How to Become a Leader as a Nurse?

Perpetual Student · Jan 23, 2012

I wouldn't say I'm a leader, but I've received compliments for actually doing something when things go sideways. Some folks (even experienced ones) kind of freeze up and hesitate for a moment, particularly when it's a sudden and unexpected change. I'm one who generally jumps right into action without hesitation. I'll try to explain my thinking and how I avoid freezing up. The key in an emergency like this is team work. No one person can optimally manage a true emergency alone.

One model for decision making is the OODA loop (PALS has a modified version in its curriculum). In decision making you observe something, orient yourself to it, decide what to do, and act. The quicker you get from observing something (say low SpO2 and unresponsiveness) to acting the better off you're going to be. The best way to decrease that time is to consider what you would do in various scenarios. For example, know what you're going to do if your patient stops breathing. When you see the patient stop breathing don't think, just do what you've already programmed yourself to do. Thinking through how you'll respond to various emergency situations is one of the most important things you can do.

Always expect the worst and prepare for it. For example, if the patient's respiratory status is rapidly deteriorating it would be prudent to provide him with more O2 and prepare a BVM along with all the other interventions. Sure, you might not actually use it if less aggressive interventions (e.g. stimulation, repositioning, reversal of drugs such as paralytics or opiods, etc.) are successful, but it's better to be ready.

Intervene early and aggressively. If something's not right fix it before it becomes a disaster. For example, if you notice a disturbing trend in your patient's VS reacting early on and preventing it from turning into a code is ideal.

Don't be afraid to tell others what they need to do, esp. if it's your patient. Coordination is important. Someone needs to immediately assign roles.

Don't worry about looking like an idiot and allow it to paralyze you. Do your best to do the best thing for the patient. It's not about you, it's not about your coworkers; it's about the dude in the bed.

ETA: does this topic really belong in this subforum? It's less about formal leadership and more about how to take charge during emergencies.

Trauma Columnist · Jan 23, 2012

I think this will come with some experience: don't be too hard on yourself.

Above comments are great. You might also talk these situations over with an experienced nurse that you admire.

It will get easier. Remember, your pulse should be slower than then the pts! Take care.

brownbook · Jan 23, 2012

I love your question and the responses are life savers! OODA is going to be posted on my locker at work. i also freeze in emergencies. I think my initial response to emergencies, for example code blue, is, Oh my gosh, panic panic, what is that arrhythmia and what dose of what drug goes with it. My initial response to fire drills is trying to remember what RACE stands for. My mind gets stuck, obsessed, over what I can't remember and I freeze up! I like OODA better than RACE and even some ACLS nemonics!

HouTx, BSN, MSN, EdD · Feb 16, 2012

OP, you cannot change your personality. There are all sorts of leaders. Not all of them are take-charge, in-your-face people. Some are more thoughtful and soft spoken but that doesn't mean that they are not effective. Great leaders are people who can inspire others to believe in a shared vision. Responding quickly to emergency situations is not a test of leadership... it is a test of technical know-how & confidence.

I would like to encourage you to do some self exploration. Start with 'Now, discover your strengths'. (Amazon.com: Now, Discover Your Strengths (9780743201148): Marcus Buckingham, Donald O. Clifton: Books) I use it in leadership development programs. It's a quick read that also includes a self-assessment tool that you can do online. I love this book, because it really helps you identify what's 'right' about your own personality and points out the most effective ways to deal with others.

I would then urge you to establish a mentoring relationship with a nurse leader. If your organization does not have a formal program for this, then arrange it on your own. Seriously - most leaders are very flattered to be recognized for their talents and happy to help others develop. There's a neat little book called "Connecting: The mentoring relationships you need to succeed" (http://www.amazon.com/Connecting-Mentoring-Relationships-Need-Succeed/dp/0891096388/ref=sr_1_19?s=books&ie=UTF8&qid=1329425216&sr=1-19) that is a great guide to beginning this process.

Finally, if you do not have a graduate degree, go ahead and start moving in the direction of your MSN. This process will help you develop confidence as you increase your skills and knowledge.

jwkwildland · Feb 17, 2012

I would say you just lack confidence in yourself. leaders are not in fact 'born' there is no specific gene for it, or im just ignorant of it.

find that confidence, and those things/people that push you into lacking it,

then minimize the confidence-diminishing by

boosting your knowledge of leadership types (yours will be specific to you and a hybrid of many),

knowledge in your field,

knowledge of your abilities,

and exercise (at least i think it helps me)

when you see a good leader, ask yourself why do I think he is a good leader?

or a bad leader. then utilize what you have identified.

Do some reading into how the military builds leaders. be sure its written by a good source. i have seen all types in my old line of work.

nyteshade, BSN · May 29, 2012

OP, I think you will feel more empowered if you seek more training. For example, your charge or supervisor can let you know what your exact role is in a code red. See if you can sign up for classes on advanced assessments, emergency response, etc.