What Is Going On With Nursing Leadership?

A chasm within nursing remains wide.

Michelangelo's iconic image of God giving life to Adam is reimagined for the robotic age. Here, God gives life to a robot, a new kind of futuristic Adam.

And at a time when I would think nursing leadership would be looking deeper for sweeping solutions to some critical healthcare and nursing issues, like:

  • Patient trust
  • Patient experience / satisfaction
  • Nurse trust
  • Nurse satisfaction
  • Compassion fatigue, etc
  • Nursing shortage

I know the bandwidth for changes is narrow for nurse leaders on the ground. Got it.

And the IOM Future of Nursing rolled out a robust road map for nursing, seizing long awaited opportunities; all inspiring and catapulting for the future of nursing.

Nurse leaders who are our national voice in leadership literature likely believe in the same vision and philosophy of nursing as other nurses.

We all come to nursing with the desire to help people, to have an impact on people’s lives.

But all caring is not equal.

Not recognizing this in the leadership conversations and literature is paralyzing the nurses and leaders in the work settings.

The race to high patient satisfaction numbers has driven program development and research to focus on what Halldorsdottir (1991) defined in her work as “bioactive” caring. This is where the nurse is kind, concerned and responsive. This is the classic description of a good nurse-patient relationship.

And this is where the bar has been set in current leadership literature for program development and even research.

But it is the “biogenic” caring, where the patient feels accepted, safe and understood, that is the gold standard for the nurse. This brings a sense of wellbeing and even patient healing, extended from the nurse. This experience reaps high satisfaction for both the patient and the nurse, and yes, maybe a DAISY Award.

But, almost more importantly, these are the experiences that bring meaning to nurses’ work and sustain nurses’ careers.

By not focusing on this “biogenic” level of caring in program development on an equal status with patient outcomes, we are dismissing it as “sweet” and marginalizing it. This sends a confusing message to nurses and nurse leaders.

The “biogenic” experiences for the nurse are what brought them to nursing. The focus on the “bioactive” caring standards they learn in the work setting are routine and limiting, and distract from their desire and efforts to achieve authentic caring, “biogenic” caring.

The current programs and literature communicate that all caring comes from committees and leadership. There is a feeling of institutional caring. And what is even worse is the notion that caring can be scripted and mandated by programs and protocols, and that accountability must be built into the programs.

Imagine if nurses’ inner aptitudes for caring were unleashed in healthcare today through system wide conversations recognizing nurses’ full professional contribution to organizational culture and caring program development and integration.

The science already exists on which to build these programs and transform organizational cultures.images-5

This would be a disruptive innovation that would indeed build deep trust and satisfaction among patients and nurses, and by the way, reduce nurse burnout and attrition.


Halldorsdottir, S. (1991). Five basic modes of being with another. In D.A. Gaut & M Leininger (Eds.), Caring: The compassionate healer. New York: National League for Nursing Press.

10 thoughts on “What Is Going On With Nursing Leadership?

  1. Thomasine Farrell says:

    Excellent and true! I will be sharing!
    Tommie Farrell RN

    1. pmcclendon says:

      Thank you.
      I needed to hear this. Our voice on this can matter!

  2. Kathy Ostapuk says:

    The root cause is that this is not taught in Nursing curriculum! The bigger problem is what is taught in Nursing curriculum…..entry to practice has never been standardized! The metrics for Nursing quality has not been universally embraced! The science of Nursing has not been codified! Until that happens, Nurses will have to practicie at the whim of administrators!

    1. pmcclendon says:

      Thank you for this information. It shows how deep it goes. How to teach and develop the personal aspects of caring does not follow organizational teaching standards. This is a personal journey.

    2. Lisa Looney says:

      How do you standardize compassion, empathy and kindness?

      1. pmcclendon says:

        Exactly, which is why I suspect organizations have stayed away from trying to capitalize on nurses’ core sources of caring as the mainstream of their ‘caring platform’.
        Compassion, empathy and kindness are universally shared by all. But for nurses, caring is a primary aspect of their work and self. Nurses need recognition for the importance of their personal caring skills (caring consciousness) within the organizations. From there we need to help nurses learn to access, grow and nurture these skills. Right now these skills have been confused with formulaic caring.
        I do believe there is enough knowledge and research on caring by many, J Watson and BM Dossey for example, to acknowledge and grow within organizations.
        Your question hit the nail on the head!! Thank you for asking…

  3. Theresa says:

    This is the most complicated way of saying nursing is not about the care of the patient anymore. I find it ironic that the author is pointing a finger at nursing leadership when it appears the article was written by a master’s OT higher person who is, like most nursing leadership in hospitals, so far removed from bedside care they have no idea what it is like to be a true bedside nurse.

    1. pmcclendon says:

      We’re all in this together for the benefit of the patient. And it is complicated. Thanks for joining in, pat

  4. Louise says:

    I am grateful for this forum and say this, let us not be fooled by the medium in which we navigate . At what point will Nursing bind together to eliminate the causation of sickness. Reductionistic medicine works directly in opposition of the caring and compassion models. When will Nursing tire of swimming against the currents and find more supportive wholistic waters. Stop the monopoly of big pharma and return to a renewed approach.

    1. pmcclendon says:

      This is a place to think about all the currents that carry nursing. And you’re right, the goal for each nurse is to find his/her supportive waters. Thank you. pat

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