ng stewards who will embark on such issues to design new financial models in order to constantly build the business side of nursing care delivery models. Such leadership will become synergistic with the work in the area of stewardship of the health care system.
Future nurse leaders or stewards will be directly centred on working with nurse practitioners and nurse educators to transform the practice environments in which they work. The intended outcome is to make practice environments more positive, healthy and engaging. Areas for dialogue may be within:4
• patient-population centredness
• safety for patients and health care personnel
• the needs of an ageing workforce
• increased autonomy for advanced nurse practitioners
• increased respect for the contributions made by professional nurses
• clarification of the caring work of the nurse, and
• enhancement of the collaborative practice of the multidisciplinary health care team.
Lastly, but perhaps most importantly, an opportunity for nursing stewardship lies in the regulatory and accreditation aspects of the profession. Nurse leaders or stewards are finding themselves collaborating with regulatory boards to improve on standards of practice, certification and accreditation, thus ensuring that standards and regulations support the nurse of the future and new models of care delivery, and remain true to a patient/population-centred health care system.
Another aspect is for nurse leaders or stewards to influence decision-making at the point of service. An ‘invigorating’ nurse leader or steward is urgently needed.8 Storch9 insists on nurses creating health care environments that uphold value-based nursing practice by acknowledging that who one is – one’s moral character – is essential for leadership. Nurse leaders or stewards need to engage with how this is to be done, utilising character, dialogue and shared meanings and values.
Stewardship of self
To meet the domains of stewardship in health care and the nursing profession, it is crucial that nurse leaders engage with the development of self. Succession planning to develop and nurture a new generation of transformational nurse leaders may be the only way to achieve this. To meet the concept of lifelong learning, nurse leaders or stewards will need to use of mentors and personal coaches to assist them in refining skills and improving competencies.4 Healthy nurse leader stewards will thus become visible and sound role models within their institutions to maintain the balance between self and professional fulfilment.4
The future of nursing is rapidly changing. Things are somewhat chaotic at times, but the opportunities for stewardship are many and varied. We are ideally suited to serve as nurse leaders or stewards in all aspects of health care. By embracing the six aims of health care improvement, the leadership of nursing can be both invigorating and transformational.
Nursing Science Editor
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2. Magill G. Organizational ethics in Catholic health care: honouring stewardship and the work environment. Christian Bioethics 2001;7(1):67-93.
3. Dingel-Stewart S, LaCoste, J. Light at the end of the tunnel: a vision for an empowered nursing profession across the continuum of care. Nurs Adm Q 2004; 28:212-216.
4. Haase-Herrick K. The opportunities of stewardship. Nurs Adm Q 2005; 29:115-118.
5. Saltman R, Ferroussier-Davis O. The concept of stewardship in health policy. Bull World Health Organ 2000;78(6):732-739.
6. Taymiya I. Public Duties in Islam: The Institution of the Hisba. Markfield, UK: Islamic Foundation, 1985.
7. Institute of Medicine. Crossing the quality chasm: a new health care system for the 21st century. Washington: National Academy Press, 2001.
8. Murphy N, Roberts D. Nurse leaders as stewards at the point of service. Nursing Ethics 2008;15(2):243-253.
9. Storch J. Ethical dimensions of leadership. In: Hibberd J, Smith D, eds. Nursing Leadership and Management in Canada. Toronto: Mosby, 2006:395-414.
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