Nursing Leadership and

Support: Opportunities for

future Directions
Katherine Breen, PhD, RN, CVRN-BC
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 Leadership Theories & Styles

Transformational Leadership
• Assumptions:
• People will follow a leader who inspires them
• A leader with vision and passion can achieve great things but
must maintain personal integrity, be willing to stand up and be
counted, and use ceremonies, rituals, and other types of cultural
symbolism to maintain motivation
• The best way to get things done is to inject enthusiasm and
energy into the effort
• Appeals to social values and encourages people to collaborate,
rather than work as individuals who compete with one another
• Gives people an uplifting sense of being connected to a higher
purpose, enhancing their sense of meaning and identity

Clark, C. C. (2009)
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 Background
During the 1980s, there was a significant nursing shortage and high turnover at hospitals. Nurse leaders
observed that some hospitals were better able to retain nurses and fill vacancies compared with similar
hospitals in the same labor markets.
A study by the American Academy of Nursing (AAN) identified 41 hospitals that acted as “magnets” for
nurses because of their more supportive work environments. 5 
In 1990, the American Nursing Credentialling Center developed a voluntary recognition program for
formally credentialing Magnet organizations, and the first Magnet hospital was credentialed 8
Magnet hospitals have been recognized thus far in 5 countries besides the United States (England, Australia,
New Zealand, Singapore, and Lebanon).

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 Magnet Nursing Leadership Model

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 Magnet Model Components

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 Opportunities for Empowering Nurse Leaders
• Nursing Leadership Internship
• Nurse Management Residency Programs
• Supporting Graduate Education of Nurse Leaders: Doctorate of Nursing Practice and PhD
prepared Nurses– The Robert Wood Johnson Foundation Future of Nursing Scholars

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 Nurse Leadership Internship
• Designed for staff nurses who express interest in leadership, but do not currently hold a
leadership position above the level of charge nurse
• Provides overview of leadership opportunities, roles, organizational structure
• Bridge program from bedside to management
• Helps identify potential leadership candidates
• Exposes staff nurses to multiple leadership roles through shadowing

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 Nurse Leadership Internship
• 7- month long internship for staff nurses interested in leadership roles and identified by nursing
management as having high potential for a leadership career.
• Interested Nurses must submit an application accompanied by a letter of recommendation from
their direct supervisor
• Applications are screened by the executive leadership team and select applicants are invited to
interview.
• Applicants interview with a team of three nurse leaders at varying levels (1 unit manager, 1
director, 1 administrator)
• Nursing executive team then selects a cohort of nurses to begin once monthly meetings

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 Nurse Leadership Internship Activities
• Once monthly hour-long group meetings with internship leaders (a manager and a director).
• Monthly meetings cover topics including leadership overview, different leadership positions,
leadership personality tests, resources available, managing staff, resolving conflict, promoting
healthy work environments.
• 32 hours of shadowing experiences set up based on applicant interest and mentor availability (
up to 16 hours shadowing different unit managers and 16 hours of the following shadowing
experiences: educator, house supervisor, nursing director, service line administrator)** can be
broken up into multiple day or experiences
• The cohort produces either a quality improvement project or an evidence-based practice
project that they present to the nursing leadership team at a house wide management
meeting.** Some internships require completion of a project or simply development with the
option of completing the project at managements request

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 Nurse Manager Residency Program
• Program Duration 6-months to 1-year
• Designed for first time managers/ Nurses transitioning from bedside to management
• Abbreviated program for new to the organization nurse managers
• To be completed in addition to manager orientation program
• Provides a supportive network of mentors and fellow novice managers
• Program benefits included
• Decreased manager turnover
• Increased nurse manager satisfaction
• Increased staff satisfaction on units in which the NM participated

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 Nurse Manager Residency An Exemplar
• Designed for the resident to obtain a broad exposure to inpatient nursing units, the nursing department,
and hospital operations, the NM resident is prepared for an NM position regardless of their clinical
specialty, be it critical care, telemetry, medical-surgical, perioperative services, maternal-child health,
mental health, or outpatient procedural areas.
• Requires ½ time dedication to current job and ½ time dedication to the residency program
• Each resident over the course of a year spends 3 months with a preceptor for 3 consecutive
periods (preceptor can be the same for all periods or can be a different preceptor for each 3-
month period) depending on availability

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 Program Objectives
Objectives for a successful NMR
• Prepare for the role and responsibilities of an NM
• Differentiate the role of a leader versus a manager
• Analyze and contrast the different leadership styles of NMs
• Design and implement an evidence-based/research or program improvement initiative
• Complete a leadership development series program
• Oversee a nursing unit for the last quarter of the program

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 NMR Preceptor Roles

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 Residency
Project

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 The Future of Nursing Report
• The Institute of Medicine’s landmark report on the Future of Nursing recommended that we must
“prepare and enable nurses to lead change to advance health care,” so that nurses can position
themselves to lead decision making across all venues, including public, private, and governmental health
care agencies.
• Because of their front-line experience and deep connections to patients and families, nurses
are critical to safeguarding the health of the nation and ensuring that health care is safe,
accessible, and high quality.
• In particular, PhD-prepared nurse scientists and researchers are in an optimal position to seek
and identify solutions to serious problems that make a difference in the lives of patients and
families. 

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 • ~ 2 0 0 P H D N U R S E S G E N E R AT E D
• 5 COHORTS

Robert Wood • 3 YEARS OF FINANCIAL REPORT ($75,000)

Johnson Future of • 7 5 % W E N T O N T O FA C U LT Y P O S I T I O N S AT
RESEARCH INTENSIVE INSTITUTIONS
Nursing Scholar • 25% WENT ON TO INDUSTRY/ MANAGEMENT
P O S I T I O N S I N H E A LT H C A R E O R G A N I Z AT I O N S

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 Robert Wood Johnson Future of
Nursing Scholar

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 The State of the PhD
• Currently, less than 1% of the nursing workforce has a PhD in nursing or a related field. To meet
the demand for a larger, more diverse cadre of nurse faculty, nurse scientists, and nurse
leaders, the number of PhD-prepared nurses needs to grow substantially in diversity as well as
number.
• Mentoring, leadership development, and research funding support after graduation, not
traditionally found in doctoral programs, are critical to creating nurse leaders who have the
capacity to put evidence-based, innovative ideas for systemic change into practice and inspire
the next generation of nurses.

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 • It will take a new generation of bold leaders—experienced in both the front lines and the
boardrooms of health care, skilled in science, research and innovation, mentored by key health
care, business and policy leaders, and networked together across the country—to create real
transformational change.- Robert Wood Johnson Foundation
• The Institute of Medicine and the Robert Wood Johnson Foundation agree that without
exceptional nursing care and leadership, readily available high-quality care cannot be attained.

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