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Interviewing a Clinical Nurse Leader Nursing LeadershipEssay

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Interviewing a Clinical Nurse Leader

Nursing Leadership

For this assignment, I chose to interview a clinical nurse leader whose primary duties involved instructing new nurses and orienting them to the healthcare environment as well as briefing existing nurses as to new changes. I selected her based upon her position but also by her attitude. I was not disappointed in the interview and was impressed by the professionalism and maturity she showed throughout it when coping with challenges. Although charged with a great deal of responsibility, she showed very little egotism or bitterness even when speaking about the most difficult facets of the workplace.

One aspect of the nurse leader's demeanor who I interviewed that particularly struck me was her accessibility and willingness to conduct the interview in such a free and open manner. She was willing answer anything I asked and did not appear to be made uncomfortable even by my most probing questions. It did not surprise me that she identified herself as a transformational leader when I asked her to detail her leadership philosophy. According to Bamford-Wade & Moss (2010), a transformational leader is one who leads by example and inspires others by underlining the common vision shared by all, which the leader embodies. For example, in an institution which treats individuals with cancer, the mission of preserving patient's dignity and making the uncomfortable treatment as comfortable as possible might be the common, shared vision. In this workplace, there was a strong commitment to patient care and the leader attempted to manifest this in all of her actions.

The leadership strategy adopted by the nurse was above all transformational and visionary, and she expressed this in a self-identified way. Without a sense of vision and mission she believed that nurses are not willing to give 100% every day. Nursing is a highly stressful occupation, particularly given the long hours, overnight shifts, and nursing shortage. It is very easy for tempers to become frayed and there is a high rate of attrition and burnout. The nurse believed that only with a higher sense of purpose can nurses push through these elements, although of course the leadership must work to solve any intractable issues that are causing nursing burnout, attrition, or compromising patient care. Vision and mission sustains the organization in the long run but there is still a need for short-term solutions.

However, while I noted in my interview that although the nurse defined her style as transformational, it deviated in many respects from that of the 'traditional' transformational leader. She also identified empowering people, including how to act on their own, as a critical dimension of her leadership approach. A clinical nurse leader cannot engage in a dictatorial approach to leadership, which is how the leadership approach of a transformational leader can sometimes seem, no matter how positive in intention. A singular vision can sometimes lead the leader to take a very hands-on style. But for a nurse leader it is critical to show respect for one's colleagues and know when to step back as well as when to step forward and lead. Sometimes, in certain situations the leader may actually be less knowledgeable than the subordinate. The clinical nurse leader must be aware of this and humble enough to step back in such instances, rather than behave in an imposing fashion.

Although not explicitly identified as situational, the nurse struck me in many ways as a situational leader. When dealing with less knowledgeable personnel, she was willing to be more explicit but she adopted a more democratic and participatory approach with more experienced staff members. The nature of the task at hand also determined the leadership style. When a change was newly enforced, she recognized the need for additional oversight but when it became an accepted standard operating procedure for the organization she was willing to step back to a greater degree.

This attitude particularly resonated with a study by Lucas, Laschinger, & Wong (2008) entitled "The impact of emotional intelligent leadership on staff nurse empowerment: the moderating effect of span of control." Individuals need a sense of a control locus over their own actions. Nurses are professionals and can make a significant personal contribution to the workplace even if they do not possess the formal title of leader. It is the day-to-day efforts of individual nurses that make patient care what it is today and leaders must always have respect for the actions of nurses in the field.

Part of this attitude, the nurse made clear, was the attitude of the institution. She summed it up best as to 'lead from the bedside.' In other words, the institution gave nurses considerable leeway and autonomy when completing their tasks. They were trusted to know what is best for the patient. This was very important to the nurse because she said it differed considerably from other institutions at which she had worked. There, in the name of evidence-based medicine, nurses were frequently told what to do and how to do it by senior management staff members, many of whom were actually not healthcare providers themselves and who came from other spheres of industry. Constant micromanagement creates tension between managers and nurses and can compromise patient care if nurses feel they are working in a hostile environment and have more bureaucracy to deal with than patients.

This was interesting to me because it adds another dimension to the 'lead from example' approach of transformational leadership. Transformational leadership stresses the leader embodying a certain ideal but in a healthcare setting, if the leader is not actually a provider him or herself, this can be extremely difficult. This underlines the importance of nurses themselves seeking out advanced degrees and assuming higher leadership roles, not simply in clinical practice but in upper-level management. Without the perspective of nurse leaders, nurses will often be mistrustful of dictates by the managers. There is often a sense that someone cannot really 'know what it is like' to be a nurse leader unless they have 'been there and done that' themselves.

The nurse leader also said that she made time for self-reflection on a daily basis in general. It is always tempting to wonder 'what could I have done better.' The nurse leader stated that she always tries to think what she could improve upon over the course of her day. A good leader is willing to admit when she is wrong and to learn from mistakes as well as successes. Often, in a healthcare setting, because changes are so difficult to instate, there can be an unwillingness amongst the leadership to retrench and reconsider the change in the face of evidence that it has not worked out as well as might be desired. The nurse's flexibility and willingness to admit that problems do occur and must be remedied was clearly a reason why she was so effective.

This ties in with the fact that the nurse's fields of expertise were not purely medically-related. This nurse had an extensive knowledge of workplace communication skills and intense self-awareness about how she communicated. She stated that effective communication was a critical component of her success as a leader. Knowing how to alter one's communication style to the needs of the listener is vital. Our healthcare environment is increasingly diverse, not simply with the patients that are served, but also in terms of the nurses themselves. The nurse was proud of the fact that her team members would listen to her as well, and share any questions or concerns they might have with any issue that arose. In modeling good communication skills, the other nurses learned by her example and were able to get along with one another through the use of emotionally sensitive and respectful dialogue.

Nursing is a service profession. Nurse leaders serve their fellow nurses as well as patients. Thus, being a good listener is essential. This is something that is also often forgotten by those who view leadership as a top-down construct. If something is not functioning as planned, then a good leader will engage in dialogue with his or her followers to determine why. Leaders should not make assumptions that the followers are inevitably at fault. When asked to list her greatest strengths, the nurse leader underlined the fact that above all she considered herself to be "approachable and open." It is when a leader seems closed off and overly quick to make negative judgments that team members are inclined to hide problems from her. Still, the leader also admitted that not everyone had the same personality and attitude that she did: different demeanors may be needed based upon the personalities of the ward and the tasks needed to be completed that day.

When asked to characterize her primary function, the leader identified it as 'education.' This was significant to me since education implies that the leader is teaching something to others, which the other individuals then go out and perform themselves. The autonomy of the followers was not a threat to this leader:… [END OF PREVIEW]

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