Nurses Are Nurse Leaders’ 21st Century Story


We nurse leaders are missing the boat, …. we’re missing our 21st century story …..

You know that feeling when you struggle and struggle, and then one day you open your eyes and the answer is right in front of you, and has been all along?

It’s there in our leadership literature.   There’s some patient satisfaction data over there.   And then there’s some Magnet information over here.  And there’s some nurse satisfaction over there.  There’s business principles throughout.  And then there’s caring science occasionally here and there.   And then there’s a great book review on this or that page.

At this moment in time, amidst the healthcare chaos and all the conflicting demands that keep nurse leaders feeling not enough and jobs at risk …..

There is one thing….  Just One Thing we need to be focusing on-

21st Century People are Motivated by Intrinsic Drivers

As we nurse leaders sit and meditate, go to yoga class, look for meaning in our lives, and try to figure out how to be more effective in our organizations …..   The answer is right in front of us. 

But instead,  I know from my own experiences, for the sake of expediency, we nurse leaders   1.  jump to scripted caring programs,  2. get caught in the message that nurses are lacking caring skills and    3. nurses need to be corrected, educated and monitored.

We leaders have not figured out how to tap into 

nurses’ intrinsic desire to care and grow.

The reality is that many nurses are more motivated by their own experiences in real caring connections with patients than by their organizations’ missions.   I have seen first hand, that the scripted caring approach creates mistrust and resistance among nurses.  

It turns out that our core responsibility to society, patients and nurses is to tap into nurses caring selves.  Hang on, this is doable.   This is where patient satisfaction, nurse satisfaction, caring science, business principles, and a good book reviews come together.

This is where Nurses feeling engaged with something bigger than the chaos that the healthcare system creates ….



A book review in JONA a while back led me to Daniel Pink’s book,  DRIVE.  His point was:   There is a vast mismatch between what science knows and what businesses do.  Business has yet to realize that 21st century people are motivated by intrinsic drivers:

  1. Autonomy – Urge to direct own lives
  2. Mastery – Desire to get better and better
  3. Purpose – Yearning to do that which is larger than ourselves

If this is true for the workforce at large, we know that this especially applies to nurses.

Programs focusing on structured contextual approaches exist that facilitate quality, leadership, engagement, autonomy and education   Shared Governance, Transforming Care at the Bedside, The Center for Nursing Excellence, Magnet Recognition.

But how about that greater good …. that which motivates us to be involved with something larger than ourselves?  What efforts exist to create and preserve this motivating factor?

Look, our literature is giving us the supporting stories:

Work place interventions have shown to improve health-promoting behaviors of nurses in numerous studies. The health-promoting behaviors were associated with spiritual growth (inner resources), interpersonal relationships, nutrition, physical activity, health responsibilities, and stress management. The significant finding in this study was the high correlation of the development of inner resources (spiritual growth) with decreases in stress and burnout.  (Tucker et al; Neville& Cole)

Amendolair found a strong correlation between nurses’ ability to express their caring behaviors (those that brought meaning in their work) and job satisfaction.

Dotson et al found a surprisingly high importance of altruism in attrition prevention; concluding that a sense of altruism can have a buffering effect on the negative aspects in the work environment.

A compassion resiliency program was developed for Barnes-Jewish Hospital to address compassion fatigue, which specifically focused on development of inner resources skills. The education program elements included self-regulation (ability to relax while caring), intentionality (following one’s inner mission), self-validation (perceptual maturation), connection and self-care.  Potter et al studied the impact of this program on nurse burnout and job satisfaction.

Based on what 21st Century nurses need and what the public in our growing wellness culture is saying to us, Our Focus as Nurse Leaders needs to be:

  1. Tapping into Nurses Intrinsic Caring Practices (more on this later)
  2. Authentic caring, Real Caring programs  (more on this to come)
  3. Integration of caring science and practices (yes, yes, yes … more coming)
  4. Proliferation of Caring Language (more on that later)


  1. Amendolair D. Caring Behaviors and Job Satisfaction. JONA, 42(1), January 2012.
  2. Heard PL, Hartman S, Beal BD, Bushardt SC. Nurse Comfort … More Than Helpful Hands. Nursing Management, April 2014.
  3. Dotson MJ, Dave DS, Cazier JA, Spaulding TJ. An Empirical Analysis of Nurse Retention. JONA, 44(2), February 2014.
  4. Potter P, Deshields T, Rodriguez S. Developing a Systemic Program for Compassion Fatigue. Nursing Administration Quarterly, 37(4), 326-332; 2013.
  5. Tucker SJ, Weymiller AJ, Cutshall SM, Rhudy LM, Lohse CM. Stress Ratings and Health Promotion Practices Among RNs. JONA, 42(5), May 2012.
  6. Neville K, Cole DA. The Relationships Among Health Promotion Behaviors, Compassion Fatigue, Burnout, and Compassion Satisfaction in Nurses Practicing in a Community Medical Center. JONA, 43(6), June 2013.
  7. Romano J, Trotta R, Rich V. Combating Compassion Fatigue- An Exemplar of an Approach to Nursing Renewal. Nursing Administration Quarterly, 37(4), 333-336; 2013.
  8. McClendon P. Authentic Caring: Rediscover the essence of nursing. Nursing Management, 2017; 48(10): 36-41.

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