GUEST EDITORIAL Discovering the Potential Within S CHAOTIC and turbulent as the health care environment is today, there also is much opportunity. Stepping back out of the noise, I see organizations using varied strategies to respond, adapt, and even lead. What I find most often, and what brings a ray of hope, is the strategy of building partnerships. Individuals and organizations are beginning to understand that tomorrow's successful partnerships require new capacities around relationships. Merely rearranging the people, the boxes, and the companies that comprise health care delivery will no longer work. Something more fundamental about who the people are, what their core work is, and how all the pieces of the system must relate and connect differently is being explored and discovered. Hopefully, through these processes, individuals and organizations not only will learn new ways of relating but also will discover new potential using their existing resources and abundance. Partnership building has much relevance for the profession of nursing. As the issues of health and relationships become more important in our evolving health care system, nursing's unique contributions become even clearer. Our essence has always included both the ability to build relationships with those we serve and to help them in every way "not only be well but to use well every power that they have" (Nightengale, 1969). These capacities in nursing have only grown over time and can serve as a foundation for creating new kinds of relationships within the profession. Applying these same concepts within nursing, beyond the scope of caring for patients, may shape our profession to fulfill the potential it holds. Unfortunately, despite effort, we have too few success stories to report. Looking within and challenging the biases and beliefs held about how nursing should be shaped has been a struggle. However, looking within at the abundance of resource and talent that exists across nursing roles and practice sites illuminates the un-
tapped capacity among us. Strengthening our partnerships internally, discovering new boundaries, and forging new connections in our collective work prepares us in many ways to position nursing for a future yet unfolding. This issue of the Journal of ProfessionalNursing contains a special feature of studies, experiences, and stories from nurse colleagues who have looked within. The uniqueness and richness of this work has many dimensions, all of which demonstrate the building of partnerships, new ways of examining the work of nurses, and new ways to advance the profession. When this issue was in the making, I was asked to review the manuscripts because of my interest and commitment to differentiated practice. The pages in the special feature certainly provide new contributions to the literature on differentiated practice, which clearly is needed, but they do far more than that. The approach, the methodologies, and the focus of this collective work is based on partnerships and a new level of integration between service, education, and research efforts. Moreover, its contribution to both service and education is noteworthy because it examines change and the process of implementing change. Whether change takes the form of RN role redesign in the service setting or how qualitative researchers are prepared, the scholarship represented in these contributions to the field are noteable. Efforts at differentiated practice have waxed and waned over the duration of most of our careers. Differentiated practice has been a goal of nursing profession for well over a decade. One of the purposes of the National Commission on Nursing Implementation Project (NCNIP) in 1984 was to facilitate differentiated practice in nursing. Despite the many far-reaching effects the NCNIP had on the organization and delivery of nursing care, the potential of differentiated practice was never fully achieved, and whatever effect it may have had on nursing today and in the future was never fully actualized.
JournalofProfessionalNursing,Vol 15, No 6 (November-December),
1999: pp 325-326
In 1995, A Model of Differentiated Practice was published out of the concerted efforts of an AACNAONE task force. This task force had a broad table of representation, including the National Organization for Associate Degree Nursing. A framework and set of values for approaching differentiated practice was proffered to the field that not only offered a process for creating more partnerships between service and education but also between practicing nurses in differentiated roles. Many health care organizations have used the differentiated practice framework and principles to design RN roles in their institutions. Some have actually created successful partnerships between service and education to facilitate this work and to continually learn from the processes involved. Despite the amount of design or redesign undergone by RN roles in most, if not all, hospitals across the country in recent years, too few are looking deep enough within the practice. Fewer are making these changes in partnerships with academia, and even fewer have studied the process and implementation of RN role changes.
The articles that follow offer new approaches to differentiate nursing practice, to teach qualitative research, and to understand role and organizational change. All reflect partnerships and a synergy of efforts. All reflect new understandings of change-whether in practice, education, or research--and offer to the field these insights. Most importantly, these articles reflect the collective abundance of resource we have when we look within and discover our interdependencies in nursing and what is achievable through them. In a recent focus group I was asked the question of what nursing is to me. I thought through my 29 years of clinical and leadership practice and stated, "It is about the discovery of potential." My believe is confirmed in the fine works that follow.
Julie MacDonald, MS, RN Guest Editor Senior Vice President of Patient Care St. Joseph Mercy Health Systems Ann Arbor, MI
American Association of Colleges of Nursing/American Organization of Nurse Executives. (1995). A model for di~erentiated nursingpractice. Washington, DC: American
Association of Colleges of Nursing. Nightingale, E (1969). Notes on nursing. New York, NY: Dover. (Original work published 1859)