This paper addresses four interconnected dimensions of contemporary nursing leadership. It examines the environmental, organizational, and psychological challenges nurses face while acquiring greater formal and informal power in policy and administration. It then considers how the evolving structure of nursing education shapes role-based versus task-based practice, emphasizing the need for creativity and critical thinking. The paper also explores Magnet Designation as a quality indicator and the role of theoretical frameworks — specifically Myra Levine's conservation principles — in guiding nursing practice. Finally, it discusses how staffing shortages, low morale, and communication breakdowns affect patient outcomes and proposes strategies for building cohesive nursing cultures.
The greatest challenges facing nursing leadership and the profession as a whole include, but are not limited to, highly political environments, budget reductions, changing reimbursement patterns, staffing shortages, and rapidly evolving technological advances (Schmidt, 2006, p. 34). In addition to these environmental and organizational challenges, nurses and nurse leaders contend with issues related to communications, public relations, and personal psychological barriers to greatness. Nurses are now endowed with more formal and informal types of power than in the past, expanding the locus of the profession from bedside care toward policy making and administration.
Nurses and nurse leaders can influence the regulatory mandates that govern and guide nursing practice. In fact, nurses — and nurses alone — are entrusted with the responsibility of developing and changing regulatory mandates that directly impact the nursing profession. Regulatory mandates that do not impinge directly upon nursing, or which have broader application in healthcare, may be presided over by more than just nurses. State laws and administrative regulations affect nurses, but nurses often do not have direct influence over the development of those mandates. Healthcare is a diverse and complex field, and nurses are only one — albeit core — component of any institution.
How to cultivate and wield power effectively has become a cornerstone of the nursing profession. Nurses are now engaged in administrative activities and policy making, influencing the health of individuals and whole communities. Federal policies related to healthcare — such as nutritional guidelines or anti-smoking campaigns — can be spearheaded by nurses. Therefore, all nurses need to be aware of the full scope of their profession and the difference they can make in improving healthcare and patient outcomes.
The structure of the nursing profession is changing rapidly and dramatically. The structure of nursing education is subsequently changing to reflect the different status and role of nurses in their communities and healthcare organizations. These changes present significant challenges and opportunities for all nurses and nurse leaders.
Nurses are engaged in both role-based and task-based practices. Nurse leaders may perceive themselves as more role-based than task-based, yet both aspects of nursing come into play regardless of the position an individual holds. In California, the role of the Registered Nurse differs significantly from that of the LPN, because the latter is viewed more as a technician than a potential future leader. However, all LPNs have the potential to become nurse leaders should they choose to do so. Nurse leaders tend to engage more in work that involves public policy, administration, politics, and communications. Their core professional goals must also relate to patient care, but patient care becomes part of the broader rubric of nurse leadership. A nurse leader should always remain grounded in bedside practice; otherwise, nurse administration becomes too detached from the actual work of caring for patients.
One challenge that nurse leaders face is striking the right balance between role-based and task-based aspects of the profession. Nurse leaders need the freedom to develop their professional skills by focusing on managerial tasks and policy making, while nurse technicians must concentrate on evidence-based practice and providing the best care within their institutions. Combining these two major objectives requires creativity and critical thinking. As Manley (2007) notes, "the skills and knowledge base of consultancy, underpinned by a strong nursing foundation, augmented by strong leadership and combined with the educator and researcher functions, are presented as the attributes of the advanced practitioner/consultant nurse" (p. 179). Shifting the image of nurses helps impart a multifaceted view of the profession and better positions nursing as a field of advanced, adaptive leadership.
"Magnet criteria and Levine's conservation theory"
"Staffing shortages, morale, and communication in hospitals"
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