Six Transformational 20th Century Nurse Leaders

Six Transformational 20th Century Nurse Leaders

In the Year of the Nurse and Midwife, one of the underlying themes is that of nurse leadership—and the nurse leaders of today and tomorrow have a wide range of inspiring role models! Below are profiles of six outstanding nurse leaders as described by Marion E. Broome and Elaine Sorensen Marshall in their new text Transformational Leadership in Nursing, Third Edition.

The story of modern Western nursing began with little-noted but great leaders, and it traditionally starts with Florence Nightingale, but the 20th century has also provided us with a wealth of transformational nurse leaders. Six trailblazers include…

Isabel Hampton Robb

Isabel Hampton led nurse training at Johns Hopkins in Baltimore and was the first president of what became the American Nurses Association. “Her vision of nursing … required a transformation of … accepted norms. [Her work] demonstrated her ability to effectively lead change and inspire others toward her cause” (Keeling et al., 2018).

Mary Adelaide Nutting

Mary Adelaide Nutting was Hampton’s student at Johns Hopkins and was among the first visionaries to foresee academic nursing education, rather than apprentice nurse training solely in hospitals. She led efforts to develop the first university nursing programs at the Teachers College of Columbia University and to secure funding for such programs (Gosline, 2004).

Lavinia Lloyd Dock

Lavinia Lloyd Dock was a strong woman who was involved in many “firsts” that influenced the profession for years. She firmly believed in self-governance for nurses and called for them to unite and stand together to achieve professional status. She was among the founders of the Society for Superintendents of Training Schools for Nurses, which later became the National League for Nursing (2019), and an author of one of the first textbooks for nurses and history of nursing. She encouraged nurses and all women to become educated, to engage in social issues, and to expand their views internationally (Lewenson, 1996). She was known as a “militant suffragist” and champion for a broad range of social reforms, always fighting valiantly for nurses’ right to self-governance and for women’s right to vote.

Lillian Wald

Lillian Wald, who modeled the notion of independent practice a century before it became a regulatory issue, founded the first independent public health nursing practice at Henry Street in New York. She not only devoted her life to caring for the poor people of the Henry Street tenements but also was the first to offer clinical experience in public health to nursing students. She worked for the rights of immigrants, for women’s right to vote, for ethnic minorities, and for the establishment of the federal Children’s Bureau (Brown, 2014).

Mary Elizabeth Carnegie

Mary Elizabeth Carnegie established one of the first baccalaureate programs in nursing in 1943 at Virginia’s Hampton University (American Association for the History of Nursing, 2018). She became the first African American nurse to be elected to a board of directors of a state nurses association (Florida). She was on the editorial staff of the American Journal of Nursing, was senior editor of Nursing Outlook, and the first editor of Nursing Research. Carnegie was a president of the American Academy of Nursing and was awarded eight honorary doctorates over the course of her career. Her legacy of leadership included making the contributions of African American nurses visible in the professional literature.

Ildaura Murillo-Rohde

Ildaura Murillo-Rohde was a Panamanian American nurse, academic, and organizational administrator. She came to the United States in 1945 and studied at Columbia University. She was the first Hispanic nurse awarded a PhD from New York University. Her specialty was psychiatric–mental health nursing, and she was an outstanding advocate for mental health needs of Hispanics. Murillo-Rohde was an associate dean at the University of Washington and the first Hispanic dean at New York University. She founded the National Association of Spanish-Speaking Spanish-Surnamed Nurses in 1975 and served as its first president. She was named a living legend in the American Academy of Nursing (National Association of Hispanic Nurses, 2019).

Today’s healthcare leaders inherit courage, vision, and grit that must not be disregarded. We stand on the shoulders of valiant nursing leaders of the past who left a foundation that cries for study of its meaning and legacy for leadership today. They were visionary champions for causes that were only dreams in their time but today are essential. They dared to think beyond the habits and traditions of the time. These leaders were truly transformational. You are among the pioneer leaders to move healthcare forward to better serve society.


American Association for the History of Nursing. (2018). Mary Elizabeth Carnegie DPA, RN, FAAN (1916–2008). Mullica Hill, NJ: Author. Retrieved from

Brown, A. (2014). Brief history of the Federal Children’s Bureau (1912–1935). The Social Welfare History Project. Retrieved from

Gosline, M. B. (2004). Leadership in nursing education: Voices from the past. Nursing Leadership Forum, 9(2), 51–59.

Keeling, A., Hehman, M. C., & Kirchgessner, J. C. (2018). History of professional nursing in the United States: Toward a culture of health. New York, NY: Springer Publishing Company.

Lewenson, S. (1996). Taking charge: Nursing, suffrage and feminism in America, 1873–1920. New York, NY: National League for Nursing Press.

National Association of Hispanic Nurses. (2019). Dr. Ildaura Murillo-Rohde, PhD, RN, FAAN. Author. Retrieved from

Why a Nursing Manager Role Might be Right for You

Why a Nursing Manager Role Might be Right for You

A nurse manager position is a career path that can be as equally rewarding as it is challenging. The decisions made by the nurse manager can drastically impact the staff on the unit. Attending important meetings, hiring staff, leading change, and addressing ongoing staff development and accountability are just a few examples of what a nurse manager does. If you find these daily tasks are of interest in your career path, then a nurse manager job might be right for you. Other responsibilities include not being afraid to take ownership of a decision while having the confidence and knowledge to feel comfortable making a decision and dealing with the consequences.

Ultimately, the decisions a nurse manager makes affects the whole staff and there will undoubtedly be those who disagree with the decision. The nurse manager must move forward confidently to earn the trust and respect of their staff and have the ability to influence colleagues. If you currently find your colleagues coming to you for help and they respond well to your decisions, you might have the personality and the natural ability to influence your colleagues for the better. This ability is a vital skill for any nurse manager to have.

Every decision in health care impacts numerous other individuals. Maybe you find that you have the ability to see how one decision impacts another and possess the forethought to better manage patient workflow. The ability to know and understand how a unit functions as part of the whole hospital is also a crucial skill for a nurse manager.

A successful nurse manager must be a dynamic influencer and nursing expert. If you find the role intriguing and possess these skills, you might find the nurse manager role to be a perfect fit!

For more information on leadership roles in nursing check out, or other useful resources available to medical professionals on

Recruiting Nurses for Optimal HCAHPS Performance

Recruiting Nurses for Optimal HCAHPS Performance

The first step in improving Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) performance is recruiting nurses with a focus on long-term retention. The national turnover rate for bedside RNs was 16.8% in 2017 with an average associated cost of $38,000 to $61,000 per nurse. Nursing turnover impacts each hospital’s bottom line, with costs averaging from $4.4 million to $7 million annually (source).

Multiple Costs of Turnover

More importantly, high nursing turnover negatively affects morale, quality of care, and HCAHPS scores. When there is a critical acute need to satisfy scheduling demands, hospitals cannot afford the luxury of being proactive in their recruitment efforts. Unfortunately, patching a schedule full of holes causes rapid hiring decisions instead of considering a quality applicant.

There are connections between patient perceptions of their health care experience and nurse staffing ratios. The hospitals with the highest number of nursing hours per patient day consistently rate higher on HCAHPS scores than other facilities. Nurses and patients alike thrive in a positive nurse work environment. But recruiting nurses with long-term retention factors is only half the battle.

Revisiting the Recruitment Process

Health systems have to streamline their recruitment process to re-focus on hiring and retaining nurses with targeted HCAHPs behaviors like responsiveness, ability to listen, and audience awareness. When interviewing candidates, it is essential to identify how the nurse will communicate with and answer patients. Optimal applicants will treat the patient with respect, communicate effectively, and respond quickly.

Hospitals must strive to recruit candidates who are committed to their work, patients, and the organization. When hospitals remain competitive to hire and retain talent, patients stand to benefit. Top-quality employees make for top-quality organizations and nurses are at the forefront.

Caitlin Goodwin MSN, RN, CNM is a Board Certified Nurse-Midwife and freelance writer. She has ten years of nursing experience and graduated with a MSN from Frontier Nursing University. 

4 Ways to Boost Morale in the Workplace

4 Ways to Boost Morale in the Workplace

With the stress of the health care profession, it can be challenging to rally your energy or exude optimism on a daily basis. If you’re in an administrative or management role, you may notice signs of dwindling happiness among the staff. Things like arguments among colleagues, less camaraderie, or increased turnover rates may be clues to indicate your coworkers are in need of a morale boost.

The best way to tackle a slump in team morale is to head it off at the pass with positive changes. Recognizing the extra time and effort your nursing colleagues give to the job and providing them with opportunities to learn and grow in the profession are a couple of the ways to improve job satisfaction. Here, we’ll look at four other ways to boost morale in the workplace.

1. Allow time for a lunch break.

Studies indicate only one in five people step away from their job duties to take a lunch break. But following the same fast-paced routine day in and day out without a pause can drain your energy and your creativity. Kimberly Elsbach, a professor at the University of California, Davis Graduate School of Management, told NPR, “We know that creativity and innovation happen when people change their environment, and especially when they expose themselves to a nature-like environment, to a natural environment.”

Encourage your nurses to take their lunch breaks and escape from the usual monotony of the day. They can head outside for a stroll around the block, order from a new restaurant, or sip on some antioxidant-rich green tea. Even just a few minutes a day can have mood-elevating effects and lead to a more positive work environment.

2. Foster an atmosphere of caring among your coworkers.

It’s so easy to get wrapped up in your own life. However, if you can celebrate your colleagues’ milestones — a work anniversary, an engagement, a promotion, a birthday, etc. — you can foster an atmosphere where your fellow nurses feel valued. The gesture of making sure your employees and coworkers know they are treasured assets to the company will go a long way toward getting people excited about coming to work each day!

3. Offer free continuing education or professional development courses.

When budgets are tight, continuing education and professional development courses are often the first items to be slashed. But continuing education and professional development courses bolster the tools that nurses need to help their patients, and sometimes, the cost of these courses comes with hefty price tags. By offering free, educational opportunities or subsidizing a portion of an enrollment fee, you support your employees in their desires to improve their skill set, cultivate their professional passions, and accomplish their long-term goals—which leads to highly-trained, loyal employees and a more uplifting work setting for everyone.

4. Learn effective communication strategies.

“To help prevent morale issues in the workplace, leaders need to spend time communicating their vision to ensure that ‘everyone is on the same page,’” suggests Jeff Parke, author of a Linkedin article about low morale in health care.

Communicating a concise message is key to managing employee expectations and conveying practical productivity guidelines. Parke states that capable leaders will permit employees to discuss these messages either in-person or during designated staff meetings, where employees have the opportunity to express their opinions and ask questions.

Allowing for feedback and the open exchange of ideas shows nurses that their thoughts and opinions matter when it comes to boosting morale in the workplace.

We’d love to hear your thoughts and ideas on how to boost workplace morale, so feel free to leave us a comment below.

Safety in Numbers—of Nurses

How many patients can a nurse reasonably care for at one time? This is perhaps the biggest issue facing the nursing profession right now. In fact, there are two bills in Congress right now that seek to decide just this, not only to protect patients but also the nurses who care for them.

California is the only state in the United States that regulates the number of patients a nurse can have under his or her care. The safe staffing law was passed there in 1999 (more than 15 years ago!) and it went into effect in 2004. The law breaks down the maximum number of patients for a nurse by acuity and type of care.

But in 49 other states and in the District of Columbia, there is no mandated limit to the number of patients a nurse can safely or reasonably be expected to care for.

What does this mean? This means on busy days in an emergency department, nurses may be caring for 4-6 acutely ill patients, some of whom need to be transferred to the intensive care unit, to a telemetry unit, or to the OR. This means a psychiatric nurse could be expected to care for more than 10 patients at a time, or that on a low-staffed unit at night, a med-surg nurse may be caring for up to eight or more patients.

A nurse’s name on a patient’s chart confers ultimate responsibility for that patient’s safety and well-being. The expectation is that the nurse will prevent a patient from harm and will keep a patient safe. It is the nurse who will discover a medication error before it gets to the patient (whether it be an error on the part of a resident or the doctor or the pharmacist); she or he will keep a patient from falling should they try to get up out of bed unassisted, and he or she will medicate, assess, chart, document, comfort, and care. But what happens when that nurse is stretched so thin there is no possible way for her to ensure a patient’s safety? The patient is at risk, and so is the nurse’s license. How can she be everywhere at once when she is caring for five or even six patients at a time?

Unfortunately, this is an issue that is unlikely to be resolved in the near future, despite the two bills currently before Congress. Over the next decade, the number of aging baby-boomers continues to increase while the number of new nurses entering the workforce decreases (not to mention those nurses leaving the profession altogether as a result of burnout and fatigue). Administrators still incorrectly fear the cost ramifications of nursing mandates. Specifically, the bill would require hospitals to write a staffing plan, and “allows a nurse to object to, or refuse to participate in, any assignment if it would violate minimum ratios or if the nurse is not prepared by education or experience to fulfill the assignment without compromising the safety of a patient or jeopardizing the nurse’s license.” Importantly, the bill also carries an anti-retaliation clause. The bills are a start, but are not a panacea by any means. And, they have yet to pass.

Earlier this week, a report released by Johns Hopkins purports that medical errors are the third leading cause of death in the United States each year. The high number of deaths relating to errors point not to bad doctors or to mistakes, but more to systemic problems, a lack of standardization, a lack of reporting and data collection about mistakes, and issues with medical staff turnover, burnout, and fatigue. Many people are quick to point out the myriad studies correlating positive patient outcomes and higher levels of nurse staffing, as well as the decrease patient lengths-of-stay.

It’s not that data don’t exist, as hundreds of studies demonstrate the positive relationship between patient safety and nurse staffing. Moreover, studies also show that increasing nursing staff does not contribute to higher hospital costs. A longitudinal study by the Agency for Healthcare Research and Quality concluded that it actually decreased costs over time, including a decreased patient length-of-stay. Additionally, increased nurse staffing has been shown to decrease patient mortality, increase patient satisfaction, and decrease nursing turnover and job dissatisfaction.

Safe staffing is an issue that is not likely to fade, and many nurses are eagerly tracking the legislation before Congress. A rally to demonstrate support of safe staffing is planned in Washington, DC, for May 12th. More information can be found here.

Patient Satisfaction and Patient Safety: A Trade-off?

Patient Satisfaction and Patient Safety: A Trade-off?

It seems that the new buzzword in health care is “patient satisfaction.” The Affordable Care Act allows Medicare to tie a portion of a hospital’s reimbursement money to patient satisfaction. Patients are mailed a survey after discharge called the HCAHPS (Hospital Consumer Assessment of Healthcare Providers and Systems), and depending on their responses, Medicare can withhold up to 1% of that hospital’s reimbursement.

At first glance, this measure of accountability makes sense; the HCAHPS rewards hospitals whose patients report receiving a high level of care. The problem, however, is that the survey’s standard of care is very high, and patients’ perceptions are not always an accurate representation of the clinical care that was delivered. The responses are too subjective, and there’s no real data to be measured or evaluated.

The HCAHPS questions cover nursing, physicians, communication, cleanliness, and an overall rating. Most questions have four possible answers: never, sometimes, usually, and always. The only answer that counts toward a hospital’s rating is “always.” For example, one question asks patients how often they received help as soon as they wanted it after pressing their call light. Even if the patient responds “usually,” this is a fail. (I’ll spare an enumeration of the possible reasons a nurse may be unable to deliver a blanket within two minutes, and simply point out that this question doesn’t differentiate between an emergent request or a routine one.)

Because of the monetary incentive to keep patients satisfied, many hospitals have changed their model of care delivery to one that, well, keeps patients happy. Customer service training has become a part of many orientation programs (some hospitals go as far as to script patient dialogues), and in many places, you may find a standard that the patient, and not the doctor, is always right. 

But the patient is not always right. One example is the over-prescription of antibiotics for viral illnesses. I triage patients all the time who are prescribed antibiotics for rhinovirus, because they demand them, and providers know a refusal will cause low scores on the question, “How often did doctors listen carefully to you?” Or consider the patient with an ankle sprain who requests narcotic pain medication. A satisfied patient in this case may become a drug-dependent, narcotic-addicted one. Is this really what we want health care to look like?

For now, let’s set aside the issue of whether patients are able to separate the evaluation of their actual care from a rating of the food in the cafeteria or noise in the hallway, and move to the larger issue: Patient satisfaction does not equal patient safety. In fact, they seem to be inversely related. According to several recent studies, high patient satisfaction leads to higher health care costs, to increased nurse burnout and nursing job dissatisfaction, and most alarmingly, to higher patient mortality.

I understand the pressure to increase patient satisfaction not just to maximize reimbursement but to keep patients coming back through the doors. Health care is changing: Patients have a say in where they are treated and by whom. We live in an age when people write Yelp reviews before they even leave a restaurant, and the same is happening to health care (websites such as Zocdoc or come to mind, and the purported purpose of the HCAHPS survey is to allow consumers to compare hospitals and evaluate their quality).

Patients have rights, certainly, but the highest emphasis should be on their safety and not on their satisfaction (and it is infuriating that the answer of “usually” on a survey doesn’t count as a high score). Some patients, after all, will never be satisfied, and will not like the answer that they cannot eat, cannot get out of bed, or cannot have six people in their hospital rooms all in the name of their safety. Linking hospital reimbursement to safety measures, such as rates of infection or hospital readmission, seems reasonable. Core measures exist for this very reason, to quantify performance in areas of patient safety. Instead of spending money on mobile charging stations or Keurig coffee makers in each room, investments should be made in hiring more nurses—recent studies have demonstrated that nurse-patient ratios are crucial to both patient satisfaction and safety.

(For more information about HCAHPS, visit

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