Abstract
Leadership in nursing administration is lived at the corporate level by the chief nurse executive, at the middle management level by directors of nursing and at the practice interface by nurse managers. Corporate and middle management exist to support the nurse manager at the practice interface. This is where the most important work is carried out to ensure that a quality practice environment exists to support nurses' practice, the education of students and the conduct of research, all ultimately supporting patient-centred care.
The Knowledge of Nursing Administration
Leadership in nursing administration requires knowledge of the future - that is, a clear perspective and an ability to picture and describe what nursing is and will be. This knowledge informs the establishment of a vision for nursing. Vision is the starting point and end goal of leadership practice. Nurse administrators must have corporate savvy and excellent communication and organizational skills. They must understand and inhabit organizational structures, roles and cultures with ease. Their effectiveness depends on their comfort with power, paradox and organizational politics. Nurse administrators require strong management skills: major foci of nursing administration include thorough assessments and analyses of context and systems issues, as well as the development of strategies, goals, objectives and plans, including budgets, human resource plans and interventions for the management of change. Leaders in nursing administration are also experts in leading the practice of nursing within the work environment.
An understanding of the business of healthcare and its influence on the practice of nursing is required to create an environment in which the mission of nursing can be expressed and the education of future practitioners becomes possible. Nurse administrators are also key to the establishment of a spirit of inquiry in the workplace and a culture that supports the conduct of research and application of research findings. Building a research culture is a strong recruitment and retention strategy. Finally, leaders in nursing administration must access and use the best available evidence within the nursing and associated literatures to apply in their role and area of focus.
Presence
Nursing administration strives to structure nursing work in a way that supports nurses' being present for patients and families. This is necessary to enable nurses to develop a relationship with those they serve. Within that relationship, they can bring their unique knowledge while delivering clinical care. Similarly, it is necessary to structure managers' span of control in a way that enables them to develop a relationship with the nursing staff they support. Nurse managers and administrators must be visible and build connections with nurses. This partnership is critical for an understanding of the issues that are important to nurses. Evidence is built from continuous study of the work environment and provides the basis upon which plans and interventions are developed to create and support a healthy workplace. Leaders in nursing administration deliver consistent and clear messages about the reality of practice and the practice workplace, and about desired outcomes for nurses and the patients and families they serve.
Leadership in nursing administration requires presence, optimism and courage. Being present as a nurse administrator is most valuable when you are being real. By this I mean being yourself, being human and fallible. Live your presence in a very personal way in concert with your values and principles. Your leadership will be judged on how you live it and the congruence of your words and actions. Being real is about the courage to express your hopes and dreams for nursing. That expression reveals the vision of nursing that you hold. Lead with your heart, with hope and with honesty.
While it is important for nursing leaders to acknowledge the ethical dilemmas and moral distress experienced by nurses, it is equally important to celebrate the triumphs that occur every day. Miraculous things happen in the healthcare workplace. Most of those are connected to nursing and the caring practice that is expressed with patients and families. Leadership in nursing administration asks that we show passion for the practice of nursing and respect for nurses.
Action
Excellence in nursing administration might be expressed as majoring in leadership with a minor in management. The capacity to act is critical in day-to-day management, but the capacity to lead is what takes us to a new tomorrow. Presence and action are a solid foundation for the development of strategy for the profession and excellence in patient care, teaching and research. Nurse administrators set the tone and expectations in the workplace. We must be bold and clear about what we expect, what is acceptable and what is not acceptable - in nursing care, and in how we treat each other and work with others in the workplace. Leadership in nursing administration requires that we accept and understand that we, individually, are role models for what we expect in future leaders and exemplars for practitioners and leaders alike.
Communication at every level within the organization cannot be overemphasized. Systems of communication are necessary to build relationships within and beyond nursing. Leadership in nursing administration rests on the cultivation of shared leadership in daily practice, education, research, management and administration. Shared leadership supports the development of a shared vision and helps to bring it alive. Similarly, shared understanding and commitment to a common mission forms the foundation for daily practice and the launching point from which all leaders in nursing reach toward a common vision and perspective of the future.
In his book, Letters to a Young Poet, Rainer Maria Rilke states, "If we think of this existence of the individual as a larger or smaller room, it appears evident that most people learn to know only a corner of their room, a place by the window, a strip of floor on which they walk up and down." Nurses have lived their professional lives in this way. It is now time for them to take their rightful place and proper role in healthcare delivery, education and research. Leaders in nursing administration are called upon to articulate the unique and valued practice of nursing. We need to convey the belief that nursing practice is knowledge work. We need to "walk the talk" of valuing the work of nurses and supporting that work to ensure a future workforce and the viability of the healthcare system. We need to create an environment in which nurses speak for nursing, are partnered with patients and are focused on health. Leadership in nursing administration means building a system to support the caring practice of nursing, to which nurses may bring their whole heart and soul. When that happens, the promise of the profession will be visible to the candidates of the future, and they will come.
Mary Ferguson-Paré, PhD
Vice President, Professional Affairs & Chief Nurse Executive
University Health Network, Toronto, Ontario
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