Nursing Practice

The Implications of Change in the Health Care Delivery System on Nurse Leadership

Methods of administering aid are continually changing in an attempt to procure the best possible outcome for patients seeking help. However, constant updates leave specialists in a continuous race to adjust their team goals following these changes. This situation could create unfavorable conditions for those in positions of leadership due to a lack of knowledge of the system resulting in inaccurate management form possibilities of error in paperwork to practice.

Nurses, as an omnipresent type of specialist in the healthcare system, rely on adequate leadership from fellow professionals that make competent execution of their work possible. According to the American Nurses Association’s (2010), a registered nurse leader must lead by example and thus communicate not just with patients but also their staff. However, numerous professionals have highlighted the fact that they do not receive regular briefings, which results in an irregular procedure, complicating work (Dyess, Sherman, Pratt, & Chiang-Hanisko, 2016). Therefore, nurse leadership is undermined due to their inability to lead by positive example.

However change is not always detrimental, as a lack of development within the healthcare system clashes with the need for nurse leaders to continuously support “continuous, lifelong learning and education for self and others” (American Nurses Association, 2010, p. 55). Thus, it is possible to argue that change that is done without input from affected specialists that becomes one of the factors that sabotage nurses’ management efforts.


Nurse leaders’ competencies are a critical requirement in the health care delivery process, affecting the quality of help provided to patients. Both lack and an excess of change in the process of aid administration become factors negatively affecting not only the status of a nurse leader but also patient health. Therefore, the procurement of a balance seemingly becomes one of the most appropriate ways of reworking healthcare delivery systems.

The Role and Importance of the Graduate (MSN) Nurse as a Leader

Different levels of education result in specialists with a varied mastery of skills and competencies, making some more suited to certain types of work. Those, earning a master of science in nursing (MSN) become eligible for managerial positions, thus making the specified degree the minimum requirement to become a nurse leader. This factor makes the duty and significance of MSN professionals interesting, considering their entry-level education levels but full responsibility.

A leadership position requires its holder to be in command of appropriate skills not limited to communication, problem-solving, and planning. A leader is expected to not only guide and regulate day-to-day occurrences but also draw out long-term plans for improvement, growth, and progress (American Nurses Association, 2010; Yoder-Wise, 2015). Through an appropriate management approach, which relies on well-honed communicative skills, nurse leaders endeavor to create a kind of work-place mood that would be beneficial to patients and staff alike (Erickson, Ditomassi, & Adams, 2018).

Thus, while MSN degrees are already demonstrative of “the formation of a professional identity as the foundation for professional functioning,” they coincidentally provide their holders with a chance to further their skills through experience (Christenbery, 2018, p. 335). Therefore, while the role of MSN nurses is the same as that of a holder of any degree in a managerial position, the importance of their stationing is their continued formation as professionals.


Any degree, higher than the MSN, is viable for a leadership position, and would seemingly be the better choice due to a possible over-qualification for the job. However, stationing entry-level professionals at managerial positions leads to an increase in their skills and qualifications rooted in practice rather than theory. Thus, providing MSNs with access to work experience results in the growth in numbers of those professionals with higher-level degrees.

Challenges to Ethical Decision Making in Nursing Practice

Practicing medicine forces professionals to solve an endless array of ethical problems and it is a process, which creates drawbacks to their mental health and quality of patient care provided. While ethical decision-making is posed as standard practice, there are numerous drawbacks and challenges to its full adherence. Successfully overcoming these challenges and solving issues is a significant part of the nursing profession’s day-to-day workload.

Limited staff, contradictory medical situations such as those prevalent in palliative care, and the need to balance between cost-control and adequate health care are all burdens on health professionals. Decision-making becomes a central issue in providing proper care to patients, with nurses being expected to carry out their job to the best extent of their judgment (American Nurses Association, 2010). It becomes evident, taking palliative care as an example, that a positive ethical outcome is almost impossible to achieve, as the patient’s condition, the pain experienced, and the administered aid’s futility create a problematic case (Wright, Lowton, Glenn, Grudzen, & Grocott, 2017).

Nonetheless, “the presumption of good will on the part of all participants, strict adherence to confidentiality, patient-centered decision making, and the welcome participation of families and primary caregivers” all become fundamental approaches to resolving dilemmas (Potter, Perry, Stockert, & Hall, 2017, p. 296). Keeping in mind the sole goal of the profession as helping the patient in their healing process allows overcoming some of the encountered issues.


Expecting nurses to be fully responsible for correctly attributing value to certain patient-related factors creates additional but unavoidable tension within the nursing profession. Trading-off between certain aspects of a patient’s wellbeing, such as cost and quality becomes an unfortunate occurrence within the healthcare process. Nurses, posed with problems regarding patient health are forced to deal with such issues, finding an optimal middle ground within a priori adverse outcomes.

The Definition, Key Terms, and Classification of Standards of Nursing

Standards create not only guidelines for appropriate practice but also help nurses attain adequate structure in their day-to-day workload. Additionally, a classification of the existing rules helps differentiate between the numerous nursing positions, their scope, practice, and fundamental responsibilities. Therefore, defining standards of nursing makes possible managing it as a highly demanding profession and helping protect professionals from overwork and encroachment on their duties and responsibilities.

The appraisal above is only possible once standards are defined and codified. The American Nurses Association (2010) effectively does this, stating them to be “assessment, diagnosis, outcomes identification, planning, implementation… evaluation” (p. 101). Their execution, thus, is reliant on a multitude of personal characteristics necessary for a nurse to be in possession of, ranging from knowledge and experience to ethics (Potter et al., 2017). An appropriate definition of standards of nursing can thus be apperceived as specific skills necessary for attaining an ordinary level of competence.


Standards are necessary for any profession, even those that do not deal directly with vital aspects of human health, a fact that necessitates their existence in the nursing profession. Identifying their key components facilitates explaining the scope and extent of nursing professionals’ practice, creating prerequisites for the development of key nursing competencies. Appraising nurses’ performance and quality against a pre-designed ideal grid, additionally, makes possible their impartial evaluation as professionals.


American Nurses Association. (2010). Nursing: Scope and standards of practice (2nd ed.). Silver Spring, MD:

Christenbery, T. L. (2018). Sequential layering of BSN, MSN, and DNP competencies and opportunities. In T. L. Christenbery (Ed.), Evidence-based practice in nursing: Foundations, skills, and roles (pp. 333-344). New York, NY: Springer Publishing Company, LLC.

Dyess, S. M., Sherman, R. O., Pratt, B. A., & Chiang-Hanisko, L. (2016). Growing nurse leaders: Their perspectives on nursing leadership and today’s practice environment. OJIN: The Online Journal of Issues in Nursing, 21(1). Web.

Erickson, J. I., Ditomassi, M., & Adams, J. M. (2018). Developing the leadership skill set for the executive nurse leader. In S. W. Ahmed, L. C. Andrist, S. M. Davis, & V. J. Fuller (Eds.), DNP education, practice, and policy (2nd ed., pp. 161-196). New York, NY: Springer Publishing Company, LLC.

Potter, P. A., Perry, A. G., Stockert, P., & Hall, A. (2017). Fundamentals of nursing (9th ed.). St. Louis, MO: Elsevier.

Wright, R. J., Lowton, K., Glenn, R., Grudzen, C. R., & Grocott, P. (2017). Emergency department staff priorities for improving palliative care provision for older people: A qualitative study. Palliative Medicine, 32(2), 1-17. Web.

Yoder-Wise, P. S. (2015). Leadership and management in nursing (6th ed.). St. Louis, MO: Elsevier.