When a nurse calls a doctor in the middle of the night because her assessment tells her something is wrong with a patient, is she exercising leadership?

Absolutely, say nursing officers of three leading Georgia health care systems. Leadership begins at the bedside, when nurses apply critical-thinking, technical, organizational, time-management, priority-setting and decision-making skills along with clinical care. Besides caring for patients, staff nurses serve on hospital committees, participate in research for evidence-based practice, train in new technology, prepare for the next level of management or mentor nursing students and new hires.

The need for leadership at every level of nursing is more critical than ever in today's health care environment.

"We live in this world of change," said Diane Chamberlain, MS, RN, C.

Chamberlain has seen plenty of change during her 39-year career. She started her training in the Crawford Long Hospital diploma program because it was the only Atlanta school at the time to admit married nursing students.

Today, she is the director of nursing and patient services for Kaiser Permanente of Georgia's multiple medical offices and specialty clinics.

Chamberlain makes a distinction between leadership and nursing leadership.

"You have to have a vision for where you want nursing to go, and understand the business side of health care, but you also have to stay connected to why you're there. It's ultimately about the patients," she said.

Nursing leaders serve many constituents — patients, staff, their organizations and the community — and often with little formal leadership training, said Brent Robinson, RNC, MS, NP-C, CCRN, vice president of patient care services and chief nursing officer at DeKalb Medical.

"We have more leadership training in undergraduate nursing programs than before, but it's not nearly enough," he said. "We need to redefine the basic nursing education. Nurses need more knowledge about finances and management.

"I still see nurses who are afraid to be assertive with doctors or don't know how to manage staff. We have to prepare nurse leaders for the future."

With greater demands on health care systems, staffing shortages and more hospitals using shared governance models of administration, more nurses are going to be asked to step up and lead.

The upside "is that nurses can do so many different things," said Melissa Sisson, RN, MN, director of women's services at Northside Hospital.

For nurses willing to learn new skills, the career opportunities are great.

"One of my former managers is helping to coordinate the construction for our new obstetrics and neonatal service building at Northside Hospital-Forsyth. Some of those side tracks can be pretty interesting," Sisson said.

With leadership, comes responsibility, challenges and many rewards, as you'll see in this month's cover story.

- Do you have any story ideas for Pulse? We'd love to hear more about your career and what you do after hours. Send e-mail to pulseeditor@ajc.com or call 404-526-2078.