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Journal of Nursing Administration:
doi: 10.1097/NNA.0000000000000040
Departments: CGEAN Perspectives

The 1st Step to a Future Agenda for Nursing Administration Research

Kowalski, Karren PhD, RN, NEA-BC, FAAN; Cherry, Barbara DNSc, MBA, RN, NEA-BC

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Author Affiliations: President/CEO (Dr Kowalski), Colorado Center for Nursing Excellence, Denver; CGEAN Board Member; Professor and Department Chair for Leadership Studies (Dr Cherry), Mildred and Shirley L. Garrison Professorship in Geriatric Nursing, School of Nursing, Texas Tech University Health Sciences Center, Lubbock.

The authors declare no conflicts of interest.

Correspondence: Dr Cherry, Texas Tech University Health Sciences Center, 3601 4th St STOP 6264, Lubbock, TX 79430 ( Barbara.cherry@ttuhsc.edu).

Nursing leaders from across the United States and Canada representing both academia and practice came together at the 2013 International Nursing Administration Research Conference (INARC). Attendees began building the foundation for a future of imaginative and futuristic research in nursing leadership and administration. With the stimulating presentations of 7 international nursing leaders, participants engaged in thought-provoking conversations to begin the challenging work of developing a future agenda for this critical research effort. Each nursing leader challenged participants to become actively involved in leading change initiatives in the new healthcare system. Leaders were unanimous in identifying the present as the turning point for the profession. It was suggested that this is the greatest opportunity nursing has had, and we must create a national agenda for nursing leadership research to provide the evidence to drive nursing practice innovation. Nursing administrative research will serve to move the profession to the forefront as leaders of a redesigned healthcare system. Each nurse leader presented intriguing content as well as pearls of wisdom, which are summarized below.

Bernadette Melnyk, PhD, RN, CPNP/PMHNP, FNAP, FAAN, stressed the importance of evidence in determining what makes leadership successful. Dr Melnyk ensured the group that change can be character building. She emphasized that external evidence is generated from level 1 rigorous research and systematic reviews. Internal evidence should be generated from outcomes management and analysis within organizations. Dr Melnyk encouraged researchers interested in administrative practice to find the evidence for the best leader preparation. Dr Melnyk suggested that the new cohort of nurse leaders prepared at the DNP level should be viewed as experts in evidence-based practice.

Mary Ann Christopher, MSN, RN, FAAN, president and CEO of the Visiting Nurse Service of New York City, has established a research center (Center) to identify solutions to issues of seniors around aging, such as staying in their communities versus institutional care (www.vnsny.org/vnsny-research/). The Center is also integrating primary care and public health, relating both to value-based purchasing. They have reduced readmissions and emergency department visits among the highest-risk populations from the poorest zip codes in New York City. Staff at the Center view others as partners including patients, acute care facilities, insurance companies, nurses, and nurse practitioners.

Angela Baron McBride, PhD, RN, FAAN, emphasized the differences between the 20th century nurse (the era of many practicing nurses) and the 21st-century nurse (the generation that will lead the profession forward). Issues in the 20th century included a focus on the infrastructure including advances in educational programs, the continued development of nurse scientists, the production and publication of evidence, and the push to shed the “handmaiden” image harbored by many nurses.1 Skills needed in the 21st century include the ability to build, lead, and study interprofessional teams with a focus on relational coordination of care and an emphasis on teamwork linking the wisdom and perspective of the participants to the whole.1 McBride1 believes that all nurses are leaders, and she described how leaders excel at sense making, helping people to understand the major issues and focusing efforts on the relationships with patients and families.

Greta Cummings, PhD, RN, FCAHS, and Carol Wong, PhD, RN (personal oral communication, November 14, 2013), addressed their current work in Canada as well as the need for research focused on leadership styles. Future research must focus on which styles are most successful in today’s environment and what skills are needed to connect these styles with patient safety, quality clinical outcomes, and staff outcomes, such as retention and engagement. Cummings suggested that we “see the present for what it is, the future for what it could be, and then take action to close the gap” (personal oral communication, November 14, 2013). She also recommended 2 Web sites to support in systematic reviews of the literature, www.epistemonikos.org and http://www.eros-systematic-review.org.

Michael Bleich, PhD, RN, NEA-BC, FAAN, committee member for the Institute of Medicine and Robert Wood Johnson Foundation Initiative on The Future of Nursing,2 was tenacious in his concern for nursing using linear strategies to solve nonlinear problems. He encouraged nurses to focus on “critical doing” rather than “critical thinking.” He strongly encouraged us to use predictive analytics to address the complex healthcare world in which we work, to ask why is this happening (statistical analysis), what if these trends continue, what will happen next (forecasting), and what’s the best that can happen (optimization)? Dr Bleich encouraged researchers to relinquish the obsession with assess and report, which is reflected in “what happened” and to focus on analytics or “why is this happening?”

Phyllis Kritek, PhD, RN, FAAN, author and consultant, challenged us to rethink our traditional notion of scientific inquiry based on the mechanistic world view and to view the nursing and healthcare world though a lens of complex adaptive systems in which systems are embedded within other systems, are coevolving, and are creating interactions that lead to continually emerging and novel behaviors.3 As the focus on acute care is being turned upside down, we must now think in terms of complex systems moving quickly to advance new models of nursing practice to promote health and manage chronic conditions in the community.

Peter Buerhaus, PhD, RN, FAAN, healthcare economist, discussed some very practical issues that were not on nursing’s radar just a few years ago. These issues include a potential for millions of newly insured patients entering a system plagued with high costs and inefficiencies,4 healthcare reform that is tied to a foundation of electronic health records,4 system consolidation across many levels,4 and new and innovative payment and care delivery models that offer a tremendous opportunity for nursing leadership.4 Questions regarding the nursing workforce provide very specific challenges for nursing leaders: How can we use the large number of retiring seasoned nurses effectively? How can we ensure quality nursing educational programs when the number of programs is increasing so rapidly? How will the lingering effects of the great recession affect the current workforce and alter projections of the nursing workforce needs? What are the characteristics of advanced practice registered nursing practice, and how can its value be increased? How do we prepare nursing students for a healthcare system that does not yet exist? Most importantly, how can nurses provide the leadership necessary to support a patient-centered system emphasizing value, measured by improved quality and lower cost, as the norm?

After the conference concluded, participants met in a session facilitated by Dr Buerhaus to identify key issues to be included in recommendations for the future research agenda. After a very rich dialog informed by the conference presentations, participants developed a list of priority issues that will be further refined through a Delphi survey of the CGEAN membership. Setting the stage for nursing leadership and administrative research over the next few years is one of the most important responsibilities undertaken by CGEAN since its inception. We look forward to finalizing this current phase to move toward a future research agenda and beginning the next phase of conducting relevant research to advance healthcare through effective nursing administration and leadership.

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References

1. McBride AB. The Growth and Development of Nurse Leaders. New York: Springer; 2010.

2. Institute of Medicine. The Future of Nursing: Leading Change, Advancing Health. Washington DC: Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing at the Institute of Medicine; 2010. http://www.thefutureofnursing.org/IOM-Report. Accessed December 10, 2013.

3. Lindberg C, Lindberg C. Nurses take note: a primer on complexity science. In: Lindberg C, Nash S, Lindberg C, eds. On the Edge: Nursing in the Age of Complexity. Bordentown, NJ: Plexus Press; 2008: 23–48.

4. Sochalski J, Weiner J. Health care system reform and the nursing workforce: matching nursing practice and skills to future needs, not past demands. In: Institute of Medicine. The Future of Nursing: Leading Change, Advancing Health. Washington, DC: Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing at the Institute of Medicine; 2010; 375–400. http://www.thefutureofnursing.org/IOM-Report. Accessed December 10, 2013.

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