Darlene D. Borromeo at EAC Ring and Pin Ceremony

Last April 17, 2009, the Emilio Aguinaldo College (formerly Marian College) has invited New Jersey nursing leader, Darlene Dilangalen Borromeo, RN, BC, FACDONA, FMNLI as its keynote speaker during the college's Ring and Pin Ceremony held at the Philippine International Convention Center.

Ms. Borromeo is an honorary member of the Beta Nu Delta Nursing Society and was recently inducted as member of the Sigma Theta Tau International Honor Society of Nursing.

Below is the speech of Ms. Borromeo

Message to Graduates of EA College
April 17, 2009
Philippine International Convention Center
Manila, Phillipines

How can we Nurses gain control of our own destinies in response to trends affecting the healthcare industry…

Positively influence change in healthcare organizations and …
Be effective leaders and supportive followers?

Did you know….that when geese fly in a “V” formation their work is more efficient than if they each flew separately?

By flying in this unique formation, they increase their flying range by as much as 71%.
When the goose leading the flight tires, it moves back into formation and another goose takes its place. If a goose falls out of formation, it quickly feels the drag of flying alone and rejoins the flock to take advantage of the power of the goose it follows. Learning how to be in a lead position, how to support and relieve the leader and how to increase work efficiency as part of a team are goose flight skills that nurses can learn and take advantage of.

Dramatic changes in healthcare have left many nurses feeling frustrated and powerless. If we as nurses, can learn some skills that geese use on their long migratory flights, we can individually and collectively influence future changes in a positive direction.

In United States, a couple of decades ago, our healthcare system was significantly less complicated. The majority of patients were treated at hospitals until they were well enough to function independently at home. The hospital bill was sent to a third party payer, which reimbursed the hospital. An increasing number of hospitals were constructed, each filling with expensive technology and increasing numbers of healthcare staff.

Expensive life saving treatments, innovative surgical procedures and non invasive imaging techniques have resulted in the world’s most sophisticated and----expensive healthcare system.
To survive in this highly competitive environment, the healthcare industry has moved to market based strategies that focus on cost containment, patient satisfaction and quality improvement.
Enter…re-engineering, job re-design and downsizing, which American nurses experienced and still experiencing. Re-engineering involves a comprehensive overhaul of patient care delivery. By re-structuring, an organization analyses processes that can lead to greater operational efficiencies. Through job redesign, components of a specific role are evaluated with the goal of combining tasks to increase productivity. The outcome of these efforts maybe downsizing: reducing the number of positions in an organization.

As organizations undergo rapid change, nurses may feel busier than ever, yet their productivity may actually decrease. Nurses may feel frustrated and powerless or see themselves as victims of some huge unseen system.

Consumed by daily problems, nurses may not be capable of talking about----let alone planning for---the future. Nurses experiencing these stresses may question the value of what they do, fracture relationships with their colleagues, choose to leave the profession, and discourage others from becoming nurses—at the very time when nursing shortage threatens the health of all people globally.

In most healthcare organizations, particularly in acute care hospitals, nursing is the largest and most labor-intensive component, representing about half the annual operating budget. In addition, much discretionary spending occurs at the unit level, where nurses are key decision makers about the use of supplies, equipment and linen—items that also have a major budgetary impact. Ironically, many nurses have no way of knowing what costs they generate as they provide care and often lack the economic awareness needed to make cost conscious decisions.
It is clear that those closest to a task bring a unique perspective to ways of trimming costs.

For example, one institution saved significantly on supply costs by limiting IV starts by inexperienced staff. In many organizations, the voices of nurses who have similar suggestions for improving quality and reducing costs are not heard because they often lack critical leadership skills.

Learning a new set of skills…

Many organizations have established Shared Governance, a model that places large number of staff nurse in pivotal leadership roles to make significant policy decisions affecting nursing practice, education, and patient care quality. Nurses can become future oriented rather than speculating about the future or adopting a “wait and see” attitude. What the future will bring can be predicted by looking at the demographics, technology, and other societal forces.

Demographic trends in the United States clearly point to an increasing number of older people needing care and decreasing number of nurses prepared in geriatrics to direct their care.
Another major trend is the increasing pace of scientific knowledge. Medical knowledge is now doubling every eight years, and 85% of the information collected by the National Institutes of Health is upgraded every five years…

Let me state this clearly…what I know when I graduated in 1978 is now obsolete….
Trends that soon will affect your work include the replacement of traditional patient care “routines” by BEST PRACTICE processes that are outcomes-related and researched based, an evolution of nursing practice from “fulfilling every patient need” to a model that is realistic and responsive to limited resources. Although you might not end up being a “nurse futurist”, learning more about projected trends will equip you more effectively with system changes.

“Seeing the big picture” is the ability to analyze how a specific situation is connected to other aspects of a broader situation. Because nurses have not always been included in decisions affecting patient care services, we have the tendency to look for a quick fix without considering the larger picture. Recent research on nurse staffing shows that the numbers and percentage of professional registered nurses in the skill mix has a significant positive effect on patient outcomes. Focusing only on mandatory staffing ratios does not automatically ensure better patient outcomes or increased nursing job satisfaction.

“More “ does not necessarily mean “better”. It is important to have a high percentage of registered nurse, but the skill mix and quality of the staff, their clinical competence and their ability to critically analyze problems and make appropriate decisions also have an impact on providing high quality care.

Leaders are able to see beyond “quick fixes” ; they are more system focused. People who see the big picture don’t become bogged down in task oriented practice, instead, they implement tasks and care interventions directed toward specific outcomes.

Communicate persuasively—Nurses need to learn how to focus on major issues and give up “sweating the small stuff”. The goal of communication, whether oral or written, is to create understanding, and the level of understanding increases directly in relationship to the clarity of message and the way it’s delivered. Nurse need to develop skills in making clear, organized presentations that are delivered confidently and in writing memos that get results because they communicate in a way that gains attention and support. Start with becoming involved with the change so that you have some influence over what will change and how the change occurs.

If the change in question is particularly difficult, consider that none of us can control changes that occur naturally in life, and it is not realistic to expect that there will be a return to a more stable healthcare environment. Before, during and after change process, stay fit and healthy by eating right, and getting sufficient exercise and rest.

Every Nurse has a vision for a better world for patients; whatever your vision is, it is important that you don’t sit back and wait for someone else to make something happen. Each of us must have a PASSION for our little corner of the Nursing world. You don’t have to be a position of authority to advocate for needed change, to raise issues, and to gain support for your ideas and to speak clearly and strongly about possible solutions.

The professional nurse who is a leader will always do something more than just complain. As practicing nurses, we all share accountability to create solutions for the problems we encounter.
As new graduates, we all begin our nursing careers in a “followership” position. With time and experience, this should change; however, many nurses depend on their nursing administrators to provide all the leadership that nursing needs in an organization.

Yet, nothing could be further from the truth. Some of the most powerful leaders have no position of authority in an organization, but were able to successfully point the way to both small and large improvements in patient service delivery.

Nurses must understand how to lead in order to understand how to nurse. It is important to view leadership as not about power, but about acting powerfully. Leadership is not an inborn ability, but a set of skills and qualities that can be learned and enhanced over the course of your career..

Registered Nurses can no longer conceive of themselves as “just nurses”. Whether you are a staff nurse or the vice president of nursing, it is vital to be self confident, to have high professional self esteem and to be visionary.

One of the most influential people to take the lead was Florence Nightingale. She had a mission, her timing was right, change was desperately needed and she had the skills to be a leader. She was also intelligent, resourceful, strong willed, and not willing to take “no” for an answer—qualities you all have.

Just the like the flying geese, we must learn to share leadership and must all take our turn doing the work that will help our patients recover, our profession evolve and our organizations thrive. Every one of you has the potential to fly the point position and serve as a leader.

As a supportive follower, in today’s flatter, leaner organizations, leaders cannot survive without committed , engaged, contributing followers. There can be no leaders without followers, and there can be no followers without leaders. Being a good follower takes special talents, just like being a good leader does. Leaders need to count on followers to provide input that focuses on finding solutions, not just identifying and complaining about problems. Followers can support leaders by asking questions, giving thoughtful feedback, working to achieve group goals and providing encouragement when the leader takes the risk on behalf of the group. Exemplary followers are those who can function independently, who think critically about ideas that are proposed or directions that are suggested and who become actively involved.

All Nurses can have a profound influence on finding the best way to deliver high quality healthcare at an acceptable cost. To achieve this goal, each of us must ask ourselves what we are personally doing to improve ourselves as individuals and to improve nursing.

As you improve your skills in problem solving, critical thinking and communicating, seek out other nurses whom you can mentor in the future.

Learn how to lead, how to follow and how to use your future knowledge and experience to act powerfully.

Your future in nursing depends on your passion to lead or passion to be an exemplary follower.

Thank you

Darlene D. Borromeo, RN, BC, FACDONA, FMNLI

With EAC's officials

With EAC's Officials

With EAC's Officials and Students During the Holy Mass celebration