Challenges for Nursing in the 21st Century

Sister Rosemary Donley


Nurs Econ. 2005;23(6):312-318. 

In This Article

Nursing Leadership Challenges

What particular challenges do professional nurses face when they think "outside the box?" How significant are barriers created by lack of vision and adherence to serial thinking, work overload, comfort with extant methods and protocols, and investment in norms, standards, and reward systems? How open is the world of nursing to new ideas; ideas that change how nurses view and respond to reality? How full is the glass? Argyris (1991) thinks smart people have trouble being creative because they are successful problem solvers. Fear of failure often stimulates defensive and accusatory behavior rather than innovation. Argyris (1991) suggests that helping knowledge workers get "out of the box" and risk failure is a particular challenge for leaders.

American nursing faces another challenge that transcends budgets, respect for tradition, or the collective ego of the profession. The boxes that make up nursing in the United States are interdependent. Statutes, codes, and standards regulate nursing education and practice. However, the transformation of nursing to meet the needs of diverse people and to deliver institutional and community-based care requires more than conversion of deans, administrators, clinical specialists, staff nurses, practitioners, faculty, students, and the keepers of the regulatory and accreditation shrines. Getting "out of the box" demands a professional commitment to think creatively about nursing practice and education. It requires the courage to try something new and the chutzpah to use different strategies to open up the profession and its practice. In line with that thinking, Burton challenged Wisconsin nurses to burn the boxes (Wisconsin Nursing, 2003).

Highlighting the work of the Oregon Center for Nursing, she argued that turbulent times and a nursing shortage require both a common vision and a strategic plan to guarantee a diverse, professional nurse workforce, sufficient in number and appropriately educated to provide evidenced-based care and contribute to positive health outcomes (Wisconsin Nursing, 2003). Recently the American Association of Colleges of Nursing endorsed a proposal to radically change graduate education and the quality of the workforce. They proposed that graduate education prepare clinical nurse leaders and nurses with practice doctorates (AACN, 2004b).


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.