Nursing Leadership

Nursing Leadership 16(2) May 2003 : 37-38.doi:10.12927/cjnl.2003.16278
Leadership Perspectives

Administration: Leadership in Administration: Meeting the Challenge Through Creativity and Opportunity

Wendy Hill


Seeking creative, achievable, proactive, sustainable and effective means to address the needs of the nursing workforce is the greatest challenge facing nursing leaders in administration today. Such opportunities do exist, and our over 300,000 nurses in Canada are key to identifying them. As nursing leaders in administration, we are in the best position to ensure that we encourage the identification of these opportunities and support their implementation.

All healthcare organizations face the same overall challenge, to ensure a sustainable health system with improved service access and care delivery. This goal can be achieved only by effective and efficient use of health human resources. As the largest single group of healthcare providers in Canada, nurses are central to meeting this goal. Any change to the nursing professional workforce has a widespread impact on the healthcare system. Recent reports have recognized nurses as key to moving the healthcare system forward. However, we have also heard that the healthcare system faces great challenges to ensure a sustainable nursing workforce. These are no longer traditional issues, and nursing leaders cannot seek traditional solutions to these current workforce challenges.

In the early 1990s, we saw multiple changes in models of service delivery with no formal role for nursing. In the late 1990s, however, there was growing recognition across Canada of the disengagement of nursing during restructuring and regionalization. Capital Health employs over 7,000 nurses who provide a range of services, including primary healthcare, secondary, tertiary and quaternary hospital care, continuing care, home care and community health nursing. The issues and the obstacles facing the nursing workforce within Capital Health are similar to those across Canada. The Capital Health Region in Edmonton responded by establishing the Executive Nursing Officer (ENO) role in 2001. As the ENO, I am responsible for executive strategic nursing leadership. This has been evolutionary role over the last three years and has provided an interesting vantage point from which to explore the issue of leadership in administration and to meet the challenges of the nursing workforce.

As a nurse and an administrator, I have contemplated the current and future challenges to support the nursing workforce. As a leader, I believe we must be aware of the issues; yet continuing to dwell on them will not allow us to move forward. We must create an environment that produces solutions. I have explored various ideas on how to seek out and identify potential solutions and opportunities. Administrators have often sought one "right" answer or solution to a challenge. This is an interesting phenomenon, because as nurses we learn to assess challenges and identify multiple solutions and opportunities for care every day. A single solution may have worked with traditional issues for nursing, but the current issues facing the nursing workforce are multifactorial and suggest that anything but one solution is going to work. Nurses have always been creative; many have identified potential opportunities for the nursing workforce but have not been provided a forum to share these ideas. As administrators and leaders, we need to harness the creative experience and expertise of nurses to provide successful solutions.

With the disengagement of nurses in the 1990s, direct communication between decision-makers and care providers was frequently lost. Repairing these communication links has proven successful for nurses to move from identifying problems to identifying solutions and opportunities. As leaders, we must demonstrate our commitment to explore these opportunities for their potential. Are they achievable, sustainable and effective? As leaders, we cannot just be present; we must be accountable to ensure a direct link between the identification of opportunities and the execution of those that are achievable, sustainable and effective. Without this commitment, we will continue a cycle of highlighting problems instead of resolving issues.

The first step is to establish the communication link and the commitment to move forward. However, nurses must learn to speak the language of decision-makers. We have frequently expected others to understand the world in our terms and language. Nurse administrative leaders have the ability to bridge the gap. We can lead those with the creative ideas to a forum that allows the presentation of these ideas to be translated into decision frameworks. To ensure that solutions are successful and are supported at the executive level, we all need to speak the same language.

Over the last three years, with the establishment of the ENO position in Capital Health, we have successfully sought creative, proactive, achievable, sustainable and effective opportunities for addressing the needs of the nursing workforce. The Capital Health Nursing Workforce Steering Committee and its three task forces have completed the majority of this work. The broad mandate of the steering committee is to provide advice and recommendations to Capital Health Executive on matters pertaining to the nursing workforce. To provide frontline context, the steering committee established three frontline task forces, RN, LPN and RPN (ad hoc). These task forces have over 30 members, each with nine frontline nurses. With a direct link to executive-level decision-makers, these task forces have rapidly moved to identify issues for a sustainable workforce, clarifying nursing work roles, scopes of practice and issues. The task forces have allowed frontline nurses a direct impact on decision-making and organizational strategic planning. With the commitment that these committees would be heard by the Executive, we have seen the task forces become cohesive and proactive, providing creative opportunities that have then been assessed for effectiveness and sustainability. Each of the members has acted as a representative for its nursing professional group and its site or sector. The success of these task forces in identifying and implementing opportunities is that they are grounded in valuing and respecting the expertise and experience of nurses at all levels.

Although we hear many reports of the negative issues currently facing the nursing workforce, I believe this is a time of opportunity to identify solutions for the future. As nursing administrators, we can either continue to identify problems and issues or foster an environment for creating solutions and opportunities. We must be the direct link for nurses to bridging any gaps and providing a commitment to promote opportunities and see them implemented. Our 300,000 nurses have a wealth of ideas. We must value and respect these to successfully meet the current and future challenges of the nursing workforce.

About the Author(s)

Wendy Hill, RN, MN
Executive Nursing Officer, Chief Operating Officer of Sturgeon Community Hospital, Leduc Community Hospital and Northeast Community Health Centre, Alberta
Chief Operating Officer of Regional Support Services, Capital Health Region, Edmonton, Alberta


Advisory Committee on Health Human Resources. 2002. Our Health, Our Future: Creating Quality Workplaces for Canadian Nurses. Ottawa: Final Report of the Canadian Nursing Advisory Committee.

Canadian Nurses Association. 2002. Position Statement: Nursing Leadership. Ottawa: CNA.


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