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Practice Tip of the Week: Agency – Choosing to Act with Purpose

Tuesday, January 8, 2019   (0 Comments)
Posted by: Roy Muyinza
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By: Ellen Martin, PhD, RN, CPHQ 
Director of Practice, Texas Nurses Association

“Speak your mind, even if your voice shakes” – Maggie Kuhn

Happy New Year! We are looking forward to a new year focusing on our mission: Empowering Texas Nurses to Advance the Profession. Advancing the profession implies change, a concept that is top of mind for many of us as we start a new year.

According to an American Medical Association study, 40-50 percent of Americans will make a New Year’s resolution to improve themselves or their environment in some way. About 46 percent will succeed. Many people don’t realize there is a whole field of improvement science which provides a theoretical framework and specific skills to determine the interventions likely to be most effective (the what) and evidence-based implementation strategies (the how). Yet, we know science by itself is not enough. Individuals and organizations still struggle with change. Two common reasons why change efforts are often challenging relate to motivating people (the why and who).

The Psychology of Change Framework is a new whitepaper released at the Institute for Healthcare Improvement National Forum in December. The framework focuses on the human aspects of change by activating people’s agency. IHI defines agency as “the ability to choose to act with purpose.” The two key drivers of agency are power and courage. Power is the ability to act with purpose and courage is having the emotional resources to choose to do so, even in challenging situations.

The change framework describes three levels of agency: self, interpersonal and system. It also describes five domains of practice important to achieve and sustain meaningful improvement:

  • Unleash Intrinsic Motivation – creating a shared commitment to act
  • Co-Design People-Driven Change – equalizing power dynamics to design improvements with people instead of for people.
  • Co-Produce in Authentic Relationship – inquiry, listening, seeing and committing to each other
  • Distribute Power – developing relational power to achieve a shared purpose
  • Adapt in Action – learning continuously and persistently with a growth mindset

Each of these concepts is highly relevant to our work as we advocate for change in organizations and at the legislature. To be effective change agents, nurses can use improvement science and psychology of change to collaborate with others to create change. For example, one change I want to see in the world is getting more nurses running for public office. So, one thing I can do personally is read the whitepaper to learn more about these concepts through the lens of motivating nurses to get involved in campaigns, and co-design and co-produce resources with nurses who express interest in getting involved. 

It takes power and courage to change the nursing work environments for the better. What change do you want to see? What do you need to develop your ability to choose to act with purpose?  How can TNA help? We want to hear from you! We all live the TNA mission as we empower each other and work collectively to advance our profession. 


Texas Nurses Association

Texas Affiliate of ANA | 4807 Spicewood Springs Rd., Bldg 3, Suite 100, Austin TX 78759

800.862.2022 | 512.452.0645 | tna@texasnurses.org