What does it take to make a good nursing leader?

[ERN]

As I looked through various topics and countless threads, one concern that many of us voice is how that "Old Demon" management treats us. I have been a staff RN, charge RN, manager, and project leader and was exposed to some of the best and worst in leadership. A wonderful person once told me that, "You can manage livestock, but you have to lead people." She told me this at a time when I was in sore need of improving my talents as a leader. I feel that nursing desparately needs a singular figure, someone to unite and focus the power that nurses possess but let others use at will many times to the detriment of nursing.

What are the attributes of a really good nurse leader?? One that can give us direction and a vision to lead us into the future of nursing? :)

[Q.]

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?

To a point I think nursing leadership is a bit different, only in that we have no power. We have no power as staff nurses or as managers. Ultimately, even the highest level exec nurse in the hospitals are not heard. Plain and simple. The concern with the hospital does not lie with nursing. There is only so much power and authority that really is with the VP of Nursing. We as staff nurses may think it's a lot, but it most likely isn't. At my former employer, they are laying off RNs and replacing with MAs. Our VP of Nursing is dead-set against this. Has it been stopped? Nope. Her concern was noted, but the administrative decision went through anyway. So in that regard I think nursing leadership is different than other forms of leadership.

I also think because in general, our profession is undefined. Even on this BB, we have nurses who think the key issues of the profession are educational standards and professionalism; others think the key lies in having skilled people perform bedside care. We can't agree on the focus of our care - is it technicolgically based? A quasi-medical model? Some would say yes. Is it about providing something different entirely? Is it a healing profession? Should we work on getting more nurses into bedside care, using whatever it takes, or should we institute a BSN minimum requirement and let our profession evolve to something more competitive with other college level disciplines? What's the right answer?

I think the problem with nursing leadership is that we as nurses can't agree on nursing's priorities either in the short or long term. Hence, nursing leadership will always be ineffective, imho.

[baseline]

Originally posted By SusyK:

QUOTE] I think the problem with nursing leadership is that we as nurses can't agree on nursing's priorities either in the short or long term. Hence, nursing leadership will always be ineffective, imho.

I don't always agree with you Susy.....but I'm with ya here!

[ERN]

Susy k and baseline

I think the problem with nursing leadership is that we as nurses can't agree on nursing's priorities either in

the short or long term. Hence, nursing leadership will always be ineffective, imho.

To a point I think nursing leadership is a bit different, only in that we have no power. We have no power as

staff nurses or as managers.

So.....We are doomed to failure by our own inability to lead ourselves towards a new mind set and value system that places a priority on the evolution and survival of nursing. Is that what you are saying Suzy k? We are 2 1/2 to 3 million strong, educated from diploma through doctorate, exposed to every level in society, and held in high esteem by society. Yet, we are powerless to change? Why aren't we heard? Why are we silent?

[Q.]

Originally posted by ERN

So.....We are doomed to failure by our own inability to lead ourselves towards a new mind set and value system that places a priority on the evolution and survival of nursing. Is that what you are saying Suzy k?

That's precisely what I'm saying. How can we have a leader of nursing if we can't agree on what that leader should lead for? Since we as a profession haven't determined our priorities or defined ourselves, the medical profession has. By and large, we follow in their footsteps and are subject to the desires of the dominant medical community.

Yes, we are valued in society, in theory, but if we were truly valued, we would be paid more. Pay, in my opinion, is a reflection of what society values. The computer industry is paid well; car salesmen are paid well; physicians are paid well. Nursing? Well, not seen as a distinct function that we can't live without. Yes, there are studies that show that less nurses on staff equal worse patient outcomes. Does it matter? No. I feel that because nursing has failed to define itself, we have been defined by the medical community (and others) as following orders and providing pyschomotor skills. Nurses in our very own profession define nursing by what we do - SKILLS wise - and nothing more. Therefore it's only a matter of time before we are replaced completely. Afterall, if we don't see ourselves as providing something greater than IV starts, assessing strips, adjusting meds, then we are comdemning ourselves to a profession that is not unique and does not provide a unique service that can only be provided by us. IV starts, assessing strips and adjusting meds can be done by a non-nurse, and they are done by non-nurses.

And yes, we are the single largest professional workforce in America. We have strength in numbers. But we can't have strength if we can't agree on what it is we want for the profession, for now, and in the future.

[Stargazer]

Excellent posts, Susy. I completely agree.

[rebelwaclause, ASN, RN]

Originally posted by konni

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.

#6...Mandatory ongoing Management training.

Good post Konni.

[ERN]

That's precisely what I'm saying. How can we have a leader of nursing if we can't agree on what that leader

should lead for? Since we as a profession haven't determined our priorities or defined ourselves, the medical

profession has. By and large, we follow in their footsteps and are subject to the desires of the dominant

medical community.

Then why are we silent? Why are we silent as staff nurses? Nurse reseachers. Nurse executives. Nurse educators. It seems to me that nursing has allowed the political manipulation that has given the medical community the power to define what we do. As you well know, our economical value is robbed, controlled and manipulated by hospitals, payor systems, MD's, and even narrow minded nurses. How many posts are there on this site that highlight situations where a nurse is asked to work (late, extra, on call, more weekends, holidays etc) without pay, or reduced pay, or for comp time by their nurse manager. $50,000 X 2 1/2 million nurses is alot of economic power. Is that how you see nursing, as a set of semiskilled tasks that anyone can be taught. Why are hospitals and private companies getting into the nurse agency/travel business? So they can continue to control the access to and economic value of nursing, thats why. Why do we as nurses INSIST on others controlling our profession. If a group of physicians feel that they are being mistreated or not given enough priority, they have the economic power to be heard. Case in point, trauma, ortho, OB-GYN surgeons are leaving my region because of outrageous malpractice fees. There is no political will to change this right now. But as soon as it has enough community pressure behind it, legislators and insurance co's will change the dynamics in favor of the MD's. Who will replace them if they leave?

Who will replace nurses if they leave because they have lousy work environments, flat income progression, disrespect, poor leadership. Yes, I agree, we have allowed other lesser licensed, and nonlicensed persons take over our skills. Hells Bells, we have even encouraged it and supported it by allowing mutiple levels of entry with same licensure so our economic value in a degree conscious society can be downgraded during nurse shortages.

Aren't these just a few of the points in nursing that we can all agree on and act towards resolving Single entry level, control in the numbers of nurses practicing, control of the value we produce as nurses. I don't know about you, but I find it less than professional to be included in the room rate, yet expected to be the darling of society. It is time to lead and I don't agree with you that we have such a weak identity that we can be replaced by anyone ( and are ). Yes, absence of well educated, skilled, and experienced RN's at the bedside results in poor pt outcomes. Who will replace them?? Technically oriented aides with computerized data collection? More doc's at the bedside?? PA's acting as nurses? Managers? Sadly, it may take a critical ABSENCE of nurses to the detrement of society to affect a change. Or are we as nurses without the spine to change for fear of loss of our subservient image. When a nursing shortage occurs, AHA, state legislators, AMA, ANA, unions all work together to pump out more nurses, usually LPN's & ADN's to maximize numbers in the shortest possible time frame. No wonder BSN programs are shunned by prospective students. How can we attract people who want a self governed and professional practice. Imagen if that senario were the norm for medicine, law, education, engineering. Take a look at what Physical Therapists have done. I agree with you in one sense.....We have set up ourselves to fail by allowing everyone else to practice nursing but nurses. By not controlling the money we generate in our practices. By not controlling entry into the field. And by letting others make our decisions for us by not leading ourselves.

[baseline]

How many nurses belong to an active nursing organization? How many belong to the ANA? Its expensive.....its also taking control...like voting. If every eligible voter in the USA voted. How different would the outcomes be? Same for nursing. Join, and complain where it will do some good..... set some definition to our practice.......make a statement and make it count.

[ERN]

baseline

I agree, participation is critically important.

What prevents or discourages nurses from joining ANA or any active nursing organization. You say it's expensive.....More expensive than giving away control of your practice?

[Q.]

Originally posted by ERN

What prevents or discourages nurses from joining ANA or any active nursing organization. You say it's expensive.....More expensive than giving away control of your practice?

Again, because most nurses don't agree with ANA agenda items, such as BSN requirements, etc, therefore don't join.

On a separate topic: the majority of nurses here who spoke out on the topic of vet nurses (here: in this thread) didn't have a problem with this. It's my opinion that this is the "larger picture" I was speaking of. The ANA (and most recently the Penn ANA) has been working to stop this. If nurses don't even agree with it's position statements, why would they join? So, they don't join, and we have the lack of one voice we so desperately need.

[ERN]

I see your point Susy K. So why do nurses remain passive and take what comes. I can't believe that there aren't 3 solid issues that concern all nurses that would immediately improve the profession. I'm not talking about whether a vet tech should be called a vet nurse. Although I realize you are using that thread as an example of disunity with nursing leadership. That(vet nurse) has little to no immediate impact on nursing. Something with substance like nurses charging for their services, complete nursing control over all education leading to a license, consolidation of requirements for entry into nursing are much more important. Certainly other professions control their practice in this way. Yet a distant and seemingly detached "organization" or group represents nursing to the public and "leads" nursing. Who decides what is important to nurses? You & me?.....or are we so fractionated and polarized that we can't develope a simple and clear agenda and move forward. Why don't nurses join and change the leadership of ANA if they don't agree the the position statements? Isn't the good of the profession more important than the needs of a few people?

[Q.]

You ask some hard questions, ERN. I myself am not a member of the ANA. Why? Well, I don't know. I seem to agree with most of its position statements, so why don't I join? Most likely apathy. I love being a nurse, but I feel like until someone, whether that's the ANA or whomever, comes along and simply forces a few changes, then we won't have any progress.

People and organizations force changes all the time, and we as nurses take it. So why can't the ANA simply force a few things? Most likely, we'd take it anyway, as we always do. As you've stated, most nurses are passive and take what comes. But could that be the problem? Is the ANA reluctant to make such a move, like having BSN be the minimum requirement, because they are inherently passive?

You know, despite the fingerhold that the AMA has on us, there is much we can learn from them. The AMA wasn't always as influential as they are now. Physicians weren't always respected; in fact, when medical education started in the US, it was a disgrace. Finally the AMA hired an outside organization to evaluate the quality of their schools, took their recommendations, and closed over half of them. The physicians sitting on the AMA were totally against closing what was their alma mater, but the AMA did it anyway, and as a result we have what we have today: standardized medical education, degree requirements, and respect.

I don't know the answers. But your original thread question of what it takes to be a good leader? Well, I guess it depends. Perhaps a good leader in nursing has to assume a more paternalistic role, and simply initiate changes based on the "it's good for you" mentality. We as nurses take it anyway, so why not try it?