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Frontline nurse leaders are the linchpin of everything health systems are trying to accomplish — from quality and patient experience to staff engagement and retention. Yet despite how central their role is, the structure and support needed to help them lead consistently and effectively has often lagged behind.
During a recent Beckers webinar, Joel Ray, Chief Clinical Advisor at Laudio, moderated a conversation with Dr. Nancy Gaden, SVP and Chief Nursing Officer at Boston Medical Center, Dr. Nicole Kolacz, VP of Patient Care Services and Chief Nursing Officer at UNC Rex, and Kelly Sutton, Director of Perioperative Services at UNC Rex. Together, they explored what it takes to define, launch, and sustain Leader Standard Work (LSW) across a health system and what nursing executives should know before beginning that journey.
A quick poll of webinar attendees set the stage: only about 4% of respondents said their organizations had a mature LSW program. Nearly half had a program in place but struggled with consistency, and roughly a quarter hadn't yet fully defined what standard work should look like for their frontline leaders. The panelists' collective experience offered a practical roadmap for moving the needle on this. Three key takeaways emerged from the conversation:
Leader Standard Work is not about adding more, it's about bringing focus to what's already there.
A common barrier to adopting LSW is the perception that it's just one more thing being piled onto already busy leaders. The panelists pushed back on that framing directly. As Dr. Kolacz explained, the goal at UNC Rex was never to create more work but to create clarity and precision around the work that matters most — things like rounding on team members, reviewing quality and safety metrics, closing communication loops, and conducting structured new hire check-ins at 30, 60, and 90 days. "We wanted to really focus on the things that matter most and then do those things consistently," she said.
Dr. Gaden echoed this at Boston Medical Center, where leaders initially feared the initiative would be burdensome. The reality surprised her. "It's not one more thing," she said. "It's what you were already doing, just much more targeted and specific, and therefore a little bit easier, a little bit faster, and with better outcomes for you as a leader and for your team." The shift, as Joel Ray put it, is from reactive management to intentional leadership. Laudio’s Leader Inspired Work framework reinforces this idea, organizing the core work of frontline leaders into two complementary domains: relational leadership — the behaviors that strengthen trust, communication, and team culture — and operational leadership, which covers the structures, processes, and performance responsibilities leaders manage every day.
Building genuine buy-in means standardizing behaviors — not leadership styles.
One of the most important distinctions the panelists made was between standardizing what leaders do and standardizing how they do it. Both UNC Rex and Boston Medical Center have found that engaging leaders in defining the work — and reinforcing that their individual style, personality, and authenticity still have a place — is critical to sustainable adoption.
"We've been very intentional in reinforcing that this is not trying to standardize their leadership style," Dr. Kolacz said. "We're standardizing those key behaviors that drive the outcomes." At UNC Rex, that has included empowering frontline teammates themselves to facilitate huddles and lead unit-level discussions around quality and safety. "That creates a sense of accountability within the unit," Kelly Sutton explained. "They all know what is expected of them and they're able to hold each other accountable in the moment if the leader is not present."
At Boston Medical Center, Dr. Gaden launched a "Thrive and Elevate" curriculum grounded in American Organization for Nursing Leadership (AONL) core competencies, featuring a book club built around Leader Inspired Work, HR education on day-to-day leadership challenges, and sessions on professional governance and finance. One of her most candid revelations: despite her belief that her team was well-supported, the leaders themselves didn't feel that way. "The surprising thing for me was that we just haven't been doing enough," she said — and that a comprehensive, structured investment in their development made them feel more valued.
Start simple, stay the course, and don't treat it like a checklist.
When asked about pitfalls, all three panelists were candid. Trying to implement too many elements at once, losing sight of the "why," and treating LSW as a compliance exercise rather than a leadership tool were among the most common missteps. "If it's too rigid, people resist. If it's too loose, you don't have the impact," Dr. Kolacz noted. The key is anchoring the non-negotiables while giving leaders room to make the work their own.
For CNOs wondering where to start, especially those with limited resources, the advice was simple: just begin. "You don't need everything in place to start," Dr. Kolacz said. "What you need is clarity and consistency." Huddle your team, listen to what's being said and what isn't, and build from there. As Nancy Gaden added, accountability is a gift, not a burden. "If you don't ask for consistency and have a way to ensure it's happening, they won't get the benefits." For nursing executives committed to building high-reliability organizations, LSW isn't just a program to roll out and hope for the best, it's a cultural and strategic investment in the people and leaders closest to the care.