LEADERSHIP OUTSIDE OF THE HOSPITAL WALLS
I spent the first half of my nursing career within the hospital walls and the last half outside. I have held positions in rehab, high-tech, consulting and the last 13 years, in academia. The skills I developed within the hospital were transferable into these other areas of healthcare. Every day, I use some of the skills I became competent at years ago yet in a different environment. Nursing offers multiple opportunities for leadership. In 2015, the American Organization for Nursing Leadership (AONL) added new competencies to the current Nurse Executive Competencies for both post-acute care and population health. AONL states:
Post-acute care nursing leadership is as much a specialty as any clinical specialty and requires proficiency and competent practice specific to the executive role. Health care systems will consolidate and become a predominant model of integrated care delivery. As such, enterprise-focused executive nursing leadership is vital to the success of community systems. Nursing practice should be aligned to the future state of nursing and a consolidated model for care delivery where the hospital will not be centric to delivery model and the health care continuum will be the focus.1
These competencies provide guidance for those leaders moving outside of the hospital walls into roles along the continuum of care. In many cases, these nurse leaders will lead interprofessional teams, manage outpatient budgets and operate in a very different way than in a hospital setting. In 2021, 60% of all Registered Nurses work in hospitals.2 The number of nurses working in the hospital has dropped over the years as care along the continuum has increased. This means that more nurses are working outside of the hospital clinically and in leadership roles, hence the theme of this issue: Leadership Outside of the Hospital Walls.
Guest editors Claire Zangerle and Nora Warshawsky secured several excellent articles and interviews with nonhospital nurse leaders for this issue. In Rhonda Anderson's interview with Rachel Behrendt, she shares her story of how her acute care leadership skills were transferred to her new "outside of the hospital" role in hospice care. Nora interviewed Representative Gale Adock, an APRN who is serving her fourth term in the North Carolina House of Representatives. Nursing leadership is evident along the continuum and other aspects of health care.
In Mary Lynne Knighten's article for our Finance Matters Column, she reviews the growth in serious illnesses, and quality of life and the need for more palliative care. Not only does she describe the need for these services but she discusses how to build a business case for home-based or community-based palliative care, which is very helpful.
As the pyramid of health care shifts from acute care being the largest component to other growth areas such as home care, chronic disease management, palliative care, hospice and more, we need nurse leaders to change their mindset of acute care being "the" place to work to other important areas along the continuum.
Enjoy the issue and, thank you for all you do for nursing, our patients, and our communities.
-KT Waxman, DNP, MBA, RN, CNL, CHSE, CENP, FSSH, FAONL, FAAN
Editor-in-Chief
Nursing Administration Quarterly
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