Nurses have more influence than they know. But they need to get into leadership

Nurses have power.

It might not seem that way sometimes. The healthcare system is fragmented and often dysfunctional. Nurses barely have time to take breaks during their shift, let alone advocate for system-level reforms. And administrators — as I’ve heard time and again — often don’t seem to be paying attention.?

Marla Weston, PhD, RN, FAAN , the former CEO of the American Nurses Enterprise , isn’t deterred. Nurses have more power than they realize, she insists. And for the past five years, she’s been a consultant and blogger on how to bring more nurses into leadership, spreading the message that collectively they can usher in substantial change.

Weston understands the challenges, of course. She’s been in the unfortunate position of having a front row seat to the dysfunction over the past year, while helping her mother navigate the healthcare system after a major fall.?

“What I have seen through all of that is nurses do have this potential to solve the problems both at a unit level and at a system level in a way that I think they aren't taking on and they aren't recognizing,” she told me.

Numerous research papers have shown the impact of bringing nurses into leadership positions, whether in formal roles or through participation in unit-based councils. They’re more engaged, and more likely to stay in their jobs. Even patient satisfaction improves.

Staffing has been one of the top concerns for nursing leaders , vexing as many as 69%, according to a recent survey from the American Organization for Nursing Leadership . And 45% are concerned about the emotional wellbeing of their staff.?

Offering professional development opportunities has been one of the solutions — not only for nurses on the units but also their managers. After being able to take time off and having work-life balance, 45% of nursing leaders pointed to professional development as key to their happiness at work.

“We tend to think of ourselves as individual nurses working with individual patients and we don't leverage the infrastructure that we have to work collectively on solving problems,” Weston said.?

In our conversation below, we discuss why nurses should get into leadership, how to find a workplace that empowers nurses and her advice for how nurses can make their voices heard beyond the bedside.

And tell me: what would encourage more clinicians to get into leadership?

The transcript below has been edited for length and clarity.

LinkedIn News: Ever since I’ve been reporting on nursing issues, nurses have told me that administrators aren’t listening to them. How do they tap into their power??

Weston: For much of the last year I've been involved in the healthcare system on the patient side, [after] my mother had a catastrophic fall.?

And I've noticed two things through that experience. One is that she has gotten amazing nursing care. Every single nurse has been caring and compassionate and committed; they advocated for her and often dealt with a system that makes it not easy for her to get the right care.

The second thing is that the system itself is so horribly fractured. That’s the world that our clinicians are living in. That is why they get burned out. It's not about the work, it is about having to go to work everyday and not only care for their patients, but navigate in this dysfunctional system.

I talk a lot about having strong professional governance structures because that's the way that we as nurses can deal with the complex issues around patient care. When we talk about issues like workplace violence, workload, staffing burnout, electronic health records — the way we solve those problems is by creating a collective list of what are the issues that we have and working systematically on fixing those. Power comes from being together.

LinkedIn News: Nurses have a lot on their plates just with patient care. And hospitals even discourage time spent away from the bedside, calling it “nonproductive time.” How do they find time to address these systemic issues?

Weston: I'm working right now on an editorial that talks about changing our language, because when we buy into that language, we're contributing to the problem. We should be expecting that when we go to work as a clinician, a certain amount of time should be spent addressing the processes around how we deliver better patient care.

LinkedIn News: What can hospitals or nurse managers do to support that kind of environment?

Weston: Both nurse managers, when they're hiring clinicians, and clinicians, when they're interviewing, need to have a conversation around what is the professional practice environment and how is that resourced with time and staffing. That begins to change the nature of how we

think about our practice.

LinkedIn News: What have you noticed in terms of what nurses want out of their careers that wasn't true a few years ago?

Weston: The good news is we all understand that our life is not about working excessively, and productivity is not about running at 100% all the time. What we want is a whole life, this richness of going to work and being able to make a meaningful difference in the lives of our patients and then going home and having a robust life at home.

Five years prior to the pandemic, I started talking about this concept of Healthy Nurse, Healthy Nation . Nurses tend to be less healthy than the average American on almost every single measure of health. The idea was that we could be role models for health. I hope that at some point people choose the profession of nursing because they can have a career where they make a meaningful difference in the world and they know that they can be a healthy person.

LinkedIn News: Another way that nurses’ voices are often overlooked is in the media. How can nurses make sure they’re at the forefront of these conversations?

Weston: Early on in my career, I was the executive director of the Arizona Nurses Association, and nurses were not being quoted in the media in Arizona. I asked to meet with the health reporter for the largest newspaper in the state, and I asked her that question.

And what she said to me was when I call nurses, they don't answer. They are reluctant to go on the record. They often check with their boss, who checks with their boss's boss, who checks with their boss's boss's boss; reporters are on this timeline where they're trying to get answers and a nurse is calling them back six hours later.

[My advice is to] reach out and get to know people who report in the space of healthcare on whatever media you happen to be following. And then make yourself instantly available. And you don't have to be perfect at [interviewing]; you just have to answer with what you know.?

LinkedIn News: I talk to nurses all the time and I’ve found them to be very accessible. Every once in a while, though, I do run into someone who says their leadership won’t allow the conversation. What about institutional barriers to interacting with the media?

Weston: If that's the case, that's the case. That's a fact that you have to live with.

But I think it's similar to what we were talking about earlier when I say nurses have more power than I think they recognize, and some of it is defining what it is that you want and then moving.

One of the things that's interesting about how we're educated is our educational process is about recognizing what's wrong or what's missing. But we need to go the next step to say, what is it that we're going to do about it? And then take action.