Principles of Nursing Leadership: Jobs and Trends

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Three nurse leaders stand atop a mountain, flying the flag of good health.

For the first time in U.S. history, people aged 65 and older will outnumber the population of children by 2030, according to U.S. Census Bureau projections. The Advisory Board reports that 73% of nurses in the baby boom generation will retire in the near future. Additionally, the supply of new nurses is insufficient to meet nursing demand due to a shortage of nursing faculty and slow growth in nursing school enrollments, according to the American Association of Colleges of Nursing (AACN).

The combination of these three factors is contributing to a strained health care system. Amid these and other challenges, there’s increasing demand for highly trained professionals ready to fill nursing leadership jobs. Nurse leaders play a vital role in delivering high-quality health care and moving the nursing profession forward.

What Is Nursing Leadership

Nurse leaders work at the highest levels to establish nursing best practices that promote safe, efficient, quality, cost-effective and patient-focused care. Their clinical knowledge, nursing practice experience and exposure to health care settings are critical components for educating, guiding and preparing new nurses.

According to the American Organization for Nursing Leadership (AONL), nurse executives should exhibit five core competencies: “communication and relationship management; knowledge of the health care environment; leadership; professionalism; business skills and principles.” These skills are essential for optimizing the care experiences and health of patients, enhancing health care operations and reducing health care costs.

Demand for Nurse Executive Jobs to Meet Health Care Challenges

Nurse executives often work with other top executives and managers, including hospital CEOs, to set up a health care organization’s goals and mission. They provide leadership and perspectives that can help optimize day-to-day nursing operations and ensure high-quality care.

Like other industries, health care is an increasingly data-driven field. More than ever, digital technology plays a critical function in running nursing operations. In addition to changing how nurses manage their patient loads, technology allows patients to involve themselves in their care management more proactively. As technology increases its footprint in the health care industry, executives look to nurse executives to guide nurses in adopting these technologies.

Demand for medical and nursing services is also on the rise due to aging baby boomers. Likewise, the aging nursing workforce is retiring in the coming decades. A big concern in the field is that the accumulated years of nursing practice experience may go with them when they leave the workforce, and not enough new nurses are being trained to replace them: according to the ACCN, in the 2016-2017 academic year U.S. universities turned away more than 60,000 qualified nursing applicants because of a lack of classroom and clinical space.

These challenges are helping to fuel the demand for nursing leadership jobs, which is expected to rise over the next decade. Health care executive roles, including nursing leadership jobs, will grow by 18% from 2018 to 2028, according to U.S. Bureau of Labor Statistics (BLS) projections. This rate far exceeds the average growth pace for all occupations.

Five essential competencies for nurse leaders include communication, leadership, professionalism, business management and knowledge of the health care environment.

Nurse Administrator Jobs: General Duties, Education and Work Environment

The primary aim of a nurse administrator is to ensure good health outcomes and provide patients with excellent experiences. This critical role requires a solid foundation of clinical and nursing care knowledge and a firm handle of workplace administration. Typically, nurse administrators are clinically skilled and provide leadership in a hospital unit. Still, their roles mostly involve administrative and team management activities. For example, they oversee record keeping, maintain nurse schedules, manage budgeting processes, and provide training and mentorship to new nurses.

The wide range of responsibilities in nurse executive roles, such as nurse administrators, can cause high stress and fatigue. They must also show mastery in the use of technology and in dealing with nursing team issues. In doing so, they help ensure optimal delivery of nursing services. In terms of education, nurse executives and administrators typically hold Master of Science in Nursing or Doctor of Nursing Practice degrees.

Nurse executives work in various environments, from small clinics to regional hospitals. Here are examples of typical health care settings for nurse administrators.

Health Care Organizations

“Health care organization” is a term describing a health care facility where patients receive care from clinically trained professionals, such as doctors and nurses. Every setting described in this list is a health care organization. The services of a health care organization can vary depending on its size. As such, the work environment of nurse executives will vary depending on the type of facility. In a health care facility such as a hospital, nurse executives may oversee a single unit. Nurse executives with C-level titles may manage all hospital units, with unit nurse leaders reporting to them.

General Medical and Surgical Hospitals

General medical and surgical hospitals include many units categorized as intensive care units (ICUs) and acute care units. Nurse executives who manage nurses in ICUs don’t typically provide direct patient care. Still, the pace of the administrative work matches the intensity of these environments. As patients face life-threatening situations that require urgent attention, nurses in these units work at a rapid pace. A nurse executive takes into account the unique environment of general medical and surgical hospitals and helps ensure that nursing operations effectively support the needs of nurses, patients and physicians.

Government Facilities

Government facilities include hospitals run by the U.S. Department of Veterans Affairs, the most extensive integrated health care system in America, encompassing 1,255 health care facilities. Nurse executives in government facilities help provide a wide range of services — including radiology, surgery, pharmacy, critical care, orthopedics, physical therapy and mental health — to 9 million veterans. In addition to their administrative responsibilities, nurse leaders in government facilities can help improve access to care by developing new models, such as the Patient Aligned Care Team (PACT).

Consulting Firms

When health care organizations need expert assistance to optimize their operations, they turn to health care consulting firms. Nurse leaders in consulting firms can use their clinical and operational knowledge to help facilities improve their nursing systems and processes. They can also collaborate with clients to define strategies that can help resolve pertinent issues and improve efficiencies. Some consulting firms specialize in health care, while others are global firms with specialized health care consulting units among their offerings. Top global firms offering health care consulting services include McKinsey & Company, Boston Consulting Group and Deloitte.

Home Health Agencies

As the U.S. patient population gets older, home health agencies will play a pivotal role in providing essential care. It’s necessary to note the difference between a home health agency and home care services. A home health agency offers medical and clinical services to patients in their homes. Patients can receive health services in their homes from home health agencies, including nursing care, therapeutic and mental health services from registered professional nurses. In contrast, home care services provide nonmedical services, such as housecleaning. Nurse executives working in home health agencies oversee teams of licensed nurses responsible for helping older adults recover from illness or injury, manage chronic health issues and achieve independence. They set policies, supervise services, maintain clinical records, oversee overall plans and budgets, and ensure adherence with state or local licensing laws. A home health agency may be a public, government-run, nonprofit or for-profit health care organization.

Research Facilities

Between 1900 to 2009, life expectancy in the United States increased from 47 to 78 years, according to the National Institutes of Health. This was made possible thanks to scientists working in research facilities to find lifesaving medicines for the world’s deadliest diseases. Another important activity in health care research involves finding ways to improve health care processes and enhance quality and safety. Patients who participate in research programs receive care from nurses. Nurse administrators provide leadership to teams of nurses, ensuring high quality of care and adherence to research standards.

Nursing Care Facilities

Nursing care facilities, or nursing homes, provide three primary services: medical care, patient rehabilitation and long-term health services. Patients may temporarily stay at a nursing care facility following an injury, disability or illness. Skilled nurses provide health-related care and services, including mental or physical conditioning for patients suffering from chronic and degenerative diseases like Alzheimer’s and Parkinson’s. As part of their operational and nurse management responsibilities, nurse leaders ensure that these facilities have 24-hour supervision and are accommodating to both temporary and permanent residents.

Academic Institutions

In academic institutions like colleges and universities, nurse leadership may include promoting quality nursing education aligned with accreditation standards for nursing programs. These nurse leaders are typically faculty members with a doctorate.

Public Health Offices

During public health crises, people rely on the medical expertise and guidance of public health professionals. Nurse leaders serve as senior-level advocates for building healthier communities. Their responsibilities may include developing policies focused on improving the general population’s overall health, running wellness programs, and driving communications efforts to keep the public informed of health-related issues. Nurse leaders can work in state-, county- or national-level public health offices.

Outpatient Care Centers

Patients who receive inpatient services in hospitals and clinics typically stay overnight for observation by nurses and other health care professionals. Outpatient centers allow patients to leave following a procedure. In some cases, patients will have to wait until the anesthesia wears off before leaving. Throughout the process, nurses provide essential services to prepare patients before their procedures and walk them through the next steps after a procedure. Nurse leaders establish the systems and processes to ensure the smooth operations of these facilities.

Primary Care Private Practices

According to the American Medical Association (AMA), a primary care private practice is a “practice wholly-owned by physicians rather than by a hospital, health system or other entity.” Ensuring proper systems for patient appointments and payments is a core responsibility of nurse leaders in this setting. Nurse leaders in primary care private practices typically manage a small team of nurses. In addition to ensuring high-quality nursing practice, they must stay current on federal health care regulations. They implement payment policies that will help maintain financially viable practice operations.

Community Health Agencies

According to the Centers for Disease Control and Prevention (CDC), “Community health centers are community-based and patient-directed organizations that serve populations with limited access to health care.” Nurse leaders in community health centers drive efforts to ensure sound administrative, clinical and financial operations. They also assess the unique needs of the people and communities they serve to provide proper health care services and supportive services, such as education and translation.

Nurse executives perform a wide range of duties, such as advocating for nurses, ensuring the highest level of patient care, managing budgets and mentoring nursing staff.

Top Nursing Leadership Jobs: Descriptions and Salary Information

According to AACN, there are more than 3.8 million registered nurses (RNs) nationwide, making nursing the largest health care profession in the United States.

Most employers require nursing candidates have at least a bachelor’s degree. Master’s degrees and doctorates are preferred for nurse leadership positions, according to AACN. The following sections contain examples of top nursing leadership jobs.

Chief Nursing Officer Description

As the top nurse, the primary focus of the chief nurse officer (CNO) is to define high patient care standards and establish clinical best practices for nurses to follow. As C-level executives, CNOs collaborate with other top executives, such as CEOs, chief operating officers and chief financial officers. A CNO designs care strategies, manages budgets, establishes health care policies, improves facility operations and champions working environments that help nurses succeed in their roles. They have extensive knowledge of health care practices, nursing procedures, nursing staff regulations and patient policies.

Chief Nursing Officer Salary

The median annual salary for CNOs is around $128,600 as of July 2020, according to PayScale. Board-certified nurse executives earn a median annual salary of around $130,700 as of July 2020, according to PayScale.

Nursing Director Description

Nursing directors make care delivery decisions at the highest levels in collaboration with other leaders. The nursing director’s central goal is to drive continuous improvement in the delivery of high-quality patient care in health care facilities, with a focus on nursing practice. Nursing directors manage the nurse workforce in a hospital or health care facility. They also ensure compliance with health care regulations and manage nursing department budgets.

Nursing Director Salary

PayScale reports that nursing directors make a median annual salary of around $88,200 as of July 2020.

Nurse Manager Description

From hiring, training and supervising nurses to managing nurse department budgets and nurse schedules, nurse managers provide nursing staff with the tools they need to succeed. They stay current with state and federal guidelines, ensure clean facilities, and regularly collaborate with physicians. Additional responsibilities for nurse managers include nurse performance assessment, risk management and policy enforcement.

Nurse Manager Salary

The median annual salary for nurse managers is around $86,000 as of July 2020, according to PayScale.

Nurse Educator Description

Nurse educators help nurses advance in their careers and improve their skills. They evaluate nursing staff’s training needs and develop education programs to promote best practices. They often deliver the training themselves, so they must have persuasive public speaking and presentation skills. Nurse educators often serve as mentors to entry-level nurses. They collaborate with others, such as nurse administrators, to develop policies that enhance patient care quality. By building productive nursing teams and motivating their performance, nurse educators contribute to optimized care outcomes.

Nurse Educator Salary

PayScale reports that the median annual salary for nurse educators is around $76,000 as of July 2020.

Lobbyist or Legislative Consultant Description

In addition to their clinical and administrative background, health care lobbyists understand the political and legislative process. They use their knowledge about public health issues to influence decision-making and changes in health care policy that affect their organizations or clients. Lobbyists must register with government agencies at the federal and state levels. Each state has different rules and definitions for lobbying, according to the National Conference of State Legislatures.

Lobbyist or Legislative Consultant Salary

The median annual salary for a lobbyist or legislative consultant is around $75,000 as of July 2020, according to PayScale.

Health Care Director Description

Health care directors oversee medical and health services in facilities of various sizes. In smaller facilities, health care directors may be involved in the office’s day-to-day running, including scheduling patient appointments and taking care of billing. In larger ones, they manage other managers across departments to ensure smooth operations. They’re knowledgeable about changes in health care regulations and laws and the latest technology.

Health Care Director Salary

The BLS reports that the median annual salary for medical and health services managers, which includes the role of health care director, was $100,980 as of May 2019.

Nursing Professor Description

Nursing professors educate the next generation of nurses in colleges, universities, teaching hospitals and trade schools. They both teach in classrooms and oversee student nurses’ clinical work hours. They often specialize in a field such as obstetrics or gerontology.

Nursing Professor Salary

According to PayScale, nursing professors earned a median annual salary of around $70,600 as of July 2020.

Nursing Care Facility Manager Description

Nursing care facility managers oversee operations of health care facilities that provide older adults with medical care, patient rehabilitation and long-term health services. They manage nursing schedules, interact with family members of patients and ensure that residents receive the best care possible. A nursing care facility manager may manage a department of a larger nursing home, such as a wing focused on patients with degenerative brain diseases. They also align procedures to health regulations and safety codes.

Nursing Care Facility Manager Salary

The BLS reports that nursing care facility managers earned a median annual salary of $97,300 as of May 2019.

Nursing Leadership Inspires Excellence in Health Care

Nurse leaders exhibit a mix of business and management skills in their jobs to lead nursing teams, set policies and oversee operations. Their knowledge of clinical practices, combined with their leadership, organization, communication and administration skills, can help elevate the health outcomes of patients and advance nursing practice and quality.