Most of the bottom/up, systems-based, front line driven 
transformation in healthcare I’ve been involved in has been implemented mostly by nurses and nursing. Being on the front lines in the ERs, ORs, ICUs, and various floors, I have become a huge fan of nurses. I love them. I don’t know how they do it all, basically holding together the rickety and often dysfunctional systems we call healthcare.
I also find it interesting that virtually all care providers on the front lines seem mostly oblivious to what has become a sort of insanity in the way healthcare is delivered. It simply becomes normal to be in a constant firefight where nothing really goes as it’s supposed to and everyone runs around in a constant state of real time, action/reaction problem solving. For any of you reading this who thinks this a sizable exaggeration, sit down with a group of nurses sometime and ask if they or their peers have any chronic ongoing problems on the job. If you’re taking notes, bring a lot of paper.
However, there is a job even more taxing than that of a nurse. That is being a nurse manager. A nurse manager is supposed to manage the nurses and insure the outcomes that managers further up the food chain deem appropriate. This mostly means attempting to douse fires, at least until the next ones emerge. There are usually many fires to douse and re-douse. Can you imagine being responsible for the outcomes produced by overworked, over stressed, under appreciated, underlings constantly working in firefighting mode, in systems over which they have no control? Welcome to the world of most nurse managers.
While herding cats may be difficult, it doesn’t have anything on trying to manage people who are forced to work in some of the most archaic and illogical systems I’ve seen in any industry. Remembering the fact that approximately 94% of the outcomes we get in healthcare, good and bad, are a function of the systems in which care providers work, not the efforts of those care providers, this situation is a perfect storm of stress and firefights for all.
Possibly worse, stress is passed from systems resisting change to care providers and on to patients, which impedes their healing and well-being. This should be instructive because we know customers (patients) will feel about a company the same as employees (care providers) do, there is just a lag. What does this say about patient experience in being funneled into an ever more stressed healthcare system?
Is it any wonder burnout is accelerating both in nurses and nurse managers, with shortages of both forecast in the near future? Our only hope—genuine, bottom/up, systems-based, front line driven transformation of healthcare. We know how to do this. But who should lead the way? I believe nurse managers are well positioned to become the champions and catalysts for this badly needed bottom/up transformation of healthcare. It may be their only salvation from the stresses of the job longer term.
