Virtual nursing (VN) addresses workforce shortages and improves patient safety through technology-enabled care. Limited evidence exists on the impact of virtual nurses on organizational outcomes and collaboration between leadership and frontline staff. Yale New Haven Health System piloted VN on 2 units (68 beds) in 1 hospital and expanded to 30 units (800 beds) across 3 hospitals, with future units planned. The nurse leader and bedside nurses co-designed workflows, clarified roles, and integrated a virtual nurse using existing infrastructure. VN supported 78% of discharges and over 50% of admissions, reduced discharge order-to-departure time by 30 minutes, increased 11 am discharge rates by nearly 4%, and reduced incidental overtime occurrences and costs by 10%. Patient satisfaction improved, and staff resilience was bolstered through workload redistribution. VN enhances care delivery, promotes workforce sustainability, and improves patient experience. Leadership engagement and frontline collaboration are vital for scaling and success.
A review of the new American Nurses Association Code of Ethics for Nurses and workplace violence application case example.
Frontline nurse leaders are pivotal in advancing safety, quality, and engagement, yet many transition into leadership roles with limited preparation and structured support. To address this gap, Kaiser Permanente Northern California established the Assistant Nurse Manager (ANM) Community of Practice (CoP) in 2019, a Caring Science-based leadership development model uniting more than 800 ANMs across 21 medical centers. Guided by Jean Watson's Theory of Human Caring, the CoP integrates leadership formation, wellness practices, and professional development through monthly sessions featuring centering rituals, reflective dialogue, and mentorship. Over 5 years, the ANM CoP has evolved into a regionwide movement that strengthens relational leadership, psychological safety, and collective resilience. Leadership micropractices such as HeartMath for self-regulation, equine-assisted leadership for relational awareness, and mindfulness for presence translate Caring Science from theory into practice. Evaluation demonstrates a 26% improvement in first-year retention (23.5%-17.3%) and a 50% reduction in turnover within 2 years. Qualitative findings highlight increased moral resilience, belonging, and trust. Now entering its sixth year, the ANM CoP represents a replicable model for cultivating psychologically safe, caring, and high-performing leadership cultures that bridge evidence and empathy, advancing both organizational outcomes and human flourishing.
Nurse managers play a pivotal role in health care, serving as their units' chief operational and cultural leader. They are responsible for creating work environments that ensure safe, high-quality care, enable positive patient experiences, and grow engaged, high-performing teams while balancing financial constraints. To succeed in this multifaceted job, nurse managers must dedicate significant time to building relationships, fostering collaboration, managing risk, and spearheading improvement. This is becoming increasingly difficult as the span of control for nurse managers widens. In the current context, the need for efficiency is paramount, yet too often a nurse manager's ability to lead is hampered by administrative burdens and manual processes. Without new approaches, the demands of the role will soon outpace a nurse manager's capacity to effectively meet them. Technology offers a path forward, helping nurse managers reclaim time and focus to sustain excellence at scale. This article explores how technology can alleviate administrative pressures, examining the value of automated tools and how they can integrate naturally into workflow. Using staff scheduling solutions as an example, the article highlights how artificial intelligence and predictive analytics can reduce repetitive work, allowing nurse managers to redirect their energy toward clinical quality, patient experience, and employee engagement.
Leadership transitions in nursing have left many first-time nurse leaders underprepared for the most challenging aspects of their role: holding courageous conversations, maintaining accountability, and sustaining civility under stress. These trends were further accelerated by the disruptions of the pandemic. This gap, combined with heightened workplace violence, burnout, and workforce instability, has threatened the culture of safety across health care. Post-COVID-19, restoring trust and resilience requires intentionally integrating Just Culture, the Highly Reliable Experience training, and nursing professional governance. Just Culture offers a fair and structured approach to accountability, distinguishing between human error, at-risk behavior, and recklessness, while promoting psychological safety and reporting. Highly Reliable Experience embeds error-prevention behaviors, leader standard work, and team communication practices, aligning safety and patient experience. Shared governance empowers frontline nurses to lead improvement, standardize processes, and own outcomes. Together, these frameworks address the leadership development gap, strengthen civility as a safety imperative, and re-engage nurses in shaping reliable care environments. Evidence shows that organizations implementing these strategies see reductions in serious safety events, improvements in patient experience, and stronger workforce engagement. As turnover stabilizes but remains above prepandemic levels, equipping nurse leaders with the skills and structures to deliver accountability with compassion is both urgent and essential to sustaining safety, quality, and trust.
Charge nurses serve as essential frontline leaders within increasingly complex healthcare systems; however, many transition into these positions without formal leadership preparation. To address this gap, a large academic hospital implemented a 6-month Clinical Charge Nurse Leadership Development Program grounded in the American Organization for Nursing Leadership (AONL) Nurse Leader Competencies. The program aimed to strengthen leadership readiness among new or aspiring charge nurses through self-assessment, case-based learning, scenario practice, mentorship, and structured role-specific tools. Core content included emotional intelligence, conflict and change management, professional practice models, human resources concepts, and basic financial principles. Participants reported increased confidence, improved communication and conflict resolution skills, and enhanced understanding of operational responsibilities. Several nurses assumed additional leadership responsibilities after completion of the program. This article describes the program's development, structure, and outcomes and offers a replicable model for organizations seeking to prepare frontline leaders. Integrating competency-based training before assuming charge responsibilities supports nurse retention, team effectiveness, and operational efficiency. Structured, role-specific training guided by national standards can strengthen nursing leadership capacity at the point of care.
Background/local problem : An integrated healthcare system conducted surveys to assess overall well-being to describe perceptions of work environment and to inform meaningful intervention. Burnout and high turnover are compromising workplace safety and quality of care. METHODS:Surveys were sent to all eligible employees in the organization and participation was voluntary and confidential. The 2022 surveys were conducted, and 6,913 nurses participated. INTERVENTIONS:Statistical testing was conducted to identify demographic differences in burnout for tenure, age, manager/non-manager, and care setting. Regressions were conducted to determine top predictors of burnout. RESULTS:Significant differences were found in tenure ( P < .001), age ( P < .001), and manager/ non-manager ( P = .009). Mental health, retention, and workload significantly predicted burnout, F (3,4609) = 1028.33, P < .001, R2 adj = 0.40. CONCLUSION:Nursing burnout ultimately affects turnover and retention in a healthcare system. Monitoring by age, tenure, manager status, and care setting are vital for addressing burnout for nurses.
Over the past 15 years, a large health care organization has embraced Caring Science as a unifying framework. Nearly 200 Caritas Coaches have been trained, and more than 1100 nurses have advanced their academic degrees through Caring Science-aligned programs. The integration of Dr Jean Watson's Theory of Human Caring has helped shift the culture toward one grounded in love, compassion, and healing-from the bedside to the boardroom. This manuscript describes the organization's strategic investment in developing Caritas Coaches, embedding Caring Science into onboarding, leadership development, and unit-level practices. Amid the COVID-19 pandemic, Caring Science emerged as a powerful anchor for resilience, purpose, and staff retention. Exemplars illustrate how executive leaders operationalized Caritas Principles to transform care delivery, create psychologically safe environments, and foster belonging. The results demonstrate that when organizations prioritize care for the caregiver, measurable improvements in staff satisfaction, patient experience, and clinical quality follow. Caring Science offers a replicable model for health systems seeking to restore humanity in health care.
This manuscript chronicles the 10-year evolution of the Kaiser Permanente Scholars Academy-an enterprise-wide investment in workforce development, academic progression, and human-centered leadership. Originally launched in 2015 as the Nurse Scholars Academy to support frontline nurses in advancing academic and clinical excellence, the initiative has since grown into 5 integrated academies: Nursing, Mental Health, Research and Innovation, Allied Health, and Caring Science. Each academy addresses pressing workforce needs while fostering lifelong learning, interdisciplinary capacity, and culturally responsive care. With equity and excellence as guiding principles, the Scholars Academy has forged strategic partnerships with academic institutions, community organizations, and internal stakeholders to align professional development with Kaiser Permanente's mission and Magnet standards. Programmatic outcomes include increased graduate-level advancement, leadership preparation, research engagement, and expanded access to historically underrepresented groups. A timeline of key milestones illustrates how the academies collectively build a compassionate, competent, and future-ready workforce. This article explores how a decade of intentional investment in people and purpose has transformed care delivery, nurtured innovation, and redefined the role of education in achieving health equity. The Scholars Academy is not only a pipeline-it is a paradigm shift in how health care systems can lead with vision, courage, and care.
Nursing stands at a critical inflection point-shaped by global complexity, rapid technological change, and the enduring moral commitment to human caring. This article explores contemporary challenges faced by the profession, including organizational hierarchies, structural bias, funding instability, and persistent gender inequities. Yet it also illuminates the profound hope emerging through special programs like the Kaiser Permanente Scholars Academy, which have strengthened disciplinary identity, advanced academic progression, expanded public policy engagement, and elevated community partnerships. By reframing investment in nursing education as a strategic imperative rather than an operational expense, the article argues for sustainable funding models that support research, innovation, and workforce development. Finally, it examines the future implications of artificial intelligence and emerging technologies, emphasizing that while tools will evolve, the core of nursing-human presence, ethical judgment, and compassionate service-remains irreplaceable.
An academic practice partnership was formed to develop a new RN-to-BSN program with a Unitary Caring Science (UCS) framework. The target population consisted of registered nurses in a large integrated health system in northern California who had not enrolled in one of the numerous RN-to-BSN options available. The nurses worked in a strong union environment with high salaries and low turnover. The primary return on investment sought by the practice partner was transformational cultural change. A mindfulness-based stress reduction course, offered in the first term, served as an experiential introduction to UCS. The faculty prioritized the affective learning domain to nurture phronesis and chose a cohort model to develop communitas. New ontological competencies were developed through a value-added proposition with four pillars to help nurses discover their vision, find their voice, tell their stories, and own their practice. Students gave examples of how the program changed their personal and professional lives. Practice leaders reported transformative behaviors in graduates and transformative changes in the culture. The academic-practice partnership achieved the goals of both organizations.
The Kaiser Permanente (KP) Scholars Academy has demonstrated unwavering commitment to education, service, and social impact since its inception. This article explores how the Scholars Academy and its support of community work has contributed to health equity, workforce development, and community partnerships. Early drivers, such as the Institute of Medicine (now National Academies of Science and Medicine) Report on the Future of Nursing, the establishment of the KP Fund for Health Education at the East Bay Community Foundation, and involvement in California's state nursing workforce center laid a foundation that would inspire Scholars Academy programs. The vision for the Scholars Academy's future encompasses strengthening academic-practice partnerships, and community health initiatives to encourage and support a robust, well-prepared workforce within our broader community.
This reflective manuscript highlights the lived experiences of 7 nurse scholars whose educational journeys and professional development were supported by the Kaiser Permanente (KP) Scholars Academy over the past decade. Their narratives describe how academic progression, leadership development, and Caring Science-informed wellness programs (eg, Healing Circles, HeartMath, and Caritas Coach Education) shaped their leadership identities, influenced local systems change, and strengthened a culture of inquiry and evidence‑based practice (EBP). These stories are framed within contemporary scholarship on lifelong learning, equity‑centered nursing leadership, and evidence‑based leadership development. Intended contribution: to offer nurse leaders practical insights on how health system-supported scholarship pipelines can catalyze measurable improvements in professional governance, EBP adoption, and leader well‑being, thereby advancing organizational goals and health equity.
The convergence of Jean Watson's Caring Science and the framework of quantum leadership creates a transformative model for nursing leadership and practice. While Caring Science provides the ontological, ethical, and relational grounding for nursing's covenant with humanity, quantum leadership introduces complexity principles that align organizational life with interdependence, nonlinearity, and emergence. Together, they create Quantum Caring Leadership-a seamless integration of caring-healing practice and human-centered leadership. This manuscript examines the convergence at 4 levels: systems, the profession, the individual practitioner, and the patient/community. A conceptual model of Quantum Caring Leadership is presented, offering direction for a new Quantum Caring Leadership Academy and a future where caring is enacted in both practice and leadership as a unified moral covenant.
Kaiser Permanente Northern California (KPNCAL) has a long-standing commitment to advancing nursing excellence through workforce development, professional education, and the integration of Caring Science and Unitary Nursing frameworks. Building on this foundation, the organization identified the need to strengthen nurse-led research, evidence-based practice (EBP), and innovation in alignment with Magnet designation standards. Historically, nursing research infrastructure lagged behind physician-led efforts, with limited structural support, few nurse principal investigators, and minimal collaboration between research-focused PhDs and practice-focused DNPs. To address these gaps, the NCAL Research and EBP Program was launched in 2019, followed by the Research & Innovation Academy (RIA) in 2021 under the Scholars Academy. RIA was designed to institutionalize nursing research and EBP across 21 medical centers through a unified infrastructure, local, national, and regional EBP and research councils, curriculum development, mentorship pathways, and academic partnerships. Initiatives included monthly office hours, grand rounds, regional conferences, and the creation of a community of practice connecting over 300 PhD- and DNP-prepared nurses. RIA also partnered with the Institutional Review Board, Research Determination Office, and KP Libraries to streamline processes and build capacity for nurse-led scholarship. With more than 28 000 nurses in the region, these efforts have accelerated engagement in quality improvement in initiatives, research studies, and dissemination of findings. Looking forward, RIA is advancing large-scale, multi-site studies while preparing for the integration of big data and artificial intelligence in nursing research. By embedding research and EBP into the culture of every medical center, RIA positions KPNCAL to advance innovation, professional nursing excellence, and patient-centered outcomes.
Strategic investment in nursing workforce development is both a financial and organizational imperative. In 2014, Kaiser Permanente Northern California launched the Nurse Scholars Academy (NSA) with an initial $30 million investment in response to the Institute of Medicine's Future of Nursing report. Over the past decade, NSA has served as a replicable model for health care organizations by aligning academic-practice partnerships with long-term workforce strategy. Degree completion among NSA Scholars consistently outperforms national benchmarks, with retention rates exceeding the 75% to 80% national average (Figure 1). Retention across degree pathways remains high during academic progression (Figure 2) and is sustained after program completion, with graduates demonstrating long-term commitment to Kaiser Permanente (Figures 3 and 4). These outcomes directly contribute to reduced turnover, with the organization reporting registered nurse (RN) turnover rates 15 percentage points below national medians, equating to an estimated $4.3 million in annual labor cost avoidance. Beyond financial returns, NSA's outcomes illustrate broader organizational value: reduced burnout, increased confidence and capability, strengthened leadership pipelines, and enhanced professional advancement opportunities. Using the Abdi ROI scale, NSA's impact extends into non-monetary domains such as cultural transformation, reputation, and community trust. Together, these outcomes affirm that investments in nursing development yield sustainable financial benefits, advance workforce resilience, and reinforce Kaiser Permanente's role as a national leader in nursing excellence.
The rapid evolution of health care-driven by advances in technology, shifting workforce demographics, increasing patient complexity, and ongoing policy changes-requires adaptability, innovation, and the cultivation of robust academic-practice partnerships. While such collaborations inevitably involve risk, they flourish when rooted in shared values, authentic communication, transparency, and mutual trust. By aligning governance, resources, and outcomes, nursing academia and clinical practice can transcend organizational boundaries to create a collective culture where transformational leadership and learning communities thrive. The collaboration between the University of San Francisco (USF) and Kaiser Permanente (KP) exemplifies this model. Jesuit values of cura personalis (care for the whole person) and Magis (striving for excellence) harmonized with Watson's Theory of Human Caring to shape curriculum, bridge the theory-practice gap, and advance nursing excellence. The partnership offered mutual benefit: USF gained insights from KP's clinical and workforce expertise, while KP drew upon academic strengths in education design and evidence-informed practice. Guided by a formal charter defining scope, structure, and outcomes, the partnership established a sustainable infrastructure for advancing health through nursing leadership grounded in tradition, innovation, and Caring Science.
