Nursing Leadership: A Call to All Nurses to Advance Quality Care and Job Satisfaction

When the Institute of Medicine (IOM) released its groundbreaking report To Err Is Human in 1999, it shook the foundations of the healthcare industry. The report revealed that as many as 98,000 patients were dying each year due to preventable medical errors in U.S. hospitals. This moment served as a wake-up call, emphasizing the need for systemic change, accountability, and, most importantly, leadership at every level of care.

More than two decades later, the messages of that report and subsequent IOM publications, such as "Crossing the Quality Chasm" and "The Future of Nursing: Leading Change, Advancing Health," remain profoundly relevant. These reports challenged healthcare to reimagine quality, safety, and access. They also issued a clear directive to the nursing profession: You are not just caregivers, you are leaders.

Review of the Reports from the IOM 

1. To Err is Human: Building a Safer Healthcare System (1999)

   1. This report examined medical errors and their impact on patient safety. Its intent was not to place blame on any one profession, but to design a safer healthcare system that had fewer medical errors and improved patient safety. 

2. Crossing the Quality Chasm: A New Health System for the 21st Century (2001)

   1. This report made an urgent call for changes to close the quality gap. If offered recommendations on how to redesign the American healthcare system for policymakers, healthcare leaders, clinicians, and others. 

   2. Six key dimensions of quality that were found to be lacking included:

      1. Safety

      2. Effectiveness

      3. Patient-Centeredness

      4. Timeliness

      5. Efficiency

      6. Equity

3. Health Professions Education: A Bridge to Quality (2003)

   1. This report provides a further examination of how healthcare professionals should be educated to enhance quality and safety, and offers a set of core competencies to guide the process. The core competencies included:

      1. Patient-centered care

      2. Interdisciplinary teams

      3. Evidence-based practice

      4. Quality Improvement

      5. Informatics

4. Keeping Patients Safe: Transforming the Work Environment of Nurses (2004)

   1. This report focuses on nursing, as the majority of healthcare workers in hospitals and nursing homes are nurses. Nurses play a crucial role in patient surveillance and care coordination with the healthcare team and the patient or their family. When nurses interact with patients or residents, they have the opportunity to intervene and prevent adverse events from occurring. 

   2. It examined the changes in the nursing role from the 80s and 90s (reimbursement, shorter length of stay, increased acuity) and the rapid advancement in new technology, requiring an increased skill and knowledge level in its use to prevent errors. 

5. The Future of Nursing: Leading Change, Advancing Health (2010)

   1. This report looked at the contributions nurses make to the delivery of care in relation to the ever-changing patient population across the lifespan. Four recommendations come from the report:

      1. Nurses should practice to the full extent of their education and training.

      2. Nurses should strive for higher levels of education and training through an enhanced education system that facilitates seamless academic progression.

      3. Nurses should be full partners, alongside physicians and other healthcare professionals, in redesigning healthcare in the United States.

      4. Effective workforce planning and policymaking require improved data collection and a more robust information infrastructure.

Leadership Is Not a Title—It’s a Mindset

Often, leadership in nursing is associated with formal roles, such as nurse manager, charge nurse, director, and CNO. But IOM reports have reinforced that leadership is not confined to organizational hierarchy. Every nurse, from novice to expert, bedside to boardroom, has the capacity—and the responsibility—to lead.

Leadership is found in the nurse who advocates for a safer medication administration process. It lives in the team member who speaks up when a protocol isn't followed. It thrives in the staff nurse who precepts new colleagues and cultivates a culture of inquiry, respect, and accountability.

The IOM’s call to action empowers every nurse to embrace leadership behaviors, such as:

• Prioritizing patient safety by following and improving evidence-based protocols.

• Engaging in lifelong learning to stay current with innovations and best practices.

• Collaborating across disciplines to ensure care is coordinated, comprehensive, and patient-centered.

• Being an advocate for patients, peers, and system-wide improvement.

Building a Culture of Quality: What Nurses Can Do

To meet the IOM’s vision of high-quality, safe care, nurses must move from passive participants to active change agents. Surveillance noted above from the report Keeping Patients Safe is one key component to becoming a change agent. It involves nurses using “early identification and prevention of potential problems, which require behavioral and cognitive skills (IOM, 2004, p. 91).” Surveillance is ongoing and primarily looks at nurses and nursing care. Effective surveillance depends on a variety of factors such as:

1. Staff competence

2. Staffing levels

3. Skill mix

4. Interprofessional issues

5. Communication

6. Teamwork

7. Staff stress and fatigue

8. Use of EBP

9. Equipment and supplies

10. Informatics

11. Leadership (Finkelman, 2017)

Effective Surveillance Systems should meet the following objectives: 

1. Be able to prioritize the overall magnitude of the problem concerning each other (which one(s) have the most significant impact).

2. Determine the incidence of the problem - is it increasing or decreasing?

3. Identify which patient or resident group(s) or care area(s) are most affected, thus requiring additional resources.

4. Conclude whether the efforts to improve are succeeding. (Finkelman, 2017)

Here are some suggestions on how to be a Change Agent:

1. Create and Use Checklists: Like the aviation industry, healthcare has found success in using structured safety checklists. Nurses can contribute to and refine these tools to prevent errors, particularly during high-risk activities such as shift handoffs or surgical preparation.

2. Engage in Quality Improvement (QI): Participate in or initiate QI projects. Collect data, identify trends, and propose solutions. Small changes can have a ripple effect on outcomes.

3. Speak Up for Safety: Psychological safety in teams encourages nurses to voice concerns without fear. By speaking up, you help identify latent system flaws before they result in harm.

4. Mentor and Be Mentored: Nursing knowledge should not be siloed. Leaders share what they know and remain open to learning from others. This knowledge-sharing helps build confident, capable teams.

5. Practice Reflective Leadership: Self-awareness fosters emotional intelligence. Reflect on what’s working, what’s not, and how your actions impact others. Then make changes—no matter how small—that move your team toward better care.

Leadership That Leads to Job Satisfaction

Job satisfaction is often tied to feeling empowered, respected, and having an impact. Nurses who adopt leadership behaviors—regardless of their title—usually find greater fulfillment in their work. They see the fruits of their advocacy, feel connected to a larger mission, and are more resilient in the face of daily challenges.

Moreover, organizations are increasingly recognizing the value of shared governance and frontline leadership. When nurses are involved in decision-making and quality initiatives, turnover rates decrease, morale improves, and patient care outcomes improve.

A Final Word: Leadership Begins with You

The IOM reports did not just call for system-wide reform—they called on individuals to take action. "To Err Is Human" highlighted how easily mistakes can occur in complex environments. But it also gave us hope: with awareness, education, and leadership, those errors can be drastically reduced.

You don’t need a title to lead. You only need the courage to care deeply, the willingness to speak up, and the commitment to improve continually.

Nursing leadership is not a future goal. It’s a present responsibility.

Let’s answer the call.

Call to Action:

How are you leading in your practice today? Whether you're initiating a change, mentoring a peer, or simply double-checking a high-risk procedure, your actions matter. Share your story, reflect on your leadership, and encourage a colleague to do the same. Together, we are the change the IOM envisioned.

References

Institute of Medicine (US) Committee on the Health Professions Education Summit, Greiner, A. C., & Knebel, E. (Eds.). (2003). Health Professions Education: A Bridge to Quality. National Academies Press (US).

Institute of Medicine (US). Keeping Patients Safe: Transforming the Work Environment of Nurses. Washington (DC): National Academies Press (US); 2004. Overview. Available from: https://www.ncbi.nlm.nih.gov/books/NBK215432/

Institute of Medicine (US) Committee on Quality of Health Care in America, Kohn, L. T., Corrigan, J. M., & Donaldson, M. S. (Eds.). (2000). To Err is Human: Building a Safer Health System. National Academies Press (US).

Institute of Medicine (US) Committee on the Robert Wood Johnson Foundation Initiative on the Future of Nursing, at the Institute of Medicine. The Future of Nursing: Leading Change, Advancing Health. Washington (DC): National Academies Press (US); 2011. 1, Key Messages of the Report. Available from: https://www.ncbi.nlm.nih.gov/books/NBK209881/

Committee on Quality of Health Care in America, Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st century. National Academies Press. 

Donaldson MS. An Overview of To Err is Human: Re-emphasizing the Message of Patient Safety. In: Hughes RG, editor. Patient Safety and Quality: An Evidence-Based Handbook for Nurses. Rockville (MD): Agency for Healthcare Research and Quality (US); 2008 Apr. Chapter 3. Available from: https://www.ncbi.nlm.nih.gov/books/NBK2673/

Daly, B., & Mort, E. A. (2014). A decade after to Err is Human: what should health care leaders be doing?. Physician executive, 40(3), 50–54. https://pmc.ncbi.nlm.nih.gov/articles/PMC4439398/

Finkelman, A. (2017). Quality improvement: A guide for integration in nursing (2nd ed.). Jones & Bartlett Learning