One of the recommendations in the recent Institute of Medicine report, The Future of Nursing: Leading Change, Advancing Health, is to "prepare and enable nurses to lead change to advance health." How do I see this happening? Here's my top 10 list of what we should do to make this a reality.
Nursing equals leadership. We must reinforce at every level of nursing education that nurses are prepared to deliver what leaders are expected to demonstrate—integrity, practical intelligence, communication skills, teamwork, an appreciation of diversity, problem solving, and systems thinking—and show how these caregiving abilities are leadership essentials too, so students can see the connection.
Admit that leadership takes time to develop. Read the lofty expectations people have for leaders, and it's easy to doubt you'll ever be one. The truth is that it takes time to feel empowered to act on our professional authority, particularly if we haven't had many role models. So our educational programs need to describe leadership as an ongoing commitment rather than as a destination and be careful not to equate leadership with having an administrative title.
Don't hesitate to "pretend" to be a leader. When you're new in a role, you may not feel comfortable acting on your own authority at the start, yet you know enough to have a sense of what that mythical creature "the good leader" would do—so don't hesitate to "pretend" to be one. That ploy may help you figure out what to do next.
Leadership doesn't mean just one thing. There's a leadership hierarchy in nursing that ranges from individual performance and productive teamwork to inspiring higher performance in others and creating enduring excellence, and each one of us must be challenged to keep developing over the course of our careers.
Leadership development must be a feature of every work setting and professional association. Thanks to Patricia Benner's classic work on how nurses move from novice to expert over time, we're clear that no nurse can be a finished product from the start. Now we need to flesh out how workplaces and professional associations facilitate leadership development over the course of a nurse's career.
Nurses need to be transformational leaders. Transformational leadership means being able to move our institutions or some aspect of health care down a new path with different expectations and structures. Thus, innovation needs to be taught in our curricula and rewarded in our workplaces.
Nurses need to be capable of strategic vision. We need to be able to perform a SWOT analysis—assessing internal strengths and weaknesses and external opportunities and threats—and then build on strengths as we seize opportunities. A strategic sensibility can be developed by reading broadly and deliberately looking out for trends.
If you're going to have a vision, it might as well be for excellence. Some area of excellence is within everyone's reach and we should be evaluated on how close we come. Excellence is a stretch goal, but if everyone stretches some, the shape and quality of health care can be transformed.
Transformative leadership requires that nurses shape more than the purview of nursing. You get to this point by understanding what nursing contributes to the world of ideas, developing a personal reputation for being accomplished, then increasingly operating in interdisciplinary and policymaking forums.
Nurses need to seize the opportunities handed to them. Last year, the Robert Wood Johnson Foundation commissioned Gallup to survey U.S. opinion leaders about the role nurses play in health systems. More than 80% of respondents said they'd like nurses to have even more influence than they do now on preventing errors, ensuring quality, promoting wellness, increasing efficiency, and addressing the needs of an aging population. We need to position ourselves on boards as experts in these areas.