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Great Nurse Leaders Focus on These 6 Areas

Analysis  |  By Jennifer Thew RN  
   November 08, 2018

One nurse leader shares her insights gained over an accomplished career.

Patricia A. Hickey, PhD, MBA, RN, NEA-BC, FAAN, is a pediatric nurse, yet the work she has done during her career transcends any single specialty. Hickey, vice president and associate chief nursing officer, cardiovascular and critical care patient services at Boston Children's Hospital and assistant professor of pediatrics at Harvard Medical School, is internationally known for her work in research and leadership development, care delivery innovation, patient safety, and bridging nursing practice and health policy.

Some of her research examines the nursing and organizational factors associated with pediatric patient outcomes and the health of the work environment.

In recognition of her body of work, the American Association of Critical-Care Nurses has named Hickey its 2019 Distinguished Research Lecturer.

True to her passion of supporting other nurses, Hickey is more than willing to impart her decades of research findings, knowledge, and wisdom to fellow nurse leaders.   

In an interview with HealthLeaders, she shares six areas in nursing that are vital for nurse leaders to focus on to grow in their roles and to move nursing forward.

1. Employee Well-Being

"Innovation in healthcare delivery, understanding employee well-being, and taking care of our teams across the continuum of care are key priorities for leaders."

"Creating and sustaining healthy work environments is an ongoing goal. We need to ensure the health of the work environment is considered in all our decisions, so that nurses and extended teams are enabled to do their best work, voice their opinions, and know that they are valued."

"A consistent passion, as a leader, has been to support and optimize care for pediatric patients and families while understanding that our most important asset is our staff. "

2. The Work Environment

"The health of the work environment includes authentic leadership, true collaboration, meaningful recognition, and effective decision-making. We all benefit when frontline nurses are involved in decision-making at every level. Nurses really do have the best questions. When leaders are working through problems, the frontline staff need to be involved." 

"Our practice environments must be a place where leaders support each other and staff are supported in their delivery of the highest quality of care. Today’s practice areas are challenged by a multitude of competing demands and patient care complexities. At Boston Children's Hospital, we use AACN's Healthy Work Environment assessment tool and results as an important measurement to improve and sustain environments that empower staff and optimize experience for patients and families."

"Patient and staff outcomes are inextricably linked, so I hold those front and center."

3. Patient Acuity Measurement

"In the 1970s and 1980s, the majority of the acuity instruments were based on time. For example, a tool may have allocated 5 minutes to suction a patient. But sometimes it takes 7 minutes."

"At Boston Children's Hospital, we’ve developed the CAMEO nursing acuity instrument as a contemporary tool to measure the cognitive workload and complexity of nursing work. The CAMEO score for each patient is helpful to staffing decisions in combination with the judgment of frontline nurses. "

4. Specialty Certification

"Through serial studies over the last 12 years, we have examined nursing and organizational characteristics and their impact on patient outcomes, including mortality and complications for pediatric patients. The most recent findings show, for the first time in adult or pediatric research, that AACN Specialty Certification is correlated with reduced complications for postoperative surgical patients. Our research findings over the last decade have also revealed that levels of nursing education and experience are significantly associated with improved patient outcomes across critical care units in the United States."


5. Empathic Teams

"It’s important to understand the attributes of 'empathic and empowered teams'. Nurses work within teams and that interdisciplinary collaboration is so critical to effective decision-making. How we support those teams to do their best work is a big responsibility of leaders. For example, we have used evidence that was generated from frontline clinical nurses to develop a path for moral resiliency in nurses caring for acute and critically ill patients. We know the topic of moral distress is prolific in articles, but there are very few unit-based interventions in the literature."

"At Boston Children's Hospital, we developed a nurse education and support team to empower critical care nurses when they feel challenged with an ethical or complex dilemma. They can receive support, mentorship, and practical tools from an experienced cardiovascular or critical care nurse. The key component of the approach is when a nurse is feeling challenged at the bedside, he or she can call a number, and an experienced critical care nurse will come to the bedside and offer real-time coaching. It is peer-to-peer support. They know the coach has walked in their shoes."

"There are a number of options for employee support in healthcare organizations including offices of clinician support. Staff can call psychosocial specialists and get an appointment [later]. However, we also need to better understand and support staff in the moment when they are dealing with challenges.  Staff have evaluated this support program positively."

6. Leadership Qualities

"Leaders should be able to articulate the value of nursing and help nurses articulate professional practice, whether that be with each other or even to influence public policy. Nurses are key to helping patients, families, and the general public understand and navigate what is becoming an increasingly complex healthcare system. Sharing and effectively communicating a collective vision for the future and supporting staff in achieving personal and professional goals is always important."

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


The health of the work environment is tied to patient outcomes.

Nurse education and experience influence patient outcomes.

Optimal nurse staffing is multifactorial.

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