Nursing leaders are sorely lacking among the top managerial ranks at many skilled care operators, a new survey has found.

Respondents noted that only about 46% of nursing facility and home health agency leaders indicate that their organization has an executive with a nursing background. And just 32% of those leaders have a designated nursing leader whose primary responsibility is innovation, according to the study, unveiled Monday by BDO and the University of Pennsylvania School of Nursing.

Experts noted that these gaps will be a huge impediment as nursing facilities look to innovate and address industry challenges.

“By not elevating nurses to the leadership levels needed to fully transform care, the industry is missing an opportunity,” Karen Meador, M.D., managing director and senior physician executive in the BDO Center for Healthcare Excellence & Innovation, told McKnight’s. “Too often, stakeholders in the health system leave nurses completely out of the process — much to their own detriment.”

About 85% of clinical leaders from nursing facilities and home health agencies indicated that placing nurses in decision-making roles on all strategic planning teams will be “very important” for their organization by 2025. Specialization in adult or geriatric health, administrative and systems leadership, chronic care coordination, and mental health were ranked as the top four areas in which nurses have the most opportunity to transform care, leaders said.

BDO and UPenn produced “Unleashing Nurse-Led Innovation” by interviewing 104 clinical leaders and 172 business leaders across various healthcare segments.

“Nurses don’t necessarily see themselves as innovators, but they are problems solvers. We need to help elevate nurses for their good work, and this includes innovative solutions that they come up with,” said Amy Stewart, RN, vice president of curriculum development for the American Association of Post-Acute Care Nursing. “When nurses are involved in the decision-making, they are looking at the solution from a care delivery point of view,” she added.