Enhancing leadership abilities for pediatric nurses: strategies for the 21st century.

D URING THIS PAST YEAR, the 1999 Child Health Policy column has highlighted several child-health programs sponsored by the Maternal and Child Health Bureau of the US Public Health Services and the Agency for Children, Families, and Youth at the US Department of Health and Human Services. These highlighted programs included the Bright Futures program; Head Start; Healthy Start; and Continuous, Coordinate Care. We, as pediatric nurses, have played significant leadership roles in the development, implementation, and evaluation of each of these programs around the nation. We have also provided direct care to children and their families and communities as a result of federal funding provided for the operation of these programs. As we approach the new millennium, we need to ensure that we remain in the forefront as leaders in improving the overall well-being of children and their families and communities well into the 21st century. This article focuses on strategies for enhancing our leadership capacity. As pediatric nurses and leaders, we are working in a health-care system that is transforming itself on a daily basis. In the past century, the health-care system was predominately focused on a medicalcare model that provided services for the individual in acute care, inpatient settings. Reimbursement for health care was provided to health-care providers, mostly physicians, on a fee-for-service scale. However, the health-care system today and in the future will focus on the management of health care over the entire lives of individuals in specific populations and communities. These populations will be more ethnically and culturally diverse than ever before in the history of our country. Fees-forservice paid to health-care providers will continue to be capitated or limited to a set price for services rendered. Information and care-delivery systems will be more computerized. Health-care workplaces will continue to transform, as well. There will be more mergers and acquisitions, new managed-care networks, and a different mix of healthcare workers functioning in different roles. As a result of these basic transformations in the healthcare delivery system of the United States, there will be a need for new quality and accreditation standards, and more evidence-based health-care practices (Porter-O'Grady, 1998). To understand the "new rules and anticipate and define the evolution of our health systems" and its impact on the delivery of care to pediatric populations, we need to educate and develop new leaders in pediatric nursing (Ferguson & Donaho, 1999, p. 91). Although a need for new pediatric nursing leaders has been documented, there are startling trends in nursing education that will drastically hamper their development. For example, an increasing number of schools are limiting training in pediatric nursing. Some clinical pediatric rotations last for less than a semester, quarter, or day. As a result, we will have fewer nurses trained in pediatric nursing and fewer advanced practice pediatric nurses, researchers, academicians, and leaders providing care and direction in local, state, and national programs. It is critical as we move forward into the next century that we not only continue to educate adequate numbers of pediatric nurses, but that we also support the development of leadership skills in these individuals.