The American Association of Critical-Care Nurses publishes AACN Advanced Critical Care. Stanford University Libraries' HighWire Press® assists in the publication of ACC Online.

Current Issue : Winter 2017

From the Editor

"Guided by Why"

The American Association of Critical-Care Nurses (AACN) National Teaching Institute & Critical Care Exposition 2017 in Houston was another successful gathering of thousands of critical care nurses—all there to learn the latest in the care of critically ill patients and to rejuvenate and connect with colleagues. At the conference, the AACN’s 48th President, Christine S. Schulman, unveiled her theme for the coming year: Guided by Why. In her President-Elect’s Theme Address1, Ms. Schulman reminded us that as adults we no longer ask “Why?” like we did as children. She encouraged us to return to that practice of inquiry—to remember why we became nurses and to question why we practice as we do—in order to provide our patients with optimal care.

Listening to Ms. Schulman’s speech, I was reminded of the method “Asking the ‘5 Whys’” put forward by Toyota’s Taiichi Ohno as part of Toyota’s notable quality improvement processes.Ohno proposed that when there is a technical problem, asking 5 levels of “why” gets to the root cause of the problem. The “5 Whys” promises deeper understanding rather than superficial answers and guides us in a proportional response. This concept of being inquisitive aligns well with nursing’s needs for scientific inquiry and for understanding the humanistic side of our patients and ourselves. Asking “Why?” provides us with the insight needed to make incremental and transformative changes to our care and our health care system. Asking “Why?” can be perceived negatively: if not proposed from a place of sincerity and with a non-threatening tone, “Why?” can appear accusatory and create defensiveness. It is important to be open to asking and to being asked “Why?” As Talichi Ono stated in the 1950s, “Having no problems is the biggest problem of all.”2  Inquisitiveness and the gaining of insight is one of the most significant ways we can ensure we are doing the right things for our patients.   

Mary Fran Tracy, RN, PhD, CCNS


1.   Schulman CS.  Guided by Why.  AACN National Teaching Institute & Critical Care Exposition. May 2017.
2.  Ono T. Ask “why” five times about every matter. Toyota Traditions. March 2006. Accessed July 10, 2017.