Healthcare, medicine, and nursing are built upon action: we jump into the fray, we take decisive action, and we save lives.

But what does it mean when an organization chooses not to act? What are the repercussions when a hospital, surgical center, or other healthcare facility makes a choice to do nothing, even when the consequences could be dire?

Nonaction is a Choice

In any situation we encounter, the choice to act or not act is almost always there. Do we help the little old lady cross the street or not? Do we comfort the crying child or do we assume their parent is nearby?

The world is filled with duality, and the choice between action and nonaction is real. Where in healthcare does nonaction occur? Almost everywhere you look.

Here are a few examples:

1. A nurse sees another nurse bullying and intimidating a colleague.

The nurse witnessing the bullying says nothing, does nothing, turns her back, and walks away. Her silence equals complicity with such aberrant behavior.

The bullying continues unabated because no one will confront the bully, stand up for her victims, or document what they’ve seen and heard.

2. Caring for a patient with chronic pain and a history of substance abuse, a third-year resident rejects the patient’s requests for pain control, telling the patient "to grin and bear it."

The resident instructs the nurses on the unit to ignore the patient’s call bell and warns them that anyone who administers pain meds is "giving in to an addict."

The patient’s pain elevates to the point where he injures himself quite badly trying to get out of bed to flag down a nurse. His lawsuit for gross medical negligence costs the hospital $20 million and ruins the career of a promising young medical professional.

3. The executive team of a large hospital knows it’s hemorrhaging nurses and other staff due to outdated onboarding procedures, rampant poor behavior by senior staff, and a lack of mentoring and proper training.

Being penny wise and pound foolish, they continue staffing the facility with travelers who have no say in how the hospital is run. Plummeting patient satisfaction scores eventually cost the facility millions in lost revenue and employee attrition.

Actions Speak Loudly

When a unit manager comes down hard on a bully and removes her from the floor, the results of that decisive action ripple out like a pebble dropped into a still pond.

On a different unit with similar issues as those mentioned above, the manager is emboldened by her colleague’s success, quickly instituting a similar initiative to rid her floor of two bullies who are skilled clinicians but make everyone else miserable. Morale, employee retention, and patient satisfaction soar.

The CEO of an ambulatory care center chooses to institute a policy that allows nurses to have more control over their own schedules. After years of saying no and doing nothing, this leader realizes that allowing nurses to handle their own decision-making processes is good for everyone concerned.

A large teaching hospital makes the decision to pursue Magnet status, and the positive fallout from that decision reverberates for years. Having achieved Magnet, the facility’s nursing staff is unparalleled in terms of its excellence, and staff attrition, medication errors, and nosocomial infection rates plummet to record lows.

Change, Nimbleness, and Strength

Action isn't called for in every situation, but nonaction can often be seen as a sign of weakness or resistance to change.

In a healthcare environment where change is the only constant and the very market seems to be built upon sand, strong leadership and nimbleness are essential. Organizational pivots are sometimes necessary, even if change is painful.

In the end, staff want to feel that an organization or facility has their back, and patients want to feel safe and cared for. It's no secret that patient satisfaction scores are tied to reimbursement, and healthcare facilities that ignore signs of their own demise may likely shutter their windows more quickly than they ever expected.

Competition is fierce, and one way to remain competitive is to remain open to change and decisive action.

Action should never be taken for action’s sake; nor should nonaction be the chosen course based on paralytic fear. Nonaction can be powerful when coupled with thoughtful consideration and analysis, but even simple analysis is an action, after all.

The willingness to be nimble in the face of change is a strong leadership style. The healthcare leader who can strike the right balance between action and its antithesis will have many successes along the way, despite the shifting, volatile sands of 21st-century healthcare.