Nursing is a profession grounded in caring for others. In the shift from historic models of nursing to modern health care models, it is increasingly difficult to reconcile holistic caring with a capitalistic model. Nursing leaders in clinical settings, community health, education, and elsewhere are often focused on capitalistic goals because of systems that have been normalized to veer away from a humanistic caring model.

The absence of caring contributes to toxic workplace culture. In an environment that is already afflicted with pernicious understaffing, inequitable pay practices, dangerous nurse-to-patient ratios, and unsafe working conditions, a lack of caring adds insult to injury. While these problems are modifiable, they remain unmodified. The messages sent through leadership’s inaction and the persistent exposure to a toxic workplace epigenetically affect those who are traumatized.

Leaving modifiable variables unmodified is violent. This constant exposure to trauma creates toxicity in the workplace. Not only has workplace culture and environment been linked to nursing burnout, post-traumatic stress, poor patient outcomes, and jeopardized patient safety, but the field of epigenetics is shedding light on how trauma affects a person’s health at the genetic level.

Although cells are encoded with a sequence of DNA specific to a gene’s function, the presence of certain DNA does not necessarily mean that a gene will be expressed. The field of epigenetics reveals that gene function may have more to do with how external stimuli “switch on/off” or “turn up/down” the intensity of a phenotype. Environmental stimuli, such as chemicals, substances, or hormones may contribute to harmful gene expression. The ripple effect generated through words, actions, and behaviors influences others' DNA expression – ultimately their health, wellness, and resilience.

Nurses traumatize other nurses. Leaders traumatize clinical staff. The profession has colloquially memorialized this trauma with cliches like “nurses eat their young.” Epigenetically, this trauma may very well be contributing to precisely what leaders try to prevent – sick calls, burnout, poor mental health, decreased productivity, patient satisfaction, inability to meet patient safety goals, etc. Until the pattern is disrupted, traumatized generations of nurses will continue to traumatize others.

Rather than focusing on leadership through the mechanics of capitalism, caring people in positions in power need to re-focus on the impact of their leadership through the continual seeking of self-awareness, self-regulation, and self-transcendence. Understanding purpose, vision, and their own ripple effect may effect change more organically in people they are leading while avoiding inflicting harm on them.

As the nursing profession is re-imagined, it is incumbent upon all nurses to realize individual leadership roles. All nurses need to evaluate what precisely it is they care about, define their vision for nursing, apply mindful modifications, then understand their epigenetic mark on humankind, now and into the future. While genetics are not modifiable, epigenetics are. As a caring leader, you have a responsibility in realizing the ripple effect you generate. How might your leadership theories and styles epigenetically affect individuals and workplace culture? 

As a leader, you are responsible for meaningfully contributing to nurses' health, wellness, and resilience. After all, healthy nurses reinforce workplace culture, environmental safety, patient safety, and quality of care. Epigenetic leadership is a novel theory developed to emphasize a leader's piece of responsibility in nursing health and wellness, rather than placing the onus solely on individual nurses.

Contrary to the hopes we placed on the Human Genome Project, DNA is not as big of a piece of the puzzle in health, wellness, and resilience as previously believed. Rather, epigenetics, or how that DNA is activated by external factors, is one key to understanding the genetic response to stimuli. Just as you are affected by physical, emotional, mental, or spiritual stimuli in your life, so is everyone with whom you come into contact. The ripple effect you generate through your own words, actions, and behaviors may epigenetically influence others' DNA expression -- ultimately their health, wellness, and resilience. As a leader, you have a responsibility to realize the intergenerational ripple effect you generate.