Welcome to the Nursing Outlook Blog – “3 Questions” – Timely Interviews with Thought Leaders in Nursing

Health reform, quality and safety, medical liability, information technology, nursing education redesign………..

These are among the hot topics of the day. All the critical issues that are important to nursing warrant rapid dialogue among informed readers and traditional modes of publishing cannot keep up with the pace of information available. “Agility” is needed to deliver contemporary arguments electronically for persuasive commentary for building consensus that is timely, substantive and prepared for discourse. Blogging and blogs are increasingly providing a paperless platform for professionals to present and debate ideas in the socially connected evolving web. Nursing Outlook is now hosting an online environment – “3 Questions” – to engage nurses with nursing leaders in discussions around focused topics that are important for the profession. Interviews will be routinely edited and posted for readers to learn from thought leaders of the American Academy of Nursing and a variety of other nursing and health care megastars.

We invite commentary that is thoughtful and provocative! Join the online dialogue!

Veronica D. Feeg, PhD, RN, FAAN



Margaret McClure – Past President of the American Academy of Nursing and “Living Legend”

On Leadership, Change and Fellow Selection in the Academy

Question 1:As one of our most esteemed thought leaders in nursing and change agents in health care, can you describe how you see the horizon of health reform and its concomitant need for leadership?

To listen, click here.

Margaret McClure: I think for nursing, probably, this is probably a golden opportunity, and one that I hope we don’t miss. We’re about to cover 32 million new lives with our health care reform act. I have great faith that it will, in fact, be implemented much the way that we have it written. I realize that there are large numbers of people who are trying hard to prevent this from happening; however, I’m very much a proponent of the changes in health care that this portends. The problem, as I see it, is that we need nurses who are prepared to step up to the plate and assist in very important ways with the changes we are about to make. One of the things helping nursing to come to the forefront is the fact that it’s pretty clear, even to people who have never paid much attention to nurses that it can’t be done without nursing. That gives us a whole different grounding in the formation of public policy and how it’s carried out. Unfortunately, it had to come to a manpower issue, but we ARE at a manpower issue. We simply will not have enough primary health care providers in any of the more powerful roles that we’ve had all along. We don’t have enough of those folks and we’re going to have to have more and more nurses who are prepared to step forward. And to be honest with you, nurses know a great deal more than they have shared with others. The potential of nursing has never been tapped. This is an opportunity for us to participate in ways that we haven’t been able to in the past.

As we go forward, we have this golden opportunity if we play our cards right. What I’m most concerned about is that we’re rational about how we do the implementation of health care reform so that it does the best for the greatest number of people across the country.

Question 2: As the current co-chairperson of the Fellow Selection Committee, Past President of the American Academy of Nursing, and a “Living Legend,” as we prepare to solicit nominations of new Fellows, what do you see as the ingredients of leadership that when added to the mixtures of position and opportunity result in the records of achievement?
To listen, click here.

Margaret McClure: The thing that has troubled me a little bit in the past few years is the fact that I believe there are more able, wonderful candidates for admission into the Academy than we’re actually seeing join. While I recognize that we have very strong criteria for applying to the Academy on the one hand, and therefore not everyone can apply, it seems to me that at the moment the fellowship in the Academy is not representative enough of the fine leadership that exists across the country. Some of this is related to the fact that there are a lot of myths about what you have to do to be in the Academy. For example, some say “You can’t possibly get into the Academy without a PhD.” Well, obviously that’s not the case. If you look at our membership, in fact, we have a large numbers of Academy Fellows – great achievers – who do not have the PhD, EdD or DNSc and are making fabulous contributions and continue to make them. We need these people for leadership in health care reform. And we need them to be in the Academy to help us to influence policy in the most important ways we possibly can!

I am anxious to see greater diversity among the people who are Academy Fellows – and I’m talking about diversity in every possible way. Our field is so diverse. We have large numbers of people doing very important work that many don’t even know about.  We want to be sure that we capture those folks and they become a part of our Fellowship so that we can tap into them and involve them. My interest in this is very serious and it is the reason that I ran for the office of the Fellow Selection Committee.

One of the most interesting issues that we stumbled on recently that I want to make very explicit to members of the Academy is the fact that the bylaws were changed some time ago, changing the criteria for admission. We discovered that many Academy members are unaware of this. In the past, the bylaws said that one criterion for being admitted was that your important leadership contributions be above and beyond your employed position – in other words, beyond your job. We changed that several years ago because there were people who were making fabulous contributions – and every one of them, you could point to and say “Yes, but that was part of his or her job.” As an example, people who have very important positions in the military, such as the Chief of the Army Nurse Corps, have done incredible work which has had very important national impact both within and outside the military. But, if you sat on the Fellow Selection Committee and looked at the old criteria, you would say that all of their work was part of the job.

The truth of the matter is, we’re looking for people who are making a national impact, not people who are doing work above and beyond their jobs. And so, it became a stumbling block to admit some of our brightest and best. The consequence of our discovering this was a change in the bylaws – but obviously many of our fellows do not know about it and they are sponsoring people to the Academy saying to them “Be sure that you say in your application that what you’re doing is above and beyond your job.” And that’s not true at all. It is absolutely not necessary any longer. The most important thing for people to demonstrate is that they are making important leadership contributions to the profession in whatever area they work in – whether it’s in academia or elsewhere. We have people in practice, we have people in information technology, we have people in the insurance part of the world, we have people in policy, we have people in state government – many are doing wonderful work – and the “above and beyond” criteria would not fit! We don’t need it to fit.

What I really would like everyone in the Academy to understand is that the old definition is gone. Now we are looking for people who are leaders in their fields who are making important contributions with a national impact. Having said that, we are looking for people from all our diverse specialties, and more and more, we are beginning to see those folks applying to the Academy, although they often think they’re not eligible.

I think one of the things we haven’t done is to have Academy Fellows see themselves as recruiters – to go up to people they recognize as real leaders and say “Are you a Fellow of the Academy? If not, we have to do something to get you into the Academy.” We need to begin to bring these folks into the fold. They may say “I don’t think I’m eligible…” when in fact you know inside your heart that they are. This is the kind of thing we can help our own Fellows understand in terms of their own responsibilities. The Academy is going to have an important role to play in health care reform and we want to realize that in big ways.

Question 3:Can you discuss the leadership role of the Academy in preparing for this freight train of health policy change through its nomination and selection of Fellows who will drive it into the near and distant future?
To listen, click here.

Margaret McClure: The Academy has over the years increasingly positioned itself, thank goodness, to serve the people of the United States in policy reform and in helping to make health care better and better. I am encouraged about our own involvement in what has gone on to date – and I’m also encouraged at our potential to be tapped as one of the leadership organizations to turn to in health care as we begin these reform processes. A good example: President Catherine Gilliss is doing a terrific job and was recently interviewed by the New York Times. This is an acknowledgement that there is an Academy and that the Academy has something to offer. We have had fine leadership from our Executive Directors: Pat Ford Roegner did a great job to set us up in Washington and get us going. It’s the reason we need to be in Washington. Our new Executive Director, Cheryl Sullivan, has wonderful ties in the Washington area and will be in a position to help the Academy find opportunities to participate to move some of this. One of the most important things you do in an organization such as the Academy is to position yourself in such a way that when people are forming new commissions, new committees, new task forces at the federal level, they call the Academy and say “Do you have someone from nursing who can serve on this commission/committee/task force so that we’ll have that voice.” That they call the Academy – and that they know about the Academy! One of the problems we had being in Wisconsin, as fine as the folks were there, it did not place us where we needed to be in terms of health care policy. The move back to Washington was overdue, badly needed, and I’m so pleased we’re there with the kind of leadership we have at this moment.

The Academy represents our brightest and best in nursing. The Academy should be where we turn. We should work hand-in-glove with the ANA because often the ANA is the group that is called. With the great relationship we have with them, we can help them to place people as well. I remember when we were putting together Quality Commissions and nominating people to serve, we worked very closely with ANA so that we were speaking with one voice and we were putting forward the same people. It’s terribly important that we speak with one voice and that we do what we need to do.

I think the Academy is in a very strong position right now and I think we need to make sure that the officers of the Academy have a way to identify the right people for the right jobs. And then, of course, we have to have members who are willing to step up to the plate and say “Yes – I will sit on that commission – Yes – I will be a part of this work.” What I know of the Fellows of the Academy, it will not be hard work. We do not have difficulty convincing them to be heavily involved. We have a very important and bright future in helping to shape what will go on in health care reform in this country.