Riding the waves of change

FigureThe world has seen what nurses can do, so now more than ever, nurse leaders must seize the opportunity to drive changes to advance healthcare into the next decade. The nurse leader's role demands fluidity, the willingness to recognize the need for change and the danger of not changing, and the skills necessary to lead and embrace change effectively. The Future of Nursing Report 2020-2030 highlights changes needed to influence all nurses directly or indirectly. The report identifies the nursing faculty shortage; social determinants of health; diversity, equity, and inclusion; health equity; and capitalizing on nursing's impact as essential opportunities for change.1 The report emphasizes that nurses at all levels must guide, accept, embrace, and effectively manage these inevitable changes. Using surfing as a comparison to nursing, concepts related to the importance of change agility and understanding various change theories support the courage and skills needed to embrace change. Like waves in the ocean, change will keep coming. Waves differ based on the weather, wind, moon, and tide. Waves can be large, small, fast, or slow. No matter the type of change, the nurse leader must recognize that they have the skills to ride these waves like a professional surfer, without fear but with skill, grace, joy, and excitement. What is change, and why is it so important? Defined as a verb, change means to make different, alter, or modify. There's no better time for nurse leaders to demonstrate their skills as change agents and consultants. These skills build on the nurse leader's commitment to patient advocacy, providing safe and quality care, education, and leadership. These are the same skills necessary to modify nursing's journey and the course of healthcare. The nurse leader is a change agent with the competencies to seize this opportunity and ride the waves of change. The Future of Nursing Report 2020-2030 provides evidence-based suggestions and specific recommendations to propel nursing and healthcare to the next level. The report identifies nurses as the leading healthcare providers and highlights their impact. Many state and national organizations are already embracing these recommendations and making changes that will occur over the following months, years, or decade. Nurse leaders are uniquely qualified and positioned to surf amid the changing tides, and they must be ready to do so smartly and without fear. Surfing lessons Nurses should embrace and learn the importance of surfing the waves of change. Just like the waves, change never stops. The waves in the ocean keep coming and are always different. However, no matter how change presents, a nurse leader must be a role model for others and have essential skills to navigate change with grace and excitement. Leaders must guide, accept, embrace, manage, and effectively surf the inevitable changes that healthcare has and will experience. When a hurricane or bad weather is in the forecast, most individuals batten down the hatches and ensure they have enough supplies and food to endure the storm. A few brave, enthusiastic, passionate individuals don't run from the storm but to the storm. With joy and enthusiasm, surfers grab their surfboards, run to the beach, and wait for the waves to rip. Are surfers reckless, unprepared, and unconcerned? No, they are precisely the opposite. Surfers do their homework. Their passion for being prepared supports their joy and enthusiasm for the gnarly waves they look forward to surfing. They embrace the changes the storm brings and the unpredictable changes in the weather. Similarly, nurse leaders must be prepared and excited to embrace the changes that will occur with or without them. What are the lessons a nurse leader can learn from surfing? Lesson 1: Improve your surfing fitness. Surfers must be fit, care for themselves, be rested, eat well, and be mindful. Surfing is both a physical and mental sport, even spiritual to some. Surfers know the importance of self-care. Lesson 2: Surf at the most suitable break. Surfers must study the waves and learn which ones they should and shouldn't surf. Surfers understand the high-reliability organization (HRO) principle of sensitivity to operations. Lesson 3: Choose the right surfboard. Surfers Plan, Do, Study, and Act to make sure their equipment is in working order. Lesson 4: Learn to read surf forecasts. Surfers understand barriers and challenges and know that surfing isn't easy. Surfers embrace the HRO principle of reluctance to simplify. Lesson 5: Learn to read the tide tables. Surfers know the basics and advanced details. Surfers know it takes time, skills, studying, and education to be a great surfer. Lesson 6: Perfect your wax job. Surfboards are waxed to perfection, so the board has the grip needed to ride the waves safely. Surfers know and understand the importance of quality and safety. Lesson 7: Repair your own equipment. Being self-reliant and strong builds confidence in a surfer. Surfers protect themselves with sunscreen and wet suits as they're committed to resilience. Lesson 8: Practice good surf etiquette. Surfers are kind and courteous to each other; they support each other, rescue each other when needed, and never take their fellow surfer's wave. Surfers understand the importance of teamwork, deference to expertise, and situational awareness. Lesson 9: Spot the rip currents. Surfers must identify unseen, unpredictable dangers and reflect on the lessons they learned from a wipeout. They consistently follow the HRO principle of preoccupation with failure. Lesson 10: Have fun at all costs. It's about being courageous and still having fun. What surfing truths do nurse leaders need to know? Surfing a wave takes confidence, strength, and knowledge. To ride the waves of change like a professional, nurses must constantly balance, adapt, adjust, focus, and return to the surfboard for another ride. Change is inevitable and hard and can't be left to chance. A nurse leader must go beyond the lessons and understand the fundamental truths of surfing and change.2 Truth 1: Learning to surf is hard work. It takes work. Surfers know you don't get better sitting on the sand, relaxing and watching. Truth 2: It's embarrassing. Surfing takes time to learn. You don't go out on your first wave and surf like a pro. A dedicated surfer wipes out and gets right back on the surfboard. Falling off a surfboard is expected. A surfer understands that failure provides an opportunity to learn, leading to improvement and success. Truth 3: We all start at the same point. Everyone was a novice once. Surfers respect that and support their fellow surfers' growth. Truth 4: You never reach your goals. There is always an opportunity to learn more and grow as a surfer. Truth 5: It's okay to need help. Everyone needs help and support; be bold and ask. Truth 6: There's more to learning to surf than you think. It's easy to look at things from the outside and think they're simple, or alternatively, to think "I could never do that." Truth 7: Always remember it's essential to enjoy yourself. No matter what, surfers enjoy and love what they're doing. What are the different types of change? Surfing, like nursing, is a unique way of life. Surfers say they belong to a unique and special community, similar to those in healthcare. Change is everywhere, inevitable, and evokes emotion and stress, primarily when uncertainty exists. Nurse leaders create the vision and guide change with a knowledge of theories and models. Like riding a wave, nurses must keep moving forward to stay balanced. They have the competencies they need to adjust and address any changes they face. A technical change addresses problems with known answers and is based on skills or knowledge. Adaptive change is about evolution; it involves changing attitudes, beliefs, or behaviors and is more complex than technical change. A transformational change is significant and may be sudden. Strategic change typically requires business processes and practices. An unplanned change is the result of an unexpected event. No matter the nature of the change, nurse leaders need to be prepared to handle it with their knowledge of change theories and models. Why are change theories and models essential? Theories and models explain how to plan, implement, assess, and measure change. Change management is a dynamic process of guiding change from the earliest stages through implementation to sustaining and finally adjusting based on data. Although change management and project management are often confused, the two require distinct types of management methodology. Change management focuses on the people affected by specific projects, tasks, or processes, whereas project management focuses on the project itself. The nurse leader must be prepared to manage the change process and the project. Whereas a model is a representation and provides structure, a theory is a set of ideas. Although theories might seem abstract and impractical, they support a plan and minimize resistance to change. Robust theories are practical, functional, focus on outcomes, and measure change. Utilizing change theories and models creates plans that result in a successful and sustained change. Numerous ideas and models are available, all of which support the importance of communication and planning. Those most popularly used and implemented in a variety of settings are Kurt Lewin: Theory of Planned Change; Everett M. Rogers: Diffusion of Innovation; Chip Heath and Dan Heath: Switch; J. P. Kotter: Leading Change; GE: Change Acceleration Process (CAP); RWJ Foundation: Transforming Care at the Bedside (TCAB); and Deming: Plan-Do-Study-Act/Plan-Do-Check-Act.3-9 These theories and models have differences and commonalities; however, all provide an approach that can support a needed change. As with surfing, preparation is essential no matter what theory or model a nurse leader selects. Asking several questions from the start will help guide the change process: Is the change necessary? What change theory or model would support this project? Do I have a solid communication plan? Have I identified the key stakeholders? Have I prepared the stakeholders for the change? Have I identified the scope of the project? Have I identified potential barriers? Have I identified potential opportunities? Have I identified a way to measure my change with data? How do we face resistance to change? Even with the best plan, facing resistance to change is always challenging. Understanding the common reasons for resistance and knowing what actions to implement before and throughout the change process to address resistance can help a nurse leader prevent a failure. Loss of control: Include the team in decisions and planning. Excess uncertainty: Keep communication clear and straightforward and provide timetables. Surprise: Avoid the temptation to plan changes in secret. Socialize the ideas, plant the seeds, and sprinkle hints that create curiosity. Everything seems different: Build from what already exists; avoid change for the sake of change. Fear of losing face: Honor past achievements. Concerns about competence: Provide support, education, and resources. More work: Acknowledge hard work; reward and recognize gains and goals. Ripple effect: Recognize that a change can have an unexpected impact. Past resentments: Sometimes the past needs to be addressed before dealing with the future. Hurtful: Change can be a real threat; be honest, fair, and transparent. What are the implications of change? The Future of Nursing Report envisions a significant role for the nursing profession in advocating for policies to eliminate health disparities and guide the future of nursing. The recommendations require understanding the importance of change, commitment, courage, and perseverance. Nurse leaders have the competencies to address these complex and crucial healthcare challenges by actively participating, leading the change process, and operationalizing robust plans. The report identifies the importance of capitalizing on nursing's impact and notes that nurses have a duty to work with other healthcare professionals to implement and manage change. The nurse leader can lead teams, promote community health, and advocate for systems change and health policy. There's no better time for nursing leaders to surf the waves of change and teach others to surf. Social determinants of health, health equity, capitalizing on nurses' potential, well-being, effective use of technology, disaster response, utilizing and building the evidence base, and healthcare expense are some of the topics from a substantial list of opportunities. These recommendations are within the scope of practice and, more important, the responsibility of all nurses. The nurse leader must ride these waves of change with skill and grace and lead the way. Understanding change management theories and principles supports the nurse leader's ability to demonstrate change agility. As a surfer looks at the waves with excitement and views them as an opportunity, so must the nurse leader embrace the opportunities to lead healthcare and help shape the future of nursing.