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Complete Issue Analysis

Frostburg State University

Meghan O’Neal

When thinking about the leaders of the healthcare world, many times the first person to

come to mind is the doctor. For centuries the focus and ideal picture of a healthcare team begins

and ends with the physician. Yes, the doctor plays a very large role in the healthcare world.

However, what about the nurse? Where does the nurse stand in this healthcare world? This paper

will help to better define the professionalism in nursing practice regarding leadership.

The title of “nurse” encompasses a variety of roles that the common person may not even

realize. Often times the nurse is the shoulder to cry on, the maid, the cook, the cleaner, the

pharmacy, the priest, the one who wakes people up at night, and so much more. Unfortunately

the title of “leader” does not often fall into the laundry list of roles the nurse plays on a daily

basis. According to Blais (2016) “Professional nurses today assume leadership and management

responsibilities regardless of the activities in which they are involved. Although leadership and

management roles are different they are frequently intertwined” (p 170). Although the leadership

efforts may not be recognized by others the nurse continues to carry a leadership role, along with

the other roles previously described, with a smile on her face.

The issue then falls into place when the nurse is not viewed in the same professional

manner as the other members of the healthcare team. In order to promote nurse professionalism

as a whole we must first establish the nurse as a leader. In the past nurses have been viewed as a

vital role in the healthcare team, just not the leader. Because some nurses have now stepped into

more managerial positions the leadership roles travel outside of the workplace and into the

community setting as well. Instead of nurses being strictly bedside participants where they may

only perform leadership roles in the patient care area, they are now able to be seen in a more

professional light as a manager. This type of role would bring leadership opportunities such as

suggesting changes on unit based policies or procedures.


In today’s healthcare world most of the leadership positions are held by individuals with

an extended education. For example, a Master’s degree in Nursing with a Master’s degree in

Business is very useful when it comes to the corporate world of the hospital atmosphere. These

nurses will not only have the science and nursing intelligence, but a well-rounded background in

the business side of the hospital which would include numbers and marketing and finance, just to

name a few. Other leadership positions may require a Bachelor’s of Science degree in Nursing.

These positions may include but are not limited to, House Supervisor, Clinical Preceptor, Unit

Manager, and shift supervisor. In addition to the education the experience also plays a large role

in these types of leadership positions. The years of experience that each nurse has worked also

contributes to the types of leadership positions that are available to her. In general these higher

authority positions are often times filled with nurses who have twenty or more years of

experience within the nursing field. In addition to the number of years most of these nurses also

have a variety of nursing experience and have developed nursing skills within many different

fields of specialty.

The options for leadership style vary from nurse to nurse as well. Following a study about

nursing students and their interactions with the instructors, Huda (2014) states

The first strategy is to use ‘transformational leadership style’ in organizations. In

transformational leadership, leaders tend to increase awareness and interest of the team

member, and inspires subordinates to achieve their goal. Transformational leaders enable

their subordinates to take responsibility of leadership, and thus preparing a second line of

leadership. (p 28)

This form of leadership brought upon the best outcomes for these new nurses and it helped to

establish a sense of professionalism in the young nurses who were still learning about the

healthcare field. This journal continues to discuss to the discouraging effects a more authoritative

approach to teaching had on the students. Instead of promoting professionalism and inspiring the

young minds of early nursing students, this type of leadership was making students uneasy and

afraid to discuss their thoughts and concerns with the instructor. Although the options are endless

when it comes to which type of leadership style is used during teaching moments, it is important

to remember the audience. It is important to promote professionalism by acting as a professional

as well as treating the students as professionals.

The pros of leadership in the nursing world are easier to point out thanks to the growth of

possibilities with a nursing degree. Effective leadership is defined by Blais (2016) as “a learned

process requiring an understanding of the needs and goals that motivate people, the knowledge to

apply leadership skills, and the interpersonal skills to influence others” (p. 176). This quote

correctly defines what is taught in nursing school. Students learn how to effective communicate

to patients as well as use techniques such as therapeutic communication. This style of

communication allows nurses to better understand and motivate their patients towards the same

goal of getting healthier. The application of skills is what the entire nursing school idea is

founded upon. Whether this application is of the physical skills learned with needles and tools or

if it is the application of ideas and knowledge regarding the disease process. Finally, the

interpersonal skills not only come from nursing school but they are also developed through

continuous interactions with a variety of patients. Nursing is all about influencing others, and

influencing others to make the right choices about their health. Nursing is a lot of teaching, and

repetitive motions. The pros of the development of leadership come from the fact that nursing

school is an ideal set up for the creation of professional leaders. Nursing school equips students

with the abilities to lead and develop professional skills.


The cons of nursing leadership occur when one examines the daily floor interactions

between team members. Each patient in the hospital setting has a team of people working on

their behalf to better their health. Often time this team consists of the physician, physical therapy,

occupational therapy, speech therapy, respiratory therapy, nursing, care management, pharmacy,

dietary, and most importantly the patient himself. Although in some smaller hospital settings this

team may not meet all together to discuss the patient and their status, this team is still in

communication via electronic charting. In a larger hospital setting this team often meets at the

patient’s bedside to discuss care from all specialties as well as plans for the day and goals for the

future. The nurse should be a main part of this communication simply because she is the one who

is with the patient for the majority of his time spent in the hospital. This is where the con of

professionalism comes into play. Instead a rounding upon patients is completed by this team and

the nurse is busy taking care of her other patients. Often times there is no phone call made to the

nurse to ask for her opinions or ideas, instead there are orders put in the computer when the

physician leaves and the nurse is forced to piece together what the plan of care is for the day and

week. New labs or testing will pop up under new orders and the nurse may already know that the

patient has had these labs or tests. Now she has to call and interrupt the physicians planning on

other patients to say something that could have simply been discussed if she was involved in the

initial rounding process. The nurse knows many things about her patients that the other

healthcare team members fail to see simply because of the amount of time she spends with him.

These actions do not help promote professionalism and cause tension within the healthcare team.

Society plays a large role in how nurses are viewed in the professional world. Most

recently female leaders have been on the rise and the promotion of female leaders has also been

acknowledged by the American society. However, in the healthcare world nurses aren’t always

viewed with the same respect as other female leaders perhaps on the business end of things.

Some parts of society still picture nursing as dress and hat wearing ladies who clean and change

bedding. Instead of realizing that nursing consists of men, women, young, and old. A prime

example of the societal view comes from the close examination of how operating room (OR)

nursing came about. The surgical field has been ran by the physician for centuries, and shows

like Greys Anatomy display the finest physicians working together within the operating room.

OR nursing is a relatively new specialty and still has much to expand upon. The duties of an OR

nurse are not as clear as a medical surgical nurse, whom is well aware of the skills and general

knowledge needed to take care of floor status patients. Moszczynski (2008) states

As the role of the professional OR nurse became clearly defined, so too it became clear

that society was beginning to hold all professionals accountable for their practice. As the

role of the professional OR nurse became clearly defined, it became apparent that society

was beginning to hold all professionals accountable for their practice. The litigious aspect

of accountability had been experienced by physicians, and OR nurses were no longer

exempt. Writings provided OR nurses with examples of practice deficits and expected

nursing accountabilities as professionals. (p. 757)

After close observation throughout the years OR nursing has now become an established

specialty in the healthcare world. Before, society viewed OR nurses as ones who possibly stood

in the operating room to watch, or maybe clean the patient. Currently there are many registered

nurses that assist during surgeries and handle all of the surgical equipment. There is also a clear

distinction between surgical technicians and nurses in today’s operating room. The technician

does not handle any aspect of patient care and is more focused on the counting of supplies as

well as the setup of equipment and supplies. Whereas nurses will handle details associated with

the patient, such as IV lines, catheters, intubation tubing and taping as well as extremity


Change has been relevant within the nursing world for quite some time now. The practice

of medicine is ever changing as new evidence is presented and new knowledge is applied. Nurses

as leaders has changed as evidence by the need for Nurse Practitioners (NP) in the healthcare

setting. Specifically primary care physician offices are focusing on their NPs because the NP has

the ability to practice on her own without physician guidance. For example if a physician wanted

to take a vacation his NP could manage and maintain his patients within his private practice

while he was gone without needing his consent and guidance regarding prescriptions or testing or

procedures. Often times these NPs will take some of the workload off of a physician within the

private practice setting so that the patients needing less attention and simply checkups can be

evaluated and assessed regularly by the NP rather than taking a spot on a busy schedule of a


On the contrary, leadership is prohibited rather than promoted when it comes to the

bedside nursing. The previous example of planning for patient care with a team of healthcare

members also goes along with this topic well. In addition to that example leadership prohibition

can be viewed in the bedside nursing area when it comes to the generation gap of nurses. Today,

there are nurses in the field that are in their sixties, fifties, even their seventies. In addition to this

generation of nurses there are also many nurses who are in their twenties, and even their early

twenties. The old phrase of “nurses eating their young” then comes into play when the generation

gap gets the best of the interaction. Instead of older, wiser nurses promoting leadership and

professionalism and growth into the new wave of younger nurses they are often discouraging and

unaccepting of new ideas and young minds. This is not the case in all areas or for all nurses,

however it does continue to be a problem amongst new graduates and does prevent them from

reaching their full potential as a professional leader.

When it comes to the inter-disciplinary and the intra-disciplinary needs of the healthcare

world the first thing that comes to mind is the quality of patient care being delivered. While

reading about the inter-disciplinary examples the quality of care to consumers is explained as a

delicate balance between the continuity of care and the decrease in medical errors. In addition to

these methods the decrease in hospitalizations in general as well as a decreased hospital stay play

a large role in the quality of care delivered to patients today (Blais, 2016, p 184). Quality care

can only be delivered when the patients respect the leadership value the nurse holds as the intra-

disciplinary herself. If the patient can listen to the nurse and her teachings and accept her

methods for care then there is no issue. The issue comes into play when the patient becomes non-

compliant or aggravated and then takes his frustration out on the nurse because she is his number

one care provider. This strains the leadership and professional role that every nurse strives to

achieve. As for the inter-disciplinary issues the nurse may face a power struggle within the team

if the other members are not viewing her as their equal. Otherwise, the issue with the inter-

disciplinary team may come from a suggestion the nurse may make for a change in plan of care

in hopes of trying to express her leadership and professional abilities, and in turn is discouraged

or not given a chance to really even explain herself without the response being a no.

The nursing field has come such a long way from the 1820s in which Florence

Nightingale walked around saving soldiers using antiseptic techniques, providing fresh air, and

using a candle for light. Currently the opportunities for nurses seem to be endless. Upon

graduation one may be overwhelmed with the possibilities that the nursing degree provides.

Before nursing was viewed as simply a bedside care type of role and today there are nurses who

have not performed the typical bedside care in years and simply answer questions on the phone

or assist in an insurance company when it comes to billing and finance. In addition to these roles

nurses around the world are also now participating in leadership roles such as managers and

supervisors of other nurses, aides, and clerks. The nurse manager of a unit in the hospital may

not perform any patient care what so ever but she also deals with all patient complaints and

issues as well as staff complaints, scheduling, holidays, and much more. As a nurse in today’s

world I feel encouraged to continue my education, and education plays a large role in the job

market today for any field but especially within the medical field. Unfortunately after reading a

complete issue analysis about nursing as a profession I was quickly disheartened by the results.

Savic (2011) states

A higher level of awareness at personal and professional levels should be achieved by

reflecting on one’s own work and therefore enhancing professional values, the process of

evaluation and belief in one’s own practice and autonomy. Professional conduct includes

positive values for the nursing profession, personal initiative, self-confidence and a desire

for involvement. Professional training for nurses can last anything from one to four

years and is not always conducted at the tertiary level. Pearson et al. summed up the

findings of different approaches in nursing education, which showed that nurses with a

university degree achieve a higher level of autonomy in their work than nurses with

vocational college education or secondary level education. Graduate nurses were more

skilled in communicating, problem solving and passing their knowledge on to others than

the other two groups of nurses. While nurses with a vocational college degree are ready

to start working immediately in a clinical setting, nurses with a university degree function

much better in a complex setting such as modern healthcare organizations. (p 291)


Although I am continuing my education and receiving a BSN degree, I have been a nurse for a

year now with the secondary level college degree. These results may be accurate for some AND

nurses, however I find myself functioning at a high level within an intensive care unit. I have

been complimented on my ability to adapt to change and provide the difficult level of care that a

neonatal intensive care unit requires. I cannot help but feel slightly offended by these results

even though I understand that they do not apply to everybody. I think instead of focusing on

nursing based upon the degree one holds it should be more based upon her abilities and level of

care provided to patients. A nurse is a nurse is a nurse and even though some have a BSN degree

we all perform the same job if one is a bedside nurse. Unless one has their master’s degree I

don’t understand why there should be any discouraging words towards a BSN or an ADN. In my

opinion it is results like these that restrict nurses from becoming leaders and growing in the

professional world. If one does not feel empowered within their position she is not going to

perform at her best. Aside from the results, the beginning sentences regarding self-evaluation and

autonomy provide me with hope that the professional world is becoming more accepting of

nurses. These sentences also reiterate my idea that professionalism is not always learned in the

classroom setting and can be acquired with experience. I think nursing is an ever-changing field

and there is something new to learn each day; therefore, professionalism should be increasing

each day as well.



Blais, K. B. & Hayes, J. S. (2016). Professional Nursing Practice Concepts and

Perspectives, 6th Edition (p.34). Hoboken, NJ: Pearson Education, inc

Huda, S. (2014). Autocratic leadership in nursing. I-Manager's Journal on Nursing, 4(3), 25-29.

Retrieved from

Moszczynski, A. (2008). Societal change and OR nursing in the pages of the AORN journal,

1963 to 1983. Association of Operating Room Nurses.AORN Journal, 88(5), 747-62.


Savic, B., & Kydd, A. (2011). Nursing knowledge as a response to societal needs: A framework

for promoting nursing as a profession. Zdravstveno Varstvo, 50(4), 286.