Preparing nurse leaders for 2020
Preparing nurse leaders for 2020
CAROL HUSTON M S N , M P A , D P A , F A A N 1,2
1President, Sigma Theta Tau International, Indianapolis, IN and 2Professor, School of Nursing, California State University Chico, Chico, CA, USA
Introduction
Planning for the future is difficult, even when environ-
ments are relatively static. When environments are
dynamic, the challenges multiply exponentially. Unfor-
tunately, few environments have been more unpredict-
able in the 21st century than health care. �The healthcare system is in chaos, as is much of the business
world. Traditional management solutions no longer
apply and a lack of strong leadership in healthcare
Correspondence
Carol Huston
10 Via Flora Ct.
Chico
CA 95973
USA
E-mail: chuston@csuchico.edu
H U S T O N C . (2008) Journal of Nursing Management 16, 905–911
Preparing nurse leaders for 2020
Aim: This article highlights eight leadership competencies likely to be an essential part of the nurse leader�s repertoire in 2020. Background: Planning for the future is difficult, even when environments are
relatively static. When environments are dynamic, the challenges multiply
exponentially. Unfortunately, few environments have been more unpredictable in
the 21st century than health care. The healthcare system is in chaos, as is much of
the business world. It is critical then that contemporary nursing and healthcare
leaders identify skill sets that will be needed by nurse leaders in 2020 and begin now
to create the educational models and management development programs necessary
to assure these skills are present.
Results: Essential nurse leader competencies for 2020 include: (i) A global perspective
or mindset regarding healthcare and professional nursing issues. (ii) Technology skills
which facilitate mobility and portability of relationships, interactions, and operational
processes. (iii) Expert decision-making skills rooted in empirical science. (iv) The
ability to create organization cultures that permeate quality healthcare and patient/
worker safety. (v) Understanding and appropriately intervening in political processes.
(vi) Highly developed collaborative and team building skills. (vii) The ability to bal-
ance authenticity and performance expectations. (viii) Being able to envision and
proactively adapt to a healthcare system characterized by rapid change and chaos.
Conclusions: Nursing education programmes and healthcare organizations must be
begin now to prepare nurses to be effective leaders in 2020. This will require the formal
education and training that are a part of most management development programmes
as well as a development of appropriate attitudes through social learning. Proactive
succession planning will also be key to having nurse leaders who can respond effec-
tively to the new challenges and opportunities that will be presented to them in 2020.
Keywords: future, leadership, nurse leadership competencies, leadership succession, management, year 2020
Accepted for publication: 2 July 2008
Journal of Nursing Management, 2008, 16, 905–911
DOI: 10.1111/j.1365-2834.2008.00942.x ª 2008 The Author. Journal compilation ª 2008 Blackwell Publishing Ltd 905
systems has limited the innovation needed to create
solutions to the new and complex problems that the
future will bring� (Marquis & Huston 2009, p. 146). It is critical then that contemporary nursing and
healthcare leaders identify the skills which will be nee-
ded by nurse leaders in 2020 and begin now to create
the educational models and management development
programmes necessary to assure these competencies are
present. This article presents eight leadership
competencies likely to be an essential part of the nurse
leader�s repertoire in 2020 (see Table 1).
A global perspective or mindset
The first competency needed by nurse leaders in 2020 is
a global perspective or mindset about healthcare and
professional nursing issues. Gupta et al. (2008, para 2)
define a global mindset as �one that combines an openness to and awareness of diversity across cultures
and markets with a propensity and ability to synthesize
across this diversity� and argue that developing a global mindset which recognizes and bridges such cultural
differences is essential to the success of any organiza-
tion. The benefit of a global mindset to the nurse
executive is that it allows him or her to proactively
identify and respond to emerging global healthcare and
nursing trends which potentially impact national,
regional or even local healthcare planning.
Indeed, Huston (2008, para 3 & 4) suggests that:
�One only has to look at the headlines to realize most healthcare and nursing issues must now be
viewed from a global perspective. The threat of
pandemics and epidemics such as Acquired
Immunodeficiency Syndrome (AIDS), Severe
Acute Respiratory Syndrome (SARS), drug resis-
tant tuberculosis, poliomyelitis, West Nile virus,
and bird flu, combined with a world increasingly
characterized by global travel, reminds us that the
health threats faced by any one country are
ultimately faced by all countries. In addition,
many professional nursing issues are now recog-
nized as global issues. There has never been a
greater urgency to establish international stan-
dards for nursing education or to identify global
standards or competencies for the novice nurse,
than right now. In addition, the current global
nursing shortage has resulted in the unprecedented
trans-national migration of nurses�,
leading to complaints of �brain drain� from donor countries and an increased risk of unethical, if not
illegal, employment practices for foreign nurses in
their host country, as a result of the lack of
regulatory oversight.
Huston (2008) also suggests:
�It is readily apparent that no one country has all the answers to the worldwide health care dilem-
mas we face today, including abuse of women and
children; care of people with HIV or AIDS; hunger
and lack of access to clean drinking water; the
multiplicity of ethical issues facing nurses and
other health care providers, as well as nations; and
health care worker shortages�.
The eight United Nations Millennium Development
Goals, which range from �eradicating extreme poverty and hunger to halting the spread of HIV/AIDS and pro-
viding universal primary education, all by the target date
of 2015, form a blueprint for all the world�s countries and leading development institutions� (United Nations 2008, para 1). Working together and sharing technologies,
strategies and successes worldwide will be an important
part of addressing these global health care dilemmas.
A working knowledge of technology
A second competency required by nurse leaders in 2020
is the ability to integrate technology which facilitates
mobility and portability of relationships, interactions
and operational processes. Electronic health records
(EHRs), clinical decision support (CDS) and biometrics
are examples of such technology, as all will continue to
impact not only what healthcare data are collected, but
how they are used, communicated and stored.
In January 2004, US President George Bush set a goal
that most Americans would have an EHR by 2014
(Office of the Assistant Secretary of the Defense (Health
Affairs) and the TRICARE Management Activity
2008). Similarly, Canada Health Infoway predicts that
Table 1 Essential nurse leader competencies for 2020
A global perspective or mindset regarding healthcare and professional nursing issues.
Technology skills which facilitate mobility and portability of relationships, interactions, and operational processes.
Expert decision-making skills rooted in empirical science. The ability to create organization cultures that permeate quality healthcare and patient/worker safety.
Understanding and appropriately intervening in political processes. Highly developed collaborative and team building skills. The ability to balance authenticity and performance expectations. Being able to envision and proactively adapt to a healthcare system characterized by rapid change and chaos.
C. Huston
906 ª 2008 The Author. Journal compilation ª 2008 Blackwell Publishing Ltd, Journal of Nursing Management, 16, 905–911
50% of Canadians will be able to access their own
EHRs by 2009 (Pooley 2006). Indeed, most developed
countries are actively moving towards the establishment
and implementation of EHRs. Australia has proposed a
strategy known as �Health Connect�, to facilitate the adoption of common standards by all e-health systems
in the Australian, State and Territory Governments
(Health Connect 2006). Czernowalow (2005) identified
the testing of EHRs at 15 State Hospitals in Africa�s Northern Cape, Western Cape and the Free State as of
2005 and reported that the Department of Health had
tasked the State IT Agency to initiate national
implementation of the system. The National Health
Service in the United Kingdom (UK) began an EHR
system in 2005 and has developed a national system to
transfer records directly and securely from one general
practitioner (GP) to another. More than 100 000
patients in 4000 GP practices in the UK are now using
this system (GP2GP 2008).
The process, however, to make such system wide
changes is not easy. Nor is it cheap. A lack of funding,
debates about who �owns� the data in the system and the challenges of getting computers to �talk to each other� will exist for some time to come (Pooley 2006).
In addition, �clinical decision support� (CDS), defined broadly as �a clinical system, application or process that helps health professionals make clinical decisions to
enhance patient care� (Healthcare Information and Management Systems Society 2008, para 1), will likely
be commonplace by 2020, giving providers the promise
of access at the point of care to cutting edge research,
best practices and decision-making support to improve
patient care. For example, Isabel Health, an online
diagnosis decision support application, �combats…
