You are a leader now...

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Transition into new roles has always been challenging, especially in the field of medicine. From the need to increase one's knowledge base, to social norms, to living up to the expectations of those around you; transition is affected by many factors. It is crucial to know your strengths, limitations, and personality to ensure that you can be an effective leader.

As a healthcare provider with 18 years of experience, and a strong interest in resuscitation, I thought that I had built a certain level of competency when it came to the active resuscitation of patients who were in extremis. These feelings were validated by those around me. My supervisors, my peers, the provider staff, and my patients and families in my role as a Critical Care Trauma Resuscitation Nurse knew I was a clinically sound, critical thinker, and an integral member of the team. I was considered a leader at the bedside, working amongst many ornery trauma surgeons and being called upon for the sickest of the sickest patients to render care. It wasn't until I became an Emergency Department Nurse Educator where my leadership skills were tested and I learned one of the greatest lessons in leadership.

On one of my very first shifts as an Emergency Educator, I responded to a rapid response for a patient in an outpatient infusion center. My heart was racing from the catecholamine response. This was not because I was nervous about resuscitating a patient, but instead, I was delving into a completely different world of practitioners whom I did not know, and I felt the pressure of being expected to be a leader in an environment of people I was not familiar with. The rapid response was called for a patient who was complaining of some dyspnea after receiving an iron infusion for anemia. The team at the bedside suspected a possible anaphylactic reaction. After speaking to a physician on the phone, the nurse manager was preparing to administer a 1 mg IV dose of Epinephrine 1:10,000. After arriving and assessing the situation I noted the chaotic nature of the room with multiple providers standing at the patient's side shouting. I looked over and noted the patient to be awake, alert, with a patent airway and whom did not appear to be in extremis. I paused for about ten seconds whilst standing at the side of the room watching the medical resident argue with the bedside nurse regarding administration of the Epinephrine. The bedside nurse manager at the time was shouting that the attending who was on the phone provided a verbal order to deliver the drug as the team was concerned for anaphylaxis.

The medical resident was attempting to assess the situation and had a similar question that I had been pondering: Why would you administer Epinephrine 1:10,000 mg IV to a patient who is awake with a patent airway? During the ten seconds of standing there, I knew that this was the incorrect concentration and route of medication from my years of working in resuscitations. I thought to myself several things quickly: Patient is awake and talking, does not appear to be in any distress, no urticaria. The patient's only complaint was feeling uneasy. As I watched the registered nurse preparing to connect the drug to the patients intravenous line and administer it, I stood there trying to rationalize why this drug was being administered. Was there a new protocol I did not know about? Perhaps the team knew something that I didn't know. What if I'm wrong? How confident am I in my knowledge to put a stop to this? I rationalized my ten seconds of ineptness with the fact that the nurse manager was an advanced practice nurse, and that the medical resident was a physician. I thought that if they were willing to deliver the drug, shouldn't I be ok with it? I recalled fearing that I was going to be looked upon as the "new guy who was trying to take over everything" had I stopped them. In the short time that I stood there, I felt nauseated from the catecholamine's surging in my body.

After 18 years of performing resuscitations, here I stood still unsure, even though inside, I was sure this was the incorrect intervention. Instead, I was letting the stature and confidence of others stand in front of me. As I watched the nurse go to connect the bristojet to the port of the IV I shouted, "Hi... I'm sorry, I'm unsure, but can you explain why we're delivering the drug in this manner?" The nurse manager hesitantly restated the fact that they were concerned for anaphylaxis in which I replied that I was concerned that the route of drug and concentration was incorrect. This halted the process and the medical resident agreed with me and the patient was instead given Epinephrine 0.3 mg of 1:1000 concentration intramuscularly. I brought the patient down to the Emergency Department with a lot of self-conflict. I questioned my ability to be a leader as for those ten seconds that I froze. Instead of relying on my gestalt instinctively and placing the patient at the forefront of the situation, I was thinking about all the other bridges I did not want to burn with the in-house staff in those ten seconds. I feared stepping on other people's territory. I feared being wrong. This was a very difficult lesson to learn and I am grateful that I learned the lesson without a poor outcome. My voice in this case, saved a patient from becoming a sentinel event. Over the course of my work I have had a better understanding of my emotional intelligence allowing me to be cognizant of my reactions to situations to prevent this ineptness from occurring again.

To be a resonant leader one must embrace this concept and have a good understanding of how our own attributes play into our leadership styles. Having a good understanding of one's own social awareness and emotional intelligence will help build the type of leader they wish to become. In this scenario, I learned the importance of having that awareness. Just because I can be an introvert, I know when I need to turn on the extrovert side to be assertive in a situation. Having that emotional courage allows me to be more effective in leading my teams.

One piece of advice that I provide to novice nurses as an educator is that they should learn a little bit from each of their preceptors. My hope is that they take a little bit of every strong characteristic that is emulated and formulate their own nursing practice. To do this, they must have a good understanding of what good nursing practice is and what poor nursing practice is. Just as such, a leader must evaluate their own leadership and personalities and understand what areas are able to be strengthened and what areas that could use improvement.

You are a leader now...

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