IOM Sees a Future Where All Nurses are Leaders

Part 3 of a 4-part series

By Catherine Garner, DrPH, RN
Dean, Health Sciences and Nursing

The prestigious Institute of Medicine (IOM) would like to empower nurses. In fact, it sees this empowerment as a key step toward realizing the objectives put forth by the recent healthcare reform legislation. In its special report titled “The Future of Nursing: Leading Change, Advancing Health,” the IOM’s third key message is that “nurses should be full partners with physicians and other health professionals, in redesigning health care in the United States.”

Here’s an excerpt from the report’s chapter on leadership:

Although the public is not used to viewing nurses as leaders, and not all nurses begin their careers with thoughts of becoming a leader, all nurses must be leaders in the design, implementation, and evaluation of – as well as advocacy for – the ongoing reforms to the system that will be needed.

The report recognizes that nurses already act as patient advocates, and now must move forward to advocate for the entire care delivery system by speaking “the language of policy” and viewing policy as “something they can shape and develop, rather than something that happens to them.”

The call for a new style of leadership

According to the IOM report, all healthcare providers play increasingly inter-dependent roles, and problems no longer have simple or clear-cut solutions. In this environment, the old style of leadership – where leaders give orders and expect them to be followed – is not relevant.

Instead, the IOM calls for “a style of leadership that involves working with others as full partners in a context of mutual respect and collaboration.” It cites studies that show this style of leadership is associated with better patient outcomes, fewer medical errors, and greater staff satisfaction. Yet it recognizes that transforming the current healthcare hierarchy into something more equitable won’t be easy.

Historically, nurses have been viewed by policy makers, administrators, and the public as workers who carry out tasks that have been delegated by physicians – and not as strategic thinkers who make informed decisions and act independently. To be effective leaders and full partners, nurses now need a new set of competencies that includes knowledge of process improvements, patient safety, ethics, cost management, policy making, care delivery models, translating research into practice, etc. Nurses must begin to see themselves as full partners, and they must be educated accordingly.

In addition to leadership training, the IOM calls for mentorship programs to accomplish this transformation. As a final recommendation, it states that: “Nurses, nursing education programs, and nursing associations should prepare the nursing workforce to assume leadership positions across all levels, while public, private, and governmental health care decision makers should ensure that leadership positions are available to and filled by nurses.”

For more information

Part four of this series will continue to examine the IOM’s discussion of transformations that should be made to nursing leadership. It will focus on the topic of nurses as policy makers.

Part one covered recommendations for transforming nursing practice. Part two covered the recommendation for higher levels of nursing education.

Be sure to see my article on how every nurse can be a leader and my videos on why nurses are not powerless. Also, download a copy of my latest paper, “Powerlessness is Bad Practice,” about how learning leadership skills can empower any nurse.

This article series is meant to briefly summarize the three key messages related to nursing that are presented in a new report by the Institute of Medicine, titled “The Future of Nursing: Leading Change, Advancing Health.” You can download the full report in PDF version or browse it for free online at

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IOM Advocates for Higher Levels of Nursing Education
IOM Envisions Nurses as Policy Makers