Priorities of Nursing Leadership.

Priorities of Nursing Leadership. It is incredibly challenging to achieve proper leadership planning in the current healthcare environment. This can be attributed to the inadequate resources and the ever-changing demands of the healthcare system. It is therefore vital to make up one’s mind on the strategies to implement as a leader. These priorities need to display their urgency in achieving quality care among the patient. This article dwells on the nursing priorities of leadership that are key in organizational systems. They include the following:

Ensuring that every patient receives the known standards of care in all settings at all times.

Even though healthcare organizations are growing in size to include more settings across the care continuum, it is vital for the standards and quality of nursing care to remain the same or get better. Despite that this strategy sounds like a matter that ought to be automatic and straightforward, it may not be easy especially in ambulatory and emergency care settings which entails intensive care and numerous procedures (Sherman, 2016). The nurse leaders may assume that the same standards of operations are observed in such areas only to get a rude shock when care discrepancies occur.

There exist fundamental standards that the nurse leader ought to ensure exist in the care centers. These include patient-centered care that is tailored to meet one’s needs and preferences and treatment with dignity and respect which encompasses privacy, equity and support one requires during service use. It also entails ensuring the safety of care being offered, seeking of consent, addressing patients’ complaints and good governance. The nursing leadership needs to be vigorous ton ensure implementation and maintenance of these basic standards in care centers (DeVon et al., 2016). This need to be monitored and evaluated on a routine basis. This is so because due to the nature of services being offered in various areas, for instance, the labor and delivery wards where there may be an emergency situation, the set standards of operations can occasionally or even habitually be breached. This ought not to be the case, and the nurse leadership has a role to play.

Prepare and addressing potential nurse shortage and nurse turnover.

It is clear that the pace of unfulfilled vacancies in the nursing profession continues to grow at any given time. The increasing signing of bonuses and use of per diem as well as the travel staff are typical signs of a looming shortage. The nurses’ shortage and high turnover create a disequilibrium between demand and supply of care. This calls for strategy and intervention by the nurse leaders and managers on factors surrounding the issues.

In the various care settings, the nurse leaders need to focus primarily on the supply qualifies nurses at all levels. This can be achieved by not only attracting the new nurses but also working on their retention in their new areas of practice. The leadership ought to embrace an open system of enhancing professional development through the educational advancement of their staff (Nei, Snyder and Litwiller, 2015). The nursing profession has the educational restrictions which usually acts as a demotivating factor to individuals who would have yearned to enter the profession. Besides, those who are already into the profession are usually pushed to the wall forcing them to exit prematurely from the profession to pursue further studies. All these lead to high turnover in such an environment which seems to be unfavorable. The turnover rates even get much higher when the restrictions continue to exists, and this calls for the nursing leadership to embrace educational development which can accommodate such nurses.

Nursing leadership ought to work towards creating a conducive environment for the nurses as this will see them executing their nursing roles efficiently with fewer destructions and job stressors.  A work surrounding that has disruptive behaviors such as demeaning treatment, humiliations, violence and passive-aggressive behaviors among the staffs can act as a facilitating factor to nurses leaving their roles and position since it is not an enabling one to support their working. Nurse Managers can apply the various styles of leadership to guide their operations and guide instances of common interest amongst the staff members. For example, democratic style of leadership can give guidance to the needs of common interest while laissez-faire leadership can act as a guide for the experienced nurses in undertaking nursing roles with no supervision from the charge nurse. In such cases, the violence and solutions to various problems gets assorted to make the surrounding supportive enough to the staff.

In the preparation or the nurse shortage and turnover, the nurse leaders need to adopt the nurse residency programs that are meant to increase the retention and reduce turnover. The program allows the graduate nurses to have resources and equipment that they need to offer their services. Just like the correction of the disruptive behaviors, the program creates an enabling surrounding to the nursing staff thus promoting professional development and allowing retention to address the nursing shortage. It is through such program that the new graduates get proper orientation and mentorship to improve their skills and knowledge. This increases their confidence and competencies in the provision of care.

The nursing leadership, as well as other stakeholders within the healthcare system, need to provide constant recognition to the nursing profession for instance by appreciation to the nurse manages and frontline players. Gelinas confesses that the increased professional recognition only comes about in the time of scarcity (2017). This calls for prioritization by the nursing leadership to give it a continuous focus that will make the profession attractive and lucrative throughout to improve its workforce. The recognition can also be attained by the creation of clinical ladders that would reward experience and level of education amongst the nurses. This can also be achieved through advanced practices roles, shared governance structure, and versatile staffing system. All these indicate the acknowledgment given to high professional performance.

There exist the need for the nursing leadership to design the working systems that would see the professional nurses are only tasked with their licensed duties where the right persons undertake right duties. The designing and implementation of the healthcare system that ascertains right functions are performed by the right individual assists in improving the quality of care that patient is offered. At the same time, it acts as part of the solution in overcoming the shortage among the nurses that are usually attributed by the nurses being burdened by undertaking unlicensed duties (Gelinas, 2017). The scraping off of the unauthorized duties leads to reduced tasks for the nurses hence reduced demand that reduces the overall shortage of nurses.

Through the nurse residency program, the new graduate nurses are being oriented, indoctrinated and educated which leads to improvement of their knowledge, experience, and skills that enable them to provide quality and safe care to patients. The environment provided to these nurses would then be favorable enough to give room for a smooth transition into the service provision and enable them to be retained. This can solve the problem of nurse shortage and turnover that accompanied poor adaptation to the environment and the culture shock that rocks the new graduates.



Making early plans concerning the reshaping of the workforce.

According to the Nursing Advisory Board, this is a critical priority especially concerning the delivery and changes in the healthcare system. With the fact that most of the nurse stay with their employers for relatively long periods of time, the nursing leadership needs to take into consideration the staff that they hire (Sherman, 2016). This can take the form of not only considering the skills set that the individual has to meet the current healthcare needs but also view the competency for future needs.

Indeed, the reshaping of the workforce in supporting the currently instituted models of care is a great opportunity in care centers despite the fact that it is a huge development challenge. From the beginning, the leadership ought to understand the patients’ needs, recruit a skilled workforce that would provide for the needs of the patients over a good period of time. This understanding can be done by the leaders facilitating the evolution of their care centers to move from ill-based, and provider-led system towards one that is patient led and focused on the preventive care and care that is closer to home. The model applied ought to come out of the usual boundaries between primary care and hospitals, between specialists and generalists, between social and health care to provide care that concentrates on what people need. This can fail when there are no radical changes in the workforce.

There exists a small number of people in the nursing school, and this threatens the provision of care to the very increasing general population. This situation alerts the nursing leadership of the urgent need to reshape the workforce in equipping it to provide the varying demand from the population it serves and meet the vision of quality and safe care to all (Imison, Castle-Clarke and Watson, 2016). This will go beyond the changing of the curriculum to include more finances to the training institutions to equip more nurses with knowledge and skills.

The plans ought to take the advantages of the opportunities that exist in developing the current workforce at various cadres encompassing redeploying support staff, extending the skills of professional nurses and training advanced nurse practitioners. The best opportunity that the nursing leadership has in reshaping the workforce is through developing the skills of the current workforce. Although this poses a challenge on both organizational and workforce development, it advances the skills that make them agents of change in care provision and hence leading to quality service provision.

The reshaping of the workforce can also take the form of advancing the practice roles among the nursing staff. This will be critical in the filling in of the gaps in the nursing workforce, enhancing continuity in the clinical area, an offering of mentorship and trying for the less experienced nurses and appreciating and acknowledging of the experienced nurses(Burton et al., 2016). All these will lead to a change in the workforce that when coordinated appropriately can deliver under the leadership of a nurse manager. In one way or the other, this system also provides room for improvement for the changes that are occurring in the healthcare system hence sensitive to the needs of the staff’s skills not only for current need s but also for the future needs by these patients.

Besides the benefits that accrue from the reshaping of the workforce, nursing leadership needs to be careful because the new and extended roles have the potential of threatening the quality of care provided by the nurses. It can also be costly as it may require supplementation instead of substitution of other nursing staffs. The demand can also increase while the care may also fragment. When all these are taken care of, then the nurse leader can working early enough to reshape the workforce to meet the constant needs of the patients.


Seeking greater consensus in relation to the right manner to staff the clinics.

Despite the fact that most emergency care settings have adequately established guidelines for staffing, this is not the case in the ambulatory care settings. In the past years, staffing in these settings has been done from care modalities being delivered. This model is however not efficient since it is vivid that these staff nurses have the potential of carrying out much more duties in the primary centers of care (Sherman, 2016). Deciding on the criteria that is right and proper to staff the clinic ought to be done while putting into consideration of the critical goals of having all the registered nurses working at the highest level of their scope of practice.

The clinics for centers of care where the services offered are essential with the number of patient passing through the units being high. In this era of value-based healthcare and optimizing the quality of care, staffing at these facilities turned to be cumbersome and required extensive consultations and plan. They can also apply the optimal nurse staffing models that would improve the well-being of both the patient and the care provider.

The consensus can also be based on a panel of researcher recommendation, thought leaders, managers, and nurses practicing in the clinic settings (Patterson, 2017). This is so because they will provide additional content that is necessary for helping in the determination of best practices staffing the clinics with nurses. In addition to the above basis of the consensus, there also exists review of the recently published literature, reports by the government as well as other publicly available evaluations of clinic staffing and the patient outcomes. These can be resourceful to the nursing leadership that is striving to improve the patient outcome while also ensuring the efficiency and development of the staff offering care in such settings.


Continuing to control the costs without cutting the labor or jeopardizing quality.

The nursing Advisory Board determines labor being a critical area that represents a good part of the hospital budget with the room for reducing it being minimal and rarely exceeding 15% reduction (Sherman, 2016). These opportunities for reducing costa occurs areas such the outmoded protocols, unfavorable contract or staffs, and equipment as well as supply waste.

Since the hospitals and nursing leadership being under pressure of reducing costs and staffing being their biggest expense, the leaders ought to prioritize this issues to ensure a smooth running of care provision while efficiency is also maintained. This is also critical based on the fact that staff layoffs also form part of the solutions to the cutting of costs. The leaders can go through this by employing strategies such as eliminating overtime. Cutting overtime can be achieved by the use of the new staffing and scheduling system as well as establishing a staffing pool that will come in for the staffing needs to supplement the workforce.

The costs can be reduced by having only staffs with multiple competencies and using them efficiently to meet various tasks and laying off the remaining staffs. For instance, the nurse leader can have the nurses to transport the patient to and from the emergency department instead of having transport staff. This so because in both cases, the nurse is required for assessment and care of the patient during the transit period. Reducing the nurse turnover is also critical to the nursing leadership since it is expensive to train new staffs. The leaders need to venture into ways of retaining the current staffs by offering competitive pay, benefit packages, streamlining processes to reduce the workload for the employees, offering rewards and recognition, treating employees with the utmost respect and promoting them based on appraisals, experience, and academic levels.

In most instances, the nursing leadership ventures in achieving very many things at the same time making them not able to spend too much on them and at long last fail to get the results from them. The cost in such instances can be cut by streamlining the services (Spetz, Brown and Aydin, 2015). This can be enhanced by the leaders visioning their ideal future state and coming up with the efficient ways of getting them done. The cost can further be cut by the elimination of unnecessary positions as the leader need to place focus first on the jobs that are not yet filled.

The use of travel and staffing agencies also raises the hospital expenses that makes it had for the nursing leadership to govern the patient care. This can be averted by reducing their use. This supplemental labor should only be introduced during the seasonal increment of patient volumes or act as a feeling in for the instances where there are large training initiatives and not on daily census demand. Besides the cutting of costs, the financial stability in the healthcare can be achieved by the nursing leadership sorting to do outsourcing. This can be achieved via services such as housekeeping and information technology.


Putting into consideration the various changes that are occurring in the healthcare environment the above priorities are worth being paid attention to. The climate within the healthcare is constantly changing, and nursing leadership needs to be vigorous in their actions to put strategies to go along with these changes. By prioritizing the standards of care that patient receive in all settings, preparing and dealing with the nursing shortage and turnover and planning for reshaping of the workforce, the nursing leadership displays their leading role and responsibilities as they can spearhead the goals of the entire nursing team. This is further demonstrated by seeking consensus on staffing clinics and continuing to control cost without interfering with required labor or quality of care.


Burton, C., Rycroft-Malone, J., Williams, L., Davies, S., McBride, A., Hall, B., … & Jones, A.

(2016). Managers9 use of nursing workforce planning and deployment technologies:

protocol for a realist synthesis of implementation and impact. BMJ open, 6(8), e013645.

DeVon, H. A., Rice, M., Pickler, R. H., Krause-Parello, C. A., & Richmond, T. S. (2016).

Setting nursing science priorities to meet contemporary health care needs. Nursing

outlook, 64(4), 399-401.

Gelinas, L. (2017). Advantages of a nursing shortage. American Nurse Today, 12(7), 4.

Huber, D. (2017). Leadership and Nursing Care Management-E-Book. Elsevier Health Sciences.

Imison, C., Castle-Clarke, S., & Watson, R. (2016). Reshaping the workforce to deliver

the care patients need. Nuffield Trust London.

Nei, D., Snyder, L. A., & Litwiller, B. J. (2015). Promoting retention of nurses: a meta-analytic

examination of causes of nurse turnover. Health care management review, 40(3), 237-


Park, S. H., Blegen, M. A., Spetz, J., Chapman, S. A., & De Groot, H. A. (2015). Comparison of

nurse staffing measurements in staffing-outcomes research. Medical care, 53(1), e1-e8.

Patterson, M. (2017). Review of Literature: The Clinical Nurses’ Perception of Their Role in

Hospital Reimbursement. Pursuit-The Journal of Undergraduate Research at the

University of Tennessee, 8(1), 12.

Sherman, R. (2016). Nurse Leader Priorities for 2016 – Emerging Nurse Leader. Emerging Nurse

Leader. Retrieved 24 January 2018, from


Spetz, J., Brown, D. S., & Aydin, C. (2015). The economics of preventing hospital falls:

demonstrating ROI through a simple model. Journal of Nursing Administration, 45(1),


Weiss, S. A., & Tappen, R. M. (2014). Essentials of nursing leadership and management. FA