October 23, 2012

Ann Campbell, RN-BC, MPH is a hospice nurse at an inpatient palliative and hospice care program in New York, and is currently an NP student at Hunter Bellevue School of Nursing. She is a research associate for the CHMP.

In nursing, we often joke about needing a feeding tube or urinary catheter ourselves. In the 14-hour workday we are often so focused on patient needs that sometimes it’s a luxury to take a break for food or even use the bathroom.

Every nurse I know wants to help people; patients and their loved ones know this from firsthand experience. However, nurses function within the confines of a system driven by economic, political, and legal forces. The challenge to turn caring into policy can seem insurmountable.

As a public health policy masters student at Columbia University, the topic of nurses in leadership positions triggered a memorable discussion. One classmate, when asked if she thought a nurse could become a CEO of a hospital or other health care organization, responded with a resounding “no.”  Nurses lack the necessary clinical and leadership training, she argued. My classmate raised a provocative question; are nurses prepared to become leaders in the redesign of healthcare?

I believe that nurses are uniquely equipped to lead. In fact, a nurse now leads the Center for Medicare and Medicaid Services (CMS).  And many others are CEOs of health care organizations.

Nurses must have the necessary tools and knowledge to influence this complex system. Obviously, the nursing role has evolved dramatically since the days of Florence Nightingale. Modern nursing education deeply involves sciences, and benefits from accomplished theorists and instructors. There are several masters’ level degrees that prepare nurses for clinical, administrative, and educational leadership. Moreover, two doctoral level advanced degrees are available: the research-focused PhD and the clinical leadership DNP.

The clinical leadership Doctor of Nursing Practice (DNP) coursework has been refined by evidence from the Institute of Medicine (IOM) reports: To Err is Human: Building a Safer Health System (1999), Crossing the Quality Chasm (2001), and Health Professions Education: A Bridge to Quality (2003). DNP clinicians are trained in health policy, scientific underpinnings of practice, organizational/systemic leadership, analytics, health information technology, and interdisciplinary collaboration. These tools can be utilized to produce quality healthcare delivery models.

Development of the DNP curriculum has been so effective that the American Association of Colleges of Nursing (AACN) took a position in 2004 recommending that all APNs be doctorally-prepared. While this is what AACN wanted, the plan will not go into effect by 2015.

Despite this progress, nurses must prepare for the challenges ahead. This includes caring for the 32 million newly insured patients with implementation of the Affordable Care Act over the next 10 years as well as a rapidly aging population. An estimated 1.2 million new nurses are needed by 2020. It also includes developing a strategy for changing the mindset of those who do not understand the leadership capacity of nurses.

The IOM report on the Future of Nursing sets forth clear goals for nurses to lead in this dynamic environment:

  1. Practice to the fullest extent of the scope of their education and training
  2. Achieve higher levels of education and training through an improved education system that provides seamless progression
  3. Provide opportunities for nurses to assume leadership positions and to serve as full partners in healthcare redesign and improvement efforts
  4. Improve data collection for more effective workforce planning, information infrastructure, and policymaking

The implications for practice, research, and advocacy are extensive.  With the right education, nurses will lead innovative transformations in healthcare into the future.