President’s message

President’s message

Laughlin, Candia Baker

Dear Colleagues:

This year, as in the past, I returned from the AAACN Annual Conference with renewed energy and enthusiasm. The difference this year is that I don’t see it waning with the daily demands of work and life. This was a very effective inoculation! I drew from our speakers, leaders, old friends, and many new friends. I also felt from those attending how they sensed the importance and urgency needed today in our profession, in our specialty, and in our association.

Realistically, when haven’t we heard leaders in the health professions tell us that nursing and health care have important challenges ahead? Is it only because I accepted the presidency of AAACN that it seems more real to me this year? I have had some new opportunities to interact with other nursing leaders and leaders of other non-nursing associations in the past year as president-elect, so perhaps their insights and commitment contributed to my epiphany. Maybe it has to do with the dynamics of an outstanding AAACN Board of Directors, and the synergy they create. Probably it is the interplay of many of these and other factors.

The change that is occurring for AAACN, for the nursing profession, and for me personally brings to my mind the image of a weather map with a warm front across the middle. According to The Weather Channel, a warm front is “the leading edge of an advancing warm air mass that is replacing a retreating relatively colder air mass.”

I think of the cold air on one side of the front as restraining forces, and the warm air on the other side as driving forces. The movement of the front depends upon the relative strength of the restraining and the driving forces. I think the front is moving because the driving forces have recently become more powerful.

We all have experienced change and are familiar with the challenges, uncertainty, and risk-taking that accompany it. These also are well represented in my “warm front” metaphor. My fellow weather buffs know that precipitation in the form of rain, snow, or drizzle, is generally found ahead of a warm front, and perhaps even thunderstorms. Fog is common in the cold air ahead of the front. Although clearing usually occurs after passage of the front, some conditions may produce fog in the warm air. Together, we in AAACN and in the nursing profession are coping with the storms, the rain, or the snow (if you’re in Cleveland), and are helping each other through the fog. I think it will be foggy for a long time to come.

Been There, Changed That

Why might this change environment be any different? Most, if not all of us have been managing incremental change throughout our careers. We assess a need, set a goal, define the steps to reach it, then implement and evaluate. We don’t have to disrupt our past patterns dramatically and we feel in control. If it doesn’t work we can return to what we have always done. We now have the opportunity and the challenge to experience “deep change.” Robert Quinn (1996) describes deep change as being major in scope, discontinuous with the past, and involving significant risks and the surrendering of control. It requires letting go of our identified knowledge and competence and “walking naked into the land of uncertainty.” Making a deep change is not something organizations or individuals have to do every day, but with all the changes affecting the profession of nursing, we need to consider it more often.

Quinn goes on to describe “slow death” as the alternative to “deep change.” When there is a need for deep change, the person or the organization may choose instead to accept the status quo, focus on tasks, ignore or deny the real problem, or continue unsuccessful methods but push these methods harder. Instead of taking risks and seeking creative solutions, Quinn says one becomes addicted to the “opium of activity.” Working really hard and being very productive are virtuous behaviors, but will not help a person or an organization survive a serious threat and need to change. We can’t just hang in there until retirement and leave our professional issues for someone else to fix.

Deep change is initiated by recognizing the desire for change or improvement and developing a sound vision that can be implemented (Quinn, 1996). Later phases involve experimenting in true and creative ways, developing insights, and integrating new and apparently contradictory elements into a new synergistic relationship. Finally, the new methods and behaviors must become mastered and routinized.

Seeking Change

I sense a desire for deep change in the nursing profession and a desire for a substantial contribution by AAACN, your professional organization. The “driving forces” for our “change front” are evident at many levels:

Messages from Leaders – At the AAACN Annual Conference in March, we heard from Harriet Forman, EdD, RN, and Donna Cardillo, BS, RN, that forces for change include:

1. A very real and growing shortage in the nursing workforce

2. Decreasing reimbursement for health care

3. Informed consumers

4. Advancing technology

5. Medical advancements

6. An aging population

7. Cultural diversity

The Call to the Nursing Profession – In response to the common threats to the nursing profession, a summit of the entire nursing community was held in September 2001, to form a comprehensive strategy and tactical plan. The result of “The Call to the Nursing Profession” was the development of an overarching “Desired Future State for Nursing.” To reach this future state, work was identified in 10 domains with targets and strategies for each (see P. Mastal, Viewpoint, November/December, 2001). AAACN participated in the summit and is helping to develop the action plans.

AAACN Membership Scanning – At our October Board meeting (in the ice and snow of Cleveland as a front moved through), the AAACN Board of Directors identified the need for perpetual environmental scanning of our membership and through our membership. We decided to engage in aprocess of directly peeking input from members, which is described on page 20. Further, we engaged about 50 AAACN volunteer leaders and emerging leaders in a pre-conference activity in which we held conversations around strategic issues. The Board plans to use input from both these activities in strategic planning at our June and September Board meetings. Additionally, we have decided to repeat the environmental survey interviews in the coming year to help us further gauge our priorities.

Vision – One of the outcomes of “The Call to the Nursing Profession” summit was the development of an “Overarching Desired Future State for Nursing,” which is relevant to the entire nursing community. It reads as follow:

“Nursing is the pivotal health care profession, highly valued for its specialized knowledge, skill, and caring in improving the health status of the public and ensuring safe, effective, quality care. The profession mirrors the diverse population it serves and provides leadership to create positive changes in health policy and delivery systems. Individuals choose nursing as a career, and remain in the profession, because of the opportunities for personal and professional growth, supportive work environment, and compensation commensurate with roles and responsibilities.”

To realize this vision, AAACN will partner with other nursing specialty organizations and participate in deep change strategies. These actions will benefit ambulatory care nurses and the entire nursing community.

Operations Update

In our strategic business plan, we have the six goals listed below. All AAACN -activities should contribute to these priorities. To keep you informed, I will provide you with bimonthly updates aligned with AAACN goals.

1. Be the Voice of Ambulatory Care Nursing: AAACN has officially joined the Nursing Organizations Alliance (NOA), formed in November from the National Federation for Specialty Nursing Organizations (NFSNO) and the Nursing Organization Liaison Forum (NOLF).

The Board approved the purchase of enhanced Web technology for improved member services, including automated ordering of memberships and products and a continually updated membership database, available to members on-line. This is scheduled to be implemented in November 2002, with much more detailed information to be provided to you prior to then.

As part of our marketing plan, the Board has developed five potential taglines for AAACN. To select one, we are soliciting your input via an Internet poll on the AAACN Web site, www.aaacn.org (see page 9). Please make sure to cast a vote!

As part of our commitment to action plans for The Call to the Nursing Profession, E. Mary Johnson, Peg Mastal, and I have begun participating in quarterly conference calls, each of us representing a different part of the plan.

The American Nurses Association (ANA) is convening a workgroup to review and revise the Scope and Standards for Nurse Administrators. ANA has asked me to participate to represent the ambulatory care nursing administrator’s perspective.

In support of Johnson & Johnson Health Care Systems, Inc.’s Campaign for Nursing’s Future, AAACN has decided to invest in 100 shares of J & J stock. For more information about the campaign, visit www.discovernursing.com or call 1-888-981-9111. Hat’s off to our treasurer, Kathy Krone for responding to this investment opportunity.

Advance for Nurses is doing a story on AAACN Board Member Deborah Brigadier, CDR, NC, MSN, RN, about her role as advisor to the Navy’s surgeon general on community health/ambulatory care issues. Debbie will also address ambulatory care nursing in the current military setting. Hat’s off to Deb and to all our military nurses.

Goal 2. Promote Professional Practice ‘

AAACN’s collaboration with the American Nurses Credentialing Center (ANCC) to promote ambulatory care nursing certification resulted in ANCC’s donation of a free registration for the exam to one of our 2002 conference participants. Please see the article on page 11 about our winner, first-time conference attendee Kathryn Scheidt.

The Ambulatory Care Certification Review Course, offered March 12 following the conference, was attended by 80 participants.

Nurses certified in telehealth nursing and in ambulatory care nursing were recognized at the conference by ribbons on their badges.

Goal 3. Stimulate Innovative Thinking

Excellence Awards were given to two outstanding ambulatory care nurses. Congratulations to Mary E. Walker, RN, C, from the VAMC in Decatur, GA, who was recognized by her peers for excellence in clinical ambulatory care practice, and Martha N. Stancil, RN, from Harris County Hospital District, Houston, TX, who was recognized for excellence in ambulatory care nursing administration.

Goal 4. Build Collaborative Relationships

AAACN was contacted by Katherine Bradley, the nursing representative on the Practice Expense Advisory Committee, advisory to Centers for Medicare & Medicaid Services (CMS) regarding practice expense in the Resource Base Relative Value Unit System (RBRVS) reimbursement. The Practice Expense Advisory Committee is currently examining clinical labor of office-based nurses for coordination of care for hospitalized patients. Katherine received the input she requested and has asked us to continue to serve as a resource for input on clinical labor in the RBRVS refinement process.

Although the Nurse Reinvestment Act has passed both houses of Congress, we have consulted with Representatives Lois Capps (D-CA) and John Dingell (D-MI) to identify the next steps in getting this measure signed into law. Because there are differences in the Senate and House versions of this bill, it needs some refinement to create a single document for the President’s signature. AAACN Board Member Regina Phillips, MSN, RN, is monitoring the status and will send a broadcast e-mail to the membership with recommended actions to support the bill at the appropriate time.

The American Association of Critical-Care Nurses (AACN) invited a AAACN leader to attend an AACN reception celebrating the contribution of donors, volunteers, special guests, and 30 years of nursing science publication. AAACN President-elect Catherine Futch, MN, RN, CNAA, CHE, will represent us at this event. The Association of Women’s Health, Obstetric and Neonatal Nurses granted AAACN a complimentary registration at their annual conference in recognition of our ongoing collaborative efforts. AAACN Board Member Nancy Kowal, MS, RN, C, NP, will represent us.

Goal 5. Strengthen AAACN Resource Base

We have contracted with Contemporary Forums to offer the AAACN Telehealth Nursing Practice Core Course as a single-day pre-conference at both the September and October courses Contemporary Forums is offering. This provides us with ongoing marketing of AAACN and our telehealth products, and some limited direct financial profit for the course itself.

Membership recruitment awards were granted at the AAACN conference to three individuals. Judi Henry, who recruited the most new members in the past year, received a free conference registration, airfare, and hotel stay for the 2002 conference. Both Maureen Espensen and Carol Rutenberg received $100 gift certificates toward AAACN membership or products for having recruited at least three new members each.

Goal 6. Develop AAACN Leadership Ability and Capacity

Exciting plans are underway for the 28th Annual Conference in Tampa, FL, April 10- 13, 2003. The conference theme is “Networking in Ambulatory Care: Advancing Innovative and Professional Practice.”

“Willingness to Serve” forms have been received from a large number of emerging AAACN leaders, and I thank you for your interest in contributing your time and energy. You will be hearing from the committee chair or designated leader for your interest area. The invitation to volunteer is open-ended, although some roles have a specific cycle for election or selection, so please contact us if you are interested in AAACN leadership opportunities.

During my tenure, I will keep you informed about AAACN activities and I welcome your input. It is truly an honor and a privilege to serve you as the President of AAACN for 2002-2003.

References

Quinn, R. (1996). Deep change: Discovering the leader within. San Francisco: Jossey-Bass Publishers.

Candia Baker Laughlin, MS, RN, C AAACN President candial@umich.edu

Copyright American Academy of Ambulatory Care Nursing May/Jun 2002

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