Moral Imagination

Marsha Hughes-Rease

MSOD, MSN, RN

Magnet^®, Pathway to Excellence^®

With 30+ years of experience in Health care and over 10 years of consulting experience, Marsha Hughes-Rease brings a wealth of knowledge about organization effectiveness, culture change management, and group process to her consulting practice.

With 30+ years of experience in Health care and over 10 years of consulting experience, Marsha Hughes-Rease brings a wealth of knowledge about organizational effectiveness, culture change management, and group process to her consulting practice. She integrates this knowledge with her consulting expertise to help Health care organizations operationalize the Magnet^® Model to achieve a professional practice environment focused on achieving empirical outcomes in a changing Health care environment.

Marsha has consulted with Health care administrators, nurse leaders, and clinical nurses in 30+ Health care organizations that have earned ANCC Magnet Recognition, or who are on the Magnet or Pathway to Excellence® journey. Using an intentional and inclusive consulting approach, she focuses on engaging clinical nurses, nurse managers, and other key stakeholders to accelerate the achievement of Magnet Recognition or Pathway to Excellence. She collaborates with senior nurse leaders and the chief nurse executive to identify and take strategic actions to create organizational alignment and commitment to the organization's mission and vision.

Marsha’s consulting specialty areas include providing an organizational assessment and gap analysis for Magnet Recognition or Pathway to Excellence, identification of concrete actions to close the gaps, facilitating the development and implementation of a professional practice model, facilitating the development and implementation of a shared decision-making model compatible with the organization's governance structure, review of written documents for Magnet Recognition submission, readiness preparation for a Magnet Recognition site visit, and customized training. Marsha regularly facilitates the two day Journey to Magnet Excellence^® workshop. She has also co-designed and facilitates the one day workshop, Empirical Outcomes: Exceeding Magnet Expectations, which provides participants with an integration of practical tools to excel as change leaders.

Summary of Services

Helps determine readiness to submit a Magnet or Pathway to Excellence application based on a gap analysis.
Conducts a self-assessment that familiarizes participants with the Sources of Evidence in the Magnet Model while simultaneously gathering quantitative data to use as part of the gap analysis report.
Conducts a self-assessment that familiarizes participants with the Pathway to Excellence Elements of Performance while engaging them in action planning to address perceived gaps.
Conducts comprehensive on-site readiness assessments in preparation for Magnet site visits, a process which includes helping clinical nurses learn a communication technique that reflects self-confidence and competence, and articulates the value of nursing at the unit level.
Provides transformational leadership development specifically facilitating peer coaching techniques to address complex issues
Uses creative strategic planning techniques to increase staff nurse engagement, alignment with nursing strategic goals, and effective execution at the unit level.
Customizes education and just-in-time training on transformational leadership, structural empowerment, and change management
Works with senior leaders to design strategic interventions to address performance gaps.
Works with nurse executives to address challenges at all levels that may potentially derail the Magnet Recognition or Pathway to Excellence designation process.

Education

BSN, University of Kentucky, Lexington, KY
MSN, Nursing Administration, George Mason University, Fairfax, VA
MS, Organizational Development, Johns Hopkins University, Baltimore, MD

Certifications

American Nurses Credentialing Center – Certificate Holder in Fundamentals of Magnet^®
Fielding Graduate University, Santa Barbara, CA – Graduate Certificate, Leadership Coaching
Graduate Certificate, Skilled Facilitator, Johns Hopkins University, Baltimore, MD

Professional Memberships

American College of Healthcare Executives
American Nurses Association
American Organization of Nurse Executives
American Society of Training and Development
Institute of Coaching
International Coaching Federation
International Leaders Association
Plexus Institute
Sigma Theta Tau International

Special Acknowledgements

Published numerous articles and book chapters including a chapter on Transformational Leadership in the award-winning text, Nursing Management Principles and Practice(2011, Oncology Nursing Society)
Served as adjunct faculty member at George Mason University College of Nursing, is a faculty member at Duke Corporate Education, and is a certified Executive Coach.

The American Nurses Association has proclaimed 2015 as the Year of Ethics. Given the increasing complexity of health care and the unprecedented ethical dilemmas nurses face each day, Nurses Week is an excellent time for nurse leaders to introduce the revised ANA Code of Ethics for Nurses with Interpretive Statements (the Code) and have learning conversations about the implications of the Code and decision making. In Magnet®-designated hospitals, there is an expectation that nurses use available resources to address ethical issues related to clinical practice and organizational ethical situations. In many hospitals I have visited as a consultant, clinical nurses are not always familiar with the resources available to them to help make decisions with ethical considerations.

I was introduced to a concept a few years ago that has helped me insert ethical reasoning into the decision making process. When President Obama was accepting the Nobel Peace Prize, he said, “Achieving peace and prosperity in the world requires the continued expansion of our moral imagination; an insistence that there is something irreducible that we all share.” The term “moral imagination” caught my attention, so I did a little inquiry to investigate exactly what moral imagination means.

In his 1993 book Moral Imagination, Mark Johnson defined moral imagination as "an ability to imaginatively discern various possibilities for acting in a given situation and to envision the potential help and harm that are likely to result from a given action." I would argue that it is this ability to imaginatively discern various possibilities for acting in a given situation or when facing problems with ethical implications that is the foundation of ethical decision making. However, we sometimes leave out the ethical dimension in the decision-making process. Unfortunately, there are well-known and classic examples where the lack of a vivid moral imagination during the decision-making process had fatal consequences. One of the most famous that many of us have studied is the faulty decision-making that contributed to the 1986 NASA Space Shuttle Challenger accident.

One approach to increasing moral imagination during the decision making process is to practice having "IF-THEN" conversations. Some of the IF-THEN questions to pose for a discussion include

IF the problem is complex and the decision has the potential for causing harm, THEN how do you reframe the problem from a variety of perspectives to get a better understanding of the situation?
IF you are entangled in the immediate situation, THEN how do you create a forum to discuss the problem in the context of the bigger picture?
IF you recognize the group is using a typical way of thinking to address an issue not faced before, THEN how do you challenge the group to use a creative approach?
IF you suspect an ethical conflict is present as part of the decision, THEN how do you make sure it is addressed?

Often the organizational culture contributes to the lack of moral imagination during decision-making. Given your organizational culture, what are some other IF-THEN scenarios you can discuss to create an opportunity for nurses to increase their sensitivity to the ethical implications during decision-making?

This article was originally published in May 2015.

*Use of ANA Consultation Services does not guarantee you will achieve an ANCC credential. ANA consultants and staff cannot influence the actions of ANCC program staff nor decisions of the Commission on Magnet® Recognition, Commission on Pathway to Excellence®, or Commission on Accreditation in Practice Transition Programs and the Commission for Nursing Continuing Professional Development..