Nurse Leader Interview
Leader Interview The nurse manager of the cardiac rehabilitation unit has been a formal nurse leader for the past five years. The conversation began with a discussion about her personal leadership style and how it evolved from a knee jerk style to her current democratic style. Being a nurse leader requires adaptation and flexibility. Administration, Medicare, and certifying organizations require changes to be made frequently to improve patient care. These changes are often tied to service reimbursement, so they must be initiated swiftly.
Many difficulties surround the role of leader in today’s health care. Being unprepared for a management role, avoiding micromanagement, and maintaining clinical competency were the biggest challenges identified during the transition and continuing role as nurse leader. Open communication was the key to overcoming the personal and professional challenges of being a leader. Formal and informal power influences the success of the organization and the role of a nurse manager. The nurse manager identified administration as a formal leader.
Patients and her staff were recognized as informal leaders. Maintaining an open relationship with both formal and informal leaders is essential to achieving the organizations mission. Leadership Style As a successful nurse leader the nurse manager of the cardiac rehabilitation unit describes her style of leadership as democratic. According to Marriner Tomey (2009) “Democratic leaders maintain less control; ask questions and make suggestions rather than issue orders; and get the group involved in planning, problem solving, and decision making (p. 182).
Staff must attend 75% of all staff meetings according to the union contract, these meetings are offered every month. During these meeting and during day-to-day activities she encourages the staff to verbalize their ideas and is open to implementing these ideas in hopes of improving everyone’s work environment and patient satisfaction. The department appreciates her openness and feels comfortable making suggestions for improvement. She confesses that she stills struggles with not falling back to her initial style of leadership; a knee jerk reaction.
A leader using knee jerk leadership will respond to situations quickly without gathering enough information to make an informed decision or will make decisions based on current emotion rather than fact (Azaare & Gross, 2011). This often leads to feelings of remorse and regret. She reports that after a knee jerk reaction she realizes what has happened and apologies to the employee involved, and makes a conscious decision not to repeat the offense. Being a leader means acting with integrity; doing the right thing and apologizing when necessary.
Adaptation In addition to a change in leadership style the nurse manager also has adapted too many changes in her leadership role such as comfort with delegation, meeting goals of administration, and maintains certifications necessary for the department particularly the American Association of Cardiovascular and Pulmonary Rehabilitation (AACVPR) certification. The cardiac rehabilitation department is in a constant state of change because new guidelines for AACVPR and Medicare are issues almost monthly.
Both the certification and Medicare guidelines tie into reimbursement so staying abreast of the changes and instituting them in the department requires the leader and employees to adapt. Administration dictates new policy and budget guidelines that a nurse leader must adapt to while preserving a solid working relationship with the staff and maintaining patient safety and satisfaction. Instituting so many changes to a department can and does cause stress and anxiety. If changes are not communicated effectively chaos ensues as employees struggle to understand their new expectations.
To be a successful leader in today’s healthcare system one must be flexible, willing to adapt to frequent changes, and communicate effectively. Adaptation also occurs when a leader has to motivate employees. Each employee has a unique personality and needs. Leaders must to some degree adapt their leadership style in order to be effective. While one employee needs structure another needs space for creativity. Knowing and communicating with employees is the best way to know what they need to be happy and productive.
Once an employee’s needs are identified the leader must do her best to fulfill those needs. Challenges One of the biggest challenges that this nurse leader encountered was being thrust into the management position with little to no guidance or instruction. This is a common challenge among nurse leaders, accepting a leadership role but not being given the tools and education to be successful (Horton-Deutsch, Young, & Nelson, 2010). When she accepted the position of nurse manager of cardiac rehab in September of 2004 administration did not offer her any formal instruction or orientation.
The previous manager left the organization abruptly, obtaining on an associate’s degree her education did not provide her with the skills she believed she needed. She reports a trial by fire, making many managerial mistakes but learning from each one. Being a nurse leader for her is about empowering employees to do the best they can. Part of empowering employees to work creatively and independently was avoiding the urge to micromanage the department. She identified delegation and avoiding micromanagement as a large personal challenge in developing herself as a nurse leader.
Trusting that the employees were competent was not the issue; it was fear of seeming bossy or being perceived as lazy. Instead of feeling assisted employees believed their leader saw them as incompetent and unskilled. This was not the case the problem was eventually resolved with open and honest communication. Another challenge for this nurse leader is maintaining her level of clinical skills and competence. Most of her duties are administrative; staffing and budgetary.
However, it is important to her to maintain her nursing skills such as starting intravenous lines, obtaining vital signs, and reading cardiac monitors. Reading research and practicing skills is important in order to continue to provide evidence based care and be a role model for continued learning. Formal and Informal Power As a middle management nursing leader there seems to be a constant struggle to balance and satisfy formal and informal power. The nurse manager identified administration as a formal leader in the hospital.
The hospital administrations are always looking at the bottom line and try to improve the hospital as a business. Implementation of new ideas while maintaining a strict budget is a challenge instituted by formal power onto a middle management nurse leader. Frequent communication with formal leaders ensures that employees are working toward the mission and vision of the organization. The individuals identified by the nurse manager as possessing informal power are the patients and her employees. Patient and employee satisfaction is an essential component of a successful organization.
If the patients are unhappy with their care or service they will not return; patients have a choice in where they receive healthcare. Without substantial patient flow the hospital loses revenue and eventually jobs. Patient satisfaction is absolutely necessary and priority for every nurse leader. Employees must also be satisfied with their work. Employees are more productive and provide better care when they are happy. Employees have an informal power affecting how the department functions. Informal leaders within a unit can quickly turn the department down a path of negativity.
The behavior is counterproductive to the hospitals mission. Informal leaders also have the potential of improving a professional environment. These informal leaders can encourage education and excellence within the department. Recognizing the influence of formal and informal power is important for the nurse leader so that all shareholders in the organization can be satisfied. Conclusion While many leadership styles exist the nurse manager of the cardiac rehabilitation unit chose to use a democratic style in her department.
The democratic style evolved from a knee jerk style that she found to be counterproductive, but used because she lacked the knowledge of how to manage effectively. After trial and error she developed a style both she and her employees were comfortable with. Even with a productive leadership style adaptation continues to be necessary. Conforming to new policy and guidelines established by administration, Medicare, and the accrediting agency the American Association of Cardiovascular and Pulmonary Rehabilitation is a challenge but necessary in order to provide safe and effective patient care.
The biggest challenge identified by this leader was initially being unprepared for a management role, learning how to avoid micromanagement, and maintaining clinical competency. While being a leader presents challenges this leader believes that through communication challenges can be overcome and from these challenges a person experiences personal and professional growth. A leader must also contend with the formal and informal powers within an organization. Meeting the needs of administration, staff, and patients all come as a challenge.