FigureNursing leadership is a long-standing and traditionally known nursing specialty practice that has a profound impact on the state of the nursing profession, patient-care delivery, outcomes, and healthcare overall. Establishing standards of practice and professionalism in nursing to describe the "who, what, where, when, why, and how" of professional nursing leadership that take into account all aspects of education, experience, setting, and population was clearly needed. Today, not only has the title of this body of work evolved from the original version published in 1988, but we've also revised many concepts, approaches, competencies, and expectations, as well as the definition of nursing leadership. This ideological and empirical evolution in nursing leadership is necessary to function optimally in today's nursing praxis and to prepare nurse leaders for what's to come in the not-so-distant future. The Nursing Administration Scope and Standards has been recently retitled as Nursing Leadership Scope and Standards (NLSS), which serves as a guide to lead teams effectively and progressively into the future.1 The American Nurses Association (ANA) and the American Organization for Nursing Leadership (AONL) collaborated in convening nurse leaders from across the country and establishing this publication as a standard for professional nursing leadership practice and performance. Overview Scopes and Standards of Practice statements are typically revised every 5 years. Just as nursing changes exponentially over a 5-year time period, so too must the documents change that describe the current practice, and its boundaries, context, application, and membership. The ANA first published the Standards for Organized Nursing Services and Responsibilities of Nurse Administrators Across All Settings in 1988, and it has had different names and revisions since that time. Prior to the recently released version, the latest revision was Nursing Administration: Scope and Standards of Practice, second edition, released in 2016. Nursing leadership is currently found in many venues beyond the hospital and in many functions other than administration. It was important for the committee to represent all the ways and areas in which nursing leadership is present. The committee was composed of nurse leaders from academia, hospital and ambulatory areas, school nursing, military service, and the department of corrections, and included those with expertise in diversity, equity, and inclusion (DEI); LGBTQ+; and population health. To comprehensively conceptualize nursing leadership and its full scope, a new definition of Nursing Leadership Specialty Practice was created: Nursing leadership is the specialty practice devoted to collaboratively and collegially setting the vision, mission, and values for health, human services, and social care. It is the art and science of nursing leadership, influence, empowerment, and governance of and with professional nurses and other team members that advance a culture of clinical and operational excellence, including but not limited to: innovation, transformation, advocacy, quality, safety, equity, diversity, inclusion, and engagement. The ANA and the AONL have long defined what nursing leadership should be but did so in different ways and in different documents. It was important to commingle these documents to provide a single source of truth for nursing leadership specialty practice. This was accomplished by incorporating the AONL competencies into the Standards and then identifying more granular examples of competencies that would exemplify the Standards. In some cases, neither organization had a current standard or competency that was needed, so new Standards with competencies were created. The American Association of Colleges of Nursing's Essentials document also served as a valuable resource.2 What has changed? Accountabilities and standards of practice have changed to meet the current challenges and opportunities in the workplace. The NLSS encourage leaders to look through the lens of their community, as well as the national and global lens. The new list of accountabilities, responsibilities, and competencies for leaders across the continuum are shown in Table 1. A section is dedicated to DEI that requires the leader to self-reflect and act courageously within suggested frameworks. Integrated within the NLSS is the core concept of professional identity for leaders, which focuses specifically on the "leader within" domain. It requires the leader to inspire self and others to transform a shared vision into reality through communication, influence, and actions.3,4 Table 1: - Accountabilities, responsibilities, and competencies for nurse leaders1 Nursing Leadership Scope and Standards of Practice Standards of Practice 1. Assessment 2. Diagnosis 3. Outcomes Identification 4. Planning 5. Implementation 6. Evaluation Nursing Leadership Scope and Standards of Professional Performance 7. Leadership 8. Environmental Health 9. Ethics 10. Resource Stewardship 11. Quality of Practice 12. Communication 13. Diversity, Belonging, and Inclusion 14. Just and Equitable Practice 15. Collaboration 16. Professional Practice Evaluation 17. Education and Lifelong Learning 18. Advocacy 19. Scholarly Inquiry Accountabilities and Responsibilities Health Advocacy Digital Technology Emergency Mitigation through Recovery Health and Well-Being of Nurse Leaders and Those They Lead Healthy Work Environments that Optimize Outcomes Incivility, Bullying, and Workplace Violence Innovation Legal and Regulatory Compliance Networking, Partnering, and Collaboration Patient and Population Health Safety, Quality, and Risk Management Strategic and Financial Stewardship Workforce Strategy These standards require the leader to embrace uncertainty, advocate, and be a disruptive innovator to ensure access to care for all. Accountability is defined as being answerable to yourself and others for your actions and the impact they may have on others. For example, accountability for health advocacy and policy is front and center, recognizing that nurse leaders have the power to achieve policy change and must engage. Advancing digital technology as a leader to align with workforce strategy is important to ensure that the workforce has efficient systems. Since the pandemic, the emphasis on emergency mitigation and recovery is expanded to be certain that leaders are prepared and connected internally and externally with the communities they serve to manage events. The accountabilities include addressing bullying and workplace violence and creating and maintaining a safe and healthy work environment. It's also critical that leaders engage staff by cocreating a shared decision-making model to make changes in the workplace. Leadership is complex and nonlinear; therefore, the standards weren't leveled for specific roles because the degree to which an accountability or standard of practice applies may differ based on the organization. The standards of practice define the competencies leaders need regardless of setting. The standards define the actions and behaviors that all nurse leaders are expected to perform. The nursing process was summarized because it's expected competency for all nurses and is fundamental to nursing practice. The committee organized these standards in a way that places emphasis on Leadership as the first standard. The competencies include Environmental Health, which promotes the six standards of a healthy work environment. Organization leaders need to be Resource Stewards and have a financial acumen that focuses on all resources and how they impact outcomes. The standard Just and Equitable Practice requires the nurse leader to promote an inclusive shared governance structure aimed at reducing barriers to care, increasing the delivery of care, and addressing inequity. DEI is threaded throughout the accountabilities and standards of practice and is a key cornerstone. How can I use the NLSS? These standards shouldn't sit on a shelf but should be an active document used as changes are made in organizations. Regardless of setting, the executive leader can use the NLSS to reflect on the nursing and/or organizational strategic plan(s) in place and determine if there are gaps that may necessitate updates to current plan(s). Evaluation of communities served will guide what needs to change in policies; for example, they may not be inclusive of the populations served. Hiring practices and succession planning should ensure a diverse workforce, which may require discussion and a plan for implementation and measurement. Job descriptions and organizational roles for nurse leaders across the continuum should be analyzed and updated to incorporate the accountabilities and competencies for that specific role. This is a wonderful opportunity for nurse leaders to come together, perhaps at the time of strategic planning, to define their accountabilities and responsibilities. Once the job descriptions are revised, an evaluation tool can be created to have a mechanism for measurement and accountability both formally and informally. The nurse leader can use these accountabilities and standards of practice to develop a needs assessment for their own education plan as well as that of the leaders who report to them. Leaders should have discussions with their staff about their role in leading through shared decision-making structures and what they can expect of leaders in the organization. It should also be used as a crosswalk to the Pathway to Excellence Standards. Academic program leaders should use the NLSS to conduct a gap analysis in their courses and ensure key competencies are incorporated throughout from the undergraduate to graduate levels. This will help with future leadership development, and it's an opportunity for academic and practice partners to come together to discuss gaps and work together to ensure congruence. Pathway to Excellence connection Organizations that seek to exemplify and magnify nursing excellence through the American Nurses Credentialing Center (ANCC) Magnet® recognition or Pathway to Excellence® designation will find the NLSS to be an effective guide. The ANCC Pathway to Excellence Program (Pathway) recognizes an organization's commitment to creating a positive practice environment that empowers and engages staff. Nurse leaders support this with leadership and shared, interprofessional decision-making. They prioritize safety for patients and staff free from incivility and violence. Nurse leaders drive quality outcomes through person- and family-centered care and evidence-based practice. They promote well-being and a culture of appreciation and support with resources and recognition. Further, they assure that nurses can grow and learn, demonstrating competency and ongoing development. These Pathway tenets are called out explicitly in both the standards and the competencies so that nurse leaders have a roadmap not only for successful designation but also to optimize their own practice.5Table 2 provides a crosswalk showing how the Pathway to Excellence elements of performance may be met through the accomplishment of the competencies within the Nursing Leadership Scope and Standards of Practice, third edition. Table 2: - Crosswalk of Nursing Leadership Scope and Standards of Professional Performance and the Pathway to Excellence Standards Nursing Leadership Scope and Standards of Professional Performance with competencies Pathway to Excellence Elements Pathway Standards (PS1: Shared Decision-Making; PS2: Leadership; PS3: Safety; PS4: Quality; PS5: Well-Being; PS6: Professional Development) 7. Leadership Influences and persuades others about the value of nursing, quality, and safety principles; builds consensus; and gains cooperation to accomplish goals. Develops the ability of others to perform and contribute to the achievement of their goals consistent with the organization's vision and mission. PS1: The organization promotes a culture of interprofessional decision-making. PS4: The organization engages direct care nurses to understand how their role and actions contribute to achieving the mission, vision, values, or goals of the organization. 8. Environmental Health Uses community assessment data and plans to develop policies, recommendations, and programs addressing threats and social determinants of health as well as prevention of hazards to both the people and the natural environment. Prevents incivility, bullying, and workplace violence. Ensures appropriate staffing. PS1: Nurses use the shared decision-making structure to promote health in the local community. PS3: The organization promotes psychological and physical safety through a culture free from workplace violence among the healthcare team. The organization establishes long-term staffing plans that reflect team composition and supports nurses to express concerns about the staffing plans. The nursing leadership team addresses concerns expressed by direct care nurses about long-term staffing. The organization obtains direct care nurses' input on daily staffing decisions. 9. Ethics Maintains and improves the ethical environments of the work setting in ways conducive to safe and quality healthcare. Promotes, advocates for, and protects the rights, health, and safety of the patient and staff. Recognizes that the nurse's primary commitment is to the patient, whether it's an individual, family, group, community, or population. Disparities in healthcare are essential to acknowledge. Advances the profession through research scholar inquiry, professional standards development, and generation of nursing and health policies. Uses an ethical, DEI- and values-driven, evidence-based framework to improve the health index of the ecosystem. PS1: Ethical concerns are managed at the organization through an interprofessional process. PS3: Direct care nurses are involved in addressing patient-related safety events. PS4: The organization promotes a culture of person- and family-centered care. Educational opportunities are provided on the application of evidence-based practice (EBP) for direct care nurses and nurse managers. Nurse managers promote a culture in which nurses can apply EBP. The organization has processes to identify and address health disparities in the local community. PS5: The organization provides opportunities to raise awareness of mental health issues prevalent among nurses, available mental health services to address those issues, and evidence-based strategies to enhance mental well-being during work hours. 10. Resource Stewardship Partners with other professionals and departments to establish a culture of interprofessional practice. Ensures engagement of clinical staff in the selection, systematic deployment, and innovation of information systems inclusive of evaluation of information technology systems on workflow/burden. Develops the business case and return on investment (ROI) for systems and workforce changes to achieve optimal outcomes. PS1: The organization promotes a culture of interprofessional decision-making. Direct care nurses are involved in the interprofessional processes to select and implement new technologies within the organization. The organization has strategies to sustain a positive practice environment regardless of leadership or organizational changes. 11. Quality of Practice Drives quality and safety by ensuring staff engagement in practice change in the organization. Is proficient in the use of appropriate data and databases to inform quality and safety decisions. PS1: Example of a direct care nurse-led change in nursing practice that was the result of using the shared decision-making structure. PS4: The organization communicates updates about new quality initiatives and performance in quality measures. External benchmarks are used to guide decisions about nursing practice. 12. Communication Communication shapes organizational culture and society and is impacted by cultural and social factors including attitudes, values, and beliefs that may be influenced by gender, race, religion, geography, sociopolitical factors, and socioeconomics. PS4: The organization promotes a culture of diversity, equity, inclusion, and belonging (DEIB) and assesses the effectiveness of associated DEIB strategies. 13. Diversity, Belonging, and Inclusion Demonstrates identification and actions to remove and prevent unconscious and systemic bias in care delivery and business operations. Leads and supports initiatives that address racism, discrimination, and bias in care delivery and business operations. Encourages creative tension and differences of opinions. PS3: The organization creates a culture in which staff can feel safe to report discriminatory behaviors and know that concerns will be addressed and follow-up provided. PS4: The organization promotes a culture of DEIB and assesses the effectiveness of associated DEIB strategies. 14. Just and Equitable Practice Advocates for, implements, and sustains initiatives and programs that reduce, with the ultimate goal of eliminating, all forms of discrimination, marginalization, and inequity in healthcare delivery, business operations, and social policy. Creates an inclusive environment in which people can flourish and contribute as their best selves to advance the mission and vision of their organization. Promotes shared governance and accountability through inclusivity in the design, implementation, and evaluation of sustainment programs, policies, and operations aimed at reducing barriers to care, increasing delivery of care, and addressing inequity. PS3: The organization creates a culture in which staff can feel safe to report discriminatory behaviors and know that concerns will be addressed and follow-up provided. PS4: The organization engages direct care nurses to understand how their role and actions contribute to achieving the mission, vision, values, or goals of the organization. The organization promotes a culture of DEIB and assesses the effectiveness of associated DEIB strategies. 15. Collaboration Amplifies the value of nurse leaders as experts in strategic planning, operations, innovation, and relationship building. PS4: The organization encourages the sharing of new ideas and supports implementation of innovation in the workplace. 16. Professional Practice Evaluation Evaluates organizational policies, procedures, and standards to guide and promote professional nursing and interprofessional EBP in diverse environments. Inspires the formal use of evidence-based evaluation frameworks in the examination of the condition and impact of nursing practice and leadership on organizational and consumer-based outcomes. PS4: Educational opportunities are provided on the application of EBP for direct care nurses and nurse managers. Nurse managers promote a culture in which nurses can apply EBP. EBP is implemented in patient-care areas. Cultivates a culture of inquiry, innovation, and transformation with a focus on future care delivery and professional nursing practice and leadership. 17. Education and Lifelong Learning Develops and builds capacity for leadership, including lifelong learning, professional development, mentorship, workforce development, advanced academic preparation, and succession planning. Solicits feedback and develops a personal and professional career plan through coaching, mentorship, sponsorship, and experiences that reflects growth and development, and enhancement of knowledge, skills, abilities, and judgment for current and future role performance. Develops a competent cadre of nurse leaders by ensuring alignment among education, experience, onboarding, and assigned leader role. Provides feedback and opportunities for others to learn through formal and informal methods. Maintains current knowledge and skills relative to the role, population, specialty, and setting, through nationally recognized certification. Facilitates a work environment supportive of ongoing education, sharing best practices, experiences, and ideas with peers, the workforce, interprofessional colleagues, and the C-suite. Supports acculturation of those in the workforce by role modeling, encouraging, advocating, and sharing pertinent information. PS2: The organization uses succession planning to develop nurses for nursing leadership roles. Nurse managers self-identify their orientation needs. The organization supports the nursing leadership team to participate in activities to enhance their role competence. Feedback from peers and direct reports is incorporated into nurse managers' performance evaluations. Lead initiatives that showcase the economic and value-based contributions of nurses and nursing, safety, and quality improvement. PS4: The organization encourages the sharing of new ideas and supports implementation of innovation in the workplace. PS6: The organization supports direct care nurse participation in professional development activities. Organization fosters a mentoring environment. Organization fosters direct care nurses as emerging nurse leaders. Nurses are encouraged to share best practices with entities outside the organization. 18. Advocacy Creates alliances that influence and shape health policy, at all levels of government, as it effects safe, quality, accessible, and affordable health. PS4: The organization has processes to identify and address health disparities in the local community. 19. Scholarly Inquiry Leads initiatives that showcase the economic and value-based contributions of nurses and nursing, safety, and quality improvement. Demonstrates knowledge, skills, and abilities to strengthen and maintain a spirit of clinical inquiry, systematic questioning, and commitments to the discovery and application of nursing research, knowledge, and evidence. Evaluates current evidence to ensure best practices are integrated to achieve positive outcomes for the individual, populations, and the communities served. Secures resources and best practices in translation and implementation science to advance innovations and care delivery across the continuum. Cultivates an organization of inquiry and continual learning. Engages and supports others in professional development and lifelong learning best practices. PS2: Nurse managers have collaborative conversations about cost management with their direct care nurses. PS4: Educational opportunities are provided on the application of EBP for direct care nurses and nurse managers. Nurse managers promote a culture in which nurses can apply EBP. EBP is implemented in patient-care areas. The organization encourages the sharing of new ideas and supports implementation of innovation in the workplace. PS6: Organization supports direct care nurse participation in professional development activities. ANA Leadership Competencies for Nurse Leaders Leading Others, Communication: Communicating effectively PS2: The CNO and nurse managers are accessible to the direct care nurses. American Association of Critical-Care Nurses Healthy Work Environment True Collaboration Meaningful Recognition PS4: Interprofessional collaboration is fostered to improve quality outcomes. PS5: Nursing leadership team fosters a culture of day-to-day recognition. New opportunities in leadership This is a critical time for bold, evidence-informed, and progressive approaches to nursing leadership. We implore all nurses to see themselves as leaders to advocate for themselves, their patients, and their communities, but we also must recognize and understand that nursing leadership is a specialty and not solely an ideology or a mindset. This revision captures the urgent need for the evolution of nursing leadership, boldly addresses the challenges, and opens up new opportunities to create healthy work environments that span the continuum of vast settings in which nurses work and practice. Nurse leaders are pivotal to the health and well-being of individuals and populations by mobilizing teams to make extraordinary things happen and leading teams that are willing to follow them, particularly during volatile and uncertain times.
Cadmus et al. (Wed,) studied this question.