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A later version of this editorial appeared in Nurse Leader, Volume 21, Issue 6, December 2023.
Editorial
There is a trend in nursing to implement new solutions as a response to the imperative that circumstances demand that we must change and innovate. In many instances, these problems may be coined as wicked problems. A wicked problem is complex, and many are difficult to solve because of incomplete, contradictory, or systemic implications, and being a symptom of another problem or facing changing requirements or trends.1
The solution to these wicked problems will require a different mindset to problem solve the issues. In many circumstances, we implement a “thing or innovation” but must later return to the table because we haven’t considered the evidence, theory, structure, process, contextual alignment, information, resources, and critical stakeholders required to ensure sustainability for transformation.
The wicked problems around autonomy, healthcare workforce, and access to care continue to persist even with the best ideas to date. Clearly, forces are at work that impede or prevent sustainability. As we find new solutions or evidence to mitigate these wicked problems, we must rethink them through a refreshed lens. In this issue, you will see how creative and innovative authors are reimagining wicked problems with an eye toward greater effectiveness. Nine articles within this issue are provided to mitigate wicked problems using strategic power, future workforce, new settings, simulation, evidence, and implementation science:
- Two nurses serving in roles as Dean and CEO are positioned strategically to transform healthcare and nursing practice in Iowa and the world.
- Undergraduate nursing students are enrolled in the Young Nurse Leaders Program to prepare for a future career in nursing leadership.
- The unit partner role was created between academic and practice leaders to fulfill both practice needs (future pipeline) and student needs (flexible hours).
- Dually certified nurse practitioners are being developed to optimize health and decrease fragmentation in care and costs, and for current and future practice needs.
- Alternative practice settings such as the Csomay Center implemented a DNP Leader in Residence Program to support the preparation of future nurse executives.
- Mobile simulation busses are being deployed in rural America to ensure access to care.
- Technological-based clinical decision support tools are essential for healthcare transformation and provide innovative effectiveness.
- The large span of control for nurse managers calls for accountability for meaningful recognition across the department of nursing, the wider organization, and the wider community.
- Shared Governance in an academic medical center was reimagined using GEMS theory and leadership coaching to improve Nursing Unit Practice Council effectiveness.
Wicked problems can seem hopeless and intractable, yet we can learn much from exemplars and best practices. As you embrace your own wicked problems, I invite you to reflect and develop an awareness about which of your current issues exemplify a wicked problem and then use reflection with intentional planning to include goals and key stakeholders in your initial steps.
References
Pesch U, Vermass E. The wickedness of Rittel and Webber’s dilemmas. Administration & Society. 2020; 52 (6) 960-979.