Courage, Heart, and Brains: A Paradigm for Nursing Reform

At first glance, the connection between nursing and The Wizard of Oz might not be apparent, but for 20 nurses from the CEE and NIS, the movie's theme of having "courage, heart, and brains" became a mantra for seven days at an innovative leadership development workshop. The nurses, all leaders in their respective hospitals, Ministries of Health, and communities, gathered in London, England from June 18-25 to participate in the first of three International Nursing Leadership Institute sessions, beginning a year-long journey down their own yellow brick road.

The Institute
The International Nursing Leadership Institute, a program developed by AIHA staff and former and current US partnership nurses, is designed to help NIS and CEE nurses develop the skills and knowledge-courage, heart, and brains-necessary to be successful leaders in today's changing healthcare environment. Through an integrated, year-long curriculum, the Institute's goal is to form a cadre of skilled nursing leaders able to disseminate their knowledge to colleagues and peers.

The five US nurses selected as faculty for the Institute were instrumental in developing the curriculum. Faculty members are Paulette Adams, professor of nursing, University of Louisville, Louisville, Kentucky; Ann-Marie Brooks, chief of nursing affairs, King Faisal Hospital and Research Center, Riyadh, Saudi Arabia; Maureen Mitchell, consultant and principal, Health Policy and Program Consults, Bratenahl, Ohio; Pamela Thompson, vice president, Children's Hospital at Dartmouth, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire; and Jane Younger, chief operating officer, Clark Memorial Hospital, Jeffersonville, Indiana.

• documentation of support from leaders at the nurse's home institution;
• access to electronic media, specifically e-mail, to facilitate participation in ongoing learning modules offered as part of the Institute;
• commitment to participate for one full year; and
• the potential to develop, implement, and evaluate an individual project to create necessary change and/or innovation.

Beginning the Journey
The participants and faculty kicked off the first Institute session by watching The Wizard of Oz, setting the theme for the coming week. Each day of the Institute built upon lessons learned from the previous day, always keeping the theme "courage, heart, and brains" in mind. Throughout the Insti-tute, as participants worked through exercises, they were often given small prizes for exhibiting one of these values.

An important component of the Institute was the keeping of a journal. On the first day, each participant was given a small notebook and asked to write down their experiences throughout the week. The journal encouraged participants to record daily lessons learned, list unanswered questions from each day's presentations, and describe their overall experiences. Faculty asked participants to refer to their journals on a variety of occasions and included time in each day's schedule for "journal writing."

One of the most enjoyable aspects of the Institute was the ability of the faculty and participants to combine a great deal of hard work with humor and lightheartedness. For example, one day each faculty member dressed up as a character from The Wizard of Oz to bring the Institute's theme to life.

Setting Goals
All the exercises and lessons presented at the Institute were aimed at giving each participant the tools they need to formulate an action plan for their individual projects. These projects will be the focus of much effort over the coming year. Each participant selected an existing real-life problem and developed an action plan to overcome it. Within the action plan, each participant stated

• the goal of the project;
• the steps to be taken to achieve the goal;
• the timeline;
• the responsible party(ies);
• anticipated barriers; and
• ways to evaluate the success of the project.

Zagreb, Croatia
Branka Rimac devised a project to prepare University Hospital in Zagreb, Croatia for a new leadership model by working on relationships among colleagues. Her first step is to organize a meeting at her hospital to gain support from the other chief nurses. As team leader, Branka will establish a base of support at her hospital and then invite colleagues from other Zagreb hospitals to meet with their leaders, thereby engaging a larger audience to work on defining leadership problems. From this larger group, a small team will be chosen to develop a new teamwork model that can be used throughout the members' hospitals. This model will include various components of effective teamwork: commitment, communication, active listening, participation of all members, and negotiated and collaborative conflict resolution. Branka plans to organize a Christmas Party in December as a means of enhancing communication and defining resources for the new leadership task force. In response to a question about barriers she anticipates, Branka says, "I have the heart and the brains to do this project. Now all I need is courage to make it happen."

St. Petersburg, Russia
Valentina Sarkisova will work to implement nursing standards of practice throughout the Russian Federation. In fact, a series of seminars for presidents of hospitals and chief nurses is already in process, and Valentina, along with chief nurses of all the institutions, is responsible for these seminars. An early November conference is planned where standards will be disseminated; literature from the conference will be sent to those unable to attend due to financial barriers. Valentina and her group plan to invite Estonian nurses, who have already implemented standards of practice in their country, to the November conference.

Moscow, Russia
Olga Pozdniakova's goal is to reorganize the performance of scrub nurses at her hospital, and to improve the quality of pre-operative nursing care. Olga anticipates few barriers, saying that her supervisor is already prepared to help her facilitate the changes. Olga described a very deliberate method for bringing surgeons and other staff on board through effective communication during meetings and conferences. One of the most significant facets of the project will focus on infection control procedures.

The action plans of each participant are a testament to the talented group of individuals who are participating in the Institute, and illustrate the dedication each one has to the profession of nursing.

Since June, participants have been in contact with faculty and each other via e-mail to share successes, ask advice, and refine action plans.

From November 5-12, 1999, participants will meet in Louisville, Kentucky for the Institute's second session. In Louisville, they will present progress made on their projects, as well as evaluate both their project and performance over the five months since June.

Veronika Oven is a program associate at AIHA.