Health Workforce

“The future of public health in our nation depends on a competent, well-trained public health workforce. A well-trained workforce is in the best interest of all those concerned with maintaining a healthy society.” (IOM, 2003). As society’s pushing for a demand in higher education, we are seeing the requirements for nursing increase as well. As most facilities are phasing out the Licensed Practical Nurse (LPN), the Associates degree RN is becoming the entry level of nursing.

Many facilities are already requiring a minimum of a Bachelor’s degree for nurses before even considering them for hire.

I feel one of the major setbacks in nursing is its lack of educational requirements. Often times the nurse being the primary care giver is the least educated in the patients’ healthcare team. As of right now, the Bachelors of Science in Nursing (BSN) degree is not a requirement for bedside nursing. It isn’t until recently that the push for the BSN has become more prevalent.

At present, the developmental role for the Associates level RN is clinically oriented (Saccomono & Pinto-Zip 2011). The educational requirements are related specifically to the clinical setting. For example; Anatomy and Physiology, Microbiology, Pharmacology and related math’s, but it lacks specific leadership teachings. Unfortunately Associate level RNs find themselves poorly prepared to delegate or preform in supervisory roles.

Even as nursing students, we are taught how to assess patients, monitor vital signs, and administer intramuscular and intravascular medications. We are told that we are supervisors to LPNs and Certified Nurse Assistants (CNA) yet the program lacks classes specifically designated to leadership and delegation.

Even in the clinical setting while we are putting all of our classroom knowledge to the test, the clinical setting is about developing bedside nursing and assessment skills. As a result, staff nurses are often thrust into managerial positions but have not been sufficiently prepared in their nursing education programs. This gap between educational preparation and the complex requirements of current practice settings leaves nurses unprepared to function effectively as front-line managers (Heller, Drenkard, & Esposito-Herr 2004). There is no opportunity to develop leadership skills. But as soon as we graduate as RNs, we are expected to delegate tasks to CNAs and other ancillary staff. Some individuals naturally have good leadership skills, but most new graduate ADNs do not.

I can say from personal experience from both sides of this situation. I started my nursing career as an LPN. I’ve had good managers and Team Leaders, as well as bad ones. Most of them were at the ADN level and I don’t think any of them had formal leadership teaching.

Depending on the style of delegation and leadership skills each had, directly related to the emotional milieu of the unit. One particular manager would walk into the unit and you could feel the tension immediately increase as she would start barking out orders to everyone and completely doing the exact opposite of what the charge nurse had delegated us to do. She would be assigning beds to patient from the Emergency Room or Operating Room without informing the charge nurse. It would create absolute chaos from her lack of knowledge of what was transpiring on the unit and from a complete lack of communication with her charge nurse. I feel that if she would have had more guidance and teaching in Leadership and effective communication and delegation, that it would help her develop her management style differently and that she could lead more appropriately. I was also on the other the side of the leadership role as well.

I was a Charge nurse of the Medical and Surgical Intensive Care Unit. I entered the supervisory role of my peers without any formal training. However, I was not new nurse by any means when I was chosen for that role. By that time, I had developed good leadership skills by assisting my peers without being asked when I could see they were overwhelmed, and during Code Blues I would often assign and delegate tasks to the other staff and ancillary team members. I was also a preceptor and mentored employees transitioning into critical care. But if I had proper education in leadership, delegation, conflict resolution and effecitive commuication my transition into a supervisory role as well as my preceptor role would have been much easier.

As we are transitioning in to the BSN role, the education steps out of the bedside and teaching is more focused on leadership roles and it encompasses a grander view of the patient and of the nurse. Throughout the BSN curriculum, it focuses on patient education in the clinical setting as well as in community health. It also focuses on scientific & clinical decision making, humanistic skills, nursing management and leadership (AACN 2014.) One of the main parts of the nursing metaparidigm is person.

The BSN reaches out to the community through teaching and education by improving and tailoring care plans specific to the patient, family, and communities. As healthcare is trending away from acute inpatient hospital treatment, the demand for higher educated nursing and a greater number of clinical specialists are needed to provide care in other outpatient centers and in community clinics. These accelerated changes have created a demand for a higher educated nursing personnel who can function more independently in clinical decision making and perform the traditional role of the care giver. The BSN must be able to effectively communicate with patients and other healthcare professionals. They must also be able to provide a broader competency as a provider, manager, and care coordinator (AACN 2014.)


  1. Gebbie, K., Rosenstock,L., Hernande, M., (2003) Institute of Medicine (IOM): Who will keep the public healthy? Educating public health professionals for the 21st century. Workshop summary. In (Eds.): Committee on Educating Public Health Professionals for the 21st Century, Board on Health Promotion and Disease Prevention, Institute of Medicine of the National Academies. Washington DC: The National Academies Press
  2. Cherry,B. Jacob,S.R. (2014) Contemporary Nursing: Issues, Trends, and Management. 6th Edition, St. Louis: Mosby, an imprint of Elsevier Inc.
  3. Saccomano,S.J., Pinto-Zip,G. (2011) Registered Nurse leadership style and confidence In delegation, Journal of Nursing Management, p522-523.
  4. Heller,B., Drenkard,K., Esposito-Herr,M. (2004) Educating Nurses for Leadership Roles, Journal of Continuing Education in Nursing; Vol. 35 Issue 5, p203-210
  5. American Association of Colleges of Nursing (2014). The Baccalureate Degree in Nursing as Minimal Preparation for professional Practice. Retrieved October 11,2014.
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