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'Wicked problems require creative solutions'

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How can student nurses, newly qualified nurses and health and social care professionals make a difference, ruminates student nurse Leanne

This week, I had the privilege of sharing a presentation at a recent conference with Alliance Scotland’s Health and Social Care Academy. Representing future leaders from across the east of Scotland, my group discussed the problematic nature of the culture of achieving targets within the NHS and proposed our vision of a more progressive view of change. 

Leanne Patrick

Leanne Patrick

Leanne Patrick

Alongside current leaders within health and social care, a number of important discussions took place. From how we have overcomplicated simple concepts, to the difficulty of changing a system that many job roles have come to depend upon, all roads lead back to the same question: how can future leaders make the kind of changes we need to see? How can student nurses, newly qualified nurses and social care professionals make a difference? 

For me, one theme resonated more than any other that day - the concept of having “permission” to make change. Keith Quinn, learning technology manager of Scottish Social Services Council, succinctly observed that “wicked problems require creative solutions”. 

Indeed, presently both health and social care face multiple wicked problems, and our current scientific method of measuring and challenging efficiency through the use of targets is inadequate.

The concept of solving social problems is somewhat of an impossibility; many of the great revolutionaries throughout history could not solve the wicked problems they faced. 

For example, Martin Luther King Junior was not able to eradicate racism in the US but his work made progressive change possible. Targets within healthcare demand impossible solutions and they don’t allow for progress.

As the day drew to a close and discussions came to an end, the event was neatly punctuated by Audrey Birt, associate director of Alliance Scotland and chair of the conference. Inspiring courageous leadership, the suggestion came that we might not ask for permission - only forgiveness.

A little frustrated, I wondered - how? In a profession like nursing, where fear of risks is commonplace and defensive practice the norm, how can we be free to make radical and creative change? As I turn the concept of culpability over in my mind, I am aware of the frontline staff shouldering the majority of blame for even organisational failures. Are we now proposing that they take on the additional burden of being revolutionaries, to risk their livelihoods?

And then I wondered - what kind of a nursing job I want anyway? One in which I spend my days meeting targets rather than meeting the real, human needs of the people I am caring for? One in which I am afraid? One in which I am complicit? We can passively and fearfully watch things happen to our profession, or we can find the courage to challenge and innovate, to confront the real problems that stand in the way of progress. For ourselves and for the people who need us to do better.

The answers may never be simple and progress is slow by nature, but perhaps we ought to begin by asking ourselves how much we are willing to compromise our values. As former army chief David Morrison once put it: “The standard you walk past, is the standard you accept”.

Leanne Patrick is currently in her first year studying mental health nursing at the University of Stirling

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