[usPropHeader] Error loading user control: The file '/CMSWebParts/WK.HLRP/LNC/LNCProductHeader.ascx' does not exist.


  1. Porter-O'Grady, Tim DM, EdD, APRN, FAAN, FACCWS
  2. Burnes-Bolton, Linda DrPH, RN, FAAN
  3. Issue Editors

Article Content

Providing good leadership is a perennial issue judging by how much public dialogue and press is devoted to covering it. Of course, this is no less true for health service. One of the most critical issues in the health sector is the assurance that there will be available competent and capable leaders over the long term. It is becoming increasingly difficult to align capable leaders with available positions in a wide range of health service settings. Quite simple, it appears that there are a declining number of health care professionals willing to assume leadership roles at a wide variety of places in the health care system. The ability to do succession planning is now compromised by the declining number of potential leaders willing to seek to accept the mantle of leadership.

Photo of Tim Porter-... - Click to enlarge in new windowPhoto of Tim Porter-O'Grady, DM, EdD, ScD(h), APRN, FAAN
Photo of Linda Burne... - Click to enlarge in new windowPhoto of Linda Burnes-Bolton, DrPH, RN, FAAN

Certainly, it is becoming increasingly apparent that leadership is tough business and not for the faint of heart. More often, one hears the adage "it's just not worth the pain, frustration and sacrifice to accept these demanding leadership opportunities." As a result, fewer leaders are covering more organizational territory than at any time in the history of American health care. Much of the work of leadership is reflecting the pressure of more demands on the leader with fewer resources available to meet them.


Complicating the lack of the potential leader's willingness to embrace the role, leaders are finding that the demands on them for adaptation to and integration of new skill sets in a more value-driven health construct calls them to demonstrate newer skills and capacity with which they are becoming increasingly unfamiliar. With the average age of the health leader now in the mid- to late 40s, the technological, methodological, and statistical landscape they must now navigate is creating demands that lie far outside of their more traditional skill range. In nursing, few leaders in the first-line management roles were actually formally prepared for these positions and have been thus challenged to learn the role "on the job." Now the role is fast eclipsing the level of skill most managers are capable of demonstrating, raising levels of frustration and dissatisfaction within the role. Seeing their own managers often overwhelmed, potential leaders are averse to accepting a role where a growing lack of satisfaction is visibly palpable.


Clearly, there is a need to drill down further into the demands and requisites of the contemporary leader role in nursing and health care and raise a different set of questions with regard to what is needed going forward. The traditional promotion process that moved those who were clinically excellent into the manger role is not sustainable. We now know that clinical excellence is a poor predictor for management success. We also know that leadership is a learned skill, not a set of personality characteristics. It is now time that the processes and disciplines associated with succession planning and leadership preparation be more formalized and structured as a part of the strategic work of systems and leaders. Leadership is also an art and is learned by doing. The art of leading takes guided practice over time, under diverse conditions with support from other leaders. The leader role at all level of complex health systems now needs intentional planning and work if we are to both find and fit the right person to the right role.


The array of articles assembled in this issue is meant to both inform and raise a number of questions with regard to what is needed in the leader role in nursing and health care and suggests a variety of approaches to getting it. The diversity of topics and approaches provides a newer lens through which to see leadership from the perspective of preparation, mentoring, succession, utility, and evaluation of effective leadership in the contemporary health system. A number of authors challenge current notions and approaches to both the development and application of leadership talent in current and future health services. Certainly, as health reform continues to move through its inevitable yet tortuous path toward a new reality for the country, new thinking and approaches will be required. We hope that the topics covered in this issue will stimulate new thinking and discussion of leadership capacity and roles in your own health service settings and serve as a catalyst for writing a new leadership health script in every place where health transformation is underway.


-Tim Porter-O'Grady, DM, EdD, APRN, FAAN, FACCWS


-Linda Burnes-Bolton, DrPH, RN, FAAN


Issue Editors