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Past, Present, and Future Come Together at AONE Meeting

Monday April 17, 2000
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The American Organization of Nurse Executives (AONE) recently held its annual meeting, and the theme, "Shaping the Future of Healthcare through Innovative Nursing Leadership," permeated the event. For me, a highlight of the conference was a panel presentation, Nursing Leadership's Evolution: Wisdom from the Past, Learnings from Today, and Insights for the Future.
Moderating was Margaret McClure, RN, EdD, FAAN. Bright lights in nursing leadership made up the panel: Barbara Donaho, RN, MA, FAAN; Joyce Clifford, RN, PhD, FAAN; Nellie Robinson, RN, MSN; Julie MacDonald, RN, MS; Karen Ehrat, RN, PhD; and Kathleen White, RN, MS. Panel members gave us a panoramic look at nursing's past and what its future holds.
Leadership Concerns
Donaho conducted us through the 1960s, a decade virtually without ICUs, PICUs, unit-dose medication administration systems, and the now ubiquitous monitors. She reminded us that seniors had to sign up for Medicare - some reluctantly because they viewed it as welfare. There were no budgets as we know them today. Costs of delivering care were passed through.
The only available management or leadership training, including how to be an evening and night supervisor, were short seminars, and even these were few and far between.
This was the decade when "triad management" - CEO, CNO, and Chief MD - was introduced. The thought of bringing nurse administrators together was new, as was the debate over whether the nurse administrator held a clinical or administrative role.
Camelot and Clinical Discipline
Clifford did a smooth segue into the 1970s, the early part of which she called the "Camelot years," when Luther Christman is remembered for saying "what you haven't done is hard." These were the years when the healthcare system underwent restructuring - and administrative and clinical roles along with it. It was a time when chief nurse administrators began to be viewed as members of senior management, responsible for developing a nursing budget rather than just implementing ones handed down from on high.
During the 1970s, nursing began to be viewed as a clinical discipline, and as technology was introduced, nurses had to master it. This was also the decade when Taft-Hartley amendments brought nonprofit hospitals under the umbrella of the National Labor Relations Board. Efforts to "humanize" the healthcare system through the idea of a patient's bill of rights gave impetus to the movement promoting primary nursing and, along with it, the need for better decision making, critical thinking, and accountability. Networking became a strategic goal, and concepts of how to manage a professional staff emerged.
Doing More with Less
Robinson took us on a trek through the 1980s, beginning with DRGs and the impact of prospective payment on healthcare and nursing. The challenge was to balance financial needs with demands for increasing levels of quality care. The mantra of the day was "Do more with less," chanted to the tune of heightened productivity. AONE's vision of enhanced nursing leadership was validated - improved preparation for nurse leaders became more readily available, and names like Wharton School and Robert Wood Johnson (RWJ) Foundation became part of the nurse leader's lexicon. Grant monies provided by RWJ aimed to strengthen nursing practice and improve care. Nursing quality assurance, nursing documentation, nursing policies and procedures - concepts and manuals both became commonplace discussion topics wherever nurse leaders met. It wasn't long before we started to look beyond nursing to the multi- and interdisciplinary team model of patient care. We all discovered that we could be better care providers as part of a comprehensive team than as lone rangers.
Partnerships and Paradigms
MacDonald led us through the 1990s, when managed care and capitation became watchwords. Nurse executives were asked to broaden their view of nurses' and nurse executives' work. Everyone was called upon to develop new and enhanced skill sets. The concept of partnerships never had so strong a meaning as in the 1990s. Nursing structures were dismantled as new paradigms emerged, while the technology explosion required nurses to develop expanded capacities, using technology to free themselves up to deliver professional care.
Meanwhile, consumer involvement grew, and patients suddenly were asking questions and demanding answers. The Balanced Budget Act became law in 1997, with its fiscal impact felt the following year.
During that decade, AONE itself needed to change - and change it did, developing the council of nurse managers. For the first time, this nurse executive organization sought out nurse middle managers to join nurse executives in a collective quest for professional nursing management from all levels of leadership. And for the first time, AONE set its sights on nurse managers and leaders from across the continuum of care, not just from the acute setting, thus forging new partnerships.
Interesting Times
Taking a look at nursing today, Ehrat noted that "it will only be in the future that we can interpret today." Even so, the broad outlines are already visible. Ehrat described what she called "snippets": consultants tearing down existing structures; declining bottom lines followed by reengineering and layoffs; services once viewed as essential now being shed like a snake's skin. It's an era of survival and retrenchment, said Ehrat, with many disciplines represented at the decision-making table. More and more, healthcare seems a fiscally driven game of political football, as government tries to balance the budget and pay down the national debt while elevating patient care from privilege to right.
We won't get to the future in a linear fashion, warned Ehrat. Chaos will reign, along with a hope that order emerges from disorder. Meanwhile, she said, AONE must organize its members to drive the evolution of patient care delivery.
Technology versus Spirituality
White took us into the future, when nurses are likely to spend lots of time on Capitol Hill advising lawmakers on healthcare issues. Consumerism, she believes, will continue to grow, not the least because of aging baby boomers.
White visualized nursing in 2020, when access will be a big issue. Nursing leadership will have developed a patient-based model of care, and access will no longer require a huge bureaucracy. Relations between MDs and RNs will be less formal. The Internet will become an even stronger force in patient-directed care. Productivity statistics will give way to patient demands that physicians spend time with them. Indeed, said White, patients will know more and be partners in their own care, demanding even more spiritually focused holistic care. Partly for that reason, perhaps, the fear that technology dehumanizes healthcare will continue, as will the importance of remembering there's a patient under all that technology.
Heady stuff, but as moderator McClure suggested, in AONE we have mutual support. When Congress needs information, it calls on the American Hospital Association. But who does the association call? AONE. McClure's dream for 2020: that when nurses get the call, they respond, "Well, Madam President, we'll be right there."
Harriet Forman, RN, EdD, CNAA, is executive director of the Florida division of Nursing Spectrum.