The nursing workforce in an era of health care reform.

n engl j med 368;16 nejm.org april 18, 2013 1470 a loss of status and income as well as disdain from peers. Although leadership is making its way into clinical training, the workforce of the near future is already practicing. How can senior leaders enable and encourage front-line leadership among today’s clinicians? Surveys suggest that clinicians want a greater leadership role but feel unprepared3 or disempowered.4 Institutional leaders can encourage and support unit-level and front-line clinical leadership by framing the organizational purpose as value creation, giving local leaders the authority to make microsystem changes, tolerating the failure of some new delivery ideas, and creating professional pathways for clinicians who want to make leadership a career option. But data remain the single most important motivator and tool for a clinical leader. High-quality, comparative, unit-level and individual-level clinical and financial data5 can both create the need for clinician leadership and be the starting point for the four tasks. Other critical resources include protected time, training and mentorship (provided by many academic centers either in house or through collaboration with professional societies and business schools), and clear organizational expectations of clinician performance. CEOs may resist investing in developing clinical leadership and decentralizing control or may believe the process will be too slow to address current pressures. But the need is evident, the tasks are clear, and the skills are at hand — data orientation, the relentless pursuit of excellence, and a habit of inquiry are all second nature to clinicians. Ultimately, investment in such leaders will be essential to achieving the goals of health care reform.