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Monday, December 08, 2008

Nursing Organizations Take Heed-Groupthink Is Dangerous to Democracy

Recently, President elect Barack Obama was discussing his decisions for inclusion of persons with diverse opinions in his staff and he made this statement: “One of the dangers in a White House, based on my reading of history, is that you get wrapped up in groupthink, and everybody agrees with everything, and there's no discussion and there are not dissenting views.”

The National Nursing Network Organization has learned firsthand with the Office of the National Nurse initiative that such "groupthink" phenomenon, the adoption of words, phrases and viewpoints that are initially expressed by someone else, and then become the norm or the supported position, is a factor in professional nursing organizations. Organizations will "sign-on" to adopt or reject a position because it is perceived to be supported by all those in a respected leadership status. Often times, additional leaders as well as rank and file members are provided no opportunity to dissent and thus have little inclination to seek an objective analysis. Without encouraging discussion, surveying members, or assuring solicitation and analysis of opposing viewpoints, 'groupthink' can polarize around an initial popular viewpoint, even when this viewpoint is, in reality, simply the initial assessment of a few individuals. Then, because it is described as the Position of a respected professional organization, the groupspeak platform is adopted and defended by similar organizations, without any opposition, dialog, investigation, analysis or critical thinking. It is reminiscent of the popular cliche' "I have made up my mind, don't confuse me with the facts."

So why does "groupspeak" occur? Is it due to a basic human tendency to "sign on" to assure personal inclusion in the group and avoid being shunned. Or in today's busy pace, is it simply expedient, and groupspeak is embraced rather than expending the time and energy to pursue a thorough analysis of all perspectives and incorporate an objective decision making process. Adopting groupspeak also minimizes confrontation, and many people have an aversion to discussions that are argumentative or represent opposing views and take passionate dialog as a personal assault. Yet this is exactly what is needed--healthy sharing of differing viewpoints, time to dialog and hear others' perceptions, and opportunity to share and reach agreement.

It is reassuring to consider the Obama administration will have the advantage of diverse viewpoints and will be an environment that weighs issues objectively to reach a true consensus. Minimizing "groupspeak" is one way leadership of nursing organizations could improve their performance, gain credibility with rank and file members, and could positively impact decisions that will have far reaching implications for healthcare reform.

The National Nursing Network Organization Team—Monday, December 08, 2008  

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Anonymous Anonymous 
What is not discussed is that the dissenting opinions on the methods of a National Nurse office may not be given a hearing. Obesity, diabetes, hypertension as examples of problems which would be approached by recommendations of diet and exercise are short-sighted and are part of a still conservative approach. What about deficient Vit D levels associated with obesity? Preliminary research shows a link. What about lower levels of postassium in hypertension? Research available. What about corn syrup solids as implicated in diabetes, and hypertension? Research done. Will the National Nurse office be innovative or simply follow the status quo?
The same difficulty of developing a questioning mind set in nurses after so much training to follow orders will be a critical challenge. Following orders is vital, but so is a questioning 'thinking ouside the box" ability. Can nurses do both? And when research is not conclusive, will nurses call for more follow-up research if it is outside the pharmaceutical industry? If not the public will view the office and nurses as an extension of an industry with a vested interest in it's own profit.
How politicized will the Office be? Credibility is on the line.
Anonymous NNNO Board of Directors 
These are excellent questions and show the value of allowing/encouraging discussion of all viewpoints. Certainly, one intent of having the ONN lead prevention efforts would be to assure that recommended interventions be evidence based.

Also, the National Nurse would support funding and incentives for continued research to develop the science and validate innovative approaches to healthcare. The National Nurse's advocacy role would serve to keep policy and funding decisions front and center for supportive legislation and action.

Envision a system that would allow for rapid processing of input, data and consideration of suggestions from nurses for progressive approaches to their local health challenges. Exploring processes and outcomes could be expedited and, when appropriate, approaches with promising potential could be rapidly inititated.

The ONN will not be funded with pharmaceutical dollars-this will also be an advantage.

Finally, you asked if the office will be politicized. We are recommending the CNO of the USPHS become a full time position with the official and legitimate title, National Nurse to provide visible, recognizable leadership for prevention efforts. Unlike the Surgeon General, this position is NOT a cabinet or presidential appointment, but rather a position reached after long meritorious service in the USPHS, with ascension to the position subject to peer approval. However, the NN would be a governmental position, and like the OSG it would be subject to aspects of the agenda of the current administration.

Please let us know if you have further comments for discussion. Thanks again for your posting.