Nurses have traditionally been underrepresented in leadership roles because the doctors, specialists, and even administrators responsible for making decisions about patient care viewed them not as partners, but as “functional doers.” That’s changing, however, as a growing body of evidence demonstrates that applying the principles of nursing leadership in clinical settings has a direct impact on patient safety, quality of care delivery, and patient outcomes. Effective leadership in nursing correlates with reduced length of stay and lower rates of medication errors, patient falls, urinary tract infections, and pneumonia. Studies linked below even suggest that nurse leaders can have a positive impact on patient mortality.
We know more about the impact of positive nurse leadership in part because the widespread implementation of collaborative care, patient-centered care, and value-based care models designed to deliver more value for less money is prompting organizations to place nurses in new leadership roles. That said, leadership in nursing is nothing new. The American Association of Colleges of Nursing (AACN) points out that, “Nursing’s professional lens has always encompassed a cost-effective approach to health care without sacrificing quality,” and a Gallup poll of more than 1,500 national opinion leaders found that most think nurses should have greater influence than they currently do.
The National Academy of Medicine has advocated for a new level of nursing leadership and recommends that health care systems “expand opportunities for nurses to lead and diffuse collaborative improvement efforts.” Today, the scope of nursing leadership is expanding rapidly and it’s easy to find concrete nursing leadership examples. There are numerous formal leadership opportunities for nurses beyond shift manager, such as clinical leader, director of nursing, and health care team leader. Chief Nursing Executives (CNEs) and Chief Nursing Officers (CNOs) represent the profession in the c-suite.
Nurses in these and other leadership roles have the power to influence the direction patient care takes as well as outcomes. They’re also more likely to have advanced education. The University of Michigan School of Nursing’s Online MSN in Leadership, Analytics, and Innovation program will give you the skills, knowledge, and tools you need to develop processes and enact policies that make health care better.
Why Nurses in Leadership Positions Have an Outsized Impact
Nurses have been in the top spot on Gallup’s Most Trusted Professionals poll for 19 consecutive years, and it’s not hard to see why. Nurses make up the largest segment of the U.S. health care workforce, representing 30% of hospital employees and a sizable segment of the workforce in other areas of health care. More importantly, they spend significantly more time with patients than other providers and have a deep understanding of the resources necessary to care for them effectively and efficiently. Nurse leaders’ frontline patient care experience also gives them a perspective that makes them uniquely suited to lead initiatives focused on clinical transformation and quality improvement.
A Press Ganey Nursing Special Report found that nurse leaders have a substantial effect on the overall quality of health care environments, as well as on safety, staff engagement, and patient satisfaction. According to numerous studies, the work of nurses in leadership positions correlates with improved staff retention, reduced medical errors, facility efficiency, and even patient outcomes.
6 Ways Nursing Leadership Positively Influences Patient Outcomes
Nurse Leaders Advocate for Appropriate Staffing Levels
A substantial body of evidence shows that short staffing in hospitals and medical facilities can be dangerous for patients. Studies find that increasing hospital nurse workloads by just one patient correlated with significant increases in post-surgical infections. Additionally, surgical patients experience increased “risk-adjusted 30-day mortality and failure-to-rescue rates” in hospitals with higher nurse-to-patient ratios. Unfortunately, short staffing is as common as it is dangerous.
Nurse executives may have the power to hire more nurses to reduce shift length and nurse-patient ratios. When they don’t, they may still be in a position to advocate for change in a compelling data-driven way. Nurses who take on this ongoing challenge get results. One study of more than 500,000 patients conducted in Queensland, Australia found that those treated at well-staffed facilities had lower mortality rates, lower readmission rates, and shorter lengths of stay. Additionally, the cost of maintaining appropriate staff was far lower than the average cost of readmissions and longer stays.
Nurse Leaders Create a Culture of Safety
According to the World Health Organization, unsafe care is one of the leading causes of death and disability around the globe. Nurse leaders acknowledge that improving safety culture may correlate with improved outcomes, which is why safety is one of the guiding principles of nursing leadership. RNs in leadership positions prioritize nursing practice safety and look for ways to drive cultural change related to patient and provider welfare.
Effective nurse leaders use “tactics such as board engagement, leadership education, goal setting, staff support, and dashboards and reports that routinely review safety data” to promote safety, according to The Joint Commission. Some design assessment systems that treat mistakes and near misses as opportunities for growth. Other nursing leaders empower nurses to identify and resolve potentially adverse events and reward them when they report and take responsibility for errors.
Nurse Leaders Support Collaboration
According to the Mayo Clinic, collaborative care “significantly improves patient outcomes,” and researchers have found that when health care professionals work together, practitioners make fewer mistakes and patient safety improves.
While collaborative care management is just catching on in some settings, nursing has long acknowledged its benefits. According to the American Nurses Association, “Registered nurses’ contributions to care coordination have been a core professional standard and competency for RNs. It is what nurses do. It is what we have always done. Whether developing care plans guided by patients’ needs and preferences, educating patients and their families at discharge, doing their best to facilitate continuity of care for patients across settings and among providers, RNs make coordinated care possible.”
Nursing leadership related to collaborative care often involves bridging gaps between staff nurses and doctors, between departments, between provider types, and between policy and practice. Sometimes RNs take on collaborative care management informally, coordinating primary and specialist care because they have a finely tuned sense of what their patients need. Other nurses head up cross-functional patient care teams in an official capacity, coordinating treatment and transition management to maintain the continuum of care.
Nurse Leaders Promote Nurse Engagement
A growing number of studies link nurse engagement with patient outcomes. Research even suggests that nurse engagement is sometimes the key to achieving desired patient outcomes. A nurse manager quoted in one study that looked at the impact of nurse engagement on quality, safety, and the patient experience said, “Staff who feel supported and who are engaged will give you the outcomes that you want. Those who feel unsupported, not valued, and not respected, will not.” The study found a clear connection between nurse engagement and patient outcomes.
It’s not surprising that nurses in leadership positions can positively influence clinical care quality by addressing administrative procedure and policy issues. Nursing leaders have a considerable effect on the quality of health care work environments and can create a positive organizational culture in which staff members can do meaningful work and grow — which correlates with elevated engagement. Increased staff engagement, meanwhile, leads to increased patient satisfaction and facility performance — both of which correlate with better patient outcomes.
Nurse Leaders Mitigate Issues that Lead to Burnout
Burnout in nursing is about more than physical exhaustion. Symptoms of burnout include emotional exhaustion, depersonalization, reduced personal accomplishment, lack of motivation, and feelings of frustration — all of which can be dangerous in health care settings. In the nursing workforce, burnout correlates with poorer-quality care and reduced patient safety. Higher levels of burnout among nurses, in particular, correlate with higher rates of patient mortality and hospital-transmitted infections. That doesn’t mean nurses suffering from burnout are endangering their patients. Nurse burnout is just another symptom of the hard-to-remedy systemic issues affecting health care.
Applying the principles of nursing leadership in clinical settings can prevent nurse burnout in several ways. Nurse leaders empower confident decision-making in their RNs by sharing their knowledge and helping novice nurses make thoughtful decisions about care. They encourage autonomy in the nursing profession because they know nurses who feel other clinicians respect their decisions are less likely to suffer from burnout. Nurse leaders also facilitate cross-departmental communication and encourage collaboration among team members to ensure no one feels constantly overwhelmed. And finally, they make work meaningful and boost job satisfaction in their units by giving staff opportunities to challenge themselves and grow in clinical nursing roles or other roles such as nurse educator or care coordinator.
Nurse Leaders Implement Value-Based Care Strategies
Value-based care (VBC) emerged as a payment model for Medicare and Medicaid reimbursement designed to replace fee-for-service (FFS). It has since grown into a care framework that incentivizes keeping patients healthy instead of rewarding practitioners for seeing as many patients as possible. The effects of VBC are multidimensional. A national study commissioned by Change Healthcare and conducted by ORC International found that value-based care not only reduces costs by up to 7.5% but also improves care quality.
Nurse leaders who implement value-based nursing care strategies create positive organizational cultures in which clinical nurses can spend more time with their patients, collaborate with other providers, and grow in their roles. Positive culture in health care organizations also correlates with reduced mortality rates, falls, length of stay and hospital-acquired infections, as well as better adherence to infection-control practices, better quality of care, and fewer treatment interruptions.
How University of Michigan’s Online MSN Teaches Effective Nursing Leadership
The National Academy of Medicine asserts that “Nurses with graduate degrees will be able to replenish the nurse faculty pool; advance nursing science and contribute to the knowledge base on how nurses can provide up-to-date, safe patient care; participate in health care decisions; and provide the leadership needed to establish nurses as full partners in health care redesign.” That’s because as effective as nurse leadership is at improving patient outcomes, it is also complex. Leadership in nursing involves not only people management but also problem-solving, critical thinking, decision-making, data analysis, and self-awareness.
Aspiring nurse leaders must learn not only the principles of nursing management but also how to thoughtfully establish workplace policies that lower rates of burnout, promote collaboration, increase patient safety, and foster positive organizational culture. Pursuing advanced education in the form of a graduate nursing degree is one way to gain the leadership skills, knowledge, and confidence necessary to lead in a way that puts patient needs first.
The Online MSN in Leadership, Analytics, and Innovation from the University of Michigan teaches nurses how to lead effectively and empathetically in a program format that lets them learn while still meeting professional and personal commitments. U-M delivers the majority of coursework in the flexible 34-credit program online and much of it is asynchronous. Two four-day on-campus immersions let students explore different roles in nurse leadership, take part in simulations and consultative experiences, and form relationships with peers in the program.
Students exit the program after two or three years with a deep understanding of how powerful nursing leadership can be, as well as the tools to identify opportunities to enhance quality of care, provider efficacy, and population health. In addition to skills related to management, informatics, and entrepreneurship, graduates have what it takes to enact the kinds of organization-wide changes that make medicine better for patients.
You can learn more about the Master of Science in Nursing in Leadership, Analytics, and Innovation program admissions criteria, graduate financial aid, or the remote student experience by registering for an upcoming online event on the School of Nursing website. When you’re ready, it’s easy to apply online.