Her work influences thousands of caregivers and millions of patients.
It is said that within a story lies the wisdom of many stories, and few are more aware of a single story’s power to capture the big picture than Bonnie Wesorick, RN, MSN, FAAN. A master at crafting narratives that expose hidden truth and bring it to the surface where it can educate and inspire, Wesorick tells her clinical stories with the fervor of an evangelist, the focus of a researcher and the quiet but intense concern of a nurse entrepreneur who has never forgotten that, ultimately, nursing is all about providing quality care. Her passion is reflected in the mission statement of CPM Resource Center, the company she founded: Forming partnerships across the world to co-create the best places to give and receive care. For Wesorick, it’s more than a mission statement; it’s her mission.
From the word mission comes missionary, and that’s what Wesorick is: a voice crying in the wilderness of health care, seeking fellow travelers who, despite health care’s ill health, have not forgotten what drew them on their journey of caregiving in the first place. She finds them every day in the corridors of hospitals, disillusioned by the realities of decreased job satisfaction, compromised patient safety, dehumanization and fragmentation. Called upon to do more and more with less and less, these workers, observes Wesorick, are experiencing “exhaustion of the soul ... exhaustion that no bonus, no day off or extra hours of sleep will make go away.”
With a soft but urgent voice that pierces the din of conventional wisdom and health care as usual, she recites for prospective clients a litany of six core beliefs that she and thousands of clinician colleagues have identified during the past 30 years: 1) Each person has the right to safe, individualized health care that promotes wholeness of body, mind and spirit. 2) A healthy culture begins with each person and is enhanced by self-work, healthy relationships and system supports. 3) Continuous learning, diverse thinking and evidence-based actions are essential to maintain and improve health. 4) Partnerships are essential to plan, coordinate, integrate, deliver and evaluate health care across the continuum. 5) Each person is accountable to communicate and integrate his/her contribution to health care. 6) Quality exists where shared purpose, vision, values and healthy relationships are lived. Wesorick delivers her credo with such conviction that even the most timid is tempted to whisper a quiet amen!
When she asks audiences to rate, on a scale of 1 to 5, the intensity of their agreement with the core beliefs, the numbers consistently average 4.8, but when asked if they live out these beliefs every day, the average drops significantly, to 3 or below. Wesorick’s mission is to bridge that gap, and she finds stories an effective tool.
Just as the story of the Good Samaritan compels one to think beyond the obvious in answering the question “Who is my neighbor?,” Wesorick’s real-life stories about Matt, Mark, Barbee and Ray—stories she terms “Wisdom from the Field”—challenge health care providers of all disciplines to seek a higher path—a place where health care is humanized and there is meaningful dialogue, integrated competency, instant access to evidence-based tools and resources, and the infrastructure to support it all.
She’s not always speaking to the choir. Some are resistant to Wesorick’s message, and not, she laments, without justification. In the face of financial cuts and personnel shortages, health care executives have been asked to be miracle workers. They’ve been told to reduce costs, meet increasing demand for service, improve outcomes, increase productivity and raise staff morale. Many have done their best to produce the desired results and, when they haven’t materialized, have turned to Plan B, summed up by the axiom “If at first you don’t succeed, try, try again.” As executives and their programs have come and gone and staff caregivers have witnessed changes that didn’t produce the desired results—or, if they did, the positive outcome was not sustained—hope has languished. In seeking change, executives inoculated staff members against change and in the end, both were frustrated.
To break through these barriers, Wesorick uses stories. As she points out, anyone who has worked with smoking cessation programs knows that human behavior doesn’t change until you touch the affective domain. Although the cognitive and psychomotor ways of learning are dominant in health care, it’s not until you connect with core values through the affective domain that real and lasting change occurs.
Healthy Culture Molecule
Before telling a story, she introduces the Healthy Culture Molecule, a visual representation—a metaphor—of the fundamental elements needed to achieve a “best place to give and receive care.” A molecule is an effective metaphor because, as Wesorick points out, if you remove an “H” from the H2O molecule, you no longer have water. Similarly, if you remove from the 10-element Healthy Culture Molecule any single element that Wesorick and thousands of her clinician colleagues have identified as fundamental, you no longer have a best place to give and receive care.
In an exercise she has repeated for hundreds of thousands, she asks each member of the audience to evaluate the degree to which each element is functioning in his or her work setting. Focusing on shared purpose, for example, the most important element in the molecule (although none of the elements is dispensable), she asks attendees to evaluate, on a scale of 1 to 5, the strength of shared purpose among the people with whom they work every day. For this element of the molecule, 5 is defined as “You can walk onto my unit, any time of the day or night, and we have a common ground. We’re absolutely clear about what matters most as healers.” Wesorick then proceeds through the rest of the elements—dialogue, scope of practice, competency, etc.—always providing clinical examples to illustrate the ideal (Wesorick, 2002).The exercise requires a public response in which all participants openly indicate the reality of their workplace by walking to the front and placing large red dots—on scales from 1 to 5—beneath each of the 10 elements. As incriminating dots begin accumulating near the lower ends of the scales, a hush falls over the room as their cultural reality sinks in.
“After you’ve done this with hundreds of thousands of health care workers,” says Wesorick, “you can predict where the dots are going to fall. No matter who I deal with—Top 100 hospitals, Magnet, Baldridge organizations, it doesn’t matter—the dots will fall into what we call a very risky level, because few have done the integrated work needed to create the best places to give and receive care. Seriously few.”
“I hope you dance”
“I’ve been at places that have won every award you can win. When I tell them that their results indicate they are at risk—and the majority are at risk; you can’t imagine how many low scores there are—people can’t believe it. They start to see, this is how we live, every day, and they begin to ask, “What must we do to change it?” That’s when Wesorick turns to one of her most powerful stories, about Vicky and Terry. Victims of a horrendous auto accident in their home state of Michigan, they were taken to a hospital in the eastern part of the state: Vicky with acute trauma and multiple injuries, including a spinal injury and a punctured lung, Terry with acute head injury. Their young children, also in the accident, were not injured.
Wesorick tells Vicky and Terry’s story in segments, letting Vicky articulately explain via video how vulnerable patients feel and how important it is for health care workers, in all disciplines, to have the right tools in the right place at the right time. Wesorick ends the session with a music video portraying Vicky, Terry and their two children over a period of six years—before, during and after the accident. The song, “I Hope You Dance,” made famous in 2000 by country music artist Lee Ann Womack and recorded for the video by Diane Penning, was chosen by Vicky to accompany their story’s poignant images.
“I hope you never lose your sense of wonder. ... May you never take one single breath for granted. ... And when you get the choice to sit it out or dance, I hope you dance.” As the last note dies away and the final image fades, Wesorick addresses a subdued, clearly moved audience and knows the video has indeed touched their affective domain.
“It isn’t often that we get to sit back and watch our practice over time,” she tells her audience. “I hope you heard the very first words of the song. Remember. This was dedicated to you by Vicky. We’re here to help you shift these 1s and 2s to 5s, to help you reach the highest level of practice. You are in the place right now to make the choice to either sit it out or dance, and I hope you dance.”
Living life to its fullest is a philosophy that Wesorick clearly embraces. Her own story begins as Bonnie Henry of Grand Rapids, Michigan, USA, where she still lives today. Her role model for nursing is her mother, although her mother was not a nurse. “She was the matriarch of a large family and a loving, nonjudgmental, helping soul,” Wesorick explains. “She cared for everybody who was sick, and I watched her. She seemed to know everything that anybody should know to give good care. Two recipients of her care who stand out are my cousin and my grandmother. I watched her care for them and thought, ‘She is magical in the care she gives.’”
Nursing or teaching?
Bonnie’s parents had limited financial means to support college tuition. As a woman, she knew that, if by some remote chance she were able to pursue a professional career, she had the same two options most women raised in the 1950s had—nursing and teaching. Eventually, she chose nursing, thanks to her mom and financial considerations. “Back then, nursing tuition was practically nothing, because students on the units were really manning the hospitals,” she notes. “Nursing was something I could afford and something that appealed to my heart because of my mom.” A memorial award honoring Helen Henry was recently established through Sigma Theta Tau International Foundation for Nursing. For more information, go to www.nursingsociety.org/awards.
Wesorick earned her diploma at Holy Cross School of Nursing in South Bend, Indiana, graduating in 1964, and continued her general education at Community College in Grand Rapids. Employed initially as a staff nurse, working in Grand Rapids and Kalamazoo, Michigan, she soon found herself assigned to intensive care, a role that had just come into existence with the development of the first intensive care units. She loved the challenge of learning and being on the cutting edge, and was thrilled when the director of nursing at Butterworth Hospital School of Nursing in Grand Rapids gave her the opportunity to fulfill, through nursing, a career option she once thought was financially out of her reach—teaching.
“I said, ‘Well, you know, I would love to teach, but I don’t even have a BSN.’ The director responded: ‘It doesn’t matter. We will help you get that, but we need someone who brings the core of nursing to our students, and they’re all talking about you doing that. I just think it would be good if you could teach us to do that.’ And I said, ‘Teach you?’”
Wesorick quickly realized that she liked teaching more than being in the “real world,” because the real world was not conducive to professional practice. She thought her teaching would help change that reality until a former student challenged her and told her she was living a lie.
“Look at me!” she yelled at Wesorick. “Look at me! I am young and I feel old. You told me we could change this place. I’ve never worked so hard in my life! I don’t think this place can ever be changed. There’s too much red tape. There’s too much bureaucracy. I’ve got to get out of here before I become like the people I work with and stop caring! What are you going to do about it?”
What was Wesorick going to do about it? “The things that are being taught and the things that happen in the real world don’t match,” the young nurse had told her. “You’ve got to stop pretending that they do and do something about it.”
“That was the beginning,” says Wesorick. “I made a decision to devote the rest of my career to creating cultures worthy of the commitment of all the people who work in the hospital and worthy of the trust of the people we are privileged to serve every day. I went back to school and focused on what I needed to know to make that happen.”
Clinical Practice Guidelines
In 1977, Wesorick graduated from Aquinas College in Grand Rapids with a BS in biology and chemistry, followed by an MSN in 1979 from Wayne State University in Detroit. During this period, she continued to work as an instructor in a diploma and BSN program where, in the late 1970s, she and some of her students developed a handy informational tool to help student nurses synthesize knowledge and practice during critical-care clinical rotations. She soon realized that what was useful for students was also useful for practicing nurses, and she spearheaded a collaborative effort by 50 nurses from clinical and academic settings to produce one-page, double-sided “standards of care.” Now called “Clinical Practice Guidelines,” they outlined the professional scope of nursing practice for specific patient populations (Hanson, Hoss, & Wesorick, 2008).
These peer-reviewed handy references, a sort of CliffsNotes for nurses, were based on expert opinion and the best-available literature. Wesorick also discovered that the educational preparation of clinical nurse specialists made them particularly well suited for compiling quality guidelines, and she instituted the requirement that a master’s prepared nurse be included in each authoring group. Thus began a process to engage bedside clinicians in scholarly work.
Contained in the initial efforts that Wesorick spearheaded to bridge the gap between education and reality were the seeds of organizations she would later found. The 50-nurse collaborative effort that she directed in the early 1980s is today reflected in two entities: 1) the CPM Resource Center (CPMRC) and 2) the CPMRC International Consortium.
The CPM Resource Center, founded in 1992 and headquartered in Grand Rapids, is now a business unit of Elsevier, providing customizable, evidence-based products and professional services to health care organizations in North America, with plans to go global. In addition to enhancing the ability of these organizations to accurately track and report patient outcomes, the company’s products help drive decisions that support patient safety, improve cost effectiveness by reducing service duplication, and advance implementation of evidence-based practice. Augmenting CPMRC’s products and services are more than 40 interdisciplinary experts, connected with clinicians in more than 1,000 settings.
The CPMRC International Consortium, which began with eight clinical settings, now reflects input from more than 240 hospitals—in rural, community and university venues—across the United States and Canada. The consortium collectively engages in scholarly work to advance all components of practice.
Clinical Practice Model
Wesorick’s Clinical Practice Guidelines, which first delineated easy-to-access standards of care for nurses, including scopes of practice, provided the initial knowledge base for her Clinical Practice Model (CPM). The CPM debuted in 1984 and provided an overarching framework for transforming clinical practice at the point of care. The model was first implemented in a 525-bed community hospital.
Over time, the CPM has evolved to provide electronic, evidence-based tools that support critical thinking and professional practice across disciplines, within various health information technology (HIT) systems. In addition to providing executable knowledge for integrated practice in nine clinical disciplines, CPMRC’s automated system daily informs the evidence-based practice of hundreds of thousands of clinicians across North America.
Is CPM Resource Center and its products effective, or is it just one more company that is long on promises and short on delivery? In light of all the programs that have come and gone, it’s a fair question, and one of vital interest to Wesorick. In her mission to create the best places to give and receive care, she has no interest in being a purveyor of tools and information that end up on the trash heap of the tried and abandoned. Having witnessed “exhaustion of the soul” among disillusioned health care workers, she wants no part of contributing to it.
One secret of Wesorick’s success in creating “best places” is her system integration approach to problem solving. “Nothing stands alone,” she observes. “If you’re in a culture without these fundamental elements all simultaneously being strengthened, it doesn’t work. We will make no change unless it supports the whole, unless it achieves the long-term sustainable goal. If you don’t have a framework for developing technology and you just automate documentation, it actually gets worse.”
Concordant with system integration, Wesorick is also a strong proponent of polarity management. With the help of Barry Johnson, author of Polarity Management (Johnson, 1996), the International Consortium found that many change efforts in health care are unsuccessful or unsustainable because decision makers try to solve problems with an either/or mentality. This fails to recognize that many issues are not problems to be solved, but chronic dilemmas—polarities—to be managed. “Polarities need ‘both/and’ thinking, so as to ensure the whole is being addressed” (Wesorick, 2002, p. 24). For example, according to polarity management doctrine, it is unproductive to focus on staff satisfaction without simultaneously working on patient satisfaction. Fail to manage polarities and you fail to build a sustainable, healthy, healing culture.
Then there’s standardization, a word that many equate with one size fits all. “When people hear ‘standardization,’” says Wesorick, “they think, ‘Oh, it’s ‘cookbook,’ not individualized. They’re scared of it. But, you see, that’s a polarity. In fact, you can’t get to individualization if you’re not standardized. You need both. From the beginning of this effort, we agreed to be clear about what matters most, and that called for standardization based on a professional practice model. This was apparent in the 1980s in our paper-based documentation system, and it’s true today with our automated approach. Without a framework for standardization, there’s no way to keep up with and make sense of the expanding knowledge that needs to be integrated into daily care.”
Wesorick is careful not to take all the credit for her achievements. In addition to expressing appreciation to the clinicians who have contributed to the CPM International Consortium and the work of the CPM Resource Center, she attributes a great deal of her success to her husband, a retired high school guidance counselor. “I would never have been able to do this work, the hardest work I’ve done in my life, and I never could have done it had he not been my husband and the father of our sons—never—because we’ve been able to sustain a strong, loving family and balance. He sees this as my calling and supports me in every single step. We’re just very blessed.”
And what do their sons do? They’re all involved in health care. The oldest, a physician, practices and teaches at the University of Michigan. Their second son is a nurse and lawyer, working in risk management in a hospital. The youngest is just finishing his third year of residency in emergency room medicine. Definitely interdisciplinary.
In more than 44 years of nursing, Wesorick has contributed much to the profession of nursing. In addition to birthing an organization of committed health care professionals with international aspirations, she has prepared another generation of leaders to carry on her work. In May 2008, she transitioned into her new role at CPMRC as chairman emeritus. She devotes significant time to deepening the organization’s work by connecting with thousands of healers through speaking engagements, writing and philanthropic pursuits.
Today, the leadership of CPMRC is in the hands of Michelle Troseth, RN, MSN, chief professional practice officer, and Diane Hanson, RN, BSN, MM, general manager, and the company is well-positioned for further growth. Asked if she has accomplished all she set out to do, Wesorick simply smiles and says: “Now, I am in a position to do my very best creative and innovative work. I feel privileged, grateful and filled with possibilities.”
James E. Mattson is editor, Reflections on Nursing Leadership.
Hanson, D., Hoss, B.L., & Wesorick, B. (2008). Evaluating the evidence: Guidelines. AORN Journal, 88(2).
Johnson, B. (1996). Polarity management, identifying and managing unsolvable problems. Amhert, MA: HRD Press.
Wesorick, B. (2002). 21st century leadership challenge: Creating and sustaining healthy, healing work cultures and integrated service at the point of care.” Nursing Leadership Quarterly, 26(5).