Nursing Leadership: They didn’t teach us that in Nursing School

Do you recall thinking in nursing school ‘I wish we had more courses on spreadsheets, statistics, and forecasting’? Or were you, like many of us, focused on learning what you needed to know to pass the nerve-racking licensure exam and get a job?

Nursing school curriculum is heavy on clinical content and schools are motivated to equip new graduates with the core competencies required to enter practice. Very few Bachelor of Nursing programs even have the option of declaring a minor. So what does the path look like for budding nursing leaders and what options are available?

Rapid advances in medicine and technology have completely transformed both the context of care and the educational preparation and ongoing professional development of those who provide it.

Not that long ago, nurses had a relatively predictable career path and often retired from the same unit they started their careers. Commitment, loyalty, and passion for your work are desirable and commendable qualities; however, today, nurses are more often enjoying professional mobility that often includes progressive and diverse leadership opportunities.

“If your actions inspire others to dream more, do more, and become more, YOU are a leader” - John Adams. With that definition, what nurse isn’t a leader? Let’s explore the path of nurse leadership through some key questions that often arise when you start asking yourself ‘what’s next?’

Q. Why do some nurses desire nursing leadership positions? How do I know I’m doing it for the ‘right’ reasons?

A desire to drive change, explore a different side of nursing, take on a challenge, a need to impart your knowledge, wish to advocate through leadership, or perhaps it’s as simple as wanting more weekends off.

There is no right or wrong reason for wanting to explore a nurse leadership role but many leaders share characteristics like hard work, curiosity, ability to problem-solve, and appetite to learn that propels them through their career.

Also, nurse leadership is a journey. It’s seldom as simple as waking up one morning and deciding to be a CEO. Leadership is an accumulation of increasing responsibility and skills. The first step can often be as simple as joining a committee or acting as charge nurse on the night shift.

Q. Is nurse leadership and management the same thing?

Sometimes, but not always. Leaders can be influential, foster change, and engage others but not necessarily have staff directly reporting to them. A ‘manager’ generally has some delegated authority that places them in a supervisory position.

Q. My nurse manager is fabulous, but she has no nursing background. Why is nursing leadership important? Should I even be pursuing a management position?

Absolutely! Great managers and leaders come in all shapes, sizes, and backgrounds, and just because a nurse is a great clinician doesn’t mean they will make a wonderful leader. However, there are times when a nursing background will come in handy. Nurses understand the work of nursing.

As a result, nurses are positioned well to not only hold other nurses accountable but understand the importance of quality care and safety. They advocate for autonomy and understand the nursing scope of practice. Nurses have a fundamental understanding of infection, prevention, and control, body mechanics, and risk assessment - all critical pieces of ensuring a safe work environment.

Q. I’m a Licensed Practical Nurse but have a desire to work as a nurse manager or in a supervisory position. What are my options?

Increasingly LPNs are working in nursing leadership roles throughout the healthcare industry including unions and regulatory bodies. LPNs often supervise unregulated staff in nursing homes or home care organizations. In some situations, LPNs may manage other nursing or allied health staff; however, LPNs in these positions often have training or education that has provided them additional leadership competences.

 Q. What type of work can a budding nurse leader expect?

Time to hang up your stethoscope and embrace digital technology. A core function of a leader is communication. Leaders consistently communicate expectations, directives, and schedules (to name a few). Prepare yourself for variety, challenges, and constant change. You will need to be comfortable with (or have a willingness to learn) several digital programs including Microsoft products such as outlook, word, and excel as well as cloud-based platforms.

Q. Will I have to do a graduate degree to develop my nurse leadership skills? If so, how do I know what the best program is for me?

A graduate degree is not essential; however, it is becoming increasingly common for nursing leadership positions to require a graduate degree. There are many options and delivery options to choose from and this decision should be made with great consideration.

That being said, pursuing a graduate degree can be both challenging and fun! Unlike your undergraduate experience, you can often find graduate programs that are part-time, online, offer evening or weekend seminars, or a mixture of all three. You may also have the added bonus of your employer supporting your studies. But where to start? Let’s look at a few options:

Master of Nursing (MN) or Master of Science in Nursing (MScN)

A common choice among those with an undergraduate nursing degree. There are essentially three streams:

Nurse Practitioner

A nurse practitioner program is a clinical extension of your undergraduate studies. It will expand your scope of practice and hone your clinical leadership skills. With increasing autonomy, more and more nurse practitioners are becoming entrepreneurs and leading their own small businesses.

Nursing Education

A focus on nursing education will prepare graduates to lead in areas of clinical consultation and education. Further nursing leadership opportunities in the world of academia will typically require a terminal degree.

Nursing Administration

A focus on nursing administration, graduates will become familiar with core leadership theory including program management and health policy. Often learners within this stream pursue roles in management and administration.

Master of Public Health (MPH)

Many nurses with a penchant for epidemiology and population health will pursue an MPH preparing them for a career in public health, health promotion, and a wide range of health and community services, including governmental and not-for-profit organizations.

Master of Business Administration (MBA)

An MBA is not only for those who have a background in accounting or finance. In fact, many MBA programs offer preparatory courses to provide you the necessary exposure to help ensure your success within the program. Key components of the program include principles of finance, management, human resources, accounting, economics, and marketing. Many schools now offer a healthcare stream through their MBA program.

Master of Health Administration (MHA)

Similar to an MBA, an MHA will provide many of the same core program elements as the MBA, but through a healthcare lens. Graduates often enjoy careers in health administration and finance, clinical leadership, insurance, and technology. Ask yourself this, do you see yourself always working in healthcare? If so, an MHA may be right for you. Or do you have an appetite to pursue other industries? If so, an MBA may have benefits over an MHA.

Master of Public Administration (MPA)

With similarities with the MN, MBA, and MHA, the MPA provides a firm foundation in the management (specifically, healthcare management); however, where the MPA differs is a focus on the public and non-profit sector. Many MPA graduates enjoy careers in the provincial or federal government or non-profit organizations. 

Q. What qualities do nurse leaders have? Do I need to be extroverted to be a good leader?

Leaders often share qualities like strong work ethic, nimbleness, embrace change, insatiable curiosity, and grit. Although explicit extroversion is not required, a degree of sociability does tend to facilitate working relationships. Also, very few people are 100% introverted or 100% extroverted but rather a blend of both.

Those more introverted are often seen as less likely to engage in social situations or stand out in a crowd, but also regarded as reflective and thoughtful. Whereas extroverts are seen as outgoing, highly social, and love being the center of attention. You can immediately see how a balance is desirable. That being said, those with more extroverted qualities do tend to adapt well in various social situations and be more adept at the art of persuasion - a handy leadership skill. 

Q. Has the pandemic changed prospects or expectations for aspiring nurse leaders?

Many changes and ‘new’ ways of doing things has resulted from the pandemic response and many changes have yet to be seen. There is still much uncertainty about how regulatory, fiscal, and legislative changes will influence the environment of nursing leadership. One thing is for certain, comfort with virtual interfaces and digitally connecting with teams will continue to be an essential leadership skill.

Q. I’ve heard that it’s important to know what your nurse leadership style is, is that true?

There is a tremendous amount of information and research available on leadership styles and you may find some benefit in determining what style is most like you. A deeper understanding of yourself can help strengthen you as a leader. However, you may find yourself in situations that you need to adapt your nursing leadership style to the needs of your team depending on the scenario. Generally speaking, there are seven leadership styles:

• Autocratic - direct and dictatorial, an autocrat may not give a lot of explanation for her actions but can be effective in a crisis
• Authoritative - visionary and inspiring, an authoritative leader is a natural at engaging the team
• Pacesetting - a driver and worker, a pacesetting leader can push team members to achieve, but may also not notice when the team is showing signs of exhaustion
• Democratic - surveys the team for suggestions and input. This can be a great approach when fostering creativity, but somewhat limiting if decisions need to be made at the moment
• Coach - invests their time in developing their team, leveraging the skills and abilities of team members to achieve results
• Affiliative - in tune with the emotional needs of team members and experts at encouraging collaboration and a positive work environment
• Laissez-Faire - although initially, staff may enjoy the hands-off approach of the laissez-faire leader, it may lead to the leader appearing disengaged

Q. Is there anticipated career growth and job security in nurse leadership?

It is expected that the healthcare industry as a whole will grow substantially for the foreseeable future. Mixed with several anticipated retirements, nursing leaders with a robust skillset will continue to be in high demand.

Q. What kind of salary could I expect in a nursing leadership role?

Depending on your province, experience, education, and tenure, salaries can range from $39 to over $60 per hour.

Takeaway

Nursing leadership is not necessarily a title or a position, it is the ability to influence and engage others. Whether you’re giving a child their first inoculation, responding to a staff scheduling crisis at 4am, or leading the merger of two health authorities, you’re a nursing leader. 

Aside from some patience, hard work, and a bit of grit, there is no secret formula for becoming a leader. So know yourself and challenge yourself, embrace change and remember the past, try new things but don’t lose sight of what worked. and Lead yourself and others and remember, all great leaders have - heart.

Author Bio  

Ro Rath is a Nova Scotian Nurse who has worked primarily in Primary Care including private for-profit, non-profit, and governmental organizations. Currently, Ro utilizes his nursing skills to inform health related content for various audiences and publications. He lives in a small coastal village with his spouse, daughter and Basset Hound. Ro can be reached at rorathwriting@gmail.com