All Nurses Are Leaders

Leadership and management skills are innate characteristics required of all clinical nurses in their role as direct caregivers. From coordinating a patient's plan of care with the multidisciplinary team (aligning and mobilizing others toward a common vision), juggling multiple priorities while ensuring positive patient outcomes (execution and drive for results), using critical thinking skills to creatively solve problems (strategic thinking and leading change), collaborating, communicating, listening, and advocating (expert relationship skills) ... it is clear that clinical nursing practice requires a skill set similar to the skills required to lead and manage at any level of an organization.

So, it should not be a surprise to anyone that in today's complex world of health care, more and more nurses are stepping into broader leadership roles and taking on greater responsibility in leading the transformation of how we deliver and finance health care in our country. I am delighted to have worked with Phil Authier to bring you this issue, focusing on what we see as an emerging trend; nurses in academia, public health, and service delivery are increasingly assuming expanded leadership roles outside of traditional nursing administrative structures.

As I write this, I am finishing my third month in a new position as the president and chief executive officer (CEO) of a health care system. This is after I had served for 15 years as a vice president for nursing and patient care services/chief nursing officer and then executive vice president. It may sound like a cliche, but it is so true for me today; all I needed to know to be a CEO I learned in my experience as a clinical nurse and nursing leader. I draw upon the foundation and parallels of nursing clinical and leadership practice every day only in a new context. I believe that nurses start to prepare for a CEO position the first time they are in charge on the night shift at the age of 23 years!

In embracing my new responsibilities, I must say that I am experiencing a series of "firsts" in the role that honestly creates the same feeling in the pit of my stomach that I had the first time I went alone into the room to start an intravenous catheter. I am enjoying every minute of this new role. My patient is now the community served by our organization, and with time and practice, the year of "firsts" is sure to get easier.

You will see in the articles and columns in this issue that it is not at all a leap for nurses to make this transition from the bedside to leading health care organizations. Nurses are deeply connected to the mission and have a laser focus on patient- and family-centered care. We understand operations from the ground up and know how to mobilize people and resources to get things done. We are passionate about improving the health of the community. We are experts in developing relationships. A similar case can be made for the success of our physicians and other clinical colleagues who step into broader health care leadership roles. Although their background and skills may bring different strengths to the leadership equation, the motivation to improve health care brings similar, positive results. It is a natural progression for clinical leaders to be tapped for healing and transforming our health care system just at the time when our country needs us most. I hope this issue of Nursing Administration Quarterly informs and inspires you as much as it did to me.

-Lois Napier Skillings, MS, RN, NEA-BC

Guest Editor