In crucible of crisis, 'Trust me' not enough

Rene Steinhauer | 11/17/2016

Foundation of trust needed when autocratic leadership is required. Part 7 of seven.


Management of personnel in a crisis is the most challenging role for any leader. Nurses have been in the forefront of leadership during Hurricane Katrina (2005), the Haiti earthquake (2010), and many other disasters. But whether it’s a large-scale disaster, such as the 2004 Indian Ocean tsunami, or a more localized calamity—a tornado, for example—such events can lead to crisis in healthcare organizations. 
Nurses working in the midst of such crises may find themselves concerned for their personal safety or that of their families. They may be required to work in grueling physiological and psychological conditions for more than 24 hours nonstop. I have personally worked in environments where I found myself hungry, tired, and weak. To adapt to such situations, standard hospital management procedures need to be modified. 
Steinhauer_GBU7_article_embed_SFWTransformational leadership not most effective in crisis
As our profession has developed and matured, our understanding of leadership has also evolved. The current leadership model within the hospital—the gold standard—is the transformational leadership model. While transformational leadership is considered the most effective and productive model within the industry, evidence-based research suggests that it is not the most effective style during crisis. In crisis, autocratic leadership is most effective (Rast, Hogg, & Giessner, 2013).
By definition, crisis occurs when a team is unprepared for an event and needs immediate direction. Crises are not common when nurses are highly trained, experienced, and well-equipped to handle a problem. During emergencies, however, autocratic leaders rapidly take control and provide explicit direction for the teams they supervise. Critical directions are given about use of resources and next steps. 
When delay is not acceptable
Transformational leaders frequently take a more democratic approach to problem-solving and look to the team for consensus whereas autocratic leaders make rapid decisions with minimal input from the team. In crisis environments, delays in time can lead to negative patient outcomes and even physical danger for staff members. Difficult decisions must be made quickly. The environment dictates leadership style.
Here’s the dilemma: Autocratic leaders are best when rapid decisions need to be made, but transformational leaders are the most trusted. Where does trust fit into this?
While researchers may recommend one type of leadership over another for a particular situation, no group of people and no environment will ever exactly match what is envisioned in a laboratory or described in a research study. Because nursing occurs in a dynamic environment, it needs a dynamic approach. Effective nursing leaders are able to transition between transformational and autocratic leadership and, incorporating the best aspects of each style, use those strengths to solve the tough and unanticipated problems that arise during a crisis.  
Worst of times requires best of leaders
In a crisis, daily nursing concerns are often less important and “take a back seat” to uncommon problems that demand a team’s attention. Normal interpersonal conflicts among nurses may suddenly disappear as they focus on the larger problem. On the other hand, a team that usually works well together may experience interpersonal conflict triggered by concern for personal safety or exhaustion. Following disasters, it is not uncommon for nurses to work more than 24 hours straight with minimal food and drink, and, despite their heroic effort, patients die, plans fail, and people break. Nurses who retain a “non-crisis” mind-set during a crisis will see themselves as failures and question their skills and decisions. It’s brutal to work in such conditions. It’s even more brutal to lead during those times.
While autocratic leadership is essential during crisis, transformational leadership—walking the walk—is critical. At such times, the leader needs to be right beside the other members of the team, not locked in an office or out of sight. The team members need to know that the leader is experiencing the same fatigue, hunger, and fear they feel. The leader needs to be certain that the team sees him or her experiencing the same physiological and psychological stressors. Never is there a more important time for the leader to “walk the walk.” 
Although it is necessary to utilize autocratic methods to rapidly intervene in a crisis, transformational leadership can have a profound effect on nurses battling to keep people alive. Because the transformational leader is trusted, team members will trust his or her decisions during a crisis and think they are appropriate, even though the leader is acting autocratically. When people are exhausted and feeling unsuccessful, they will trust their leader when he or she describes the team’s success relative to the environment and available resources. They will work harder, accomplish more, and bond more tightly than ever before. In the crucible of crisis, the team will be transformed. 
Foundation of trust critical
Nurse managers who are transformational in their regular work environment will find that they’ve built a solid foundation for team trust when autocratic leadership is required. Trust, built over the course of years, becomes their most valuable resource. 
If you are that leader, your team members will trust that they can bring new information to you. They will trust that you will make good decisions. They will trust you to continue valuing their safety and considering their personal needs just as you did before the crisis.
As a disaster manager who has responded to some of the largest disasters of our time, I can honestly tell you there is no greater challenge than managing a team in crisis and no greater reward than earning the trust of the team. 
Rene Steinhauer, RN, EMT-P, has served as a nurse on all seven continents—as flight nurse in Antarctica; as combat medic in Iraq; as disaster manager following the Indian Ocean tsunami (2004), Hurricane Katrina (2005), Haiti earthquake (2010), and Typhoon Haiyan, known as Yolanda in the Philippines (2013); and as chief nurse in an Ebola Treatment Unit in Liberia (2014). The author of Saving Jimani: Life and Death in the Haiti Earthquake, Steinhauer is presently working toward his MSN degree at Hawai’i Pacific University.
Rast, D. E., Hogg, M. A., & Giessner, S. R. (2013). Self-uncertainty and support for autocratic leadership. Self & Identity, 12(6), 635-649. doi:10.1080/15298868.2012.718864
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