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The image of nursing has changed since the days of its founder, Florence Nightingale; however, the devotion is the same. Nursing as a profession, coupled with the men and women who make up its numbers, function as the first line of defense for their patients. Therefore, stewardship, governance, and advocacy for the profession must be employed by nursing leaders for its protection and progression.

Importance of Stewardship

               The nursing profession is a vital component in functioning society, and nurses fill the roles of an educator, facilitator of care, administrator, counselor, and advocate. Nursing leaders have a pivotal role in the process of progress and change for the profession. They are the representatives and the face of their departments. They must exercise stewardship at the point of service while working to advocate for respectful interactions with patients and promote a just culture (Murphy, 2009). Stewardship is a concept that includes the philosophy of practical analysis and practice of serving others in such a way as to provide leadership while observing the shared values of the staff for which they are in charge. The staff is the intrinsic force in a department; therefore, its steward’s goal is to serve, protect, and perpetuate its growth and function (Murphy, 2009).

               The steward at the point of service must be aware of challenges and differences while cultivating these aspects into objective and impartial practices. Nurse leaders and staff members can promote their practice while creating change by the effective communication of ideas and observations made on patient care. Further, the transformation of current practice into a more efficient delivery of care can be facilitated by open collaboration with nursing leaders and physicians. A realization that we are all in this together would serve to impact nursing in such a positive way.

Improving Nursing Through Shared Governance

               Shared governance is a term that was introduced over twenty years ago and was used to provide actionable strategies to provide nurses with power over their practice. Shared governance is a collaborative strategy used by organizations to encourage nursing staff to manage their practice with a high level of commitment to practice (Green & Jordan, 2004). Further, the process of shared governance works to stimulate workplace advocacy, which operates at the local, state, and national levels of government.  Without nurse leaders, staff participation, and the use of collective knowledge of patient care implications related to poor staffing ratios, policies will not change. Simply put, shared governance provides nursing with a vehicle to promote their collective voice.

The Leader and Advocacy

               Nurses and nursing leaders are already aware that health care reform is needed. They are the first to see a breakdown in the efficiency and efficacy of patient care;  therefore, it is the nursing profession’s collective responsibility to promote change (Abood, 2007). Further, to be an effective advocate for change, one must possess the desire, will, time, and energy required to engage in reform at the legislative level. There are a growing number of uninsured patients, a rise in the costs associated with providing quality care, and a continual decrease in the healthcare workforce. These problems impose a great strain on the nurses currently in practice. The strain further imposes the numbers of those who choose to be involved in reform. The current workforce is under excessive stress, which directly corresponds to a lack of interest in representing themselves or sharing their collective voice. Work stress aside, Abood asserts that nurses find it difficult to leave the comfort of their practice to engage in the battle to be heard by their legislators (Abood, 2007).  However, without representation from the nursing leadership in practice, policies cannot be changed. It is the combined knowledge and field experience held by the nursing profession that is needed to influence those who make policies for change to occur.

                Nursing leadership will encounter greater challenges in the near future. The management of human capital, digital technology advancement, and cost control are three of the major challenges and opportunities that nursing leaders will face in the 21st Century (Lee, Daugherty, and Hamelin, 2017). Nursing leaders will play a critical role in transforming healthcare through active participation on the nursing units and in executive boardrooms. Critical issues, such as an aging population and the nursing shortage, continue to be prevalent in the United States and globally. Therefore, nursing leaders will need to address issues that affect retention and create new ways to promote the profession.

               Nursing leaders need to expand upon the foundation created by nursing pioneers such as Florence Nightingale. The integration of shared governance into the workplace begins with the nursing leader. There also needs to be a collective effort to revise and reform policies at all levels of administration within an institution and our state and national governing bodies. There is a legacy to uphold. By joining state nursing associations and showing solidarity, the profession can serve the public in a much larger capacity. The nurse leader has many challenges ahead. In taking pride at the bedside, the nurse has the power to impact not just those that he or she serves, but to the families, administrators, and peers alike. Our presence can be our voice, as well.

Sources

Abood, S. (2007). Influencing health care in the legislative arena. The online journal of issues in nursing, 12(1).Retrieved September 14, 2020 from http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume122007/No1Jan07/tpc32_216091.aspx

Alexander, K. L. (2019). Florence Nightingale. Retrieved September 14, 2020 from https://www.womenshistory.org/education-resources/biographies/florence-nightingale

Green, A. & Jordan, C. (2004). Common denominators: Shared governance and workplace advocacy – strategies for nurses to gain control over their practice. The online journal of issues in nursing, 9(1). Retrieved September 14, 2020 from http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume92004/No1Jan04/SharedGovernanceandWorkPlaceAdvocacy.html

Lee, E., Daugherty, J., & Hamelin, T. (2019). Reimagine health care leadership, challenges and opportunities in the 21st Century. Journal of PeriAnesthesia Nursing, 34(1), 27–38. https://doi-org.ezproxy.umgc.edu/10.1016/j.jopan.2017.11.007

Murphy N. S. (2009). Nurse leaders as stewards: the beginning of change. The open nursing journal, 3, 39–44. https://doi.org/10.2174/1874434600903010039. Retrieved September 14, 2020 from  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2737121/

Nightingale, F. (1946). Notes on nursing: What it is, and what it is not. Philadelphia: J.B. Lippincott.

Summers, S. J. & Summers, H. J. (2004). Media ‘nursing’: Retiring the handmaiden. Retrieved from https://www.nursingcenter.com/pdfjournal?AID=483200&an=00000446-200402000-00002&Journal_ID=54030&Issue_ID=483197

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Nancy Bellucci, Ph.D., MSN-Ed. RN, CNE, CNOR
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