The recent Future of Nursing Report 2020-2030: Charting a Path to Achieve Health Equity
) has stimulated a great deal of discussion. This report is clearly not business as usual. Thinking about and planning for what and how nurses must exercise their social and moral responsibility and mobilize their power to address the myriad challenges surrounding health inequities provides just the challenge we need. Given our profession's history rooted in advocacy and care of those in vulnerable communities of color, that bear the burnt of poverty, poor education and illness, many would assume we will accept that responsibility once more. But will we?
I ask ‘will we’ because for the past 3 decades at least it seems much of our advocacy has been focused inward- often necessary and highly appropriate. Pushing for higher levels of entry level education in the nursing workforce, expanding the scope of practice, developing and claiming an evidence base for practice are only three of many areas we have succeeded in ‘moving the needle’ based on consistent and strong leadership. To achieve profession-wide goals our professional associations became more focused on developing coalitions to push many of these initiatives forward in ways that were essential to that progress. Leaders focused their research programs on studying the impact of a better educated workforce, a more independent scope of practice and how EBP improved care outcomes. Forward progress in these areas must continue as those 3 initiatives in particular should enable the workforce to now support advocacy and innovative approaches that will directly and meaningfully reduce health disparities and improve health outcomes. And we will need the power of nurses collectively to make a difference.
Yet we will also need an expanded and different cohort of leaders to be successful. Leading to ‘make a difference’ is tough work. It will require emerging and seasoned leaders working together. They must be more curious and self-reflective about what is and what can be than what we each think should be viewed only from our individual lens. For us, as individuals and as a profession, to ‘make the difference’ and lead in ways we are called on in the 2030 report requires close examination of 1) why and how higher education and expanded scope of practice really enables nurses to lead and 2) what we must change to use power and influence to really change access, where care is delivered, how care is funded, partner with communities (thereby sharing our power and belief about what is needed) and speaking out louder than ever about what is needed and what must change!. Over the past thirty years we have wriggled (clawed?) our way to the tables of system leadership in education, research, practice and policy. Now we have to do the hardest work- engaging others in our vision and goals and strategies for changing health outcomes. And that will mean we have to say and do things in ways that others can ‘listen and hear’.
Influential leaders of all ages and stages in their careers are focused on where we need to be - call it a vision, a big goal or even a dream. But dreams don't become a reality without measured steps along the way. If nurses now turn outward and truly engage in pushing innovative, person- and community centered approaches to working with others at all levels to improve health we won't need to demand change to get others’ attention- change will happen. Collaborative leadership will require we develop intraprofessional as well as interprofessional models of care delivery. Reality suggests that we have built such silos around our practice expertise that often we don't see the experts within our profession we can learn from. For instance, although their numbers have dwindled over the last two decades we still have very passionate nurses, nurse educators and nurse researchers who have a wealth of knowledge and skills to share about how to create and sustain collaborations in rural areas and urban communities outside of traditional boundariesof academe and health systems. Whether we call them public health nurses, or community health nurses, or population health nurses seems less important to me than just to call on them. They have a passion and skill for teaching us what needs to be done. They are acutely aware of how what is found in an electronic medical record is only a sliver of a reflection of an individual's actual health status. They have been fighting for inclusion of housing status, educational attainment, income and other important social determinants of health in those records. They know how to see strength and talent in others outside of degrees and work experience. And they know how to base their assessment on what the people they work with think the problem is and are willing to share decision-making with those ‘less well educated’ but far more experienced at the challenge at hand. These are the women and men in our profession are who we need to be seeking out and learning from.
I know I may sound like a broken record but it our younger colleagues who must be supported to lead in this new paradigm. Every ‘experienced, seasoned’ nurse leader needs to reach out to one or two younger colleagues NOW. But not just work with them individually and ‘mentor’ them. I think as a first step seasoned leaders should use their influence and power to challenge systemic thinking about who is ready to be a leader. All seasoned leaders have some influence and power and should use it to challenge old and tired definitions of ‘leadership, ability, competence and readiness’. Too often we use time spent doing something as a measure of what one has learned and become skilled at. The fact is people learn and become skilled at different rates. So time and exposure is not a reasonable way to think about whether someone is ready for a leadership challenge. In fact, the challenge itself may be just what they need to grow into being a leader! To meet the challenges in 2030 we must allow young nurses to tell us when they think they are ready, as well as to tap some on the shoulder and share why you think they are ready. We must ask ‘why?’ when told that some promising young nurse doesn't have the experience they need. We must give up quantifying the number of hours, positions, etc. as a translation directly into learning anything.
Just what does the passionate, talented young leader need from us? What would that ‘experience’ look like if they had it? What are the other obvious strengths of this individual that can be leveraged? And what areas may be points of pain for them as they charge ahead with passion? Most importantly how do we support them to come to ‘know’ these things? For both seasoned and emerging leaders patience will be critical. Patience with self and others is hard for most of us to develop- especially those who are used to setting and achieving goals we have set. Yet patience is essential if emerging and seasoned leaders are to work together and learn from each other. Creating a new professional force of leaders mandates deep listening on both sides, willingness to take time out to reflect on what it is both want and have to contribute, clear messaging and coaching about what may be challenges and a focused commitment to support and re-group with the emerging leader when things don't go as hoped. Every seasoned leader was once impatient, focused and on occasion, righteous about whose truth counted (at least I was ☺). These kinds of collaborative leader relationships will challenge and support both the seasoned and emerging leader. Yet it will strengthen the profession to lead in numbers sufficient to ‘make a difference’.
I know we got this! As a profession we are steeped in the stories and are still leaning on the courage and legacies of strong women and men who came before us and forged new paths. We can find new ways to relate, engage, challenge and support emerging leaders from diverse backgrounds who have new visions and different ‘ways of knowing’ to share as we all tackle what is before us. But it has to be a priority. Commit yourself to engaging 2 emerging leaders. And then hang on and enjoy being part of growth!
© 2021 Published by Elsevier Inc.