Change Leadership in Nursing (ChLN)

Brief Chapter Synopsis, and Change and Implementation Process Description

Chapter two of Change Leadership in Nursing (ChLN) explored the theory of focusing on the good aspects of nursing which totally breaks the myth that effective quality improvement is achieved from the analysis of wrongdoing. Chief Nursing Officer (CNO) Mairead Hickey enabled an interchange of ideas on the assessment and definition of nursing at Brigham and Women’s Hospital (BWH) and what nursing excellence really meant for the staff. This initiative was named “Finding and Defining the good of Nursing” and was implemented following philosophy and change strategy “appreciative inquiry” (Hickey & Kritech, 2012). This strategy targeted the identification of “the best” of an organization with the purpose of envisioning and achieving an ideal, or in other words, “what might be”. Based on this premise, nurses from all areas of the organizations were interviewed following a multistep process that encompassed unit-based focus groups, analysis, review, validation, clarification and refinement of data (Hickey & Kritech, 2012). Furthermore, the themes, definitions and descriptors utilized in the appreciative inquiry process provided a basic window into the excellence of nursing at BWH, and through a refinement process five excellent nursing practice characteristics were defined as standard of care. The initiative was considered a success since it received the constant engagement and support from the senior leadership team, it validated the results of focus groups and narrative sessions with staff nurses and findings from the literature highlighting the high level of research and rigorousness of the initiative (Hickey & Kritech, 2012).

Chapter three defined the importance of a healthy work environment. While exploring the good of nursing on the previous chapter, the author realized that a supportive work environment is a prerequisite for a professional practice environment and excellence in nursing. For the Department of Nursing (DON) at BWH the idea of nursing being seen as a unified collective core aimed to advance patient care and process development wasn’t too clear. Previous leadership fragmentation consisted in nurses and nursing leaders reporting to administrative vice-presidents outside the scope of the DON which resulted in inhibition of discipline and our identity as a nursing community. Based on these flaws, leadership at BWH road mapped a strategy that began with a deep assessment of what a healthy work environment means. This process was carried out by interviews at all levels of nursing within the organization, designation of Advanced Professional Nursing (ANP) meetings, and evidenced based support provided by the American Association of Critical Care Nurses (AACN). After a vigorous debate, dialogue, and literature review, several priority areas were identified and subsequently narrowed down to “collaboration, skilled communication, authentic leadership, and appropriate staffing” (Hickey & Kritech, 2012). According to the authors, in order to implement change, areas of priority needed to be realistic, clear, and achievable. On that note, a further refinement of the list of priority areas was identified based on previous experiences and accomplishments by the nursing department. These included “collaboration, authentic leadership, and practice excellence (Hickey & Kritech, 2012). Finally, engagement and presentation of the of the operational definition to nursing leaders was accomplished with great success. Work teams also disseminated the findings that made “commitment to authentic leadership, true collaboration, and practice excellence” available to clinical nurses and highlighted the evidence for evaluating the benefits of adding the priority areas into leadership practice (Hickey & Kritech, 2012).

Nurse Professionalism and Poor Collaboration among Nursing Departments

When we hear the word “professional” people colloquially link this vocable to high performance sport athletes or mastering of a specific branch of work. There is a tendency to use this term lightly in every aspect of our life. However, the truth is that professionalism means reuniting core skills that make an individual exceptional in seeing beyond expectations and representing a role model for our society. On that note, being a nurse professional means much more than healing the ill and nurturing the wounded. According to Walker, Clendon and Walton (2015), nurse professionalism in an individual is adherence to a code of ethics, honesty, integrity, trust, commitment to cultural safety, empathy, caring, compassion and owning up to mistakes among other characteristics (Walker, Clendon, & Walton, 2015).

In today’s healthcare landscape patient care demands for more than the mere act of treating a patient in order to provide a positive patient experience. The expectations not only require a new optic of thinking regarding the capabilities of a team but also the collaboration among those teams to deliver the best care possible. Lack of communication between hospital departments precipitates situations where medical errors can occurs resulting in patient injuries and team frustrations (O’Daniel & Rosenstein, 2008). Collaboration between nursing departments is defined by the interaction of multiple parties to achieve a common goal, it consists of an active and constant partnership of diverse background institutions and professionals who work together to provide services (Morley & Cashell, 2017). Collaboration is a process that includes effective communication, cooperation, respect, trust, and self-awareness to create a synergistic association that upgrades the contribution of each party involved (Morley & Cashell, 2017).

Based on the readings from Change Leadership in Nursing (2012) and a literature review of the topic, steps to improve true collaboration between nursing department start by self-awareness (Hickey & Kritech, 2012). A self-analysis of the individual, group, department or organization provides information about own triggers or hotspots which will help in developing techniques to avoid conflict (O’Daniel & Rosenstein, 2008). Another aspect of effective collaboration converges in creating a safe work environment. As stated in chapter two of ChLN this is an important factor in true collaboration since “a healthy work environment that is supportive and respectful is a necessary prerequisite of a professional practice environment and of nursing excellence (Hickey & Kritech, 2012). Moreover, according to experts, poor conflict management represents the single most critical barrier to safe collaboration between nursing teams. Although entire conflict avoidance isn’t necessarily suggested since standing on your opinion shows patient advocacy and character, having the ability to handle conflict with effective communication will ultimately promote collaboration and subsequent quality improvement and patient care (O’Daniel & Rosenstein, 2008).


  • Hickey, M., & Kritech, P. B. (2012).

    Change Leadership in Nursing.

    New York: Springer Publishing Company.
  • Morley, L., & Cashell, A. (2017). Collaboration in Healthcare.

    Journal of Medical Imaging and Radiation Services

    , 48(2017):207-216.
  • O’Daniel, M., & Rosenstein, A. H. (2008).

    Patient Safety and Quality: An Evidence-Based Handbook for Nurses.

    Rockville (MD): US Agency for Healthcare Research and Quality.
  • Walker, L., Clendon, J., & Walton, J. (2015). What nurses think about professionalism.

    Kai Tiaki Nursing New Zealand

    , 21(1):12-13.