Closing the Gap: Women Leading Nursing Teams

It is well-known that most nurses in the United States are female. The U.S. Bureau of Labor Statistics confirms that 89 percent of the nursing workforce comprises women; however when it comes to executive leadership positions, the numbers skew in the opposite direction. A study on gender balance by 20-First published in the Harvard Business Review reveals a troubling trend among leadership in America’s top 20 companies, with 78 percent of executive committee positions being held by men. A closer look at the 22 percent of women who are on executive committees reveals that only one-third of them hold C-level executive positions with the remaining two-thirds of women serving in supportive staff roles in departments such as human resources and communications.

Although the movement toward gender equity in corporate healthcare is progressing, America’s largest industry gives a grave diagnosis: the gender disparity in healthcare leadership still persists. Taking proactive steps to address individual and institutional shortcomings, gender equity in healthcare leadership can be achieved and, in doing so, can provide economic and social health benefits for everyone in the United States.

Gender equity encompasses more than economic prosperity; it’s also a human rights priority. The correlation between economic health and upward social mobility is an intertwined relationship which has drawn global attention. In 2015, the United Nations made a pledge of sustainable development goals to achieve by 2030 and number five on the list is eliminating gender inequity.

The Bill and Melinda Gates Foundation states that while women and girls face many gender-based barriers in reaching their full economic potential, time and again the economic empowerment of women has improved the economic and social health of all. From a purely dollars and cents perspective, the fiscal health of a company run by women has been demonstrated: a study by the Peterson Institute for International Economics surveyed 21,980 publicly traded companies in 91 countries and concluded that companies with more female leaders in top positions of corporate management have increased profitability. Acknowledging that solutions for achieving gender equality are varied, the authors of this report recommend that females ought to be encouraged to pursue roles in corporate management beginning with girls in elementary school and continuing throughout a woman’s child-bearing years.

The increased economic outcomes achieved by the inclusion of women on corporate executive boards extends to healthcare institutions. A study by the American Journal of Medical Quality (AJMQ) in 2015 found that 44 percent of the boards of high-performing hospitals included at least one nurse as a voting member compared to 11 percent of low-performing hospitals.

Additionally, research published by the National Institutes of Health shows that Chief Nursing Officers (CNOs) are highly effective, self-taught learners and objective leaders despite having been mentored largely by non-clinical nurse executives. This study calls for comprehensive improvements to clinical and financial nursing leadership education and mentorship programs to prepare highly qualified women to pursue nursing leadership positions.

With plenty of institutional support calling for the inclusion of women in nursing leadership, individual nurses must also take responsibility in advocating for and pursuing their upward career mobility.

Sheryl Sandberg, the Chief Operating Officer (COO) of Facebook, calls on all women to determine and pursue their professional priorities in her pivotal book Lean In: Women, Work, and the Will to Lead. In a similar vein, a feature piece on WorkingNurse.com highlights the numerous leadership pathways available to women in nursing careers.

A Gallup survey of American opinion leaders published by the Journal of Nursing Administration shows the public perceives nurses as knowledgeable and trustworthy professionals who are underrepresented in leadership roles. The book The Future of Nursing: Leading Change, Advancing Health (2011) also implores all future nursing professionals to consider themselves as future leaders and pursue leadership development opportunities in order to transform the field of healthcare.

Read on to learn about how one woman’s health crisis inspired her professional journey into nursing leadership.

Opera singer turned nurse leader Jennifer Ness Schmid quips: “I’ve had the most backward career path.” She found her way to nursing through illness; she became sick with chronic digestive problems in her 20s and was devastated when her doctors ran multiple diagnostic tests and told her that she “would have to live with it”—that there was nothing they could do to help her.

Her dissatisfaction with their responses drove her to learn about nutrition, alternative medicine, energy work, herbs and supplements, and chiropractic care. By making healthy habitual changes in her lifestyle and diet, she cured herself of her debilitating digestive problems in two months. Wanting to empower and give others hope through holistic healing, she went on to become a traditional naturopath.

Ness Schmid’s view on the profession of nursing was not always positive. Before becoming a nurse, she held much disdain for the profession based on previous unhelpful experiences with medicine. It wasn’t until her mother got a cancer diagnosis requiring a ten-day hospital stay that she began to see the helpful and healing examples of women working in nursing: “My mom’s nurses were amazing and very busy, so they delegated some tasks to me, like helping her take a walk. They needed help, and I was happy to learn how to care for my mom.”

Through the experience of being inspired by her mother’s nurses, she realized that the traditional naturopathy route “didn’t give [her] all of the tools [she] needed,” and so she enrolled in a master’s entry degree program for nursing. “I was pleasantly surprised by how supportive the faculty were about my holistic and non-pharmaceutical methods,” Ness Schmid shared.

After graduating in 2012 with a clinical nurse leader (CNL-MSN) credential, Ness Schmid worked in a few different healthcare settings. She started out as a healthcare manager for a summer camp, then worked as a nurse in a special education classroom, and later transitioned to a position as an RN team lead for Apple.

A professional contact recommended Ness Schmid for an intermittent position at a clinic with the Veterans Affairs Palo Alto Healthcare System and later a full-time position as the assistant nurse manager running the spinal cord injury outpatient clinic. Still inspired by her desire to give people hope and a full spectrum of options for empowering healing, she founded Oasis Wellness to educate and inspire people in their wellness journeys.

Ness Schmid is currently the chief nurse of integrative health at the San Francisco VA and is very passionate about the holistic care she and her team provide in service of veterans’ healthcare needs: “The VA is about patient-centered care” she says. “It is the prime example of how successful the single-payer healthcare system can be.”

Among other issues, Ness Schmid and her team help veterans who are experiencing “the moral injury of being in combat, the ‘silver tsunami’ (the onset of age-related health issues appearing earlier in Vietnam War veterans, such as Alzheimer’s and dementia), and issues of loneliness due to isolation and estrangement from families.” To address these healthcare needs, the VA provides care in nine modalities of integrated health, including mindfulness-based practices such as yoga.

When asked if she believes there’s an underrepresentation of women in nursing leadership positions, Ness Schmid says: “Yes, but there are so many opportunities in nursing for women to pursue: charge nurse, assistant nurse manager, nurse manager, program director, chief nurse, chief nurse executive, director of nursing, assistant director of nursing…the list goes on.”

When asked about the underrepresentation of women in leadership positions in healthcare, she calls for two actions: first, for women to “not stunt our own growth” when it comes to pursuing leadership positions by feeling as if they are not qualified; and second, for more equitable industry gender expectations when evaluating leaders of both genders, saying: “The expectations on women leaders tend to be higher in whatever their professions.”

On the subject of encouraging more women to pursue nursing leadership positions, Ness Schmid recommends the following to female nurses uncertain about their ability to be a leader:

• “First: Find a mentor. Start in nursing school. Ask your professors or nurse managers from clinical practice and find a mentor whom you can observe and watch. Ask them: ‘What skills do I need to be an effective leader?’
• Second: Start local. Join a committee at work and look around for opportunities. There are always positions for service. Look into becoming a member of an organization; for example, I joined the American Holistic Nurses Association. Look around for local and national chapter organizations and get involved.
• Follow your passion. Pursue subfields of nursing that interest you or dig deeper into your current nursing position.”

Ness Schmid’s advice for all female nurses is, “Don’t give up. You might get turned down initially for leadership roles, but keep trying. Nursing needs you and healthcare needs more women leaders.”