Less than 25 percent of leadership roles are filled by nurses, according to an analysis published in the New England Journal of Medicine.
Despite this low representation, about three-quarters of clinicians, clinical leaders and healthcare executives surveyed believed nurse leaders should be considered equal to physician leaders in care delivery.
“Nurses, especially those with advanced degrees and experience, make skilled leaders because they have more experience at the bedside and can often see issues with a variety of solutions that may not be seen by someone who has less time available with the patients and the health system as [a] whole,” one clinician wrote in the survey, which analyzed the responses of the NEJM Catalyst Insight Council.
A lack of nurses among the leadership ranks could have negative impacts on the future and the transformation of care delivery, according to Stephen Swensen, MD, MMM, professor emeritus of Mayo Clinic College of Medicine, senior fellow at Institute for Healthcare Improvement, and theme leader for NEJM Catalyst’s Leadership theme.
Yet, nearly 80 percent of organizations have a chief nursing officer, according to the survey, and 95 percent of respondents said CNOs are involved in strategic decision-making.
While many agree nurses should hold more leadership roles, 58 percent of respondents estimated less than 25 percent of nurses are interested in these roles. However, it is unclear if nurses are disinterested or if they don’t see a pathway to leadership. Non-nurse respondents were 20 percent more likely to say there was a leadership path for them at their organizations compared to nurse respondents.
“You’ve got these nurses who spend these years training, love what they do, and don’t want to move beyond it,” Swensen said.
Barriers to advancement, including inherent gender bias and the perception that nurses aren’t strategists, may also prevent nurses from entering leadership roles, the report found. Tradition of physicians and non-clinical administrators as leaders was cited as the main barrier to nurses by survey respondents (37 percent).
To combat the leadership issue, more nursing academic partners are developing their internships and externships to extend skills beyond patient care to leadership and team development. Team-based training is not yet widespread, however.
A team-based approach could also boost confidence among nurses through a multidisciplinary team and allow other care team members to become more comfortable with a nurse in a leadership role.
This approach may be more challenging for smaller hospitals compared to larger health systems and academic centers, which may already have the ability to offer leadership tracks for nurses. The recent uptick in mergers and acquisitions in the space may have some advantages for nurses to advance, as well. For example, Geisinger Health System, which acquired community hospitals, opened up more opportunities for nurses to receive more training and education to advance their careers once the organizations merged, according to the analysis.
“It’s not that they didn’t want to do the training. Some of them just didn’t see the value of it. When we merged, the opportunities grew for those nurses,” Susan Robel, RN, BSN, MHA, NEA-BC, CPXP, executive vice president, chief nursing officer, and chief patient experience officer at Geisinger, said in the report.
The pipeline for nurse leaders may be further bolstered by the number of retiring baby boomers in the space. As millennials take over more of the workforce, they may be more likely to move jobs more frequently and pick up additional education and training that can lead to more leadership roles.