Reframing the View of Falls and Care of the Older Adult: The Role of the Nurse Leader in Combatting Ageism Stereotypes and Promoting Equity

When an older adult falls, the fall is often a proxy for underlying conditions, such as gait and balance issues or changes in cognitive or functional status. The ageist bias that “old people just fall” can hinder a holistic evaluation and management of the root causes of the fall, many of which are modifiable. Ageism has a profound impact on the health outcomes and experiences of older adults, and should not be overlooked as a social determinant of health. Nurse leaders can advance health equity for older adults by integrating evidence-based care planning using a nurse-driven, technology-enabled approach.     

The Evolving Role of Nurse Leadership in the Fight for Health Equity

Devastating disparities in COVID-19 infection and outcomes among socioeconomically marginalized groups have resulted in a public outcry to address longstanding societal inequities that have contributed to the present situation. Nurse leaders have an opportunity and an obligation in this moment to lend their skills as scientists, innovators, advocates, and educators to lead in these efforts, advancing health equity for all.     

Cultural Humility Meets Antiracism in Nurse Leader Training

Following the tragic killing of George Floyd in May 2020, nurse leaders had the opportunity to take advantage of this national moment of collective reflection by establishing or renewing individual and organizational commitments to racial equity. Nursing at the University of California Davis Health used this unique window of sustained attention to develop a training approach that integrated the concept of cultural humility with antiracism and equipped nurse leaders to confront how the nation’s dysfunctional history of race relations continues to undermine achievement of the goal of health equity. This discussion highlights key pivotal leadership decisions that facilitated cocreation of strategies to advance equity in nursing practice and organizational change.     

Inclusive Behaviors: Keys for Creating Empowering Practice Cultures

In many health care organizations, the principles of diversity, equity, inclusion, and belonging (DEIB) are now given greater importance. However, deeper levels of cultural awareness require nurse leaders to not only understand DEIB, but also to possess cultural intelligence. Nurse leaders who espouse inclusive leadership competences could achieve empowering practice cultures where all nurses are respected, trusted, and know that they belong. This article describes obstacles that negate inclusive cultures, necessary competencies, and solutions that when adopted, could result in nurse leaders building sustainable inclusive practice cultures where all nurses thrive.     

The role of the chief nurse executive in the knowledge-intense organization of the future.

The health care world is being upended. Nurse executives, like other leaders, must develop new roles or risk being displaced or discarded. The health care organizations of the future are likely to look and function much more like "knowledge-intense organizations," peopled by knowledge professionals working in sophisticated interdisciplinary groups or teams. Nurse executives are well positioned to create new leadership roles in these knowledge-intense organizations.     

The changing face of academic nursing: Nurturing diversity,inclusivity, and equity

This paper captures collective experiences of nursing and organizational leaders in creating organizational cultures attentive to diversity, inclusivity, and equity in schools of nursing. Within a cultural proficiency framework, exemplars and leadership lessons are shared. Most importantly, what it takes organizationally to start the ongoing journey towards cultural proficiency is explored. Ensuring the intentional systematic change at multiple levels facilitates sustainability when leadership changes occur.     

Governance education for nurses: Preparing nurses for the future

The complexities of today's health care environment require organizational governing boards to have deeper understanding of health needs, influences, and outcomes with diverse board leadership. Nurses understand the complexities and demands of health care, but few nurses are engaged on boards of directors and many nurses feel unprepared for the governance leadership role. The nurse of the future requires governance knowledge and competencies to influence organizational policies that will improve health care outcomes and advance health promotion. Governance education is a necessary component of preparing the nurse of the future to influence health care transformation. Until nurses can confidently embrace governance leadership as a part of their professional identity, convincing and expecting non-nurse board leaders to appoint nurses to boards will continue to be a challenge. This paper describes a strategy for incorporating governance competencies into nursing curricula across all education levels by leveraging the American Hospital Association Governance Core Competencies (2009) and the Massachusetts Nurse of the Future Core Competencies©-RN (Massachusetts Department of Higher Education Nursing Initiative, 2016).     

Action learning: a tool for the development of strategic skills for Nurse Consultants?

young s., nixon e., hinge d., mcfadyen j., wright v., lambert p., pilkington c. & newsome c. (2010) Journal of Nursing Management 18 , 105–110
Action learning: a tool for the development of strategic skills for Nurse Consultants? Aim This paper will discuss the process of action learning and the outcomes of using action learning as a tool to achieve a more strategic function from Nurse Consultant posts. Background It is documented that one of the most challenging aspect of Nurse Consultant roles, in terms of leadership, is the strategic contribution they make at a senior corporate Trust level, often across organizations and local health economies. A facilitated action learning set was established in Brighton, England, to support the strategic leadership development of eight nurse consultant posts across two NHS Trusts. Evaluation Benefits to patient care, with regard to patient pathways and cross-organizational working, have been evident outcomes associated with the nurse consultant posts involved in the action learning set. Key issues Commitment by organizational nurse leaders is essential to address the challenges facing nurse consultants to implement change at strategic levels. Conclusions The use of facilitated action learning had been a successful tool in developing the strategic skills of Nurse Consultant posts within this setting. Implications for nursing management Action learning sets may be successfully applied to a range of senior nursing posts with a strategic remit and may assist post holders in achieving better outcomes pertinent to their roles.     

North Carolina School Nurse Leadership Institute.

Recognizing that school nurse leaders are essential to the development of school nurses, the North Carolina School Nurse Leadership Institute was developed to enable school nurse leaders to update and advance their leadership skills. The Institute was a collaborative endeavor between the North Carolina Department of Health and Human Services, Eastern Area Health Education Center, and East Carolina University School of Nursing. School nurse leaders were empowered to assume a role in public policy, and they were provided opportunities to network with leaders in other counties throughout the state. A combination of face-to-face and asynchronous discussion via the Internet was used to foster continuous rather than episodic learning. Participant evaluations were positive and indicated a significant increase in learning in key areas.     

An innovative communication model to disseminate information

Nurse leaders need effective communication models to articulate the functions, processes, and activities of health care organizations. This article describes the development and use of a communication model to streamline the dissemination of information to the targeted organizational entities that need it. The model's step-by-step process enhances the broadcasting of information needed to ensure patient safety and promote quality patient care by capturing the components integral to the communication process.     

Work-based learning: a leadership development example from an action research study of shared governance implementation

AIM: An empowering action research study was undertaken to evaluate and strengthen the implementation of shared governance. One aim was to identify factors that acted as aids or barriers to effective decision-making by clinical leaders. As a work-based learning approach, action research was expected to lead to integration of learning into practice by researcher and participants alike. BACKGROUND: Shared governance replaces traditional hierarchies and requires and develops clinical leaders. Strategies are needed to maximize learning from introduction of such initiatives at the individual, group and organizational level. METHODS: Participant-observations and interviews were undertaken with shared governance council members from one model in north-west England. RESULTS: Leadership skills and knowledge and shared governance practices were significantly enhanced. Preparation for council roles was considered inadequate. Increased structured time for reflection and action planning was indicated. CONCLUSIONS: Implementation of shared governance has succeeded in developing leadership capacity. Evaluation findings have led to improvements in the overall shared governance model. Action research has been found to have great utility at optimizing work-based learning. Nurse Managers need to develop their coaching and facilitating skills and recognize there is no "quick fix" for developing clinical leaders. Implications include the need to support learners in identifying and implementing changes arising from work-based learning activities, the significant resource implications and the need to optimize the organizational climate if work-based learning approaches to leadership and management development are to succeed.     

Nurse Leaders Continuing the Work and Conversations on Diversity,Equity, Inclusion,and Abilities

The nursing profession is at a pivotal place in its history, in the United States and the world. The nursing profession is being asked to address diversity, equity, inclusion, and abilities in a meaningful way. Societal forces coupled with the report by the National Commission to Address Racism in Nursing are requiring action to address organizational spaces and work environments. In a survey conducted by the National Commission to Address Racism in Nursing, 70% of black nurses said they experienced racism at the hands of a leader. Additional survey findings highlighted that 64% of nurses surveyed, who challenged racism, saw no change.     

Moving Toward Health Equity by Addressing Social Determinants of Health

Social determinants of health—the conditions in which people are born, grow, work, live, and age that affect health and quality of life—are strongly associated with disparities in health status and life expectancy. Nurses require a comprehensive understanding of social determinants and their associations with health outcomes to provide patient-centered care. Nurses can be leaders and change agents in advancing health equity by screening for social determinants that affect women and by engaging in cross-sector collaboration to build partnerships outside the health care system to address complex social needs. Nurses can also use their experience and knowledge to advocate for system-level change, which is required to address the upstream factors influencing the health of women.     

Fall Prevention Program in the Community: A Nurse Practitioner’s Contribution

Nurse practitioners (NPs) are members and leaders of health care teams who address population health needs in the community. This brief report describes an 8-week fall prevention program delivered by an NP and health care team for older adults attending 2 community senior centers. The fall risk score was the nursing outcome, and a 1-group, pretest-posttest design was implemented. The NP provided a weekly class with evidence-based education on fall risk factors. Using paired t test analysis, fall risk scores improved significantly (P < .05). NPs can collaborate to reduce fall risk and improve health outcomes.     

Taking a Stand:: Developing a Nurse’s Pledge to Champion Diversity,Equity, and Inclusivity

Last year, the Organization of Nurse Leaders (ONL), which represents nurse leaders in Massachusetts, Rhode Island, New Hampshire, Connecticut, and Vermont, worked with the New England Regional Black Nurses Association (NERBNA) to create the Nurse’s Pledge to Champion Diversity, Equity, and Inclusivity. This article details the development of the pledge.     

Leadership’s Role in Assimilating DEI to Improve Health Care

The Institute for Health Care Improvement (IHI) recently added health equity as the fifth aim to its framework of priorities. This article considers the importance of this aim for nurse leaders interested in transforming their organizations. It addresses a humbleness mindset necessary to begin understanding diversity, equity, and inclusion’s role, and the significant impact of one’s individual uniqueness to problem solve. It calls leaders to be self-reflective and understand the unconscious bias that may prevent inclusivity. Most important is the concept of acceptance of the multiverse that must be embraced to improve the collective health of all populations.     

The Leadership Role of Nurse Educators in Mental Health Nursing

Leadership behaviors and actions influence others to act, and leadership in clinical practice is an important mediator influencing patient outcomes and staff satisfaction. Indeed, positive clinical leadership has been positioned as a crucial element for transformation of health care services and has led to the development of the Practice Doctorate Movement in the United States. Nurse educators in health care have a vital leadership role as clinical experts, role models, mentors, change agents, and supporters of quality projects. By enacting these leadership attributes, nurse educators ensure a skilled and confident workforce that is focused on optimizing opportunities for students and graduates to integrate theory and practice in the workplace as well as developing more holistic models of care for the consumer. Nurse educators need to be active in supporting staff and students in health care environments and be visible leaders who can drive policy and practice changes and engage in professional forums, research, and scholarship. Although nurse educators have always been a feature of the nursing workplace, there is a paucity of literature on the role of nurse educators as clinical leaders. This discursive article describes the role and attributes of nurse educators with a focus on their role as leaders in mental health nursing. We argue that embracing the leadership role is fundamental to nurse educators and to influencing consumer-focused care in mental health. We also make recommendations for developing the leadership role of nurse educators and provide considerations for further research such as examining the impact of clinical leaders on client, staff, and organizational outcomes.     

Growing leaders in a professional membership organization

shekleton m .e ., preston j .c . & good l .e . (2010) Journal of Nursing Management  18, 662–668
Growing leaders in a professional membership organization Aims This study describes the background, development and delivery of an innovative approach to prepare elected state association leaders for their new leadership roles in their respective state organizations. Background State-based professional associations face unprecedented threats to scope of practice in the current volatile healthcare environment. In 2009 the American Association of Nurse Anesthetists (AANA) began offering a Leadership Development ‘Boot Camp’ for all nurse anesthetist state association presidents-elect designed with the intent of providing the participants with information, resources and tools they need in their new role. Methods An organizational assessment examined the philosophy of and need for leadership development across the entire organizational structure. Results Recommendations from the assessment included the need for intensive leadership development at the state level. A 3-day intensive workshop was designed and implemented. Adult learning theory was used for its development. Conclusions The success of this programme has lead to its implementation as part of leadership development of the AANA. Implications for nursing management Nurse managers and elected volunteer leaders in state-based professional associations face similar challenges requiring sound leadership ability. Principles applied to the development of the AANA programme can be applied to leadership development for new nurse managers.