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Competing Interests: The author declares no conflict of interest.

Innovation keeps an organization competitive and adaptive to change. Nurse leaders are looking for new ways to innovate and transform, being challenged to influence quality, design new care delivery models, and create workplaces that empower nurses to advance new ideas that lead to innovation. Innovation involves risk as well as new ways of thinking. The workforce must feel confident that a creative approach to problem-solving is valued and supported. The nurse leader must role model use of creative approaches to problem-solving and promote a spirit of innovation among today's workforce. The nurse leader can learn to be more creative and can use education to empower staff to use creative thinking techniques to solve problems in practice. The transformational nurse leader can use any one or more of the tools and techniques offered in this article to inspire and educate the workforce on creative approaches to problem-solving and ultimately to generate innovative solutions to real practice problems.

To lead others in achieving exemplary outcomes, nurse leaders need to understand the vital and interdependent connection between quality, safety, the patient and RN experience of care, and RN engagement. The triple aim of improving population health, enhancing patient experience, and reducing cost cannot be accomplished without a robust and engaged workforce that finds joy and meaning in its work. This is especially true for the nursing workforce. The vital connection of nurse engagement to the experience of care, and ultimately to nurse and patient outcomes, is clear. Quality improvement efforts that equally emphasize initiatives to improve patient experience and create and sustain a highly engaged nursing workforce are key to achieving desired outcomes.

Person- and family-centered care (PFCC) is a philosophy that has been espoused for decades and yet is rarely embedded in health care organizations. Difficulties dispelling the numerous myths about what PFCC is, as well as daunting challenges to designing and implementing it, have hindered progress. The chief nurse officer is well-positioned to assume organizational leadership in successfully navigating this effort. This article provides 9 specific steps a chief nurse officer should take to create a culture, with supportive systems and an environment, to ensure authentic PFCC.

The aim of this research was to describe nurse managers' leadership and management competencies (NMLMC) from the perspective of nursing personnel. Nurse managers are responsible for the management of the largest professional group in social and health care. The assessment of NMLMC is needed because of their powerful influence on organizational effectiveness. An electronic survey was conducted among the nursing personnel (n = 166) of 1 Finnish hospital in spring 2016. Nursing personnel assessed their manager using a NMLMC scale consisting of general and special competences. The data were statistically analyzed. Leadership and management competencies were assessed as being quite good by the nursing personnel. The best-assessed area of general competence was professional competence and credibility and the weakest was service initiation and innovation. The best-assessed area of special competence was substance knowledge and the weakest was research and development. The nursing personnel's assessment of their nurse manger's competencies was associated with the personnel's education level, working experience, and with their knowledge of the manager's education. Conclusion was made that nursing personnel highly value professional competence as part of nursing leadership and management. To achieve more appreciation, nurse managers have to demonstrate their education and competence. They must also work in more open and versatile ways with their nursing personnel.

Executive nursing practice is experiencing "head-snapping change." Health care has transitioned from the managed care era to the disruptive innovation era. As chief nurse executives (CNEs) navigate evolving care delivery models, they must consider retooling their roles and responsibilities related to emergent models. This integrative review's purpose was to examine evidence for the roles, responsibilities, characteristics, and competencies of CNEs and system CNEs to better guide future generations of nurse executives. Ganong and Cooper's integrative review methodology was chosen to guide the evidence synthesis. Seventeen articles were identified that pertained to the clinical inquiry. The evidence is inconsistent for specific CNE roles, responsibilities, characteristics, and competencies due to many areas of overlap and an absence of definitions. The evidence does describe who CNEs are, what they do, and how they articulate executive practice. Embedding evidence regarding emerging roles, responsibilities, characteristics, and competencies into the personal journeys of nurse executives helps articulate shifting paradigms and the CNE's role in transforming health care. Review results have the potential to create a blueprint for the recruitment, development, and retention of the next generation of nurse executives. New knowledge for the ever-changing worlds of CNEs is needed by robust research studies and other evidence.

Inequalities in society, culture, and finance have resulted in civil unrest, rioting, and intentional violence throughout our history. Nowhere is this currently more apparent than in the cities of Ferguson and Baltimore. It is not the civil unrest itself, but the resulting rioting and intentional violence that can create a disaster situation. This increases the care burden of health care providers during times when the governmental structure may be overwhelmed or functioning in a less than optimal manner. Beginning with the death of Michael Brown, civil unrest over the last 2 years has necessitated a closer examination of the role nurse leaders play in preparing their staff and facilities for potential results of this civil unrest. The similarities between the results of rioting and violence and natural disaster are obvious, but the differences are significant. Without adequate preparation, providers may not offer the appropriate response. Attention to the 10 "musts" for preparedness for civil unrest will facilitate a planning process and provide for a better response and recovery when communities face these issues.

Strong leadership is critical in disaster situations when "patient surge" challenges a hospital's capacity to respond and normally acceptable patterns of care are disrupted. Activation of the emergency operations plan triggers an incident command system structure for leadership decision making. Yet, implementation of the emergency operations plan and incident command system protocols is ultimately subject to nursing and hospital leadership at the service- and unit level. The results of these service-/unit-based leadership decisions have the potential to directly impact staff and patient safety, quality of care, and ultimately, patient outcomes. Despite the critical nature of these events, nurse leaders and administrators receive little education regarding leadership and decision making during disaster events. The purpose of this study is to identify essential competencies of nursing and hospital administrators' leadership during disaster events. An integrative mixed-methods design combining qualitative and quantitative approaches to data collection and analysis was used. Five focus groups were conducted with nurse leaders and hospital administrators at a large urban hospital in the Northeastern United States in a collaborative group process to generate relevant leadership competencies. Concept Systems Incorporated was used to sort, prioritize, and analyze the data (http://conceptsystemsinc.com/). The results suggest that participants' institutional knowledge (of existing resources, communications, processes) and prior disaster experience increase leadership competence.

American health care organizations are experiencing increasing change driven by emerging partnerships, market demographics, population health initiatives, and merger and acquisition trends. The health care business environment necessitates alterations in how companies operate on a larger scale. New regional leadership roles are being created to provide leadership to systematize networks, build market share, and strengthen market needs. It is important and necessary to explore, review, and contrast the roles, skills, and behaviors of regional leader's roles and the solo organization leaders. It is also imperative to review the benefits of new affiliations for the community and hospital entity.

Health care bullying is a pervasive, underestimated, and underreported problem that results in poor outcomes for staff, patients, and health care organizations. The most common form of health care bullying occurs between nurses. Nurse managers hold an important role in the prevention and elimination of frontline nurse-to-nurse bullying. An anonymous Web-based survey was conducted to uncover what behaviors nurse managers perceive as bullying and how they respond to bullying acts. Respondents who had witnessed or been victimized by bullying were more apt to identify bullying and those who had been victimized or supervised nurses for more than 20 years were more prone to act upon bullying behaviors. There was only a moderate correlation between the identification of and response to bullying behaviors. Finally, overt bullying elicited a stronger response for intervention than covert bullying. Although nurse managers are well positioned to prevent and eliminate nurse-to-nurse bullying, they may not recognize it and often lack the skills and support necessary to address it. Decreases in nurse-to-nurse bullying reduce health care costs, improve nurse and patient satisfaction, and enhance patient outcomes. Therefore, nurse managers at all levels need education and support to ensure proper identification of bullying and, furthermore, to prevent and eliminate the behaviors.

The nurse executive has been especially vulnerable to unexpected job loss as a result of financial and other pressures in the health care environment. The nurse leader is often the one who holds the standards of quality and safety above those of cost. While there may be many reasons or factors that affect a sudden removal of a nurse leader, the problem is that the unexpected job loss is often a devastating and traumatic event to the individual affected. Twelve nurse executives who experienced unexpected job loss were interviewed in depth for this study. Stories collected illustrated deep personal and professional loss of identity and self-esteem as well as colleagues and friends. Their resilience and ability to get past this adversity aided the nurse leaders in their healing, recovery, and reinvention of their professional selves. Finally, following reflection, the participants offer strategies for averting unexpected job loss as well as preparing for transition.

The health care environment has changed but the future remains uncharted. Organizations are keenly aware of the need to chart their course with an eye on addressing the Institute for Healthcare Improvement Triple Aim. Today health system boards are under growing scrutiny to prepare the organization to meet the demands of the new world of health care. The 2010-2011 American Hospital Association survey of 1000 nonfederated community hospitals found that only 6% of board members were nurses. The reasons for this disconnect are many but will not be addressed in this article, but one major reason is the limited expertise of nurses serving in the role of trustee. This article will address the basic operations of boards and the role and responsibility of a trustee.

The current and projected nurse workforce shortage has created significant pressure on health care organizations to examine their approach to managing talent. This includes the need for strategic development of new formal leaders. This article reports on a succession planning program for prospective nursing unit managers. Eight prospective management candidates participated in a Future Nursing Unit Managers program. The effectiveness of the program was measured through a comparison of pre- and postprogram surveys relating to participants' perception of personal managerial and leadership skills. Significant differences in scores from baseline to 6-month follow-up surveys were observed in the participants' confidence in undertaking the nursing unit manager role and in their management skills. Investment in structured programs to prepare nurses for leadership roles is strongly recommended as a management workforce strategy.

The purpose of this research was to identify the profile of an excellent nurse manager who can lead effective health care teams. Leadership attributes and competencies that characterize an excellent nurse manager and tools to identify them are lacking in the literature but are required to efficiently and effectively address the growing shortage of registered nurses (RNs) in health care team leadership roles and the critical linkage of these roles to patient outcomes. A profile of an excellent nurse manager was developed on the basis of the responses of nurse managers across the United States who had been identified as excellent or competent by chief nurse executive assessment or/and the Nurse Manager Ability, Leadership, and Support of Nurses staff survey to the Kouzes and Posner Leadership Practices Inventory: Self Instrument. Statistically significant distinctions exist between nurse managers who are excellent and those who are competent as assessed by the Five Practices of Exemplary Leadership, which together comprise the profile of an excellent nurse manager. The Kouzes and Posner Leadership Practices Inventory: Self Instrument can be used to identify, recruit, and develop RNs in the nurse manager role as excellent leaders of effective health care teams.

Background: A healthy work environment can improve patient outcomes and registered nurse (RN) turnover. Creating cultures of retention and fostering healthy work environments are 2 major challenges facing nurse leaders today., Specific Aims: Examine the effects of the healthy work environment (communication, collaboration, and leadership) on RN turnover from data collected from a research study., Methods: Descriptive, cross-sectional, correlational design. Pediatric critical care RNs from 10 pediatric intensive care units (PICU) completed the Practice Environment Scale of the Nursing Work Index Revised and a subscale of the Intensive Care Unit Nurse-Physician Communication Questionnaire. These staff nurses were asked whether they intend to leave their current job in the next 6 months. Statistical analysis included correlations, multiple linear regression, t tests (2-tailed), and 1-way analysis of variance., Results: A total of 415 RNs completed the survey. There was a statistically significant relationship between leadership and the intent to leave (P < .05). There was also an inverse relationship between years of experience and intent to leave. None of the communication variables between RNs and among RNs and MDs or collaboration were significantly associated with PICU nurses' intention to leave., Conclusion: Effective leadership in the PICU is important to PICU RNs and significantly influences their decisions about staying in their current job.

Purpose: The purposes of this article are to: (a) describe the first, national, collection of quality measures for nurse-managed health centers (NMHCs); (b) present the quality findings; (c) compare findings with national ambulatory care benchmarks; and (d) discuss the feasibility of national quality data collection, including NMHCs' experiences with data submission and the utilization of findings., Methods: Quality outcomes appropriate for aggregated assessment of NMHC quality were proposed by a committee of the National Institute for Nursing Centers. Quality measures related to these outcomes were developed for breast cancer screening, cervical cancer screening, diabetes care, hypertension management, and smoking cessation based on protocols of the Health care Effectiveness Data and Information Set. Nine NMHCs were recruited to participate in retrospective data collection, manually from record audits or electronically from the submission of data files., Results: Overall, quality measure findings compared favorably with national benchmarks, with particularly high quality demonstrated for chronic disease care management., Conclusions: Good to very good quality of care was documented across NMHCs, and NMHCs compared favorably with national benchmarks. Data were useful to NMHCs in identifying quality strengths and areas for improvement. National data collection proved to be feasible.

Balancing clinical quality, safety, and cost is not new to health care leaders; however, the current environment of public transparency coupled with unprecedented economic challenges has created a sense of urgency to this triathlon-like balance. The implementation of clinically proven, life-saving therapy in the care of patients with sepsis is one of the highest financial burdens incurred by acute care facilities; however, the absence of that care is known to be the leading cause of death in noncoronary intensive care units and the 10th leading cause of death worldwide. Can we afford to save these lives? Through root-cost analysis of intensive care unit-care in conjunction with population management strategies, the synergy of bundled therapies in driving positive clinical outcomes can be replicated in the achievement of an outcome bundle including quality improvement, safety enhancement, and financial stewardship.

This article reviews how the nurse leaders of a 136-bed medical/surgical service developed and implemented a methodical plan to fill RN vacancies, decrease labor costs, and improve quality. This simple, straight-forward approach was designed to rapidly fill core staff positions while minimizing the impact of the vacancies and ultimately eliminate the use of temporary nursing staff. The detailed components of the plan provided a way to assess vacancy data, time temporary replacements, and structure beneficial hospital partnerships, all of which were instrumental in the success of the plan. The plan was implemented throughout the facility because of proven success in the medical/surgical service. The leaders' focus on decreasing labor costs resulted in hiring a stable core staff that was able to attain established quality initiatives. The financial and quality outcomes of the service demonstrate the ability to sustain excellent results over time.

Nurses at the bedside serve on "the front lines" as hospitals strive to prove their "meaningful use" of technology to the federal government in hopes of securing significant funds from the American Recovery and Reinvestment Act. Nurse informaticians, working in concert with chief nursing officers, guide the nursing organization toward the most effective and efficient ways to demonstrate "meaningful use." Armed with data points from the point of care, nurse informaticians and chief nursing officers will be able to quantify, for the very first time, the value of nursing's contribution to the quality of patient care in America.

With dramatic increases in health care costs and growing concerns about the quality of health care services, nurse executives are seeking ways to transform their organizations to improve operational and financial performance while enhancing quality care and patient safety. Nurse leaders are challenged to meet new cost, quality and service imperatives, and change cannot be achieved by traditional approaches, it must occur through innovation. Imagine an organization that can mitigate a $56 million loss in revenue and claim the following successes: Increase admissions by a 8 day and a $5.5 million annualized increase by repurposing existing space. Decrease emergency department holding hours by an average of 174 hours a day, with a labor savings of $502,000 annually. Reduce overall inpatient length of stay by 0.5 day with total compensation running $4.2 million less than the budget for first quarter of 2010. Grow emergency department volume 272 visits greater than budgeted for first quarter of 2010. Complete admission assessments and diagnostics in 90 minutes. This article will address how these outcomes were achieved by transforming care delivery, creating a patient transition center, enhancing outreach referrals, and revising admission processes through collaboration and innovation.

While evidence strongly suggests that nursing leadership impacts nursing home care, most nursing home (NH) RN leaders have not had the benefit of a structured educational program that emphasizes the skills necessary to effectively lead in today's complex NH environment. The University of Missouri Leadership Development Academy for RNs in Long-Term Care was developed as an innovative educational program to prepare NH RNs to become effective leaders. Early data evaluating the leadership academy suggest that participation in a structured leadership program over an extended period of time may enhance the leadership behaviors of NH RNs.

The performance appraisal process is a key component of professional nursing practice. The peer review process is referred to frequently in Magnet Nursing Standards as a key element in professional nursing. The peer review process allows professionals from common practice areas to systematically assess, monitor, make judgments, and provide feedback to peers by comparing actual practice to established standards. Peer review can engage a multigenerational workforce and lead to more satisfied, engaged employees. As a component of the annual performance appraisal, peer review can create positive relationships, foster a better work environment, and allow peers to increase individual and group accountability. Peer review has many common elements that can be individualized to fit any type of unit or work culture. This article describes how to design, implement, and evaluate a unit-based peer review program. The content and steps outlined are intended to support nurse managers in implementing unit-specific peer review programs by focusing on existing expertise and best practices. The implementation steps are divided into 5 phases describing the introduction of concepts and getting nurses engaged, implementation guidelines, piloting the process, staff education, and ongoing evaluation. Staff involvement is the key to a successful unit-based peer review process.

The call for evidence has swept the healthcare landscape in medicine and nursing and more recently in nursing management. Nurse managers and administrators have been identified as important to support research use and evidence-based practice. The primary focus of this article is (1) to describe the concept of evidence, (2) to challenge the wisdom of basing the practice of leadership on a narrow (reductionistic) understanding of the concept of evidence, and (3) to argue for a rethinking on what should count as evidence in nursing administration. Semantic analysis and examination of dictionaries reveal that evidence as a concept has both an internal and an external dimension. To understand the concept of evidence in a profound sense as well as its significance for leadership this article describes 3 different meanings of the concept: ontological, contextual, and King's evidence.

The chief nursing officer is in a unique position to guide his or her organization to excellence by creating a compelling vision; maintaining objectivity regarding the nursing department's accomplishments; holding senior nurse leaders accountable as Magnet champions; demonstrating strategic thinking, business planning development, operational connection, and awareness of clinical aspects of care; and establishing levels of ownership and decision making within the nursing department's operational framework. The clear definition of terms including responsibility, authority, delegation, accountability, and empowerment are necessary and, coupled with specific actions, skills, and measures of success, guide individual and group processes to achieve organizational excellence and ultimately Magnet designation.

The achievement of Magnet recognition is the beginning of a new way of being as an organization. Strategies to support innovation leadership, value-based decision making, agility, sustainability of excellence, technology advancements, and lifelong learning are discussed within the framework of the Magnet organization. Behaviors and challenges of living the expectations of the Magnet organization are presented as opportunities to assist healthcare leaders in this important work.

The nursing shortage and specifically the shortage of new nursing leaders has fueled heightened recognition of the need for leadership development. This article considers the application of the quality improvement process to leadership curriculum development for the Center for Nursing Leadership's (CNL) Journey Toward Mastery program. Both the postmodernist approach and a commitment to scholarship are used as a framework to develop, evaluate, and revise the program. Further, the importance of symmetry between philosophical perspective and curriculum design are illustrated.

The investigators report validation of a survey tool called the Interview Guide to assist in the selection of nurses who will be effective as managers. Nurse administrators rated nurse managers at six months and two years after hire. The Interview Guide rated the management qualities "seeing the big picture" and potential for "rehire" as the best predictors of managerial success. After two years, a good "self-concept" or a "flexible attitude" was the best predictor. The ability to manage conflict was the most significant competency for predicting rehire at both six months and two years.

A retrospective of joint Commission changes from it's early days to the present is provided in this column. How the Joint Commission on the Accreditation of Healthcare Organizations evolved from the American College of Surgeons initiative to standardize hospital systems and equipment is discussed. Structural standards developed into important functions that crossed departments within an organization. Discussion of the current initiatives and future challenges to improve care to the public is included.

Very little research exists regarding qualities that characterize an excellent head nurse (HN). Sixteen nurses were asked to tell the researcher about an excellent HN that they had worked with at some point in their career. The excellent HNs could be characterized as having a humanistic management philosophy and being skilled at negotiating and conflict resolution. These leaders have excellent interpersonal skills and are powerful advocates for nurses and patients. They are viewed as highly credible, innovative and even tempered. Generally, these leaders were able to meet the needs of the nurses--be they clinical, professional, or personal.