Beyond busyness: creating slack in the organization.

Human beings are not machines. The patient safety literature documents the price we pay for excessive overtime, long hours, and no breaks. Disengaged staff, high vacancy rates, and turnover are the products of cultures that do not support a professional environment where nurses are seen as knowledge workers. At his retirement dinner, a factory worker accepted accolades for his years of dedicated service. In his farewell speech, he noted that for 40 years the factory used his hands but never his brains. His expertise and knowledge were never acknowledged or solicited. Consequently he watched in silence for years as directives came down from managers and leaders that were totally unrealistic and bore no relevance to the reality in which he worked. And he watched the initiatives fail. Unfortunately we in health care can create that exact situation if we do not incorporate time (slack) into the schedules of our knowledge workers so they can unleash their genius, reinvent health care, and fix health care from the inside out. Nurse leaders must be the architects of participation and allow this to happen.