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We Need More Nurses In Healthcare Leadership Positions

There’s an archaic stereotype that looms over the leadership hierarchy of the healthcare industry. That is, that physicians are the leaders, the delegators, the most knowledgeable in the field of medicine. And nurses are the helpers, performing administrative tasks and taking direction from the doctor in charge.

While a century ago this might have been the case, it is far from reality today. In today’s healthcare system, a clear-cut hierarchy no longer exists. Nursing responsibilities are expanding, and the roles of all healthcare providers are becoming more and more interdependent.

In response to this cultural shift in healthcare, the Institute of Medicine (IOM) published the study “The Future of Nursing: Leading Change, Advancing Health” in 2010, which called for a style of leadership that involves working with others as full partners in a context of mutual respect and collaboration,” citing evidence that this leadership style is linked to better patient outcomes, fewer medical errors, and greater staff satisfaction.

The report urges nurses to expand their roles not just as patient advocates, but as policy makers who “advocate for the entire care delivery system.” While nursing responsibilities have expanded, from treating acute and chronic diseases, to ordering and reading diagnostic tests, to prescribing medications and administering anesthesia without the supervision of a doctor, nurses’ initiatives to lead and shape the healthcare industry have been stagnant, and sometimes even punished.


In her 2015 op-ed in The New York Times, Alexandra Robbins referenced an instance Jack D. Weiler Hospital of the Albert Einstein College of Medicine in New York threatened its own nurses with arrest for even daring to publicly address the issue of staffing shortages.

Robbins also goes on to explain, “Nurses are unsung and underestimated heroes who are needlessly overstretched and overdue for the kind of recognition befitting champions.”

This issue can be addressed in part by implementing the IOM report’s third key message on empowering nurses -- that nurses should be full partners with physicians and other health professionals, in redesigning health care in the United States.”

Not only do nurses often make up the largest component of a hospital’s staff, but they also usually have more interactions with patients’ compared to other types of providers. This, in turn, makes them one of, if not the most trusted professionals in the healthcare industry.

"Nurses are a proxy for the voice of the customers, the patients," says Paula Roe, BSN, operational excellence leader at Simpler Consulting. 

Nurses are greatly in tune with the ever-changing needs of patients, and they know exactly what is required of the nursing staff in order to meet those patients’ needs.

Yet nurses are mostly absent from the most influential healthcare policy-making groups, which include elected officials in Congress, state legislatures, hospital boards, and local governing bodies.

In light of this, the IOM stresses: 

Although the public is not used to viewing nurses as leaders, and not all nurses begin their careers with thoughts of becoming a leader, all nurses must be leaders in the design, implementation, and evaluation of – as well as advocacy for – the ongoing reforms to the system that will be needed.

Aptly named, Enclothed Cognition is the official Medelita blog for medical professionals interested in topics relevant to a discerning and inquisitive audience. Medelita was founded by a licensed clinician who felt strongly about the connection between focus, poise and appearance.