Nursing's Legacy of Leadership in South Carolina Mandate for Nursing Leadership in South Carolina

South Carolina Nurse, The, Apr-Jun 2003 by Goodman, Petra

Nursing leadership is critical in today's environment in light of a changing health care system and a national nursing shortage. Sociopolitical changes, market and economic forces, and technological advances have altered the regulation, access, provision, and payment of health care services. Escalating costs have led to a decreased growth in in-patient hospital services and conversely to a growth in out-patient services and pharmaceuticals. Advanced technology has led to new models of health care delivery and pharmaceuticals. With the current demographic trend of an increase in the aging population, there is a parallel increase in the number of people requiring long-term care in nursing homes, assisted living, and home care services. The nation is experiencing a nursing shortage due to a) a significant number of nurses retiring within the next ten years, b) a decrease in the number of nurses with baccalaureate and higher degrees, c) and increase in the number of elderly need nursing services, and d) failure to recruit and retain a sufficient number of nurses. The changes in health care and the nursing shortage illuminate the need for leadership within nursing to ensure the viability of the profession. They influence the profession of nursing in a variety of ways, ranging from the education of nurses to practice differentiation across educational level to types of nursing services offered to roles that nurses play in the health care sector. Skilled nursing leaders are needed at all levels of practice, administration, and education.

For a clinical practice discipline such as nursing, providing quality services in concert with the changes in health care delivery and the nursing shortage presents a major challenge to leaders at the front-line-nurse managers. Providing high quality patient care amid increasing public concern, retaining staff in the face of intense labor shortages and increasing nurse turnovers, and meeting rising patient demand with shrinking budgets are among the challenges nurse managers face daily. Nurse managers must address issues, verbalized by embittered staff nurses, regarding staffing, lack of respect, lack of input into decision-making, patient and provider safety, wages, benefits, hours, and working conditions. They must be able to a) leverage staff's knowledge, intellectual skills, and experience with workload b) allocate and ration scarce resources, and c) develop and maintain care standards. They need to collaborate with peers and staff to ensure that their unit or facility is prepared for things to come, whether that is a change in the care delivery system, new care procedures, or new actions from government, regulatory, or reimbursement sources. Nurse managers can effectively deal with these challenges, issues, and workload requirements only through equipment with leadership skills in areas such as problem solving, decision-making, communication, mentoring, coaching, precepting, negotiation, and conflict resolution.

Nurse administrators and executives require leadership skills which can effectively promote an organizational culture that responds positively to change in a timely manner. The incessant change demands leadership skills to deal with the ambiguity and uncertainty that restructuring brings. Nurse administrators and executives must respond to transformational changes and a) deliver care to those who are truly in need of services and who might not otherwise receive care, b) reconceptualize health care delivery, c) design new models of care, and d) make contributions to social change. Nursing leaders at the administrative and executive level are needed for the vision and the advocacy of models of care that maintain quality outcomes while being cost-effective. There are challenges, however, because at the same time nurse administrators and executives are under great pressure to a) control costs, b) minimize treatment time, c) minimize health care professional time with patients, d) limit care to the growing population of uninsured, and e) focus on those patients, treatments, and procedures that maximize income.

The transformation of health care and the nursing shortage also forces nursing academe to adapt if nursing is to continue to be taken seriously as a full-fledged member of academe. The onus is on academic leaders to align education with changes in health care and to design programs which will recruit and retain nursing students. Leadership is necessary to transform traditional educational models and incorporate curricula with increased attention to multiculturalism, consumer demands, increased use of technology inclusive of information systems, emerging practice trends, increased emphasis on quality, cost-effective health care, and critical thinking, negotiation, collaboration, conflict resolution and other requisite skills as the forces that will shape future nursing practice. Infrastructure to provide increasingly more capacity for computer-based and distance learning and provision of experiential learning in the realm of telehealth need to be created. Nursing leaders are needed to establish congruence between the educational enterprise and changes in health care to respond. Therefore, leadership skills are essential for nurse educators to engage in innovative teaching, clinical practice, and research that lead to learning and work environments that are conducive to the creativity of faculty and students while effectively responding to changes in health care and the nursing shortage.