Who ARE the LEADERS in Nursing???

Trauma Columnist · Mar 12, 2004

The overwhelming emotion I felt reading your post was your frustration. Is it your institution? Your specialty? Nursing? Maybe a change is needed for you. Life is too short to be unhappy.

Repat · Mar 12, 2004

lee1 - I, too, hear your frustration. And, I agree with you. The "Head Nurse" used to be seen as a dragon, demanding things be done right, but also sticking up for her staff who got things done right. No such person anymore. But, the thing I always think about is that those of us who feel this way are obligated to keep on, and maybe try management (boo, hiss). But think about it - the complaints are always focussed on how management hasn't been in the trenches, is so removed from real life that they are a joke, etc. The answer - some of us in the trenches work from the inside and see if we can change things. There are no leaders in nursing at the moment - I lived in Britain for 15 years, and the head of the Royal College of Nursing was in the news almost weekly. But, because it is a national health service, nurses represent a huge unified workforce by nature of the fact that most of them are employed by a single employer (although they are trying to change that). We don't have that cohesiveness, and that's to our detriment. We all need to get active, not sit back and complain that no one is doing it. Even little things are a start - write letters to the editor about anything that may come up in the news. The other day there was a letter in our newspaper concerning an article I hadn't seen, but the letter got the point across. Apparently, the article talked about some patients seeing a nurse practitioner for a condition. The letter writer said that the article had spoken about the nurse practitioner numerous times, but had never used her name. She continued that the practitioner had studied 6 years to gain her expertise, and the least the paper could do was to honor her with her name being published. Got the point across!

orrnlori, RN · Mar 12, 2004

The administrator of our division in the hospital started out as a nurse, then obtained a JD and MBA. He attends some meetings and speaks to us from times to time, when we voice complaints-concerns, he writes them down dutifully, however, I feel that getting onto a piece of paper is as far as any notations go. He is a lawyer through and through and beholding to the university administration. He is no nurse leader and has long forgotten anything about what we do in the trenches. I feel this is the future of nursing administration, at least where I work. For all the lofty goals one is taught in upper division nursing classes, nursing leadership is pretty much relagated to lower level management and nursing education. Business is business and the two are not compatible in today's healthcare despite lip service to the contrary.

lee1 · Mar 13, 2004

The overwhelming emotion I felt reading your post was your frustration. Is it your institution? Your specialty? Nursing? Maybe a change is needed for you. Life is too short to be unhappy.

Is yours better? I have been on a very political committee in the hospital for the last few years (practice committee) and therefore have seen first hand my frustrations. Trying to change/challenge the system that is NOT working for us is what we need, not to run away. Most nurses still just do their jobs as they have no energy left to think beyond.

Just asking for opinions.

lee1 · Mar 13, 2004

But, because it is a national health service, nurses represent a huge unified workforce by nature of the fact that most of them are employed by a single employer (although they are trying to change that). We don't have that cohesiveness, and that's to our detriment. We all need to get active, not sit back and complain that no one is doing it.

Dear Repat,

How did the system work with one national empoyer? What were the downsides to such a system? Do you feel that being hired by an individual hospital and then trying to work your best under your standards of care that may be compromised by the hospital's current budgetary crisis (which is perpetual it seems, but then have you seen THEIR salary and bonuses--the top CEOS including nursing) is better? I do personally feel that a unionized environment is better as in 35 years of critical care nursing I have not yet seen in the 8 hospitals I have worked at a nursing leader who does stand up and do the right thing. Although let me rephrase that as in the beginning of my career it WAS nurses and MDs who ran hospitals and THEY did the right thing for the patients it seemed in my memory. Now that it is big business only the budget seems to mean anything.

Repat · Mar 13, 2004

lee1 - You are so right about doctors and nurses running the show - it was better. Level playing field - doctors did not stand to make major money by running a corporation. I do think that makes a difference. However, as I said they are trying to change the NHS to be more of a "market oriented" system, and people are leaving. I have a good friend who was an anesthesiologist who has left because she felt that things were deteriorating as far as safety is concerned. I believe in the strength of numbers, and I believe that a strong union (or, professional organization - look at the power of the AMA) is important. I guess I lean toward a professional organization because it would avoid the split between "management" and "staff", and, hopefully, begin to emphasize nursing concerns. There have been many studies conducted as to increased positive outcomes and better ratios, and the cost effectiveness of an effective nursing system. We need to make our voices heard in a collective way. But, I guess I could write a book about it. The downsides of working for the NHS were the same as working for any other enormous institution (think VA). Not much flexibility or individuality. Lots of bureaucracy.

sjoe · Mar 13, 2004

Can you name me 1 person who stands in your memory as a true LEADER in Hospital Nursing? I am finding it harder and harder as they all seem to be cowtowing to the CEOs that run the hospitals. There seem to be NO Generals (true leaders)anymore, SOOOOO what is the point then of Nursing leadership????? They seem mostly to just sell us down the river. Cut positions, replace with unlicensed, increase ratios, etc. etc. Are their salaries and bonuses so important that their ethics have been totally compromised???
Why then should we work FOR hospitals as RNs. Maybe it is time to find another way?????
Lee

This is true not only in hospitals.

Effective leadership of ANY kind and at ANY level seems to be rare-to-nonexistent in healthcare organizations in my experience. Why? Because the workers are so busy carping, griping, undermining, and attacking each other that they don't understand the simple fact of the overall lack of direction, support, and organization of the facility.

By the same token, it is this very lack of leadership that creates a situation where this kind of carping, etc. becomes the norm. If this atmosphere exists in your facility, that is a clear marker for absence of effective leadership. When people are not headed in the same direction, when there is no leader, they tend to start chewing each other up.

No one is in charge and accepting complete responsibility for the future and daily operation of these facilities. No one is providing and supporting a vision that is effectively motivating for most of the workers. No one is "enlisting the willing cooperation" of the members of the facility--all these are just the basic fundamentals of leadership.

Few even understand the concept of leadership, IMHO, much less do they have any experience, skills, talents, or even training in that area. Small wonder the "industry" is in such a mess.

Repat · Mar 13, 2004

Thanks, sjoe! You said it! So, how to change?

sjoe · Mar 13, 2004

Thanks, sjoe! You said it! So, how to change?

1) re-read my post, since I edited it again.

2) read a LOT of books on leadership (and you could do worse than starting with Rudy G.'s recent book "Leadership"), effective management (the Dummies series has several good ones on management and leadership for starters, and contains many ideas for further references and learning). But don't go overboard on reading--10 good books will be enough to understand what these people are talking about.

3) look around and see what is really going on in your facility, with those ideas in mind. Which ones seem best bets for your situation?

4) be aware of what kind of environment motivates YOU to do an excellent professional job, and actually think about what motivates others near you to do the same thing (the details will be a bit different for everyone, but the same general atmosphere will be effective for most people).

5) be aware that perhaps 5% of people will NEVER be motivated to do an excellent job no matter what, so don't get bogged down trying to find the "key" to them. They need to leave anyway.

6) based on all this learning, research, practice, experimentation--begin to treat your situation in such a way that more functional behavior is likely to increase in your workplace. Make verbal or written suggestions and/or offers to supervisors and management on how to actually and measurably improve the situation. Keep track of what happens. Was the suggestion accepted? Was the implementation adequate? Was it effective? What would make any of these steps more effective? Etc.

7) unless you are the CEO, you will not be able to "fix everything," at one fell swoop (and not even then, BTW), so don't expect to. Accept promotions ONLY when you are reliably guaranteed the support you recognize is necessary to perform these management tasks effectively. Spell all this out at the promotion interview/offer (which means you will have already done your homework and will KNOW what is required).

8) know "when to hold 'em and when to fold 'em." Know when to move on when you can no longer be effective and/or your interventions simply make things worse because of the negative reaction AND lack of support from supervisors. No point in burning yourself out for no good end (particularly since to do so is only an indication that YOU don't know how to take an effective leadership role in your own life, just as your past managers haven't known what they are doing in the workplace).

9)then decide whether you need more formal or informal management training. If so, get it. Be a member of a sports team and pay attention to what are winning and losing strategies. Notice, watching sports on TV for example, how losing teams seem to be those with frequent member changes, negative feedback from coaches and owners, low morale, mutual backbiting, etc. Be aware that these are causes, not effects. Shop carefully for your next position so you don't wind up in a similarly frustrating and dead-end situation.

So, off the top of my head, those are the suggestions I offer.

Repat · Mar 13, 2004

Fabulous!!! I will reread these when I have time, and get started. Every shift I go in with your saying about only getting what we take - Thanks for some more great suggestions!