How to Become a Leader as a Nurse?

  1. I've come to realize (well, I have known for a while but...) that I am NOT a leader. I understand that some people are natural leaders...for better or worse. What I mean by that I have seen people who take on a leadership role, but have no idea what they are doing...but just doing something, because that's what comes naturally.

    Anyway, my issue is that I hate the fact that I am not a natural born leader. I've worked as a floor nurse for 2 years now and have called or witnessed "crisis" situations where Codes or RR are called...and I've had a couple recently. The latest was a Code Red--my first experience as one and although I saw the flame, my mind went dumb and I didn't know what to do. Thankfully, the nurse who actually was the first to witness it put it out before it got any worse. The Code was called just as soon as the fire was put out and a ****load of people came and tried to squeeze in to help. Too many people in a small room and I just backed out and let the rest of them deal with the situation. There was even one nurse who ran from a completely different department and helped more than I did (since I actually work on that floor). All I did was close a couple of pt's rooms nearby, but other than that I pretty much just stayed and manned the station with a couple other people (non-nursing).

    After the situation abated, administration and whomever congratulated everyone for doing a great job, etc. etc. I felt terrible and felt I should not be included in that group.

    This also takes me back to a previous situation I had in which I called RR for a pt of mine. I felt bad that I don't think I did much either. I kept second guessing myself (which I do A LOT, even though I'm quite sure I KNOW what to do) and I understand there is no time for that in a crisis situation. I think having undergone these situations, I'll be more prepared for next time, but I wonder if I'll be able to take a stance and be assured of myself and my abilities...(And as a side note, I've never done CPR on a pt yet, and the idea does scare me...)

    What does it for you? How do you become a leader as a nurse? Does it come natural to you? Do you take initiative? What can I do to become a better leader or gain leadership skills in a crisis situation?
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    About Little_Mouse

    Joined: Feb '09; Posts: 147; Likes: 110


  3. by   Perpetual Student
    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.
  4. by   traumaRUs
    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.
  5. by   brownbook
    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!
  6. by   HouTx
    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'. ( 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" ( 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.
  7. by   jwkwildland
    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.
  8. by   nyteshade
    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.