The Evolution of Nursing Leadership

Imagine the many changes in hospitals and patient care over the 39 years that I have been a registered nurse! Equally remarkable are the changes I’ve observed and experienced in nursing leadership, evolving from being a director in the mid-1980’s to “moving to the C Suite” in the 21st century.

As a director of nursing in the 1980’s, my role was limited to scheduling staff, staying within budget, having policies and procedures consistent with regulatory requirements, and supervision and direction of my direct-report head nurses. My role evolved over the years into that of leader, as did the role of most nurses in administration.

Leadership, so well outlined by Max De Pree in Leadership is an Art, is about relationships. Broad in scope and content, it involves the use of inspiration and influence to achieve a common goal, or shared purpose.

In the 21st century, the nursing leader, frequently titled Chief Nursing Officer, or CNO, inspires and influences the culture of nursing and the quality of patient care in the organization or system. He/she manages a highly complex environment and has a broad scope of responsibility and accountability for patient care departments, clinical quality, and patient and staff satisfaction. According to the American Organization of Nurse Executives (AONE), nurse leaders “design, facilitate, and manage care.”

Given the breadth and depth of their leadership skills, knowledge, and experience, nurse leaders are in the best possible position to inspire and influence the delivery of care across the full healthcare continuum—never forgetting that their most important relationships are with the patients and families they serve.