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Systems-Based Practice and Leadership

Systems-Based Practice and Leadership. Systems-based practice may not be a familiar term for many nurses. Most prelicensure nursing programs are packed with skills, pharmacology, and pathophysiology often leaving little time for considering the impact of the larger systems on individual patient care and the impact of nursing care on the larger systems. This week, we will explore how professional nurses can understand and use the competencies of systems-based practice and leadership to grow in their professional practice.

Systems-Based Practice

The healthcare systems of today and tomorrow are changing and complex. From microsystems that may involve only your assigned team of patients or unit all the way to the global healthcare structure, the professional nurse must be skilled in systems-based practice to impact quality patient care. It is no longer enough to ask, “How can I improve my patient care?” Instead, professional nurses need to ask, “How can I create change in the healthcare system at all levels that will improve quality patient care?” Professional nurses must be alert to the issues and context of the larger system, not just their own care of their own patients.


“Nurses deliver health care in complex systems, so it is important that they understand the nature of these systems and are able to manipulate them” (Hood, 2018, p. 6).

Systems theory is concerned with the parts and the whole. Interaction among these impact all areas. Because nurses extensively study body systems, they are familiar with the basics of this theory. Nurses understand that the cardiac system and the respiratory system are two different parts (microsystems) that interact to influence the entire body and person (macrosystem).

As its label suggests, systems theory applies to healthcare systems. Nurses may work in hospitals that are part of a larger enterprise comprised of several healthcare delivery organizations.

Within a hospital are several departments, such as the critical care department, environmental services department, nutritional services department, and many others. Within the critical care department are units such as intensive care, coronary care, step-down, telemetry, and others. Within a unit are teams comprised of an RN (and sometimes LPNs/LVNs and/or unlicensed assistive personnel) caring for a specific group of patients.

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Most staff nurses tend to practice at the microsystem level. Several theories and models of professional nursing are based on systems theory. As we grow in our profession, we need to become increasingly aware of the issues at all levels of the system, as well as the interrelationships between and among those microsystems and the macrosystem.


“The goal of systems-based practice for the nurse of the future is to enhance and improve the interdisciplinary system of patient care while understanding the legal, political, regulatory and economic factors that influence the delivery of health care” (Massachusetts Action Coalition Future of Nursing, 2014, p. 10).

Leadership in Professional Nursing

Leader or Manager?

Although all managers should be leaders, not all leaders are managers. Out of necessity, managers often need to enforce the rules. Non-managerial leaders may be free to think in creative ways to find solutions to complex problems. Leaders have vision and the ability to empower others to accomplish shared goals.

Informal leaders lead subtly yet have a powerful influence on those around them. Leaders in the field of nursing have self-confidence when providing care and can accomplish change in order to make situations better for patients, colleagues, and themselves.


Think of a nurse at your workplace whom everyone goes to with questions.

  • What qualities does this leader possess that make that individual the person everyone gravitates towards in times of challenge?
  • How does this leader approach problems to develop meaningful solutions?

The leader does not solve all the problems of the workplace. Instead, the leader helps the staff to find answers and try solutions. Empowerment and involvement of others is a key factor in leadership.


Think of an example where a leader empowered you to make a decision. Consider how you felt. Now, compare this to a time when the leader simply told you what to do.

  • Did you feel differently? Which did you prefer?

Characteristics of Leaders

There are characteristics commonly found in leaders that make them effective. Although some believe that leaders are born, others assert that you can develop leadership qualities to make you effective.


  1. Think of the best leader you have ever known. This could be a supervisor, colleague, or historical figure. What characteristics did this person exhibit?


View Answer

Leadership Styles

There are several styles of leadership that have been used in nursing. Review the table and consider the style of your leaders.

Style of Leadership Description Source (as cited in Hood, 2018)
Autocratic Leader controls others to finish tasks White & Lippitt
Democratic Group contributes to decision making White & Lippitt
Laissez-faire Hands off style; absence of leadership White & Lippitt
Transformational Leader empowers group, shares vision, engenders trust, and is charismatic Burns
  Leader empowers followers to serve others Greenleaf
Quantum Shared leadership where group members arise based on need and skills in technical, relational, and intentional areas. Porter-O’Grady

Let’s look more closely at shared leadership, and in particular, shared governance. There is a growing movement toward broadening the amount of power that employees have to make decisions. Instead of putting one person in charge, a committee may be asked to propose solutions to problems, develop new policies, and support growth, but there is a downside to this approach. These activities can be time consuming. Many nurses express concern over the time it takes to participate in decision-making when they are away from patient care, particularly when they are not paid for these hours.

Fast Facts

The focus of shared governance is to empower nurses to be involved in decision-making in multiple levels of the system. Committees, task forces, and unit-based councils are commonly used. “The underlying principle of shared governance is that employees will be more committed to an organization’s goals if they have had input into planning and decision making” (Blais & Hayes, 2011, p. 178).

Implementation of shared governance has been likened to “pinning Jell-O® to a wall” (Hess, 2004, Abstract) because it may be implemented differently in each organization. Hess also claimed that implementation is more of a journey than a destination, where nurses learn leadership skills and become empowered to participate in changing workplace processes.

Leaders demonstrate lifelong learning. As leaders grow in their education and their leadership skills, they often progress in their employment setting.

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In Week 6, we studied the less familiar competency of systems-based practice and the more familiar nursing core competency of leadership. Each is important to professional nursing. Each is interrelated with other nursing core competencies, which is a great example of systems-based practice.

Test Your Knowledge

Systems-Based Practice and Leadership

Systems-Based Practice and Leadership