Different ways to achieve high-level nursing leadership roles

Currently, nurses are 4 million strong in the US, with almost half over the age of 50. As of 2018, 57% had achieved their BSN, and 18% had graduate degrees. Nurses with doctoral degrees doubled between 2010 and 2018, but still only accounted for 1% of the total workforce. Perhaps the most impressive figure is this: 500,00 nurses are projected to retire by 2022, driving a need for more than 1 million new nurses to replace them. Assuming that most leadership roles are filled by seasoned nurses, many of these spots will be the ones left vacant by this mass exodus. 

In short—we need nursing leaders like never before!  

If you feel your career path is aiming you towards nursing leadership, great! But, it’s important for you to know the various roles available, how leadership styles differ, as well as what differentiates a nursing manager from a nursing leader.

Nurse manager vs. nurse leader—what’s the difference?

More than just a difference in semantics, nurse managers and nurse leaders have distinctly different roles. In general, nursing leaders work with both nursing teams as well as overseeing patient care directives. They draw from a well of extensive clinical expertise in order to direct operations so that patients have the best healthcare possible. 

In comparison, nursing managers focus more on team supervision. They tend to be more tuned in to the daily logistics of personnel management and are not as involved in improving patient health outcomes. In addition, nurse managers often oversee departmental needs like inventory, patient flow, and budgets. Nurse managers need to have experience in hiring and training staff, as well as coordinating with other departments in their facilities. 

In short, nursing managers focus on the trees, and nursing leaders, the forest. 

What are the different leadership styles?

Nursing leaders tend to operate from one particular style of leadership. The right style depends on your personality, your team’s needs, and the culture of your organization. Highly effective leaders are those who are able to keep their egos reeled in, and put the good of the team and department over their own self-interests. Here are some examples of leadership styles and a brief overview of each:

  • Democratic Leaders place value on having a laterally unified team where everyone has equal input. Instead of issuing directives and delegating initiatives you decide on, you take into account what your team collectively thinks is best. 

  • Authoritarian/Autocratic Leaders can be thought of as the parent who likes to say, “because I said so.” While some autocratic leaders can be effective at managing large organizations, generally speaking, no one appreciates being dictated to and morale can suffer.

  • Transformational Leaders recognize and value the autonomy of their teams and encourage innovative problem-solving. If you are constantly evaluating ways to improve systems, and love to mentor, this style can be very rewarding in an environment that encourages change.

  • Transactional Leaders use a “reward/punishment” approach to motivate their teams. This style can be helpful in terms of defining clear expectations, but using threats to manage behavior may inspire creative work-arounds. 

  • Bureaucratic Leaders are often placed in their positions by promoting up from within, rather than being the best candidate for the job. The rigidity that comes from “checklist” leading can be stifling and restrictive, especially in healthcare environments where leaders should always be seeking new evidenced-based approaches. 

  • Servant Leaders focus on leading by example. If you’ve ever been described as a “natural leader” than you may possess the trustworthiness and self-depreciating attitude that this style requires. Servant leaders are the “helpers” that Mr. Rogers told us to look for in times of crisis. 

  • Laissez-Faire Leaders set their teams up for success with the appropriate resources and then get out of the way. Translated from the French, leave it be, this style of leadership can either be empowering to teams, or an immense source of frustration. 

  • Charismatic Leaders have that “it” factor that makes people pay attention to them—for better or worse. This type of extrinsic motivator can bring out the best in people and inspire peak performace; however, charismatic leaders are prone to becoming hyper-focused on their own goals at the expense of their team’s. 

  • Gentle Leaders combine the best of transformational and servant leadership styles. They seek to better their teams, lead by example, and display a high level of emotional intelligence, compassion, and wisdom while doing so. 

What are the different nursing leadership roles?

Nurses who aspire to attain nurse leadership roles need to have a graduate level degree. Which means—if you currently hold your Associates Degree in Nursing (ADN or ASN), you would first need to get your bachelors in nursing (BSN). From there, going on for your Master of Science in Nursing (MSN) or Doctor of Nursing Practice (DNP) is recommended. Pursuing Post-grad certificates or focusing on role specialties like Family Nurse Practitioner (FNP), Nurse Executive, or Nurse Educator are also options. 

With degree in hand, nurse leaders are employed in myriad of settings, ranging from hospitals, to ambulatory care centers, long-term care, and academia. Some examples are as follows:

  • Chief Nursing Officer (CNO)—oversees all other nursing departments and is the top of the nursing food chain, so to speak, for hospital nursing administrators. 

  • Chief Executive Officer (CEO)—is the uppermost echelon of leadership positions in the hospital; this position combines medical knowledge, public relations, business acumen, and financial prowess. 

  • Chief Operating Officer (COO)—if metrics and system analytics are in your wheelhouse of talents, this role offers plenty of both. As second in charge, the COO ensures that all daily functional operations of the hospital are running smoothly.

  • Chief Clinical Officer (CCO)—in this role, you would be in charge of recruiting and hiring clinical staff at the hospital, as well as provide a supervisory role for academic programs like medical residencies. 

  • Dean of Nursing—in charge of a nursing program within a college or university, the dean of nursing must work closely with nursing education faculty to promote excellence.

  • Clinical Nurse Leader—this position works with clinical staff as well as the community to ensure that patient care directives are being met within a hospital or other direct patient care setting.

  • Patient Care Director—a patient-centered role that focuses on their well-being, as well as ensuring that the hospital remains in compliance with regulatory bodies. 

  • Clinical Operations Director—this hospital-based role focuses on compliance and patient safety practices as well as performs staff management duties.

  • Director of Nursing (DON)—perhaps the most familiar on the list to hospital nurses, the DON is an accessible figure in the hospital who is responsible for all nursing staff and who serves as a liaison between them and administration.

Whatever leadership role you are striving towards, always remember to work with passion and empathy—both for your team and the patients you care for.

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