What does it take to make a good nursing leader?

whipping girl in 07, RN · Nov 22, 2002

I think the problem with nursing management is that most nurses do not know how to manage employees. A management course would be very helpful (and more than the "nursing management" joke of a course I took in nursing school). A real management course. Or at least reading "Management for Dummies." If that book doesn't exist, someone needs to write it! I know my manager needs a lesson in leading her employees. Our unit meetings are such a joke. The last one consisted of us getting a lecture from our manager on all thing things we were doing wrong that needed to be fixed before JCAHO comes in February, followed by our director (yeah, I know, too many chiefs...) talking about how wonderful our new Heart Hospital is going to be. Ugh. We brought up significant staffing problems, only to be told, NO, WE CAN'T DO IT THAT WAY, WE CAN'T AFFORD IT, not even, well, we'll look into it. Now, we have the $$$ to build the new Heart Hospital, buy new "state of the art" IV pumps and new "state of the art" SCDs, but we can't staff an extra nurse without having them "task" to three other units in the hospital so they can share the cost, only to get slammed with a code and a trauma at 3 AM, when it would be easier to have two different nurses without a full load, so they could each take one of these unstable patients. I realize the budget is not each manager's individual decision, but I know they have some say in it. I would gladly, say, pay for my own CEUs if I could go to work in a safely staffed unit every day. I wouldn't mind picking up overtime more often if my manager or director would come in and take patients occasionally instead of letting us run short (or pulling a nurse from another unit who has no clue about ICU).

I just realized this post lists many attributes of a bad leader. So here are some of a good leader:

1) Willingness to roll up your sleeves and get your hands dirty occasionally when things get hairy in the unit.

2) Actually listening to employee concerns and making an effort to do something about the problems.

3) Keeping up your nursing skills by actually practicing them regularly.

4) Telling the truth when you hire someone (not:"We have openings on night shift only," then scheduling you for day shift every two or three weeks)

5) Develop policies about staffing and then stick to them and back the nurses when we try to stick to them.

l.rae · Nov 22, 2002

managing is about being right...leadership is about doing right.

it is ashame because upper mngmt stiffles leadership skills by hounding managers about the bottom line and it does roll down hill! one of my pet peeves about management is when they hound everyone for the sins of a few....l mean like notes all over about..."such and such will not be tolerated anymore".....for cripes sake, talk to the perpetrator/s...that's your job....those notes and lecturing everyone is such a morale buster!.......LR

SmilingBluEyes · Nov 22, 2002

I agree w/ l.rae. we need more LEADERS and fewer MANAGERS.....and we need to SUPPORT those leaders when and if we are lucky enough to work with them. It's a two-way street!

K O'Malley · Nov 22, 2002

A few years ago I had a wonderful manager. Our unit had almost no turnover. He would bend over backwards to accomodate our personal needs and as a result the staff would go all out to work extra in times of crisis. He let us write our own schedules, helped with pt. care when the unit was busy, even came in on nights if we were short. He also had cojones--if visitors were raising a ruckus--to h-ll with customer satisfaction--out they would go. He would even confront docs who were causing problems. Also had a great sense of humor! He was paid far less than he was worth and was eventually snatched up for a non-nursing position with a large company making much better money. What a loss!

Dr. Kate, BSN, RN · Nov 22, 2002

It seems to me that there are so many problems in and confronting nursing (and healthcare for that matter) that there is no way one person could rise to the top and emerge as a leader of a unified body of nurses. The very complexity of our world tends to work against everyone getting behind one leader for very long.

Now, on the matter of management and leaders. I have long maintained that there is a distintict difference between management and supervision. Far too many nursing managers think that by getting an MBA they have learned all they need to run an organization. Most managers have very limited experiecne in supervision and directing the activities of other people on a day to day basis.

One of the great loses in nursing (IMO) is of the traditional Head Nurse. The person on the unit who provided the day to day oversight of the staff and the care being delivered. The HN was there to lend a hand, to run interference with administration, physicians, and patients and families, and the ancillary departments. Those HNs sometimes stayed where they were for their entire career, others went on to become area or department managers, Asst. DONs, DONs, and in one place I worked the hospital administrator (cf. CEO.)

I think nursing and healthcare are struggling to find a flexible, adaptable model of management that will work in the ever changing climiate of the 21st century.

oramar · Nov 22, 2002

Boy Dr. Kate you said a mouth full. The old style head nurse had one foot on the unit and one in managment. Upper level managment had some idea of the realities of nursing at unit level because the head nurses told them what was going on. Now they call them unit managers, they usually manage several units. Mostly spend their time at meetings. I really suspect that is the way upper levels of managment want it. They want to wheel and deal and they don't want any info from the real world raining on their parade. They consider real world info back talk or complaning.

sjoe · Nov 22, 2002

You might want to read Rudy Giuliani's new book "Leadership," for some basic components.

There will be no one national nurse leader, but as you have no doubt noticed, leadership is all but completely absent in most nursing and healthcare environments, which, by default, puts the bean-counters in charge.

ceecel.dee, MSN, RN · Nov 22, 2002

What does it take? Nerves of steel, objectivity, the perfect combination of flexibility and consistency, kindness, assertiveness, endless energy, tact.....just to name a few.

Can be a thankless job...can never make everyone happy....torn by serving 2 masters, nursing staff and administrator.

Not for the faint of heart! God bless ours!

mario_ragucci · Nov 22, 2002

Really? To be a nursing leader, you have to be able to move quickly if needed and have power communication skills.

kmchugh · Nov 23, 2002

This is a problem that I have spent time thinking about. I don't generally like the term "manager." As pointed out by ERN, you don't "manage" people. They must be led. Leading implies the leader is out front.

Look at the model used by all the branches of the military. They understand that leaders are not born, they are made. They are trained to become leaders. In every branch, should you decide to make the military a career, you will be promoted to leadership positions, owing to an "up or out" policy. But, the military does not promote a soldier, then throw that newly minted leader (sergeant, lieutenant, etc) to the wolves. Before assuming a leadership position, that soldier attends leadership training schools. And at each new level, there is a new school to teach leadership at the level the soldier is about to enter.

Contrast that with nursing. If a nurse wants to become a leader, s/he applies for the position, gets the position, and is thrown into the mix. Today a staff nurse, tomorrow a shift supervisor. Hopefully, s/he will be mentored by another, more experienced supervisor. S/he will make a lot of mistakes, and will learn the position through hard experience. And most often, the employees suffer for the mistakes of the new leader. It is a cycle that repeats itself as the nurse climbs the "management ladder."

What makes a good leader? Lots of things, small and large. Ultimately, a leader has two responsibilities: Accomplish the "mission," and take care of the people. Usually, if the people are taken care of properly, the "mission" is taken care of by the people. So, what qualities go into good leadership?

-Set high standards, and expect the people to meet them. Don't expect them to meet those standards magically, get the appropriate training for your people in order to help them meet those standards.

-The leader must not only meet the high standards s/he sets, but must exceed them. Never ask an employee to do what you yourself will not or can not do.

-Make sure employee needs are met. In the military, this is expressed as "a leader never eats until all the soldiers have had the opportunity to eat." Get your people lunches, breaks, etc. Get the people to work together on scheduling, so that when a nurse needs off for personal reasons, that need can be met.

-Protect your employees. Fight to ensure that upper management does not impose impossible or stupid conditions. Remind upper management of the two goals of leadership.

-Never let employees see you fight with upper management. That's done in private. You must speak with one voice.

-Never reprimand an employee in front of others. Reprimands are a private affair. Rewards are to be given publically.

-Never forget that employees are human, and humans make mistakes. Do not set up a zero defect environment, because no one, not even you, will ever live up to the standard. Use mistakes as opportunities to teach, rather than opportunities to punish.

-Never punish the whole for the actions of one, or a few.

-Above all, be FAIR. A leader can have no favorites. The same standard applies to all, except the good leader has a higher standard for self than for the employee.

-Catchwords: Knowledge, courage, focus, fairness.

The list could go on and on, but I think I have painted a pretty good picture. Its a shame that budgetary restrictions force nursing into a "sink or swim" policy. A good hospital would develop its leadership, so that the new leaders would not feel thrown to the wolves. New leaders would know the basics of leadership, and be expected to apply those principles. New leaders would know they were supported. And employees would know they were protected from the mistakes new leaders would be bound to make.

Kevin McHugh

ERN · Nov 23, 2002

I read great insight and wisdom born from experience in the above threads. Unfortunately, I also see the same laments from nurses who no doubt have repeatedly been exposed to the same poor leadership behaviors from those who are suppose to be our colleagues. I also see evidence of the strong pull to leave nursing if one's leadership talents are evident and not rewarded. This is a theme that is seen over and over in nursing.

One of the threads on this site is entitled, " Nursing alternatives". The working environment of clinical nursing is very bad in some areas. I don't think I will get any argrument to the contrary. But is that the real base reason we are leaving nursing? If we can express cogent and experienced based leadership attributes that we need and desire in nursing, why don't we demand them. Is nursing leadership any different than any other form of leadership? Are we so burdened with our own historical baggage that we can't change? Can the cyclical nonproductive leadership practices be the result of societal pressure to remain a "feminine profession"; polictical and economic forces to keep nursing a noncompetitive heath delivery system, nonprofessional self image, lack of a professional will? So far the response to this thread has leaned towards those aspects of leadership at the beginning or midlevel "manager". What of our national or international leadership? Can't we as intelligent, thoughtful, and dedicated health practitioners speak with one voice and use our own identity to lead ourselves to a better future?