Organizationally Minded Nursing Leadership

An Academic Perspective

Reading this book, I remembered a graduate student who once took a course of mine.  She came to class annoyed at her boss who was not helping her be successful in her clinical position.  After she described her situation, I asked her “What do you think your boss needs from you?”  It was clear from her response that she thought it was an inappropriate question, and even believed that meeting the expectations of her manager constituted toadying behavior.  I disagreed with her and said “Even if you don’t personally like your boss, it’s being savvy to understand whether your work meets her expectations and those of the organization.  Every leader counts on others to do certain things at their level so they can deliver outcomes at another level.”  One week later, this student sought me out again to let me know that the approach worked and their relationship had improved. She had started to ask regularly “What does my boss/organization need from me?’ more than “What do I need from my boss/organization?”

What this student really needed to exert leadership in her clinical role was the content of this book because it focuses on nurses’ learning to think organizationally.  But she would not be alone in thinking her leadership would only be empowered if her manager understood her professional needs rather than her also needing to understand the building blocks of organizational life—e.g., mission, vision, values, teams, communication, governance, policies, resources, planning and change.

Nurses largely function within complex organizations—hospitals, universities, military, health departments, government, industry and the like—so why didn’t she understand?  Historically, the emphasis in the literature has been on leadership as personal (the attributes a good leader should possess) rather than on leadership as achieving organizational mission (what leaders need to know to establish an organizational culture of performance excellence).  In health care and academia, there also has been an underlying predisposition to think that the provider-patient relationship or the student-teacher relationship is infinitely more important than how the establishments in which we function operate, and only those who self-designate as on the administrative track need to bother with figuring out the context in which their employment is embedded.  In short, we equate organizational savvy with mind-numbing bureaucratic thinking, and that is a mistake.

Well, the world has changed.  All RNs/APRNs have to operate increasingly in circumstances where leadership can only be exerted if one understands systems thinking no matter the job title.  Those who report to you need to be clear about what they’re expected to do so you can meet your role expectations, and you need to understand how what you do fits into the mission and values of the overall organization.  And this book is an excellent means of developing these sensibilities.

Most chapters begin with vignettes from clinical and academic leadership, so the reader can think about some of the dilemmas faced by nurse leaders.  And most chapters end with questions that encourage the reader to reflect further on the vignettes.  Since each chapter begins with both a clinical case study and an academic case study, I found this approach to be particularly effective in healing the historic divide between practice and education.  For example, if you’re a faculty member, the academic vignette will force you to think about your work setting and the clinical vignette will encourage you to think about what you need to do to prepare your students for those kinds of settings.

One of the major strengths of this book is the five authors.  Collectively they represent a broad range of leadership experiences.  All made their reputations in clinical areas that encourage big-picture, systems thinking:  Gilliss (family care), Berkowitz (community health and policy), Johnson (patient safety), Reid Ponte (oncology), and Milone-Nuzzo (home care). They have led in both public and private institutions, and in unionized and non-unionized settings.  Gilliss, Berkowitz, Johnson, and Milone-Nuzzo have all served as deans; Reid Ponte has held executive positions at the Dana-Farber Cancer Institute, Brigham and Women’s Hospital, and the American Nurses Credentialing Center.  All of them have had extensive experience heading professional organizations and serving on national boards.  Milone-Nuzzo is now president of an inter-professional organization.

Dr. Darrell Kirch, former president and chief executive officer of the Association of American Medical Colleges, spoke at Milone-Nuzzo’s installation as the 6^th president of the MGH Institute of Health Professions.  In his remarks, he called her a “multiplier” which he described as someone who brings people together to make positive changes in an organization.  That is exactly what this book is about; it aims to help nurses learn to think of themselves as having a multiplier effect on their organizations.

Angela Barron McBride, PhD, RN, FAAN
Distinguished Professor and University Dean Emerita
Indiana University School of Nursing

A Clinical Perspective

Ever wish you had a practical “go to” resource for navigating your entire nursing career leadership journey regardless of whether you were a novice or expert leader in a service setting?  Have you ever been struck by the observation that your ability to lead and drive change were intertwined with the organizational culture, mission, vision, values, and decision-making structure? Have you ever felt alone as an organizational leader? I have.

Fortunately, this timely book has been written just for you.  No matter where you are along the continuum of leadership, this book will help you become even more effective in leading and managing change in your organization.

We live in an interconnected world of speed, connectivity, instant communication, and complexity. Change is constant. Knowledge, adaptation, imagination and leadership are essential, especially when responding to the unexpected and uncertain future as we so vividly highlight our incredible experience with the Covid-19 pandemic. Leaders and the workforce have had to run twice as fast to stay in the same place!

The World Health Organization (WHO) designated 2020 as the Year of the Nurse and Midwife.  Little did we anticipate that the pandemic would feature the heroic nature of nursing’s work while challenging our organizations (clinical and academic) like never before.

Imagine the incredible pace of change needed for health care service organizations to adapt to the rapidly evolving pandemic.  How does one lead when traditional strategic responses aren’t in the communication plan or procedure manuals as information is constantly evolving?  How does a leader flexibly steer the organization in a socially just manner in the midst of enormous challenges while providing the necessary support to the workforce? How does the leader care for the staff while also caring for self?

As I reflect on my career and leadership journey, I am struck by the insight that each successive position—starting in academia, then professional associations, and finally in service settings—built on the learnings and challenges of leading in these different types of organizations. Each role enhanced my awareness, learning and understanding of leadership within the organizational context. This book would have been invaluable as a resource guide to better understand the linkages between my role as a leader and the organization’s success.

It’s been a joy to have had the opportunities to work with each author in various situations over our careers.  They individually and collectively bring a wealth of diverse leadership experiences across the academic-service continuum. Together they have written this book targeted for the novice to expert nurses who aspire to be and/or are already in formal leadership positions.

The structure of the book is unique. The format embeds key literature combined with clinical and academic vignettes and key questions to ask yourself as well as invaluable personal reflections, case studies and questions.  This book makes you think.  I found myself reflecting on my own past service leadership situations and wondered: how else might I have handled that situation?  What else could have been done?

This book will be invaluable across your career journey.  Whether you are just starting out or are an experienced nursing leader.  It’s rare to have a team of talented, accomplished nursing leaders share their personal stories and leadership lessons with such openness and honesty.

This book provides hope through theory + practical + real life experiences.  It is a foundation and inspiration for nursing leaders everywhere as we take on the enormous challenges of steering our organizations toward health and health equity for all people in a globally interconnected world that is changing at warp speed.

Now let’s get reading and reflecting in hopes of making the world a better place for all!

Marilyn P Chow, PhD, RN, FAAN
Distinguished Professor and University Dean Emerita
Indiana University School of Nursing