Journal of Nursing Education

Editorial Free

Leadership and Communication Competencies in Nursing: What Are We Missing?

Amy J. Barton, PhD, RN, FAAN, ANEF

On February 14, 2018, a tragic shooting took place where 17 students and faculty were killed at Marjory Stoneman Douglas (MSD) High School in Parkland, Florida Burch & Mazzei (2018). In the days and weeks following the horrific events, the typical gun control debates and political polarization occurred, but in addition, something unexpected happened. From the depths of grief, a new voice emerged—the voice of students, who cried, “Never again!” Students from MSD effectively used social and traditional media to speak out and demand change and to create a movement with international impact.

Mills (2017) promoted five Cs of influential communication: be clear, be concise, be confident, be credible, and be compelling. The communication from the MSD students clearly met these attributes of influential communication. Their message was clear: School shootings must never occur again. Social media and the use of hashtags contributed to the clarity and conciseness of messages: #NeverAgain, #MSDStrong, #MarchForOurLives. Their message was concise: Gun violence must end. There is no need for rampant availability of assault-style rifles. Their message was confident: Even though we are children, we demand change. The poise with which they spoke transcended their years. They engaged in dialogue with adults and legislatures to let both their disappointment and their hope for the future be known. Their message was credible: We were there. We experienced the death of our friends and teachers. Finally, their message was compelling: Children should be safe in schools; our lives matter. Another “C” I observed was collaboration, as in collaborative leadership. The MSD students spoke as one voice, although many leaders came forward. They worked in such a way that the message they attempted to convey was more important than themselves as individuals. The outcome was the focus, not the promotion of a single leader. They also gave voice to others with similar messages. How might we apply these lessons learned to enhance nursing education?

Watching the events unfold and reflecting on the effectiveness of student activism led me to think about how we prepare nursing students to advocate on behalf of patients.

Nurses, for the 16th year in a row, ranked as the profession at the top of The Gallup® Poll for honesty and ethical standards (Brenan, 2017). Respect and endorsement of the nursing profession was recently lauded by Pope Francis (Brockhaus, 2018). According to the U.S. Bureau of Labor Statistics (2015), nurses constitute the largest proportion (23%) of the health care workforce with current estimates of over 2.8 million RNs (U.S. Bureau of Labor Statistics, 2017). Yet, why does the voice of nurses not rise to the top in debates about health care policy and social justice?

The American Nurses Association (2015) defines nursing as “the protection, promotion, and optimization of health and abilities, prevention of illness and injury, facilitation of healing, alleviation of suffering through the diagnosis and treatment of human response, and advocacy in the care of individuals, families, groups, communities, and populations.” The American Nurses Association further cites “influence on social and public policy to promote social justice” as one of the six essential features of professional nursing.” The American Association of Colleges of Nursing (2008) Essentials of Baccalaureate Education add that “As advocates for high quality care for all patients, nurses are knowledgeable and active in the policy processes defining healthcare delivery and systems of care” (p. 9).

It's clear that nursing's role in advocacy for patients via public policy were concerns of the Institute of Medicine panel that developed The Future of Nursing (2010) report. Their recommendations clearly indicated that nurses must lead from the “bedside to the boardroom.” The need for nursing leadership in improving the health of the public is being recognized globally. The International Council of Nurses and the World Health Organization are collaborating on an initiative, Nursing Now (2018), to enhance the role of RNs in developing new models of community-based care and advocate for policy change to improve health globally. The campaign's patron is Her Royal Highness the Duchess of Cambridge and the initiative is led by a board of global-health leaders (Gibson, 2018).

Several years after the initiation of The Future of Nursing, and on the cusp of a global campaign, what progress has been made? The National Academies of Sciences, Engineering, and Medicine (2016) assessed progress toward recommendations. They cited educational programs that added courses, but most were at the graduate level. Further, they identified lack of an official data source to facilitate tracking of leadership programs or courses in which nursing students participate (National Academies of Sciences, Engineering, and Medicine, 2016). It's important that activities be created for entry-level educational programs so nurses can adequately serve the advocacy function.

The American Association of Colleges of Nursing (2008) identified a few essentials that, when taken together, allow faculty to creatively design learning activities to support achievement of competence. Those essentials are:

  • Essential II. Basic organizational and systems leadership for quality care and patient safety.
  • Essential V. Health care policy, finance, and regulatory environments.
  • Essential VI. Interprofessional communication and collaboration for improving patient health outcomes.

Although it is important to assess that students learn the content and be able to write scholarly papers, with advocacy it is even more important that they reach their intended audience. The SBAR (Situation, Background, Assessment, Recommendation) tool is an evidence-based approach and a standard safety intervention to facilitate communication among health care professionals when a change in situation or staffing occurs (Thomas, Bertram, & Johnson, 2009). Perhaps SBAR principles can be combined with the five Cs to produce concise and compelling messages. Given the proliferation of online courses within nursing, where are students provided with the opportunity to speak publicly and receive critique on their style and effectiveness?

I challenge faculty to create assignments that incorporate leadership, communication, and policy competencies. The assignments must be meaningful and ignite a passion for action. I challenge faculty to role model effective communication and policy advocacy for their students. Embrace the five Cs, plus one:

  • Be clear.
  • Be concise.
  • Be confident.
  • Be credible.
  • Be compelling.
  • Be collaborative.

Nurses are highly respected by the public and comprise the largest proportion of the health care workforce. It's time we learn how to use our voices effectively to advocate for our patients and the health of the public.

Amy J. Barton, PhD, RN, FAAN, ANEF

Associate Editor



The author has disclosed no potential conflicts of interest, financial or otherwise.


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