Through a new lens
by Wendy S. Carter Kooken
Complexity science, writes the author, is a useful method
for predicting future trends in nursing education.
One
year ago, I served on a committee assigned to make renovation
recommendations for our university department of nursing. Other
committee members made decisions about the building area each
would investigate, but I took the role of thinking about the future.
Since such recommendations may not occur for many years, the salient
question for me was, “What amount and kinds of space would
be needed 10 years from now to educate student nurses?”
The project led me to think about the future needs of nursing
education. I discovered little available literature on this topic.
At the time, I could not make any confident predictions related
to the education needs of nurses. However, one year later, I can
offer some suggestions.
The lens of complexity science
My confidence in making suggestions about future needs in nursing
education does not come from a belief that I suddenly am better
able to predict the future, but from viewing the future through
a new—for me—lens, complexity science. Complexity
science suggests that prediction and control in complex systems
are illusions at best, and the focus in such systems should be
adaptability (Zimmerman, Lindberg, & Plsek, 2001).
My premise is that schools of nursing are complex adaptive systems.
To thrive, nurse educators need to be familiar with and apply
the principles of complexity science, particularly the principle
of designing preferred futures. Designing preferred futures is
a way to respond to current problems in an environment in which
the future is not predictable. This does not mean ignoring possible,
plausible or probable futures (Roy, 2000; World Future Society,
2002). It does mean, however, that energies in the present context
are devoted to visioning what nursing education could be. Designing
preferred futures in schools of nursing is a hallmark of leadership.
One year ago, I struggled to predict what might be needed for
the renovation of our department. Now, guided by complexity science,
I would turn in a different report than I did a year ago. I now
conclude that building needs cannot effectively be determined
outside the vision of curricular and program needs in nursing
education. If I were to write a report today, I would cite common
problems in nursing education and provide my response to those
problems in terms of preferred futures. Requests for changes to
the building would derive from the real renovation recommendations
that relate to the preferred futures of nursing education.
Problem: Nurse educators cannot keep up
with the latest trends in society, technology and health care.
Medical knowledge doubles every eight years. At that rate, our
current technological knowledge will represent only 1 percent
of such knowledge in the year 2050 (Hall, 2001). Nursing faculty
shortages compound the problem of managing ever-increasing knowledge.
Faculty have difficulty keeping pace with the present and cannot
see how investing scarce time and energy into “future think”
will benefit them now.
Preferred future: Schools of nursing will
each have a “future committee.”
The future committee would have the same status as other committees
in the school. This group would function as a formal knowledge-sharing
network (Allee, 2003), managing and sharing knowledge related
to the latest and predicted trends in society, health care and
technology. Knowledge sharing of this sort encourages resourcefulness,
creativity and diversity of ideas that can be used in strategies
to better educate nursing students. Noticing the emergence of
unexpected relationships between new trends (Zimmerman et al.,
2001), as well as identifying important characteristics of upcoming
generations (Tough, 2002) would inform the continuing design of
nursing education’s preferred future in the school.
Problem: Schools of nursing cannot keep
up with costs and training related to changing technology.
Literature suggests that nursing faculty are only advanced beginners
(McNeil et al., 2003) in their use of information technology.
Barriers to the use of technology include budget, time for training
and an overall lack of technological skills (Potempa et al., 2001).
Preferred future: Nurse educators and health
care technology companies will partner in research, design and
implementation of technology in health care. Adequate time for
technology training will be incorporated into faculty workload.
Nurse educators need to control the way technology shapes
the futures of nurses. For example, a technology corporation-nursing
school partnership is described as a kind of arrangement that
could allow co-evolution to take place, where each partner mutually
benefits and grows in ways not possible alone (Zimmerman et al.,
2001; Connors, Weaver, Warren & Miller, 2002). In partnerships
such as this, corporations would have access to the next generation
of nurses, who ultimately will use the designed products. Conversely,
schools of nursing would have access to the latest technology
rather than draining their budgets to remain technologically up-to-date.
Entrepreneurship of this kind is an emerging and important trend
in health care (Hall, 2001; McBride, 2005).
Problem: Student nurses feel unprepared
for practice in current health care settings, which are also complex
adaptive systems (Ross & Clifford, 2002).
The transition from student nurse to practitioner is widely acknowledged
as an extremely stressful period, with some of the stress related
to the feeling that one has to know everything (Charnley, 1999).
Preferred future: Nurse educators will consistently
incorporate futuristic assignments and complexity science into
coursework. Nursing students will learn to design preferred futures
in order to become leaders in this profession.
Student nurses should learn that in complex adaptive systems,
it is impossible to know everything and that leadership is never
about being in the center of one’s comfort zone. Rather,
it is about being comfortable with leading at the edge (Zimmerman
et al., 2001). Nurse educators beckon students to leadership through
vision as told in Flatland, a story about having the vision necessary
to lead others (Abbott, 1992). In this story, a square who sees
the world in two dimensions suddenly has new dimensions revealed
to him when he is exposed to a sphere. Once the square sees a
new way of looking at the world, he cannot return to his old way
of seeing only flatness.
Nurse educators must also be open to seeing new dimensions.
One way I incorporate the future into coursework is by using “Star
Trek Next Generation” episodes as the base from which students
learn to resolve current health care problems in futuristic ways.
I am consistently amazed by their ability to design preferred
futures in which they creatively resolve presently unsolved health
problems.
Problem: Nurses are relatively invisible
and silent in health care and the world.
Gordon (1998) first raised the question of why nurses, who are
human caring experts, are seldom consulted in regard to that expertise.
As a follow-up, it was proposed that part of the answer to this
question relates to nurses’ self-imposed silence about what
we do (Buresh & Gordon, 2000).
Preferred future: Interdisciplinary alliances
in research and creative collaborations will be strategically
initiated by nurse educators.
Through interdisciplinary interaction, nurses will make visible
what we do. This should begin with school of nursing faculty members
mindfully engaging with other disciplines to shape both the profession
of nursing and health care. Out-of-the-ordinary collaborations
should be sought to encourage emergence of unexpected relationships
leading to innovation (Zimmerman et al., 2001). It is the responsibility
of leaders to use authority to create a vision for the future
that benefits the profession (McBride, 2005). Imagine a future
in which nursing students regularly participate in and make important
contributions to interdisciplinary research outcomes.
What will nursing education become?
Nurse educators are crucial in designing the future of nursing.
We prepare students for entry into the complex world of health
care. Watson (2002) posed a question in poetic form:
What will nursing be,
What will nursing become,
How will nursing be defined/redefined,
When the systems that have defined it,
Controlled it, and given it its identity
Are no longer standing behind it?
For me, the answer to Watson’s question is that, in designing
preferred futures, nurses and nurse educators will define and
determine what nursing will become. When we lose our way in the
complexities of health care, we will remember the path is clear
through the vision of preferred futures. What is your preferred
future for nursing education? RNL
Wendy S. Carter Kooken, RN, MSN, is assistant
professor in the Department of Nursing at Bradley University in
Peoria, Ill.
References:
Abbott, E. (1992). Flatland: A romance of many dimensions.
Mineola, NY: Dover.
Allee, V. (2003). The future of knowledge—Increasing
prosperity through value networks. Burlington, MA: Butterworth-Heinemann.
Buresh, B., & Gordon, S. (2000). From silence to voice—What
nurses know and must communicate to the public. Ottawa, Ontario:
Canadian Nurses Association.
Charnley, E. (1999). Occupational stress in the newly qualified
staff nurse. Nursing Standard, 13(29), 33-36.
Connors, H., Weaver, C., Warren, J., & Miller, K. (2002).
An academic-business partnership for advancing clinical informatics.
Nursing Education Perspectives, 23(5), 228-233.
Gordon, S. (1998). Life support: Three nurses on the front
lines. USA: Back Bay Books.
Hall, H. (2001). Trends, models, and new approaches: A review
of futurist literature with implications for program development
in Georgia’s technical colleges. Retrieved November
2, 2005, from http://www.coe.uga.edu/ORG/research/trends.pdf
McBride, A. (2005, June). Orchestrating a faculty career.
Presentation in Leadership in Complex Systems, Indianapolis, IN.
McNeil, B., Elfrink, V., Bickford, C., Pierce, S., Beyea, S.,
Averill, C., et. al. (2003). Nursing information technology knowledge,
skills, and preparation of student nurses, nursing faculty, and
clinicians: A U.S. survey. Journal of Nursing Education, 42(8),
341-349.
Potempa, K., Stanley, J., Davis, B., Miller, K., Hassett, M.,
& Pepicell, S. (2001). Survey of distance technology use in
AACN member schools. Journal of Professional Nursing, 17(1),
7-13.
Ross, H., & Clifford, K. (2002). Research as a catalyst for
change: The transition from student to registered nurse. Journal
of Clinical Nursing, 11, 545-553.
Roy, C. (2000). The visible and invisible fields that shape the
future of the nursing care system. Nursing Administration
Quarterly, 25(1), 119-131.
Tough, A. (2002). Four urgent requests from future generations.
Retrieved November 2, 2005, from http://www.wfs.org/fgtough2.htm
Watson, J. (2002). Nursing: Seeking its source and survival.
ICUs Nursing Web Journal. Retrieved November 2, 2005, from
http://www.nursing.gr/J.W.editorial.pdf
World Future Society. (2002). The future—An owner’s
manual. Retrieved November 2, 2005, from http://www.wfs.org/ownermanual.htm
Zimmerman, B., Lindberg, C., & Plsek, P. (2001). Edgeware—Insights
from complexity science for health care leaders. Irving,
TX: VHA Inc.
Photo: Duane Zehr
