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Objective: The purpose of this qualitative survey was to document executive nurse leaders' perception of their own leadership qualities in the context of the American Hospital Association (AHA) recommended membership requirements for executive hospital board appointment., Background: Hospital boards of trustees are increasingly responsible for the quality of care and its impact on financial performance. High-performing boards are focused on the accountability of chief executive officer for quality metrics. Nurse leaders have valuable insight into key shared governance issues such as quality of care, financial performance, legal requirements, and regulatory oversight., Methods: Fifty senior-level nurse executive members polled from the American Organization of Nurse Leaders, the Texas Organization of Nurse Leaders, and the Texas Nurse Practitioners Association completed an online quantitative survey using The Center for Healthcare Governance (CHG) Assessment Tool© of the AHA, which details a list of skills, experience, and personal qualities for executive hospital board placement. Respondents ranked their individual knowledge and skills on a 4-point Likert scale., Results: Participant responses indicated that senior-level nurse executives have significant expertise in the key areas of quality, patient safety and performance, healthcare administration and policy, and business management. Areas ranking lower are those associated with organizational specialties: legal, construction project management, and finance., Conclusion: This information can be used to educate executive hospital boards regarding the qualifications of nurse leaders members. Nursing leaders, professional organizations, and academia can use this information to assess the skills of senior nursing leaders as it relates to potential board appointments., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Objective: This research study was designed to analyze the impact of an evidence-based charge nurse (CN) education program on novice and experienced CNs' self-confidence and satisfaction with the role, skill competencies, and nursing metrics., Background: Charge nurses are critical to effective daily unit operations. However, executive nursing leadership found that unit performance varied by CN despite experience., Methods: University faculty partnering with nurse leaders developed an evidence-based CN education program including a series of classes, coaching in skills and role responsibilities by nurse leaders, and evaluation of skills competencies before and after the CN education program., Results: The CN program was associated with significant positive changes in CN performance, nurse-specific metrics, hospital-acquired events, and patient satisfaction., Conclusions: Interventions targeting frontline leaders positively impact CN performance., Competing Interests: The authors declare no conflicts of interest., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Competing Interests: The author declares no conflict of interest.

Background: Despite decades of intensive resource allocation to eliminate preventable harm and increase high reliability in the hospital, the prevalence of serious harm remains consistent., Local Problem: A hospital reduced targeted preventable harms using audit and feedback (A&F) but failed to globally reduce harm or increase proactive awareness. Nurse leaders lacked a defined process for identifying errors, mitigating risk, and teaching systems thinking to influence resiliency among teams., Methods: Nurse leaders underwent A&F of daily safety rounds. Adherence data on frequency, high-quality, and high-reliability organizational (HRO) leader practice standards and precursor incident reporting rates were trended., Results: Rounding practice adherence increased for the following defined standards: frequency (63%-79%); high quality (50%-90%); and HRO leadership (0%-67%). Precursor incident reporting rates increased 25%., Conclusions: A&F reinforced quality and accountability for daily safety rounds. HRO theory-guided feedback offered an innovative way to translate HRO influence into nurse leader practice.

We are midway through a milestone year for nursing, and we have just finished a month-long celebration of Florence Nightingale's 200th birthday. The party may be over, but the work continues. How do we keep the momentum going, not just for 2020, but well beyond? In this month's Magnet Perspectives column, we explore ways to continue to promote the Year of the Nurse through its 3 anchors: nursing excellence, leadership, and innovation. We also take a look at how Magnet organizations stay relevant in these areas, by infusing lifelong learning, evidence-based practice, and clinical inquiry into the culture and making every day an opportunity to celebrate and elevate nursing.

Given the implications of value-based reimbursement, nurse leaders must thoughtfully assimilate an extraordinary amount of quality, safety, and patient experience data to effectively drive behavioral change. This article proposes Swanson Caring Theory (SCT) as context for Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) improvement strategies. The diagnostic model described herein is not intended to encompass the full scope of nursing care, but rather to help nurse leaders interpret HCAHPS results in terms of the SCT attributes of compassion, competence, and patient well-being.

Objectives: To evaluate the reliability and validity of the Financial Management Competency Self-assessment (FMCA) in executive nurse leaders (ENLs) and to determine how ENLs develop and apply financial knowledge., Background: Financial literacy (FL) helps in planning, implementing, and evaluating fiscal decisions, but many ENLs report weaknesses in this core competency., Methods: An explanatory-sequential mixed-methods study was conducted to psychometrically test the FMCA and explore how ENLs with different levels of FL develop and apply financial knowledge. Eligible participants (n = 178) were recruited from a population of ENLs across the United States., Results: The test-retest reliability of the FMCA was good (mean difference, 6.80; 95% confidence interval). Correlations between domain scores (P < .01) and the overall score (Cronbach's α = .99) demonstrated the reliability and validity of the instrument. The cutoff scores were fair indicators of different levels of FL in ENLs (P < .001). Self-awareness, gaps in hospital and graduate nursing education, application of financial knowledge, and a micro versus macro view emerged as important themes in the qualitative analysis., Conclusion: FMCA reliability and validity were established. FMCA cutoff scores were established to determine FL level, and the ENL lived experience described in financial knowledge development and application.

Nursing leadership can play an essential role in the development of nursing informatics solutions by virtue of their broad understanding and oversight of nursing care. We describe a systems-level method for creating nursing informatics solutions with clearly defined structure and leadership from nursing executives. Based on the guiding principles of clear lines of responsibility, respect for expertise, and commitment to project aims, this allows nursing executive leadership to organize, set up, and own the development of nursing informatics solutions.

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.

In this month's Magnet Perspectives column, the director of the Magnet Recognition Program highlights the program staff and leadership at ANCC responsible for the Magnet Program.

Objectives: The study examined nurse leader roles, barriers, and the need for nurse leader succession planning in North Carolina (NC)., Background: This study was conducted to assess leadership capacity in NC and further the efforts of the Future of Nursing report, which calls for nurses to lead change and advance health., Methods: This study employed an exploratory research design using the Florida Action Coalition 56-item survey of active RNs and advanced practice RNs in NC., Results: Key findings include nurse leader demographics, roles, barriers, retirement and succession plans, and development needs of current leaders in NC. NC nurse leaders are predominately female, white, non-Hispanic, and older than 50 years; plan to retire within the next 10 years; and report that their organizations do not have succession plans for nursing leadership., Conclusions: Attention toward assessing nurse leadership capacity should be a priority to meet workforce needs.

Objective: The aim of this study was to describe the role preparation and competency development of nurse managers., Background: Approximately 70 000 nurses are retiring annually. This represents a significant loss of nursing leadership wisdom. Few systematic studies of nurse manager role preparation and competency development have been conducted., Methods: An electronic survey was completed by a national sample of 647 nurse managers managing 964 patient care units in 54 hospitals., Results: Findings suggest that nurse managers rate themselves as competent for the 1st 6 years as a nurse manager. They begin to reach proficiency by year 7. Experience had the strongest association with nurse manager competence, followed by graduate leadership education., Conclusions: Nurse executives need to evaluate the bench strength of their nursing leadership talent pool. They need to develop policies and strategies that promote nurse manager competence.

Objective: The purposes of the study were to describe levels of innovativeness in nurse executives, clinical directors, and nurse managers in acute care settings in the United States and to compare innovativeness between the groups., Background: Nurse leaders must navigate the complex ever-changing landscape of healthcare. New strategies are necessary for managing resources and improving patient outcomes., Methods: A survey was posted in the American Organization of Nurse Executives newsletter using the Scales for Measurement of Innovativeness to measure innovativeness. The sample included 137 nurse leaders in executive and management positions in acute care settings., Results: The largest percentage of nurse leaders across all leadership roles fell into the innovativeness category of early majority. Of the total sample, only 2 individuals were categorized as innovators, and only 15 as early adopters. Fifty-one individuals were early majority; 49 were in the late majority; and 20 individuals were at the lowest category of innovativeness, that of laggards. Both nurse executives and clinical directors had significantly higher levels of innovativeness compared with nurse managers. Graduate-level education and certification were not associated with higher levels of innovativeness., Conclusions: Understanding the levels and components of innovativeness may assist nurse leaders to affect change in themselves and their organizations.

Objective: This study explored the types of decisions and differences in decision making that nurses made in different types of hospital units., Background: The relationship between nurses' participation in decision making and the different types of hospital units where they work is not well understood., Methods: Nurses' participation in decision making was explored using the Participation in Decision Activities Questionnaire. The final sample included 307 nurses in 24 nursing units in 6 hospitals., Results: Nurses overall participated more in clinical than administrative decisions, and there were significant differences based on unit type. Critical care nurses had the highest and general care units the lowest levels of participation in decision making., Conclusions: Nurses in critical care units participated in higher amounts and at higher levels of clinical decisions overall than either intermediate or general care units. Nurse leaders should determine barriers to decision making in general care units and explore mechanisms to increase participation by clinical nurses.

Objective: This study aimed to examine the relationship between experiential learning and nursing management competency among nurse managers (NMs) in the early years of a supervisory role., Background: The relevance of experiential learning to the development of NMs has been explored in an effort to harvest the knowledge embedded in shared NM practice narratives. However, the relationship between experiential learning and nursing management competency has not been empirically measured., Methods: The author developed an experiential learning-based program for NMs in the initial 3 years of a supervisory role. Sixty-three NMs were enrolled. The relationship between experiential learning and nursing management competency was evaluated using multiple regression analysis after completing this program., Results: The results of multiple regression analysis revealed a significant relationship between experiential learning and nursing management competency (P < .001)., Conclusions: A significant relationship was identified between experiential learning and nursing management competence.

Background: Interruptions during handover may compromise continuity of care and patient safety., Local Problem: Interruptions occur frequently during handovers in the intensive care unit., Methods: A quality improvement study was undertaken to improve nursing team leader handover processes. The frequency, source, and reason interruptions occurred were recorded before and after a handover intervention., Interventions: The intervention involved relocating handover from the desk to bedside and using a printed version of an evidence-based electronic minimum data set. These strategies were supported by education, champions, reminders, and audit and feedback., Results: Forty handovers were audiotaped before, and 49 were observed 3 months following the intervention. Sixty-four interruptions occurred before and 52 after the intervention, but this difference was not statistically significant. Team leaders were frequently interrupted by nurses discussing personal or work-specific matters before and after the intervention., Conclusions: Further work is required to reduce interruptions that do not benefit patient care.

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.

Rebecca Graystone, the Magnet Program Director, dispels some myths about the Magnet Recognition Program®. Ms Graystone encourages leaders interested in Magnet or those already designated to feel free to access resources including those of the Magnet Program Office.

This article describes the inception and evolution of a 3-month immersion experience between hospital and nurse leaders where sociological principles were applied to support nurse leader succession. Unique to this program, the bedside nurse joins the nursing executive team full time to participate in all organizational leadership activities as part of the experience.

Objective: The aim of this study was to understand how nurses in a 25-bed critical-access hospital (CAH) led change to become the 1st to achieve Magnet®., Background: Approximately 21% of the US population lives in rural areas served by CAHs. Rural nurse executives are particularly challenged with limited resources., Methods: Staff nurses, nurse managers, interprofessional care providers, the chief nursing officer, and board of directors (n = 27) were interviewed. Observations of hospital units and administrative meetings were done, and hospital reports were analyzed., Results: Nine themes emerged to support a conceptual model of leading change. The CAH spent 3 years of its 6-year journey establishing organizational readiness. Nurses overcame complex challenges by balancing operational support and fostering relationships. The Magnet journey led to significantly improved nurse and patient outcomes. A new organizational culture centered on shared governance, evidence-based practice, and higher education emerged., Conclusions: The journey to Magnet leads to improved nurse, patient, and organization outcomes.

Background: In 2010, the Veterans Health Administration issued a Staffing Methodology (SM) Directive to provide a standardized, data-driven method for determining appropriate inpatient nurse staffing., Objective: We aimed to describe experiences and factors related to SM implementation., Methods: We administered a Web-based survey to chief nurse executives to obtain their implementation experiences. Structural, process, and outcome factors and barriers associated with self-reported implementation success were identified., Results: Respondents representing 104 of 117 facilities participated. Almost all facilities (96%) had completed at least 1 cycle of SM, yet only half (52%) rated their implementation highly successful. Early implementation date, higher levels of leadership confidence in SM, and higher frequency in which nursing staff think in terms of hours per patient day were associated with higher SM implementation success. Time, staff training and educational needs, and engagement were common barriers., Discussion: Understanding factors that influence successful implementation of staffing policies is important to ensuring safe staffing.

With the industry in flux as federal healthcare reform legislation debates continue, leaders are preparing for what the post-Affordable Care Act world might look like. Predictions include patients assuming more responsibility for healthcare costs and therefore behaving like consumers, including choosing providers based on perceived value. What actions should chief nurse executives take to ensure the nursing enterprise responds to rising consumerism in healthcare?

The CGEAN Board established a goal to support MSN administration programs to thrive and meet the need for well-prepared nurses to assume leadership roles. This column addresses how we embarked on this work through creation of a Circle of Advisors composed of national nursing leaders who came together to address specific curricular issues and more importantly to voice support for continuation of MSN administration programs.

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.

Professional practice models (PPMs) are an integral part of any organization on the Magnet® journey, whether initial designation or redesignation. Through the journey, the PPM should become embedded within the nursing culture. Leadership at multiple levels is crucial to ensure successful adoption and implementation.

Objective: This study provided insight into the level of engagement of nurse managers (NMs) and strategies used to achieve and sustain engagement in acute care settings., Background: Nurse managers have a significant role in staff satisfaction and unit outcomes and therefore need to be engaged in their work to influence others. Little is known about the level of individual NM engagement and strategies they use to remain engaged., Methods: A mixed methods approach was used to elicit information about NM engagement. This study used a sample of 47 NMs to measure their level of engagement, and for those achieving scores indicating high levels of engagement, interviews were conducted, and a content analysis was completed to identify themes., Results: Results showed that there were significantly higher levels of NM engagement among those managers who had been practicing as nurse leaders for a longer period and also those who had advanced degrees. Qualitative review revealed the themes of expert communication, autonomy, and influence as the key factors driving NM engagement., Conclusions: The role of the nurse executive in NM engagement is significant in supporting educational advancement and retention, both of which proved to have an impact on the level of engagement.

The wave of retirements is beginning to hit nursing, taking a toll on our cadre of nursing leaders. Ongoing healthcare reform is adding to the stress burden and exerting an effect on nurse leader turnover. The next generation of leaders will likely come from our millennial nurses, who have different attitudes toward work than previous generations. The AONE assembled a panel of experts to create guidelines to assist nurse executives in recruiting the next generation of talent into formal leadership roles.

Objective: The aim of this article is to refine and validate a new instrument, Nursing Informatics Competency Assessment for the Nurse Leader (NL)., Background: Because health information technology rapidly advances, the NL requires greater levels of informatics knowledge., Methods: Item reduction and psychometric analysis methodology RESULTS: A total of 357 national NLs completed the survey. Exploratory factor analysis resulted in a final 6-factor solution that contained 26 items: (1) strategic implementation management, (2) advanced information management and education, (3) executive planning, (4) ethical and legal concepts, (5) information systems concepts, and (6) requirements and system selection. Cronbach's α were .96, .91, .90, .83, .92, .81, respectively., Conclusion: We established a valid and reliable nursing informatics competency assessment instrument with sufficient specificity to guide NLs to recognize the competencies required in their role, create solutions to address potential gaps, and enhance delivery of patient care.

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.

To date, health care quality improvement (QI) has focused on the engagement of executive leadership and frontline staff as key factors for success. Little work has been done on understanding how mid-level unit/program managers perceive their role in QI and how capacity could be built at this level to increase success. We present ethnographic data on the experience of hospital middle managers to consider how the expectations and capacity of their current position might influence QI progress organizationally.

Chief nurse executives (CNEs) face challenges in providing high-quality, patient-centered care for diverse populations. Although the implementation of culturally and linguistically appropriate services (CLAS) may improve patient satisfaction, the cost of initiatives and education coupled with shortened episodes of care pose obstacles. The article describes themes from a qualitative study with CNEs, describes resources and best practices, and highlights nurse leader rounds as a vehicle for implementing CLAS.

A highly visible transition occurred earlier this year with the retirement of Pam Thompson, MS, RN, CENP, FAAN, from her role as CEO of the American Organization of Nurse Executives. Ms Thompson was always an advocate of promoting the voice of nursing. This month, the spotlight will shine on a team of nurse leaders who found their voice, got involved, and led the conversation. We will trace their journey as they analyzed their situation, applied the evidence, and used their seat at the table.

In the 2nd of a 3-part series on the value of patient and family advisory councils, an early adopter at a large, Magnet®-recognized healthcare system reveals ways in which an environment focused on strong partnerships, a culture of safety, and a commitment to transparency led to the creation of successful councils at multiple hospitals. The authors discuss nursing's integral role in championing and leading the councils, as well as the benefits of a strong patient-family voice in hospital operations and care processes.

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 Accountable Care Act of 2010 is stimulating rapid transformations of healthcare systems. The shift from a focus on providing healthcare in a closed system to improving the health of communities demands rapid innovation by nurse leaders. Nurse leaders prepared at the doctorate of nursing practice level and PhD-prepared nursing health services researchers are needed to develop and evaluate best practices as they emerge. This column expands on the findings from CGEAN's Delphi study.

This cross-sectional quantitative study was undertaken to determine the extent to which individuals who have differing health care leadership roles perceived the importance of selected leadership competencies in their specific roles based on their experience. A total of 313 participants responded to the health care questionnaire. Principal component analysis identified factor structure and Cronbach α at .96 supported the reliability of the factor analysis. Multivariate analysis of variance tested the 4 health care leadership roles to determine if an effect was present among the competencies. A subsequent analysis of variance test was conducted on the competencies to confirm an effect was present, and a Games-Howell post hoc test followed. These tests indicated that there was a significant difference in rating the perceived importance of specific leadership competencies by the health care leaders in each competency domain. The participants included in this study consisted of the chief executive officer (CEO), director of nursing (DON), operating room director (ORD), and director of radiology (DOR). Based on the Games-Howell post hoc test, a commonality existed between the leaders. The CEOs and DONs often indicated no significant difference in competency perception to one another in relation to the dependent variables, yet indicated a significant difference in competency perception when compared with the ORDs and DORs. Similarly, the ORD and DOR variables often indicated no significant difference in competency perception to one another in relation to the dependent variables, yet indicated a significant difference in competency perception compared with the CEO and DON variables. This study positively indicated that health care leadership's perception of competencies does differ between the various leadership roles.

Patient engagement is an important element in transitioning care delivery to achieve population health management goals. Providers are challenged to develop care delivery processes that better engage patients in their life journey across the healthcare continuum. Nurse leaders are central to this process. Building upon the American Organization of Nurse Executives competencies for nurse executives, the nurse manager role requires specific skills to translate the vision of patient engagement into practice.