Significance: The purpose of the class was to help nurses find their voice, gain a sense of empowerment and regenerate their enthusiasm and passion for nursing. With newly acquired skills in appreciative inquiry, they were able to see possibilities where they once saw burdens, barriers and bureaucracy. They were able to use the appreciative inquiry model to develop change projects to create safer environments for themselves and their patients. This eight-week course includes four on-line learning modules that cover: 1) Building a safe work environment – start with strong footings, 2) Laying the foundation – teamwork and group dynamics; 3) Framing the organization – exploring the structural elements, and 4) Building a safer workplace – blueprints for change.
Implications: Nurses are skilled problem-solvers trained to quickly assess, diagnose and formulate a plan of action. This approach to clinical decision-making can trickle into the organizational culture, looking at what is wrong and how to fix it. An alternative is the positive asset-based method of appreciative inquiry, which instead highlights successes, strengths, and best-practices (Ramage et al., 2017). Using the 4-Ds of AI: Discover, Dream, Design, and Destiny, nurses can promote a compassionate and caring healthcare environment. Like many quality improvement models, AI is a cyclical generative process of examining “what is working well’ to co-creating and co-evolving plans for “what can be” (Cooperrider, Whitney & Stavros, 2008). AI has been used to cultivate interprofessional collaboration, transform negative work environments (Kahn, Rivera, Manzano & Fitzpatrick, 2018; Ramage et al., 2017) and promote passion and commitment in nursing (Halm & Crusoe, 2018).
Conclusion: There is growing interest in the appreciative inquiry model and how it can be used by nurses in practice to improve the healthcare environment for patients and employees. The utility of the AI model requires the development of a different skill-set, so there is a need for education to fill the gap in skill development. For AI to truly be transformational, the process needs to engage all of the stakeholders (Watkins, Dewar & Kennedy, 2016). This helps promote positivity and gives all those involved a sense of empowerment to co-construct new possibilities to enhance care and services within an organization. It is critical that nurses are adequately trained not only as competent clinicians by savvy change agents as well.
It is critical that nursing schools provide students with basic organizational and systems improvement skills to become transformative change agents for healthcare and professional nursing practice. In the academic setting, the AI model can be incorporated into a variety of courses, such as a leadership course, or an asset-based capacity-building community health class. For one nursing program, the course on Creating Healthy Work Environments addressed several areas of the BSN Essentials (AACN, 2008) including quality care and patient safety, interprofessional collaboration, professionalism and promoting the professional values of caring. With the appropriate training in appreciative inquiry, nurses are destined to compassionately design and deliver healthier work environments.