Leadership in the California Nurse Association


California Nurses Association (CNA) was founded in 1903 to promote the financial and professional requirements of nurses in California (Clark,2018). Since then, the association has fought relentlessly to ensure that the government addresses the needs of nurses. Before CNA became active, nurses in California were being mistreated by the government and other workers in the medical field. They had a narrow scope of practice that prevented them from practicing essential patient practices such as performing cardiopulmonary resuscitation (CPR) and administering some medications. More so, the corporate hospital industry, which was responsible for employing nursing, dismissed most qualified nurses, and replaced them with unlicensed staff. Such actions raised concerns from nurses and even patients.The purpose of this paper is to address the efforts and outcomes of the association and how effective leadership affected their outcomes. Besides, an evaluation of how their efforts can be applied to improve the practices of APRNs is included.

Comprehension: Efforts and Outcome of California Nurses Association

When the California Nurses Association came into action, it activated nurses’ strikes and demonstrations in an attempt to gain attention from the concerned bodies (Gastón,2017). Firstly, the CNA leaders mobilized their members to fight for collective bargaining contracts so that their salaries can be increased. At that moment, nurses were being paid low wages as compared to the services they provided. Although it took long for the government to respond, the pressure from demonstrating nurses and the support from patients convinced it to sign the contract that led to a rise in nurses’ wages. Also, the efforts to improve working conditions were successful in 1976 when the government of California agreed to initiate safe staffing of nurses by adopting CNA-sponsored law that demanded that a registered nurse should only handle a maximum of two patients in intensive care units.

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In 1992, the association established a new model for nursing organizations in response to changes that had affected patient healthcare delivery, such as the dismissal of licensed nurses. As a result, most unlicensed staff were replaced with qualified nurses, and nurses took charge of most nursing organizations. Similar efforts by nurses to improve nursing practice have been witnessed in Canada, whereby leaders try to negotiate with the healthcare management to support new and evidence-based nursing practiced (Willcox et al., 2018).

Application: Core Leadership Concepts to the success of the California Nurses Association

The success of CNA resulted due to the strong leadership skills approaches applied by nurses in California.  Firstly, the nurses in the association understood that empowering themselves could earn them their economic and professional needs. As such, they formed a new model for nursing organizations that mobilized the replacement of unlicensed staff with Registered Nurses. A well-formed organization culture allows members to have shared values, beliefs, and assumptions (Manojlovich,&Ketefian, 2016). Therefore, they work in unity to achieve desired goals. CNA leaders as well applied the transformational theory of leadership, which aims at introducing change in healthcare to improve health outcomes. The nurses fought for the improvement in their working conditions, and this led to the reduction of the number of intensive care unit patients that each nurse should manage.

Cultural competency is essential in healthcare, especially when working in a healthcare facility situated in a multicultural setting (Dave, 2019). In that case, nursing leaders should ensure that employees understand the needs of patients during patient care. However, this was not the case in California, whereby the corporate hospital industry opted to replace qualified nurses with unlicensed staff who were not competent with the culture of patients. Demonstrations from patients indicated that they were not satisfied with the services provided by the unlicensed staff. As a result, the government was forced to replace them with qualified nurses who understood the culture and needs of patients (Mahon, Brogan, Thomason, & Kennedy,2019). Besides, Registered Nurses understood the patient safety culture and climate. Safety climate entails keeping both the patient and the nurse safe (Huber, 2017 p.53). Thus, nurses who had undergone full training could enhance a patient safety culture and climate that can lead to better health outcomes.

The government also plays an essential in promoting healthcare. The California Nurses Association involved the government in solving their problems. Since the nurses could not reach the government themselves, CNA officials represented them effectively by presenting the grievances. According to Huber (2017 p. 54), leaders should promote a just culture that values patients by acting as a bridge between the senior nursing leadership and nurses. The CNA leaders acted as a bridge, in this case, to ensure that nurses in California acquire their desired needs from the government.

Analysis/Synthesis: Variables contributing to the success of the California Nurses Association

The success of the California Nurses Association fighting for the rights of nurses depended on several identified variables. Firstly, transformational leaders leading the association contributed highly by mobilizing the government to respond to the grievances aired by nurses ((Dempsey, & Reilly, 2016). Despite the challenges encountered in the process, they were destined to achieve their desired goals. Besides, they led other nurses in strikes and demonstrations, which helped them to gain media alert. Through them, nurses were able to unite and fight for a common goal. Secondly, the support of patients in demonstrations contributed highly to their success. Patients understood that nurses deserved what they were fighting for, especially an increment in their wages. Also, the walkout of nurses from the hospital greatly affected patient outcomes (Allen, Aldrich, & Adams,2019). As such, they had a reason to demonstrate in favor of nurses so that they can return to their healthcare aid.

Lastly, their persistent spirit of fighting for their rights contributed highly to the success. Studies show that the nurses engaged in several strikes before the government of California responded to their grievances. Initiating a change in nursing practice has always been a challenge, especially when the majority seem to reject the suggested change. In this case, nurses were fighting against the top heath management body, which was reluctant to accept their plans. However, they had a strong fighting spirit since the change meant a total change in the perception of nursing in the country.

Evaluation: Efforts of the CNA as a Model to enhance APRN Practice

The efforts shown by California Nurses Association were meant to remove barriers that affected the convenient delivery of healthcare. For example, nurses were denied the mandate of some of the essential procedures, such as cardiopulmonary resuscitation. Also, the board dismissed most nurses without any valid reason since they had no strong representation. As such, the reason for forming the association was to bring change in the field of nursing practice. Therefore, their efforts can be summed up into the transformational model of leadership, which involves leading employees in initiating a positive change. The model can as well be applied by APRNs to initiate change in their scope of practice. In some healthcare facilities, APRNs are not allowed to practice some of the functions that they are certified to perform, such as diagnosing diseases in patients (Kumar, Larrison, Rodrigues, &McKeithen, 2019). Effective APRN leaders can mobilize other nurses in the field to fight for their professional rights. Also, they should show develop persistence while fighting for a change in the scope of practice since transformation in nursing takes some time due to incidences of rejection from other healthcare providers.


Allen, J. I., Aldrich, L. B., & Adams, M. A. (2019). Preparing for Large-Scale Disruptions in Health Care Delivery: Nursing Strikes and Beyond. Clinical Gastroenterology and Hepatology17(8), 1424-1427.

Clark, P. L. (2018). Nurses Unions Efforts to Give RNs a Greater Voice in Patient Care. Members-only Library.

Dave, A. (2019). The Need for Cultural Competency and Healthcare Literacy with Refugees. Journal of the National Medical Association111(1), 101-102.

Dempsey, C., & Reilly, B. (2016). Nurse engagement: What are the contributing factors for success. OJIN: The Online Journal of Issues in Nursing21(1).

Gastón, P. (2017). A Caring Class: Labor Conflict and the Moral Economy of Care in California Hospitals. University of California, Berkeley.

Huber, D. (2017). Leadership and nursing care management-e-book. Elsevier Health Sciences.

Kumar, P., Larrison, C., Rodrigues, S. B., & McKeithen, T. (2019). Assessment of general practitioners’ needs and barriers in primary health care delivery in the Asia Pacific region. Journal of Family Medicine and Primary Care8(3), 1106.

Mahon, M., Brogan, G., Thomason, J., & Kennedy, C. (2019, November). Experience, Research, and Policy: Improving the Health and Safety of Nurses and Patients. In APHA’s 2019 Annual Meeting and Expo (Nov. 2-Nov. 6). American Public Health Association.

Manojlovich, M., &Ketefian, S. (2016). The effects of organizational culture on nursing professionalism: Implications for health resource planning. Canadian Journal of Nursing Research Archive33(4).

Willcox, A., Sutherland Boal, A., de Padua, A., Balaski, B., Ens, B., Toye, C. R., … & MacPhee, M. (2018). Leadership and Influencing Change in Nursing. University of Regina Press.

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