Nursing’s progress leads to better care
From the boardroom to the military, nurses are making strides
While nurses remain at the front lines of the nation’s healthcare system, they’re also serving as leaders in government, the military and industry with increasing frequency. They’re sitting on boards, driving research and developing technology.
By Lisette Hilton
In some cases, today’s nurses are rethinking healthcare.
Susan Hassmiller, PhD, RN, FAAN, senior adviser for nursing, Robert Wood Johnson Foundation (RWJF), believes harnessing what nurses know and do can change healthcare delivery. Hassmiller leads the foundation’s nursing strategies in an effort to create a higher quality of care in the United States for people, families and communities.
“Nurses have historically been the first line of defense for marginalized and disadvantaged populations and unmet needs, and we’re seeing those roles re-emerge in recent years as the needs of people and communities evolve,” Hassmiller said. “Through the foundation’s extensive research with nurses, we know that nurses are aware of challenges related to the social determinants of health, like food insecurity, unemployment, substance abuse, and neighborhood walkability, for example, and how much of a ripple effect these issues have on their surrounding communities.
“Nurses are being asked to help respond to these issues because of their insights into patients’ lives and how they intersect with the healthcare system,” she said.
Nurses’ role in building a culture of health
Nursing’s progress in the military
Nursing has a long legacy of providing healthcare in times of war and for humanitarian missions. In recent years, military nurses have increasingly taken on executive leadership roles as commanders of our hospitals, including field hospital units, public health centers, recruiting battalions and regional medical commands, where they have oversight of several hospitals and more, according to Col. Jennifer Wiley, BSN, CEN, MHA, MSS, Army Nurse Personnel Proponent Officer with the U.S. Army.
“Nurses are now able to compete for these commander roles, along with other strategic roles,” Wiley said.
Today’s military nurses need to have dual competencies in military and clinical leadership, according to Wiley.
“Around 10 years ago, we had our first combat support hospitals commanded by Army nurses supporting the combat operations in the Middle East,” she said.
Nurses have excelled in leadership positions, paving the way for the first Nurse Corps Officer – retired Lt. Gen. Patricia Horoho — to serve as the Army Surgeon General in 2011, according to Wiley.
Horoho was passionate about wellness and preventive medicine. Her influence led to the Army looking more comprehensively at soldier health with new initiatives to address fitness, getting proper sleep and nutrition.
On other fronts, advanced practice nurses in the Army are taking on department chair leadership roles, such as chief of primary care. Informatics nurses are helping to lead acquisition programs that are involved with the Army’s electronic health records. And Army nurses are involved in research to further evidence-based nursing practice.
For example, the Army’s nurse anesthetists are researching traumatic brain injuries, hemorrhage control, post-traumatic stress disorder and more.
“We have nurses, whether they are Army nurses or civilian nurses employed in our organization, that are leading so many local initiatives to support soldiers and their families,” Wiley said. “We’ve got nurses advocating for lactation rooms that has resulted in many of them being installed. Using the words of our newest Corps Chief Brigadier General Jack Davis, ‘Army nurses are leaders whether leading in a clinic, hospital or downrange in combat operations.’”
About the Author
Lisette Hilton is a freelance writer. Photo of Col. Wiley courtesy of the United States Army Office of the Surgeon General.
Like the nurses interviewed for this article and many others in the profession, Pamela F. Cipriano, PhD, RN, NEA-BC, FAAN, embodies nursing’s progress. Cipriano, who serves as the Dean and Sadie Heath Cabaniss Professor at the University of Virginia School of Nursing, is past president of the American Nurses Association.
Cipriano, who began her career as a staff nurse at the University of Utah Medical Center on a general orthopedics floor in 1976, has held executive positions in healthcare systems, academia and national professional organizations.
Susan Hassmiller
Jennifer Wiley
Simply, thanks.
Nurses, your dedication to public health during this challenging time shows considerable strength, bravery, and resilience. We acknowledge your extraordinary efforts and commitment to your profession, and all of us, now more than ever. We're trying to do what we can to help support you. We aim to provide you with the resources and tools you need to grow and protect the career you worked so hard to build.
Learn more at
The National Academies of Medicine has a committee charged with charting a path for U.S. nurses to help reduce health disparities and improve people’s health and well-being. The committee’s resulting
Future of Nursing 2020-2030
report will be released in December.
“Lots of nurses are already trying to do so much for their patients beyond simply providing healthcare, with very little in terms of resources and support,” Hassmiller said. “We’ve been asking how we can support them. That has included conversations with hundreds of nurses across the country about working conditions, the kinds of roles nurses are being asked to perform, the role of technology in practice, and many other subjects.”
The notion of a culture of health has emerged, meaning health isn’t just a thing that happens at the hospital or the clinic. It’s a part of every place where people live, work and play, according to Hassmiller.
“This is a very familiar idea for nurses,” she said. “The founders of professional nursing were very concerned with how to improve health by addressing factors such as childhood nutrition and unsafe housing. They advocated for things like playgrounds and safer neighborhoods. Even for nurses practicing in clinical settings, our roles in patient advocacy and education often lead us to think about what is going on in patients’ lives outside the hospital.”
In many ways, the healthcare system is just catching up to the way nurses have been thinking for a long time, with a new emphasis on how social factors influence people’s life outcomes, according to Hassmiller.
“Nurses are being asked to think about all of this on top of their existing workload,” she said. “We’re considering how to best help them respond while also taking care of themselves. Nurses are a key part of building a culture of health, but we also need to acknowledge that they can’t do it all on their own.”
Lots of nurses are already trying to do so much for their patients beyond simply providing healthcare, with very little in terms of resources and support. We’ve been asking how we can support them.
— Susan Hassmiller, PhD, RN, FAAN
Other ways nurses are forging ahead
Nurses are very involved in public policy now, according to Cipriano, and they didn’t used to be.
“We have more nurses being elected to public office, in our local areas, our states and we fortunately have two highly respected nurses in Congress,” Cipriano said.
Nurses’ roles as healthcare providers also are expanding.
“One example is within all of our states as we continue to push for full practice authority for advanced practice registered nurses, who are able to provide a large amount of primary care in this country,” Cipriano said. “The APRN workforce has doubled in the last decade, so it’s a real opportunity to say that nurses are able to work to the full extent of their education.”
Thanks to decades of advocacy and professional development, there are many leadership opportunities available to nurses that weren’t there before, according to Hassmiller. For example, the Nurses on Boards Coalition has inspired and documented thousands of nurses contributing their unique perspectives to the governance of hospitals and other institutions.
Educating others on nursing’s value
During the past decade, there have been more leadership opportunities for nurses.
Nurses have advanced their educations at historically high rates and achieved positions in management that would not have been available a generation ago, according to Hassmiller.
The nursing profession, however, still needs to educate the public about nurses’ leadership potential.
Hassmiller said her colleagues have been looking into this at the Center to Champion Nursing in America — an initiative of AARP, the AARP Foundation and the RWJF. While studying population health initiatives, they noticed that while nurses played a role in almost all the sites they visited, the leaders didn’t always know all the things nurses were capable of doing. Some of that was related to scope of practice, but some of it was related to what people typically call “soft skills,” according to Hassmiller.
“A lot of the leadership and decision-making opportunities available to nurses are not in formal management positions,” she said. “We can do a lot to support nurses in those opportunities, both by giving them more resources and by better educating other stakeholders about what they can do.
“I have great faith in the new generation of nurses, in their ability to problem solve and innovate,” she said. “I believe they will help all of us — nurses, health system leaders, policymakers and others — find ways to work toward greater health and well-being for all people.”
Pamela F. Cipriano
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