Review the Huston (2010) article listed under reading assignments. Which skills described for the Nurse Leader in the year 2020 are important now? Explain your rationale and provide an example from your practice setting (or from your prelicensure program) to support it.
This is the article:
eynote speaker at the conference, American
nursing professor and former president of
the international honour society of nursing,
Sigma Theta Tau, Carol Huston, painted a
picture of a brave new nursing world in 2020,
in her opening presentation, Preparing nurse
leaders for 2020.
She outlined eight leadership competencies
every nurse leader would need in the 2020. The
first was a global perspective. “Every health care
issue has to be looked at from a global perspective.
We used to think pandemics were confined
to developing countries. We now know they are
just one short flight away.”
There was a more urgent need for international
standards for basic nursing education.
The nursing shortage was one of the most
serious threats to global health, she said, and
it would get significantly worse before it got
better. Nurse migration was a global problem.
(See news p7.)
The second leadership competency was better
use of technology to connect people. Technology
had driven so many changes already in health
care but knowledge and information acquisition
and distribution was going to multiply exponentially.
“Forty percent of what we know today will
be obsolete in three years,” Huston said.
She listed a range of technological developments
that would have a major impact on health
care in the next 20 years. By 2030 diagnostic
body scans, which could identify underlying
pathology, would become part of showering.
Improvements in body scanning technology
would mean there would be no need for invasive
surgery or tests. “Nano bots” circulating in the
blood stream would identify disease processes
and begin to repair them. Gene therapy would
mean what was now untreatable would be treatable
and could see cancer abolished completely
within two decades. Stem cell therapy would
eliminate the need for organ transplants “as we
will grow new organs. It is predicted we will be
able to grow heart, kidneys and livers by 2020.
There are already clinical trials underway growing
new teeth – instead of dentures you would
grow you own new teeth.”
Merging of the human and the machine would
advance significantly and by 2020 there would
be pancreatic pacemakers for diabetics and the
technology to enable blind people to see and
deaf people to hear.
Robotics would continue to develop, with
physical service robots which could wash patients
and help feed and carry patients. There
was the potential for the use of robots in
therapeutic roles. Paro, a robotic seal developed
in Japan, responded to patting by closing its
eyes and moving its flippers and was already
being used as a therapeutic device for those
with autism and Alzheimers. Kansei (emotion)
robots are being developed and are programmed
so key words trigger facial expressions.
Robotic simulation for nursing education
provided a safer environment for students and
mannequins could now cry, sweat, and become
cyanotic. “The challenge for nurse leaders in
2020 will be how much simulation is too much?
How important is human contact to learning the
art of professional nursing?” Huston said.
Other areas of development would be digital
records of health care history, the continued
development of biometrics, with confidentiality
protected by biometric signatures, the increasing
use of “smart” objects, including a bed that
could call a nurse if the patient was attempting
to get out of bed, or a coverlet which could take
a patient’s vital signs as they lay in the bed.
“Nursing leaders will have to balance technology
and the human element. I’m not worried
about the science of nursing but I am a little
worried about the art of nursing. Technology
can supplement but not replace nursing care,”
Huston said.
The third leadership competency was expert
decision-making skills rooted in both empirical
science and intuition. She referred to “wicked”
problems, ie those with no right answers. Clinical
decision support software packages will, with
provider input of data, come up with a list of
differential diagnoses and best practice.
There would be increasing numbers of tools
to help decision makers, including the opportunity
to buy information and advice from expert
networks of thinkers. Nurse leaders with both
right brain and left brain skills were needed and
Huston suggested that nurse leaders should surround
themselves with people with a different
brain dominance from their own.
The fourth leadership competency was the
development of organisational cultures which
emphasised quality patient care and worker and
patient safety. “There has been an inordinate
amount of money spent on medical errors but
we haven’t seen that greater reduction in error
rates. Part of the reason is how health care
systems are created.”
If as much energy was focused on fixing the
underlying processes which caused errors as was
focused on blame, much more would be learnt.
“I’m not absolving individual health providers.
We must find a balance between creating safer
health care systems and individuals’ responsibility
for the care they provide.”
Being politically smart was the fifth leadership
competency. “Nurses are the largest group
of health care professionals but they are not
always an integral part of health care decision
making. This has something to do with how
women are socialised to view power and with
how they have been controlled by outside forces,
notably medical and administrative. Politics can
be defined as the art of using power effectively.
In 2020 nursing input will be needed more than
ever. Nurses must use their political skills to
solve problems such as workforce shortages,
turnover rates, reforming broken health care systems
and bringing nursing education entry levels
up to that of other professions,” Huston said.
Team building skills
Nurse leaders of 2020 must also have highly
developed collaboration and team building
skills. The key to leadership success in 2020
would be the ability to integrate the priorities
of industrial age leadership, with its emphasis
on productivity, and relationship age leadership.
“Health in 2020 will be characterised by highly
educated, multidisciplinary experts and this will
complicate, not ease teamwork. The key will be
to create teams of experts, not expert teams. The
nurse leader will have to be a team builder.”
The nurse leader of 2020 must be visionary
and proactive in response to an environment
which will be increasingly characterised by
chaos and change. “Health care organisations
in the 21st century will be in a state of constant,
dramatic change and will be more fluid,
more flexible and more mobile. Nurse leaders in
2020 will be experts in addressing resistance
The three-day conference programme featured
a plethora of speakers, including five plenary
speakers. As well as Carol Huston, Michal Boyd
and Debbie Gell, the other two plenary speakers
were MidCentral District Health board clinical
nurse specialist community, Denise White, and
respiratory programme manager at Harbour
Health Primary Health Organisation in Auckland,
Wendy McNaughton.
McNaughton spoke about the web-based
asthma assessment and decision support tool,
GASP (giving support to asthma patients) she
was instrumental in developing and which
enables health professionals to follow the New
Zealand Guidelines on asthma.
She introduced her presentation with a
rundown of international and national asthma
statistics, including that there are 300 million
sufferers worldwide, New Zealand is second only
to the United Kingdom for asthma prevalence,
asthma is the most common chronic condition
among children, that in 2007 asthma was one
of the top three avoidable hospital admissions
in the Waitemata DHB region and that there are
huge disparities between Mâori and non-Mâori
asthma rates.
She said more than 300 GASP nurses had
completed a two-day, New Zealand Qualifications
Authority-accredited course based on the
Asthma Foundation’s course but with sections on
critical thinking and how to establish nurse-led
clinics added. Two GASP audits of 205 patients
ranging in age from five to 64, had revealed a
76 percent decrease in hospital admissions, a
58 percent decrease in exacerbations and a 46
percent decrease in use the of oral steroids. Mc-
Naughton “implored” the government to fund
nurse-led respiratory clinics.
continued on p16
THE NURSE LEADERS OF 2020 NEED?
conference coverage KAI TIAKI NURSING NEW ZEALAND > JULY 2010 > VOL 16 NO 6 1 5
to change and helping followers work through
that change.”
The final leadership competency was ensuring
leadership succession, given the average age of
a nurse in the United States is 47. “We must do
a better job of mentoring the newest members
of our profession.”
She explained the “Queen Bee Syndrome”, a
characteristic of female occupations – “the nurse
leader who has had to struggle to get to the top
and is so embittered by the struggle she thinks
every nurse should have to go through that to
get to the top.”
Huston said mentoring and nurturing was
the key to advancement in traditionally male
occupations.
She referred to “demographic invisibles”, ie
those people not even considered for leadership
roles because of their ethnicity, gender,
age or nationality, and “stylistic invisibles”, ie
those who didn’t fit the stereotype of a leader.
“Nursing education programmes must be much
more open about where the next generation of
leaders is going to come from. Education and
management development programmes must
ensure nurse leaders have the skill set and
competencies to be successful.”
Huston said the ability to achieve a balance
between old and new skills, technology and
the human element, national and international
perspectives, empirical science and intuition,
productivity and relationship, and using power
wisely for the benefit of self and others, would
be critical for future nurse leaders.
“We must be proactive in identifying, preparing
and supporting our nursing leaders to
address the realities in 2020.”
• Huston’s second presentation on the last day
of the conference, was a light-hearted look
at her own nursing leadership journey and
examined her mistakes and what she learnt
from them. •
PRISON NURSES WORK IN UNIQUE PRIMARY HEALTH CARE ENVIRONMENT
Prison nurses provide primary health care
nursing services to around 8680 prisoners
in the unique and challenging environment
of the country’s 20 prisons, the Department of
Correction’s clinical director Debbie Gell told the
conference. Prisoners, on the whole, were not a
healthy group, with a high prevalence of mental
illness, communicable and chronic diseases and
up to 70 percent of prisoners were alcohol and
drug dependent, she said.
“The prison environment is not very conducive
to supporting health needs and this is compounded
by isolation and worries about home
and family,” Gell said.
The average length of stay was nine months,
with some remand prisoners staying just a few
days, so nurses had to get positive health messages
across within short timeframes. Nursing
practice was also affected by security concerns,
with prisoners having to be escorted to
health clinics or to hospital by custodial staff,
sometimes up to three. Nurses on medication
administration rounds had to be accompanied
by custodial staff and a round always involved
myriad locked gates.
There are 280 prison nurses and last year
they were involved in 200,000 nursing consultations.
Gell outlined a “typical” day in the life of a
prison nurse, with the aid of videos of nurses
talking about their work. Nursing clinics were
held in prison health centres and included immunisation,
sexual health clinics, dental health
and chronic care management. In large prisons,
doctors visited daily but care was led by nurses
with the support of doctors. “Prison nurses see
a wide variety of presentations from serious
traumatic injuries to minor injuries, alcohol and
drug withdrawal, sexually transmitted infections
to sport injuries. They can encounter very complex
self-harm behaviours. They need excellent
assessment skills, for example they must assess
whether a prisoner’s severe abdominal pain is
genuine or a way of securing a drug drop at the
emergency department.”
Each prisoner underwent a “reception health
triage” when first arriving in prison and then
a full health assessment within 24 hours to
seven days of arrival. “The full assessment is a
great opportunity to engage prisoners to look
at their own health. Nurses are dealing with a
high-needs population who are usually in prison
for a relatively short period of time. Nurses
must use that time effectively to help improve
the prisoner’s health and hopefully the health
of the prisoner’s family and wider community,”
Gell concluded. •
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