As healthcare continues to get more complex, nurses in leadership are redefining how clinical expertise and education come together to shape the future of patient care.
Currently, there are over 4 million RNs working in the U.S., according to the National Council of State Boards of Nursing. And it’s no secret that nurses are an integral part healthcare, serving as advocates, educators, coordinators, caregivers, and more.
Research shows nurses spend more time with patients than most other healthcare professionals. Yet when it comes to making high-level decisions, especially ones that shape care delivery, policies, and operations, their voices are far too often absent.
However, this imbalance is shifting, and more nurses are stepping into leadership roles. In fact, the American Organization for Nursing Leadership represents more than 12,000 nurse leaders as members.
Some are even expanding the boundaries of traditional leadership by taking on dual roles. These leaders are bringing bedside expertise to the decision-making table, which is helping to reshape the future of the profession.
One great example of a nurse in leadership is Shakira Henderson, PhD, DNP, MS, MPH, EMBA, IBCLC, RNC-NIC, who serves as Dean of the University of Florida (UF) College of Nursing and Chief Nurse Executive for UF Health.
In a recent NurseDot podcast episode, Henderson discussed her career journey and how it represents something larger than just personal success. It’s a roadmap for what’s possible when nurses lead from both sides of healthcare.
“Nurses are never at the table, but we’re always on the menu,” said Henderson. “So I’m going to ask our nurses to just pull up a folding chair to the table if you’re not invited.”
The growing need for nurses in leadership
Burnout, staffing shortages, increasing care complexity, and other stressors reveal growing healthcare challenges. Nurses, especially those with experience at the bedside, are easily positioned to help fix it.
But research shows that fewer nurses actually hold top roles. According to the Bureau of Labor Statistics, nurses make up nearly 58% of hospital staff, with only 25% of nurses holding leadership positions.
In addition, many organizations have fewer than 5% of nurses represented on their governing boards, according to the American Hospital Association 2022 National Health Care Governance Survey Report. This shows that nurses’ perspectives may be missing from decisions that affect them most, including staffing, technology, education, and policy.
However, in Henderson’s roles, she is a part of a model that joins two important areas: education and clinical practice.
“I got the opportunity to be able to bridge nursing practice and academia, which nobody in the country is doing right now, but is so needed,” she said. “But like medical schools where the dean is the CEO of the hospital, we’re trying to model that approach where nurses, our largest group of healthcare professionals, can marry and have a professional home with the nursing school.”
Combining academia and clinical leadership
One of the most innovative approaches to nurse leadership is the dual-role model, where nurse leaders hold positions in both academic and clinical administration settings. This structure fosters direct collaboration between nursing schools and health systems, creating a feedback loop that benefits both education and practice.
At the UF College of Nursing, Henderson leads this endeavor. As both dean and nurse executive, she has a view of nursing education and workforce operations. This allows her to influence a curriculum that directly prepares students for the challenges they’ll face as new nurses, and Henderson stressed that the need for change is now more than ever.
“There are a lot of things we can do to be able to support our [new] nurses, to be prepared so that they stay,” she said. “And that starts with looking at how we train them.”
She added that it involves addressing non-traditional skills, including resilience and self-care, so new nurses are better prepared.
She also emphasized the importance of fostering a strong sense of belonging, which is a priority for UF.
“Our students will feel like they have a home. They're not just a student. They're coming in, and they’re part of UF Health, and they’ll build that connection while in school so that they can feel more connected and more grounded when they graduate,” she said.
This intentional focus on connection enhances the student’s experience but also supports professional growth, confidence, and long-term retention within the healthcare system.
The impact of dual roles in nursing leadership
In her role, Henderson embodies what it means to bridge the academic and clinical worlds. Rather than operating in silos, her dual leadership ensures that nursing education is responsive to clinical realities.
“They’re in a complex environment where they have to know about nutrition, environmental, pharmacy, but we don't actually train them to be able to understand how all of these different areas actually intersect,” she said.
And that’s where Henderson aspires to drive change — to reimagine how to effectively prepare nurses for success.
Aligning curriculum with clinical realities
Too often, nursing graduates leave school well-informed but underprepared. They’ve passed their exams, but they feel overwhelmed by real-world complexities of the job.
Henderson shared that nursing students and new grads have the knowledge but need more tangible experience.
“They’re not getting as much practical, hands-on experience,” she said. “And so, when they come to the hospital, we technically have to train them [on] what it’s like to be a nurse in real life…and it’s a steep learning curve.”
With dual roles, nurses in leadership can more effectively ensure that the skills taught in nursing school mirror the actual demands of the care settings they’ll work in.
Strengthening the pipeline from student to staff nurse
According to Henderson, new nurses are turning over in their first year because they didn’t expect some of the challenges they experienced.
“Maybe they don't feel as skilled, [or] it's a very complex healthcare system,” she said. “They probably didn't have practicums in such complex areas, and now they're expected to be able to do that. They may not have nurse residency programs — there are so many factors that our new nurses [face].”
When students train in hospitals where their deans also lead operations, they form early connections to the health system. This increases loyalty, reduces orientation time, and improves retention.
“Being able to be more connected with our hospitals, so that [nursing students] can have more hands-on training — and we can have nurse residencies — is a model that we have to look for in the future,” Henderson said.
Building the future through nurses in leadership
If more widely applied, this dual approach would strengthen the partnership between nursing schools and health systems and elevate the standard of nursing education. By empowering practicing nurses to step into faculty roles, the next generation of nurses can benefit from instructors who bring current, real-world experience into the classroom. Simultaneously, hospitals will gain team members who understand the academic pipeline and are invested in shaping it.
Henderson’s vision goes beyond her own achievements. She sees her dual role not as an exception, but as a starting point for a larger movement, one that redefines how healthcare and education collaborate.
“I hope that we can actually create more dual roles so that we have hospital staff being faculty to be able to support the clinical mission,” she said.
