Problem: Nurses, the largest group of health care professionals in the nation, are on the front lines of patient care and have unique insights into the health care system. Yet despite their expertise in health and health care, nurses are underrepresented in discussions about how to improve the health care system in this country.
Background: What do nurses and mothers have in common? They are society’s primary caregivers—a role that can be as rewarding as it is daunting and confusing.
To help women thrive as mothers, Angela Barron McBride, Ph.D., R.N., wrote The Growth and Development of Mothers, a revolutionary tome that decoded the needs of mothers at a time when children were the subject of most parenting literature.
Published in 1973, The Growth and Development of Mothers was a critical success, recognized as one of the best books of the year by both the New York Times and the American Journal of Nursing. That early accomplishment set McBride—then a young nurse educator and a new mother—on a trailblazing path to nurse leadership.
Now, nearly four decades later, McBride—chair of the National Advisory Committee for the Robert Wood Johnson Foundation (RWJF) Nurse Faculty Scholars program—is drawing on her experience as a nurse leader to do for nurses what she did for mothers all those years ago: help them understand their roles and realize their potential. She has built a reputation as a powerful advocate for women’s health and has received many honors for her contributions to both women's health and nursing.
“Really, the tasks of mothers and nurses are not that different,” she says. “Nurses and mothers both have jobs that can be scary at times, and they are often held to impossibly high standards. They’re both often talked about by people who spout pious drivel about what they should be doing and how they should be doing it that isn’t realistic.”
In her new book, The Growth and Development of Nurse Leaders, McBride aims to help nurses—no matter their position or specialty—recognize and acknowledge their full potential and grow into leaders of the nation’s health care system.
The publication of her book comes as a groundbreaking report by the Institute of Medicine (which was supported by the Foundation) is calling on nurses to become full partners in—and leaders of—the development, design and the delivery of health care.
More nurse leaders will improve the delivery of care and patient outcomes, according to the report, called The Future of Nursing: Leading Change, Advancing Health.
Nurses comprise the largest group of health care professionals in the nation and have unique insights into the health care system, thanks to their specialized education and close proximity to patients, McBride says. Yet they are often left out of discussions about how to improve health and health care in the United States because they are considered to be subordinate to physicians and administrators.
Excluding nurses from key decision-making positions, however, is a detriment to nurses and the organizations and patients they serve, McBride and other experts say.
As members of the most trusted profession in the country, nurses enhance health care organizations’ credibility with patients, policy-makers and the public and help facilitate communication between patients and providers.
They also raise unique issues and concerns when they sit on hospital boards and hold other leadership positions.
“When you get on a hospital board, you ask questions from the background you have,” McBride says. “The banker on the hospital board asks about business plans. The physician may ask about the number of MRI machines. And the nurse may ask about discharge planning. It’s critical to have diverse leadership so that all bases are covered.”
McBride speaks from experience.
She served on the National Advisory Council of the Alcohol, Drug Abuse, and Mental Health Administration and on the advisory committee of the National Institutes of Health’s Office of Research on Women’s Health. And she currently serves on the board of Indiana University Health (formerly Clarian Health), and chairs the board’s Committee on Quality and Patient Safety. Quality measures are improving under the leadership of McBride, the first non-physician to chair the committee.
“There are many qualities I have as a result of a career in nursing that have made me effective,” she says.
Solution: McBride hopes to help other nurses follow in her pioneering footsteps by sharing the wisdom she has gained from five decades in the field. Indeed, she describes her book as a kind of literary mentor to practicing nurses who lack the support of a professional coach.
In The Growth and Development of Nurse Leaders, McBride draws on a deep well of personal and professional experience in nursing to break down the qualities of leadership into digestible bits. She hopes the book will inspire and motivate nurses to find ways to achieve their goals in a complex and changing health care system and society.
“My hope was to make leadership practical,” she says. “This is not a book that’s going to help you read a financial report better. It is designed to help nurses at all levels realize that leadership is within their grasp.”
One barrier to leadership is that many nurses feel that they can’t be leaders unless they hold administrative positions, McBride says. But that is simply untrue. “Look at Mary Wakefield, the head of the Health Resources and Services Administration. She is a leader today because she demonstrated leadership at every stage of her career.”
Another hurdle is the conventional definition of leadership, she says. “It would appear that only charismatic, extroverted people could be leaders. But the reality is leadership comes in many flavors.”
McBride knows this first hand.
Her own emergence as a renowned nurse leader and internationally recognized scholar may be surprising, given her background as the daughter of an immigrant family in working-class Baltimore where few people—including her father—finished high school.
In the 1950s, McBride won a scholarship to Georgetown University, where she completed a degree in nursing. She then went on to earn a master’s in nursing from Yale University and a doctorate in developmental psychology from Purdue University.
During her illustrious career, she has held several prominent leadership posts, including dean of the eight-campus School of Nursing at Indiana University and president of Sigma Theta Tau International and the American Academy of Nursing.
“It took a long time for me to realize I was capable of being a leader,” she says. “I hope this book will help other nurses realize that they too can become leaders—and to reach that conclusion more quickly.”
RWJF Perspective: McBride is chair of the National Advisory Committee of the Robert Wood Johnson Foundation Nurse Faculty Scholars program, which cultivates nurse leaders by providing talented junior faculty in academic nursing with three years of career development support through mentorship, leadership training and salary and research support. The Foundation also supports bringing more nurses into key decision-making positions; to do that, it created Nurse Leaders in the Boardroom, which was designed to facilitate relationships between health care organizations and nurses, and to train future nurse leaders.