This chapter switches gears, away from what leadership means from the view-point of personal qualities to the perspective of what one need to do to achieve the goals of our workplace. Leadership is increasingly defined as the ability to work successfully with others to achieve the organization’s mission and goals. Stereotyped views of nursing stress virtue and busyness but not strength and innovation, thus reinforcing the notion that nurses are helpers, not leaders. The point of naming what one do is for others to see what one does and how one contributes to the organization as a whole. The more others see the contributions of nurses to the organization, the more nurses will be included in key decision-making forums. The more all nurses are expected to be leaders, the more nurse leaders cannot operate from a command-and-control framework but must lead by developing the leadership of others.

Career opportunities are projected to grow faster for nursing than all other occupations through 2026. The advantage of a career framework with multiple stages is that one doesn’t start out expecting to be fully developed at the beginning. Mentoring is needed throughout a career, not just at the start. This chapter provides an overview of the career model that the author has fleshed out over time, greatly influenced by Dalton, Thompson, and Price’s classic article (1977) on stages of a professional career and subsequent work. There are five career stages whereby the individual moves from: (a) becoming prepared, to (b) demonstrating the ability to work independently and interdependently in achieving professional goals, then (c) developing others and the home institution, then (d) advancing the profession and healthcare, and eventually (e) daring to be a truth teller. Exerting leadership presupposes complete career development, going through all five career stages.

Since ancient times, self-knowledge has been regarded as the key to effective leadership. No nurse is good at all aspects of nursing; therefore, each nurse needs to figure out what will be her or his area of special contributions. Instead of focusing largely on weaknesses, organizations should identify their employees’ strengths for the purpose of using them strategically and then managing to those strengths. It is better to admit one’s limitations early on, and deal with them, rather than spend years trying to hide them. No one really likes criticism, but criticism is the lifeblood of professional development and improvement; therefore, leaders need to know how to give and accept criticism in an ego-enhancing way. Self-knowledge is never complete; it is achieved through ongoing introspection, candor, figuring ourselves out in different situations, and looking at ourselves through the eyes of others.

Heart failure (HF) is a terminal disease. Predicting the illness trajectory is much harder in HF than in cancer. Nursing has a key role in the management and outcomes of patients with HF. Patients often turn to nurses for information on their disease especially in the end stages of the disease. A coordinated effort by nursing has been developed as to how to help patients with not only the physical symptoms of HF but also the psychosocial aspects. In caring for the patient with advanced HF, there are clinical, evidence-based therapies that should drive clinical decision making. This chapter helps the reader to understand the disease of HF: how important disease management is, how nurse-based HF interventions can lead to positive outcomes, and, most importantly, how to communicate with patients and families regarding their treatment options and what is important to them in the final phase of their life.

This chapter focuses on leadership as transformational. Transformational leadership means moving a profession, an institution, or some aspect of healthcare down a new path with different expectations, structures, and ways of conceptualizing how the mission can be achieved in light of changing conditions. Looking back on all that nursing has achieved in the last half century can be energizing; it makes trying to do something different yourself not seem quite as daunting. Nursing is much stronger now as a profession than it has been in the past—larger, better educated, somewhat more diverse with a solid infrastructure, demonstrated outcomes, specialty expertise, a growing research base, more opportunities, and no longer time and place bound. Nursing’s commitment to the optimization of health and ability, alleviation of suffering, and advocacy hasn’t changed over time; values endure, but how they get expressed will vary as new sensibilities and knowledge become available.

This chapter stresses that one has to be involved in resource development if one wishes to play a larger role in shaping an organization. Nurses have to be resourceful to accomplish their goals and realize their values. Nurses in hospitals, universities, and other settings should play an active role in any fund-raising campaigns mounted by their institutions to ensure that their priorities are front and center as the public is engaged. Resource development is essential to organizational effectiveness, so it must be an expectation of professional leadership and not just a responsibility of those with administrative titles. Resource development can take many forms, from helping others take advantage of opportunities already in place and developing strategic partnerships to lobbying for new programs and fund-raising. Fund-raising requires one to explain the nature of nursing to stakeholders, lining up the values of our profession with what others value.

It has been said that working in interdisciplinary teams is a core competency all health professionals will need in the 21st century; they need to be able to collaborate, coordinate, and, most of all, communicate with one another in order to optimize care and maximize operational excellence. Nurses need to be active in interdisciplinary organizations from the start of their careers, and present/publish their work in interprofessional forums. Nurses have many advantages in interdisciplinary collaboration—sound basic education in humanities, social sciences, and basic sciences; many community connections; and experience in facilitating care across different providers. Interdisciplinary opportunities provide more prospects for effecting large-scale change than discipline-specific opportunities do. Moving beyond the discipline specific doesn’t mean that nurses leave nursing; it means they assume positions in which they can now advance the perspective of nursing in ways that others can appreciate, while attracting additional public support.

Core competencies are important to the nursing profession as they play a role in advancing mastery of nursing behaviors and skills essential to practice. Genetic/genomic-based health care is one essential core competency for today’s nursing practice; it also is vital for the future of nursing. The advances in genetics/genomics are important to practice as health care moves toward significant developments in risk assessment, diagnostics, treatments, pharmacogenomics, and personalized and precision medicine that impact individuals across the life span and throughout the health and illness spectrum. This chapter describes essential genetic and genomic competencies for nurses with graduate degrees and states specific skills required for advanced practice registered nurses (APRNs) regarding the risk assessment process. The Essential Genetic and Genomic Competencies for APRNs were introduced, as they are considered core competencies and skills that all APRNs should acquire.

Healthcare organizations are determined to implement, information technology (IT) projects in supporting its strategic initiatives, improving clinical and business efficiencies, and delivering safe, effective patient care. Through these projects, management can ensure the interoperability of health records in meeting regulatory compliance and stay competitive in the healthcare market. Healthcare leaders in the 21st century must possess project management skills and be competent in their fields of specialty or business. Although the nursing informatics specialist (NIS) education and training provides a basic foundation in using the nursing process as part of the standard of nursing practice, it is important to acquire project manager training and skills in managing complex healthcare IT projects successfully. Having the informatics knowledge and clinical background gives the NIS an advantage in assuming an overarching role in managing healthcare IT projects. This makes the NIS a valuable asset to the organization.