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Three Keys to Unlock the Power of Nurse Leadership

Nurse often face barriers to leveraging their leadership potential, both as clinical experts and in formal leadership positions. What actions can health professionals, advocates and others take to harness the leadership abilities that nurses at all levels inherently have?
Paulo Fabre Paulo Fabre
Adrianna working at the Luzia de Pinho Melo Hospital ICU

Nurses account for half of the global health workforce. At 27.9 million strong, nurses, 90% of whom are women, are invaluable to health systems and patient care but often face barriers to leveraging their leadership potential, both as clinical experts and in formal leadership positions. This is not only detrimental to nurses’ professional, economic and social mobility, but it impedes health innovation at large.

There are several factors at play—though gender is one notable lens through which we must assess these challenges. Though they hold the lion's share of health roles, very few women occupy health leadership positions. In the United States healthcare industry, women lead just 19% of hospitals, hold 13% of CEO roles and make up only 33% of senior leadership positions. Nurses—of all gender identities—often struggle to rise in ranks in part because of the gendered perception of nursing as a “feminine” and “nurturing” profession and, thus, less equipped or qualified to lead teams, departments and facilities, as described in a new article by Barbara Stilwell in the Creative Nursing journal. Stilwell goes on to note that these biases have real-world consequences on how women’s work is valued and compensated. Further, health profession leadership is often associated with specific roles or titles; but for nurses, leadership is a set of skills that they exercise every day.

In February, the Johnson & Johnson Center for Health Worker Innovation brought together a panel of speakers including health workers, academics, physicians and advocates from around the globe for a Front Line in Focus virtual event to explore key solutions to improve access to leadership opportunities for nurses. With 180 participants across 39 countries and six continents, the event highlighted the personal experiences of panelists and provided an open forum for candid discourse and novel ideas.

Below are three key takeaways to enable nurses to leverage their full suite of leadership skills and the power of nurse innovation, as informed by our panel of leaders.

1. Traits valued in nursing often conflict with those that are associated with good leadership—they shouldn’t.

“I did not know I was a leader until others “forced” me to be a leader,” Eunice Ndirangu, Dean of the School of Nursing and Midwifery of Aga Khan University, shared.

Her statement resonated with the other speakers who agreed that nurses must develop a mindset shift to perceive themselves as leaders and truly unlock their potential. “We must redefine what leadership is,” Ndirangu declared. Traditional characteristics of leadership, such as forcefulness and other attributes often associated with masculinity, often have harmful impacts on work environments across professional disciplines. Several speakers affirmed that these perceptions undermine, in particular, young nurses’ confidence to lead. If both nurses, as well as other health workers and people in power in health systems, acknowledge strong leadership can come through compassion, empathy and nurturing—all of which are often seen as “feminine” traits which are also integral to nursing—nurses have a better chance to realize their potential.

Reimagining successful leadership also means reimagining work environments so that nurses can thrive. Dr. Nadine Hachach-Haram, surgeon, TED speaker and founder of Proximie, spoke directly to physicians and health system leaders and administrators, calling on them to create a culture that enables nurse leadership: “As a leader, you are responsible for the culture you foster. Foster environments in which it’s okay to learn from mistakes.”

2. Collaboration and solidarity in nurses’ networks can foster nurse leadership.

“Pushing for capacity-building and having a network where you can exercise what you have learned and contribute to the discussion on the issues confronting nurses and the health system is how we hone the nurse leaders for the future,” reflected Sheila Bonito, Professor and Project Coordinator of NurseLEAD Leadership Course for Advanced Practice in Public Health Nursing at University of the Philippines Manila College of Nursing. Nursing networks can help nurses learn from each other and establish solidarity so they can grow together and support one another.

At the same time, “we need to invest in the future of nursing through graduate and undergraduate programs,” added Isabel Mendes, professor at the University of Sao Paulo Ribeirao Preto College of Nursing, Brazil. Considering a workforce composed of only 25% of nurses holding degrees, and 75% of nursing technicians holding degrees in her country, Mendes noted, investing in education while empowering colleagues through networks is essential and will increase the capacity to train future nurses.

Professional and academic initiatives, such as the Nursing Now Challenge, which works with health employers and universities around the world to provide leadership development opportunities for 100,000 nurses and midwives in more than 150 countries by the end of 2022, are increasingly important pathways to set nurses up for success.

3. Nurses are essential drivers of health innovation.

Elisa Konyama of Unjani Clinic Botshabelo reflected on when, as a young woman, she was nominated as a committee secretary in a maternal health meeting. She identifies this critical role as her first leadership position. “They actually needed me like I needed them,” Elisa said.

Nurses have the inherent ability to lead in all areas of health, but they don’t always perceive themselves as leaders beyond the bedside. Despite exercising a set of skills essential to leadership daily, nurses are seldom formally recognized through titles. As Isabel Mendes shared, “In the moment, nurses sometimes don’t see that what they’re doing is an innovation and should be shared with other nurses.” When nurses’ everyday innovations are recognized and shared widely, they can transform patient care and how health systems function.

Nurses’ experience on the front lines provides invaluable support and insight for innovation. Dr. Joel Selanikio, physician and TED speaker, celebrated nurses' role at the forefront of mobile health, or mHealth. “Nurses who have access to phones will shape mobile health care technologies, not just benefit from it.” As the primary users of new health technologies, nurses have the unique ability to influence health policy as it relates to patient experiences, health outcomes and breakthroughs in innovation. Where nurses have been enabled to lead health services, there have been better health outcomes, retention and greater innovation.

What's next?

As Liz Madigan, Chief Executive Officer of Sigma Theta Tau International Honor Society of Nursing, concluded, “Nursing leadership happens at every level. If we harness that leadership ability that we inherently have, I think we could change the world.” So, what actions can health professionals, advocates and others take to drive progress?

Each speaker shared some concrete suggestions:

1. Moderator and host of the J&J and ANA See You Now Podcast, Shawna Butler, highlighted how you can get involved by applying for the Nursing Now Challenge to accelerate nurse leadership in your organization. Butler also recommended that all nurses build up their social media presence and amplify their voices to position themselves as leaders and build their networks.

2. International Council of Nurses Chief Nurse, Michelle Acorn, recommended staying up-to-date by following fellow nurse leaders and advocates on social media, including @ICNurses, @MichelleAcornDr and joining the WHO Community of Practice. She issued a nursing leadership challenge that called on nurses, from all backgrounds and levels of experience to 1) Connect on social media and amplify your voice, 2) Advance your competence and confidence clinically as a leader, 3) Be bold—invite your Chief Nurse or Director for a leadership coffee, 4) Be active in an organization committee and with your national nursing association, and 5) Engage a mentor.

3. For Latin American participants, Isabel Mendes recommended joining the Latin American Association for Nursing schools and the Brazilian Council for Nursing.

Do you have suggestions on how to support and advance nurse leadership? Share your ideas on Twitter and tag @JNJGlobalHealth.