In Johnnie Maier’s description, the true leader is the symphony conductor, who creates the vision and the direction that merges the many sounds into harmony. For Maier, the most important lesson for a nurse leader is to learn the skills of the symphony conductor achieving harmony, balance, and an extraordinary performance without making a sound. Nurse leaders would do well to study the orchestra conductor’s understanding of his/her work and leadership role. Because of the foresight, the vision, and the direction of a few legislative leaders, the health care professions involved, nurses and others, were able to play their instruments together. Observing the orchestra conductor is key to understanding how good leadership should work. A leader must combine vision and direction with an understanding of those he seeks to lead. An effective leader must strike the right balance between task orientation and people sensitivity.

The care management nurse faces a different task than the nurse in the inpatient or outpatient setting. The focus for the latter is typically narrow: care for the patient during the acute treatment, then releases the patient to home, a nursing facility, a step-down unit, and so on. This chapter discusses the Triple Aim of care, health, and cost, which serves as a framework to discuss other key dimensions of leadership in managed care. A nurse leader’s basic skill set is similar to that of a nurse leader in any role. Innovative organizations are realizing that successful clinical management can be a huge competitive advantage for both employers and health plans. This sector of the medical industry is poised for explosive growth as population health management takes center stage in the era of health reform.

Karen Gross shares eight lessons learned about leadership that occurred not from leading per se but from the process of hiring an academic nursing leader. The search now successfully concluded gave her an opportunity to reflect on what type of health care leader they were seeking at Southern Vermont College (SVC). Although not a health care professional, she spent more than 15 months thinking about leadership in the context of nursing. The whole search process from creating the job description to identifying a quality candidates’ pool to interviewing and ultimately selecting a divisional chair to helping the successful candidate see the fit with the institution allowed her to consider what qualities are critical to nursing leadership within the academy. In an interesting way, the search for a leader in nursing enabled her to think more effectively about leadership, and in the world of unintended consequences, made her a better leader.

Interprofessional education (IPE) and collaborative practice are increasingly called upon to improve these domains such as patient care, community health, health care delivery systems respective and overlapping spheres of activity with the larger goal of improving the overall health care system. Nurse leaders are moving the interprofessional collaboration agenda forward by serving in key leadership positions nationally and on local campuses. Nurse leaders, through a combination of their training, professional experiences, and personal preferences, have unique knowledge and skills for which they are enthusiastic champions. Effective leaders apply principles of good communication in their work with individuals and groups. Nurse leaders possess valuable professional knowledge and skills, and when coupled with individual talents and strengths, they offer important assets to the success of a collaborative effort. Nurse leaders should recognize how they can best capitalize on their leadership abilities and confidently apply them.

Kate Judge’s first glimpse of nursing leadership in action came the day she arrived at the University of Pennsylvania School of Nursing for an in-person interview to lead Penn Nursing’s development and alumni relations program. During her 8 years at Penn Nursing, she collaborated with a number of faculty members who were gifted in attracting philanthropy. Leadership in philanthropy combines a deep personal moral purpose and the perfect balance between impatience for immediate impact and a desire to achieve long-term outcomes. To be a nurse leader in philanthropy, one must expose oneself to other values, interests, and priorities. Nursing can assume a larger role in tomorrow’s health care delivery if it commands a larger portion of U.S. and global philanthropy. Finally, to be leaders in philanthropy, nurses need to educate themselves about the larger world and the values and issues that resonate with donors.

Anne Rosewarne has a wealth of experience working with nurses at all levels in many different roles. Through the Council a leadership development program was established, focused primarily on preparing nurse managers as leaders within their health care facilities. The purpose of the Leading Toward Tomorrow project was to design, implement, and evaluate a comprehensive Leadership Development Program (LDP) that would assist in a nurse’s leadership growth. The national and state changes in the delivery and reimbursement systems will continue, with nurses poised as well-trained, cost-effective leaders in the shortage-ridden primary care workforce. New opportunities in an evolving health care system will also include nurses engaging as team members in interprofessional (IPE) settings. Nurse policy leaders could develop in-depth understanding of other members of the health care team, their practice parameters, and relevant health policy issues. Diverse involvement is also low among nurse leaders both in practice and academia.

This chapter explores how three successful nursing leaders, using different leadership approaches, demonstrate traditional leadership attributes such as strategic vision; risk-taking and creativity; interpersonal and communication effectiveness; and inspiring and leading change. It discusses the opportunities and implications for nursing leaders and those external to the profession to develop collaborative and transformative partnerships to advance quality health care. Pragmatic leaders demonstrate leadership excellence by effectively translating their nursing care assessment skills into the ability to approach organizational problem solving and decision making in a systematic, logical manner. In contrast to the present-needs focus of pragmatic leaders, charismatic leaders are vision-based leaders who predicate their leadership agenda on attaining future goals. Each of the three nursing leaders profiled understands the importance of being politically astute and effectively leveraging power and influence to make value-added contributions. To varying degrees, the various constituents of the nursing leaders profiled view them as socialized leaders.

Louise Woerner, the author has often been called a friend of nursing. From her perspective, she is an admirer of nursing and nurses. In fact, she is virtually in awe of nurses. She became part of the health care system through a turn in her business concept based on the regulatory environment in New York, and through that, an admirer of nurses. Over the course of her career, she has come to know there are many different types of nurse leaders. Leadership has to incorporate some exibility based on the situation and the goal. Home Care Rochester (HCR) began a successful “Roadway to Independence” program that took the home health aide employees from “bussers” to car owners, which enabled more care to be delivered in the hard- to-reach suburbs, and offered a new opportunity for both the patients and employees. Home care is a nursing-driven business with quiet leaders.

Jerry Cromwell has a rich history of both preparing nurse leaders in research and collaborating with nurse researchers. On the basis of his extensive experience, he offers cogent advice on leadership roles that nurses can fill in research on health care policy formulation and implementation that will change the course of health care payment, delivery, and quality throughout the United States. Cromwell believes that nurse researchers can provide leadership through the development of skills in management, program development, research, and teaching. To illustrate the characteristics of nurse research leaders, Cromwell describes one such leader with whom he has worked for more than two decades. He details her skills in project leadership, her technical research skills, and her management skills. Cromwell also identifies other nurse researchers who are leading policy development at the government levels, including those at some of the top federal agencies.

This chapter presents the address of Steven C. LaTourette, a former member of the U.S. Congress and co- chair of the Nursing Caucus in the U.S. House of Representatives. He addresses the role nurses can and should provide in shaping national policy. The nursing profession must engage a more signifcant percentage of its constituents to be influential. For the last several sessions of the Congress, LaTourette have had the pleasure of being the Republican co-chair of the Nursing Caucus in the House of Representatives. Congress had earlier adopted locality pay schedules for Veterans Administration (VA) nurses that were designed to increase nursing salaries: a noble goal since a large number of VA nurses were, at the time, on average 55 years of age and women. The staff can also be a resource for how the Congress works and assists you in going from great idea to great law.