6 Ways to be a More Strategic Nurse Leader

By Rose O. Sherman, EdD, RN, FAAN

“Take time to deliberate, but when the time for action comes, stop thinking and go in.” Napoleon Bonaparte

I was recently talking with a nurse executive from a free standing community hospital. As she looks at the future health care landscape, it has become clear to her that her organization is not well positioned for the changes ahead. At some point, she anticipates that her hospital will have to merge with a larger organization to be successful, but her board of trustees is unwilling at this point to even have the discussion.

Figuring out a winning strategy in today’s health care environment is challenging. The pace of change is rapid. It can be difficult for nurse leaders to figure out how to respond to and anticipate future needs. In an article published in the January-February Harvard Business Review, Schoemaker, Krupp and Howland identify six essential skills to be a more strategic leader based on their research with more 20,000 executives. These skills include the following:

1. The ability to anticipate

Effective leaders must be able to identify threats and opportunities to their organization. The nurse executive that I had the conversation with had been carefully studying information from national health care experts. She is concerned about changes in health reform legislation which would appear to favor more integrated health care agencies who are positioning themselves to assume the role of an accountable care organization. In her own mind, she is using scenario planning and has considered who the most likely merger partner might be.

2. A willingness to challenge assumptions

Strategic thinkers are willing to challenge the status quo. For this nurse leader in a small community hospital, she understands that although they are currently a provider of choice, this could radically change with a shift in reimbursement.

3. Recognize patterns and interpret the environment

Effective leaders are able to see patterns in the environment that could lead to change. Sometimes data can be ambiguous, and one needs to look at the bigger picture to assess implications. For my nurse leader colleague, a turning point was their struggle to implement an electronic medical record. She talked with her colleagues in larger organizations who had economies of scale in implementation and clout with their physician groups in demanding interoperability between outpatient and inpatient records. As she looks ahead into the future, she can see that new health care policies will demand much closer working relationships between providers and hospitals.

4. Make the tough decisions in a timely way

Schoemaker, Krupp and Howland point out in their article that decision making in tough times is both an art and a science. Many organizations and leaders err on the side of not moving quickly enough. When leaders wait too long to initiate change, they can end up losing opportunities and possibly market share. The authors suggest that staged commitments and smaller bets can pay off.

5. Align all the stakeholders

Strategic leaders need to find common ground with their stakeholders. My CNO colleague has assessed her board readiness to have a discussion about the future and knows that any discussion will need to be slowly introduced. Two of the most effective strategies are to communicate early and often about changes in the environment.

6. Look for lessons learned

The most effective leaders are continuous learners and look for lessons learned in every situation. The ability to honestly reflect on one’s leadership decisions and actions is key to becoming a more strategic leader.

While she loves her current organization, my CNO colleague is fearful about it’s future if more realistic strategic planning does not occur. Her biggest personal challenge at this point is whether to stay in the organization or leave. Regardless of which decision she makes, there will be many lessons she learns as a leader both on a personal and an organizational level. For her as for most of us, our leadership careers are not a destination but rather a journey.

Read to Lead

Schoemaker, P.J.H., Krupp, S. & Howland, S. (2013). Strategic leadership: Essential Skills. Harvard Business Review. January-February 2013, p. 131-134.