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Discussion:
Leaders use systems-based practice to empower other nurses. Considering your current or former clinical setting, share how you will use principles of systems-based practice to grow in your role as a leader in nursing. Include a scholarly outside source to support your answer.
Information:
Leaders in nursing empower others. In this discussion, you will be exploring the connection between systems-based practice and your growth as a leader in nursing. As you post this week be sure to include with leadership looks like across the continuum of care. How do you lead to advocate for staff or direct reports? How do you lead in advocating for patients that may be involved in care across a system, for example, outpatient clinic, surgical services, critical care, med/surg unit, skilled nursing facility might be an example of one journey.
For those of you how work in ambulatory, procedural or non-traditional settings it might look very different.
How do you lead from the bedside in an informal leadership position as nurses are all leaders by definition. If you are a Leader in a formal leadership position what does that look like?
By now, your APA Format should be shaping up so you have solid in-text citations and you are using the library for journal articles to support your posts
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Clinical Nurse SpecialistA Copyright B 2017
Wolters Kluwer Health, Inc. All rights reserved.
Nurse Entrepreneur
Leadership in Nursing
The Importance of Influence
Susan Alexander, DNP, ANP-BC, ADM-BC
T
he delivery of high-quality patient-oriented healthcare is an ongoing need, changing rapidly and
requiring flexible and talented leadership to navigate
its many changes. Key to the implementation and success of
these changes is the estimated 4.1 million professionally active nurses in 2017.1 In 2011, the Institute of Medicine, now
known as the National Academy of Medicine, published its
landmark report, The Future of Nursing: Leading Change
and Advancing Health, addressing the critical role of
nursing in improving accessible and high quality care for
patients.2 The report discussed the need for a transformation in leadership, in which nurses would be ‘‘Ifull
partners, with physicians and other health professionals,
in redesigning health care in the United States.’’2(p33Dr)
Despite the acknowledgement of the need for nursing’s
contribution and the responsibility for existing leaders to
foster the growth of emerging leaders,3,4 barriers to the promotion of nurses into executive positions continue to exist.
A recent survey of hospitals found that only 6% had nurses
as board members.5 In the same survey, respondents identified the need for nurses to play a greater role in reducing
medical errors, increasing quality care, increasing efficiency,
and reducing costs, stating that nurses should have more of
an impact in policy development and healthcare planning.6
How can nurses use history and expertise gained at the bedside to become key decision-makers in the boardroom?
Nurses comprise the largest number of professionals in the
healthcare workforce and are consistently rated as the most
trusted profession.7 Why does their influence in practice environments continue to be limited? Finding answers to these
questions began as a research interest and evolved into a
Author Affiliation: Associate Professor, College of Nursing, University of
Alabama in Huntsville.
The author reports no conflicts of interest.
Correspondence: Susan Alexander, DNP, ANP-BC, ADM-BC, College of
Nursing, University of Alabama in Huntsville, 301 Sparkman Dr, Huntsville,
Alabama 35899 (susan.alexander@uah.edu).
DOI: 10.1097/NUR.0000000000000328
Clinical Nurse Specialist
global healthcare organization for 1 nurse who recognized
the need for further study on how to help nurses exercise
their skills to create a positive influence across organizations.
WHAT LEADERSHIP LOOKS LIKE IN NURSING
PRACTICE
Jeffrey M. Adams, PhD, RN, NEA-BC, FAAN, began his career
as a clinical informatics consultant in the early 1990s. While
working with nurses and nurse executives in the implementation and on-boarding processes for clinical information
systems, he quickly learned that these groups, who were
expected to be skilled end users in practice, had little impact
on selection or design of those systems. ‘‘I spent a lot of time
with nurse executives and researchers trying to understand
more about why they weren’t influential in decision-making
and discovered that nurse executives were not influential
within their organizations on many topics’’ (Adams, phone
communication, 2017). Working with colleagues including
Joyce Clifford, PhD, RN, FAAN, Adams participated in research
projects identifying the lack of influence as a shortcoming
of many nurses, finding that ‘‘leadership is not a position or
title, but rather leadership is behavior; how one acts, thinks,
and communicates are all part of leadership and should be
a part of every nurse’s professional practice.’’8(p57)
Adams went on to complete doctoral studies at Boston
College in 2008, studying the topic of executive influence
in his dissertation. ‘‘We grew the idea that we need to see
what leadership looks like,’’ states Adams. In his studies, he
constructed a conceptual model of influence, the Adams
Influence Model (AIM), as a visual depiction of the interaction between the target of influence and the influence
agent. ‘‘There is a huge turnover in nurse executive positions, with an average time in the position of 3 years. One
of the reasons for this turnover is the difficulty in describing
exactly what a ‘‘good leader looks like,’’ says Adams, ‘‘there
are components of what makes us influential I distinct
factors and attributes we all have that can make us more
or less influential.’’ The AIM provides a framework for
A
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309
Nurse Entrepreneur
the development of influence in nursing leadership, linking
the influence of nurses in leadership positions to the improvement of practice environments and empowerment
of nurses to provide high-quality patient care.9
FROM RESEARCH TO ACTION
Throughout his career, Adams has served with leading
healthcare institutions across the country, melding research,
education, and practice as a consultant, nurse scientist, and
faculty. He has worked with other researchers who share his
interests in leadership and expanding the vision of enhancing
the influence of nurses. Along with colleagues, Teri Pipe, Pat
Reid-Ponte, and Jackie Somerville, the Workforce Outcomes
Research Leadership Development (WORLD)YInstitute was
established. ‘‘We created the WORLD-Institute to be able to
quantify and understand the influence of leadership in practice, academics, and professional organizations/associations;
coordinate with other leading researchers across the country;
and link it to outcomes to develop an empirical basis for nursing leadership enhancing their influence,’’ states Adams.
Working with colleagues, Adams has developed 2 instruments based on the AIM to evaluate influence in nurses. The
Leadership Influence over Professional Environment Scale
was developed in his work with Massachusetts General
Hospital, ‘‘because we know so much about the relationship
linking positive practice/work environments for nurses and
better outcomes for patients, clinicians, and organizations.’’
Working with a cohort of peers as a Robert Wood Johnson
Foundation Executive Nurse Fellow, Adams participated in
developing an instrument entitled the Leadership Influence
Self Assessment to ‘‘evaluate one’s individual own strengths
and opportunities for influence factor/attribute enhancement,’’
states Adams, noting that the capacity to describe enhance
these characteristics is of particular interest to individuals
and the nursing profession as a whole. ‘‘In study after study,
nurses are identified as the most trusted profession; at
3.6 million, nurses are larger in number than all other licensed healthcare provider groups combined, yet at the
same time regularly fall near the bottom as a group (below
patients) as our influence on health policy and other influence studies. For the health of our nation, this simply cannot
continue, nurses have too much value and a purposeful approach to how we nurses as individuals and a profession can
influence is an imperative.’’
RECOGNIZING COMMITMENT AND EXCELLENCE
Since the inception of AIM, Adams has published 2 additional
models describing the interrelationships of leadership
environments and outcomes for nurse executives and innovations in care delivery that can be used to frame policy
initiatives. In 2015, Adams was inducted as a fellow to the
American Academy of Nursing (AAN), and received an invi-
310
tation to lead the AAN’s Expert Panel on Building Exemplary
Health Systems. At the Richmond Invitational Meeting,
which focused on Executive Nurse Leadership and the
Quadruple Aim, Adams was elected to serve as panel chairperson in 2016.
CONTINUING THE WORK
Although Adams will complete the Robert Wood Johnson
Foundation nurse executive fellowship program this year,
his commitment to enhancing the influence of nurses will
continue. With colleagues Deb Zimmermann, Pam Cipriano,
Sharon Pappas, and Joyce Batcheller, a series of publications and presentations from the Richmond Invitational
Meeting will be shared later in 2017. The AAN Panel on Building Healthcare System Excellence has just recently adopted a
purposeful approach to understanding and enhancing the
influence of nurses and advancing the quadruple aim: enhancing patient experience, improving population health,
reducing costs, and caring for the provider.10 Adams describes
his continued interest in promoting the influence of nurses
in professional environments, saying, ‘‘We need to focus on
how we make practice environments betterVaccelerating
innovations in access to care and quality of care. We need
to understand how nurses go about influencing things.’’
References
1. Kaiser Family Foundation. State health facts: total numbers of
professionally active nurses. Kaiser Family Foundation Web site.
http://www.kff.org/other/state-indicator/total-registered-nurses/
?currentTimeframe=0&selectedDistributions=total-professionallyactive-nurses&selectedRows=%7B%22wrapups%22:%7B%22unitedstates%22:%7B%7D%7D%7D&sortModel=%7B%22colId%22:
%22Location%22,%22sort. Accessed July 10, 2017.
2. Institute of Medicine (US) Committee on the Robert Wood Johnson
Foundation. The Future of Nursing: Leading Change, Advancing
Health. Washington, DC: National Academies Press; 2011.
3. Huston C. Preparing nurse leaders for 2020. J Nurs Manag. 2008;
16(8):905Y911.
4. Dyess SM, Sherman RO, Pratt BA, Chiang-Hanisko L. Growing
nurse leaders: their perspectives on nursing leadership and today’s practice environment. Online J Issues Nurs. 2016;21(1):7.
5. Hassmiller S, Combes J. Nurse leaders in the boardroom: a fitting
choice. J Healthc Manag. 2012;57:8Y11.
6. Khoury CM, Blizzard R, Wright Moore L, Hassmiller S. Nursing
leadership from bedside to boardroom: a gallup national survey of
opinion leaders. J Nurs Adm. 2011;41(7Y8):299Y305.
7. American Nurses Association. Nurses rank #1 most trusted profession for 15th year in a row. American Nurses Association Web
site. http://www.nursingworld.org/FunctionalMenuCategories/
MediaResources/PressReleases/Nurses-Rank-1-Most-TrustedProfession-2.pdf. Accessed July 10, 2017.
8. Adams JM. The emergence of nurse executive influence in practice. J Nurs Adm. 2011;41(2):55Y57.
9. Ducharme MP, Bernhardt JM, Padula CA, Adams JM. Leader Influence,
the professional practice environment, and nurse engagement in
essential nursing practice. J Nurs Adm. 2017;47(7Y8):367Y375.
10. Bodenheimer T, Sinsky C. From triple to quadruple aim: care of
the patient requires care of the provider. Ann Fam Med. 2014;
12(6):573Y576.
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November/December 2017
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