Running head: WHAT DOES IT TAKE TO LEAD?
What does it take to lead?
Thomas Robinson
Ferris
Leadership in Nursing
NURS 440
Eppie LaBiche RN, MSN, MBA/HCA
May 29, 2012
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WHAT DOES IT TAKE TO LEAD?
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What does it take to lead?
Nursing has been established as a dignified career for generations. The climb to such
status has been a thorny ladder riddled with professional jest and disrespect. Those who have
chosen such a path, and remain with nursing as a career, note that the professional balance lies
within its boundaries and the discipline of maintaining the knowledge, education, and clinical
expertise that dictates that nursing get the respect it deserves. Nursing leaders and managers are
subject to codes of conduct and guidelines of ethical considerations in patient care. In keeping
with the tradition of caring for others, balancing a budget, maintaining a schedule for proper
patient to care-giver ratio, what does a leader do to maintain their sense of leadership? Is it
simply the position so deemed by those who have placed them there that mandates the respect of
those who they reign over? I propose the question of whether or not it takes a nurse to lead a
nurse.
Nursing is a profession based upon knowledge, experience, continued education, ethics,
commitment, and most of all caring. The American Nursing Association describes nursing as
“the protection, promotion, and optimization of health and abilities, prevention of illness and
injury, alleviation of suffering through the diagnosis and treatment of human response, and
advocacy in the care of individuals, families, communities, and
populations.”(http://www.nursingworld.org) Respect and participation by those who are affected
mostly by their leaders are characteristics earned by the demonstration of these qualities. The
nursing leader that sheds their naivety and recognizes that a blind ignorant role will cultivate no
nursing knowledge or growth is already better than their predecessors.
WHAT DOES IT TAKE TO LEAD?
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Indulge if you will the evaluation of John. John is a manager of a well-established
Cardiac Catheterization Lab with approximately forty employees ranging in qualifications from
R.C.I.S. to R.N to E.P. (exercise physiologist), all which care for patients in the same setting and
under the same circumstances which is the procedure area. However, within this Cath. Lab is the
recovery area. The recovery area has eight R.N.’s and five nursing aides and is separate in that
they work only in the recovery area of twenty-four beds. John is the manager of the recovery
area as well as the Cath. Lab, however; the recovery area is a nursing unit not a procedure area.
John has a degree in exercise physiology and extensive experience working in an E.P. lab in the
past allowing him the ability to effectively manage a procedure area that demands budgetary
restraints and personnel costs. The multi-million dollar budget of the Cardiac Cath. Lab has its
demands, as does its staff with on-call policies and physician demands. John worked as a
clinical supervisor in the E.P. lab prior to being anointed the Cath. Lab manager in his ten years
prior, and this all occurred at the current facility.
John’s job duties include department budget maintenance and new product evaluation/
purchase. John maintains payroll for Cath. Lab and for recovery department. He attends
meetings with nurse educators and nursing leaders throughout the hospital to discuss procedure
and policy implementation that involves Cath. lab and recovery department. John also is
responsible for disciplinary actions as well as professional evaluations that occur yearly of all
staff. John is the medium through which physicians speak their needs. He is the final step for
purchase of new items, removal of old items, implementation of new policies and procedures,
and the creator of rules and regulations for Cath. Lab and Recovery Room as well as the final say
on education and conferences. John also has no nursing experience, nor does he want it.
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In the hierarchy of the hospital, John reports directly to Fred. Fred is the Director of
Cardiovascular Services and is one rung higher than John on the ladder of bosses. Fred’s career
history is still a mystery at this point; however he has been in this position as long as John has
been the manager of the C.C.L. and recovery room. The one thing that is also true of Fred is that
he has no nursing experience, nor does he want it. Fred is a pharmacist.
Different careers and educations bring different lights to challenges being overcome and
that is one potential benefit to having several qualifications in positions of power working
together on a common task. Objectively, that would be opportune.
Consider also the following which is Bill and Sue. Bill is the Clinical Supervisor for the
Cath. lab recovery area, and Sue is the educator for the Cath. lab and recovery area. Both Bill
and Sue are nurses. The staff will usually follow a chain of command from themselves to either
Bill or Sue, which then filter out the concerns and bring them to John who can bring them to
Fred if necessary. The concern is that some concerns are being lost in translation. Issues that are
viable concerns to Sue and Bill as nurses are not necessarily being felt as concerning by John or
Fred. Blatant concerns over patient safety are easily agreed upon, however some issues of
continuing education, and C.E.U.’s are lost. When the hospital asked staff to decrease hours, the
nurses are the ones responsible for the maximum allotment being sacrificed. The matter is not of
collaboration, it is a matter of professional respect. “Many consider the principle of respect for
others as the highest principle. Respect for others acknowledges the right of individuals to make
decisions and to live by these decisions.” (Yoder-Wise pg.90)
Yoder-Wise expands that The Code of Ethics for Nurses (ANA, 2001) “The code begins
with addressing respect for others, as the first provision of the code refers to the ‘inherent
dignity, worth, and uniqueness of every individual.” (pg.91) is our core. Nurses will respect
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another nurse based upon experience and approach because the need is not necessarily to display
superiority to nursing when professionally one is part of it. In the instance of John and Fred, the
defiance of the nursing approach is at sometimes, degrading. John stated “The primary objective
of Bill and Sue’s positions was their clinical roles, and to remove the nursing obligation from the
role of John.” The fact that nursing managers should possess a solid foundation is true. How can
one seemingly encourage the growth of two nursing positions and in turn stifle the results of the
professionals that hold those positions? Lanette L. Anderson, MSN, JD, BBA, RN, speaker,
writer and educator writes “A leader often doesn’t have delegated authority. The “power” that
the leader has acquired has come informally from others in the group. Leaders focus on
empowering others, as well as motivating, inspiring, and influencing others. A leader typically
has good communication and interpersonal skills. True leaders must be sincere and energetic. A
leader may be a risk-taker, but not to the extent that others feel that they are
reckless.”(www.nursetogether.com, 2012)
Ethical concerns have come to light for John (manager) and Sue (educator). Within the
department, it became apparent that the staff did not meet the requirements of reimbursable
qualifications in the Cath. lab to actively work in the Cath. lab. Therefore the R.C.I.S. exam was
mandated by John for all staff, and rather emergently at that. The issue brought to light was that
of a lack in continued education in the procedure area and how it could have come to the point
where it jeopardized that productivity of the area up to this date. Although repaired now via Sue,
essentially it had gone neglected for years. Yoder-Wise cross references “Continuing education
contributes to professional growth. …is defined as ‘systematic professional learning experiences
designed to augment the knowledge, skill and attitudes of nurses and therefore enrich the nurses’
WHAT DOES IT TAKE TO LEAD?
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contributions to quality health care and their pursuit of professional career goals.’ (A.N.A.,
2000,p.5)”(pg.588,2011)
The departmental decision making process can involve Bill and Sue as participatory
nurses and leaders within the department. However, the final say is rooted to John. As of
recently a group of unit employees has been put together by the upper management to quell the
complaints about participation in the department and they are tasked to addressing the common
issues with in the department. This group is called the Unit Action Council. They unfortunately
have no guidance, and empower themselves to take on tasks that are sometimes already being
fixed and addressed by Bill and Sue because of the lack of communication. A broader view of
the same situation would consider the need for participation by Sue and Bill with in the U.A.C.
for just the communication alone. Perhaps the U.A.C. could submit approval to Bill or Sue not
necessarily for approval, but simply to weed out the issues already addressed, therefore avoiding
unnecessary duplication. Empowerment is great for incentive, however lacks in accountability
and therefore direction at times. No direction leads to no productivity and ultimately frustration.
Conclusively, it becomes a matter of being a leader vs. being a manager. Nurses and
others managing nurses can be either. Does John possess the ‘power’ informally from his peers,
and coworkers? I don’t believe he does by any other means other than coercion or force, being
fear. He functions with in his role, allowing others to do his job for him whilst he takes the
credit. Does John empower others and motivate, or inspire to accomplish goals? There has been
no evidence of that with the exception of the necessity to accommodate for neglect in the
education. There has been a flash of motivation to decrease staff, and he has complied with no
consideration on the impact on the staff financially or their morale. The inspiration to
accomplish goals is reinforced with negative ramifications threatened such as a loss of position
WHAT DOES IT TAKE TO LEAD?
or job or preferred schedule. I understand that the information provided does not provide a
definition of whether or not a nurse would conclusively provide a better leadership role and
perhaps a manager role. But, I believe that overall, nurses tend to be more sincere and energetic
in their roles as they have faced opposition from the infancy of their careers and therefore
already have a grasp on who they would prefer to lead them and equivalently a good start.
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References
American Nurses Association (2012). “ What is Nursing?”, Retrieved from
http://www.nursingworld.org
Anderson, Lanette L. (2012), “Nurse Leadership vs. Management”, Retrieved from
http://www.nursetogether.com/DesktopModules/EngagePublish/printerfriendly.aspx?itemId=113
8&PortalId=0&TabId=102
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Yoder-Wise, P.S. (2011). Leading and Managing in Nursing (5th ed.). St Louis, MO:
Elsevier Mosey