Nursing leadership? Reminds me of a movie.

Rene Steinhauer | 10/13/2016

Things are not always what they seem. First of a seven-part series.

Image of Clint Eastwood

Nursing leadership is unique and unlike the standard business model, yet our leadership model is derived from business. Business leaders do not lead teams who perform CPR and administer lifesaving medications or therapies. Business leaders do not typically manage disasters that involve scores of critically injured individuals. Apart from corporate liability concerns, they do not have to worry that their decisions will directly impact a person’s chance of survival. Outside of healthcare, business leaders will never have to decide which patient receives medical resources and which patient dies because there are not enough resources and personnel to care for all of the injured.
Rene SteinhauerBeyond managing the dramatic life-and-death events associated with the healthcare environment, nursing leaders often must have some of the same business leadership skills such as managing budgets, ensuring a safe work environment, and de-escalating interpersonal conflicts. Nurse leaders perform their functions while sleep-deprived, physically exhausted, and emotionally invested in outcomes that affect individuals and families. In no other career field are leaders expected to master so many aspects of leadership and manifest those skills in such a dynamic environment.
Field tested
As a disaster manager working in Haiti following the 2010 earthquake, I was able to rapidly quantify the results of leadership as they related to the rate of fatalities associated with our care. During that time, the injured frequently died, but as a team developed into a more organized group, the rate of fatalities rapidly decreased. As a nurse manager, my highest priority is not profit, but people. In responding to disasters, serving my country in wartime, and working in hospitals at home and abroad, my career has taken me to all areas of the world. This vast experience has provided me with unique insights into nursing leadership.
Over the years, I have learned that the dynamic environment in which nurses work requires an equally dynamic form of nurse leadership. The most successful nurse leaders master multiple leadership approaches. Outside of healthcare, the business environment remains relatively static; a leader may spend the vast majority of his or her time exemplifying a specific leadership style, such as autocratic, transactional, or transformational. Nursing, however, is never static. I have been fortunate enough to experience nursing in the most extreme situations and have learned to lead teams regardless of the dynamics involved.
Effective leadership requires lifelong learning
As nurse leaders, we need to continue developing our abilities and be engaged in lifelong learning. The role of the nurse is as complex as the leadership environment in which he or she works. All nurses find themselves simultaneously in roles of both follower and leader. As follower, we facilitate doctors’ orders, receive direction from the charge nurse or, as a charge nurse, receive direction from the chief nursing officer.
Our roles as leaders permeate every level of nursing. As a student nurse or floor nurse, a basic duty is to display leadership in our daily activities, whether encouraging patients to adopt healthy lifestyles, educating them in medication therapy, or upholding our sworn duty to serve them as advocates. There are times when the nurse must encourage the physician to consider a different modality for ethical reasons or because it’s more culturally sensitive. As we progress in our careers, we lead new generations of nurses toward safer and better patient care that is evidence-based. We practice situational awareness as well as self-awareness of the leaders that we are and want to become. Leadership is a core competency of nursing.
Nursing leadership sometimes reminds me of the Clint Eastwood movie “The Good, the Bad, and the Ugly.” Just as the three characters in that film accomplish specific tasks in the story line, so too do leadership styles I find most often in nursing. And sometimes, things are not as they seem. In the series that follows, stay with me as I share how I have seen these styles play out in specific ways. The first is transformational leadership. That would be “the good.”
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. 
Part 2: Transformational leaders: Change agents for good
Part 3: When ‘bad’ is good: A time and place for autocratic leadership
Part 4: Laissez-faire leadership: You’d have to be crazy to be this kind of leader
Part 5: Trish and Cheesy: A story about transformational leadership ​
Part 6: The most transformational leader I've ever known
Part 7: In crucible of crisis, "Trust me" not enough
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