FORT WORTH, Texas — Nurse leaders comprise the largest portion of the health care management workforce in the U.S. As such, they have a "tremendous" potential to influence health care quality and cost outcomes, said academic researchers Maja Djukic, R.N., and Jeffrey Adams, R.N., during the third day of this year's American Organization of Nurse Executives' annual meeting.

The meeting as a whole marked a growing awareness about the impact and importance of nursing leadership nationwide. AHA President Rick Pollack underscored this in his plenary address when he spoke about "the importance of having the nurses' perspective at the table whenever we talk about the future of hospitals and health care."

Indeed, "we have a lot of people leading a lot of people," Adams said. "We need to understand what makes them great."

Adams and Djukic sought to do just that through a multisite analysis of nurse leaders' influence in the hospital environment. Prior to their research, they hadn't been able to find any quantitative, empirical information about how to define nurse leadership — via characteristics such as status, influence and management style, for example — and how these affect care. So Djukic and Adams embarked on what they say is the first-ever study to empirically link nurse leader characteristics at the practice level with patient outcomes.

The researchers examined the effect of nursing leadership on key quality outcomes essential to cost containment, such as patient satisfaction and “key nurse sensitive indicators” at a unit level.

"We think we can change health care by looking at how we can make better leaders," Jeffrey said. “There’s a need to understand how leadership works and optimize that."

Their findings point to patterns between the relationship of nurse leaders' influence on patient outcomes in such areas as urinary tract infections, nurse communication, staff responsiveness and cleanliness. They also found takeaways related to how nurses' access to resources impacts patient outcomes. For example, the researchers found that having a more hierarchical structure vs. a collaborative structure negatively affects physician communication and the reduction of central-line infections. The researchers also concluded that establishing clear nursing leader authority and increased access to resources plays the biggest role in determining patient outcomes.

Djukic says this is important information for CEOs who are asked to invest in nurse leadership development programs. While there is little empirical data showing that relationship-based leadership training produces positive patient outcomes, a CEO should “focus on figuring out how to ensure [that nurse leaders have authority] and provide [them with] adequate access to resources,” Djukic said. “Those two [areas] seem to be most influential in terms of patient outcomes.”