Why Nursing Schools are Preparing Nurses to Lead Organizationally

Being a nurse executive in today's healthcare environment requires much more than clinical expertise.

As nurse leaders' responsibilities have evolved into managing complex healthcare systems, collaborating across specialties, leading strategy, and budgeting, nursing educators are responding by adapting their curriculum.

Mercy College of Health Sciences in Des Moines, Iowa, recently began offering the first graduate program in its 123-year history—a Master of Science in Nursing (MSN) with an emphasis on Organizational and Systems Leadership—joining other colleges and universities in preparing nurses to lead.

Seton Hall University, for example, offers an MSN degree in Health Systems Administration; Walden University offers the MSN-Nurse Executive; and nursing students at the University of Wisconsin-Green Bay can earn an MSN in Nursing Leadership and Management in Health Systems.

"We've heard from nurse executives about the complexities of being a nurse leader in today’s healthcare environment," says Nancy Kertz, PhD, FNP-BC, Mercy's vice president of Academic Affairs and provost.

"Our MSN in Organizational and Systems Leadership recognizes these changes and offers students a relevant curriculum," she says, "and empowers them with the necessary tools to become the next generation of nursing leaders."

Mercy's new program reflects nurse leaders' evolving responsibilities, preparing graduates to be experts in the operations, finances, and evolution of healthcare delivery systems, with such courses as health systems leadership, translational research, statistical methods, finance, quality improvement, planning, management and evaluation of programs, and health policy. 

"It is my opinion that nurse leaders who have a deep knowledge and a framework in organizational and systems leadership will be in high demand," Kertz tells HealthLeaders.

"The COVID-19 pandemic has demonstrated that strong nursing leadership is required for the nursing profession. The pandemic has forced nurse leaders to respond to a rapidly changing and increasingly complex healthcare environment."

A benefit to patients

Such progression in nurse leader responsibilities can only help patients, according to a 2018 study.

"The need for highly educated nurses to manage complex healthcare systems, build relationships with healthcare teams in order to collaborate and coordinate across all specialties and professions within the healthcare industry is paramount to achieve better patient outcomes," the study says.

"This will be accomplished by reinventing the nursing curriculum to include all aspects of competency in leadership, health policy, systems, research, and evidence-based practice," the study advises.

Enhancing the nursing team

A nurse leader well-schooled in such competencies is a benefit to the nursing team, as well, says Vickie Swanson, MSN-HCSM, RN CENP, CNOR,  chief nursing officer (CNO) of Olympic Medical Center in Port Angeles, Washington.

Swanson was in nursing school in the early 1980s studying for her associate degree when she realized that her chosen profession would require more than instruction in patient care.

"I could see that healthcare was a business and that nursing didn't have some of the tools that it needed to actively come to the table and be heard amongst other business professionals who were non-clinical," Swanson says.

"If I'm going to speak their language and get what I need for my team or the care of my patients, I have to at least communicate with them in a language that they understand and know," she says. "You're able to walk into a meeting and be heard, as well as you have a greater ability to understand where other individuals may be coming from."

Serving the organization

Nurses make up about 30% of a hospital's staffing, according to the U.S. Bureau of Labor Statistics, so a CNO's business and financial understanding can play a critical role in an organization's financial health, writes Kathy Douglas, MHA, RN, in the frequently referenced article, Taking Action to Close the Nursing-Finance Gap: Learning from Success.

"Nurse leaders control the largest part of a hospital labor budget, in some cases the largest part of the overall budget," Douglas writes. "The effectiveness of overseeing this responsibility can mean the difference between an organization’s financial stability and financial turmoil."

Indeed, nurse executives are more sought out for their leadership abilities, education, and competencies rather than on clinical expertise, according to Kathleen Sanford, DBA, RN, FACHE, FAAN, executive vice president and chief nursing executive (CNE) of CommonSpirit.

"The competencies include specific actions and abilities under the domains of communications and relationship management, professionalism, knowledge of the healthcare environment, business skills and principles, and leadership, as outlined by the American Organization of Nurse Leaders (AONL)," Sanford wrote in a piece for the Journal of the Catholic Health Association of the United States.

Those competencies will best serve the healthcare organization, according to Kertz.

"A master’s prepared nurse with a specialization in organizational and systems leadership may serve in senior and mid-level positions within healthcare organizations," Kertz says, "making sure its goals and mission are carried out in day-to-day operations."