Multisystem structure and organization

Nursing Leadership

With the increasing complexity of medical technology and the healthcare system as well as the ebb and flow of nursing needs in national medical centers, more than ever nurses with strong leadership skills are required at the patients' bedsides in addition to those in administrative positions. The complexity of healthcare is compounded because of the level of need not only in hospitals but also in physicians' offices, clinics, homecare agencies and long-term care facilities. In addition, as the population ages, the number of patients with multiple diagnoses with increasing severity is steadily rising (Lippicott Williams & Wilkins, 2006). Nursing professionals must therefore have a broad knowledge base about these multisystem conditions and how to assume leadership roles within them. "Nursing requires strong, consistent and knowledgeable leaders who are visible, inspire others and support professional nursing practice" (Canadian Nursing Association, 2002, np). However, although nursing educational programs train new nurses on how to operate the latest technology and complex medical equipment, these new nurses rarely get the opportunity to apply even basic leadership skills once at the patient's bedside (Valentine, 2000). A mentorship/educational system must be in place that progresses from the nursing curriculum in the school directly into the healthcare facilities and into continuous improvement through continuing education.

The supply of good leadership in healthcare has diminished, because smaller numbers are entering the profession and nursing is not developing leadership characteristics for clinical nursing practice (Valentine, 2000). Horton-Deutsch and Mohr (as cited in Valentine) found an "absence of nursing leadership" that directly contributed to the students' unfavorable opinions on their profession, and there is a critical need to "develop one's own leadership skills as well as those of one's staff." Nursing is responsible for motivating and supporting new members of the profession when they become competent clinicians. Nursing must also make these nurses competent leaders.

Sherman and Pross (2010) stress that the development of leadership skills must be seen as an ongoing journey. However, present-day leaders are challenged with knowing how to predict the knowledge, skills, and abilities needed in the future healthcare delivery system. Sherman and Pross recommend a competency model that is becoming increasingly popular called the Nurse Manager Leadership Collaborative (NMLC) Learning Domain Framework. This model was developed to identify competency domains required by present and future nurse leaders. The NMLC also developed a list of key competencies that delineate skills needed by nurse managers in each competency domain area. This inventory is appropriate for leadership instruction for nurses, unit facilitators, and emerging leaders.

One of the most important areas in this framework is the starting point with the nurse him/herself or what is called the Leader Within (Sherman & Pross, 2010). For a person to develop leadership skills that individual must first understand him/herself. Personal mastery is an essential factor in leadership success, and excellent leaders are self-confident, empathetic, trusting of others and have the ability to empower others. With this foundation of self-esteem and confidence, the nurse can acquire the other traits needed on the competency inventory. This self-confidence does not develop overnight. It must be encouraged and developed throughout the nursing education so that upon graduation into the clinical setting, the nurses already have the personal empowerment to take on a leadership role. Just as important, nursing needs to continually develop the mentors who will bridge these new nurses from their education into the nursing environment. This requires continuing education to build leaders who others want to follow.

Developing future nurse leaders is a continuous challenge that necessitates structural planning and action. Leadership experts Kouzes and Posner (as cited in Sherman & Pross, 2010) note that the most important contribution current leaders can make for the future is to develop their successors to adapt, prosper, and grow. It is essential for all nursing leaders to groom their future leaders. These emerging leaders will eventual replace them and carry on the critical multisystem work that is being accomplished to improve nursing work environments and of most importance, the outcome of patient care.