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Research indicates that narcissistic personality disorder and subclinical narcissism may be reaching epidemic proportions within American society. It is thus probable that nursing administrators will encounter narcissistic behavior among their staff, supervisors, and/or patients and patient family members. It is therefore crucial that nurse leaders understand the causes of narcissism and how narcissistic behaviors might be addressed within health care settings. An awareness of these issues can help decrease the damage that narcissistic behaviors can have on individuals and institutions.

The "glass escalator" refers to the structural advantage that males possess in female-dominated occupations that tend to enhance their careers. Males are less likely to enter female-dominated occupations, but when they do, they tend to rise faster and quicker to upper levels of leadership. There is limited research on the glass escalator and its effect on nursing. However, the concept has far-reaching effects for both nurse leaders and the nursing profession. Thus, a critical examination of this phenomenon is crucial. Although males represent 10% of the nursing workforce, they hold close to half of top leadership positions in nursing. While the impact of the glass escalator is clear for White males, it does not appear to apply to minority males or persons of color equally or equitably. In light of each of these factors, it is crucial that nurse leaders understand the glass escalator phenomenon, prior and current research, its implications, and have clear suggestions for addressing it in the workplace moving forward.

An organization's financial statements reflect their financial well-being and determine their ability to meet the health care needs of the citizens in their community. It is imperative that nursing leadership recognize the key components of an organization's annual consolidated financial statements, the balance sheet and income statement, and know how to interpret them to provide efficient, high-quality health care and to be successful in their role as nurse leaders. This article provides exemplars of these key documents with detailed instructions for the interpretation and understanding of the organization's financial statements, which will enable the reader to accurately and adeptly interpret their own organization's financial statements, as well as the statements from other organizations.

Narrative Nursing is a form of storytelling that is used as an intervention with nurses to empower them to share their profound experiences in the nurse-patient relationship. Nurses participating in the Narrative Nursing workshops each share an individual encounter that was meaningful in their own nursing career. The shared experience serves to acclaim the power of nurses as leaders at the point of care and nurse leaders mentoring others. Four stories of nurse leadership are included in this article, 2 from clinical nurses providing care at the bedside and 2 from nurses in leadership roles. Participants in Narrative Nursing describe the workshops as inspirational, affirming, and empowering of the essence of professional nursing. Leadership lessons learned from the Narrative Nursing experiences thus far are included as are plans for future work to inspire all nurses at all levels of leadership. The future work includes embedding the intervention within relationship-based leadership theories.

Multiple articles have explained the benefits of nurses as hospital board members. The Nurses on Boards Coalition has been working for several years to increase the number of nurse board members. Yet, the percentage of hospital and health care board positions filled by nurses has been decreasing. This article shares what all nurse leaders can do to increase the visibility of nurses as competent, valuable voices at the board table.

The coronavirus-2019 (COVID-19) pandemic has resulted in turbulent times challenging nurse leaders to adopt, adapt, and develop new leadership competencies to navigate current and future challenges. In never-imagined approaches, nurse leaders have responded to a different type of crisis management. In this new era, nursing leadership will need competencies to reshape the future of nursing and nurses' role in caring for patients, families, and promotion of healthy communities along with a focus on reducing health disparities. The pandemic has drawn critical focus on the health and well-being needs of nurses. The American Organization for Nursing Leadership and the Association for Leadership Science in Nursing have offered insights of nursing leadership competencies critical for practice and education in shaping the future.

The Future of Nursing Report from 2010 offered key recommendations for the practice of nursing, including the need for nurse residency programs for all new graduate nurses. Although numerous articles can be found about the programs themselves, finding information about the support of nurse leaders for such programs is more challenging. In the spring of 2019, a small group of invited nurse leaders from across the United States met during a "Think Tank." The purpose of this gathering was to discuss a policy brief offered by the American Academy of Nursing requiring all new graduate registered nurses to participate in a nurse residency program as part of their transition into practice. To determine nurse leaders' assumptions and attitudes toward nurse residency programs, the think tank planners conducted a national survey. Over 500 members of the American Organization for Nursing Leadership participated in this survey. In this article, the authors offer that nurse leaders are supportive of residency programs for new graduate nurses although some are still struggling with demonstrating the value proposition. In addition, nurse leaders are not in support of a national mandate.

Burnout has been demonstrating its presence in the nursing profession for decades. The advent of the world pandemic exacerbated the impact of burnout, and health care workers are suffering. In this article, the authors offer a review of burnout and its effect on the nursing profession. The authors describe a health care system's response to support its 48000 nurses. On the basis of critical drivers that influence the state of engagement of any nurses, we implemented a program allowing us to proactively partner with core leaders to support the emotional well-being of their caregivers. We provide focused coaching and support to leaders and their teams experiencing the highest stress levels. Finally, this article offers concrete interventions that nurse leaders should consider to support their respective nurses.

Health care organizations are challenged by numerous and rapid changes. Although nurse leaders seldom lead the whole organization's response to these changes, most changes impact the nursing workforce. To be prepared and proactive, nurse leaders need to consider the process of disrupting what the nursing workforce does to keep current with what society expects of nursing.

"Innovation" has become a ubiquitous term in the business of health care. The concept of disruptive innovation adds a new complexity to this popular notion. The emergence of artificial intelligence, virtual reality, and venture capitalists generates excitement, doubt, and curiosity for stakeholders across health care organizations. As companies such as Amazon, Apple, CVS, and JP Morgan enter this sector, disruptions will emerge that aim to improve the quality of care while reducing overall cost. The purpose of this article is to differentiate the concepts of innovation and disruptive innovation, explore their significance to the nursing profession, and outline 3 key roles nurse leaders can occupy as they navigate the future ever-changing trajectory of health care.

Today's nurse leaders are challenged to successfully implement and sustain healthy work environments and promote staff engagement. Authentic leaders possess inner core values that are consistent with the nursing profession. Authentic nurse leaders are able to create a healthy work environment that leads to engaged nurses. The first aim of this study was to develop the authentic nurse leadership conceptual framework and instrument. The second was to identify nurses' perception of authentic nurse leader attributes, grounded in the nursing discipline, that support a healthy work environment and promote nurse engagement. A crossover design was employed to compare the Authentic Nurse Leadership Questionnaire (ANLQ) with the Authentic Leadership Questionnaire, which has been used for leaders from multiple disciplines. The study sample consisted of 309 registered nurses, whose work includes at least 50% direct patient care. Results of the study indicate that the ANLQ is valid and reliable; ANLQ concepts were statistically supported by both exploratory and confirmatory factor analyses. The ANLQ better identified nursing values, as indicated by a stronger relationship with nurse work-life and nurse engagement.

This article contrasts the nursing leadership styles of introverts and extraverts and examines what each brings to the nurse leader role. While introverts and extraverts bring unique strengths, it may appear to introverts that extraverts garner the preponderance of attention in meetings and committee work. Strategies for the self-identified introvert nurse leader to successfully lead in an extraversion-centric workplace are described. The article ends with the personal journey of 2 nurse leaders who embraced their introversion traits and learned ways to flourish in health care and academic settings.

The future of leadership and nurse engagement requires the use of technology. The nursing workforce is becoming more mobile, flexible, and dynamic. Technology can support nurses to build trusted professional relationships and enhance their professional practice. Nursing leaders need to learn how to effectively use technology in addition to in-person interactions to support their nursing workforce. This article provides tips and tricks for nurse leaders to build relationships with their teams through technology.

Over the next 10 years, the World Health Organization estimates that there will be global shortage of 18 000 000 health care workers. A perfect storm of an aging demographic, long-term drop in birth rate, and a retiring workforce has all the factors contributing to this impending crisis. In nursing, efforts to narrow the shortage gap through strategies that increase the number of admissions to nursing schools, such as increasing faculty members, clinical sites, preceptors, and scholarships, will likely not be enough to offset the shortfall. Solutions, in part, will be to make nurses more productive by reducing waste through the use of technology. This article evaluates how various types of technology such as electronic health records, data analytics, predictive modeling, artificial intelligence, speech recognition, natural language processing, robotics, the Internet of Things, and others can improve nurse productivity by using a Lean framework to eliminate waste and create value.

Guam, an unincorporated territory of the United States, is one of the ten (10) US Affiliated Pacific Islands. The geographic location in the western Pacific Ocean, as well as the ties to the US position Guam as a strategic hub between the continental US, Asia, and the Pacific region. Health disparities in Guam and the Micronesian region are significant, and the non-communicable disease crisis is worsening, threatening the existing poor health infrastructure on the islands. Migration of islanders from the Micronesian region, whose countries also suffer health disparities, adds to the burden of the weak health care system on Guam. A critical nursing workforce shortage plagues the health care community, and strong nursing leadership is needed to address the problems. Nurse leaders, through many organizations, are working to implement strategies to address the issues facing the islands. Increased collaboration with partners on the island, on the US mainland, and globally, are necessary to effectively address Guam's health care concerns.

Consolidation through mergers and acquisitions is occurring across health care as a strategic move to address the disruptive forces of complexity. While consolidation is improving the overall fitness and viability of health care organizations, it is having the opposite effect on the professionals working within them who are reporting increasing rates of burnout from ongoing complexity in the health care environment. This happens in all organizations that try to respond to complexity with traditional bureaucratic leadership approaches. What is needed is to replace bureaucratic leadership with the networked approach of complexity leadership. The idea is not to "do more with less" but to "do things better." In this article, we show how to do this by applying complexity leadership to the nursing context. Complexity leadership is a framework for enabling people and organizations for adaptability. It views leaders not as managerial implementers of top-down directives but as collaborators who work together to enhance the overall adaptability and fitness of the system. From a complexity leadership perspective, the role of nurse leaders should be not only to help the system run but also to help it run better by increasing organizational adaptability.

Note from the Editor: This article is written by Pat Mastors, founder of the Patients' View Institute. While we traditionally publish articles by nurse leaders for nurse leaders, Ms Mastors offers us a view of hospital care from patients and families. We are publishing this as a gift to our readers because who can better tell us what is most important to those who receive our care than the recipients themselves.

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.

The nurse leader is ethically responsible for creating diverse and inclusive spaces for both nurses and those we care for. The leader must openly acknowledge and address the negative influence of bias and prejudice within health care organizations. This requires both an awareness of the influence of unconscious bias within the organization and appropriate actions to mitigate its impact. This process begins with an in-depth examination of one's own biases and continues through actions at the individual and organizational levels. Nurse leaders are well positioned to address and mitigate the negative influence of bias within organizations. This article discusses the influence of unconscious bias as well as strategies that the nurse leader can use to build diverse and inclusive organizations.

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.

Given the acceleration and increasing complexity of integrative care models across health systems, the question how governance and management structure(s) should be operationalized and evolved to achieve peak system performance is paramount. In a recent evaluation of partnerships with the University of Kentucky HealthCare (UK HealthCare), the conceptualization of the integration management model was explored. It was recognized that nursing leadership, governance structure, and relationships are vital for successful movement and migration of appropriate care models. In this case, the evolving governance models and the forecasted impact on models of care delivery were carefully considered. This included the potential impact on nursing practice. As the model was developed, a conceptual framework was utilized to examine potential variant relationship arrangements and to provide organization to key constructs. Utilization of a blueprint to optimize decision making and provide a replicable approach was essential to management of the integration philosophy.

Addressing health inequities and the social determinants of health for all people of the world is a primary goal of the World Health Organization. This article describes how a "Connecting Communities educational program" enabled nurse leaders from academic institutions from different sides of the globe to develop a reciprocal relationship of mutual interest around the topics of the nursing role in population health and care delivery. Grant funding resulted in the sharing of knowledge, expertise, and experiences directed toward encouraging the development of nurses as global citizens, with a broader view on what influences health and well-being. This initiative demonstrates how nurses can contribute to the improvement of world health and address the social determinants of health while practicing locally but thinking and contributing globally.

Within a large integrated health care system that includes local, regional, and national medical centers and offices, quality and patient safety teams, and research institutes, more than 58 000 nurses are employed, with the vast majority providing point-of-care service to patients and members. A small but increasingly important number of nurses are involved in quality improvement and research teams to improve patient care. Within this environment, a number of developments point to a growing need for nursing leadership in systems-level and delivery science policies and research. This article describes a partnership between clinical operations leaders and researchers (nurse scientists) to determine and utilize evidence-based practices to meet a system goal. The first objective of this article is to describe the barriers and potential solutions in combining practice, quality improvement, and research efforts across regions within a large integrated health care system. The second objective is to describe the uniqueness and importance of nurse leaders across interdisciplinary teams to simultaneously pursue research, quality improvement, and operational goals for the organization.

The evolution of care delivery from an acute care and inpatient standard to the outpatient setting and health promotion model is generating the need for innovative workforce and infrastructure adjustments to meet the new paradigm of population health management. Successful transformation of the nursing workforce necessitates a positive style of thinking that addresses rational concerns during times of difficult transition. Nurse leaders are called to recognize and appreciate the strengths of the nursing workforce by involving them in the course of change through collaboration, planning, and discussion. One unique way to plan and develop new care delivery models is to adopt the framework used in health facility planning and design for new services, units, or hospitals. This framework is flexible and can be adjusted easily to meet the objectives of a small nursing workforce innovation project or expanded to encompass the needs of a large-scale hospital transformation. Structured questioning further helps the team to identify barriers to care and allows for the development of new concepts that are objective and in accord with evidence-based practice and data. This article explores the advantages and disadvantages of implementing innovative workforce redesign and workforce reduction strategies.

Health care practice settings are replete with competing priorities for nurse leaders who are responsible to the staff, the organization, and the patients and their families. In the midst of the competing priorities, there is a mandate for successful nursing leadership that is patient centered. To support the continuance of nurse leader success and avoid discouragement and attrition, a caring and resilient model for leadership may be necessary. This article considers the practices of nurse leaders that support caring, resiliency, and, ultimately, their success. Successful navigation toward patient-centered solutions through the intentional and inextricably linked living caring and resiliency was enhanced with practices of self-care, accountability, and reflection. Within each of the 3 intentional practices, a primary process emerged that revealed how nurse leaders actualize their caring and resiliency. The practices and mutually supportive processes are discussed. Useful questions are provided to guide any nurse leader who is contemplating practices of self-care, accountability, and reflection for supporting caring and resiliency.

Resilience is an essential component of effective nursing leadership. It is defined as the ability to survive and thrive in the face of adversity. Resilience can be developed and internalized as a measure to improve retention and reduce burnout. Nurse leaders at all levels should develop these competencies to survive and thrive in an increasingly complex health care environment. Building positive relationships, maintaining positivity, developing emotional insight, creating work-life balance, and reflecting on successes and challenges are effective strategies for resilience building. Nurse leaders have a professional obligation to develop resilience in themselves, the teams they supervise, and the organization as a whole. Additional benefits include reduced turnover, reduced cost, and improved quality outcomes through organizational mindfulness.

As more nurses consider serving on boards, it is important that they have resources to help them prepare for trustee positions. The Northwest Organization of Nurse Executives (NWONE) has recently put together a program to introduce nurse leaders to these roles. A variety of experts and experienced nurse board members shared their experiences and advice to the organization's members. NWONE encourages other organizations to support individuals who can add value to governance as we move into the next era.

There is no escaping the fact that the ability to skillfully influence change is a requirement for nurse leaders. This need is intensified as the national health care system reforms and as the morphology of health care systems continues to change, especially in academic health care systems. The purpose of this article was 2-fold. The first objective was to relay the experience of the integration of nursing practice, education, and research within an academic health care system. The second was to, through this story of integration, expose the uniqueness and importance of nurse leader roles influencing innovation across a multisystem enterprise to fulfill the organization's mission.

The purpose of this study was to describe nurses' needs and how they are being met and not met after caring for surgical patients who died after a failure to rescue (FTR). A qualitative, phenomenologic approach was used for the interview and analysis framework. Methods to ensure rigor and trustworthiness were incorporated into the design. The investigator conducted semistructured 1:1 interviews with 14 nurses. Data were analyzed using Colaizzi's methods. Four themes were identified: (1) coping mechanisms are important; (2) immediate peer and supervisor feedback and support are needed for successful coping; (3) subsequent supervisor support is crucial to moving on; and (4) nurses desire both immediate support and subsequent follow-up from their nurse leaders after every FTR death. Nurses' needs after experiencing an FTR patient death across multiple practice areas and specialties were remarkably similar and clearly identified and articulated. Coping mechanisms vary and are not uniformly effective across different groups. Although most nurses in this study received support from their peers after the FTR event, many nurses did not receive the feedback and support that they needed from their nurse leaders. Immediate nurse leader support and follow-up debriefings should be mandatory after patient FTR deaths. Developing an understanding of nurses' needs after experiencing an FTR event can assist nurse leaders to better support nurses who experience FTR deaths. Insight into the environment surrounding FTR deaths also provides a foundation for future research aimed at improving patient safety and quality through an improved working environment for nurses.

Nurse leaders are challenged with ensuring that research and evidence-based practices are being integrated into clinical care. Initiatives such as the Magnet Recognition Program have helped reinforce the importance of advancing nursing practices to integrate best practices, conduct quality improvement initiatives, improve performance metrics, and involve bedside nurses in conducting research and evidence-based practice projects. While seeking research funding is an option for some initiatives, other strategies such as seeking funding from grateful patients or from philanthropic resources are becoming important options for nurse leaders to pursue, as the availability of funding from traditional sources such as professional organizations or federal funding becomes more limited. In addition, more institutions are seeking and applying for funding, increasing the pool of candidates who are vying for existing funding. Seeking alternative sources of funding, such as through philanthropy, becomes a viable option. This article reviews important considerations in seeking funding from philanthropic sources for nursing initiatives. Examples from a multiyear project that focused on promoting a healthy work environment and improving nursing morale are used to highlight strategies that were used to solicit, obtain, and secure extension funding from private foundation funding to support the initiative.

The topic of patient-centered care is at the very epicenter of the contemporary emphasis on a value-based approach to health care. Multiple studies confirm that positive outcomes are consistently achieved when clinicians and administrators put appropriate emphasis on patient-centered care. Although we would agree that the patient-centered approach is necessary for achieving positive clinical outcomes for individual patients, we suggest that this approach alone is insufficient to sustain these outcomes across large populations over an extended-period of time. We believe that a science-based approach to population health coupled with patient-centered care pathways will achieve the most effective, long-term impact for large groups of individuals. Furthermore, we believe that nurses play a central role in a science-based approach to patient-centered medical care. In this article, we discuss the intersection of preventative science, patient-centered care, and the role of nurses. We present our experience at Texas Health Resources with the use of clinical nurse leaders in a science-based population health approach to achieve more consistent, positive outcomes during transition of care. Finally, we suggest that care providers integrate the science of prevention with the principles of patient-centered care to more consistently deliver on the promise of population health.

BACKGROUND More than half of United States nurses are estimated to be overweight or obese. Interventions are needed that help nurses live healthier lifestyles. With most registered nurses being female and with an average age of 45.5 years in the category most likely to be obese, it is not promising that US nurses will become healthier over time without intervention. The Nurses Living Fit (NLF) program, an exercise- and nutrition-based intervention innovated by nurses, was developed to decrease body mass index in nurse participants and to help nurse's care for themselves and their families and patients. SUBJECTS A total of 217 nurses self-selected to the NLF intervention (n = 108) or contrast (no intervention; n = 109) groups. METHODS The NLF program included exercise (12 once-weekly sessions, 1 hour each), yoga (4 once-monthly sessions, 1 hour each), nutrition education (4 once-monthly sessions, 1 hour each taught by registered dietitians), diary completion (completed daily for 4 weeks specifying time spent on exercise/yoga, types and amount of food consumed, amount of water consumed, and hours slept), and healthy lifestyle principles education. Evaluation of the NLF program components was also completed. RESULTS The NLF participants had significant decreases in body mass index (NLF = -0.5 kg/m; contrast = -0.2 kg/m) and waist circumference (NLF = -0.9 in; contrast = -0.2 in). Overall, program component evaluation demonstrated that participants wanted more personalized exercise, more nutrition education, and year-round program provision. As a result of the NLF program, nurses specified they exercised more and improved nutrition. CONCLUSIONS Evidence-based intervention or programs are needed to educate nurses on healthy lifestyles. Nurse leaders need to promote healthy workplace environments, which can be done in part through the facilitation of exercise- and nutrition-based programs, such as NLF, to help nurses better care for themselves and their families and patients.

Nurses, the largest group of clinicians in the health care workforce, are increasingly called on to fill a number of strategic leadership roles. As nurses' roles and prominence in health care increase, the development of future generations of nurse leaders becomes ever more vital. Learning how to thrive, not simply survive, in this era of health care reform that is changing the landscape of care across the continuum requires all leaders and managers to possess new knowledge and skills. Preparing tomorrow's leaders must now begin with an organizational commitment to inspire the next generation of nurse leaders.

Continuum Care is different today from in the past. It requires care coordination with an emphasis on relationships and new roles. Nurses and nurse leaders must be located at the epicenter of developing strategies to align resources with patients and family along all points of the continuum.

If today's need for highly competent nurse leaders is urgent, and there seems to be no controversy about this fact, what will be the need in the next few years? And what will ensure the availability of these highly competent persons? Between the opportunities offered by the Accountable Care Act, and the IOM Report on the Future of Nursing's recommendations, the consensus is that the need will be great. This is not a new concern: During the 1960s, the pendulum in graduate education in nursing swung from functional preparation in teaching, supervision, and administration to clinical specialization. While the change was a logical one, inadequate consideration was given to the preparation of people who would fill these roles in the real world. Consequently, Boston University School of Nursing held an invitational conference in 1978 to respond to the call for preparation of competent nursing leaders. The author interviews some of the leaders who attended and/or presented at this conference to see just how much we could learn for the past to apply today.

Our "Blueprint for Nursing Leadership" emerged from dialogue with our nurse leaders on the daily challenges that managers encounter with competing and compelling priorities in the increasingly complex health care environment. Recognizing this as a transformational opportunity, the reorganized nurse executive council members were invited to a leadership retreat to further explore this topic. From this dialogue, 3 key components, distributed responsibility, nonstop skill development, and accountability became the framework on which the "Blueprint for Nursing Leadership" was created. The blueprint is to empower, engage, and sustain a culture of accountability.

This article describes leadership in innovation opportunities for executive nurse leaders seeking a change from the traditional hospital setting. Concepts of disruptive innovation underlie the challenges in today's healthcare field. Recommendations for nurse leaders include developing a versatile portfolio of experience, establishing collegial partnerships, creating cultures of innovation, and being passionate about innovation to inspire others to a more creative approach to work. Many opportunities are available in healthcare for leaders committed to innovation.

Nurse leaders play an important role in the shaping of healthcare policy and the care delivery models of the future. It is vital for nurse leaders to understand the role of money in politics and how donations to a candidate's campaigns can be beneficial in getting one's concerns addressed by Congress. The political action committee (PAC) is a major vehicle for campaign contributions for candidates from any party. This article will detail the following related to PACs: history and background information, government regulations, and why PACs are an important vehicle for nurse leaders to gain access and influence in Congress.