critical thinking leadership nursing

The Value of Critical Thinking in Nursing

• How Nurses Use Critical Thinking
• How to Improve Critical Thinking
• Common Mistakes

Some experts describe a person’s ability to question belief systems, test previously held assumptions, and recognize ambiguity as evidence of critical thinking. Others identify specific skills that demonstrate critical thinking, such as the ability to identify problems and biases, infer and draw conclusions, and determine the relevance of information to a situation.

Nicholas McGowan, BSN, RN, CCRN, has been a critical care nurse for 10 years in neurological trauma nursing and cardiovascular and surgical intensive care. He defines critical thinking as “necessary for problem-solving and decision-making by healthcare providers. It is a process where people use a logical process to gather information and take purposeful action based on their evaluation.”

“This cognitive process is vital for excellent patient outcomes because it requires that nurses make clinical decisions utilizing a variety of different lenses, such as fairness, ethics, and evidence-based practice,” he says.

How Do Nurses Use Critical Thinking?

Successful nurses think beyond their assigned tasks to deliver excellent care for their patients. For example, a nurse might be tasked with changing a wound dressing, delivering medications, and monitoring vital signs during a shift. However, it requires critical thinking skills to understand how a difference in the wound may affect blood pressure and temperature and when those changes may require immediate medical intervention.

Nurses care for many patients during their shifts. Strong critical thinking skills are crucial when juggling various tasks so patient safety and care are not compromised.

Jenna Liphart Rhoads, Ph.D., RN, is a nurse educator with a clinical background in surgical-trauma adult critical care, where critical thinking and action were essential to the safety of her patients. She talks about examples of critical thinking in a healthcare environment, saying:

“Nurses must also critically think to determine which patient to see first, which medications to pass first, and the order in which to organize their day caring for patients. Patient conditions and environments are continually in flux, therefore nurses must constantly be evaluating and re-evaluating information they gather (assess) to keep their patients safe.”

The COVID-19 pandemic created hospital care situations where critical thinking was essential. It was expected of the nurses on the general floor and in intensive care units. Crystal Slaughter is an advanced practice nurse in the intensive care unit (ICU) and a nurse educator. She observed critical thinking throughout the pandemic as she watched intensive care nurses test the boundaries of previously held beliefs and master providing excellent care while preserving resources.

“Nurses are at the patient’s bedside and are often the first ones to detect issues. Then, the nurse needs to gather the appropriate subjective and objective data from the patient in order to frame a concise problem statement or question for the physician or advanced practice provider,” she explains.

Top 5 Ways Nurses Can Improve Critical Thinking Skills

We asked our experts for the top five strategies nurses can use to purposefully improve their critical thinking skills.

Case-Based Approach

Slaughter is a fan of the case-based approach to learning critical thinking skills.

In much the same way a detective would approach a mystery, she mentors her students to ask questions about the situation that help determine the information they have and the information they need. “What is going on? What information am I missing? Can I get that information? What does that information mean for the patient? How quickly do I need to act?”

Consider forming a group and working with a mentor who can guide you through case studies. This provides you with a learner-centered environment in which you can analyze data to reach conclusions and develop communication, analytical, and collaborative skills with your colleagues.

Practice Self-Reflection

Rhoads is an advocate for self-reflection. “Nurses should reflect upon what went well or did not go well in their workday and identify areas of improvement or situations in which they should have reached out for help.” Self-reflection is a form of personal analysis to observe and evaluate situations and how you responded.

This gives you the opportunity to discover mistakes you may have made and to establish new behavior patterns that may help you make better decisions. You likely already do this. For example, after a disagreement or contentious meeting, you may go over the conversation in your head and think about ways you could have responded.

It’s important to go through the decisions you made during your day and determine if you should have gotten more information before acting or if you could have asked better questions.

During self-reflection, you may try thinking about the problem in reverse. This may not give you an immediate answer, but can help you see the situation with fresh eyes and a new perspective. How would the outcome of the day be different if you planned the dressing change in reverse with the assumption you would find a wound infection? How does this information change your plan for the next dressing change?

Develop a Questioning Mind

McGowan has learned that “critical thinking is a self-driven process. It isn’t something that can simply be taught. Rather, it is something that you practice and cultivate with experience. To develop critical thinking skills, you have to be curious and inquisitive.”

To gain critical thinking skills, you must undergo a purposeful process of learning strategies and using them consistently so they become a habit. One of those strategies is developing a questioning mind. Meaningful questions lead to useful answers and are at the core of critical thinking .

However, learning to ask insightful questions is a skill you must develop. Faced with staff and nursing shortages , declining patient conditions, and a rising number of tasks to be completed, it may be difficult to do more than finish the task in front of you. Yet, questions drive active learning and train your brain to see the world differently and take nothing for granted.

It is easier to practice questioning in a non-stressful, quiet environment until it becomes a habit. Then, in the moment when your patient’s care depends on your ability to ask the right questions, you can be ready to rise to the occasion.

Practice Self-Awareness in the Moment

Critical thinking in nursing requires self-awareness and being present in the moment. During a hectic shift, it is easy to lose focus as you struggle to finish every task needed for your patients. Passing medication, changing dressings, and hanging intravenous lines all while trying to assess your patient’s mental and emotional status can affect your focus and how you manage stress as a nurse .

Staying present helps you to be proactive in your thinking and anticipate what might happen, such as bringing extra lubricant for a catheterization or extra gloves for a dressing change.

By staying present, you are also better able to practice active listening. This raises your assessment skills and gives you more information as a basis for your interventions and decisions.

Use a Process

As you are developing critical thinking skills, it can be helpful to use a process. For example:

• Ask questions.
• Gather information.
• Implement a strategy.
• Evaluate the results.
• Consider another point of view.

These are the fundamental steps of the nursing process (assess, diagnose, plan, implement, evaluate). The last step will help you overcome one of the common problems of critical thinking in nursing — personal bias.

Common Critical Thinking Pitfalls in Nursing

Your brain uses a set of processes to make inferences about what’s happening around you. In some cases, your unreliable biases can lead you down the wrong path. McGowan places personal biases at the top of his list of common pitfalls to critical thinking in nursing.

“We all form biases based on our own experiences. However, nurses have to learn to separate their own biases from each patient encounter to avoid making false assumptions that may interfere with their care,” he says. Successful critical thinkers accept they have personal biases and learn to look out for them. Awareness of your biases is the first step to understanding if your personal bias is contributing to the wrong decision.

New nurses may be overwhelmed by the transition from academics to clinical practice, leading to a task-oriented mindset and a common new nurse mistake ; this conflicts with critical thinking skills.

“Consider a patient whose blood pressure is low but who also needs to take a blood pressure medication at a scheduled time. A task-oriented nurse may provide the medication without regard for the patient’s blood pressure because medication administration is a task that must be completed,” Slaughter says. “A nurse employing critical thinking skills would address the low blood pressure, review the patient’s blood pressure history and trends, and potentially call the physician to discuss whether medication should be withheld.”

Fear and pride may also stand in the way of developing critical thinking skills. Your belief system and worldview provide comfort and guidance, but this can impede your judgment when you are faced with an individual whose belief system or cultural practices are not the same as yours. Fear or pride may prevent you from pursuing a line of questioning that would benefit the patient. Nurses with strong critical thinking skills exhibit:

• Learn from their mistakes and the mistakes of other nurses
• Look forward to integrating changes that improve patient care
• Treat each patient interaction as a part of a whole
• Evaluate new events based on past knowledge and adjust decision-making as needed
• Solve problems with their colleagues
• Are self-confident
• Acknowledge biases and seek to ensure these do not impact patient care

An Essential Skill for All Nurses

Critical thinking in nursing protects patient health and contributes to professional development and career advancement. Administrative and clinical nursing leaders are required to have strong critical thinking skills to be successful in their positions.

By using the strategies in this guide during your daily life and in your nursing role, you can intentionally improve your critical thinking abilities and be rewarded with better patient outcomes and potential career advancement.

Frequently Asked Questions About Critical Thinking in Nursing

How are critical thinking skills utilized in nursing practice.

Nursing practice utilizes critical thinking skills to provide the best care for patients. Often, the patient’s cause of pain or health issue is not immediately clear. Nursing professionals need to use their knowledge to determine what might be causing distress, collect vital information, and make quick decisions on how best to handle the situation.

How does nursing school develop critical thinking skills?

Nursing school gives students the knowledge professional nurses use to make important healthcare decisions for their patients. Students learn about diseases, anatomy, and physiology, and how to improve the patient’s overall well-being. Learners also participate in supervised clinical experiences, where they practice using their critical thinking skills to make decisions in professional settings.

Do only nurse managers use critical thinking?

Nurse managers certainly use critical thinking skills in their daily duties. But when working in a health setting, anyone giving care to patients uses their critical thinking skills. Everyone — including licensed practical nurses, registered nurses, and advanced nurse practitioners —needs to flex their critical thinking skills to make potentially life-saving decisions.

Meet Our Contributors

Crystal Slaughter, DNP, APRN, ACNS-BC, CNE

Crystal Slaughter is a core faculty member in Walden University’s RN-to-BSN program. She has worked as an advanced practice registered nurse with an intensivist/pulmonary service to provide care to hospitalized ICU patients and in inpatient palliative care. Slaughter’s clinical interests lie in nursing education and evidence-based practice initiatives to promote improving patient care.

Jenna Liphart Rhoads, Ph.D., RN

Jenna Liphart Rhoads is a nurse educator and freelance author and editor. She earned a BSN from Saint Francis Medical Center College of Nursing and an MS in nursing education from Northern Illinois University. Rhoads earned a Ph.D. in education with a concentration in nursing education from Capella University where she researched the moderation effects of emotional intelligence on the relationship of stress and GPA in military veteran nursing students. Her clinical background includes surgical-trauma adult critical care, interventional radiology procedures, and conscious sedation in adult and pediatric populations.

Nicholas McGowan, BSN, RN, CCRN

Nicholas McGowan is a critical care nurse with 10 years of experience in cardiovascular, surgical intensive care, and neurological trauma nursing. McGowan also has a background in education, leadership, and public speaking. He is an online learner who builds on his foundation of critical care nursing, which he uses directly at the bedside where he still practices. In addition, McGowan hosts an online course at Critical Care Academy where he helps nurses achieve critical care (CCRN) certification.

• 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

Nurse leaders thriving

A conceptual model and strategies for application.

Frangieh, Jihane PhD, MSN, RN; Hughes, Victoria DSN, MA, RN, CENP, FAAN; Mewborn, Emily DNP, FNP-BC

At Johns Hopkins University School of Nursing in Baltimore, Md., Jihane Frangieh is associate faculty and the track coordinator of the MSN Healthcare Leadership Programs, and Victoria Hughes is an assistant professor. Emily Mewborn is an Internal Medicine NP at the University of Tennessee Health Science Center, College of Nursing in Memphis, Tenn.

The authors and planners have disclosed no financial relationships related to this article.

For more than 130 additional nursing continuing professional development articles related to management topics, go to NursingCenter.com/CE .

Copyright © 2023 The Authors. Published by Wolters Kluwer Health, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY-NC-ND), where it is permissible to download and share the work provided it is properly cited. The work cannot be changed in any way or used commercially without permission from the journal.

It's crucial for nurse leaders to thrive at work so they can positively impact staff, patient care, and organizations. This article defines thriving, discusses its antecedents and outcomes, and proposes practical solutions nurse leaders can use to create a thriving environment.

Now more than ever, nurse leaders are facing complex challenges in healthcare systems that demand highly developed skills to adapt to physical, psychological, or social adversity and to influence change at the macro- and microlevels of an organization. Nurse leaders are expected to positively influence the workplace environment and to build thriving teams. 1 Evidence focuses on the leader's role in creating experiences in which employees feel motivated and supported. For example, Mortier and colleagues found nurse managers' authentic leadership enhances nurses' thriving at work. 2

However, nurse leaders aren't really thriving at work, and they're struggling to enhance their functioning and effectively perform their job. 3 The American Organization for Nursing Leadership reported in their longitudinal study that 45% of nurse leaders who left their positions in the past 6 months did so because of challenges they faced with their leaders, colleagues, or organization. 4 Thriving at work is essential for nurse leaders to positively impact their staff members, the quality of patient care, and the organization. In nursing, the concept of thriving at work is mainly borrowed from psychological and organizational research. The purpose of this article is to define thriving, discuss the antecedents and outcomes of thriving, and propose practical solutions nurse leaders can use to create a thriving environment.

Definition of thriving at work

Thriving can be defined as a positive psychological state characterized by two essential dimensions: a sense of vitality and a sense of learning. 5 Vitality is a positive feeling of being alive and energetic, and learning is acquiring and applying knowledge and skills. 5 The experience of these two dimensions should be joint and simultaneous because an employee can't thrive if they experience burnout or have no energy. Vitality without opportunity for learning stunts the growth innate in thriving. Likewise, learning without vitality impairs the desire to apply new knowledge and skills.

According to Paterson and colleagues, “the two components of thriving interact to create an overall sense of forward momentum and progress at work that isn't captured by either vitality or learning alone.” 6 When nurse leaders acquire new skills (learning) without the desire and energy (vitality) to apply them, they're not thriving. Likewise, when leaders feel alive in their work with no growth or potential, they can't thrive.

Conceptual model of thriving in nursing

Su and colleagues describe thriving as the fullest range of mental, physical, and social positive functioning and well-being. 7 Both Spreitzer's and Su's definitions emphasize that the outcomes of thriving often relate to personal psychological well-being. 5,7 We expand the definition of thriving and propose that thriving in the workplace exists on a growing continuum and includes social, psychological, emotional, and cognitive well-being. Figure 1 depicts a conceptual model of personal and organizational antecedents of thriving (see Figure 1A ). These antecedents develop the continuum of thriving (see Figure 1B ). Only when an individual is thriving in the workplace can positive personal and organizational outcomes occur (see Figure 1C ).

However, reciprocal relationships exist among the antecedents, thriving, and outcomes. For example, when nurses have meaningful work and a supportive organizational work culture (antecedents), they can thrive, leading to improved job satisfaction, reduced staff turnover, and cohesion. Consequently, these outcomes can improve work engagement, trust, and personal characteristics (such as positivity), feeding back into the thriving continuum.

Domains and concepts of thriving

The concepts of vitality, learning, autonomy, purpose, and growth directly influence the psychological, cognitive, emotional, and social well-being domains of an individual. The antecedents previously described filter into the concepts of thriving, which feed the individual well-being domains. These four well-being domains are essential for thriving (see Figure 1 ).

Psychological well-being broadly includes a positive outlook and satisfaction with one's life and mental health. Related, yet distinct, emotional well-being constitutes healthy regulation of emotions and attitudes. For example, a person's mental health may affect the emotions they experience, but mental health doesn't dictate emotions. Likewise, emotional distress doesn't dictate mental health. Many individuals experience painful emotions without developing a mental health condition.

An individual's attitude and cognitive perception of the distressing situation can lead to the development of resilience. Gratitude practices and emotional regulation can improve cognitive and emotional well-being and promote better communication. Cognitive well-being includes aspects of learning, growing, and challenging yourself. A positive mindset sets the tone for solution-focused cognitive processes and may lead to an optimistic attitude. Healthy relationships and conflict resolution demonstrate social well-being. Separating the well-being domains into distinct, interrelated categories appreciates and aligns with nursing's holistic lens of health.

Antecedents of thriving at work

Liu and colleagues' meta-analysis revealed four themes of antecedents of thriving: 1) unit contextual features, 2) resources produced at work, 3) individual agentic work behaviors, and 4) personality traits. 8

Some of the unit contextual antecedents identified for thriving include stress, autonomy, work control, trust, supportive climate, organizational justice, and useful feedback. 8 Moderate stress levels can positively induce personal learning, growth, and accomplishment, supporting the notion that adversity spurs thriving. 8,9 Autonomy leads to employees being more invested, feeling necessary, and having positive work experiences. 10

Under resources produced at work are the categories of leadership style, purposeful and meaningful work, and work experience. 8 Transformational, authentic, empowering, and servant organizational leadership promote thriving. 8,10 Work climates in which leadership values employee well-being, promotes learning, and provides support during adversity foster individual thriving. 6 In line with learning, workplaces that offer training and advancement also facilitate thriving. 11 There's no doubt that the foundation of nursing is purposeful, meaningful work; however, leadership style and workplace culture can create obstacles and often thwart thriving.

Individual agentic work behaviors include exploration, task focus, and heedful relating. 8 Exploration demonstrates discovery, innovation, and risk-taking, which increases self-directed, creative problem-solving. 6,8 Although process and protocols are important to patient safety and care, nurses' critical thinking and creativity to practice the nursing model can be stifled. This leads to task-oriented rather than patient-oriented care, which diminishes thriving. Heedful relating involves cooperative and mutually supportive interactions among workers, which increase vitality, learning, and cohesion. 8 In line with this theme, Kleine and colleagues suggest individual work engagement fosters thriving. Engagement increases connections with coworkers and their work, vitality, and the desire to learn new skills. 10

The final category of antecedents to thriving is employee personality traits , such as self-efficacy, optimism, openness, proactiveness, and conscientiousness. 8,10 Kleine and colleagues describe these terms as psychological capital. 10 Self-efficacy occurs when individuals have the confidence to master tasks. 10 Optimism exists when individuals feel they can succeed. 10 Conscientiousness involves self-discipline, a sense of responsibility, and continued motivation to achieve goals. 8

In nursing literature, few studies have highlighted the personal and organizational antecedents of thriving at work. Some personal factors such as being open, present, and nonjudgmental were identified as essential to thriving. For example, Sahin and colleagues found that nurses who practice mindfulness by focusing their attention on the present moment without judgment and fully accepting the experience have reported higher levels of thriving. 12 Some organizational factors contributing to nurse thriving are empowerment, the mood of the organization, an enabling environment, organizational justice (perception of fairness and equality), togetherness with colleagues, and leaders' connectivity. 13 Congruent to the psychology-derived literature, supportive work environments that provide training, recognition, guidance, and mentoring promote thriving in nursing. 14

In addition, some workplace constraints can inhibit nurses' ability to thrive. For example, Zhao and colleagues found that workplace violence had a significant negative impact on nurses' thriving. 15 Additionally, healthcare systems with excessive administrative burden, a lack of autonomy, inadequate support and resources, and poor communication promote moral distress and moral injury in nurses, the antithesis of thriving. 16

Outcomes of thriving

Spreitzer and Sutcliffe proposed thriving as an essential foundation to the health and well-being of employees that can positively affect organizational outcomes. 17 Positive personal outcomes include increased job satisfaction, fulfillment, and social engagement. Reducing employee moral distress, moral injury, and the resulting burnout are also outcomes of thriving. Adversity and stress loom throughout the nursing profession, but employee thriving improves skills for coping with adversity, which leads to personal and professional growth. Additionally, Kleine and colleagues found a positive correlation between thriving at work and individual subjective health. 10

Mutually beneficial outcomes of thriving exist for the employee and organization. These benefits include cohesion, which means the organization and the employee work synchronously and even synergistically. Other benefits are increased productivity and better job performance.

Organizational outcomes of employee thriving include lower staff turnover, better organizational citizenship, and increased financial savings. 10 Organizational citizenship occurs when employees take ownership in the organization; demonstrate commitment, knowledge, and skills; and proactively help others within the organization. 10 These benefits ultimately save the organization money with decreased turnover and onboarding, and fewer temporary or agency nurses. Therefore, it's incumbent on organizations and leadership to provide cultures and resources with a focus on promoting employee thriving.

Much of the literature on thriving derives from psychology; however, thriving's relevance to nursing is clear and paramount for the future and health of the profession. Zhao and colleagues found job satisfaction to be an important predictor for thriving and nurse turnover. 18 Additionally, work engagement affects thriving and ultimately nurses' affective commitment. 15 These findings highlight the relationship among the antecedents, thriving, and outcomes.

Practical suggestions and actions

Personal strategies.

Thriving at work is an opportunity for nurse leaders to be involved in making choices that create a positive work environment and influence how individuals respond to adversity. To achieve optimal psychological, emotional, cognitive, and social well-being, nurse leaders must embrace and enhance their personal characteristics while operating within an environment that fosters thriving. By cultivating their own traits and skills and creating a conducive workplace, nurse leaders can contribute to a state of thriving for themselves and their team members, ultimately improving overall outcomes and well-being in the healthcare setting. Table 1 describes actionable personal strategies that nurse leaders can adopt and implement to help them thrive at work.

Organizational strategies

Nurse leaders can't thrive in isolation, and their personal characteristics and vitality alone aren't enough. Creating an environment that supports and nurtures thriving is equally essential. Nurse leaders require a workplace culture that values well-being, growth, and innovation. When organizations prioritize the cultivation of a thriving culture, nurse leaders are empowered to reach their full potential and positively impact their teams. Table 2 highlights key strategies and initiatives organizations can adopt and implement to support nurse leaders in their pursuit of excellence and well-being.

A synergistic relationship

The best practice for nurse leader thriving includes combining personal strategies with organizational strategies. Nurse leaders can influence the organizational environment by sharing information and knowledge that promotes learning and by maintaining their own energy, vitality, and passion for the contributions that nurses can make to meaningful healthcare delivery. Positivity and solution-focused thinking can be infectious when modeled by a nurse leader who lives according to their values. Similar to the conceptual model in which reciprocal relationships exist between thriving, antecedents, and outcomes, nurse leaders and organizations can influence each other in a way that produces synergy.

Thriving senior leaders serve as role models and a source of inspiration for their teams. When leaders demonstrate vitality, enthusiasm, and a passion for learning, it can inspire team members to adopt a similar adaptive and positive mindset. Nurse leaders are often positioned between upper management and staff, putting them in a pivotal place to positively influence the organization at multiple layers.

Senior nurse leaders can meet regularly with the nurse leaders who report to them to individualize the strategies proposed in Table 1 and to create an action plan to fit their needs, preferences, passions, and aspirations. By enabling them to choose learning opportunities and pursue their areas of passion, senior nurse leaders can identify knowledge gaps within the leadership team and address those gaps through targeted training programs, workshops, and seminars. Senior nurse leaders should create opportunities for nurse leaders to develop new skills and encourage them to take on new challenges and expand their knowledge, which benefits the individual's growth and the team's collective capabilities.

The mark of truly successful nursing leadership is fostering the success of staff, patients, and the organization. How nurse leaders deal with failure, disappointment, and adversity influences the work climate for others. A nurse leader can choose to create the context for thriving environments or contribute to a culture of blame and shame. Many of the antecedents or contributing factors for thriving stem from organization- or system-level processes.

A two-dimensional approach

This narrative review defined thriving at work, focusing on the two vital dimensions: vitality and a sense of learning. Without vitality, the desire to learn and grow diminishes, and without opportunities for learning, vitality alone can't sustain thriving. However, the interaction between vitality and learning creates a sense of forward momentum and progress that goes beyond either dimension alone. Nurse leaders who acquire new skills without the energy and motivation to apply them hinder their ability to thrive. Likewise, feeling alive and engaged in their work without opportunities for growth and development limits their potential for thriving.

The expanded definition of workplace thriving presented here includes social, psychological, emotional, and cognitive well-being. Vitality, learning, autonomy, purpose, and growth directly impact an individual's well-being in these domains. Recognizing and fostering these distinct yet interconnected dimensions of well-being aligns with nursing's holistic perspective on health and acknowledges the multifaceted nature of thriving in the workplace.

Nurse leaders can advance their own capacity to thrive by engaging in mentorship, pursuing leadership opportunities, and embodying a positive mindset. At the system level, healthcare organizations should tangibly value nurses by recognizing achievements, assisting work-life balance, and promoting autonomy and clear communication to contribute to the overall prosperity of nurse leaders. By creating the right environment to promote both vitality and learning, and nurturing the broader well-being domains, nurse leaders can establish a solid foundation for thriving, ultimately enhancing their effectiveness and the overall well-being of their teams.

INSTRUCTIONS Nurse leaders thriving: A conceptual model and strategies for application

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 5, 2025 .

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, Florida, New Mexico, South Carolina, and West Virginia, CE Broker #50-1223. Your certificate is valid in all states.

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

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

Readers Of this Article Also Read

Developing emerging nurse leaders, transforming cultures from incivility and bullying to a positive practice..., the authentic leadership checklist: positive leadership in action, high-impact communication in nursing leadership: an exploratory study, designing structures to support a 4-day workweek for nurse leaders.

ANA Nursing Resources Hub

Search Resources Hub

Problem Solving in Nursing: Strategies for Your Staff

4 min read • September, 15 2023

Problem solving is in a nurse manager’s DNA. As leaders, nurse managers solve problems every day on an individual level and with their teams. Effective leaders find innovative solutions to problems and encourage their staff to nurture their own critical thinking skills and see problems as opportunities rather than obstacles.

Health care constantly evolves, so problem solving and ingenuity are skills often used out of necessity. Tackling a problem requires considering multiple options to develop a solution. Problem solving in nursing requires a solid strategy.

Nurse problem solving

Nurse managers face challenges ranging from patient care matters to maintaining staff satisfaction. Encourage your staff to develop problem-solving nursing skills to cultivate new methods of improving patient care and to promote  nurse-led innovation .

Critical thinking skills are fostered throughout a nurse’s education, training, and career. These skills help nurses make informed decisions based on facts, data, and evidence to determine the best solution to a problem.

Problem-Solving Examples in Nursing

To solve a problem, begin by identifying it. Then analyze the problem, formulate possible solutions, and determine the best course of action. Remind staff that nurses have been solving problems since Florence Nightingale invented the nurse call system.

Nurses can implement the  original nursing process  to guide patient care for problem solving in nursing. These steps include:

• Assessment . Use critical thinking skills to brainstorm and gather information.
• Diagnosis . Identify the problem and any triggers or obstacles.
• Planning . Collaborate to formulate the desired outcome based on proven methods and resources.
• Implementation . Carry out the actions identified to resolve the problem.
• Evaluation . Reflect on the results and determine if the issue was resolved.

How to Develop Problem-Solving Strategies

Staff look to nurse managers to solve a problem, even when there’s not always an obvious solution. Leaders focused on problem solving encourage their team to work collaboratively to find an answer. Core leadership skills are a good way to nurture a health care environment that supports sharing concerns and  innovation .

Here are some essentials for building a culture of innovation that encourages problem solving:

• Present problems as opportunities instead of obstacles.
• Strive to be a positive role model. Support creative thinking and staff collaboration.
• Encourage feedback and embrace new ideas.
• Respect staff knowledge and abilities.
• Match competencies with specific needs and inspire effective decision-making.
• Offer opportunities for  continual learning and career growth.
• Promote research and analysis opportunities.
• Provide support and necessary resources.
• Recognize contributions and reward efforts .

Embrace Innovation to Find Solutions

Try this exercise:

Consider an ongoing departmental issue and encourage everyone to participate in brainstorming a solution. The team will:

• Define the problem, including triggers or obstacles.
• Determine methods that worked in the past to resolve similar issues.
• Explore innovative solutions.
• Develop a plan to implement a solution and monitor and evaluate results.

Problems arise unexpectedly in the fast-paced health care environment. Nurses must be able to react using critical thinking and quick decision-making skills to implement practical solutions. By employing problem-solving strategies, nurse leaders and their staff can  improve patient outcomes  and refine their nursing skills.

Images sourced from Getty Images

Related Resources

Item(s) added to cart

Want to create or adapt books like this? Learn more about how Pressbooks supports open publishing practices.

2.4 Critical Thinking and Clinical Reasoning

Prioritization of patient care should be grounded in critical thinking rather than just a checklist of items to be done. Critical thinking is a broad term used in nursing that includes “reasoning about clinical issues such as teamwork, collaboration, and streamlining workflow.” [1] Certainly, there are many actions that nurses must complete during their shift, but nursing requires adaptation and flexibility to meet emerging patient needs. It can be challenging for a novice nurse to change their mindset regarding their established “plan” for the day, but the sooner a nurse recognizes prioritization is dictated by their patients’ needs, the less frustration the nurse might experience. Prioritization strategies include collection of information and utilization of clinical reasoning to determine the best course of action. Clinical reasoning  is defined as, “A complex cognitive process that uses formal and informal thinking strategies to gather and analyze patient information, evaluate the significance of this information, and weigh alternative actions.” [2]

When nurses use critical thinking and clinical reasoning skills, they set forth on a purposeful course of intervention to best meet patient-care needs. Rather than focusing on one’s own priorities, nurses utilizing critical thinking and reasoning skills recognize their actions must be responsive to their patients. For example, a nurse using critical thinking skills understands that scheduled morning medications for their patients may be late if one of the patients on their care team suddenly develops chest pain. Many actions may be added or removed from planned activities throughout the shift based on what is occurring holistically on the patient-care team.

Additionally, in today’s complex health care environment, it is important for the novice nurse to recognize the realities of the current health care environment. Patients have become increasingly complex in their health care needs, and organizations are often challenged to meet these care needs with limited staffing resources. It can become easy to slip into the mindset of disenchantment with the nursing profession when first assuming the reality of patient-care assignments as a novice nurse. The workload of a nurse in practice often looks and feels quite different than that experienced as a nursing student. As a nursing student, there may have been time for lengthy conversations with patients and their family members, ample time to chart, and opportunities to offer personal cares, such as a massage or hair wash. Unfortunately, in the time-constrained realities of today’s health care environment, novice nurses should recognize that even though these “extra” tasks are not always possible, they can still provide quality, safe patient care using the “CURE” prioritization framework. Rather than feeling frustrated about “extras” that cannot be accomplished in time-constrained environments, it is vital to use prioritization strategies to ensure appropriate actions are taken to complete what must be done. With increased clinical experience, a novice nurse typically becomes more comfortable with prioritizing and reprioritizing care.

• Klenke-Borgmann, L., Cantrell, M. A., & Mariani, B. (2020). Nurse educator’s guide to clinical judgment: A review of conceptualization, measurement, and development. Nursing Education Perspectives, 41 (4), 215-221. https://doi.org/10.1097/01.nep.0000000000000669 ↵

A broad term used in nursing that includes “reasoning about clinical issues such as teamwork, collaboration, and streamlining workflow.”

A complex cognitive process that uses formal and informal thinking strategies to gather and analyze patient information, evaluate the significance of this information, and weigh alternative actions.

Leadership and Management of Nursing Care Copyright © 2022 by Kim Belcik and Open Resources for Nursing is licensed under a Creative Commons Attribution 4.0 International License , except where otherwise noted.

Share This Book

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

Critical thinking in nurse managers

Affiliation.

• 1 Ambulatory Patient Care Services and Quality, North Shore Long Island Jewish Health System, Long Island, NY, USA.
• PMID: 19492771

Formal education and support is needed for nurse managers to effectively function in their role in the current health care environment. Many nurse managers assume their positions based on expertise in a clinical role with little expertise in managerial and leadership skills. Operating as a manager and leader requires ongoing development of critical thinking skills and the inclination to use those skills. Critical thinking can have a powerful influence on the decision making and problem solving that nurse managers are faced with on a daily basis. The skills that typify critical thinking include analysis, evaluation, inference, and deductive and inductive reasoning. It is intuitive that nurse managers require both the skills and the dispositions of critical thinking to be successful in this pivotal role at a time of transformation in health care. Incorporating critical thinking into education and support programs for the nurse manager is necessary to position the nurse manager for success.

PubMed Disclaimer

Similar articles

• The role of preceptor and nurse leader in developing intensive care unit competency. Elmers CR. Elmers CR. Crit Care Nurs Q. 2010 Jan-Mar;33(1):10-8. doi: 10.1097/CNQ.0b013e3181c8e0a9. Crit Care Nurs Q. 2010. PMID: 20019505
• Thoughtful nursing practice: reflections on nurse delegation decision-making. McInnis LA, Parsons LC. McInnis LA, et al. Nurs Clin North Am. 2009 Dec;44(4):461-70. doi: 10.1016/j.cnur.2009.07.002. Nurs Clin North Am. 2009. PMID: 19850182 Review.
• Implementation and evaluation of critical thinking strategies to enhance critical thinking skills in Middle Eastern nurses. Simpson E, Courtney M. Simpson E, et al. Int J Nurs Pract. 2008 Dec;14(6):449-54. doi: 10.1111/j.1440-172X.2008.00719.x. Int J Nurs Pract. 2008. PMID: 19126073
• Critical thinking in health care supervision. McKenzie L. McKenzie L. Health Care Superv. 1992 Jun;10(4):1-11. Health Care Superv. 1992. PMID: 10118934 Review.
• Intuition and the nurse manager. Davidhizar R. Davidhizar R. Health Care Superv. 1991 Dec;10(2):13-9. Health Care Superv. 1991. PMID: 10114916
• Development and Evaluation of the "High-Up" Program for Enhancing the Nursing-Management Competency of Mid-Career Hospital Nurses: A Quasi-Experimental Study. Kim S, Lim JY. Kim S, et al. Int J Environ Res Public Health. 2022 Apr 6;19(7):4392. doi: 10.3390/ijerph19074392. Int J Environ Res Public Health. 2022. PMID: 35410072 Free PMC article.
• Search in MeSH

LinkOut - more resources

Full text sources.

• Ovid Technologies, Inc.
• 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.

In order to continue enjoying our site, we ask that you confirm your identity as a human. Thank you very much for your cooperation.

22 Leadership Qualities in Nursing Every Nurse Leader Must-Have in 2024

Are you a nurse leader or aspiring to achieve a leadership position in nursing? Have you wondered, "What are the leadership qualities in nursing every nurse leader must-have to be successful?” If this sounds like you, this article has information you could find helpful. Throughout this article, you will discover 22 leadership qualities in nursing every nurse leader must-have to be successful in 2024 and learn why developing strong leadership qualities is crucial for nurse leaders.

What Exactly is a Nursing Leadership Quality?

Are leadership qualities a must-have for every type of nurse leader, 5 reasons why every nurse leader must have great leadership qualities.

1. Good leadership qualities in nursing are vital for strengthening the integration of effective, safe, high-quality patient care. 2. Strong leadership in nursing creates a positive work environment. 3. Great leadership qualities in nursing promote positive patient experiences and outcomes. 4. Strong nursing leadership is influential in reducing errors in nursing care which helps reduce healthcare costs. 5. Nurse leaders with excellent leadership qualities inspire others to put forth their best efforts.

What are the Leadership Qualities in Nursing Every Nurse Leader Must-Have to Be Successful?

1. integrity, what is it:, why is this a must-have quality to be a successful nurse leader:, 2. critical thinking, 3. excellent communication skills, 4. mentorship, 5. strong ethics, 6. professionalism, 7. respect for others, 8. dedication, 9. accountability, 10. emotional intelligence, 11. empathy, 12. service-oriented, 13. authenticity, 14. good conflict resolution skills, 15. motivational, 16. self-awareness, 17. embraces diversity, 18. confidence, 19. active listener, 20. promotes employee development, 21. builds relationships, 22. technologically proficient, 5 ways to strengthen your leadership qualities in nursing, 1. identify and maintain your values and morals., 2. become a listener, 3. practice positivity., 4. get involved with community and professional organizations., 5. never stop learning, 12 bad leadership qualities every nurse leader should stay away from, 1. poor communication:, 2. lack of a good professional track record:, 3. acting disrespectfully toward others:, 4. downplaying unethical behaviors:, 5. lack of integrity:, 6. avoiding conflict:, 7. blaming others:, 8. unwilling to compromise or be flexible:, 9. being self-centered:, 10. being satisfied with the status quo:, 11. unteachable:, 12. lack of accountability:, my final thoughts.

opens in a new window

• The Official Publication of the Nevada Nurses Association.

Using the Nursing Process and Critical Thinking to Mitigate Future Pandemics

Norman Wright

RNformation (Nevada) July 2024

This article appears on page 10 of

Norman Wright, MS, BSN, RN

It has been four years since the COVID-19 pandemic began, and now there is enough history and data to start exploring what happened, why it happened, and how nurses can be essential to mitigate the impact of future pandemics. The Sars-Cov-2 virus has existed since 2019, and since then, like it or not, we all have been participating in what can be called “The Greatest Medical Experiment Ever Done.” COVID-19 infections and disease continue, but thankfully, the impact is minimal at this time.

Medical experiments are meticulously conducted by separating populations into groups or cohorts. A cohort can be divided in multiple ways, but most medical experiments only include two variables. Thus, studies on vaccine efficacy divides the sample population into two cohort groups, those who were vaccinated and the unvaccinated. Both the vaccinated group and control group must be randomly selected and representative of the whole population. For example, if the average age of the vaccinated population is under 40, but the average age of the control group is over 60, false results could occur. Additionally, the control group must be represented equally to the experimental group on many variables including sex-at-birth status, and racially balanced to have generalizability back to the population and universal validity. 

For this reason, studying the impact of Sars-Cov-2 on the entire Earth’s population is impossible because there are infinite numbers of variables and potential confounding effects involved. These potential variables include: 

• When the population was initially exposed. 
• When lockdowns were initiated. 
• How long the lockdowns lasted. 
• Was the population vaccinated. 
• What news and information sources was the population exposed to. 
• The quality of available health care. 
• Political dynamics. 
• Depending on which side of the equator you live on, was it summer or winter when the infections and deaths occurred? 

Our World in Data compared the excess mortality in various nations worldwide since the COVID-19 pandemic began. “Excess mortality is a term used in epidemiology and public health that refers to the number of deaths from all causes during a crisis above and beyond what we would have expected to see under ‘normal’ conditions”. ourworldindata.org/excess-mortality-covid

To reduce the variables, we will only review excess deaths data per 100,000 population from three nations: 

• Australia, 127 
• Canada, 181 
• The United States, 404

Question, why does the USA have well over 200 excess deaths per capita? Mortality Risk of COVID-19 – Our World in Data

Another way to define the success or failure of the interventions calculates deaths per million population (DPM). According to Worldometer , as of April 14, 2024 (the last day Worldometer posted COVID-19 statistics), Australia had 937 COVID-19 related DPM, Canada 1,538, and the USA had 3,642 DPM. Again, the question is “Why does the United States have over 2,100 more DPM than Australia and Canada?” 

The impact of the COVID-19 pandemic can be divided into two distinct eras – before, and after the vaccines became widely accessible. Prior to vaccine availability in the spring of 2021, the main approaches to prevent the spreading of infection were masking, quarantines, and lockdowns.

All three sample nations declared a COVID-19 health emergency between March 15 and March 17, 2020, and initiated quarantines/lockdowns within a few days of each other. Later, Australia implemented a Zero-COVID initiative which lasted until the fall of 2021. During the time that Zero-COVID was implemented the number of infections and deaths in Australia were minimal. Just a few months after Australia’s restrictions were relaxed, the Omicron variant, which sent infection rates soaring worldwide, dramatically increased Australia’s infection and death rates. The majority of infections and deaths that occurred in Australia happened after January 2022. (See coronavirus.jhu.edu/region/australia )

A Zero-COVID response initially saves lives but there are also consequences, including social and economic ramifications. Additionally, a population that was never exposed to the pathogen has no natural immunity and when the ZeroCOVID policies ended, infections and deaths in China increased exponentially. China began COVID-19 travel restrictions in Wuhan in January 2020 and the restrictions progressed to a draconian Zero-Covid policy of lockdowns and quarantines which were maintained until December 2022.

China’s travel and quarantine restrictions were finally relaxed in early December 2022 after many large protests were occurring. Immediately after China’s ZeroCOVID strategies abruptly ended, the number of infections skyrocketed. On December 25, 2022, China ceased reporting infections and deaths. China’s National Health Commission to stop publishing daily COVID-19 figures – CNA

According to estimates by researchers Du et al. (2023) “China announced a slight easing of its zero-COVID rules on November 11, 2022, and then a major relaxation on December 7, 2022. We estimate that the ensuing wave of SARS-CoV-2 infections caused 1.41 million deaths in China during December 2022–February 2023, substantially higher than that reported through official channels.” ( Estimate of COVID-19 Deaths, China, December 2022–February 2023 ). 

Reporting dangerous pathogens in a timely, accurate, forthright and honest way is essential to prevent future pandemics. China began to understand the virulence of the virus by late 2019, but delayed notifying the world, and this delay is a factor that contributed to causing to the worldwide pandemic ( Allam, 2022 ). China must be criticized for its lack of transparency, which is ongoing to this day. Also, according to current data, both from Australia and China, strict extended lockdowns may initially save lives but this intervention also has social and economic costs.  

Canada considered, but never initiated a Zero-COVID policy. The quarantine/ lockdown response did not remain in place as long as Australia’s, but Canada’s restrictions were relaxed at a slower pace than in the USA, which rapidly opened up after April 16, 2020, when the Trump Administration released its plan outlining how states should reopen. Within 2 weeks, some states began reopening. CDC Museum COVID-19 Timeline

Although the pandemic was politicized in Australia and Canada, the politicization of the Sars-Cov-2 virus and disinformation surrounding it was most prevalent in the USA. COVID became a part of the 2020 Presidential election campaigns. False cures, including ivermectin and hydroxychloroquine, were touted by various media outlets. Protests against using masks began, and nurses who were once hailed as heroes were attacked by individuals who believed the COVID-19 pandemic was a hoax, which some news sources and social media outlets promoted incessantly.

After the vaccines became widely available in early 2021, many people flocked to get vaccinated and for the next few months demand for the vaccines far exceeded supply. But soon the anti-vax campaign began promoting lies and disinformation about the vaccines saying the vaccines were (a) developed too fast, (b) not tested enough, (c) microchips were injected, (d) the vaccinations made us magnetic, or (e) our DNA was changed. The vaccines purportedly also impacted female fertility and made male gonads grow abnormally. These are only a few of the outright lies that were constantly spread. Reports about the COVID vaccines causing sudden deaths were hyped to the point where an August 2022 poll by the Kaiser Family Foundation (KFF) found over 20% of those polled believe that more people have died from the COVID-19 vaccines than have died from the COVID-19 virus. KFF Health Misinformation Tracking Poll Pilot

Disinformation about the safety and efficacy of the COVID vaccines, especially the mRNA vaccines, has led to serious harm and death in some communities where a large percent of the community remains unvaccinated. These lies about the mRNA vaccines even convinced some Idaho legislators to propose a 2023 law making it a misdemeanor to give an mRNA vaccine. Thus, if passed, giving a Moderna or Pfizer COVID vaccine, or any vaccine that uses updated mRNA technology could land a nurse in jail for up to a year. Fortunately, this bill did not become law. HOUSE BILL NO.154 (2023) – Vaccines, misdemeanor

The Nurses’ Responsibility to Address Disinformation Nursing 101 taught us the nursing process. According to the American Nurses Association the nursing process is “a systematic, dynamic way to collect and analyze data about a client, the first step in delivering nursing care. Assessment includes not only physiological data, but also psychological, sociocultural, spiritual, economic, and life-style factors as well.” 5 Core Areas of the Nursing Process Explained | ANA

We were taught to use the nursing process to promote the health of the individual patient that we are caring for, but now we expand the concept and use it to address the health of our community as a whole. Thus, our patient becomes everyone living in the community we serve.

The USA is a diverse nation, and although there were 3,642 deaths per million in our nation as a whole, when we compare the DPM in the individual states, we find that COVID ravaged some states more than others. Arizona’s 4,726 DPM is the highest of all the states, while Hawaii at 1,531, Utah at 1,784, and Vermont at 1,825 are the lowest. https://www.worldometers.info/coronavirus/country/us/

According to the Lancet, “If Arizona were a country, our crude COVID-19 mortality rate would rank among the worst in the world, similar to Russia, Romania, and Belarus and just behind Peru.” arizona-had-the-highestper-capita-standardized-covid-19-death-rate-in-the-u-s/

Now the question becomes what caused this dramatic disparity? Why is Vermont’s DPM number of 1,825 close to Canada’s 1,538? We could erroneously assume that because Vermont and Canada are both located in the North their similar climates are the reason until we learn that Utah, a state that borders Arizona has 1,784 DPM, so other variables are involved, and this is where critical thinking becomes essential.

Since the beginning of 2020 each state individually decided how to address COVID-19. Unfortunately, we still do not have a nationwide plan developed to mitigate Sars-Cov-3 or any other future pathological pandemic.  

False data skews statistics and is misleading. Therefore, it is essential to collect and use accurate data to mitigate the impact of a pandemic. When the community is constantly bombarded with faulty inaccurate data, when a disease is politicized, when news sources constantly hype dishonest sources and question those that are reliable the health of the community is at risk and proper response to combat the disease becomes impossible. 

It is our responsibility to separate the truth from fake news, misinformation and disinformation, and this involves critical thinking. We have learned to use the nursing process on an individual patient and to appropriately treat your patient you must constantly reassess your patient without having preconceived beliefs, biases, or prejudices. Expand the nursing process to address how a disease impacts the society as a whole.

For the past four years we have all lived with COVID-19. The media and on-line sources of information that we listen to has a direct correlation to our perception of reality. Perhaps you once believed all of the disinformation about the pandemic. Indeed, some reading this article may still believe the anti-vax rhetoric, and if so, please reassess and update the validity of the information you received. Recall what your understanding and beliefs were in 2021 regarding ivermectin, vaccines, and COVID-19 in general. Are they the same today? 

According to the nursing process, “Assessment includes not only physiological data, but also psychological, sociocultural, spiritual, economic, and life-style factors as well.” 

Even though we all live in Nevada, we all perceive reality differently because we have diverse backgrounds. Our reality depends on our past and present life experiences, the friends we associate with, the information we consume and how we perceive that information through the lens we view our environment. 

Although it is proven that the COVID-19 vaccines are effective in preventing hospitalizations and death the anti-vax machine continually uses faulty, slanted and distorted data to “prove” the vaccines don’t work. A recent example of this is a November 2023 lawsuit that Texas Attorney Ken Paxton filed against Pfizer that purports that the vaccines were not as effective as claimed. 

aimed. In a December 4, 2023, rebuttal article titled “Texas sues Pfizer with COVID an anti-vax argument” Beth Mole writes that the lawsuit conflates relative vs. absolute risk to evaluate the efficacy of the vaccine. Do your own research into the merits of the lawsuit and ask yourself, is this lawsuit just another attempt to cause confusion for political gain? Texas-sues-pfizerwith-covid-anti-vax-argument

Researchers Wallace et al. (2023) researched the question, “Was political party affiliation a risk factor associated with excess mortality during the COVID-19 pandemic in Florida and Ohio?” The cohort study evaluated 538,159 deaths in individuals aged 25 years and older in Florida and Ohio between March 2020 and December 2021. The finding was that “excess mortality was significantly higher for Republican voters than Democratic voters after COVID-19 vaccines were available to all adults, but not before. These differences were concentrated in counties with lower vaccination rates, and primarily noted in voters residing in Ohio.” Their conclusion was, “differences in excess mortality by political party affiliation after COVID-19 vaccines were available to all adults suggest that differences in vaccination attitudes and reported uptake between Republican and Democratic voters may have been a factor in the severity and trajectory of the pandemic in the US.” https://doi.org/10.1001/jamainternmed.2023.1154

No matter what your political bias may be, tuning into different channels and exposing yourself to ideas that you may not agree with can be difficult, but it is essential to identify what disinformation is. Use your critical thinking skills to sort out the information and data in an open, nonprejudicial way.

It is June 1, 2024, and we are in the middle of an election cycle like none I have ever witnessed. Fake news, lies, disinformation and spin constantly flood our broadcast, print and social media. As we approach November this year, use the nursing process and your critical thinking skills to cast your vote in a responsible way. Whether you consider yourself Republican, Democrat, Libertarian, Independent or other, do the research, seek out the truth and use accurate information to make your decision. 

References Allam Z. (2020). The First 50 days of COVID-19: A Detailed Chronological Timeline and Extensive Review of Literature Documenting the Pandemic. Surveying the Covid-19 Pandemic and its Implications, 1–7. https://doi.org/10.1016/B978-0-12-824313-8.00001-2

American Nurses Association. “The Nursing Process.” Nursingworld.org, 2019, www.nursingworld.org/practice-policy/workforce/what-is-nursing/the-nursingprocess/

“Australia – COVID-19 Overview – Johns Hopkins.” Johns Hopkins Coronavirus Resource Center, coronavirus.jhu.edu/region/australia

CDC. “COVID-19 Timeline.” Centers for Disease Control and Prevention, CDC, 15 Mar. 2023, www.cdc.gov/museum/timeline/covid19.html

“China’s Top Health Body Stops Publishing Daily Covid Case Figures as Infections Soar.” CNN, 25 Dec. 2022, www.cnn.com/2022/12/25/asia/china-covid-casespublishing-nhc-intl/index.html . Accessed 17 Jan. 2023.

Du, Z., Wang, Y., Bai, Y., Wang, L., Cowling, B., & Meyers, L. (2023). Estimate of COVID-19 Deaths, China, December 2022–February 2023. Emerging Infectious Diseases, 29(10), 2121-2124. https://doi.org/10.3201/eid2910.230585 .

“Excess Mortality during the Coronavirus Pandemic (COVID-19).” Our World in Data, ourworldindata.org/excess-mortality-covid .

Harper, K. B. (2023). Texas Attorney General Sues Pfizer, Claiming Vaccines Didn’t End Pandemic Quickly Enough. The Texas Tribune, 30 Nov. 2023, https://www.texastribune.org/2023/11/30/texas-attorneygeneral-pfizer-lawsuit/ .

LEGISLATURE of the STATE of IDAHO Sixty-Seventh Legislature First Regular Session -2023 in the HOUSE of REPRESENTATIVES HOUSE BILL NO. 154 by HEALTH and WELFARE COMMITTEE an ACT

Lopes, Lunna, et al. “KFF Health Misinformation Tracking Poll Pilot.” KFF, 22 Aug. 2023, www.kff.org/coronavirus-covid-19/poll-finding/kff-healthmisinformation-tracking-poll-pilot .

Our World in Data. “Mortality Risk of COVID-19 – Statistics and Research.” Our World in Data, 2020, ourworldindata.org/mortality-risk-covid .

The Lancet: Arizona Had the Highest Per-Capita Standardized COVID-19 Death Rate in the U.S between January 2020 & July 2022 – AZ Public Health Association. 28 Mar. 2023, https://azpha.org/2023/03/28/the-lancet-arizona-had-the-highestper-capita-standardized-covid-19-death-rate-in-the-us-between-january-2020-july-2022/ .

Wallace, J., Goldsmith-Pinkham, P., & Schwartz J.L. (2023). Excess death rates for republican and democratic registered voters in Florida and Ohio during the COVID-19 pandemic.” JAMA Internal Medicine, 183, 9; 916–923, https://doi.org/10.1001/jamainternmed.2023.1154 .

Worldometer. “Coronavirus Toll Update: Cases & Deaths by Country.” Worldometer, 13 Apr. 2024, www.worldometers.info/coronavirus/ .

Heat Waves: Assessing Patient Risk and Tracking Heat-Related Illnesses

Related Articles

Tech Trends: Nursing’s Evolution with Healthcare Innovation

NNA at the Mental Health Summit in Fallon

• DOI: 10.1186/s12912-024-02089-3
• Corpus ID: 270637227

Can internship programs affect nursing students’ critical thinking disposition, caring behaviors, and professional commitment?

• Zahra Sarkoohi , M. Nematollahi , +4 authors Jamileh Farokhzadian
• Published in BMC Nursing 21 June 2024
• Education, Medicine

35 References

The effect of nursing internship program on burnout and professional commitment..

• Highly Influential

Nursing Student Work-Study Internship: Partnering to Bridge the Education-to-Practice Gap

Correlation between critical thinking disposition and mental self-supporting ability in nursing undergraduates: a cross-sectional descriptive study, the effects of reflective training on the disposition of critical thinking for nursing students in china: a controlled trial., an international cross-cultural study of nursing students' perceptions of caring., assessing the caring behaviors of critical care nurses, the challenges of nursing students in the clinical learning environment: a qualitative study, the relationship between problem solving ability, professional self concept, and critical thinking disposition of nursing students, barriers and facilitators of nursing professional commitment: a qualitative study, the effectiveness of teaching strategies for the development of critical thinking in nursing undergraduate students: a systematic review protocol, related papers.

Showing 1 through 3 of 0 Related Papers

Search form

Fighting for nursing as a STEM field

By DailyNurse    |    June 25, 2024

Given the importance of nursing in such concepts as evidence-based care and critical thinking, to regard nursing as anything but a science seems misinformed at best.

Share this:, tagged under:, most popular, researcher: paxlovid is 'game changer' in treatment of covid-19.

Recent research on Paxlovid shows there is "solid data on its effectiveness," a co-author of the study told HealthLeaders. ...

Bon Secours Mercy Health Invests in Local Supplier of PPE

A new personal protective equipment manufacturing company is set to open in Cincinnati next year. ...

Get the latest on healthcare leadership in your inbox.

More From Forbes

5 steps leaders can take to make better decisions.

• Share to Facebook
• Share to Twitter
• Share to Linkedin

5 people discussing strategy as a team and making decisions on how to move forward.

If you’re plagued by indecisiveness and often doubt every decision you must make as a leader, you’re certainly not alone.

Leaders often fear making tough decisions because they are acutely aware of the potential consequences and the impact on their team and organization. This reluctance can stem from a fear of failure, the possibility of making the wrong choice, and anxiety over how others will perceive their decisions. Additionally, the weight of the responsibility and the desire to maintain harmony can make leaders hesitant to make decisions that may lead to conflict or dissatisfaction among team members.

In a global survey of 14,250 people in January 2023, Oracle and economist Seth Stephens-Davidowitz found that 85% of business leaders have suffered from decision distress – regretting, feeling guilty about, or questioning a decision they made in the past year. Not only that, but 70% of those leaders would prefer “to have a robot make their decisions.”

However, according to the Cloverpop 2023 Decision IQ Benchmark Survey , the quality of a company’s decision-making is its most valuable asset. Do leaders really want to leave their most valuable asset up to robots?

Getting to a decision point isn’t always easy. Often, these situations involve significant change, intense pressure, or even balancing opposing opinions – all of which can make figuring out what decision to make much harder.

So, what steps can you take to improve your decision-making?

1. Know You Must Make The Decision

Best high-yield savings accounts of 2024, best 5% interest savings accounts of 2024.

For many leaders, the biggest obstacle to decision-making is ignoring that a decision must be made and that the responsibility to make it rests with you. Ignoring a problem or delaying a decision, hoping it will resolve itself, is a common but flawed approach. Problems rarely disappear independently; in fact, they often escalate if not addressed promptly.

So, the first critical step is acknowledging the existence of an issue and understanding that it requires your action.

· Develop your awareness and observation skills to recognize moments when timely decisions are necessary

· Cultivate a mindset that embraces responsibility and accountability for your decision-making

· Prioritize timely actions to prevent minor issues from growing into significant challenges

2. Embrace Data-Driven Decision Making

To make effective, solid decisions, leaders shouldn’t rely solely on their “gut” as the foundation for making an important decision. Decisions made after reviewing solid data are more likely to lead to successful outcomes.

As a leader, you must combine your experience with the information presented to you and then analyze it to find the best solution.

· Collect and analyze relevant data

· Use analytical tools and software (for example: Alterx , Google Data Studio , Microsoft Power BI ) to interpret data patterns

· Combine quantitative data with qualitative insights for a more comprehensive view

Gathering information is essential–it helps ensure more objective decisions and reduces bias.

3. Promote A Collaborative Environment

Leaders often make the best decisions when they gather information from diverse perspectives. By seeking input from various stakeholders, leaders can uncover blind spots and consider a broader range of solutions.

· Cultivate an inclusive culture, so team members feel safe sharing their opinions

· Encourage open dialogue and active listening during discussions

· Ask exploratory questions to gather as much information as possible

· Leverage the collective intelligence of your team to explore various solutions

Collaboration enhances decision quality and cultivates a sense of ownership and commitment among team members.

4. Develop Your Critical Thinking Skills

Critical thinking is essential as it equips you with the skill set to analyze situations thoroughly and objectively. It helps you identify critical issues, evaluate alternatives, and make decisions based on sound reasoning.

· Be curious and ask probing questions to challenge your assumptions and examine alternatives

· Engage in regular reflective practices, such as journaling or debriefing after significant decisions

· Attend workshops or training sessions focused on enhancing critical thinking abilities

· Practice genuinely listening to team members to gather valuable insights

5. Be Decisive, But Flexible

Effective leaders know when to make decisions quickly and when to adjust their strategies based on new information. This essential flexibility ensures adaptability in dynamic environments. Balancing these two qualities helps leaders navigate uncertainties and drive their teams forward.

· Set clear priorities so you can identify which decisions can and must be made swiftly and which can afford more time for consideration

· Develop contingency plans so you can quickly pivot if circumstances change

· Review the results from the decisions made and be open to adjusting your approach based on what you learn

Decisiveness is vital in leadership because it keeps projects moving forward and demonstrates confidence to your team. Ultimately, the responsibility of decision-making rests with the leader. Since it is a pivotal asset that significantly influences an organization’s performance, leaders must develop strong decision-making skills and confidence in their ability to make the right decisions.

• Editorial Standards
• Reprints & Permissions

Join The Conversation

One Community. Many Voices. Create a free account to share your thoughts. 

Forbes Community Guidelines

Our community is about connecting people through open and thoughtful conversations. We want our readers to share their views and exchange ideas and facts in a safe space.

In order to do so, please follow the posting rules in our site's  Terms of Service.   We've summarized some of those key rules below. Simply put, keep it civil.

Your post will be rejected if we notice that it seems to contain:

• False or intentionally out-of-context or misleading information
• Insults, profanity, incoherent, obscene or inflammatory language or threats of any kind
• Attacks on the identity of other commenters or the article's author
• Content that otherwise violates our site's  terms.

User accounts will be blocked if we notice or believe that users are engaged in:

• Continuous attempts to re-post comments that have been previously moderated/rejected
• Racist, sexist, homophobic or other discriminatory comments
• Attempts or tactics that put the site security at risk
• Actions that otherwise violate our site's  terms.

So, how can you be a power user?

• Stay on topic and share your insights
• Feel free to be clear and thoughtful to get your point across
• ‘Like’ or ‘Dislike’ to show your point of view.
• Protect your community.
• Use the report tool to alert us when someone breaks the rules.

Thanks for reading our community guidelines. Please read the full list of posting rules found in our site's  Terms of Service.

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

• New! Member Benefit New! Member Benefit
• Featured Analytics Hub
• Resources Resources
• Member Directory
• Networking Communities
• Advertise, Exhibit, Sponsor
• Find or Post Jobs

• Learn and Engage Learn and Engage

• Compare AACSB-Accredited Schools
• Explore Programs

• Advocacy Advocacy
• Featured AACSB Announces 2024 Class of Influential Leaders
• Diversity, Equity, Inclusion, and Belonging
• Influential Leaders
• Innovations That Inspire
• Connect With Us Connect With Us
• Accredited School Search
• Accreditation
• Learning and Events
• Advertise, Sponsor, Exhibit
• Tips and Advice
• Is Business School Right for Me?

The Role of Humans in an AI World

• Now more than ever, b-school curriculum needs to complement technical skills with human creativity and other unique characteristics, to enhance the capabilities of both.
• Business educators need to teach students how to think critically about employing AI to identify problems and interpret solutions, rather than allowing AI tools, such as ChatGPT, to determine what’s relevant.
• A new value framework—based on critical thinking and purposeful analysis—can help guide business schools, and accordingly students, to more meaningful solutions.

Ana Freire : [0:15] In my view, AI will replace everything. There are some human characteristics that need to be in place always, such as creativity, or the natural intelligence, the common sense, and many other features inherent from human behavior.

[0:32] We just need to find the way in how to basically combine artificial intelligence and the most wonderful characteristics of human beings in order to multiply the effects that both parts can generate together.

[0:51] Higher education institutions have the responsibility to not just teach the technological content, which is behind artificial intelligence, but also soft skills like communication or critical thinking in order to give the future leaders the opportunity to decide or to augment their own capabilities in order to multiply the effects of artificial intelligence when it's needed.

[1:17] Because maybe not in all environments and in all tasks artificial intelligence will be needed in our work.

Higher education institutions have the responsibility to not just teach the technological content, but also soft skills like communication or critical thinking.

David De Cremer : [1:26] Creativity is seen as something uniquely human. If you look at what creativity is about, it's really finding new solutions to problems that are relevant and meaningful to us.

[1:37] If you use that definition and we apply it to generative AI like ChatGPT, we see that there are a number of skills that our educators should train. First of all, ChatGPT provides solutions, it generates solutions, but who phrases the question? A human.

[1:54] It's about identifying a problem and then specifying in a question. It generates something, but who interprets what is generated? A human as well, because it needs to be seen as meaningful and relevant to a human. These are two important skills.

[2:10] Identifying the question relates to use generative AI in a way that you push our students to think critically. What are the big business questions? What are the big questions in life that business can help? Those are the problems that we define.

[2:24] That's related to what we call prompt engineering as well. If you know the right question, do you also know how to prompt ChatGPT to come up with an answer that's relevant?

Prompt engineering is a good skill to have, but it's not the job of the future.

[2:35] Prompt engineering is not the job of the future, I must say. Some people think it still is the case, but you have to remember ChatGPT is probabilistic. It's not deterministic, which means sometimes even with the same prompt, it may generate a different answer.

[2:52] Prompt engineering is a good skill to have, but it's not the job of the future. The job of the future in my view, is much more looking at what has been generated when you ask the right kind of question. That's based on your own purpose, what kind of value you want to create.

[3:06] That's why critical thinking about what is it that I'm doing, what is the value of my business, is important because you interpret from that framework. What's going to be the job of the future is really a content analyst.

[3:17] As humans, we participate in the real world. AI doesn't, so we assess the relevance and the meaning of it, and we can do so because we are active participants.

[3:28] Being a content analyst, knowing this is an outcome that ChatGPT generated, how can I transfer that into knowledge that I can use to come up with a solution for a problem? Those are skills that as educators, we really need to foster and ChatGPT is a very helpful tool to help in that process.

• artificial intelligence
• critical thinking
• future of work
• higher education
• soft skills