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Preparing the Nurse Executive of the Future

Sanford, Kathleen, DBA, RN, FACHE, FAAN; Janney, Michelle, PhD, RN, NEA-BC, FAAN

JONA: The Journal of Nursing Administration: April 2019 - Volume 49 - Issue 4 - p 171–173
doi: 10.1097/NNA.0000000000000732
Departments: AONE Leadership Perspectives

This month's edition of AONE Perspectives column discusses the challenges for nurse leaders and particularly nurse executives in the future. How can we prepare ourselves for change and to be effective and what will nurse executive practice look like in the future?

Author Affiliation: Executive Vice President and Chief Nursing Officer (Dr Sanford), CommonSpirit Health, San Francisco, California; Executive Vice President and Chief Nurse Executive (Dr Janney), Indiana University Health, Indianapolis.

Correspondence: Dr Sanford, CommonSpirit Health, 198 Inverness Dr West, Englewood, CO 80012 (

As nurse executives, how can we successfully prepare to lead in changing times? Imagine some of these scenarios as we contemplate healthcare leadership in 2025, less than a decade from now:

  • Inpatient-centric care replaced with the center of care in the home
  • Dissolution of traditional organizational boundaries
  • New technologies disrupting old work practices
  • Leaders communicating across multiple channels
  • Staff meetings evolving to daily messages delivered through social platforms

Our environment is changing, and so is our workforce. Deloitte's Future of Workforce 1 reports that baby boomers will be working into their 70s and 80s, and millennials are entering the nursing workforce at nearly double the rate of boomers. Nurse executives will lead across cultures and generations with different values and expectations. Early careerists will anticipate many employers and expect expanded experiences at every stage. Measures of turnover will be redefined. Managing diverse types of workers, both contingent and virtual, will reinvent traditional work locations, staff assignments, and schedules.

In an increasingly complex environment, future-ready leaders will lead through influence with a social process guiding alignment and commitment. They will think of possibilities instead of constraints, be comfortable with big data, and use it to make informed judgments. Tomorrow's leaders will constantly test new ideas rather than rely on conventional wisdom and years of experience.2

Nurse executives of the future will be evaluated on their agility, creativity, and ability to connect teams. Leadership trends identified by Forbes Coaches Council3 suggest leaders will be expected to help employees thrive in all aspects of their lives, take a stand on social and political issues as ambassadors for the values of their organizations, and tackle workplace sexual harassment and violence. Tough-minded optimism during turbulent times will be essential.

Taylor4 asks, “How can accomplished leaders be sure that all they know—their hard-earned wisdom and experience—doesn't limit what they can imagine? Leaders will question, “Am I learning as fast as the world is changing?” And, “When was the last time I did something for the first time?”

The future is already being shaped, creating a need for new learning opportunities to ensure nurse leaders are ready for what will come tomorrow and beyond. The American Organization of Nurse Executives (AONE) recognizes this and sponsors multiple programs to prepare nurse managers and executives for a dynamic future. The most recent offering is the AONE Nurse Executive Fellowship.

This 9-month program is intended for nurses who are new to senior executive positions. It is personalized (each participating leader receives a validated personality assessment followed by 1:1 coaching) and team based. (A cohort of nurse leaders with 0 to 3 years of experience in an executive role will learn together through dialogue, sharing of experiences, experiential simulation, and situational analysis.) This design acknowledges that leaders are individuals with different styles and learning needs, but that essential general principles and competencies must be mastered if executives are to thrive in a rapidly changing environment. These include strategic thinking and decision-making; executive presence (EP) and C-suite communication skills; methods for innovation and change leadership; governance and board relations; and executive business skills, as well as how to leverage big data.

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Strategic Thinking and Decision-Making

An accelerated rate of change in just about everything (technology, consumer expectations, workforce cultures, payment systems, government mandates and regulations, societal norms, population composition, scientific breakthroughs) is already here. This mandates an ability for executives to make (and change) assumptions and decisions while thinking strategically. Nurse executives are often the leaders who determine and implement tactics (effective and efficient methods or models to accomplish strategic objectives). They also must be part of the team that understands the changing world and develops strategies that can adapt to drastically altered realities. That is going to require an ability to let go of past practices (no matter how successful these may have been before) and to find new solutions to both old and new problems.

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Executive Presence and Communication Skills

Executive presence is something that is easily recognized in highly successful leaders but is not always simple to describe. It has 3 components: how a person looks, acts, and speaks. According to Hewlett,5 EP is the “missing ingredient between merit and success.” In other words, some individuals who have the qualifications and abilities for leadership are not promoted or are not accorded the respect they should receive when they are promoted because they are not perceived to be confident, poised, credible, or clear and concise in their communications. Female executives are especially at a disadvantage because of an unconscious (or even conscious) bias that favors males whose body language, confident bearing, and even voice pitch make them look like the proverbial executive.

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Innovation and Change Leadership

All industries are looking for individuals who are able to break precedents by changing methods, departing from traditional models, and implementing new or different solutions. That talent is rare because it is much more difficult to be innovative than most people realize. Humans and organizations suffer from inertia caused by their past success, current comfort level (even though they can see discomfort on the horizon if they do not change), and fear of doing the wrong thing (or making a mistake). Leaders add great value when they take informed risks, innovate, and then manage their new models or solutions with evidence-based change management techniques.

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Governance and Board Relations

Chief executive officers are the primary executives that interact with the organization's governing body. However, the other C-suite members, including the chief nursing officer, are exposed to the board and will need to understand the appropriate relationships, communications, and role delineations between those who govern and those who manage. Board members could be very familiar with the healthcare roles that businesses employ, such as the chief financial officer, chief legal officer, chief strategy officer, or chief human resources officer. However, clinical leaders may be an enigma to board members who have not been involved in healthcare. Nurse executives have an opportunity, through their own EP, to help board members understand that nurses and nurse leaders are educated professionals vital to the health of individuals and communities. They also can establish themselves and their nurse colleagues as experts in quality, safety, and patient experience, which are all hot topics for healthcare boards.

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Executive Business Skills and Big Data

At the organization's highest level, nurse leaders are voices for frontline caregivers, patients, and consumers. To do this effectively, they must command influence on executive decisions. This requires a credibility that can only be gained and maintained if individual nurse executives have mastered requisite skills and acumen to manage the nursing enterprise. In addition, nurse executives need the education and vocabulary to participate and contribute to strategic, tactical, financial, and legal/compliance discussions. Among these skills is the appropriate use of what is being called big data (very large data sets). When these data are competently analyzed, it can be an effective tool for helping healthcare organizations better understand their operations. With information gleaned from their own and other organizations' data, healthcare systems will be better able to forecast and strategize for the future. Nurse executives will need to gain skill in using these data.

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Preparing for the Future

Change and the reality of limited resources will lead to greater scrutiny of the value added by individuals and groups, including leaders. Today, nurse executives have much to offer healthcare organizations because of their expertise in both wellness care and sick (medical) care. That will not be enough to demonstrate value in the future. Nurses' value as executives in an evolving world will be enhanced when they have honed their strategic thinking and decision-making skills. Development of an EP will increase their ability to influence the future for their organizations and communities. By practicing innovative thinking and evidence-based change management, they can help both their systems and care teams thrive in a transformed environment. With a better understanding of governance, along with access to boards, they can ensure that those at the very top of their organizations understand and appreciate the unique contributions of nurses to individuals, communities, and the healthcare system. Competency in executive business skills will support all of these imperatives for nurse executives of the future.

The AONE Executive Nurse Fellowship has been planned to educate leaders in a rapidly changing world. We believe well-prepared nurse executives are essential to the well-being of all the individuals and communities we serve.

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1. Deloitte Touche Tohmatsu Limited. The Future of the Workforce: Critical Drivers and Challenges. Deloitte Touche Tohmatsu Limited; 2016. Accessed December 1, 2018.
2. What Future-Ready Leaders Do Differently. 2018. Accessed December 1, 2018.
3. Forbes Coaches Council. (2018). 14 Leadership Trends That Will Shape Organizations in 2018. Accessed December 1, 2018.
4. Taylor B. 2017. The 4 Kinds of Leaders Who Create the Future. Accessed December 1, 2018.
5. Hewlett SA. Executive Presence: The Missing Link Between Merit and Success. New York: Harper Collins Publishing; 2014.
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