Challenging Your Own Paradigms

By Rose O. Sherman, EdD, RN, NEA-BC, FAAN

Many health systems are seeking ways to redesign nursing care delivery in 2024. Our current models are no longer serving us well, and most are proving challenging to sustain with the current shortage of RNs. New models will inevitably include more of a team-based approach, whether using a virtual nursing component or adding team members other than RNs. Some nurse leaders have been frank with me that they see these trends as a step backward in nursing, irrespective of the need. To some extent, it is because some team nursing models were historically poorly executed. However, some have a paradigm that only RNs should deliver care in acute care settings.

Changing one’s paradigm takes work. Paradigms are deeply ingrained mental frameworks that shape our thoughts, beliefs, and behaviors. It is the lens we use to view nursing practice. When our paradigms are threatened, our reaction can be pretty visceral. Shifting paradigms requires conscious effort and a commitment to personal transformation. A paradigm shift occurs when a person, group, or organization encounters new information that significantly alters their thoughts and actions. Moving on to a new stage is a massive feat. It requires courage to abandon old certainties and experiment with a new worldview. Several leaders, such as those below, are working hard to change their perspectives:

A nurse leader recently told me she was shifting her paradigm about care delivery. She has realized that although she had always championed primary nurses – her staff was not delivering care using the foundational principles of that model. There needed to be more continuity, commitment, or even accountability. To staff her primary care delivery model, 80% of her nurses now had less than two years of experience, impacting quality. She noted, “I am advocating for something that is not happening and may never be possible again.”

Another leader talked with me about her resistance to the role of technology in care. She noted, “I believed using a robot would dehumanize our care delivery. I was shocked to see how much our patients and staff loved the robot – maybe I was delusional about how hands-on some of our care is.”

A manager worried about adding virtual nurses to the team and how it would impact the nurse-patient relationship. “I thought patients (and staff) would see these virtual nurses as intrusive on their privacy, but it is quite the opposite. Our patients and nurses feel safer with another set of eyes – the idea of privacy violation has never been raised by patients, family, or staff. This was my paradigm. I thought back to the relationship I tried to establish with patients and superimposed it onto a different environment. 

Gallup researchers note that one of the first steps to shifting your paradigm is acknowledging that the current environment is different and there is no going back. When something changes, don’t get stuck thinking about how things used to be — focus on how things are now, and what you can do to make the most of the new situation. Paradigms are simply mindsets—the way we think about and view the world around us. By focusing on finding solutions, we open ourselves up to possibilities instead of getting bogged down in negativity.

© emergingrnleader.com 2023

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From Traditional Nurse Leader to Nurse Leader Coach – Click Here for the Flyer

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Recommended Book by the Association of Critical Care Nurses – The Nuts and Bolts of Nursing Leadership: Your Toolkit for Success