New scope and standards of practice reflect post-pandemic realities

The U.S. healthcare system has changed profoundly over the past decade, and the skills, competencies, and knowledge nursing leaders need to succeed in this reshaped landscape likewise have evolved. These new realities pervade the American Nurses Association (ANA) Nursing Leadership Scope and Standards of Practice, 3rd Edition (NLSSP), published in April (hubs.ly/Q02B6x_K0).

This comprehensive document reflects more than a dusting off of its 2016 predecessor, with the very name of the specialty changed to nursing leadership from nursing administration.

“We felt that administration was an older term used in hospitals many years ago; one that doesn’t reflect the expansive role leaders play in today’s healthcare continuum,” said Edna Cadmus, PhD, RN, NEA-BC, FAAN, co-chair of the review and revision work group that produced the NLSSP. “The title didn’t really reflect the people these standards were serving. We also wanted to make sure that this document didn’t get shelved but was available for and used by all leaders within an organization.” A New Jersey Nurses Association member, Cadmus is executive director for the New Jersey Collaborating Center for Nursing and a clinical professor at Rutgers University School of Nursing.

“Nursing is evolving constantly, and our scope and standards have to evolve as well,” added work group co-chair Christina Dempsey, DNP, MBA, RN, CENP, CNOR, FAAN. “We took the great work that had been done previously and recognized that nursing leadership is about more than nursing administration, which almost has a negative connotation. We wanted this to be all about how nursing leaders lead and function in all the various places where nursing leadership happens, which is way outside just hospitals.” Former CNO at Press Ganey, Dempsey, a Missouri Nurses Association member, is CEO of Christina Dempsey Enterprises and president of the Missouri Organization of Nurse Leaders.

Merged standards and competencies

Cadmus and Dempsey, selected as co-chairs of the work group by ANA and the American Organization for Nursing Leadership (AONL), respectively, reflect the two organizations’ collaboration in developing the new standards.

The work group utilized standards and competencies from ANA, AONL, the American Association of Colleges of Nursing, and also reports from the Institute of Medicine (2010) and National Academies Future of Nursing reports (2022). Drawing from all these sources, NLSSP outlines six standards of practice (assessment, diagnosis, outcomes identification, planning, implementation, and evaluation) and 13 standards of professional performance such as communication, just and equitable practice, and collaboration. The document also describes 116 accountabilities across 13 domains, including incivility, bullying, and workplace violence; health advocacy; and strategic and financial stewardship.

The standards of practice, professional performance, and accountabilities relate to all nurse leaders, from those in informal and frontline roles to executives, regardless of practice settings, according to Cadmus and Dempsey. For example, leaders in different settings would deal in various ways with their accountabilities involving safety, quality, and risk management. In healthcare provider organizations, frontline nurse leaders would be more concerned with ensuring the provision of safe and quality care while nurse executives would set and implement the organization’s quality and safety strategy. In contrast, a nurse leader in a payer organization might be more engaged in evaluating the quality and safety care experience of member beneficiaries.

In considering nurse leaders to join them on the work group, Cadmus and Dempsey cast a wide net for 26 leaders from diverse backgrounds and practice settings. “We had people who were expert in the LGBTQIA+ community to ensure that we were not only inclusive but also accurate and current,” Cadmus recalled. “We had people who were strong in acute care, long-term care, home care, public health, and informatics. We had representation from roles and places where nurse leaders practice—correctional care, the military, academia, hospitals, and ambulatory care.”

One of the work group’s heavy lifts was to develop a definition of nursing leadership that encompassed its broad vision of the specialty. (See Nursing leadership defined.)

“This new definition is broad enough that it’s all encompassing of all roles and inclusive and can be applied by varied leaders in nursing, whether they’re leading nursing departments in hospital settings or care settings across the continuum, in academic institutions, or professional societies,” said work group member Hussein M. Tahan, PhD, RN, FCM, FAAN, a Maryland Nurses Association member and system vice president for nursing professional development and workforce management and CNO for MedStar Ambulatory Services and MedStar Medical Group in Columbia, MD.

The NLSSP also brings out the emerging concept of professional identity—the set of beliefs, attitudes, and understandings about one’s professional role—and calls on nurse leaders to model the way by aligning their actions with shared values.

“Dialogue and science involving professional identity in nursing started to become more common right before the pandemic. We were intentional about bringing in leading researchers in this area to share with us what they’re learning,” noted Hussein. “If I expect the team I lead or the practice I represent to present a professional stature, demeanor, and existence, it’s important for me to demonstrate that in the way I act and model the way.”

New emphases

In recognition of the new realities of healthcare, the NLSSP emphasizes diversity, equity, inclusion, and social justice; digital technology; innovation; and emergency mitigation through recovery in ways the prior editions didn’t. The pandemic, in particular, brought hard-won knowledge and lessons that required consideration, according to Cadmus.

The document calls on nurses to be leaders of social change, to understand their responsibilities to dismantle racist systems, and to confront dissonate cultural norms. The NLSSP urges nurse leaders to consider these actions as their North Star.

“As nurse leaders, we’re obligated to represent everyone, to create opportunities for everybody, to demonstrate equity and diversity in the way we make decisions, and to also accept feedback and recognize when we may not be as inclusive as we ought to be so that we can recalibrate and improve,” Tahan elaborated.

In the innovation sphere, the document notes that nurse leaders “need to have the will for disruptive change and a strategic thinking mindset for innovation with a clear understanding of the problem they are trying to solve.” This declarative statement and others in the document reflect new demands on nurse leaders forged by the pandemic, according to work group member Joseph Marc A. de Veyra, DNP, MBA, MPH, RN, CNL, PCCN, a Washington State Nurses Association member and CNO of NPHub. During the NLSSP development process he served as associate chief nursing officer for Harborview Medical Center in Seattle.

“Nurse leaders now must have a bias for execution, and we need to pivot and adapt to our strategy on the fly,” he observed. “Projects now have to be completed on an accelerated timeline, so instead of implementing after say 3 months of planning, we now have a short window to plan, pilot early on even if it’s not perfect, and sharpen our strategy based on a month or so of learning. We can’t go into decision paralysis.”

The NLSSP also pointedly notes that nurse leaders “dramatically impact nurse well-being by shaping the day-to-day work life of nurses, setting the culture and tone of the workplace, developing and enforcing policies, and serving as exemplars of well-being.” The trials and tribulations of the pandemic also focused the work group’s thinking on this matter, according to Dempsey. “If there was a word bigger than ‘dramatically,’ we would have used it,” she said. “It’s that important, when you think about the data around a positive work environment impacting engagement, patient experience, and outcomes. The positive practice environment is huge and that is absolutely set by the nurse leader.”
With the NLSSP redefining nursing leadership, Cadmus,

Dempsey, and other members of the work group see good reason for the document to be widely circulated and used extensively wherever nurse leaders practice. “Of course, we’d like nurse leaders to read this and integrate into their practices, but organizations can also use this in the evaluation of their leaders,” suggested de Veyra. “This is like the road map to becoming the best nurse leader you can be as your organization emerges from the pandemic.”

— Genna Rollins is a writer/editor at the American Nurses Association.

American Nurse Journal. 2024; 19(8). Doi: 10.51256/ANJ082428