nursing leader assignment

Leadership Concept

Leadership in health care takes many forms and styles. Every nurse needs to be prepared to lead as appropriate for their scope of practice, role in the healthcare system, and as a member of a care team. 

For entry-level nursing students, we recommend schools prepare students with situational leadership skills. Situational leadership is an adaptive style that is well suited for a variety of nursing roles at both the entry- and advanced-levels of practice.  

Situational leadership skills have the potential to help nurses meet the core concepts of clinical practice more effectively. These include clinical judgement; communication; compassionate care; diversity, equity, and inclusion; evidence-based practice; health policy; and the social determinants of health. Adaptable as needed, the style of the leader may change continually to meet the needs of others in the organization based on the situation. 

The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity underscores the critical need to develop a more diverse nursing workforce as key to achieving the goals of reducing health disparities, providing culturally relevant care for all populations, and leading to health equity. Diversity encompasses more than race or ethnicity. Diverse workplaces are composed of individuals with varying characteristics including, but not limited to, religious and political beliefs, mental and physical abilities/disabilities, gender, age, ethnicity, education, socioeconomic background, sexual orientation, and geographic location. It is critical to build an inclusive environment where all students receive individualized support and are encouraged to thrive academically and professionally. Equally important, "nurse leaders have a responsibility to address structural racism, cultural racism, and discrimination based on identity (e.g., sexual orientation, gender), place (e.g., rural, urban), and circumstances (e.g., disability, mental health condition) within the nursing profession and to help build structures and systems at the societal level that address these issues to promote health equity" (National Academy of Medicine, 2021, pp. 10-11).

Definitions 

Situational leadership in nursing is defined as the ability to:  

• Take the lead in patient care scenarios as appropriate to one’s role; and, 
• Demonstrate both leadership and followership skills on healthcare teams. 

Diversity, equity, and inclusion are defined as: 

Diversity references a broad range of individual, population, and social characteristics, including but not limited to age; sex; race; ethnicity; sexual orientation; gender identity; family structures; geographic locations; national origin; immigrants and refugees; language; physical, functional, and learning abilities; religious beliefs; and socioeconomic status. Inclusion represents environmental and organizational cultures in which faculty, students, staff, and administrators with diverse characteristics thrive. Inclusive environments require intentionality and embrace differences, not merely tolerate them. Everyone works to ensure the perspectives and experiences of others are invited, welcomed, acknowledged, and respected in inclusive environments. More broadly, equity is interrelated with diversity and inclusion. Equity is the ability to recognize the differences in the resources or knowledge needed to allow individuals to fully participate in society, including access to higher education, with the goal of overcoming obstacles to ensure fairness (Kranich, 2001). To have equitable systems, all people should be treated fairly, unhampered by artificial barriers, stereotypes or prejudices (Cooper, 2016). These definitions can be found in the AACN Position Statement - Diversity, Equity, and Inclusion in Academic Nursing (2021) .  

Essentials Competencies Addressed

Key Resources

1. Federal Plan for Equitable Long-Term Recovery and Resilience  

View Executive Summary  | View Full Report

The plan focuses on seven vital conditions to frame a plan for health and well-being for individuals and communities. As trusted professionals, nurses can play a critical role providing leadership within the community to address health inequities and enhance wellness and resilience.  

Faculty Suggestions for Use: Recommended for classroom discussions on leadership and policy development. 

2. The Development of the Person-Centered Situational Leadership Framework

Lynch, B. M., McCance, T., McCormack, B., & Brown, D. (2017). The development of the person-centered situational leadership framework: revealing the being of person-centeredness in nursing homes . Journal of Clinical Nursing , 27(1-2), 427–440.

The Person-Centered Situational Leadership Framework captures seven core attributes of the leader that facilitate person-centeredness in others. This framework relates to harmonizing actions with the vision; balancing concern for compliance with concern for person-centeredness; connecting with another person in the moment; intentionally encouraging the other person to act; listening to the other person with the heart; and unifying through collaboration, appreciation, and trust. This framework can close the gap in knowledge about leadership. It can be applied to many practice settings.  

Faculty Suggestions for Use: Recommended as a basis for classroom exercises focused on mindfulness and relaxation.  

3. Leadership and Job Satisfaction Among Azorean Hospital Nurses: An Application of the Situational Leadership Model. 

Furtado,  Carlos Do Rego Furtago, L., Da Graca Bapitsta, M., & Silva, F. (2011). Leadership and job satisfaction among Azorean hospital nurses: an application of the situational leadership model.  Journal of Nursing Management vol. 19(8), 1047-57. doi:10.1111/j.1365-2834.2011.01281 .

Nurse leader satisfaction can be linked to their ability to implement situational leadership styles. Nurse managers can develop staff nurses’ skills through awareness of their own leadership, while promoting nurse satisfaction. 

Faculty Suggestions for Use: Recommended for use to introduce wellness and leadership concepts in the classroom and then to encourage students to self-practice.

4. Nursing Leadership Must Confront Implicit Bias as a Barrier to Diversity in Health Care Today

Stamps, D. C. (2021) Nursing leadership must confront implicit bias as a barrier to diversity in health care oday . Nurse Leader , 19 (2), 630 -638. 

Nurse leaders must be aware of implicit bias and help all nurses, from novice to senior, recognize its existence as a barrier to diversity. Raising awareness will help to create a safe environment for nurse retention at all levels and support patient outcomes decreasing healthcare disparities. Identification of types of bias and strategies to mitigate the impact are multifactorial; however, can be accomplished to impact retention and patient outcomes. There are triggers that can assist the person to identify bias.   

This article can serve as the foundation to a discussion post or reflection paper. Unconscious bias is common, persistent, and can be activated quickly and unknowingly despite a nurse’s best intentions. We cannot eliminate bias; however, we can interrupt it and the outcomes in healthcare disparities. 

Faculty Suggestions for Use: Recommended for use to introduce reframing in the classroom and then encouraged self-practice.  

5. A Model to Streamline Career Progression For Nurse Managers and Retain Emerging Leaders: Nursing Management,

Stamps, D., Beales, S., Toor, M. (2019). A model to streamline career progression for Nurse managers and retain emerging leaders . Nursing Management , 50(10), 29–34.

Career progression leads to the development of nurse leaders and improves retention, which has an impact on quality patient outcomes. Retaining experienced RNs who are emerging leaders is important for the continuity of patient safety and organizational quality. When an organization creates an environment that supports professional development this can lead to retention. 

Faculty Suggestions for Use: Recommend as a read and discussion, or reflection.   

Integrative Learning Strategies

Self-Care and Leadership Development

It is very difficult to take care of others if you're not taking care of yourself; therefore, developing leadership skills starts with yourself and managing your own health and well-being whether it is financial, emotional, or physical well-being. Improving one’s own well-being impacts others and trickles out to the people you work with and lead. It is impossible to talk about leadership without self-care and the ability to regulate one’s own well-being.  

Integrating Leadership and DEI into Nursing Education

Content related to situational leadership, as well as diversity, equity, and inclusion, can be woven throughout the entire nursing curriculum, including leadership courses. Some of the areas of focus will be on how to lead effectively during a crisis, when patient or team satisfaction can be improved, and when the quality of patient care can be impacted. Content related to situational leadership, addressing implicit biases, and improving health inequities can be integrated across the curriculum in almost all coursework including didactic and clinical experiences.  

Suggestions for Curriculum Integration

• Shared Language - Diversity, Equity, Inclusion, Cultural Humility and Cultural Responsiveness 
• Pronouns 
• Personal vs. Social Identity 
• Inclusive Culture 
• Role Transitions 
• Nutrition and Cultural Considerations 
• Maternal Health Disparities 
• Gender Affirmation 
• Sexual and Reproductive Health Gaps 
• Importance of Communication 
• Health Equity 
• Health Disparities 
• Health Equity, Quality Care, and Patient Safety 
• Systems/Structural Racism 
• Isms (racism, sexism, ageism, etc.) 
• Social Determinants of Health (SDOH) 
• Awareness of Disability, Mental Health, etc. 
• Cultural Differences and Stigmas 
• Stereotypes, Microaggressions, and Implicit Biases 
• Nursing’s Role in Addressing Health Equity 
• Supporting Nurses’ Well-Being to Advance Health Equity 
• Ally, Advocate, Accomplice 

Situational Leadership Case Scenarios for Classroom Activities

Situational leadership scenarios can be used during a leadership course or throughout the nursing curriculum. 

Below are five scenarios that could be used for discussion and application of situational leadership. These exemplars can be used in a variety of ways, including role plays, case studies and/or simulations but always with debriefing. It is recommended that faculty build upon these  and other scenarios developed specifically for your program. Students and faculty may have their own experiences they can share and debrief. 

Self-assessment, looking inward, exploring one’s own wellness and resilience are important, but it is also equally important to look at one’s own biases are. They also play an important role in one’s leadership and the outcome of patient care. Self-awareness is important to developing the competencies needed to leading others.

These case scenarios were used and recommended by faculty as excellent for classroom activities or group work in a transition-to-practice or senior leadership course.

Case Scenario #1 - Addressing Bias in Patient Care

A 44-year old African American woman comes in for an annual physical with her longtime primary care provider. Her sister accompanied her to the appointment due to patient mobility issues and to help her sister advocate for better pain management. The provider was defensive at the onset of the visit due to the sister’s stance on previous care. During the discussion about pain management, the provider suggested the patient was drug seeking, dismissing/downplaying patient concerns. The provider then cut the visit short due to the perceived tension he felt by the sister’s advocacy. Therefore, the patient didn’t receive her physical, pain meds or follow up, and later saw that “drug seeking” was added to her patient record. 

Issues:  Previous experience Care based on provider attitude  Bias: Drug seeking  Stereotype:  Didn’t know her pain assessment  Microaggression:  Cutting visit short because of sister’s advocacy  Ideal Encounter: Pause and dissect stereotypical behaviors. LEAN IN to identify what's there that’s not being said. Personal views are limiting and sometimes dangerous.  Labeling a patient can be colored by personal biases and can impact care 

Case Scenario #2  - Supporting Diverse Nursing Students

A 27-year old, English as a Second Language (ESL) nursing student in her last semester reached out to her faculty adviser for help/support. She had been diagnosed with COVID and had lost of two family members to COVID. She was passing all subjects, until the last few exams, when she began feeling defeated. The student could benefit from a referral to a school counselor or behavioral health counselor; however,  her advisor offers that "nursing school is tough and maybe you should consider withdrawing or taking a leave of absence."

Issues: Bias:  Faculty did not perceive that it was her job to help the student navigate to the finish line  Stereotype: Did language play a role or a difference in cultures?   Microaggression: Is there a commitment to enhancing diversity in the nursing workforce?  Ideal Encounter:  It is our job to meet people where they are and to provide holistic care/support.  Cultural responsiveness is a way of being that affirms our own culture without negating others and seeing diversity as a benefit.  Having an inclusive and supportive environment is beneficial for our students. 

Case Scenario #3 - Knowing Your Role 

Student nurses are on a medical surgical unit for clinical training. They receive report from each nurse assigned to the patient they are assigned by their faculty. During morning care the covering RN asks the student to administer medications to the patient. The student states he is unable to complete the task without his clinical faculty present. The nurse assigned to the patient states, “don’t worry I am here, you can do it without your faculty”.  

Outcome: Student did not administer the medications without his faculty present.  He went to his faculty immediately; he understood his scope and responsibility as a student and wanted to be sure he didn’t jeopardize patient safety. The assigned RN was not happy; however, the clinical faculty did take the opportunity to huddle with the staff nurse and nurse manager to explain student scope of practice and the role of assigned RNs.  

Leadership Skills: Delegation, education, communication, ability to teach and mentor, integrity, maintaining compliance and promoting ethical practice. 

Case Scenario #4 - Developing Innovative Career Paths for Future Nurses 

Many nurses have left the bedside or the nursing profession since the pandemic. This impact is presenting new challenges to health systems struggling to meet their mission of providing high quality care. In addition to the impending retirement of nurses, health systems must implement innovative approaches to healthcare delivery. One way is to implement career paths for current employees to become nurses. Though this is a longer pathway and depletes internal talent, providing support for individuals to go back to school and become a nurse is rewarding and benefits the employer. Short-term goals could rest with hiring incentives, tuition forgiveness, retention bonuses, additional days off for service provided, and addressing the social determinants of health for nurses to support health and wellness. 

Outcome: Meeting with community and health system stakeholders to create a workforce development track that can be offered to healthcare workers and community members. This approach allows for growth of the current workforce and provides a path for developing nurses for the future.  Leadership Skills: Personal, professional, and leadership development, advocating for the team, communication, innovation, collaboration, change management, commitment, and ability to teach and mentor. 

Case Scenario #5  - Staff Implemented Wellness Strategy 

Many nurses and other healthcare workers are experiencing burnout at an unprecedented rate. During a shared governance meeting on a medical surgical acute care unit, nurses shared “Code Lavender”. Recently two RNs attended a conference and learned about the impact of providing a safe place to debrief when feeling stressed. What other strategies might the unit nurses recommend or take a leadership role in implementing to address burnout?   Outcome: Nurses felt supported leading to a feeling of well-being.  Leadership Skills: Communication, ability to teach and mentor, change management, advocating for staff, relationship building, and commitment.   

Assessment Strategies

• Utilize the scenarios described above or other scenarios for individual self-reflection or group discussion and debriefing. Self- or group- reflection allows students to assess their own biases and leadership competencies.     
• Encourage the use of similar scenarios or actual patient care experiences to provide students opportunities to recognize when their current knowledge, skills, and abilities as practitioners and leaders are insufficient to address the situation and when additional resources for effective resolution are needed.  
• Guide students in developing a career plan, identifying additional leadership training opportunities, and types of experiences needed to achieve their goals.

Additional Resources

Journal Articles

Chatalalsingh, C. & Reeves, S. (2014).  Leading team learning: what makes interprofessional teams learn to work well?   Journal of Interprofessional Care,   28 (6), 513-518. doi:10.3109/13561820.2014.900001 Doyle, K. & Hungerford, C. (2015). Leadership as a Personal Journey: An Indigenous Perspective.  Issues in Mental Health Nursing ,  36 (5), 336-345. doi:  10.3109/01612840.2015.1009663

García García, I. & Santa-Bárbara, E.S. (2009). Relationship between nurses' leadership styles and power bases .  Revista Latina Americana Enfermagem, 17 (3), 295-301. doi:10.1590/s0104-11692009000300003

Intaraprasong, B., Potjanasitt, S., Pattaraarchachai, J., & Meennuch,  C. (2012).  Situational leadership styles, staff nurse job characteristics related to job satisfaction and organizational commitment of head nurses working in hospitals under the jurisdiction of the Royal Thai Army .  Journal of the Medical Association of  Thailand, 95 (Suppl 6), S109-S119.

Lynch, B. M., McCormack, B., & McCance, C. (2011). Development of a model of situational leadership in residential care for older people .  Journal of Nursing Management,   19 (8), 1058-69. doi:10.1111/j.1365-2834.2011.01275

Murray-García, J. L., Harrell, S., García, J. A., Gizzi, E., & Simms-Mackey, P. (2014). Dialogue as skill: Training a health professions workforce that can talk about race and racism.  American Journal of Orthopsychiatry, 84 (5), 590–596.  doi.org/10.1037/ort0000026

National Academy of Science, Engineering, and Medicine. (2021). The Future of Nursing 2020-2030: Charting a Path to Achieve Health Equity . Washington, DC: The National Academies Press. doi.org/10.17226/25982

Nonaillada, J., & Martin, R.A. (2022). Applying Situational Leadership to Redeployment Duties During COVID-19: Lessons Learned . Quality Management in Health Care , 31 (4), 274-277. doi: 10.1097/QMH.0000000000000350

Schreuder, J.A.H., Groothoff, J.W., Jongsma, D.  et al.  (2013). Leadership Effectiveness: A Supervisor’s Approach to Manage Return to Work.  Journal of Occupational Rehabilitation, 23 , 428–437.  doi.org/10.1007/s10926-012-9409-6

Tervalon, M. & Jann Murray-García. (1998). Cultural Humility versus Cultural Competence: A Critical Distinction in Defining Physician Training Outcomes in Multicultural Education . Journal of Health Care for the Poor and Underserved, 9 (2), 1 17–25. doi.org/10.1353/hpu.2010.0233

Resources and References

American Nurses Association: National Commission to Address Racism in Nursing

American Organization for Nursing Leadership: Leading Through Crisis: A Resource Compendium for Nurse Leaders  

Campaign for Action:

• Diversity and Inclusion: Promoting Health Equity by Understanding Unconscious Bias
• Fostering Mental Health and Well-Being Among Mentees and Faculty
• Health Equity Toolkit Resource Hub
• Improving Student Wellness by Understanding Microaggressions  

Health Quality BC: Cultural Humility and Nursing in BC / BC Patient Safety & Quality Council

National Academy of Medicine: The Future of Nursing Podcast

Top Nursing Leadership Roles & How to Become a Nurse Leader

Nursing leadership roles, skills & education needed to be a nurse leader, what does effective nurse leadership look like, nurse leadership styles, why do we need nurse leaders, next steps to become a nurse leader.

The American Nurses Association (ANA) Leadership Institute describes a nurse leader as “a nurse who is interested in excelling in a career path, a leader within a healthcare organization who represents the interests of the nursing profession, a seasoned nurse or healthcare administrator interested in refining skills to differentiate them from the competition or to advance to the next level of leadership.”

The truth is, nursing leadership can take a lot of different forms. In this article, we’ll explore the different leadership roles available for nurses, the skills nurses need to lead, leadership styles, and more.

Popular Online Healthcare Leadership Programs

The University of Scranton offers multiple online degrees in the growing healthcare industry. The comprehensive coursework is based on real-world scenarios and is equally rigorous and rewarding. The return on investment will be as big as the change you can make in a variety of healthcare leadership roles!

Enrollment: Nationwide

• MHA - Master of Health Administration
• Certificate - Healthcare Administration
• Dual MBA-MHA
• MBA - Health Care Management Specialization

• MSN - Nursing Leadership in Health Care Systems
• MBA & MSN - Nursing Leadership in Health Care Systems
• MSN - Health Care Quality & Patient Safety
• DNP - Educational Leadership

At Purdue Global, discover a faster, more affordable way to earn your Nursing degree. Purdue Global is committed to keeping your tuition costs as low as possible and helping you find the most efficient path to your degree.

Enrollment: Nationwide, but certain programs have state restrictions. Check with Purdue for details.

• MSN - Executive Leader

WGU's award-winning online programs are created to help you succeed while graduating faster and with less debt. WGU is a CCNE accredited, nonprofit university offering nursing bachelor's and master's degrees.

• BSN-to-MSN - Nursing Leadership & Management
• RN-to-MSN - Nursing Leadership & Management

As a working RN, you need a flexible, transfer-friendly program to help you save time and money as you take the next step in your nursing career. In our CCNE-accredited4 RN to BSN program, you can transfer in up to 134 credits—which is nearly 75% of program requirements. Your transfer credits can be reviewed in one business day (on average).

Enrollment: FL

• MSN - Nursing Leadership & Admin

AONL’s Certified Nurse Manager and Leader (CNML®) credential is designed exclusively for nurse leaders in the nurse manager role and is the only of its kind. With the CNML certification, you will become recognized as a leader in your health care community. AONL also offers the Transition to Nurse Manager Practice program where incoming and new nurse managers can build the leadership skills necessary for their new role.

• Certified Nurse Manager and Leader
• Transition to Nurse Manager Practice

Nursing leadership roles can vary ranging from running a hospital to running a unit. Here are some of the leadership roles available in the nursing profession.

1. Chief Nursing Officer (CNO)

A CNO is a top-level, nonclinical, administrative position within a healthcare system. 

They are considered the top-level nurse within an organization and they oversee other nurses and the implementation of patient care. 

The CNO is the voice of the nurses in an organization and they must work together with the staff to deliver the mission, values, and vision of the healthcare organization. 

2. Clinical Nurse Leader (CNL)

CNLs provide oversight and improvement over much of the activity in a specific clinical setting. 

They coordinate collaborative care for patients, analyze outcomes and quality of care, act as mentors to staff and liaisons, and collect and integrate data to further their understanding of outcomes. 

CNLs work in the space between bedside and administration. 

Popular Online Master of Science in Nursing (MSN) Programs

GCU's College of Nursing and Health Care Professions has a nearly 35-year tradition of preparing students to fill evolving healthcare roles as highly qualified professionals. GCU offers a full spectrum of nursing degrees, from a pre-licensure BSN degree to a Doctor of Nursing Practice (DNP) program.

• MSN - Family NP
• MSN - Adult Gerontology Acute Care NP
• MSN - Nursing Education
• MSN - Health Informatics
• MSN - Public Health Nursing
• See more GCU nursing programs
• BSN-to-MSN - Family NP
• BSN-to-MSN - Psychiatric Mental Health NP
• BSN-to-MSN - Nursing Education
• RN-to-MSN - Nursing Education
• MSN - Pediatric NP - Primary Care
• MSN - Adult-Gerontology NP - Primary Care
• MSN - Psychiatric-Mental Health NP
• MSN - Healthcare Tech, Simulation & Informatics
• See more Rasmussen nursing programs
• Accelerated BSN-to-MSN
• MSN - Adult-Gerontology Acute Care NP
• MSN - Psychiatric Mental Health NP
• MSN - Nurse Educator

3. Nurse Administrator/ Executive

Nurse administrators manage day-to-day operations for nursing staff either on a specific unit or throughout an entire hospital. 

Other responsibilities include budget and financial planning, creating operational strategies, as well as decision-making regarding staffing and protocols. 

Specific job duties will depend on the size and organization of the facility of employment. 

4. Nurse Manager

Nurse managers typically manage a specific unit or department. Nurse Managers create schedules for employees, give annual performance reviews, and help create policies within the unit. The average annual nurse manager salary ranges from $107,248 to $121,300, making it a lucrative leadership position for nurses.

>> Related:  Charge Nurse vs Nurse Manager: What's the Difference?

5. Nursing Director

The nursing director's responsibilities include overseeing the nursing staff, as well as communicating between the nursing and medical teams and other healthcare professionals throughout the organization. They are responsible for reviewing policies and procedures, implementing changes, developing a budget, and supporting the staff.

This high level of responsibility warrants one of the highest nursing leadership salaries. Read our comprehensive guide to learn more about director of nursing salary expectations and factors.

Nurse leaders are required to have a specific set of skills in order to be effective. Common skills include 

• Strong decision-making skills
• Conflict resolution
• Effective communication
• Adaptability
• Prioritizing quality and safety 
• Strong bedside clinical skills
• Knowledge of budget and policy
• Business mindedness
• Delegation skills 
• Strong critical thinking skills
• A positive attitude
• Honesty and loyalty
• Passion for their jobs

The education needed to become a nurse leader varies depending on the position. For example, a Chief Nursing Officer would benefit from a Master’s degree in Business Administration (MBA) or a Master’s Degree in Healthcare Administration (MHA). 

More education is always better for leaders in healthcare. Most nurse leaders can expect to earn a degree in an MSN to be an effective leader. Additional education and degrees open many doors for individuals and will make you more competitive with potential employers. 

This will vary depending on the location and position but ideally, a nurse leader should be committed to providing the best care to patients in the unit as well as the staff. 

Nurse leaders should be able to positively influence their employees and strive for excellence and commitment. 

A good nurse leader should be present on a consistent basis in the unit, department, or healthcare setting. 

There are a variety of leadership styles for becoming an effective nurse leader. These include, 

• Transformational
• Laissez-faire

Transformational leaders will utilize a collaborative leadership style by using a shared vision for a unit/department/healthcare setting to encourage and inspire change. 

Democratic leadership uses a shared leadership style in which others (staff nurses/other healthcare professionals) guide decision-making and management. 

A laissez-faire leadership style is a facilitative one in which a leader makes few decisions. Autocratic leadership is a unilateral style in which the leader delegates to others with rules and orders. 

Servant leadership is a supportive style in which the leader provides team members with the skills, tools, and relationships they need to perform to the best of their ability. 

Nurse leaders are essential to the organization of a healthcare system. They allow bedside nurses to function effectively, patients to receive appropriate and safe care, and ideally will advocate for the nursing staff on a variety of issues. 

Nurse leaders can help create a positive work environment for staff and patients alike. 

Furthermore, nurse leaders will help alleviate staffing concerns, manage payroll, and should be available to staff on a regular and consistent basis. 

If you are already an RN, becoming a nurse leader will take time and dedication. 

The first step is speaking with your nurse manager and inquiring about training to become a charge nurse on a unit or a nurse supervisor. This can act as an introduction to leadership positions. Responsibilities will vary but they will include multi-tasking, overseeing nursing assignments, reassignments and more. 

If the roles and responsibilities of a nurse leadership still excite you, consider gaining additional education in the form of an MSN, MBA, and/or MHA. These are often a requirement for most nurse leader positions.

Kathleen Gaines (nee Colduvell) is a nationally published writer turned Pediatric ICU nurse from Philadelphia with over 13 years of ICU experience. She has an extensive ICU background having formerly worked in the CICU and NICU at several major hospitals in the Philadelphia region. After earning her MSN in Education from Loyola University of New Orleans, she currently also teaches for several prominent Universities making sure the next generation is ready for the bedside. As a certified breastfeeding counselor and trauma certified nurse, she is always ready for the next nursing challenge.

Plus, get exclusive access to discounts for nurses, stay informed on the latest nurse news, and learn how to take the next steps in your career.

By clicking “Join Now”, you agree to receive email newsletters and special offers from Nurse.org. You may unsubscribe at any time by using the unsubscribe link, found at the bottom of every email.

• Juris Doctor (J.D.)
• MSW Traditional Track
• MSW Advanced Standing
• Accelerated Bachelor of Science in Nursing
• MSN Nursing Education
• MSN Forensic Nursing
• MSN Clinical Nurse Leader
• MSN Specialized Populations
• MSN Family Nurse Practitioner
• MSN Psychiatric Mental Health Nurse Practitioner
• Post-Graduate Certificate FNP
• Post-Graduate Certificate PMHNP
• Other Online Programs
• Why Cleveland State University?
• Law Externships
• Law Clinics
• Message from the President
• Student Services and Support
• Faculty Profiles
• State Authorization
• Career Resources
• Accreditation and Recognition
• Preceptor Guide (MSN-NP)
• Becoming A Preceptor (MSN-NP)
• Field Placement (MSW)
• Becoming A Preceptor (ABSN)
• Preceptor Guide (ABSN)
• Get Started

Leadership in Nursing: Qualities of a Good Nurse Leader

Effective nursing leadership is essential for quality outcomes in healthcare. Outstanding leadership is demonstrated every day when nurses rise to challenges and accept opportunities to make a meaningful difference in the health care of our population. The importance of leadership in nursing cannot be overstated. 

Qualities of a good nurse leader include:

• Commitment to patients and families
• Perseverance and a humble mindset
• Aptitude for conflict resolution
• Empathy and professional communication
• Strong clinical skills
• Dedication to evidence-based practice

From an educational perspective, graduate nursing programs are available to train nursing educators and clinical nurse leaders (CNLs). With a Master of Science in Nursing (MSN) degree , a world of possibilities for specialization and increased practice autonomy becomes available to registered nurses (RNs) who aspire to formalize their leadership roles.

These are two distinct pathways that aspiring nurse leaders can take to develop their professional skills and gain additional experience for vital leadership roles in the community and within our nation’s existing healthcare systems. 

Qualities of a Good Nurse Leader

Are you a registered nurse with a desire to develop your leadership skills in nursing beyond the bedside? You are well-positioned to pursue additional training that can set you apart in the job market and grow your confidence to take on new challenges. 

Nursing leadership qualities can be encouraged through faculty mentorship and further developed through nursing experience and graduate education. 

Let’s look at some of the best qualities of a good nurse leader. 

Empathy and Compassion

Empathy is the ability to understand a situation from another person’s perspective, including the emotions experienced and potential motivations for decisions. Good nurses can empathize with others and express compassion in how they communicate, both verbally and nonverbally. When a nurse is empathetic it enables meaningful connection with another person on a human-to-human level.

In nursing leadership, empathy promotes ethical and professional conduct. Good leaders can see problems from multiple angles and consider how various potential solutions may impact several different stakeholders. The ability to empathize also helps a nurse leader implement sensible decisions when there are multiple approaches that can make the best decision more difficult to discern.

Nurse leaders are also advocates for patients and other nurses, and advocacy allows a good nurse leader to:

• Suggest processes, policies and interventions that are in the best interest of patients and staff
• Connect patients and staff with helpful community resources
• Encourage self-care and participation in programs designed to reduce nurse burnout
• Help patients and families articulate their needs for quality health care

Closely linked to the skills of empathy and compassion are excellent communication skills. Effective communication is a hallmark of quality nursing care and quality leadership.

Communication Skills

Nurses communicate daily with many different people and through different modalities. A good nurse can communicate with other clinicians about patient status clearly and accurately and also relay this information to their patients in ways they can understand, all while empowering and educating them in their health care. 

Written communication is also critical for leadership in nursing as documentation of the nursing plan of care is recorded in medical records where nurses need to be thorough yet succinct. 

Nursing leaders mentor other nurses to promote professional development and continuity of care through shift changes and between visits (depending on the area of nursing practice). Strong leaders maintain open lines of discussion and work to resolve interpersonal conflict in ways that encourage teamwork and mutual understanding. Communication-savvy nurses can motivate, inspire and urge collaboration for a positive work environment.

Adaptability and Resilience

Nursing is a profession where adaptability to change and flexibility in daily activities are essential qualities. Good nurses can prioritize urgent actions and important details of their schedules as drawbacks occur. This can include:

• Declines or improvements in the health status of patients
• New patient admissions and discharges
• Nurse staffing and regular shift changes
• Assessment initiatives for quality improvement
• Accreditation audits and other regulatory reviews

Each of these instances would require a nurse to reevaluate priorities and adapt to the changing needs of patients and families within the healthcare facility. A good nurse can critically think about the urgency and importance of tasks to achieve quality patient care within the changing environment. 

Nurse leaders must be adept in strategic thinking, as well. As there are changes in staffing or new needs for facility accreditation, nursing leadership needs to proactively plan unit-based and organizational strategies for successfully navigating change.

Decision-Making and Problem-Solving Abilities

Within a team of healthcare personnel, there are many valuable viewpoints to consider when making decisions. A nurse leader will observe and request input from the departments and disciplines involved when working to solve problems effectively. 

Problem-solving is as much about the problem itself as it is about the professional relationships and collaboration that may be required. Skills for nursing leaders that can aid in effective problem-solving include:

• Active listening to understand what others are communicating and why
• Willingness to consider differing viewpoints on a situation
• Self-awareness to understand personal motives and potential bias
• Emotional regulation and a propensity toward conflict resolution

Nurses who make good leaders are also those who give attention to detail. Many times, the details are often where the root cause of a problem can be identified and solutions can be proposed. Good leaders are willing to try potential solutions and honestly evaluate when a different route may be better. Proposing data-driven solutions, admitting faults and learning from mistakes are critical abilities for nursing leadership to possess.

Importance of Continuing Education for Nurse Leaders

Another quality of a good nurse leader is the expertise and knowledge gained through continuing education. Skills in health informatics allow nursing leadership to access and analyze available data to report measurable progress and identify areas for improvement in health care delivery. 

The desire to enhance knowledge and skills is a motivational factor for continued development and growth in any career. It is especially important for nurse leaders to pursue and model this growth mindset as mentors for other nurses and to exemplify standards for professionalism. 

Areas for continuing education include:

• Organizational leadership strategies
• Teaching methods in patient care and academics
• Soft skills for team building and working effectively with others
• Clinical knowledge and advancements for managing specific conditions
• Emerging technology with health care application

Research evidence for best practices continues to be published as discoveries are made and real-world interventions are implemented and evaluated. The ability to provide timely, evidence-based care is rooted in the practice of continuing education and willingness to learn. 

Next, let’s take an in-depth look at two pathways for becoming a nurse leader: Nursing Educator and Clinical Nurse Leader (CNL). 

Nursing Educator vs. Clinical Nurse Leader

If you are interested in a nursing career with ample opportunity for teaching, mentorship and leading individuals and teams toward improved health outcomes, both the nursing educator and clinical nurse leader roles will provide this. 

A CNL and a nurse educator are similar in that they both work to educate and train healthcare personnel through professional development opportunities and continuing education. 

A nursing educator may work in a clinical facility, such as a hospital or public health agency, or they may be found working in academic roles teaching student nurses. A clinical nurse leader is generally responsible for overseeing direct patient care and improving patient outcomes in a leadership position. 

Both roles are prepared through graduate education and require a master’s degree in nursing. 

Roles and Responsibilities of Nursing Educators

As a nursing educator , you may be responsible for conducting activities such as:

• Designing coursework and curriculum for students and nurses
• Researching best practices in teaching
• Planning professional development activities
• Teaching clinical skills for direct patient care
• Process-outcome evaluations of learning in the classroom and clinical setting

The specific activities of a nursing educator's role are somewhat dependent on the setting in which they are employed. Academic settings carry additional responsibilities of student mentorship, grading assignments and regular communication with other faculty to ensure alignment of the educational content with academic accreditation standards. 

Within the hospital or clinical setting, a nursing educator may work with students. However, when nursing educators are positioned within clinical employment positions, they are also frequently responsible for ensuring opportunities for growth and development for a particular unit or nursing specialty. 

Summary of Nursing Education Role

Roles and Responsibilities of Clinical Nurse Leaders

The CNL role is known for leadership commitment with the primary goal of improved patient outcomes through quality improvement, education and other methods for enhancing care delivery within healthcare systems. 

Some of the responsibilities of a CNL include:

• Coordinating care and communication within interdisciplinary teams
• Designing evidence-based care plans for patients and families
• Identifying areas for quality improvement through data analysis and evaluation
• Promoting patient safety through risk assessments
• Facilitating transitions of care from one discipline or facility to another

In times of crisis, CNLs are on the front lines of nursing leadership as they stay abreast of current news and the latest recommendations for implementation. A CNL may be the person to suggest process changes for patient treatment plans and nursing care delivery based on an emerging technology or available community resource.

Summary of Clinical Nurse Leader Role

Leadership Styles in Nursing

Many of the qualities of a good nurse and leader are important when implementing distinct styles of leadership in nursing. Depending on your personality or the unique dynamics of your workplace, different nursing leadership styles may be more effective than others. 

Leadership styles that are good for nursing leadership include:

• Transformational - the leader focuses on mentorship to bring the best out of a team
• Servant - the leader prioritizes meeting the needs of others and leads by example
• Laissez-faire - the leader entrusts decision-making responsibilities to those they oversee
• Democratic - the leader builds concensus and makes decisions by creating strong team dynamics

Transformational leadership is especially useful when visionary leaders are working to develop a strong nursing team for the future. Compassion and empathy are valuable qualities in many situations, especially when applying the servant leadership style. The laissez-faire style of leadership promotes a hands-off approach that is especially effective in situations with experienced and self-directed nurses. However, this style may provide too much autonomy for newer nurses who would benefit from greater direction and presence from a leader. 

Nursing leaders who can effectively apply a combination of styles can lead with the benefits of several styles while minimizing the shortcomings a particular style may have. 

If you are ready to embark on your journey to become a dynamic nurse leader, Cleveland State University (CSU) offers high-quality graduate nursing programs to help you reach your goals.

Cleveland State University’s Online MSN - Nursing Education 

The Online Master of Science in Nursing - Nursing Education program at CSU prepares nurses to become educators in academic and clinical settings. This program prepares graduates to design and implement innovative teaching strategies, mentor future nurses and contribute to curriculum development. 

Program features include: 

• Completion in two years on a part-time schedule
• Experiential hands-on learning in your community
• Accredited by the Commission on Collegiate Nursing Education (CCNE)
• Prepares you for the National League for Nursing’s (NLN) Certification for Nurse Educators (CNE) exam

With an MSN degree, you may begin working in academia as a clinical instructor. If you are interested in a future role in academic faculty, an MSN degree is the next step to furthering your education toward a doctorate that will allow you to achieve professorial roles in colleges and universities. 

Cleveland State University’s Online MSN - Clinical Nurse Leader

The Online Master of Science in Nursing - Clinical Nurse Leader program at CSU prepares nurses for leadership roles in health care delivery by developing advanced clinical skills and interdisciplinary collaboration. Graduates of the CNL program are prepared to improve patient outcomes through evidence-based practice in complex health delivery situations. 

Program features include:

• Completion in one year and seven months on a part-time schedule
• Accredited by the Commission on Collegiate Education (CCNE)
• Prepares you for the Commission on Nurse Certification’s (CNC) Clinical Nurse Leader (CNL) certification exam

Cleveland State University’s online MSN programs prepare you with the essential qualities of a nursing leader. For more information and details on how to apply, visit the Online MSN-NE and Online MSN-CNL program pages.

• Subscribe to journal Subscribe
• Get new issue alerts Get alerts

Secondary Logo

Journal logo.

Colleague's E-mail is Invalid

Your message has been successfully sent to your colleague.

Save my selection

How leadership matters

Clinical nurses' perceptions of leader behaviors affecting their work environment.

Raso, Rosanne DNP, RN, NEA-BC, FAAN, FAONL; Fitzpatrick, Joyce PhD, MBA, RN, FAAN, FNAP

Rosanne Raso is the editor-in-chief of Nursing Management and the vice president and CNO at NewYork-Presbyterian/Weill Cornell in New York, N.Y. Joyce Fitzpatrick is the director of the Marian K. Shaughnessy Nurse Leadership Academy and Elizabeth Brooks Ford professor of nursing at Case Western Reserve University Frances Payne Bolton School of Nursing in Cleveland, Ohio.

The authors and planners have disclosed no potential conflicts of interest, financial or otherwise.

For 131 additional nursing continuing professional development articles related to management topics, go to NursingCenter.com/CE .

What should nurse leaders do to ensure a healthy work environment? This article presents positive and negative leader attributes in the words of clinical nurses and actions you can take to boost your relational leadership competencies.

What should nurse managers and leaders do to ensure a healthy work environment for clinical nurses? What we know is that relational styles of leadership have been studied in nursing for years and are consistently associated with positive workforce outcomes. 1,2 Relational leadership is built on solid relationships with direct reports and individuals from other disciplines, as its name implies. This type of leadership is positive, particularly in nurturing employee engagement and healthy work environments. Mastering the skills of interpersonal engagement and creating trust and influence through connections are hallmarks of great nurse leaders. 3 Yet, even though there's considerable support for relational leadership, there are still gaps in the implementation of programs to develop nurse leaders. Developmental programs for nurse managers often focus on the management skills needed, such as finances, budgeting, and resource allocation and procurement, creating a significant gap in preparation related to the development of relational leadership competencies.

From a qualitative perspective, we were interested in determining what clinical nurses describe as positive and negative leadership behaviors that affect their work environment. In this article, we present our findings in the words of clinical nurses, along with implications for nurse leaders seeking to understand the impact of clinical nurses' perceptions of their supervisors' actions, especially their relational leadership competencies.

Relational leadership is based on positive psychology, which focuses on helping people find meaning and purpose, live meaningful lives, and search for personal strength and value. 4 Therefore, relational leadership is grounded in optimism, integrity, positive emotions, and employee growth and development. The link to nursing leadership is obvious—ethics, positive change, purpose, growth, and social connection are all part of who we are as nurses and nurse leaders.

The most common relational leadership styles are transformational, authentic, and servant. All three leadership styles have connections to healthy work environments and staff engagement, which, in turn, provide the foundation for positive workforce and patient outcomes. 5,6 (See Figure 1 .) To add empirical support to these connections, we previously conducted two research studies on authentic nurse leadership and its relationship with a healthy work environment, expecting a positive relationship. In both studies, we found a significant positive relationship, providing empirical evidence that authentic nurse leadership is a standard for a healthy work environment. 7,8

We used Giordano-Mulligan and Eckhart's authentic nurse leadership model in our studies. This model has three main domains with five subcomponents or attributes: personal integrity to include moral-ethical courage and self-awareness, transparency to include relationship integrality and shared decision-making, and altruism to include caring. 9 These attributes were found to be important for nurse engagement. Caring was identified as an integral attribute that nurses seek in their leaders, which makes this one of the first nursing leadership models with caring science embedded in the practice. 10 (See Table 1 .)

We also used the American Association of Critical-Care Nurses' (AACN) healthy work environment model, which is evidence-based and relationship-centered and includes six standards: skilled communication, true collaboration, effective decision-making, authentic leadership, meaningful recognition, and appropriate staffing. All six elements are considered essential, meaning that missing any one of them won't result in a sustainable healthy work environment. 11 (See Figure 2 .)

This study received Institutional Review Board approval. Participants were recruited at the 2019 American Nurses Credentialing Center National Magnet ® Conference. Two open-ended questions were asked after quantitative and demographic questions in an anonymous survey:

• How does your manager positively affect your work environment?
• How does your manager negatively affect your environment?

What did clinical nurses say?

Four-hundred and fifty-six open-ended comments were collected, split between positive (n = 245) and negative (n = 211) from a final sample of 254 clinical nurses. Eighty of the “negative” comments were either blank or positive rather than negative. Most respondents practiced in critical/progressive care (27%) and adult medical-surgical (26%) areas on the day shift (77%). The responses revealed behaviors that clinical nurses valued and criticized in their managers, which trended into several categories.

For positive comments, the top trends were related to relational skills, such as communication, positivity, and approachability (n = 87); caring and professional growth (n = 68); visibility (n = 57); and advocacy (n = 10), aligning with both authentic nurse leadership attributes and healthy work environment standards. There were 10 comments about flexible scheduling. (See Table 2 .)

In the words of clinical nurses, positive leadership attributes included:

• “By inspiring me to be my best.”
• “When I see her, she's supportive and responsive to my concerns. She has asked me to be a part of various committees to further my career development.”
• “She's very approachable and is an active listener.”
• “She's concerned for my well-being as a person.”
• “She's very involved in encouraging advancement and uplifting her staff.”
• “Listens and takes suggestions/concerns seriously.”
• “She uses open communication at all times in all situations.”
• “Sends out a bulletin every Friday that's helpful for keeping up with nursing news and hospital updates.”
• “She fights for us on a daily basis.”

For negative comments, the top trends were lack of presence and caring (n = 28), lack of follow-through and open-mindedness (n = 18), lack of visibility/unapproachable (n = 16), and inadequate communication (n = 11). There were seven negative comments about staffing and scheduling. (See Table 3 .)

In the words of clinical nurses, negative leadership attributes included:

• “The overall feeling on our unit is that our managers need to communicate more effectively.”
• “She isn't always approachable and cares about budget more than staff wellness.”
• “She doesn't always notice work I've done.”
• “The manager focuses only on problems.”
• “Night shift workers are unfortunately neglected.”
• “She's judgmental. Has a hard time taking our opinion into consideration. She makes decisions without consulting us.”
• “Doesn't have confidence in self and, therefore, doesn't instill confidence in staff.”
• “Is too scattered, starts many things without finishing. Lacks follow-through and accountability.”

These qualitative results with a vast majority of positive comments aren't surprising considering our previous empirical findings that both authentic nurse leadership and healthy work environments were present in the national prepandemic sample of clinical nurses. In the second, midpandemic study in the summer of 2020, we also found that authentic nurse leadership was present in a much larger sample, signaling that nurse leaders throughout the country demonstrate authentic attributes as noted by their direct reports, even in a crisis. 8 Finding many more positive comments than negative points to the same conclusion about the overarching presence of sound nursing leadership.

Because the top positive trends were related to communication skills, caring, professional growth, and visibility, we understand what aspects of leadership are important to clinical nurses. It isn't their leaders' nursing acumen or clinical skills, although being able to help was mentioned several times. It isn't a perfect schedule or staffing, although flexible scheduling was brought up, albeit infrequently. Rather, it's about the alignment of relational competencies, authentic nurse leadership attributes, and healthy work environment standards. Clinical nurses want to be heard, receive honest information, be supported by a visible leader, grow, and be recognized. Values-driven leadership, shown in the comments on advocacy and “fighting” for staff, is integral for the authentic nurse leadership attribute of moral-ethical courage. We believe that nurse managers aspire to be this type of leader.

The negative behavior trends were consistently the opposite of the positive ones. Lack of presence, communication, recognition, follow-through, and collaborative decision-making are noticed and can contribute to disengagement. Staffing and scheduling were only occasionally mentioned, which was surprising considering there wasn't agreement that appropriate staffing was present in the rating of healthy work environment standards. Perhaps clinical nurses consider staffing to be out of the scope of the frontline manager and more of an organizational issue.

The attribute of caring in the authentic nurse leadership model, with its concomitant depiction as nurturing, compassionate, kind, and personally interested, was frequently mentioned and important to clinical nurses, further supporting this relatively new framework for nursing leadership. This attribute isn't specifically included in the healthy work environment standards, although the standard of meaningful recognition certainly includes professional growth and feeling valued for your contributions.

Implications for nurse managers

The link between relational leadership and nursing values, such as ethical practice, positive change, purpose, growth, and interpersonal connections, was evident in our findings, as was the association with healthy work environments and staff engagement—the foundation for positive patient outcomes. Nurse leaders must remove the barriers to relational, authentic, and visible leadership. Covering two geographically separate units, being inundated with meetings and tasks, or not having a frontline leader at all impacts clinical nurses' perceptions of leadership support. Making this case to senior leaders is imperative when decisions are being made about frontline leaders' scope and responsibilities.

Effective communication and meaningful recognition are practices we can all do, and structures are needed to support them. Regarding communication, you must get information first, which may be challenging, and share it in as many formal and informal ways as you can (verbal, written, posted, emailed, cascaded), with night supervisors on the same page. Shared governance structures can be effective not only for decision-making, but also communication. 12 If you think you've communicated enough, do it again. As a human resource colleague often implores, get the message out seven times in seven different ways.

Recognition is the same—there's never enough. Do you get tired of being recognized for your value? Of course not. Structured mechanisms include daily shout-outs, bulletin boards, “random acts of kindness” programs, DAISY awards, employee of the week/month, Nurses Week activities, thank-you cards, leader rounds, and numerous other ideas. Leaders must make recognition as important as any other responsibility in the job description. 13

Our obligation to teach and learn relational behaviors, authentic nurse leadership attributes, and healthy work environment standards and how to build and demonstrate them is another implication. Effective leadership development occurs through experiential learning, as well as didactic mechanisms. 14 This applies to aspiring leaders, clinical leaders, and formal leaders.

Leadership matters

Our clinical nurses have spoken. The importance of relational competencies, caring behaviors, and visibility is evident. Relational leadership is even more critical as we continue to be challenged through our second year of the pandemic. This type of leadership alone isn't enough to create a healthy work environment for clinical nurses; nevertheless, it's required. We're all obligated to be present and lead with integrity, caring, and transparency. Leadership matters.

INSTRUCTIONS How leadership matters: Clinical nurses' perceptions of leader behaviors affecting their work environment

Test instructions.

• Read the article. The test for this nursing continuing professional development (NCPD) activity is to be taken online at www.NursingCenter.com/CE .
• You'll need to create an account (it's free!) and log in to access My Planner before taking online tests. Your planner will keep track of all your Lippincott Professional Development online NCPD activities for you.
• There's only one correct answer for each question. A passing score for this test is 7 correct answers. If you pass, you can print your certificate of earned contact hours and access the answer key. If you fail, you have the option of taking the test again at no additional cost.
• For questions, contact Lippincott Professional Development: 1-800-787-8985.
• Registration deadline is September 6, 2024 .

PROVIDER ACCREDITATION

Lippincott Professional Development will award 1.5 contact hours for this nursing continuing professional development activity.

Lippincott Professional Development is accredited as a provider of nursing continuing professional development by the American Nurses Credentialing Center's Commission on Accreditation.

This activity is also provider approved by the California Board of Registered Nursing, Provider Number CEP 11749 for 1.5 contact hours. Lippincott Professional Development is also an approved provider of continuing nursing education by the District of Columbia, Georgia, and Florida, CE Broker #50-1223. Your certificate is valid in all states.

Payment: The registration fee for this test is $17.95.

• Cited Here |
• PubMed | CrossRef |
• Google Scholar
• View Full Text | PubMed | CrossRef |
• + Favorites
• View in Gallery

Readers Of this Article Also Read

Leadership strategies to promote frontline nursing staff engagement, nurse leader competencies: a toolkit for success, high-impact communication in nursing leadership: an exploratory study, are you a transformational leader, keeping the peace: conflict management strategies for nurse managers.

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings
• My Bibliography
• Collections
• Citation manager

Save citation to file

Email citation, add to collections.

• Create a new collection
• Add to an existing collection

Add to My Bibliography

Your saved search, create a file for external citation management software, your rss feed.

• Search in PubMed
• Search in NLM Catalog
• Add to Search

The essentials of nursing leadership: A systematic review of factors and educational interventions influencing nursing leadership

Affiliations.

• 1 Faculty of Nursing, Edmonton Clinic Health Academy, University of Alberta, 11405 87 Ave NW, Edmonton, AB T6G 1C9, Canada. Electronic address: [email protected].
• 2 Department of Nutrition, Dietetics and Food, School of Clinical Sciences at Monash Health, Monash University, Level 1, 264 Ferntree Gully Rd, Notting Hill, VIC 3168, Australia.
• 3 Faculty of Nursing, Edmonton Clinic Health Academy, University of Alberta, 11405 87 Ave NW, Edmonton, AB T6G 1C9, Canada.
• 4 Faculty of Nursing, Edmonton Clinic Health Academy, University of Alberta, 11405 87 Ave NW, Edmonton, AB T6G 1C9, Canada; Technical High School of Campinas, State University of Campinas (UNICAMP), Barão Geraldo, Campinas - São Paulo 13083-970, Brazil.
• PMID: 33383271
• DOI: 10.1016/j.ijnurstu.2020.103842

Background: Nursing leadership plays a vital role in shaping outcomes for healthcare organizations, personnel and patients. With much of the leadership workforce set to retire in the near future, identifying factors that positively contribute to the development of leadership in nurses is of utmost importance.

Objectives: To identify determining factors of nursing leadership, and the effectiveness of interventions to enhance leadership in nurses.

Design: We conducted a systematic review, including a total of nine electronic databases.

Data sources: Databases included: Medline, Academic Search Premier, Embase, PsychInfo, Sociological Abstracts, ABI, CINAHL, ERIC, and Cochrane.

Review methods: Studies were included if they quantitatively examined factors contributing to nursing leadership or educational interventions implemented with the intention of developing leadership practices in nurses. Two research team members independently reviewed each article to determine inclusion. All included studies underwent quality assessment, data extraction and content analysis.

Results: 49,502 titles/abstracts were screened resulting in 100 included manuscripts reporting on 93 studies (n=44 correlational studies and n=49 intervention studies). One hundred and five factors examined in correlational studies were categorized into 5 groups experience and education, individuals' traits and characteristics, relationship with work, role in the practice setting, and organizational context. Correlational studies revealed mixed results with some studies finding positive correlations and other non-significant relationships with leadership. Participation in leadership interventions had a positive impact on the development of a variety of leadership styles in 44 of 49 intervention studies, with relational leadership styles being the most common target of interventions.

Conclusions: The findings of this review make it clear that targeted educational interventions are an effective method of leadership development in nurses. However, due to equivocal results reported in many included studies and heterogeneity of leadership measurement tools, few conclusions can be drawn regarding which specific nurse characteristics and organizational factors most effectively contribute to the development of nursing leadership. Contextual and confounding factors that may mediate the relationships between nursing characteristics, development of leadership and enhancement of leadership development programs also require further examination. Targeted development of nursing leadership will help ensure that nurses of the future are well equipped to tackle the challenges of a burdened health-care system.

Keywords: Interventions; Leadership; Nursing workforce; Systematic Review.

Copyright © 2020. Published by Elsevier Ltd.

PubMed Disclaimer

• Targeting personalised leadership factors based on the organisational needs of nurses may cultivate and improve their nursing leadership. Singh S, Kapoor S. Singh S, et al. Evid Based Nurs. 2022 Apr;25(2):68. doi: 10.1136/ebnurs-2020-103385. Epub 2021 Aug 18. Evid Based Nurs. 2022. PMID: 34407986 No abstract available.

Similar articles

• Factors contributing to nursing leadership: a systematic review. Cummings G, Lee H, Macgregor T, Davey M, Wong C, Paul L, Stafford E. Cummings G, et al. J Health Serv Res Policy. 2008 Oct;13(4):240-8. doi: 10.1258/jhsrp.2008.007154. J Health Serv Res Policy. 2008. PMID: 18806183 Review.
• Beyond the black stump: rapid reviews of health research issues affecting regional, rural and remote Australia. Osborne SR, Alston LV, Bolton KA, Whelan J, Reeve E, Wong Shee A, Browne J, Walker T, Versace VL, Allender S, Nichols M, Backholer K, Goodwin N, Lewis S, Dalton H, Prael G, Curtin M, Brooks R, Verdon S, Crockett J, Hodgins G, Walsh S, Lyle DM, Thompson SC, Browne LJ, Knight S, Pit SW, Jones M, Gillam MH, Leach MJ, Gonzalez-Chica DA, Muyambi K, Eshetie T, Tran K, May E, Lieschke G, Parker V, Smith A, Hayes C, Dunlop AJ, Rajappa H, White R, Oakley P, Holliday S. Osborne SR, et al. Med J Aust. 2020 Dec;213 Suppl 11:S3-S32.e1. doi: 10.5694/mja2.50881. Med J Aust. 2020. PMID: 33314144
• Faculty development initiatives designed to promote leadership in medical education. A BEME systematic review: BEME Guide No. 19. Steinert Y, Naismith L, Mann K. Steinert Y, et al. Med Teach. 2012;34(6):483-503. doi: 10.3109/0142159X.2012.680937. Med Teach. 2012. PMID: 22578043 Review.
• Leadership styles and outcome patterns for the nursing workforce and work environment: A systematic review. Cummings GG, Tate K, Lee S, Wong CA, Paananen T, Micaroni SPM, Chatterjee GE. Cummings GG, et al. Int J Nurs Stud. 2018 Sep;85:19-60. doi: 10.1016/j.ijnurstu.2018.04.016. Epub 2018 May 3. Int J Nurs Stud. 2018. PMID: 29807190
• Promoting and supporting self-management for adults living in the community with physical chronic illness: A systematic review of the effectiveness and meaningfulness of the patient-practitioner encounter. Rees S, Williams A. Rees S, et al. JBI Libr Syst Rev. 2009;7(13):492-582. doi: 10.11124/01938924-200907130-00001. JBI Libr Syst Rev. 2009. PMID: 27819974
• [Skill-grade mix and shared governance in the intensive care unit: development of a management triangle and the advancement of nursing roles]. Siegling C, Mertins E, Wefer F, Bolte C, Krüger L. Siegling C, et al. Med Klin Intensivmed Notfmed. 2024 Sep 4. doi: 10.1007/s00063-024-01175-3. Online ahead of print. Med Klin Intensivmed Notfmed. 2024. PMID: 39231839 Review. German.
• Head Nurse Leadership: Facilitators and Barriers to Adherence to Infection Prevention and Control Programs-A Qualitative Study Protocol. Cappelli E, Fiorini J, Zaghini F, Canzan F, Sili A. Cappelli E, et al. Nurs Rep. 2024 Jul 26;14(3):1849-1858. doi: 10.3390/nursrep14030138. Nurs Rep. 2024. PMID: 39189268 Free PMC article.
• Succession Planning and Leadership Development in Nursing: A Bibliometric Analysis (2000-2023). Al Hajri AK. Al Hajri AK. Nurs Res Pract. 2024 Aug 9;2024:6191008. doi: 10.1155/2024/6191008. eCollection 2024. Nurs Res Pract. 2024. PMID: 39156228 Free PMC article. Review.
• Hit the ground running: Starting to manage personnel and budgets as a new nurse scholar. Fauer AJ, Wilson R. Fauer AJ, et al. Asia Pac J Oncol Nurs. 2024 Jun 12;11(8):100533. doi: 10.1016/j.apjon.2024.100533. eCollection 2024 Aug. Asia Pac J Oncol Nurs. 2024. PMID: 39040224 Free PMC article. No abstract available.
• Development of a training program prototype to enhance implementation leadership competencies and behaviours of Chinese unit nurse managers: a qualitative descriptive study. Chen W, Graham ID, Hu J, Lewis KB, Zhao J, Gifford W. Chen W, et al. BMC Nurs. 2024 May 30;23(1):359. doi: 10.1186/s12912-024-01989-8. BMC Nurs. 2024. PMID: 38816867 Free PMC article.

Publication types

• Search in MeSH

LinkOut - more resources

Full text sources.

• Elsevier Science

Other Literature Sources

• scite Smart Citations
• MedlinePlus Health Information
• Citation Manager

NCBI Literature Resources

MeSH PMC Bookshelf Disclaimer

The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Unauthorized use of these marks is strictly prohibited.

Warning: The NCBI web site requires JavaScript to function. more...

An official website of the United States government

The .gov means it's official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you're on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings
• Browse Titles

NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.

Institute of Medicine (US) Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine. The Future of Nursing: Leading Change, Advancing Health. Washington (DC): National Academies Press (US); 2011.

The Future of Nursing: Leading Change, Advancing Health.

• Hardcopy Version at National Academies Press

5 Transforming Leadership

Key Message #3 : Nurses should be full partners, with physicians and other health professionals, in redesigning health care in the United States.

Strong leadership is critical if the vision of a transformed health care system is to be realized. Yet not all nurses begin their career with thoughts of becoming a leader. The nursing profession must produce leaders throughout the health care system, from the bedside to the boardroom, who can serve as full partners with other health profes sionals and be accountable for their own contributions to delivering high-quality care while working collaboratively with leaders from other health professions.

In addition to changes in nursing practice and education, discussed in Chapters 3 and 4 , respectively, strong leadership will be required to realize the vision of a transformed health care system. Although the public is not used to viewing nurses as leaders, and not all nurses begin their career with thoughts of becoming a leader, all nurses must be leaders in the design, implementation, and evaluation of, as well as advocacy for, the ongoing reforms to the system that will be needed. Additionally, nurses will need leadership skills and competencies to act as full partners with physicians and other health professionals in redesign and reform efforts across the health care system. Nursing research and practice must continue to identify and develop evidence-based improvements to care, and these improvements must be tested and adopted through policy changes across the health care system. Nursing leaders must translate new research findings to the practice environment and into nursing education and from nursing education into practice and policy.

Being a full partner transcends all levels of the nursing profession and requires leadership skills and competencies that must be applied both within the profession and in collaboration with other health professionals. In care environments, being a full partner involves taking responsibility for identifying problems and areas of waste, devising and implementing a plan for improvement, tracking improvement over time, and making necessary adjustments to realize established goals. Serving as strong patient advocates, nurses must be involved in decision making about how to improve the delivery of care.

Being a full partner translates more broadly to the health policy arena. To be effective in reconceptualized roles and to be seen and accepted as leaders, nurses must see policy as something they can shape and develop rather than something that happens to them, whether at the local organizational level or the national level. They must speak the language of policy and engage in the political process effectively, and work cohesively as a profession. Nurses should have a voice in health policy decision making, as well as being engaged in implementation efforts related to health care reform. Nurses also should serve actively on advisory committees, commissions, and boards where policy decisions are made to advance health systems to improve patient care. Nurses must build new partnerships with other clinicians, business owners, philanthropists, elected officials, and the public to help realize these improvements.

This chapter focuses on key message #3 set forth in Chapter 1 : Nurses should be full partners, with physicians and other health professionals, in redesigning health care in the United States. The chapter begins by considering the new style of leadership that is needed. It then issues a call to nurses to respond to the challenge. The third section describes three avenues—leadership programs for nurses, mentorship, and involvement in the policy-making process—through which that call can be answered. The chapter then issues a call for new partnerships to tap the full potential of nurses to serve as leaders in the health care system. The final section presents the committee’s conclusions regarding the need to transform leadership in the nursing profession.

• A NEW STYLE OF LEADERSHIP

Those involved in the health care system—nurses, physicians, patients, and others—play increasingly interdependent roles. Problems arise every day that do not have easy or singular solutions. Leaders who merely give directions and expect them to be followed will not succeed in this environment. What is needed is a style of leadership that involves working with others as full partners in a context of mutual respect and collaboration. This leadership style has been associated with improved patient outcomes, a reduction in medical errors, and less staff turnover (Gardner, 2005; Joint Commission, 2008; Pearson et al., 2007). It may also reduce the amount of workplace bullying and disruptive behavior, which remains a problem in the health care field (Joint Commission, 2008; Olender-Russo, 2009; Rosenstein and O’Daniel, 2008). Yet while the benefits of collaboration among health professionals have repeatedly been documented with respect to improved patient outcomes, reduced lengths of hospital stay, cost savings, increased job satisfaction and retention among nurses, and improved teamwork, interprofessional collaboration frequently is not the norm in the health care field. Changing this culture will not be easy.

The new style of leadership that is needed flows in all directions at all levels. Everyone from the bedside to the boardroom must engage colleagues, subordinates, and executives so that together they can identify and achieve common goals (Bradford and Cohen, 1998). All members of the health care team must share in the collaborative management of their practice. Physicians, nurses, and other health professionals must work together to break down the walls of hierarchal silos and hold each other accountable for improving quality and decreasing preventable adverse events and medication errors. All must display the capacity to adapt to the continually evolving dynamics of the health care system.

Leadership Competencies

Nurses at all levels need strong leadership skills to contribute to patient safety and quality of care. Yet their history as a profession dominated by females can make it easier for policy makers, other health professionals, and the public to view nurses as “functional doers”—those who carry out the instructions of others—rather than “thoughtful strategists”—those who are informed decision makers and whose independent actions are based on education, evidence, and experience. A 2009 Gallup poll of more than 1,500 national opinion leaders, 1 “Nursing Leadership from Bedside to Boardroom: Opinion Leaders’ Perceptions,” identified nurses as “one of the most trusted sources of health information” (see Box 5-1 ) (RWJF, 2010a). The Gallup poll also identified nurses as the health professionals that should have greater influence than they currently do in the critical areas of quality of patient care and safety. The leaders surveyed believed that major obstacles prevent nurses from being more influential in health policy decision making. These findings have crucial implications for front-line nurses, who possess critical knowledge and awareness of the patient, family, and community but do not speak up as often as they should.

Results of Gallup Poll “Nursing Leadership from Bedside to Boardroom: Opinion Leaders’ Perceptions”. Opinion leaders rate doctors and nurses first and second among a list of options for trusted information about health and health (more...)

To be more effective leaders and full partners, nurses need to possess two critical sets of competencies: a common set that can serve as the foundation for any leadership opportunity and a more specific set tailored to a particular context, time, and place. The former set includes, among others, knowledge of the care delivery system, how to work in teams, how to collaborate effectively within and across disciplines, the basic tenets of ethical care, how to be an effective patient advocate, theories of innovation, and the foundations for quality and safety improvement. These competencies also are recommended by the American Association of Colleges of Nursing as essential for baccalaureate programs (AACN, 2008). Leadership competencies recommended by the National League for Nursing and National League for Nursing Accrediting Commission are being revised to reflect similar principles. More specific competencies might include learning how to be a full partner in a health team in which members from various professions hold each other accountable for improving quality and decreasing preventable adverse events and medication errors. Additionally, nurses who are interested in pursuing entrepreneurial and business development opportunities need competencies in such areas as economics and market forces, regulatory frameworks, and financing policy.

Leadership in a Collaborative Environment

As noted in Chapter 1 , a growing body of research has begun to highlight the potential for collaboration among teams of diverse individuals from different professions (Paulus and Nijstad, 2003; Pisano and Verganti, 2008; Singh and Fleming, 2010; Wuchty et al., 2007). Practitioners and organizational leaders alike have declared that collaboration is a key strategy for improving problem solving and achieving innovation in health care. Two nursing researchers who have studied collaboration among health professionals define it as

a communication process that fosters innovation and advanced problem solving among people who are of different disciplines, organizational ranks, or institutional settings [and who] band together for advanced problem solving [in order to] discern innovative solutions without regard to discipline, rank, or institutional affiliation [and to] enact change based on a higher standard of care or organizational outcomes. (Kinnaman and Bleich, 2004)

Much of what is called collaboration is more likely cooperation or coordination of care. Katzenbach and Smith (1993) argue that truly collaborative teams differ from high-functioning groups that have a defined leader and a set direction, but in which the dynamics of true teamwork are absent. The case study presented in Box 5-2 illustrates just how important it is for health professionals to work in teams to ensure that care is accessible and patient centered.

Case Study: Arkansas Aging Initiative. A Statewide Program Uses Interprofessional Teams to Improve Access to Care for Older Arkansans B onnie Sturgeon was an independent 80-year-old in 2005 when shortness of breath began to slow her down. She had been (more...)

Leadership at Every Level

Leadership from nurses is needed at every level and across all settings. Although collaboration is generally a laudable goal, there are many times when nurses, for the sake of delivering exceptional patient and family care, must step into an advocate role with a singular voice. At the same time, effective leadership also requires recognition of situations in which it is more important to mediate, collaborate, or follow others who are acting in leadership roles. Nurses must understand that their leadership is as important to providing quality care as is their technical ability to deliver care at the bedside in a safe and effective manner. They must lead in improving work processes on the front lines; creating new integrated practice models; working with others, from organizational policy makers to state legislators, to craft practice policy and legislation that allows nurses to work to their fullest capacity; leading curriculum changes to prepare the nursing workforce to meet community and patient needs; translating and applying research findings into practice and developing functional models of care; and serving on institutional and policy-making boards where critical decisions affecting patients are made.

Leadership in care delivery is particularly important in community and home settings where nurses work more autonomously with patients and families than they do in the acute care setting. In community and home settings, nurses provide a direct link connecting patients, their caregivers, and other members of the health care team. Other members of the health care team may not have the time, expertise, or first-hand experience with the patient’s home environment and circumstances to understand and respond to patient and family needs. For example, a neurologist may not be able to help a caregiver of an Alzheimer’s patient understand or curtail excessive spending habits, or a surgeon may not be able to offer advice to a caregiver on ostomy care—roles that nurses are perfectly positioned to assume. Leadership in these situations sometimes requires nurses to be assertive and to have a strong voice in advocating for patients and their families to ensure that their needs are communicated and adequately met.

Box 5-3 describes a nurse who evolved over the course of her career from thinking that being an effective nurse was all about honing her nursing skills and competencies to realize that becoming an agent of change was an equally important part of her job.

Nurse Profile: Connie Hill. A Nurse Leader Extends Acute Care Nursing Beyond the Hospital Walls I t was at a 2002 meeting at Children’s Memorial Hospital in Chicago that Connie Hill, MSN, RN, reviewed the chart of a child who had been on a ventilator (more...)

• A CALL FOR NURSES TO LEAD

Leadership does not occur in a social or political vacuum. As Bennis and Nanus (2003) note, the fast pace of change can be managed only if it is accompanied by leaders who can track the context of the “social architecture” to sustain and implement innovative ideas. Creating innovative care models at the bedside and in the community or taking the opportunity to fill a seat in a policy-making body or boardroom requires nurse leaders to develop ideas; approach management; and courageously make decisions within the political, economic, and social context that will make their solutions real and sustainable. A shift must take place in how nurses view their responsibility to those they care for; they must see themselves as full partners with other health professionals, and practice and education environments must socialize and educate them accordingly.

An important aspect of this socialization is mentoring others along the way. More experienced nurses must take the time to show those who are new and less experienced the most effective ways of being an exceptional nurse at the bedside, in the boardroom, and everywhere between. Technology such as chat rooms, Facebook, and even blogs can be used to support the mentoring role.

A crucial part of working within the social architecture is understanding how leadership and practice produce change over time. The nursing profession’s history includes many examples of the effect of nursing leadership on changes in systems and improvements in patient care. In the late 1940s and early 1950s, nurse Elizabeth Carnegie led the fight for the racial integration of nursing in Florida by example and through her extraordinary character and organizational skills. Her efforts to integrate the nursing profession were based in her sense of social justice not just for the profession, but also for the care of African American citizens who had little access to a workforce that was highly skilled or provided adequate access to health care services. Also in Florida, in the late 1950s, Dorothy Smith, the first dean of the new University of Florida College of Nursing, developed nursing practice models that brought nursing faculty into the hospital in a joint nursing service. Students thereby had role models in their learning experiences, and staff nurses had the authority to improve patient care. From this system came the patient kardex and the unit manager system that freed nurses from the constant search for supplies that took them away from the bedside. In the 1980s, nursing research by Neville Strumpf and Lois Evans highlighted the danger of using restraints on frail elders (Evans and Strumpf, 1989; Strumpf and Evans, 1988). Their efforts to translate their findings into practice revolutionized nursing practice in nursing homes, hospitals, and other facilities by focusing nursing care on preventing falls and other injuries related to restraint use, and led to state and federal legislation that resulted in reducing the use of restraints on frail elders.

Nurses also have also led efforts to improve health and access to care through entrepreneurial endeavors. For example, Ruth Lubic founded the first free-standing birth center in the country in 1975 in New York City. In 2000, she opened the Family Health and Birth Center in Washington, DC, which provides care to underserved communities (see Box 2-2 in Chapter 2 ). Her efforts have improved the care of thousands of women over the years. There are many other examples of nurse entrepreneurs, and a nurse entrepreneur network 2 exists that provides networking, education and training, and coaching for nurses seeking to enter the marketplace and business.

Will Student Nurses Hear the Call?

Leadership skills must be learned and mastered over time. Nonetheless, it is important to obtain a basic grasp of those skills as early as possible—starting in school (see Chapter 4 ). Nursing educators must give their students the most relevant knowledge and practice opportunities to equip them for their profession, while instilling in them a desire and expectation for new learning in the years to come. Regardless of the basic degree with which a nurse enters the profession, faculty should feel obligated to show students the way to their first or next career placement, as well as to their next degree and continuous learning opportunities.

Moreover, students should not wait for graduation to exercise their potential for leadership. In Georgia, for example, health students came together in 2001 under the banner “Lead or Be Led” to create a student-led, interprofessional nonprofit organization that “seeks to make being active in the health community a professional habit.” Named Health Students Taking Action Together (Health-STAT), the group continues to offer workshops in political advocacy, media training, networking, and fundraising. Its annual leadership symposium convenes medical, nursing, public health, and other students statewide to learn about health issues facing the state and work together on developing potential solutions (HealthSTAT, 2010). The National Student Nurses Association (NSNA), initiated in 1998, offers an online Leadership University that allows students to enhance their capacity for leadership through several avenues, such as earning academic credit for participating in the university’s leadership activities and discussing leadership issues with faculty. Students work in cooperative relationships with other students from various disciplines, faculty, community organizations, and the public (Janetti, 2003). Box 5-4 profiles two student leaders, one of whom eventu ally became NSNA president; both represent as well the growing diversity of the nursing profession, a crucial need if the profession is to rise to the challenge of helping to transform the health care system (see Chapter 4 ).

Nurse Profile: Kenya D. Haney and Billy A. Caceres. Building Diversity in Nursing, One Student at a Time D espite improvements to thedemographic make up of the nursing workforce in recent decades, the workforce remains predominantly white, female, and (more...)

Looking to the future, nurse leaders will need the skills and knowledge to understand and anticipate population trends. Formal preparation of student nurses may need to go beyond what has traditionally been considered nursing education. To this end, a growing number of schools offer dual undergraduate degrees in partnership with the university’s business or engineering school for nurses interested in starting their own business or developing more useful technology. Graduate programs offering dual degree programs with schools of business, public health, law, design, or communications take this idea one step further to equip students with an interest in administrative, philanthropic, regulatory, or policy-making positions with greater competencies in management, finance, communication, system design, or scope-of-practice regulations from the start of their careers.

Will Front-Line Nurses Hear the Call?

Given their direct and sustained contact with patients, front-line nurses, along with their unit or clinic managers, are uniquely positioned to design new models of care to improve quality, efficiency, and safety. Tapping that potential will require developing a new workplace culture that encourages and supports leaders at the point of care (whether a hospital or the community) and requires all members of a health care team to hold each other accountable for the team’s performance; nurses must also be equipped with the communication, conflict resolution, and negotiating skills necessary to succeed in leadership and partnership roles. For example, one new quality and safety strategy requires checklists to be completed before certain procedures, such as inserting a catheter, are begun. Nurses typically are asked to enforce adherence to the checklist. If another nurse or a physician does not wash his/her hands or contaminates a sterile field, nurses must possess the basic leadership skills to remind their colleague of the protocol and stop the procedure, if necessary, until the checklist is followed. And again, nurses must help and mentor each other in their roles as expert clinicians and patient advocates. No one can build the capabilities of an exceptional and effective nurse like another exceptional and effective nurse.

Will Community Nurses Hear the Call?

Nurses working in the community have long understood that to be effective in contributing to improvements in the entire community’s health, they must assume the role of social change agent. Among other things, community and public health nurses must promote immunization, good nutrition, and physical activity; detect emergency health threats; and prevent and respond to outbreaks of communicable diseases. In addition, they need to be prepared to assume roles in dealing with public health emergencies, including disaster preparedness, response, and recovery. Recent declines in the numbers of community and public health nurses, however, have made the leadership imperative for these nurses much more challenging.

Community and public health nurses learn to expect the unexpected. For example, a school nurse alerted health authorities to the arrival of the H1N1 influenza virus in New York City in 2009 (RWJF, 2010c). Likewise, an increasing number of nurses are being trained in incident command as part of preparedness for natural disasters and possible terrorist attacks. This entails understanding the roles of and working with community, state, and federal officials to assure the health and safety of the public. For example, when the town of Chehalis, south of Seattle, experienced a 100-year flood in 2007, a public health nurse called the secretary of Washington State’s Department of Health, Mary Selecky, to ask how to “deal with and dispose of dead cows, an unforeseen challenge [for] a public health nurse. The nurse knew she needed [to provide] tetanus shots and portable toilets but had not anticipated other, less common, aspects of the emergency” (IOM, 2010).

The profile in Box 5-5 illustrates how nurses lead efforts that provide critical services for communities. The profile also shows how nurses can also become leaders and social change agents in the broader community by serving on the boards of health-related institutions. The importance of this role is discussed in the next section.

Nurse Profile: Mary Ann Christopher. Cultivating Neighborhood Nursing at the Visiting Nurse Association of Central Jersey A t the Visiting Nurse Association of Central Jersey (VNACJ), president and chief executive officer Mary Ann Christopher, MSN, RN, (more...)

Will Chief Nursing Officers Hear the Call?

Although chief nursing officers (CNOs) typically are part of the hierarchical decision-making structure in that they have authority and responsibility for the nursing staff, they need to move up in the reporting structure of their organizations to increase their ability to contribute to key decisions. Not only is this not happening, however, but CNOs appear to be losing ground. A 2002 survey by the American Organization of Nurse Executives (AONE) showed that 55 percent of CNOs reported directly to their institution’s CEO, compared with 60 percent in 2000. More CNOs described a direct reporting relationship to the chief operating officer instead. Such changes in reporting structure can limit nurse leaders’ involvement in decision making about the most important product of hospitals—patient care. Additionally, the AONE survey showed that most CNOs (70 percent) have seen their responsibilities increase even as they have moved down in the reporting structure (Ballein Search Partners and AONE, 2003). CNOs face growing issues of contending not only with increased responsibilities, but also with budget pressures and difficulties with staffing, retention, and turnover levels during a nursing shortage (Jones et al., 2008).

Nurses also are underrepresented on institution and hospital boards, either their own or others. A biennial survey of hospitals and health systems conducted in 2007 by the Governance Institute found that only 0.8 percent of voting board members were CNOs, compared with 5.1 percent who were vice presidents for medical affairs (Governance Institute, 2007). More recently, a 2009 survey of community health systems found that nurses made up only 2.3 percent of their boards, compared with 22.6 percent who were physicians (Prybil et al., 2009). 3 While most boards focus mainly on finance and business, health care delivery, quality, and responsiveness to the public—areas in which the nature of their work gives nurses particular expertise—also are considered key (Center for Healthcare Governance, 2007). A 2007 survey found that 62 percent of boards included a quality committee (Governance Institute, 2007). A 2006 survey of hospital presidents and CEOs showed the impact of such committees. Those institutions with a quality committee were more likely to adopt various oversight practices; they also experienced lower mortality rates for six common medical conditions measured by the Agency for Healthcare Research and Quality’s (AHRQ’s) Inpatient Quality Indicators and the State Inpatient Databases (Jiang et al., 2008).

The growing attention of hospital boards to quality and safety issues reflects the increased visibility of these issues in recent years. Several states and the Centers for Medicare and Medicaid Services, for example, are increasing their oversight of specific preventable errors (“never events”), and new payment structures in health care reform may be based on patient outcomes and satisfaction (Hassmiller and Bolton, 2009; IOM, 2000; King, 2009; Wachter, 2009). Given their expertise in quality and safety improvement, nurses are more likely than many other board members to understand the issues involved and often can educate other members about these issues (Mastal et al., 2007). This is one area, then, in which nurse board members can have a significant impact. Recognizing this, the 2009 survey of community health systems mentioned above specifically recommended that community health system boards consider appointing expert nursing leaders as voting board members to strengthen clinical input in deliberations and decision-making processes (Prybil et al., 2009).

More CNOs need to prepare themselves and seek out opportunities to serve on the boards of health-related institutions. If decisions are taking place about patient care and a nurse is not at the decision-making table, important perspectives will be missed. CNOs should also promote leadership activities among their staff, encouraging them to secure important decision-making positions on committees and boards, both internal and external to the organization.

Will Nurse Researchers Hear the Call?

Nurse researchers must develop new models of quality care that are evidence based, patient centered, affordable, and accessible to diverse populations. Developing and imparting the science of nursing is also an important contribution to nurses’ ability to deliver high-quality, safe care. Additionally, nurses must serve as advocates and implementers for the program designs they develop. Academic–service partnerships that typically involve nursing schools and nearby, often low-income communities are a first step toward implementation. Given that a nursing school does not exist in every community, however, such partnerships cannot achieve change on the scale needed to transform the health care system. Nurse researchers must become active not only in studying important care deliv ery questions but also in translating research findings into practice and developing and setting the policy agendas. Their leadership is vital in ensuring that new state-and federal-level policies are based on evidence and will help increase quality and access while decreasing costs and health care disparities. The Affordable Care Act (ACA) provides opportunities for demonstration projects and pilot programs directed at various elements of nursing. If these projects and programs do not adequately track nursing inputs and intended/unintended outcomes, they cannot hope to achieve their potential.

Nurse researchers should seek funding from the National Institute for Nursing Research and other institutes of the National Institutes of Health, as do scientists from other disciplines, to help increase the evidence base for improved models of care. Funding might also be secured from other government entities, such as AHRQ and the Health Resources and Services Administration (HRSA) and local and national foundations, depending on the research topic. To be competitive in these efforts, nurses should hone their analytical skills with training in such areas as statistics and data analysis, econometrics, biometrics, and other qualitative and quantitative research methods that are appropriate to their research topics. Mark Pauly, codirector of the Robert Wood Johnson Foundation’s Interdisciplinary Nursing Quality Research Initiative, argues that, for nursing research to achieve parity with other health services research in terms of acceptability, it must be managed by interprofessional teams that include both nurse scholars and scholars from methodological and modeling disciplines. For nurse researchers to achieve parity with other health services researchers, they must develop the skills and initiative to take leadership roles in this research. 4

Will Nursing Organizations Hear the Call?

The Gallup poll of 1,500 opinion leaders referenced earlier in this chapter also highlighted fragmentation in the leadership of nursing organizations as a challenge. Responding opinion leaders predicted that nurses will have little influence on health care reform over the next 5–10 years (see Figure 5-1 ). By contrast, they believed that nurses should have more input and impact in areas such as planning, policy development, and management ( Figure 5-2 ) (RWJF, 2010a). No one expects all professional health organizations to coordinate their public agendas, actions, or messaging for every issue. But nursing organizations must continue to collaborate and work hard to develop common messages, including visions and missions, with regard to their ability to offer evidence-based solutions for improvements in patient care. Once common ground has been established, nursing organizations will need to activate their membership and constituents to work together to take action and support shared goals. When policy makers and other key decision makers know that the largest group of health professionals in the country is in agreement on important issues, they listen and often take action. Conversely, when nursing organizations and their members disagree with one another on important issues, decisions are not made, as the decision makers often are unsure of which side to take.

Opinion leaders’ predictions of the amount of influence nurses will have on health care reform. NOTE: Govt. = Government; Ins. Execs. = Insurance executives; Pharma. execs. = Pharmaceutical executives; HC execs. = Health care executives.

Opinion leaders’ views on the amount of influence nurses should have on various areas of health care. SOURCE: RWJF, 2010b. Reprinted with permission from Frederick Mann, RWJF.

Quality and safety are important areas in which professional nursing organizations have great potential to serve as leaders. The Nursing Alliance for Quality Care (NAQC) 5 is a Robert Wood Johnson Foundation–funded effort with the mission of advancing the quality, safety, and value of patient-centered health care for all individuals, including patients, their families, and the communities where patients live. Based at the George Washington University School of Nursing, the organization stresses the need for nurses to advocate actively for and be accountable to patients for high-quality and safe care. The establishment of the NAQC “is based on the assumption that only with a stronger, more unified ‘voice’ in nursing policy will dramatic and sustainable achievements in quality and safety be achieved for the American public” (George Washington University Medical Center, 2010).

• ANSWERING THE CALL

The call for nurses to assume leadership roles can be answered through leadership programs for nurses; mentorship; and involvement in the policy-making process, including political engagement.

Leadership Programs for Nurses

Leadership is not necessarily innate; many individuals develop into leaders. Sometimes that development comes through experience. For example, nurse leaders at the executive level historically earned their way to their position through their competence, rather than obtaining formal preparation through a business school. However, development as a leader can also be achieved through more formal education and training programs. The wide range of effective leadership programs now available for nurses is illustrated by the examples described below. The challenge is to better utilize these opportunities to develop a greater number of nursing leaders.

Integrated Nurse Leadership Program

The Integrated Nurse Leadership Program (INLP), 6 funded by the Gordon and Betty Moore Foundation, works with hospitals in the San Francisco Bay area that wish to remodel their professional culture and systems of care to improve care while dealing more effectively with continual change. The program develops hospital leaders, offers training and technical assistance, and provides grants to support the program’s implementation. INLP has found that the development of stable, effective leadership in nursing-related care is associated with better-than-expected patient care outcomes and improvements in nurse recruitment and retention. The impact of the program will be evaluated to produce models that can be replicated in other parts of the country.

Fellows Program in Management for Nurse Executives at Wharton 7

When the Johnson & Johnson Company and the Wharton School joined in 1983 to offer a senior nurse executive management fellowship, the program concentrated on helping senior nursing leaders manage their departments by providing them, for example, intense training in accounting (Shea, 2005). The Wharton Fellows program has changed in many ways since then in response to the evolving health care environment, according to a 2005 review (Shea, 2005). For example, the program has strengthened senior nursing executives’ ability to argue for quality improvement on the basis of solid evidence, including financial documentation and probabilistic decision making. The program also aims to improve such leadership competencies as systems thinking, negotiation, communications, strategy, analysis, and the development of learning communities. Its offerings will likely undergo yet more changes as hospital chief executive and chief operating officers increasingly come from the ranks of the nursing profession.

Robert Wood Johnson Foundation Executive Nurse Fellows Program

The Robert Wood Johnson Foundation Executive Nurse Fellows Program 8 is an advanced leadership program for nurses in senior executive roles who wish to lead improvements in health care from local to national levels. It provides a 3-year in-depth, comprehensive leadership development experience for nurses who are already serving in senior leadership positions. The program is designed to cultivate and expand fellows’ capacity to lead teams and organizations. The fellowship program includes curriculum and program activities that provide opportunities for executive coaching and mentoring, team-based and individual leadership projects, professional development that incorporates best practices in leadership, as well as access to online communities and leadership networks. Through the program, fellows master 20 leadership competencies that cover a broad range of knowledge and skills that can be used when “leading self, leading others, leading the organization and leading in health care” (RWJF Executive Nurse Fellows, 2010).

Best on Board

Best on Board 9 is an education, testing, and certification program that helps prepare current and prospective leaders to serve on the governing board of a health care organization. Its CEO, Connie Curran, is a registered nurse (RN) who chaired a hospital nursing department, was the dean of a medical college, and founded her own national management and consulting services firm. A 2010 review cites the growing recognition by blue ribbon panels and management researchers that nurses are an untapped resource for the governing bodies of health care organizations. The authors argue that while nurses have many qualities that make them natural assets to any health care board, they must also “understand the advantages of serving on boards and what it takes to get there” (Curran and Totten, 2010).

Robert Wood Johnson Foundation Health Policy Fellows and Investigator Awards Programs

While not limited to nurses, the Robert Wood Johnson Foundation Health Policy Fellows and Investigator Awards programs 10 offer nurses, other health professionals, and behavioral and social scientists “with an interest in health [the opportunity] to participate in health policy processes at the federal level” (RWJF Scholars, Fellows & Leadership Programs, 2010). Fellows work on Capitol Hill with elected officials and congressional staff. The goal is for fellows to use their academic and practice experience to inform the policy process and to improve the quality of policies enacted. Investigators are funded to complete innovative studies of topics relevant to current and future health policy. Participants in both programs receive intensive training to improve the content and delivery of messages intended to improve health policy and practice. This training is critical, as investigators are often called upon to testify to Congress about the issues they have explored. The health policy fellows bring their more detailed understanding of how policies are formed back to their home organizations. In this way, they are more effective leaders as they strive to bring about policy changes that lead to improvements in patient care.

American Nurses Credentialing Center Magnet Recognition Program

Although not an individual leadership program, the American Nurses Credentialing Center (ANCC) Magnet Recognition Program 11 recognizes health care organizations that advance nursing excellence and leadership. In this regard, achieving Magnet status indicates that the nursing workforce within the institution has attained a number of high standards relating to quality and standards of nursing practice. These standards, as designated by the Magnet process, are called “Forces of Magnetism.” According to ANCC, “the full expression of the Forces embodies a professional environment guided by a strong visionary nursing leader who advocates and supports development and excellence in nursing practice. As a natural outcome of this, the program elevates the reputation and standards of the nursing profession” (ANCC, 2010). Some of these Forces include quality of nursing leadership, management style, quality of care, autonomous nursing care, nurses as teachers, interprofessional relationships, and professional development.

Mentorship 12

Leadership is also fostered through effective mentorship opportunities with leaders in nursing, other health professions, policy, and business. All nurses have a responsibility to mentor those who come after them, whether by helping a new nurse become oriented or by taking on more formal responsibilities as a teacher of nursing students or a preceptor. Nursing organizations (membership associations) also have a responsibility to provide mentoring and leadership guidance, as well as opportunities to share expertise and best practices, for those who join.

Fortunately, a number of nursing associations have organized networks to support their membership and facilitate such opportunities:

• The American Association of Colleges of Nursing (AACN) conducts an expertise survey that is used to identify subject matter experts across topic areas within its membership; it also maintains a list of nursing education experts. Names of these experts are shared with members on request. These resources also are used to identify experts to serve on boards, respond to media requests, and serve in other capacities. In addition, AACN offers an annual executive leadership development program and a new deans mentoring program to further promote and foster leadership.
• The National League for Nursing (NLN) has established an Academy of Nurse Educators whose members are available to serve as mentors for NLN members. NLN engages these educators in a variety of mentoring programs, from a National Scholarly Writing Retreat to the Johnson & Johnson mentoring program for new faculty.
• While AONE does not have a formal mentoring program, it has developed online learning communities where members are encouraged to interact, post questions, and learn from each other. These online communities facilitate collaboration; encourage the sharing of knowledge, best practices, and resources; and help members discover solutions to day-to-day challenges in their work.
• The American Academy of Nursing keeps a detailed list of nurse “Edge Runners” 13 that describes the programs nursing leaders have developed and the outcomes of those programs. Edge Runner names and contact information are prominently displayed so that learning and mentoring can take place freely. 14
• The American Nurses Association just passed a resolution at its 2010 House of Delegates to develop a mentoring program for novice nurses. The program has yet to be developed.
• Over the years, the National Coalition of Ethnic Minority Nurse Associations (NCEMNA) has offered numerous workshops, webinars, and educational materials to develop its members’ competencies in leadership, policy, and communications. NCEMNA’s highly regarded Scholars program 15 promotes the academic and professional development of ethnic minority investigators, in part through a mentoring program. It serves as a model worth emulating throughout the nursing profession.

Involvement in Policy Making

Nurses may articulate what they want to happen in health care to make it more truly patient centered and to improve quality, access, and value. They may even have the evidence to support their conclusions. As with any worthy cause, however, they must engage in the policy-making process to ensure that the changes they believe in are realized. To this end, they must be able to envision themselves as leaders in that process and seek out new partners who share their goals.

The challenge now is to motivate all nurses to pursue leadership roles in the policy-making process. Political engagement is one avenue they can take to that end. As Bethany Hall-Long, a nurse who was elected to the Delaware State House of Representatives in 2002 and is now a state senator, writes, “political actions may be as simple as voting in local school board elections or sharing research findings with state officials, or as complex as running for elected office” (Hall-Long, 2009). For example, engaging school board candidates about the fundamental role of school nurses in the management of chronic conditions among students can make a difference at budget time. And if the goal is broader, perhaps to locate more community health clinics within schools, achieving buy-in from the local school board is absolutely vital. As Hall-Long writes, however, “since nurses do not regularly communicate with their elected officials, the elected officials listen to non-nursing individuals” (Hall-Long, 2009).

Political engagement can be a natural outgrowth of nursing experience. When Marilyn Tavenner first started working in an intensive care unit in Virginia, she thought, “If I were the head nurse or the nurse manager, I would make changes. I would try to influence that unit and that unit’s quality and staffing.” After she became a nurse manager, she thought, “I wouldn’t mind doing this for the entire hospital.” After succeeding for several years as a director of nursing, she was encouraged by a group of physicians to apply for the CEO position of her hospital when it became available. Eventually, Timothy Kaine, governor of Virginia from 2006 to 2010, recruited her to be the state’s secretary of health and human resources. In February 2010, Ms. Tavenner was named deputy administrator for the federal Centers for Medicare and Medicaid Services. Like many nurses, she had never envisioned working in government. But she realized that she wanted to have an impact on health care and health care reform. She wanted to help the uninsured find resources and access to care. For her, that meant building on relationships and finding opportunities to work in government. 16

Other notable nurses who have answered the call to serve in government include Sheila Burke, who served as chief of staff to former Senate Majority Leader Robert Dole, has been a member of the Medicare Payment Advisory Commission, and now teaches at Georgetown and Harvard Universities; and Mary Wakefield, who was named administrator of HRSA in 2009 and is the highest-ranking nurse in the Obama Administration. Speaker of the House Nancy Pelosi’s office has had back-to-back nurses from The Robert Wood Johnson Foundation Health Policy Fellows Program as staffers since 2007, providing a significant entry point for the development of new health policy leaders. Additionally, in 1989 Senator Daniel Inouye established the Military Nurse Detailee fellowship program. This 1-year fellowship provides an opportunity for a high-ranking military nurse, who holds a minimum of a master’s degree, to gain health policy leadership experience in Senator Inouye’s office. The fellowship rotates among three branches of service (Army, Navy, and Air Force) annually. 17 During the Clinton Administration, Beverly Malone served as deputy assistant secretary for health in the Department of Health and Human Services (HHS). In 2002, Richard Carmona, who began his education with an associate’s degree in nursing from the Bronx Community College in New York, was appointed surgeon general by President George W. Bush. Shirley Chater led the reorganization of the Social Security Administration in the 1990s. Carolyne Davis served as head of the Health Care Finance Administration (predecessor of the Centers for Medicare and Medicaid Services) in the 1980s during the implementation of a new coding system that classifies hospital cases into diagnosis-related groups. From 1979 to 1981, Rhetaugh Dumas was the first nurse, the first woman, and the first African American to serve as a deputy director of the National Institute of Mental Health (Sullivan, 2007). Nurses also have served as regional directors of HHS and as senior advisors on health policy to HHS.

As for elected office, there were three nurse members of the 111th Congress—Eddie Bernice Johnson (D-TX), Lois Capps (D-CA), and Carolyn McCarthy (D-NY)—all of whom had a hand in sponsoring and supporting health care–focused legislation, from AIDS research to gun control. Lois Capps organized and co-chairs the Congressional Nursing Caucus (which also includes members who are not nurses). The group focuses on mobilizing congressional support for health-related issues. Additionally, 105 nurses have served in state legislatures, including Paula Hollinger of Maryland, who sponsored one of the nation’s first stem cell research bills. None of these nurses waited to be asked; they pursued their positions, both elected and appointed, because they knew they had the expertise and experience to make changes in health care.

Very little in politics is accomplished without preparation or allies. Health professionals point with pride to multiple aspects of the Prescription for Pennsylvania initiative, a state health care reform initiative that preceded the ACA and is also described in Box 5-6 . As is clear from a detailed 2009 review, success was not achieved overnight; smaller legislative and regulatory victories set the stage starting in the late 1990s. Even some apparent legislative failures built the foundation for future successes because they caused nurses to spend more time meeting face to face with physicians who had organized opposition to various measures. As a result, nursing leaders developed a better sense of where they could achieve compromises with their opponents. They also found a new ally in the Chamber of Commerce to counter opposition from some sections of organized medicine (Hansen-Turton et al., 2009).

Case Study: Prescription for Pennsylvania. A Governor’s Leadership Improves Access to Care for Residents of a Rural State W hen Pennsylvania Governor Edward Rendell took office in 2003, one-twelfth of the state’s 12 million residents had (more...)

Hansen-Turton and colleagues draw three major lessons from this experience. First, nurses must build strong alliances within their own professional community, an important lesson alluded to earlier in this chapter. Pennsylvania’s nurses were able to speak with a unified voice because they first worked out among themselves which issues mattered most to them. Second, nurses must build relationships with key policy makers. Pennsylvania’s nurses developed strong relationships with several legislators from both major political parties and earned the support of two successive sitting governors: Thomas Ridge (Republican) and Edward Rendell (Democrat). Third, nurses must find allies outside the nursing profession, particularly in business and other influential communities. Pennsylvania’s nurses gained a strong ally in the Chamber of Commerce when they were able to demonstrate how expanding regulations to allow nurses to do all they were educated and demonstrably capable of doing would help lower health care costs (Hansen-Turton et al., 2009).

Perhaps the most important lesson to draw from the Pennsylvania experience lies in the way the campaign was framed. The focus of attention was on achieving quality care and cost reductions. A closer examination of the issues showed that achieving those goals required, among other things, expanding the roles and responsibilities of nurses. What drew the greatest amount of political support for the Prescription for Pennsylvania campaign was the shared goal of getting more value out of the health care system—quality care at a sustainable price. The fact that the campaign also expanded nursing practice was secondary. Those expansions are likely to continue as long as the emphasis is on quality care and cost reduction. Similarly, the committee believes that the goal in any transformation of the health care system should be achieving innovative, patient-centered, highvalue care. If all stakeholders—from legislators, to regulators, to hospital executives, to insurance companies—act from a patient-centered point of reference, they will see that many of the solutions they are seeking require a transformation of the nursing profession.

• A CALL FOR NEW PARTNERSHIPS

Having enough nurses and having nurses with the right skills and competencies to care for the population is an important societal issue. Having allies from outside the profession is important to achieving this goal. More nurses need to reach out to new partners in arenas ranging from business, government, and philanthropy to state and national medical associations to consumer groups. Additionally, nurses need to fortify alliances that are made through personal connections and relationships. Just as important, society needs to understand its stake in ensuring that nurses are effective full partners and leaders in the quest to deliver quality, high-value care that is accessible to diverse populations. The full potential of the nursing profession in care, leadership, and research must be tapped to deal with the wide range of health care challenges the nation will face in the coming years.

Eventually, to transform the way health care is delivered in the United States, nurses will have to move not just out of the hospital, but also out of health care organizations entirely. For example, nurses are underrepresented on the boards of private nonprofit and philanthropic organizations, which do not provide health care services but often have a large impact on health care decisions. The Commonwealth Fund and the Kaiser Family Foundation, for instance, have no nurses on their boards, although they do have physicians. Without nurses, vital ground-level perspectives on quality improvement, care coordination, and health promotion are likely missing. On the other hand, AARP provides a positive example. At least two nurses at AARP have served in the top leadership and governance roles (president and chair) in the past 3 years. Nurses serve on the health and long-term services policy committee, and the senior vice president of the Public Policy Institute is also a nurse. AARP’s commitment to nursing is clear through its sponsorship, along with the Robert Wood Johnson Foundation, of the Center to Champion Nursing.

Enactment of the ACA will provide unprecedented opportunities for change in the U.S. health care system for the foreseeable future. Strong leadership on the part of nurses, physicians, and others will be required to devise and implement the changes necessary to increase quality, access, and value and deliver patient-centered care. If these efforts are to be successful, all nurses, from students, to bedside and community nurses, to CNOs and members of nursing organizations, to researchers, must develop leadership competencies and serve as full partners with physicians and other health professionals in efforts to improve the health care system and the delivery of care. Nurses must exercise these competencies in a collaborative environment in all settings, including hospitals, communities, schools, boards, and political and business arenas. In doing so, they must not only mentor others along the way, but develop partnerships and gain allies both within and beyond the health care environment.

• AACN (American Association of Colleges of Nursing). 2008. The essentials of baccalaureate edu cation for professional nursing practice . Washington, DC: AACN. Available from http://www ​.aacn.nche ​.edu/education/pdf/BaccEssentials08.pdf .
• AACN. 2010. Enhancing diversity in the nursing workforce: Fact sheet updated March 2010 . http://www ​.aacn.nche ​.edu/Media/FactSheets/diversity.htm (accessed July 1, 2010).
• ANCC (American Nurses Credentialing Center). 2010. Program overview . http://www ​.nursecredentialing ​.org/Magnet/ProgramOverview ​.aspx (accessed August 25, 2010).
• Ballein Search Partners and AONE (American Organization of Nurse Executives). 2003. Why senior nursing officers matter: A national survey of nursing executives . Oak Brook, IL: Ballein Search Partners.
• Bennis, W., and B. Nanus. 2003. Leaders: Strategies for taking charge . New York: HarperCollins.
• Beverly, C. J., R. E. McAtee, R. Chernoff, G. V. Davis, S. K. Jones, and D. A. Lipschitz. 2007. The Arkansas aging initiative: An innovative approach for addressing the health of older rural Arkansans . Gerontologist 47(2):235-243. [ PubMed : 17440128 ]
• Bradford, D. L., and A. R. Cohen. 1998. Power up: Transforming organizations through shared leadership . Hoboken, NJ: John Wiley & Sons, Inc.
• Center for Healthcare Governance. 2007. A seat at the power table: The physician’s role on the hos pital board . Chicago, IL: Center for Healthcare Governance.
• Curran, C. R., and M. K. Totten. 2010. Expanding the role of nursing in health care governance . Nursing Economic$ 28(1):44-46. [ PubMed : 20306878 ]
• Evans, L. K., and N. E. Strumpf. 1989. Tying down the elderly. A review of the literature on physical restraint . Journal of the American Geriatrics Society 37(1):65-74. [ PubMed : 2642501 ]
• Gardner, D. B. 2005. Ten lessons in collaboration . OJIN: Online Journal of Issues in Nursing 10(1):2. [ PubMed : 15727545 ]
• George Washington University Medical Center. 2010. NAQC: Nursing alliance for quality care . http://www ​.gwumc.edu ​/healthsci/departments/nursing/naqc/ (accessed August 25, 2010).
• Governance Institute. 2007. Boards x 4: Governance structures and practices . San Diego, CA: Governance Institute.
• Hall-Long, B. 2009. Nursing and public policy: A tool for excellence in education, practice, and research . Nursing Outlook 57(2):78-83. [ PubMed : 19318166 ]
• Hansen-Turton, T., A. Ritter, and B. Valdez. 2009. Developing alliances: How advanced practice nurses became part of the prescription for Pennsylvania . Policy, Politics, & Nursing Practice 10(1):7-15. [ PubMed : 19383617 ]
• Hassmiller, S. B., editor; , and L. B. Bolton, editor. (eds.). 2009. Transforming care at the bedside: Paving the way for change . American Journal of Nursing 109(11):3-80.
• HealthSTAT. 2010. About us . http://www ​.healthstatgeorgia ​.org/?q=content/about (accessed June 29, 2010).
• IOM (Institute of Medicine). 2000. To err is human: Building a safer health system . Washington, DC: National Academy Press. [ PubMed : 25077248 ]
• IOM. 2004. In the nation’s compelling interest: Ensuring diversity in the health care workforce . Washington, DC: The National Academies Press. [ PubMed : 25009857 ]
• IOM. 2010. A summary of the December 2009 Forum on the Future of Nursing: Care in the com munity . Washington, DC: The National Academies Press.
• Janetti, A. 2003. NSNA leadership university: A practicum in shared governance . DEAN’S Notes 25(1).
• Jiang, H. J., C. Lockee, K. Bass, and I. Fraser. 2008. Board engagement in quality: Findings of a survey of hospital and system leaders . Journal of Healthcare Management 53(2):121-134; discussion 135. [ PubMed : 18421996 ]
• Joint Commission. 2008. Behaviors that undermine a culture of safety . Sentinel Event Alert (40). [ PubMed : 18686330 ]
• Jones, C. B., D. S. Havens, and P. A. Thompson. 2008. Chief nursing officer retention and turnover: A crisis brewing? Results of a national survey . Journal of Healthcare Management 53(2):89-105; discussion 105-106. [ PubMed : 18421994 ]
• Katzenbach, J. R., and D. K. Smith. 1993. The wisdom of teams: Creating the high-performance organization . Boston, MA: Harvard Business School Press.
• King, S. 2009. Channeling grief into action: Creating a culture of safety conference call , February 25, 2009, Hosted by Institute for Healthcare Improvement.
• Kinnaman, M. L., and M. R. Bleich. 2004. Collaboration: Aligning resources to create and sustain partnerships . Journal of Professional Nursing 20(5):310-322. [ PubMed : 15494965 ]
• Mastal, M. F., M. Joshi, and K. Schulke. 2007. Nursing leadership: Championing quality and patient safety in the boardroom . Nursing Economic$ 25(6):323-330. [ PubMed : 18240833 ]
• Mehrotra, A., H. Liu, J. L. Adams, M. C. Wang, J. R. Lave, N. M. Thygeson, L. I. Solberg, and E. A. McGlynn. 2009. Comparing costs and quality of care at retail clinics with that of other medical settings for 3 common illnesses . Annals of Internal Medicine 151(5):321-328. [ PMC free article : PMC2805258 ] [ PubMed : 19721020 ]
• Olender-Russo, L. 2009. Creating a culture of regard: An antidote for workplace bullying . Creative Nursing 15(2):75-81. [ PubMed : 19507768 ]
• Paulus, P., editor; , and B. Nijstad, editor. , eds. 2003. Group creativity: Innovation through collaboration . New York: Oxford University Press.
• Pearson, A., H. Laschinger, K. Porritt, Z. Jordan, D. Tucker, and L. Long. 2007. Comprehensive systematic review of evidence on developing and sustaining nursing leadership that fosters a healthy work environment in healthcare . International Journal of Evidence-Based Healthcare 5:208-253. [ PubMed : 21631788 ]
• Pennsylvania Governor’s Office. 2009. Governor Rendell thanks “pioneers” for making Pennsyl vania the national leader on chronic care management and creating patient-centered medic al homes . http://www ​.portal.state ​.pa.us/portal/server ​.pt?open=512&objID ​=3053&PageID ​=431159&mode ​=2&contentid=http: ​//pubcontent ​.state.pa.us/publishedcontent ​/publish ​/global/news_releases ​/governor_s_office ​/news_releases/governor ​_rendell_thanks ​__pioneers__for_making ​_pennsylvania_the ​_national_leader_on_chronic ​_care_management ​_and_creating_patient ​_centered_medical_homes.html (accessed July 1, 2010).
• Pisano, G. P., and R. Verganti. 2008. Which kind of collaboration is right for you? Harvard Business Review 86(12):78-86.
• Prybil, L., S. Levey, R. Peterson, D. Heinrich, P. Brezinski, G. Zamba, A. Amendola, J. Price, and W. Roach. 2009. Governance in high-performing community health systems: A report on trustee and CEO views . Chicago, IL: Grant Thornton LLP.
• Quisling, K. E. 2009. Resident orientation: Nurses create a program to improve care coordination . American Journal of Nursing 109(11 Suppl):26-28. [ PubMed : 19826330 ]
• Rosenstein, A. H., and M. O’Daniel. 2008. A survey of the impact of disruptive behaviors and communication defects on patient safety . Joint Commission Journal on Quality and Patient Safety 34(8):464-471. [ PubMed : 18714748 ]
• RWJF (Robert Wood Johnson Foundation). 2010. a. Nursing leadership from bedside to boardroom: Opinion leaders’ perceptions . http://www ​.rwjf.org/pr/product ​.jsp?id=54350 (accessed May 14, 2010).
• RWJF. 2010. b. Nursing leadership from bedside to boardroom: Opinion leaders’ views . http://www ​.rwjf.org/pr/product ​.jsp?id=54491 (accessed August 25, 2010).
• RWJF. 2010. c. Unlocking the potential of school nursing: Keeping children healthy, in school, and ready to learn . Charting Nursing’s Future July(14):1-8.
• RWJF Executive Nurse Fellows. 2010. Overview . http://www ​.executivenursefellows ​.org/index ​.php?option=com_content&view ​=article&id ​=1&Itemid=34 (accessed September 28, 2010).
• RWJF Scholars, Fellows & Leadership Programs. 2010. Robert Wood Johnson Foundation Health Policy Fellows . http://www ​.rwjfleaders ​.org/programs/robert-wood-johnson-foundation-healthpolicy-fellow (accessed September 28, 2010).
• Shea, G. 2005. Developing the strategic voice of senior nurse executives . Nursing Administration Quarterly 29(2):133-136. [ PubMed : 15923976 ]
• Singh, J., and L. Fleming. 2010. Lone inventors as sources of breakthroughs: Myth or reality? Man agement Science 56(1):41-56.
• Strumpf, N. E., and L. K. Evans. 1988. Physical restraint of the hospitalized elderly: Perceptions of patients and nurses . Nursing Research 37(3):132-137. [ PubMed : 3368353 ]
• Sullivan, P. 2007. Rhetaugh Dumas, 78; nurse rose to become NIMH deputy director . The Washington Post , July 27.
• Wachter, R. M. 2009. Patient safety at ten: Unmistakable progress, troubling gaps . Health Affairs 29(1):165-173. [ PubMed : 19952010 ]
• Wuchty, S., B. Jones, and B. Uzzi. 2007. The increasing dominance of teams in production of knowledge . Science 316(5827):1036-1039. [ PubMed : 17431139 ]

Gallup research staff—Richard Blizzard, Christopher Khoury, and Coleen McMurray—conducted telephone surveys with 1,504 individuals, including university faculty, insurance executives, corporate executives, health services leaders, government leaders, and industry thought leaders.

See http://www ​.nurse-entrepreneur-network ​.com/public/main.cfm .

It should be noted that, while there are many more physicians than nurses on hospital boards, health care providers still are generally underrepresented.

Personal communication, Mark Pauly, Bendheim Professor, Professor of Health Care Management, Professor of Business and Public Policy, Professor of Insurance and Risk Management, and Professor of Economics, Wharton School of the University of Pennsylvania, and Codirector of the Robert Wood Johnson Foundation’s Interdisciplinary Nursing Quality Research Initiative, June 25, 2010.

See http://www ​.gwumc.edu ​/healthsci/departments/nursing/naqc/ .

See http://futurehealth ​.ucsf ​.edu/Public/Leadership-Programs ​/Home.aspx?pid=35 .

See http: ​//executiveeducation ​.wharton.upenn.edu ​/open-enrollment/health-care-programs ​/Fellows-Program-Management-Nurse-Executives.cfm .

See http://www ​.executivenursefellows.org .

See http://www ​.bestonboard.org .

See http://www ​.rwjfleaders ​.org/programs/robert-wood-johnson-foundation-health-policy-fellow .

See http://www ​.nursecredentialing ​.org/Magnet/ProgramOverview ​.aspx .

This section draws on personal communication in 2010 with Susan Gergely, Director of Operations, American Organization of Nurse Executives; Beverly Malone, CEO, National League for Nursing; Robert Rosseter, Chief Communications Officer, American Association of Colleges of Nursing; and Pat Ford Roegner, CEO, American Academy of Nursing.

The Edge Runner program is a component of the American Academy of Nursing’s Raise the Voice campaign, funded by the Robert Wood Johnson Foundation. The Edge Runner designation recognizes nurses who have developed innovative, successful models of care and interventions to address problems in the health care delivery system or unmet health needs in a population.

See AAN’s Edge Runner Directory, http://www ​.aannet.org ​/custom/edgeRunner/index ​.cfm?pageid=3303&showTitle ​=1 .

See http://www ​.ncemna.org/scholarships.asp .

This paragraph draws on personal communication with Marilyn Tavenner, principal deputy administrator and chief operating officer, Centers for Medicare and Medicaid Services, May 11, 2010.

Personal communication, Corina Barrow, Lieutenant Colonel, Army Nurse Corps, Nurse Corps Detailee, Office of Senator Daniel Inouye (D-HI), August 25, 2010.

• Cite this Page Institute of Medicine (US) Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine. The Future of Nursing: Leading Change, Advancing Health. Washington (DC): National Academies Press (US); 2011. 5, Transforming Leadership.
• PDF version of this title (6.0M)

In this Page

Related information.

• PMC PubMed Central citations
• PubMed Links to PubMed

Recent Activity

• Transforming Leadership - The Future of Nursing Transforming Leadership - The Future of Nursing

Your browsing activity is empty.

Activity recording is turned off.

Turn recording back on

Connect with NLM

National Library of Medicine 8600 Rockville Pike Bethesda, MD 20894

Web Policies FOIA HHS Vulnerability Disclosure

Help Accessibility Careers

• Toggle navigation

The Nurse Leader Within (NUR 3110)

An oer for introduction to nursing leadership for bs students.

Weekly Class Assignments

This is where you will find your weekly assignments:

Weekly Assignments

You can use the links below to get all the needed information for weekly classes:

Leave a Reply Cancel reply

You must be logged in to post a comment.

The OpenLab at City Tech: A place to learn, work, and share

The OpenLab is an open-source, digital platform designed to support teaching and learning at City Tech (New York City College of Technology), and to promote student and faculty engagement in the intellectual and social life of the college community.

New York City College of Technology | City University of New York

Accessibility

Our goal is to make the OpenLab accessible for all users.

Learn more about accessibility on the OpenLab

Creative Commons

• - Attribution
• - NonCommercial
• - ShareAlike

© New York City College of Technology | City University of New York

Nursing Schools

Galen College Of Nursing, Tampa Bay

Galen College Of Nursing is a institution with a campus in Saint Petersburg, Florida. The institution is approved to offer nursing programs by the Florida Board of Nursing.

Nursing Programs

• Licensed Practical Nursing (LPN)
• Associate of Science in Nursing (ASN)
• LPN to Associate of Science in Nursing (LPN to ASN)
• Bachelor of Science in Nursing (BSN)
• Online RN to Bachelor of Science in Nursing (RN to BSN)

Visit the Galen College Of Nursing website to learn how to apply for the nursing programs listed above. We also recommend that all nursing students in Florida periodically review the requirements for a CNA, LPN, and RN nursing license as presented by the Florida Board of Nursing . Understanding the CNA, LPN, and RN nursing license requirements and duty restrictions for Florida will help you navigate your education needs and avoid career planning mistakes often made by nursing students.

Campus Location

Click the map below to see the campus location and to get driving directions to Galen College Of Nursing . You can also see the Galen College Of Nursing campus setting and nearby attractions in satellite or street view mode.

• Address: 11101 Roosevelt Blvd N, Saint Petersburg, Florida 33716
• Phone Number: 727-722-9292

Galen College Of Nursing students, employees, and website visitors may notify us of a correction using our contact us page. When submitting corrections, please include a website URL where we can verify the nursing school information.

Last updated: May 25, 2020

Nursing Schools in Florida

References:

• Galen College Of Nursing .
• National Center for Education Statistics .
• Florida Board of Nursing .