthy work environments.
• Individual qualities needed for this journey are courage, being a good citizen of the organization, and generosity of spirit.
• A group of experts is not a team; team performance is a necessary, new, and trainable skill across the interprofessional care team.
• Living together with shared vision, mission, values, and norms of action creates the foundation for civility among working groups.
• Today, nurses are in an unprecedented position in health care to lead in the creation of healthy work environments for the betterment of the patient and family, health professionals, and the health care system.

Will the challenge require new skills? New actions? New mettle? You bet!

Are nurses “up to the task?” THE NURSES IN THIS GROUP ARE!

Conversations with colleagues throughout the day reaffirmed that the goal of healthy work environments is achievable. For nursing, this goal is not an option; it is a socially obligated mandate. Our patient’s lives and well being hang in the balance.

I look forward to tomorrow, to being part of the rising awareness of the problem and the sharing of additional strategies. I do so with the old axiom ringing in my ears, “If you are not part of the solution, you are part of the problem.” I know where I want to be in this journey!

For Reflections on Nursing Leadership (RNL), published by the Honor Society of Nursing, Sigma Theta Tau International.