"Towering genius disdains a beaten path" Abraham Lincoln

We see nursing leadership existing at all levels in nursing...all nurses leading. Nurse executives within academic health environments across Canada will be influencing health policy directions and dialogue within the profession nationally. They will be contributing to the development of a national agenda for nursing practice, education, research and leadership. These nurse executives will lead in a way that makes an invigorating impact on human service in health care environments and they will be dedicated to preparing the nursing leaders of tomorrow. The Academy of Canadian Executive Nurses will connect with the Office of Nursing Policy, Canadian Nurses Association, Canadian Association of University Schools of Nursing, Association of Canadian Academic Health Care Organizations and others to develop position papers regarding key issues such as patient safety, health human resource planning and leadership in the Canadian health care system. Our definition of professional nursing practice, fully integrated with education and research, will be advanced through these endeavours. The end result of a strong individual and collective voice will be improved patient outcomes supported by professional nursing practice in positive practice environments. This paper is intended to stimulate dialogue among nursing leaders in Canada, dislodge us from a long and traditional path, and place us firmly in a new millennium of leadership for the profession and practice of nursing, a style of leadership that is needed, wanted and supported by nurses and the clients we serve. It is the responsibility of those of us who lead in academic health science centres to be courageous for the students we support, the puactitioners we lead and the renewal of the profession. We are the testing ground for nursing research, and need to be the source of innovation for nursing practice. It is incumbent on us to leap forward to engage a new vision of the professional practice of nursing with a reconfigured work design and work environment compatible with the new economy, workplace and workforce.     

Shaping the Future of the Critical Care Nursing Workforce

Professional organizations can be valuable partners in identifying strategies that help nurse leaders chart a course toward positive experiences for both staff and patients. These associations leverage their networks and provide national perspectives that support their identified nursing specialties. As 1 example, the American Association of Critical-Care Nurses (AACN) seeks to reinforce healthy work environments, help nurses make their optimal contributions, ensure that patients receive optimal care, and help nurses shape the nursing profession and health care. Engaging professional nursing organizations as strategic thinking partners may serve nurse leaders efforts to shape a positive future for the nursing workforce.     

Developing a shared leadership model at the unit level

As the nursing profession again faces a serious shortage, many are seeking ways to attract and retain talented people in the nursing profession. Creating both empowering and healthy work environments is a way to achieve this goal. Shared leadership is a nursing management model that supports staff nurses in extending their influence about decisions that affect their practice, work environment, professional development, and self-fulfillment. It is a way to strengthen continuous learning and enhance relationships, which are the foundation upon which nurses can develop a new type of relationship with management and with each other.     

Promoting leadership and management in Australian general practice nursing: what will it take?

Aim This paper outlines the current state of Australian practice nursing, describes the context of general practice and establishes the importance of promoting leadership and management in this setting. Background Australian general practice nurses have emerged as key stakeholders in primary health care. However, their role in leadership and management has been largely invisible. The reasons for this are multifactorial, including the delay to establish a strong professional organization, their negative power relationships with general medical practitioners, limited nursing leadership and poorly defined roles. To date, the impetus for practice nurse growth has been largely external to the nursing profession. Growth has been driven by the increasing burden of chronic disease and workforce shortages. This has further weakened the control of nurse leaders over the development of the specialty. Conclusions The Australian practice nurse role is at a crossroads. While the practice nurse role is a viable force to improve health outcomes, the growing strength of the practice nurse challenges traditional professional roles and practice patterns. Implications for nursing management There is an urgent need to develop practice nurse leaders and managers to not only embrace the challenges of Australian general practice from an operational perspective, but also undertake a clinical leadership role. As clinical leaders, these nurses will need to develop a culture that not only optimizes health outcomes but also advances the status of the nursing profession.     

Nurse manager leadership development: leveraging the evidence and system-level support

The complexities of healthcare demand new leadership approaches to achieve organizational goals while developing and sustaining healthy work environments. The nurse manager is the defining role, crucial to achievement of workplace outcomes. Preparing nurses for this dynamic, complex role is often dependent on didactic education or on-the-job training that falls short of true leadership development. The authors describe an innovative approach to the development of successful nursing leaders across an integrated healthcare system.     

The pivotal role of nurse managers, leaders and educators in enabling excellence in nursing care

Mcsherry R., pearce P., Grimwood K. & Mcsherry W. (2012) Journal of Nursing Management 20, 7–19
The pivotal role of nurse managers, leaders and educators in enabling excellence in nursing care Aim The aims of this paper are to present the findings from a discursive analysis of key issues associated with providing excellence in nursing care; and to provide an exemplar framework to support excellence in nursing care and describe the potential benefits when excellence in nursing care occurs. Background The challenge facing the nursing profession is in ensuring that the core principles of dignity, respect, compassion and person (people) centered care become central to all aspects of nursing practice. To regain the public and professional confidence in nursing, nurse leaders, managers and educators play a pivotal role in improving the image of nursing. Key issues Excellence in nursing care will only happen by ensuring that nurse managers, leaders and educators are able to respond to the complexity of reform and change by leading, managing, enabling, empowering, encouraging and resourcing staff to be innovative and entrepreneurial in practice. Conclusions Creating healthcare environments that enable excellence in nursing care will not occur without the development of genuine shared working partnerships and collaborations between nurse managers, leaders and educators and their associated organizations. Implications for nursing management The importance of adopting an authentic sustainable leadership approach to facilitating and supporting frontline staff to innovate and change is imperative in restoring and evidencing that nurses do care and are excellent at what they do. By focusing attention on what resources are required to create a healthcare environment that enables compassion, safety and excellence in nursing care and what this means would be a reasonable start on the journey to excellence in nursing.     

Leadership by collaboration: Nursing's bold new vision for academic-practice partnerships

In 2016 the American Association of Colleges of Nursing issued a report, Advancing Healthcare Transformation: A New Era for Academic Nursing that included recommendations for more fully integrating nursing education, research, and practice. The report calls for a paradigm shift in how nursing leaders in academia and practice work together and with other leaders in higher education and clinical practice. Only by doing so can we realize the full benefits of academic nursing in this new era in which integration and collaboration are essential to success. In this paper we: 1) examine how academic nursing can contribute to healthcare innovation across environments; 2) explore leadership skills for deans of nursing to advance the goals of academic nursing in collaboration with clinical nursing partners, other health professions and clinical service leaders, academic administrators, and community members; and, 3) consider how governance structures and policy initiatives can advance this work.     

Toward a new future for healthcare and nursing practice

The healthcare trends described in this article will eventually lead to transformation of healthcare delivery and nursing practice. The nursing profession needs to be proactive in creating new models of care delivery and in redefining the work of nursing. The authors describe 2 examples of emerging models and principles for the creation of future models, related leadership challenges for nurse executives, and strategies for leading change. Ensuring that changes in care delivery models lead toward a desired future that fulfills nursing's social contract is a mandate for nursing leaders.     

Authentic leadership,empowerment and burnout: a comparison in new graduates and experienced nurses

Aim To examine the effect of authentic leadership and structural empowerment on the emotional exhaustion and cynicism of new graduates and experienced acute-care nurses. Background Employee empowerment is a fundamental component of healthy work environments that promote nurse health and retention, and nursing leadership is key to creating these environments. Method In a secondary analysis of data from two studies we compared the pattern of relationships among study variables in two Ontario groups: 342 new graduates with <2 years of experience and 273 nurses with more than 2 years of experience. Results A multi-group path analysis using Structural Equation Modelling indicated an acceptable fit of the final model (χ² = 17.52, df = 2, P < 0.001, CFI = 0.97, IFI = 0.97 and RMSEA = 0.11). Authentic leadership significantly and negatively influenced emotional exhaustion and cynicism through workplace empowerment in both groups. Conclusions The authentic behaviour of nursing leaders was important to nurses’ perceptions of structurally empowering conditions in their work environments, regardless of experience level, and ultimately contributed to lower levels of emotional exhaustion and cynicism. Implications for nursing management Leadership training for nurse managers may help develop the empowering work environments required in today’s health-care organizations in order to attract and retain nurses.     

Healthy work environments: a validation of the literature

Nursing leaders are under intense pressure to ensure that safety and quality exist at every point of service. Landmark reports set forth many calls to action to transform systems and processes of care to improve healthcare delivery. Evidence indicates that healthy work environments (HWEs) are at the heart of the solutions to significantly affect patient outcomes and professional nursing practice. Findings from an HWEs literature review and focus groups indicate that nursing leaders must prioritize efforts to improve the culture in the work environment. Three elements emerged to help nursing leaders set the tone and standard of practice for HWEs: (1) effective communication, (2) collaborative relationships, and (3) promoting decision making among nurses.     

Assessing nurse graduate leadership outcomes: the "typical day" format

Readiness for professional nursing practice in the current diverse and complex healthcare environment requires leadership capabilities. Faculty are challenged to identify specific leadership capabilities needed by graduate nurses upon entry into professional practice and to develop models from which they can accurately and authentically assess their demonstration. This article presents the development and implementation of an innovative leadership outcome assessment model. The model was developed in collaboration with nurse practice leaders and uses nurse practice leaders as external assessors and a "typical day" in nursing practice format.     

Elevating Nursing Leadership at the Bedside

If we are to achieve healthy work environments that produce competent nurse leaders at the unit level, care must be taken now to ensure a talent pool of nurse leaders for the future. When nurses at the bedside share in the decision-making authority in their work environments, front-line leadership emerges. Growing talent from within at organizational, microsystem, and corporate strategy levels is important for succession. By investing in our front-line nurses, we can enhance leadership at all levels within the healthcare system and enable nurses to be well-positioned in effecting transformational change.     

Leadership perceptions of nurse practitioners

Education in leadership principles is included in Master's Degree programs for nurse practitioners (NPs). NPs have an opportunity to be leaders in a variety of roles and to make major decisions within their profession and within the healthcare system. NPs' collaboration with nursing professionals, colleagues, and other healthcare professionals--including clients and families--demonstrate their expanded practice. The purpose of this study was to examine perceptions of leadership by Master's-prepared NPs and determine if they are providing leadership in practice. There has been minimal research to evaluate whether NPs graduating from Master's programs are effectively using leadership skills in their practice. Master's Degree education has a strong focus on leadership and, combined with the need for lower cost of healthcare, NPs have the potential to provide important leadership and cost savings to the healthcare delivery system.     

The Relationship Between Nursing Leadership Practices and Hospital Nursing Retention

With the current nursing shortage and the shrinkage of the American workforce, the challenges of recruiting and retaining nurses for hospital nursing are becoming increasingly difficult. Nursing leadership is responsible for the retention of nurses once they are recruited. Leadership styles exhibited by leaders are a major contributing factor to a nurse's decision to stay in a current position, transfer, or seek employment elsewhere or outside the profession. Researchers have found a link between the effectiveness of a transformational leadership style and that of a transactional leadership style in retaining nurses in hospitals.     

Global nursing leadership: a practical guide

Nursing leaders of today must be prepared for a nursing practice environment inclusive of local, national, and global work and issues. The educational preparation of nursing leaders should incorporate a fundamental curriculum that offers a broad preparation and basic leadership skills along with guidelines and experiences to support global outreach and collaboration with many cultures and health care environments. This article provides a practical guide on entry into Global Nursing Leadership for nursing leaders from the nurse executive including all levels of nursing management.     

Use of video-feedback, reflection, and interactive analysis to improve nurse leadership practices

The chronic shortage of registered nurses (RNs) affects patient safety and health care quality. Many factors affect the RN shortage in the workforce, including negative work environments, exacerbated by ineffective leadership approaches. Improvements in the use of relationship-based leadership approaches lead to healthier work environments that foster RN satisfaction and reduce RN turnover and vacancy rates in acute care settings. In this article, an innovative approach to reduce nurse turnover and decrease vacancy rates in acute care settings is described. Video feedback with reflection and interactive analysis is an untapped resource for nurse leaders and aspiring nurse leaders in their development of effective leadership skills. This unique method may be an effective leadership strategy for addressing recruitment and retention issues in a diverse workforce.     

A “Co-CREATES” framework to foster a positive learning environment for nursing students’ professional development in Rwanda

AimThe future of the nursing profession in Rwanda in large part depends on the students who join the workforce and the education they have received. Preparing students with the necessary knowledge, values and judgement requires practice settings to be learner-centered. This study aimed at exploring strategies that might improve the current practice-based learning environment.DesignA focused ethnographic approach was used.MethodsNursing students, staff nurses, clinical instructors and nurse leaders from three hospitals and an educational program participated in individual interviews.ResultsFive key areas of improvement emanated from study data: 1) strengthening institutional support; 2) improving school-hospital collaboration; 3) building the capacity of nurses and clinical instructors; 4) restructuring clinical placement; and 5) reviewing the current supervision model. Based on these findings a “Co-CREATES” framework grounded in the actions of collaboration, care, recognizing, empowering, actively engaging, transforming, enhancement and support was developed. The framework offers a collaborative approach that engages every stakeholder in “cocreating” conditions that build positive practice environments which are conducive to preparing students as professional nurses.ConclusionThe positive outcomes stemming from such a collaborative approach can further enhance a positive culture of collaboration in nursing education and practice.     

The hidden treasure in nursing leadership: informal leaders

downey m., parslow s. & smart m. (2011) Journal of Nursing Management 19 , 517–521
The hidden treasure in nursing leadership: informal leaders Aim The goal of the present article was to generate awareness of characteristics of informal leaders in healthcare with the emphasis on nurses in acute care settings. There is limited research or literature regarding informal leaders in nursing and how they positively impact nursing management, the organization and, ultimately, patient care. Identification of nurses with leadership characteristics is important so that leadership development and mentoring can occur within the nursing profession. Background More than ever, nursing needs energetic, committed and dedicated leaders to meet the challenges of the healthcare climate and the nursing shortage. This requires nurse leaders to consider all avenues to ensure the ongoing profitability and viability of their healthcare facility. Key issues This paper discusses clinical nurses as informal leaders; characteristics of the informal nurse leader, the role they play, how they impact their unit and how they shape the organization. Implication for nursing management Informal nurse leaders are an underutilized asset in health care. If identified early, these nurses can be developed and empowered to impact unit performance, efficiency and environmental culture in a positive manner.