In offering the charismatic Beverly Malone the job of general secretary, the RCN may have, at a stroke, gone a long way to countering its reputation as a risk-averse, cautious and conservative organisation.
If her track record in the US is anything to go by, the theatrical (by UK standards) and ultra-professional Ms Malone could signal not so much a change of approach in the way the RCN is managed as a cultural revolution.
She is a master of the quotable phrase. It is likely the nursing profession will take a little time to acclimatise to a leader who does not shy away from making statements like: "We all need to start thinking about acquiring a taste for chaos."
The appointment of a black American woman to one of the biggest trade unions in the UK would be unprecedented. It is, in NHS cultural terms, a move not dissimilar to the appointment of Sven Goran Eriksson to the job of England football coach.
Ms Malone has a reputation as America's "top nurse". She is politically influential - most obviously as an adviser to former US president Bill Clinton - professionally experienced and has an extensive grasp of health policy.
But it is, perhaps, her approach to leadership which will cause the biggest ripples throughout the NHS. She is a fluent and witty speaker, radical and unafraid to speak her mind, often in a folksy, un-British "inspirational" manner.
"To hear Beverly Malone speak is to come away with renewed nursing pride and with a missionary zeal to harvest the 'best and the brightest' into the profession - now," says one nurse, writing on an American nursing website.
A former psychiatric nurse, Ms Malone's CV is a lengthy story of professional and academic success, topped off with a spell as president of the American Nurses Association (ANA) and a year as deputy assistant secretary at the US Department of Health.
Despite being an "outsider" - she is not registered as a nurse in the UK and reports suggest she may face problems getting a visa to work here - the issues that she has majored on in the US are remarkably similar to those faced by nurses in the UK.
On professional issues, she is an advocate of extending the medical role of nurses to take on more of the work currently done by doctors, and of raising professional standards by supporting degree-level qualifications for nurses. She is a fervent believer in personal and professional development (often expressed in a guru-ish motivational style), she supports whistleblower protection for nurses, is big on health and safety in the workplace and on workplace rights. On wider health policy issues, she is a firm believer in patient (or in US terms, "consumer") centred care, the need for government to regulate health markets, and the need to ensure clinical decisions are made by clinicians rather than accountants.
Ray Rowden, a nurse and RCN activist, has been critical of the way the RCN has handled the appointment. But he welcomed the possibility Ms Malone might come to the UK. "She's absolutely brilliant," he says.
