Introduction

Leading and managing in nursing constitute a consistent challenge. Even nurses who say they do not want to lead or manage find that new demands call for continuous leadership and increased self-management skills. More important, the work of the future is being accomplished in teams, and a strong team does not emerge from weak members. You may have heard President Harry S. Truman’s often-quoted phrase, “The buck stops here.” But Michael Hammer, author of Beyond Reengineering, in the videotape “The Secrets of Shared Leadership,” says, “The buck stops everywhere!” This is the point: We are all accountable for something, and unless our part in the overall scheme is inconsequential, which it usually is not, we must lead when we have the insight, the ability, or the skill needed to move a situation forward. As stated in Chapter 1, every role has tasks associated with it. Thus every nurse has some leadership role to execute in practice.

The first part of the twenty-first century brought new challenges and opportunities, some for which we were well prepared and others for which we struggled for some time. Think, for example, about the change to Y2K and the prediction that computers could shut down everywhere because they might not be able to recognize that the number 2000 was a new century. Endless hours were spent in testing and fixing computers worldwide so that when the clock struck midnight throughout the world, we would all still have computer access. Compare that event with how we have struggled for years to meet the needs of a post-Katrina New Orleans or how in 2010 we handled the eruption of a volcano in Iceland and the massive oil spill in the Gulf of Mexico. These events illustrate the dichotomous times in which we live and how the future is expected to be.

Leadership Demands for the Future

Nurse administrators and leaders consistently say that the characteristic they are most seeking in tomorrow’s professional nurse is leadership. In probing what that means, we often find themes that relate to our activities that may have serendipitous outcomes. We shape the public’s view of the profession, the organization in which we work, and health care in general. We influence interdisciplinary views of what it is to be a professional, and we create the expectations of the profession’s potential. All of those examples form some of the leadership potential that exists for the future.

If we think about the world as a loose web, we know that every element has the potential to influence every other element. This connectivity with each other, whether within our profession or within the team, means that we influence others all of the time. This influence molds our practices and beliefs as we move health care forward and also changes how we influence others subsequently. Thus even positions without formal leadership titles contain an element of leadership, and we must all be prepared and willing to lead whenever the need arises. Said another way, Brafman and Beckstrom (2006) compared this individual leadership to the starfish. Their book, The Starfish and the Spider, conveys that when you remove the head of a spider, it dies. However, when you cut a starfish in half, each half regenerates, resulting in two starfish.

Leadership Strengths for the Future

When Lipman-Blumen (2000) proposed six leadership strengths, she may have had no idea how important these strengths would seem for the future. Box 30-1 provides a summary of the six strengths. Any one of these strengths is valuable to an organization or an individual, but the combination of all makes a leader invaluable. Ethical political savvy can be based on the Code of Ethics for Nurses (American Nurses Association [ANA], 2008), the Nursing Administration: Scope and Standards for Practice (ANA, 2010), and the nurse manager competencies (American Organization of Nurse Executives [AONE], 2005). Basing our actions on ethical principles to affect the political system that influences the availability of healthcare (and other) resources allows us to demonstrate the trust the public places in us. Most of us have capitalized on our authenticity and accountability to demonstrate our concern for others, whether through collective action, crying with families, or listening carefully to what our colleagues and patients say.

Because so much of nursing’s work is accomplished in teams, we have considerable strength in inclusivity (politics of commonalities). This is in contrast to what many of us face in our everyday work of not capitalizing on thinking long-term and acting short-term. Much of the work of the Institute for Healthcare Improvement (www.ihi.org), for example, is built around the fact that change is slow and cumbersome. It has short-circuited that drawn-out process through its program “Transforming Care at the Bedside.” Although this rapid change (known as rapid cycle change) has produced positive results, nurses’ abilities to embrace this intensity of change are limited. (See the Research Perspective on p. 600.)

When we are faced with the pressures of providing care to patients versus changing the system, we often remain focused on the patient, thus losing the opportunity to change an issue for many patients. To be effective in the future, we must embrace the opportunities to think longer term so that more people are affected by our actions. Perhaps because of our history of attention to details, we may need to challenge ourselves in developing our ability for leadership. Moving from micromanaging to focusing on setting expectations for those for whom we are accountable may feel uncomfortable. However, that movement reinforces our ability to deal with longer-term issues. In addition, the quest for meaning suggests that our actions today create the foundation on which future leaders will build. Thus if we fail to capitalize on today’s opportunities, we are diminishing the place at which future leaders will start their careers. It is incumbent on us to raise expectations about what comprises good, safe, quality care and how nurses contribute to those expectations. This potential is especially critical in times of dramatic changes, such as those evolving from the 2010 Health Care Reform legislation.

These abilities develop over time, but the key is that the foundation is present. As Malcolm Gladwell suggested, it takes about 10,000 hours to be an expert at anything (2008). (See the Literature Perspective above.) Our foundation begins with our concern for and advocacy about patient care. That foundation is fairly well engrained in professional nurses’ beliefs. The movement from focusing on the nurse-patient relationship to the big picture of nursing (politics and public or health policy activities) may take several years, but the foundation is there. What we do in our professional lives is the legacy we leave for future generations.

Literature Perspective

Resource: Gladwell, M. (2008). Outliers: The story of success. New York: Little, Brown.

This book, based on research findings in numerous fields, identifies the characteristics of highly successful people. Some of those characteristics, such as when we are born, are uncontrollable. Other characteristics, such as the amount of time spent mastering a strength, are within the control of the individual. Various characteristics such as generations, family, socio-economic status, and culture are explored. In addition to providing some insights into individuals’ lives and cultures, he presents a compelling case for the 10,000-hour rule. The gist of the rule is that in fields in which people must think critically, they achieve mastery around the time they have devoted 10,000 hours doing that critical thinking. Further, the findings of multiple studies suggest that an apprenticeship model allows individuals to demonstrate what they can do.

Implications for Practice

Emphasis on thinking critically throughout schools and subsequently work roles is warranted. The 10,000 hours equates to approximately 5 years of full-time devotion to building skills in complex decisions.

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1. Context
2. Patient Safety
3. Making Decisions and Solving Problems
4. Care Delivery Strategies

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