Creating Nursing Leadership and Management

Health Sciences

When I think about the challenges of the health profession in the 21st century, a very direct quote from former Health and Human Services Secretary Donna Shalala and Linda Bolton, Head of Nursing at Cedars Mt. Sinai Medical Center comes to mind:

The image that people often have of nurses as acute care handmaidens…. Is so out of date and inaccurate that it may impede the nation’s ability to harness the expertise and vision of these professionals in ways that can produce the needed improvements in the quality of health care…. The evidence is clear that we must shift our focus to the care that individuals and populations need to improve and protect their health, whether it means changing the way nurses are educated or addressing the interprofessional competition that results in resistance to the full utilization of nurses (Mason,, 2011, 401).

This may seem a bit of a cynical statement, but when one looks at the statistics for nursing shortages, the demographics of an aging population, and the clear importance of healthcare professionals now that there is an enactment of the Affordable Care Act, nurses are even more critical than ever before. Registered nurses constitute the largest healthcare occupation, with almost 3 million job openings as of 2011, 60 per cent of which are in hospitals (U.S. Department of Labor, 2011). Further, the professional nurse of today must face a number of challenges like highly charged political environment, budget reductions, changing reimbursement packages, staffing shortages and fast-paced technological advances. Even more significant is the actual pace which the modern nurse must strategically anticipate the future needs of the healthcare system. No longer is it even feasible for the professional nurse to be anything but a highly-competent and energized leader (Schmidt, 2006). In fact, the American Organization of Nurse Executives defined the core competencies of nurse leaders as: 1) Communication and relationship building, 2) Knowledge of the health care environment, 3) Active leadership, 4) Professionalism, and 5) Business Skills (AONE, 2005).

From a personality perspective, a Registered Nurse combines the abilities of clinical knowledge with the subjective sides of past-knowledge and empathy, communication, understanding other’s reactions and problem solving to find solutions, and is, in fact, a more multi-dimmensional way of looking at the patient in a holistic, rather than disease based, model. Modern healthcare and nursing are more complex than ever before. The nurse’s role is far more than simply an assistant, and requires the understanding and application of a large toolbox to deal with many different situations within the course of any given time period. There are two ways of approaching an interdisciplinary issue within modern nursing: 1) preparation and expertise, and 2) using other human resources. In the first, preparation might include classes in psychology, communication, ethics (philosophy), anthropology or sociology (dealing with diverse populations), and business issues (budgets, scheduling, etc.). In the second, it is important to take an active and contributing role within an interdisciplinary team since we now view the client (patient) in a more holistic manner. This would include being part of the team that works on mental health issues, family or social situations, literacy to understand procedures or medications, specialists, general care, advocacy, and above all, helping the patient take some responsibility for their own healthcare – as a partner in become well (Borkowski, 2011). The other issue I discovered about modern nurses is that nursing is about both covert and overt leadership — or servant leadership. Servant leadership, in brief, is a way to provide opportunities for others to succeed through allowing them making situations easier — finding ways for others to succeed by helping to prevent previous mistakes or errors you might have made, etc. (; Clark, 2009)

We must add to this challenge the very real issues of time requirements in which to implement leaders who can teach effective courses to nursing students while remaining active in scholarship and practice (Ashcraft,, 2007). Additionally, to be able to remain professional involved in clinical care and to take on the challenge of a leadership role in academics requires a great deal of passion and commitment to the challenging environment — a true personality that must become a change agent (Adams, 2007).

Is this a daunting time for the professional nurse? Are the challenges seemingly overwhelming at times? Are we, as a nation, at a critical juncture in the nursing profession? The answer is an overwhelming YES! However, upon reflection, what better time to be in the profession that at the locus of change with the ability to become part of the change paradigm!

I am reminded of the story of The Hundredth Monkey, which has many permutations relevant to our situation. In brief, scientists were studying snow monkeys on the islands of northern Japan who ate sweet potatoes that grew near the coastal bog waters. One day, on Island A, one of the scientists got hungry, and pulled up a potato to eat as a snack. Of course it was covered in muck and sand, so the scientists washed it off in the ocean. Unbeknownst to the scientist, a dominant female monkey was watching this and later that day, also washed her sweet potato. Soon, all the monkeys in her tribe were washing their sweet potatoes — they probably tasted a lot better clean and with the salt from the ocean. For argument’s sake, let us say that on Island A there were 100 monkeys — oddly, when the 99th monkey taught the 100th monkey to wash its potato, monkeys on Islands B, C, and D. also began to wash their potatoes.

This is extremely relevant to our profession in the early 21st century. However we want to define this phenomenon, it has happened again and again throughout history — once enough humans imagine something, then it becomes real. It might mean technological change, it might mean spiritual change, or it might mean attitudinal change or a combination. I am excited about this in relation to nursing leadership because we can ensure that somewhere we touch that 100th monkey that will forever change the paradigm of nursing. It may be through spiritual ministry at the hospital or care center, it may be working in a busy ward, or it may be coaching and guiding the next generation of nurses so that they, too, can help find that 100th monkey.

As far as career goals, I believe my educational and clinical knowledge from Kaplan will assist me in the initial stages of a nursing career, then moving forward to either a specialization or working toward a Family Nurse Practitioner. This will allow me a broad base from which to help more individuals as well as stay challenged within the medical profession. Family Nurse Practitioner. This will allow me a broad base from which to help more individuals as well as stay challenged within the medical profession.. This is particularly important in the managed care situation, and when one might wish to develop a degree for an eventual position as an Advanced Practice Nurse or Nurse Practitioner.

I am confident that I can meet this challenge based on the broad academic background I received, my ability to think critically and strategically, my love of life-long learning, my skill and competency in medicine, my compassion and empathy, and frankly, due to some good old-fashioned tenacity. However, it has been said that our greatest strength is often our greatest weakness. At times, being overly empathetic to patients is both psychologically trying and can sometimes ruin objectivity. I believe I need to continue to develop a kind and empathetic manner while remaining objective and mindful of my role — and to remain professional so that I am able to do my upmost for all patients. My personality traits also show that I have the ability to be both a covert and overt nursing leader — both of which are essential within the modern healthcare environment. I listen well, but am able to use techniques like quality questioning to help engender greater discussion about issues that are pertinent to the issue or meeting. I tend to be optimistic, the “cup is half full, rather than half empty,” and I have a genuine care and love for the wide divergence and diversity of the population.

This confidence is reflected in the personality tests I recently undertook, showing that I have a strong social and conventional level, which will engender my tenacity to complete courses, to understand and work with tangible problems, and to develop a differing nature when it comes to handling crisis or critical situations. My notes on being enterprising show that I will be able to look outside the box and handle situations that require more thought, past knowledge, and creativity to become successful. My lowest score is in being realistic, which for me is a positive attribute

As we see time and time again — from the professional mountain climber or sporting individual to the inventor to the physically challenged individual — all can be overcome if one has the desire and will to ensure success backed up with the competency and skill to perform. The skill and knowledge come from both academics and experience, the desire and commitment from inner personality traits. I look forward to a long and challenging nursing career.


Adams, L. (2007). Nursing academic administration: who will take on the challenge?

Journal of Professional Nursing. 23 (5): 309-15.

American Organization of Nurse Executives. (2005). AONE Nurse Executive Competencies. The Nurse Leader. 3 (2): 15-21

Ashcraft, A., (2007). Time requirements for implementation of the course facilitator role. Journal of Nursing Education. 46 (7): 334-8.

Borkowski, N. (2011). Organizational Behavior in Health Care. Sudbury, MA: Jones and Bartlett.

Clark, C. (2009). Creating Nursing Leadership and Management. Sudbury, MA: Jones and Bartlett.

Critical Thinking Company . (2013, June). Critical Thinking and Nursing. Retrieved from

Mason, D., (2011). The Nursing Profession: Development, Challenges, and Opportunities. Princeton, NJ: Jossey-Bass.

Schmidt, K. (2006). The Invention of a Nurse Leader. The Nurse Leader. Retrieved from:

U.S. Department of Labor. (2011). Occupational Employment — Registered Nurses. Bureau Of Labor Statistics. Retrieved from:

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