Leadership in Nursing: 5 Essential Skills

“Leaders do more than delegate, dictate, and direct,” the American Nurses Association (ANA) writes. “Leaders help others achieve their highest potential.”

Ever since the Institute of Medicine released its “Future of Nursing” report in 2010, nurses have assumed a greater role in medicine. Originally, the report called on the nursing profession to advance and help support the evolving healthcare system under the Affordable Care Act. Leadership skills, education and scope of practice were identified as barriers that needed to be overcome to transform quality and care standards and fulfill the demand for more healthcare professionals.

Despite progress on these goals, challenges remain. More nurse leaders are needed; for nurses pursuing career advancement, certain skills are crucial.


The Online Journal of Issues in Nursing states that although teamwork and collaboration are often used synonymously, collaboration forms a part — the most important aspect — of team care. Collaboration is conceptualized as both a process and an outcome. The process is framed into three phases: problem setting, direction setting and structuring. As an outcome, collaboration synthesizes different perspectives to form a solution that could not be accomplished by a single person or organization.

Collaboration places healthcare professionals in a position to enhance the effectiveness of care. It also involves a range of other skills. Successful collaboration requires the integration of interpersonal and organizational skills, including interpersonal attributes such as cooperation and self-confidence, and process skills such as systems thinking. It also relies on other foundational skills such as conflict resolution and communication.


Negotiation is an essential skill for conflict management. According to Communication Skills for Nursing Practice, negotiation is a two-way process that requires the presence of two conditions: “a degree of disagreement or resistance from one or both parties; and a mutual interest in an exchange of service, goods, information, time or money that will have some benefit for both.”

Negotiation is a common fixture in patient-centered care. For instance, Communication Skills for Nursing Practice describes how a nurse may negotiate with a patient to mobilize after surgery by giving the patient extra time and some analgesia. A nurse leader might use negotiation to cover a shift and to interact with supervisors, whether implementing a program, approving a budget or adjusting patient care standards.

Several theories exist on the art of negotiation. Many touch on the importance of listening and asking questions of the other party for defining what may be exchanged. Negotiation also requires an awareness of one’s behavior and feelings, as well as the facts that guide and dictate what will occur.


Communication is the number one transformative skill that nurses should have and refine. Communication allows nurses to interact and build relationships with patients and other healthcare professionals. And it’s also crucial for maintaining high-quality patient care, as well as its role in shaping and impacting process and outcome.

According to author and educator Ros Wright, “The positive results of effective communication are well documented and are essential in achieving, amongst others, increased recovery rates, a sense of safety and protection, improved levels of patient satisfaction and greater adherence to treatment options.” Without strong communication, patient safety is undermined.

Strong communication skills involve listening, nonverbal communication and the ability to develop personal relationships with kindness and compassion. Also important is awareness of any roadblocks that can undermine communication. Nursing Standard mentions that patients can be affected by noise, lack of privacy, fear and anxiety, and the inability to explain feelings. For professional communication, barriers include lack of time or support, high workload and staff conflict.


The Journal of Professional Nursing describes coordination as a “skill set [that] addresses how often nurses function as the communicative hub of their health care teams.” Coordination can involve assigning responsibilities, organizing team member roles, directing and supervising others, and delegating tasks. As a result, coordination is directly related to leadership.

Other characteristics define leaders who excel in coordination. The study in the Journal of Professional Nursing found that medical residents, new nurses and patient care assistants greatly appreciated when nurses mentored them and taught them new procedures. Nurses who encouraged input and helped team members feel valued were also mentioned.


In Critical Thinking in Nursing: A Cognitive Skills Workbook, Saundra Lipe and Sharon Beasley define evaluation as “the assessment of the information obtained.” And by using specific questions, nurses can evaluate or assess new information to determine its usefulness. “Is the source reliable?” Lipe and Beasley write. “Is the information credible? What are the chances that bias could be involved? Is the information relevant to the current problem?”

Evaluation can also be used to assess a client’s condition or well-being. This determines whether nursing care was ultimately effective and if the outcome for the patient was achieved. By being cognizant of evaluation, nurses can help ensure that favorable client outcomes are met.

Benefits of Nurse Leaders

A well-managed healthcare staff leads to better patient care. With skilled and knowledgeable nurse leaders in place, these professionals can meet the ANA’s goal of advancing health and leading change.

In light of the nursing shortage described by the American Association of Colleges of Nursing, more nurse leaders are needed. They will play a pivotal role in overseeing nursing staff members, helping and mentoring them to deliver a high level of patient care. As a result, leadership in nursing is enhanced, which is one of three barriers named in the “Future of Nursing” report; a second, expanded scope of practice, can advance with more nurse leaders.

Finally, nurse leaders will help nurses further their education. At the time of the report, 50 percent of the U.S. nursing workforce was BSN-prepared; the report called for 80 percent of nurses to hold a BSN by 2020. Today, educational standards have changed. Not only is the degree a standard requirement for all new nurses in hospitals and employers throughout the country, but it is often the minimum for leadership positions.

Alvernia University is committed to advancing the nursing profession and developing leaders who can pave the way. The online RN to BSN Completion Program helps nurses enhance their careers and pursue leadership positions. In a flexible and convenient online environment, the program allows nurses to reach their goals and maintain their current work and personal schedules.

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