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Nursing leadership skills include leading change, sharing vision, empowering people and inspiring others

By Holly Carlson, RN

Leadership is the process of producing favorable outcomes by skillfully orchestrating a team. In order to orchestrate a team a leader must have a complete understanding of the end goal. Productive leaders are objective, creative, and surround themselves with the right people in the right positions that have attributes, skills, and talents that align with the leadership’s goals. Effective Leaders have the ability to discern, develop, and channel team members for success. They allow their team members to utilize their skills and talents to their fullest capacity without interfering. Leaders must be able to inhibit their instinct to micromanage, tyrannize, and oppress the members of their team, as this will inevitably result in decreased productivity.

Nursing Leadership Styles

I joined a care system as a Regional Director. The system had 7 facilities within a large metropolitan area. This company had a regional leadership turnover rate of 55% with a staffing turnover rate of 67% annually. This turnover rate was resulting in unsafe resident care. We definitely were not the living environment of choice and revenue levels were unacceptable.

The Corporate Chief Operational Officer firmly believed that the loss of revenue was related to mismanagement of staffing on the facility level. She demanded labor intensive reports from all managers that justified the number of staff being used every 4 hours around the clock. She personally manipulated staffing levels based on a revenue generating calculation rather than resident safety, resident needs, or regulatory agency mandated staffing requirements. She was condescending and quick to judge in all of her interactions and as a result the Executive Directors in my facilities were paralyzed. Their morale was low, they were afraid of acting independently, and were reluctant to be resourceful. This low morale, fear, and reluctance passed from the Executive Directors to every employee, resulting in unacceptable resident care and a tarnished reputation for our facility within the community. Our resident care was impacted by the effects of ineffective leadership.

Determining Nursing Leadership Skills

After a short observational time in my new position the damage of the ineffective leader was obvious, I had my work cut out for me. The Corporate Chief Operational Officer was going to be difficult to deal with. The members of my team were going to require an extraordinary amount of rehabilitation and service recovery in the community would be arduous. In order to improve revenue, I knew the ultimate goal had to be service recovery and image redesign in the community however, I knew I could not help our community until I stabilized my team of leaders and they stabilized their facilities. My managers needed to be empowered to effectively lead their staff members. They were talented, skillful, and resourceful people who had become paralyzed by tyranny. Their inability to lead had transcended to the caregivers and was evident by our care outcomes and community reputation.

My first step in the rehabilitative process was to create a barrier between my team members and the Corporate Chief Operational Officer. I did all the interacting with her and created a more efficient staffing justification report. My second step was to meet daily with facilities Executive Leader, and weekly with their teams. This time was used to reestablish healthy communication, build trust, and problem solve. I encouraged them to be autonomous and resourceful and reaffirmed that there was safety within my open-door policy. I made a point to be accessible to staff and residents. I served food to the residents to provide them an opportunity to voice concerns. In addition to inviting open communication on every level and participating in various daily activities, I was setting a standard and establishing expectations for my Executive Directors.

Lead By Example

I believe leaders should lead by example. Leaders lose perspective, diplomacy, and credibility within their team when they are not actively engaged in the processes required to achieve the team’s goals. Healthcare leadership is a delicate balancing act of providing excellent care, supporting our staff, and being fiscally responsibility. Our industry ultimately generates revenue in a supply and demand business model based on customer service. This model leaves very small margin for error. In addition to the delicate balance of daily operations our residents require emotional investment from their caregivers, an added dynamic that requires a healthy work environment in order to provide excellent care.

The challenge of this dynamic leadership model does not pale in comparison and everyone within an organization is responsible for its success. Healthcare leadership is a unique and rewarding experience on every level. The impact of leadership is best seen from the side of the resident. All members of the staff from maintenance and dietary, to caregivers and nursing, on up to executive leadership are equally responsible for a healthy work environment and excellent care. Integrating dedication, empowerment, and compassion into our daily practice will only pave the way for present and future success.

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