Nurses Lead: Breaking the Historical Trends in Healthcare Leadership

Over the past decade, I have observed healthcare systems that have begun placing physicians at the helm where nurse leaders at one point had a seat—a trend that raises questions about leadership in nursing practice and the evolving roles of healthcare professionals. While physicians undoubtedly bring valuable knowledge to the table, this shift invites a critical conversation about the nuances of leading nursing teams and whether this practice aligns with the core values of patient-centered care.

The central question is: Are physicians best suited to lead nursing teams?

Physicians and nurses play distinct but complementary roles in healthcare. Physicians focus on diagnosing and treating illnesses, while nurses are deeply involved in managing patient care holistically, advocating for patients, and coordinating care across multiple providers.

Nurses don't just follow orders—they lead care delivery at the bedside, manage patient outcomes, and educate patients and families. Nursing leadership is about understanding these dynamics and fostering environments where nurses feel empowered to make critical decisions. Physicians, however, are typically trained with a hierarchical mindset, one that doesn't always align with the collaborative, patient-centered culture of nursing. 

It's not a question of competence. It's a question of approach. When physicians step into roles requiring critical input into the profession and practice of nursing, the impact can be both insightful and harmful.

On one hand, having a physician leader can bring a fresh perspective to interdisciplinary collaboration. Physicians may help bridge gaps between medical and nursing teams, ensuring everyone is on the same page.

On the other hand, there's a real risk of nurses losing their voice. Nursing practice is about autonomy, advocacy, and a deep understanding of patients beyond their diagnoses. When physicians lead nursing teams without a deep appreciation of nursing culture and understanding of the profession, there's a danger that care and the work of nursing become more directive and less collaborative.

There's a saying in healthcare: "Nurses work with patients; physicians work with diseases." Leading a nursing team requires a shift in focus—from managing outcomes on a chart to managing people and their well-being. Without that shift, the essence of nursing leadership is lost.

For many nurses, this trend feels like an erosion of their hard-fought professional identity. Nursing is a distinct discipline with its own body of knowledge, licensure, and standards of practice. To many, having physicians lead nursing teams feels like a step backward in the ongoing battle for nursing recognition and autonomy.

While I was working at a very large multi-state HMO (who will remain unnamed :), the institution systemically began replacing nurses in prominent roles with physicians or created reporting structures that placed the nurse leader directly under a physician. During that time, one nurse leader mentioned:

"It feels like we're being told we need a physician to 'oversee' us as if we're incapable of managing ourselves."

Nurses are not just support staff but leaders in their own right with their own practice and professional evidence, standards, and ethics. Many hold advanced degrees, conduct research, and lead initiatives that improve patient and population outcomes. The concern is that by putting physicians in charge of nursing teams, healthcare systems risk undermining the independent and autonomous practice and profession of nursing.

A great nursing leader isn't necessarily someone with a medical degree. It's someone who understands nurses' unique challenges, VALUES their contributions, and fosters a culture of autonomy, empathy, and advocacy.

While physicians bring medical expertise, nursing leadership requires a unique set of skills. It's not about prescribing treatment but empowering nurses to deliver the best care possible.

So, what's the solution? Healthcare systems must recognize that the best outcomes come from collaboration, not hierarchy. Why not create dual leadership models instead of replacing nursing leaders with physicians or having hierarchies that don't provide nurses a seat at the decision-making table? Pair physician leaders with nursing leaders to ensure that both perspectives are represented equally.

This kind of shared leadership model acknowledges the unique contributions of both professions. Physicians can focus on medical strategy, while nursing leaders focus on care delivery and team dynamics.

At its core, healthcare is a team sport. Physicians and nurses each bring something valuable to the table. However, when it comes to leading nursing teams, healthcare systems must ask themselves: Who understands the unique challenges of nursing better than nurses themselves?

The answer seems clear. NURSES!