A Call for a Paradigm Shift in Nursing and Healthcare Leadership


Several years ago, after attending a nursing leadership conference, I thought why are we still trying to solve 21st-century nursing shortage, education, and practice issues with 20th-century answers? These old answers won't work now. Nursing as a profession needs to find new answers to today's issues, not try to continue to answer old issues and use the lack of answers to those issues as an excuse for not answering today's needs.

The nursing shortage today and in the near future calls for leadership that will find new and innovative ways to meet nursing practice and education needs without sacrificing quality and safety. However, our leadership at many levels tries to solve our current issues by saying we have to solve issues that are 40–50 years old or by throwing more money into education by creating more spaces for nursing students. The answer of more spaces for students creates some immediate relief and brings nursing needs to the attention of the public. However, it doesn't address the hundreds of thousands of nurses needed in the next half a century. Nor does it address the need for nursing educators or establish a process for meeting the need for hundreds of thousands of nurses.

What does nursing need? We need a paradigm shift in all of our leadership, nursing, and health care too. We need to think of different/new alternatives to just increasing the number of slots for students. One of the attempts at an alternative is the Versant Program developed by a foundation at the Children's Hospital of Los Angeles. Taking the concept of a residency program, an old idea, and melding it with the recruitment, productivity, and orientation needs of today's new graduates, this program uses a mentorship process and lengthy clinical orientation to provide the experiences new graduates need to be successful. This answer does not produce more nurses but it is a small step toward making the work environment the place where the nurse can gain initial and ongoing clinical experiences not always available in the clinical experiences in their basic program.

Many more nursing programs with solid curriculum, simulated experiences, and a plan for accomplishing the education for success in the licensing exam are needed. However, not all clinical experiences have to be during the basic education. Simulations and virtual clinical experiences can be developed to address the basic needs of student nurses. Hospitals, nursing care centers, and rehabilitation centers can develop partnerships of internships and residencies so that the nurses become clinically competent after licensure. We need a process like the one just described or some other new variation that will assist the Board of Registered Nursing (BRN) to allow more new and competent nursing programs to come into existence. This type of change could diminish the concerns about fulfilling requirements for a large number of clinical facilities and experiences. We need new, different ways and we need the current leadership to embrace people with different ideas as well as to come up with collaborative efforts to solve the nursing shortage.

Other issues that contribute to the problem of meeting the shortage include healthcare facilities that need to be profit centers. Why don't we forgo health care as a profit center and do what is needed—provide adequate care to those who need it, finance residency program in nursing, and find other solutions to this shortage problem. In addition, nursing leadership cannot spend another 40 years debating what is entry into practice and who is a nurse. The public doesn't care unless it affects their care, safety, or pocketbook. As nurses, we must stop looking for our identity and self-esteem in what we promote among ourselves and begin to lead the healthcare team to provide quality, safe care. The healthcare team, including administrators and physicians, cannot achieve the outcome of safe and quality care without us, the nurses, unless we give it away by not coming to the forefront with new answers now.

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