Ever since Florence Nightingale first came to the aid of wounded soldiers with her legendary lamp a century and a half ago, nurses have broken through some of the toughest social barriers and risen to positions of prominence, improving and saving lives, conducting groundbreaking research, and revolutionizing health and health care along the way.
Now, the long story of nurse leadership may be starting a new chapter, some nursing experts say.
A confluence of events is creating a climate that some experts say could accelerate the movement of nurses into executive-level positions in health care, government, business and other sectors and will help nurses at all levels to take on more informal and formal leadership roles within their organizations. These events are building on decades of work within and outside of the nursing community to promote nurse executives and cultivate nurse leaders.
“All of these things are saying, ‘Hey Nurses! This is your time!’ And I think nurses are waking up all over the country and saying, ‘Hey! Did somebody call my name?’ It is so exciting!” said Beverly Malone, Ph.D., R.N., F.A.A.N., head of the National League for Nursing.
There could be a wealth of opportunities for nurses to move into positions of leadership as health care executives, policy-makers, government officials and business leaders, Malone said. Among the factors driving these opportunities: last year’s passage of a law overhauling the nation’s health care system; the release of a groundbreaking Institute of Medicine (IOM) report calling on nurses to contribute as essential partners in the redesign of the nation’s health care system; and the multifaceted Future of Nursing: Campaign for Action supported by the Robert Wood Johnson Foundation (RWJF) to implement the IOM report’s recommendations.
“Now more than ever, the nursing profession is well positioned to expand its impact on improving the health care system,” said David Goodman, M.D., M.S., a professor of pediatrics and health policy at Dartmouth Medical School and a member of the RWJF-supported study committee that drafted the IOM report. “Nurse leaders and executives have a unique and important role to play in health care decision making. They have a broad perspective on health and health care, they know how to improve communication between and among patients and providers, and they place emphasis on patient needs and priorities,” he added.
These events build on numerous other initiatives undertaken by the Foundation and other nonprofit and advocacy organizations to help nurses move into executive-level and leadership positions within and outside health care. There is even an effort to create the position of a “National Nurse” to advise the public on health matters alongside the Surgeon General.
“Nobody’s starting from scratch on this,” said Pamela Thompson, M.S., R.N., C.E.N.P., F.A.A.N., chief executive officer of the American Organization of Nurse Executives (AONE).
Indeed, nurse executives and leaders are nothing new.
In the wake of Nightingale’s giant footsteps have come nursing titans such as Dorothea Dix, a pioneering advocate for the mentally ill, and Clara Barton, the founder of the American Red Cross. Other leaders include modern-day figures such as Shirley Chater, Ph.D., R.N., who served as U.S. Commissioner of the Social Security Administration under President Clinton, Mary Wakefield, Ph.D., R.N., current head of the Health Resources and Services Administration in the U.S. Department of Health and Human Services, and Sheila Burke, R.N., M.P.A., F.A.A.N., the former chief-of-staff to former Senate Majority Leader Robert Dole of Kansas who chairs a blue-ribbon panel guiding the Campaign for Action.
The commitment by non-nursing as well as nursing organizations around the country to identify and prepare emerging nurse leaders could open up more doors for nurses to serve in executive and other leadership roles, Malone and others say.
“There is a much greater realization that the people who are on the front lines, who are the nurses, need to be very, very involved in health care system redesign,” said Amy Gillespie, R.N., M.S.N., Ed.D., the Nurse Leadership Advisor at the Nurse Leadership Institute of Virginia. “I definitely see the focus on developing nurses as good leaders as being a priority.”
There is no data tallying the number of nurse executives in the nation’s health care organizations, and there appears to be no official definition of nurse leader or nurse executive, making it impossible to say whether the actual number of nurse executives and leaders is on the rise.
One small indication of the activity of nurse executives comes from the AONE, where membership shot up from 7,000 to 8,000 in the last year—a major increase for an organization that was founded in 1967. In addition, the number of nursing administration programs, and enrolled nursing administration students, has ballooned in the last decade, according to the American Association of Colleges of Nursing.
A more telling observation comes from AONE’s Thompson, who says nurses have moved in recent decades beyond their traditional executive-level roles as chief nursing officers at health care organizations and are now more likely to hold broader and more senior executive-level positions in and outside of health care organizations and systems.
That trend, she said, is likely to accelerate. “It’s one of the most exciting times in my career, to see the work that’s been in play and all the other forces that are all aligning” to promote nurses as executives and leaders, she said.
Among the forces is RWJF’s Campaign for Action, which is a broad-based, collaborative effort to implement solutions to the challenges facing the nursing profession and to build upon nurse-based approaches to improving quality and transforming the way Americans receive health care.
The Campaign for Action aims to implement the recommendations of the IOM report, The Future of Nursing: Leading Change, Advancing Health, which includes a specific call to cultivate and promote leaders within the nursing profession so they have the skills needed to help improve health care and advance their profession.
The health care reform law, meanwhile, will create new opportunities for nurses to take on innovative roles in health care and to serve in leadership positions.
Ascension of Nurse Executives and Leaders Was Decades in the Making
These nationwide phenomena build on other initiatives over recent decades that have increased the number of nurse executives and cultivated a pipeline of future nurse leaders.
Decades ago, the American Nurse Credentialing Center created a program to recognize health care organizations that were best able to recruit and retain nurses during nursing shortages. A key characteristic of success is an organizational structure that includes nurses in “C-Suite” executive-level positions.
Providing incentives for health care organizations to involve nurses in this way has helped move nurses into executive-level ranks, said Linda Cronenwett, Ph.D., R.N., F.A.A.N., co-director of the RWJF Executive Nurse Fellows program, a three-year advanced leadership program for nurses who aspire to lead and shape health care locally and nationally.
Meanwhile, programs supported by the Foundation and other groups have identified and prepared emerging nurse leaders for positions of authority as executives or as nurse leaders.
In addition to the RWJF Executive Nurse Fellows program, the Foundation, for example, supports Nurse Leaders in the Boardroom, designed to help more nurses sit on boards of directors of the nation’s leading health care and quality organizations; the Nurse Faculty Scholars program, which aims to develop the next generation of national leaders in academic nursing through career development awards for outstanding junior nursing faculty; and Partners Investing in Nursing’s Future, designed to support the capacity, involvement and leadership of local foundations to advance the nursing profession in their own communities.
“Over the last 30 years, as nurses have achieved higher levels of education, higher levels of impact on science, and higher levels of authority within health care organizations, there have been an increasing number of nurses who by virtue of their talent have risen to the top levels of decision-making,” Cronenwett said.
At the same time, society has undergone a cultural shift that has allowed nurses to take on more responsibility and facilitated women’s move into positions of authority, said Fran Roberts, Ph.D., R.N., F.A.A.N., an alumna of the RWJF Executive Nurse Fellows program (2000-2003) who oversees business and clinical developments by creating strategic health care alliances at DeVry, Inc., a global provider of education services. As gender barriers continue to fall, nurses—still predominantly women—will be better able to climb executive ladders, she said.
Still, nurses remain a minority in executive-level and leadership positions, Cronenwett noted. Physicians and hospital employers still dominate most decision-making involving health and health care.
Says Sue Birch, R.N., M.B.A., an RWJF Executive Nurse Fellow alumna (2002-2005) and head of the Colorado Department of Health Care Policy and Financing: “I certainly haven’t met many nurses at the helm of major state agencies.”
Some nurse leaders expect that to soon change.