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The Future of Nursing Is Leadership

A nurse leader in scrubs ties on a protective face mask.

Historically, nurses have played an essential role in improving clinical outcomes, patient satisfaction, and employee engagement and retention as informal leaders. Today, nurses can step into more formal leadership roles than ever before, and nurse leaders are gradually becoming full partners in health care practice, strategy, and policy. There may not yet be enough leaders to give nurses a seat at the decision-makers’ table, however. As the New England Journal of Medicine (NEJM) puts it in one report, there is “broad acceptance” of nurse leadership but plenty of “room to grow.”

All signs point to influential nurse leadership being the future of nursing — for reasons outlined in detail below — but giving nurses that seat at the table hinges on an influx of nurses willing to do what it takes to be recognized as leaders by the broader health care community. How to develop effective leadership skills in nursing is a question professional associations, organizations, and individuals have grappled with for decades. With the role of nurses in modern health care evolving rapidly as part of widespread value-based care implementation, training nurses to take on more authority and responsibility is crucial.

Advanced education is one answer. In the NEJM report, less than half of front-line nurses surveyed said they could see a path to leadership within their organizations. Ambitious nurses can expand their access to management and leadership opportunities in a leadership-focused Master of Science in Nursing program like the Online MSN in Leadership, Analytics, and Innovation from the University of Michigan. Unlike clinical MSN programs that lead to careers in advanced practice nursing, U-M’s master’s in nursing leadership, analytics, and innovation prepares clinical nurses to be part of a future in which nurses take charge.

Why Health Care Organizations are Looking to Nurses for Leadership

Patient-care facilities, health care networks, and hospitals are reevaluating the role nurses play in decision-making for several reasons. First, nurse leaders are particularly good at promoting efficiency, production, and cost-effectiveness in health care delivery and nursing administration. As managers, nurse leaders make work meaningful by giving staff nurses opportunities to challenge themselves and grow in their roles, preventing clinician burnout and leading to higher patient satisfaction rates. Most importantly, qualified nurse leaders tend to have a profound impact on quality improvement and patient care.

Their work correlates with improved staff retention, reduced medical errors, and facility efficiency — which can positively influence outcomes and reduce costs. A study examining the association between nursing leadership and patient outcomes found that nurse leaders can increase patient satisfaction and reduce medication errors, restraint use, hospital‐acquired infections, and even patient mortality.

How Nurse Leadership Has Evolved

People assume nurse leaders are primarily responsible for the limited oversight of nursing departments, but nurse leaders “do more than delegate, dictate, and direct,” writes Robin Schaeffer, MSN, RN, CAE, Executive Director of the American Nurses Association Idaho. The American Nurses Association describes a nurse leader as “a nurse who is interested in excelling in a career path, a leader within a health care organization who represents the interests of the nursing profession, a seasoned nurse or health care administrator interested in refining skills to differentiate them from the competition or to advance to the next level of leadership.”

Many nurses are true health care leaders who evaluate leading-edge treatments and new research, giving other practitioners tools to implement evidence-based practice. They make data-driven decisions about safety protocols, cost control, staffing, technology implementation, and care coordination to ensure practitioners meet departmental and patient goals. And they act as communication hubs of cross-discipline health care teams, engaging with support staff, doctors and specialists, nurses and trainees, patients and their families, and senior executives to ensure everyone is on the same page.

According to the World Nursing Congress, “21st Century nursing is the glue that holds a patient’s health care journey together.” There’s still room for growth in the scope of nursing leadership in both clinical nursing positions and non-clinical nursing roles, however. The National Academy of Medicine has advocated for a new level of nursing leadership and recommends that health care organizations “expand opportunities for nurses to lead and diffuse collaborative improvement efforts.” A Gallup poll of more than 1,500 national opinion leaders found that most think nurses should have more influence than they currently do in the critical areas of quality of patient care and safety. And The Future of Nursing, a report funded by the Robert Wood Johnson Foundation, found that allowing advanced practice registered nurses such as nurse practitioners to practice to the full extent of their education and training increases patient satisfaction and practitioner quality of life.

The Essential Characteristics of Effective Nurse Leaders

A systematic review of studies conducted by Nursing Management magazine found that effective leaders in nursing share certain leadership qualities and competencies. For example, they tend to be comfortable with evidence-based practice implementation, committed to patient safety, and fast-acting and adaptable. They’re also supportive, engaging, strong communicators, and able to motivate and empower others to do their best work. The results of the review aren’t particularly surprising. The essential characteristics of successful nurse leaders, as well as the skills they need, mirror the traits and skills of successful leaders in other fields.

Nurturing essential non-clinical skills in a program like U-M’s online master of science in nursing leadership lets nurses explore new professional pathways and empowers them to expand the scope of nurse leadership by helping new nurses grow into confident leaders. According to the National Academy of Medicine, “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.”

Nursing Leadership and Management Roles

Creating an exhaustive list of leadership and management roles in nursing is challenging because the expansion of leadership roles in nursing is a relatively recent phenomenon. Established roles for nurse leaders include clinical manager, director of nursing, and nurse manager. Newer leadership roles for experienced nurses include senior positions such as Chief Nursing Executive (CNE), Chief Nursing Officer (CNO), nurse executive, and executive nurse leader, as well as clinical oversight roles such as health care team leader, nurse educator, and patient care coordinator.

Fitting some emerging leadership titles into a traditional nursing hierarchy is difficult. CNO and CNE are the terminal leadership positions in nursing, but it’s up to individual health care organizations to determine whether, for instance, a clinical manager is higher on the org chart than a health care team leader. This is another reason the path to leadership in nursing can be vague. Established nursing career paths can vary significantly between health care organizations, and some still rely on informal nurse leaders to take charge instead of giving nurses titles like those above.

The Challenges Aspiring Nurse Leaders Face

Nurses who want to lead may encounter many roadblocks. For instance, evidence suggests there is overt and systemic resistance to nursing leadership in some organizations and that acceptance of nurse leadership is lagging behind acceptance of physician leadership. One NEJM study found that while 51% of non-nurse health care workers surveyed felt that nursing leadership skills were “widely recognized” by their organizations, only 24% of nurse respondents agreed. One of the most significant barriers to nursing leadership, according to the survey, was tradition. Many organizations only open leadership positions to physicians and non-clinical administrators and don’t offer similar professional development opportunities to nurses.

Overt exclusion may stem from physician resistance fueled by antiquated ideas about what nurses can and can’t handle in clinical and non-clinical roles. The American Society of Anesthesiologists and the American Association of Family Physicians went so far as to create a nurse practitioner information kit that included five papers outlining why NPs cannot substitute for physicians in primary care. However, as the Future of Nursing report points out, the “contention that APRNs are less able than physicians to deliver care that is safe, effective, and efficient is not supported by research.” Similarly, there’s no research to suggest that doctors or health care administrators make better managers than nurses, assuming they’ve spent equal time studying the tenets of strong leadership.

Systemic exclusion, whether overt or otherwise, may have roots in gender discrimination. Close to 90% of RNs are women, but women remain underrepresented in health care leadership positions at all levels.

Lack of opportunity is another barrier ambitious nurses face. The study above found that clinicians are less likely to say they see a clear career path of advancement in their organizations than administrators. A quarter of respondents worked in health care environments with no clear leadership pathways, learning opportunities, or leadership development opportunities for staff nurses. Others cited the perception of nurses as doers rather than strategists in their work environments as yet another barrier to advancement. According to one executive interviewed, the lack of leadership opportunities for nurses is no accident and comes down to issues of respect. They stated on the record that “There is a limit to the impact any non-MD can have in reaching the MD audience.”

Finally, nurses who want to step into leadership roles may discover that having a BSN and copious clinical experience is no substitute for leadership-focused education at the master’s degree level. Many nurse leaders assume their positions based on expertise in clinical roles but have very little to no experience related to leadership. Others want to advance into leadership but don’t have the necessary skills. There may be a hidden leadership education and experience gap in nursing. “Nurses will need to augment their education and experience significantly to appreciate population care delivery and the science defining it,” asserted one survey respondent. The question nurses run up against is how to develop leadership skills in nursing — especially while working. In Initiating and Sustaining the Clinical Nurse Leader Role, Dr. Linda Roussel, RN, and Dr. James Harris, APRN, write, “There is a need for a more programmatic, strategic approach to clinical leadership.” The University of Michigan’s online master of science in nursing leadership, analytics, and innovation provides precisely that for RNs who need flexibility.

Where Nursing Leadership Is Headed

Many nurses launch clinical careers with no intentions of joining the ranks of leadership — not because they don’t aspire to lead but rather because they’re unaware of leadership roles for nurses beyond charge nurse, head nurse, nurse manager, or nurse administrator. Now that employers are creating new leadership opportunities for nurses, there’s every reason to believe more nurses will, as the Future of Nursing report puts it, become leaders “who can serve as full partners with other health professionals and be accountable for their own contributions to delivering high-quality care while working collaboratively with leaders from other health professions.”

The future of nursing is now, and if you want to be a part of it, this is the time to enroll in an accredited master’s degree program such as U-M School of Nursing’s 34-credit hour Online MSN in Leadership, Analytics, and Innovation. Many organizations have a lot of catching up to do when it comes to offering advancement opportunities to nurses, making it unlikely you will ever receive leadership training on the job. Enrolling in a flexible graduate-level leadership program is the most straightforward way to develop the skills and knowledge you’ll need to take your place among nursing leaders while still meeting your current professional and personal commitments. After graduation, you’ll be able to lead cross-functional care teams, improve nursing processes in diverse health care systems, educate and empower nurses, and influence health policy. More importantly, you’ll have the knowledge, tools, and advanced credentials necessary to help shape the future of both nursing practice and nurse leadership so you can empower the next generation of nurses to grow in their roles.

To learn more about what it takes to get into U-M’s master’s in nursing leadership program, the financial aid options available to MSN candidates, or how a master’s in nursing will benefit your career, register for an upcoming online event. To take the next step on your journey into nursing leadership, apply online.