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3 Ways Nurse Leaders Influence Change in Healthcare

Analysis  |  By Jennifer Thew RN  
   June 26, 2018

CNO Katie Boston-Leary says bold nurse leaders are the key to moving the nursing profession forward.

Nurses can influence change in healthcare and, if given the opportunity, be drivers of innovation.

But to reach their full potential in improving quality and outcomes, enhancing an organization's culture, and reshaping care delivery, they need strong nurse leaders who are willing to be their advocates in the C-suite.

Katie Boston-Leary, RN, MBA, MHA, BSN, CNOR, NEA-BC, former chief nursing officer and senior vice president of patient services at Union Hospital in Elkton, Maryland, and chief nursing officer at University of Maryland Prince George's Hospital Center in Cheverly, Maryland, recently shared with HealthLeaders Media three ways nurse leaders can help the nursing profession advance healthcare delivery.

1. Be Proactive Leaders

The shift to value-based care, while necessary, is posing a challenge for nurse leaders, who may feel like they have one foot in two boats as they try to manage a dual reality—the long-standing fee-for-service models still in use, plus the outcomes-based models that are increasingly being adopted.

"The value-based approach to care, which is a much-needed change, has many challenges for leaders and organizations as we are making tough changes with declining reimbursement and the financial penalties that come with it while we continue to care for very sick patients," Boston-Leary says.

Yet, however large these obstacles are, they also present an enormous opportunity for nurse leaders to reshape care by creating new ways to best utilize nurses in this updated care model.

"We are now recognizing that we are appropriately in the business of maintaining wellness, so how do or will our bedside nurses fit into that strategy? Strategies should not be constrained to providing care within the four walls, but well outside of that, and we should be able to measure impact on outcomes," she says.

Nurse leaders should be taking a proactive approach and creating solutions that will move nursing and healthcare into the future. "It's that adage of skating to where the puck is going," Boston-Leary says.

2. Be C-suite Advocates

The key to moving forward is having strong nurse leaders who are willing to advocate for nursing in the C-suite.

"It is really being able to have nurse leaders that can stand with their finance person, with their CEO, and work to get proper data analytics or IT resources to better utilize and manage nursing resources," she says.

"When our frontline nurses are stretched with managing volume and high acuity, nurses barely have time to perform value-added care that is meaningful versus what we see today—less critical thinking and largely computer-driven protocols, which is 'color by numbers' nursing care," she explains.

In addition, she notes, "in many organizations, nursing productivity and [patient] acuity is not measured well. Yet in most cases, staffing decisions are being based on singular data points that are forcing nurse leaders to make decisions that will hurt their team and will cause them to lose top talent."

Boston-Leary points to the hospital census as an example of this. When one of Union Hospital's pediatric units had issues with patient volume and nurse retention, instead of relying on the traditional low-census day model of nurse staffing, Boston-Leary came up with an alternative solution.

"At Union Hospital, we had a small pediatric unit challenged with declining volumes and occasional spikes without having enough staff to care for patients. We also had high turnover and low retention with nursing," she says.

"A quick phone call from me to the large reputable pediatric hospital, pitching an idea for that hospital to run our pediatric unit, resulted in a management service agreement with that hospital two years later. Nurse leaders need to take the lead with these types of collaborative strategies with the support of their peers in the C-suite," Boston-Leary says.

Boston-Leary advises nurse leaders to look at data trends and put together a proposal for their C-suite peers on how they plan to manage workforce and labor expense.

"That innovation and taking that entrepreneurial approach and using analytics is what we need to do in a more proactive way," she says. "Otherwise, of course your CFO or CEO is going to need answers and implementation of changes that nurse leaders will not be comfortable with, and you're not going to be left with much choice. Then you're sunk. When you're in the red in terms of your variances, that doesn't leave enough lead time to try new innovative ideas without the financial pressures for an immediate turnaround."

3. Empower Your Nurses

C-suite level support for nursing innovation is necessary to effect organizational change.

"For you to be able to impact your nurses at the grassroots level, you need to be able to be at the table as a nurse leader and impact decisions," says Boston-Leary, "because in a lot of organizations nursing is the largest resource."

And nurses can come up with amazing solutions when they have support, she says.

"Empowerment reveals the goldmine of talent and innovation you have within your building that we typically don't take advantage of. I think taking that lid off and being less oppressive with our policies and empowering people breeds innovation," she says.

That is why Union Hospital stresses empowerment during its nurse residency program.

"That's the one thing that we impress upon folks when they come in here new to practice—that you are a leader at the bedside. That is important for people to know early in practice," says Boston-Leary. "There's no submission here. You have a voice, these are your avenues, and we want you to be an innovator, too."

In fact, each nurse residency cohort at Union Hospital puts forth a research-based idea that the hospital can implement. "We have a major presentation at graduation that we also turn into actionable items for change in our organization," she says.

One example is the creation of a tranquility room where staff members can go when they need to de-stress during a shift. "We saw marked improvement with our RN satisfaction scores in almost every domain in comparison to two previous years, as nursing felt that they were being listened to," Boston-Leary says.

Jennifer Thew, RN, is the senior nursing editor at HealthLeaders.

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