Have gained new insights on how nurses can impact healthcare worldwide.
A member of the board of directors of the Honor Society of Nursing, Sigma Theta Tau International shares three themes she is passionate about and how her board membership has provided additional insights into nursing globally and changed the focus of her research.
In line with advancing world health and celebrating nursing excellence in scholarship, leadership, and service—the mission of the Honor Society of Nursing, Sigma Theta Tau International (STTI)—President Cathy Catrambone’s call to action, “Influence to advance global health and nursing,” challenged members to exercise influence in four areas: advocacy, policy, philanthropy, and lifelong learning.
Three themes, three passions
I have always been strongly passionate that we as nurses need to provide the best care we can to patients and families. To do that, we need to foster leadership and scholarship that promote research and education in all arenas of nursing. Secondly, I have long felt that we need to promote our own professional development and strengthen the emancipation of nurses and nursing, which calls for leadership and influence at all levels. And third, I have always been interested in other countries and cultures. Living as I have for almost three decades outside my native country of Iceland has made me more conscious of cultural differences and similarities. This experience has contributed to my passion about the need for cultural sensitivity and awareness. Each of these themes has been important in my work as a nurse and has helped shape my career.
Knowing where to influence, how to influence, and which outcomes to advance requires scholarship, research, and education. And determining what action to take requires leadership skills. Indeed, each of the four areas identified by Catrambone can be influenced through leadership and scholarship.
Through advocacy on behalf of patients, clients, and families, we impact and positively influence the health and well-being of populations. Through lifelong learning, research, and scholarship, we make informed decisions and positively influence healthcare and education. Through philanthropy of time, expertise, and effort, we support the continuous growth and sustainability of STTI and positively influence actions that promote the betterment of humanity. And through policy—by taking part in discussion and engaging in policy-shaping within healthcare facilities and government institutions—we positively influence the development and advancement of public health and the nursing profession.
How has STTI board membership influenced my work and passion?
In 2014, I was elected to the STTI board of directors to complete the term of a member who was not able to continue in that role. One reason I was asked to consider serving was the idea that a board member from another global region with somewhat different views might strengthen the board. Although I had gained board experience in other nursing organizations and in the honor society as chapter president and regional coordinator, I had not even thought about putting myself forward for a board position. I felt very honored!
In 2015, when I campaigned for the position of director-at-large on the STTI board, I vowed that, if elected, I would support nurses in their leadership, scholarship, and service to improve the health of people in all corners of the world, and I would do so by drawing on my years of leadership experience and involvement in helping STTI fulfill its vision and mission. As an English-speaking, non-North American director, I try to continuously remind myself and other board members of the need to be culturally sensitive and aware of the global diversity of nurses.
The STTI board of directors has ultimate corporate authority and accountability for advancing the mission and vision of the Honor Society of Nursing, Sigma Theta Tau International, which it achieves through its policy-setting and administrative powers. The focus of board members, therefore, is on direction-setting and governance; stakeholder relationships; policy-setting, implementation, and evaluation; fiscal responsibilities; and operational outcome measurement. Adhering to guiding principles, board members fulfill their strategy-planning, policy-setting, and oversight role with support from staff members as well as various committees and task forces.
Since my move from Iceland to the Netherlands, my research has focused on patients with stroke and how to influence nurses to improve their care and rehabilitation. My international work has led to a growing interest for how nursing has developed differently in the various European countries. Through my chapter and regional work with STTI, I have learned that we can influence nurses and nursing to positively impact patient care through leadership and scholarship.
My membership on the STTI board has given me additional insight into global nursing. I have learned that, despite some differences, nurses in various world regions generally face similar challenges. As a result of my board membership, my research focus has changed to include nurse leadership and scholarship to influence healthcare and patient outcomes.
Healthcare is constantly changing worldwide. We face a growing number of older adults with chronic conditions, higher costs of care, large populations with diverse health disparities, lack of access to care, economic differences, and a growing gap between rich countries and poor countries. These realities call for new ways to approach healthcare, innovative thinking, and improved technical solutions for the care and treatment of patients. To develop these healthcare innovations and solutions, we need well-educated nurses and nurse researchers collaborating nationally and internationally with other healthcare professionals.
Through the years, I have collaborated internationally with nurses and other healthcare professionals, as well as professionals in other fields, to develop stroke guidelines and to improve nursing rehabilitation and technical applications for patients with stroke. More recently, in collaboration with European partners, I have expanded my work to include development of nursing leadership and mentoring programs.
Unified voice of nursing
Although nurses constitute up to 80 percent of the global healthcare workforce, they do not have a unified voice. Instead, they have a limited role in determining and implementing healthcare changes and are generally not present at the policy table. Is this because women make up the largest segment of the professionally active nursing workforce?
Globally, there is a growing shortage of nurses in all arenas of healthcare, a shortfall that will increase in coming years. Although a modest decline of the nursing shortage is expected around 2030 in most regions, the shortage is forecasted to worsen in the African and Eastern Mediterranean regions if current trends continue. Thus, we need to strengthen our leadership and scholarship and unify our global voice.
Through STTI’s members, we are doing that. Sigma Theta Tau International has an important role in strengthening collaboration among members at chapter, regional, and international levels. At the international level, STTI collaborates with organizations such as the International Council of Nurses, the World Health Organization, and the United Nations. An important testimony to STTI’s strong international leadership is the Global Advisory Panel on the Future of Nursing & Midwifery (GAPFON), a forum of visionary nurse leaders who convened to identify global healthcare issues, specifically those related to a voice and vision for nursing.
As nurses, we are committed to transforming the wide variety of settings where we work. We are expected to have the appropriate knowledge, skills, and attitudes to provide cost-effective, evidence-based care to patients. Growing evidence supports the premise that more highly educated nurses reduce preventable hospital deaths and provide better patient care (Aiken et al., 2014). The World Health Organization acknowledges the positive contributions of well-educated nurses to cost-effective healthcare delivery.
However, despite these findings—and the fact that nursing has been developing as an academic discipline for decades—nursing preparation differs significantly from country to country. In many countries, research infrastructure is limited, and research capacity is fragile; also, programmatic approaches to research and academic career opportunities for nurses are lacking, especially in research (Moreno-Casbas, 2005; Richards, Coulthard, & Borglin, 2014; Segrott, McIvor, & Green, 2006).
Within countries, wide variation exists in the number of formally appointed university professors. Despite general agreement that all nursing education should be university-based, some countries still rely on in-service nursing education. Further, there are huge differences among countries regarding criteria for professional development of nurses.
We need to strengthen our voice. We need more highly educated nurses with strong leadership and mentoring skills who can develop sustained careers in nursing research. Nurses must collaborate internationally in their research and help shape policy on national and global healthcare issues. Through its wide variety of programs, activities, leadership academies, books, journals, and magazine, STTI provides a variety of forums that strengthen nursing scholarship worldwide.
There are many definitions of leadership, but I like this one by Peter Northouse (2013): “Leadership is a process whereby an individual influences a group of individuals to achieve a common goal” (p. 5). Northouse describes leadership as a process that entails influence, occurs in groups, and involves common goals.
There is growing evidence of a positive association between transformational leadership and improved job satisfaction, organizational commitment, staff health, and well-being; greater nurse empowerment; and higher team and organizational productivity (Cummings et al., 2010). Good leadership practices of nurses were positively associated with improved outcomes for organizations and patients (Wong & Cummings, 2007) and healthcare providers (Cummings, Hayduk, & Estabrooks, 2005). Also, current evidence suggests relationships between positive relational leadership styles and higher patient satisfaction and lower patient mortality, medication errors, restraint use, and hospital-acquired infection (Wong, Cummings, & Ducharme, 2013).
A recent review that my colleagues and I conducted of various leadership programs revealed a lack of studies investigating outcomes. The findings did, however, show that mentoring has a positive influence on research productivity, including increases in publications, grant writing, and research career development as well as improved leadership skills and knowledge. Mentoring also positively influences nurse health and well-being, staff relationships, work culture, and collaboration. Postdoctoral nurses cited mentorship, leadership, and peer support as essential in promoting ongoing research activity (Hafsteinsdóttir et al., 2017). Our review, however, was limited by a lack of outcome studies, variations in leadership definitions, and differences in outcomes and instruments used. Much work is still needed in this area.
I am chairing a leadership and mentoring program for postdoctoral nurses that focuses on leadership and professional development of nurses and its impact on various outcomes. In an international collaboration with European nurse leaders, we recently received funding to set up a leadership and mentoring program for doctoral students and postdoctoral nurses that includes research investigation of outcomes. Through its focus on leadership and scholarship, STTI provides a great forum to support nurse researchers in their efforts to develop leadership and mentoring skills to set up a global research network.
I am still working as a researcher in the Netherlands and Iceland with a focus on two areas: 1) improving care of patients with stroke, and 2) leadership and scholarship of nurses. Worldwide, nurses face evolving healthcare systems and growing populations of older adults. We need to provide answers to these ever-changing developments. We need to take part in international research collaborations. And, we need to have a voice at the policy table on a global level in the development of healthcare sciences and technology.
As a nurse leader, researcher, and teacher, I try to daily influence nurses and nursing students involved in clinical practice, education, and research to grow in their leadership, to take responsibility for their own professional development, and to show leadership in their decision-making at the bedside, in their teaching, and in their research. In these ways, I aim to positively influence the care of patients worldwide. After 33 years as a nurse, I am still doing that. RNL
Thóra B. Hafsteinsdóttir, PhD, RN, is senior researcher and course coordinator in the Nursing Science Department, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, Netherlands. Hafsteinsdóttir is also professor of nursing, Faculty of Nursing, University of Iceland, and board director, Honor Society of Nursing, Sigma Theta Tau International.
Aiken, L. H., Sloane, D. M., Bruyneel, L., van denHeede, K., Griffiths, P., Busse, R., … for the RN4CAST consortium. (2014). Nurse staffing and education and hospital mortality in nine European countries: A retrospective observational study. Lancet, 383(0031), 1824–1830.
Cummings, G. G., Hayduk, L., & Estabrooks, C. A. (2005). Mitigating the impact of hospital restructuring on nurses: The responsibility of emotionally intelligent leadership. Nursing Research, 54(1), 1–11.
Cummings, G. G., McCregor, T., Davey, M., Lee, H., Wong, C. A., Lo, E., … Stafford, E. (2010). Leadership styles and outcome patterns for the nursing workforce and work environment: A systematic review. International Journal of Nursing Studies, 47, 363–385.
Hafsteinsdóttir, T. B., van der Zwaag, A. M., & Schuurmans, M. J. (2017, July 6). Leadership mentoring in nursing research, career development and scholarly productivity: A systematic review. International Journal of Nursing Studies, 75, 21–34. doi: 10.1016/j.ijnurstu.2017.07.004 [Epub ahead of print]
Moreno-Casbas, T. (2005, December). Nursing research in Europe scoping report. Madrid, Spain: Institute of Health Carlos III.
Northouse, P. G. (2013). Leadership: Theory and practice (6th ed.). Thousand Oaks, CA: Sage Publications.
Richards, D. A., Coulthard, V., Borglin, G., & REFLECTION review team. (2014). The state of European nursing research: Dead, alive, or chronically diseased? A systematic literature review. Worldviews on Evidence-Based Nursing, 11 (3), 147–155.
Segrott, J., McIvor, M., & Green, B. (2006). Challenges and strategies in developing nursing research capacity: A review of the literature. International Journal of Nursing Studies, 43(5), 637–651.
Wong, C. A., & Cummings, G. G. (2007). The relationship between nursing leadership and patient outcomes: A systematic review. Journal of Nursing Management, 15(5), 508–521.
Wong, C. A., Cummings, G. G., & Ducharme, L. (2013). The relationship between nursing leadership and patient outcomes: A systematic review update. Journal of Nursing Management, 21, 709–724.