Nursing is by far the largest healthcare profession. As of 2025, there are approximately 5.2 million registered nurses in the United States, and around 1 in 5 people working in healthcare are nurses. Because they make up such a large portion of the workforce, nurses, and especially nursing leadership, have the potential to be hugely impactful in shaping healthcare culture and policies.
Nursing leaders continue to have more influence over major decisions and have a responsibility to ensure they act ethically and in the best interest of their staff and the people their staff care for.
Related CE course for nurses: Leadership: The Foundation of All Successful Healthcare Facilities
History of nursing
Nursing has topped the charts as the most trusted profession for over two decades. However, nurses weren’t always considered skilled professionals. What was once a very task-oriented profession has become one requiring high-level critical thinking, collaboration with physicians, and substantial knowledge.
Likewise, nursing leadership has evolved from simply managing schedules and handling day-to-day operations to a much broader scope of practice. Chief Nursing Officers and Chief Nursing Executives were introduced to teams in the 1970s and were the first nursing positions giving nurses formal authority in high-level structures.
Nursing leadership and education
Just like all other areas of nursing, nursing education has greatly expanded in recent decades. In 2001, the first Doctorate of Nursing Practice was introduced by the Kentucky College of Nursing. This program aims to prepare nurses for advanced leadership positions by focusing on quality improvement initiatives, evidence-based practice, designing healthcare systems, collaboration, and integration of healthcare technology.
Since then, schools have opened over 400 DNP programs across the United States. These programs maintain a primary focus on nursing leadership and education.
Current leadership structures
Current nursing leadership structures are typically formed using a “chain of command” system. Charge nurses own the day-to-day operations. Unit managers handle individual unit policies, discipline, and quality improvement. CNOs affect overall hospital budgets and policies.
The future of nursing leadership
While nursing, as a profession, has grown exponentially in recent decades, there is still significant growth potential for nurses in leadership positions.
Related CE course for nurses: Leadership Skills in Today’s Healthcare Climate
Influencing policy
One of the largest focuses of many professional nursing organizations is higher-level policy development. For example, as of 2025, the American Nurses Association has been hard at work to maintain the “professional degree” title for nurses, address problems with staffing and nursing shortages, reinstate OSHA emergency policies to decrease workplace violence in hospitals, and expand the APRN scope of practice.
Because nursing remains one of the most trusted professions, nurses are in a unique position to gain public support. Even nurses who are not in formal leadership positions can influence policy by:
- Sharing evidence-based information
- Writing letters to congress leaders
- Participating in town halls
- Providing expert insight into the strengths and weaknesses of healthcare plans
Technology integration
Healthcare is becoming increasingly reliant on technology. Nurse leaders must stay up to date on how to use tools such as AI and electronic health records. While technological advances have the potential to improve healthcare and decrease nurse workload, there are also some risks that must be managed.
Nurse leaders have a responsibility to ensure that their teams are using technology safely, ethically, and efficiently. In addition, over-reliance on technology may lead to poor outcomes and a decrease in nurses’ critical thinking. Nurse leaders should have frequent check-ins with their teams to identify. Here, they can eliminate safety risks and redundancy when using new technologies.
Workforce empowerment
Empowering their own workforce to take pride in their jobs, develop their own quality improvement projects, and share their voices is one of the most impactful things a nurse leader can do for their organization.
Many DNP programs have a heavy emphasis on workforce empowerment. This encourages leaders to foster shared governance, improve communication, increase transparency, and allow autonomy. An empowered nursing workforce is more likely to avoid burnout and report higher job satisfaction. In turn, this decreases turnover and improves patient outcomes.
Leaders everywhere are moving away from implementing rules for their staff and moving towards a more collaborative approach. Staff who know their leaders listen to and trust them often have much higher productivity scores and use fewer sick days. For nurses, specifically, empowerment of staff leads to improved patient satisfaction scores and better health outcomes overall.
Informal nurse leadership
In addition to an expansion of formal leadership positions, nurses are continually encouraged to act as informal leaders in their workplace and communities.
Nurses can practice good informal leadership by mentoring new nurses, heading up quality improvement projects, and fostering a culture of teamwork. While more experienced nurses are often accused of “eating their young,” the current nursing culture encourages experienced nurses to take new graduates under their wing. This helps them develop their knowledge and skill set.
Formal nurse leaders, especially direct managers and charge nurses, can help nurses develop their informal skills. They can offer training and be quick to recognize and reward strong leadership behaviors.
