Four Tips on Systems Change needed to be more Impactful Nurse Leaders


Hi nurse friends! Tell me, What Kind of Systems changes do YOU think we need to be Better Nurse Leaders?  I’m going to do some storytelling and I hope that it gives you some inspiration & ideas that you can take back to your organization.  As you know Transform Nursing is led by the mission of:

“Training nurses globally to confidently address health policy, social justice, and health equity through a dynamic leadership approach.”

I can’t wait for you learn more about my course “The Nurse’s Influential Leadership Lab”, it will be ready to go in a couple of weeks!  So excited! (See my tab Training for more information.) . Take a listen to my most recent Facebook LIVE “What Kinds of Systems Changed do we Need to be Better Nurse Leaders?”  for ALL of the insights, tips and thoughts on this topic.  

And remember,  if you like what I’m saying  give me a ?? or a ? in the comments section.  And if this is just some amazing content for your brain and you think someone else she read it, share and share around!! Tag somebody in the comments!

I asked for feedback on the question: what kinds of systems change do we need to be better nurse leaders and Jason, a nurse from Trinidad said:

Jason Ramcharan
Jason G. Ramcharan MScN, RN
Trinidad & Tobago

“I wish to see a system whereby aspiring nurse leaders who demonstrate competency, passion, drive and a genuine interest in bettering the lives of those they serve, are given the opportunity to do so. A system of succession planning which leads to a smooth transition of leadership when the time comes. Too many “wannabes” who dress up and walk around (not often) trying to materialize a selfish agenda which strokes their own ego rather than improve patient outcomes. Sadly they do not see that they have become the very thing they once despised when they were at the bedside.”

Do we get in that ivory tower when we start climbing the ladder to success?  Or do we stay poised as responsive and inclusive leaders?

 I was having a conversation with the a big wig Director doing amazing research around reducing stigma and barriers for folk with HIV through the use of Community Health Workers.  What’s truly unique about the program I am speaking of is that it is designed to assist Community Health Workers-who are frontline public health workers to meet the unique needs of their communities, .  

We were discussing work related travel and I was sharing that it was going to be extremely difficult for me to be present at a session where they wanted supervisors to be.  In sharing about the extreme difficulty I also shared what I was doing on a daily basis with work related to the program, definitely requiring more time than the 4 hours a week I am being paid through this grant to perform.  (And I love the work, it’s amazing work).

The response was a professional, albeit even courteous, that this was still going to be my responsibility and furthermore no one else had a problem with travel.

 I stopped talking, shut down because I felt my issues had been presented and were being ignored.

It got me to thinking about our systems. I couldn’t help but think, here we have this amazing program, great goals and objectives, and still leading the charge are systems thinkers who are inflexible to changing their agenda.  

What’s wrong with this picture? Would we tell a patient professionally yet courteously, “I’m sorry, but this is your responsibility?”

I am a 38 years old working professional and I also can’t help but notice that the team that is doing the work around reducing stigma in HIV through the use of CHW’s is almost exclusively white.  Furthermore, they are all professionals, with PhD’s, spent lots of time doing research, and they are working with a population of people who are predominantly people of color, with a great deal more barriers and environmental challenges.  

If I felt like shutting up when they spoke to me in “systems talk” as I like to call it, I can only imagine what a less “school” educated, person with greater barriers might feel like doing.

Are our systems flexible when we as workers express our need for greater compassion? Are our systems flexible when our patients have a greater need for compassion?

Dr. Rupa Marya-Associate Professor of Medicine at University of CA, San Francisco

Dr. Rupa Marya-Associate Professor of Medicine at University of CA, SF had to force another doctor to provide care to a black woman in the hospital-a woman who was denied emergency cardiac care.  This woman had back pain that caused chest pain, and was histrionic.  Knowing that black women have the worst outcomes with a heart attack Dr. Marya did an EKG which revealed she was having a heart attack. Appropriately, she called the cardiologist and he refused to intervene.  Dr. Marya said she didn’t want this woman to become a statistic that black women get worse healthcare.  The doctor responded: Are you calling me a racist?

Dr. Marya says I think our system is racist, we are all participants in the system and I had to check myself and ask: what am I not seeing?

Many of our patients/clients say I don’t go back to the doctor because I wasn’t treated very well, or I wasn’t listened to.  We need to do better if we are going to reach across the aisle, patients and health care workers need to feel supported, cared for and included in the decisions that are made pertaining to them.

Are you challenging yourself and other colleagues to say “what might I have missed”? How many of our systems are informed by “you have to do what i’m telling you to do” versus “let’s do this together”?


Here are a few TIPS & RECOMMENDATIONS for you my nurse friends: 

  1. Encourage inclusiveness.  Encourage people to share their perspective even if you don’t agree with it.  Get to know each other so that you work better as a team.  Remember what Jason was saying so we help those trying to climb to the top to be the next leaders. You ARE NOT  going home with your patient, you so get to empower them.  This is their life and choice and it’s up to them whether they choose your advise or not when they step out of the hospital or not, you still support them.
  2. Listen better.  We can engage our patients better, we can practice cultural humility. We can ask the question “what am I not seeing?”  Use different strategies like a harm reduction, trauma informed care-(which I teach about in my course) which help us appreciate each other better.
  3.  Honor each others right to our beliefs and values and come together to address barrier and stigma.  We have to get better about how we power share & how we give that vibe that we are not just experts in knowledge but experts in compassion and care.
  4. To be better nurse leaders we need systems that are:
  • Flexible
  • Adaptable
  • Patient driven
  • Promoting harm reduction
  • Promoting trauma informed care
  • Responsive right now
  • Person-centered

Systems are a lot like empires right?  So I’ll leave you with this quote:

“Our strategy should be not only to confront the empire, but to lay siege to it. To deprive it of oxygen. To shame it. To mock it. With our art, our music, our literature, our stubbornness, our joy, our brilliance, our sheer relentlessness – and our ability to tell our own stories. Stories that are different from the ones we’re being brainwashed to believe.  The corporate revolution will collapse if we refuse to buy what they are selling – their ideas, their version of history, their wars, their weapons, their notion of inevitability.”

Arundhati Roy

I love that quote, makes me feel powerful, like I have a choice to be involved in changing the system or sitting and complaining about it.  I hope when the time comes that you will have the course to tell your own story, no matter how different it may be, to lay siege to everything that would harm your ability to provide the best and most amazing patient-directed care.  Tata for now.

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