Circling Back on Old Problems - Emerging Nurse Leader

By Rose O. Sherman, EdD, RN, FAAN

When I took my first leadership role, my mentor told me that there are few truly new problems that I would encounter over time but rather old problems that I thought I had solved would again re-emerge. This was sage advice. Most nurse leaders have the experience of wondering whether we will ever truly solve problems such as mislabeled lab specimens, delayed transfers to imaging, insufficient supplies or staff sick calls with little notice. We engage staff and then change our processes & policies when we have these problems. For a time, the solutions seem to work but then we often find ourselves back having the same discussions. There is great truth to the old adage – what gets measured, gets done. When we direct our attention and efforts to problems, most can be solved. It is hardwiring the change that is more complicated. Inevitably, our attention gets redirected to other challenges that arise in our complex environments.

Hardwiring Change

The authors of the Influencer: The Power to Change Anything make the point that there are no silver bullets in the change process. Through their research, they have found that you will be more effective if you can identify 2-3 key behaviors that will have the most impact on the change. It is helpful to view nursing practice as a collection of habits. Charles Duhigg, an investigative reporter for the New York Times, has written an
interesting evidence-based book about how habits are formed and what we can do to change them.

Duhigg contends that habits make up 40% of our daily routines, whether at work or at home. What you see in your work environments is in a sense a collection of habits that develop over time. Habits are the brain’s way of saving energy. Yet, not all of our work or personal habits are good habits. If we want to replace bad habits with good habits, we need to be intentional whether it involves changing a practice to make it more evidence-based or getting staff to wash their hands before they enter a room. A mistake that leaders make is that they forget how ingrained habits really are. Hardwiring a new habit can take more than the 30 days that we often devote to implementing new initiatives.

McFadden and Ellington of Zero Point Leadership offer the following 5 step model to embed new practices:

Leadership is critical at every stage of the process. We can’t let up. We need to implement tools to measure our progress. Nurse leaders sometimes complain about lack of staff compliance yet the problem with many performance appraisal tools today is that they are too general and don’t include specific behavioral expectations.

Leaders must build a culture that reinforces the new habit to make it stick and this includes changing rewards and recognition to influence the development of new behaviors. It is only through the intentional evaluation of our habits that we are able to change. Understanding habits is an important leadership skill. Duhigg suggests “once you see everything as a bunch of habits….it’s like someone gave you a flashlight and a crowbar and you can get to work.”

Read to Lead

Duhigg, C. (2012). The Power of Habit: Why We do What We do in Life and Business. New York: Random House.

Patterson, K., Grenny, J., Maxfield, D., McMillan, R. & Switzler, A. ( 2008). Influencer: The power to change anything. New York: McGraw-Hill.