Anne L. Heid

Date of Award


Document Type


Degree Name

Doctor of Philosophy (PhD)




As health care undergoes pervasive transformation, the need has become acute to develop leadership at all levels of nursing. Decision-making by staff nurses at the point of care has significant impact on patient care outcomes and quality of health care in today's decentralized institutions. Little empirical research has been undertaken to understand the process of leadership at the staff nurse level. This study used the framework of symbolic interactionism and grounded theory research methodology to explore the process of staff nurse leadership. Descriptions of the process used to practice leadership at the staff nurse level were collected from staff nurse leaders and nurse managers in tertiary care and critical access hospitals in a largely rural state. This process of leadership is illustrated in the theory of Leading at the Point of Care, Making a Choice emerged as the category central to the process of staff nurse leadership. Antecedents, intervening factors, consequences, and contextual factors are described. Staff nurse leadership is defined and reveals the vital role this leadership has in the delivery of quality patient care. Changes in existing systems of nursing education, healthcare institutions, and the profession are recommended to remove roadblocks to leadership by staff nurses.