In the few years since passage of the Patient Protection and Affordable Care Act (PPACA), and the release of the Institute of Medicine’s report Future of Nursing: Leading Change, Advancing Health in March and October of 2010 respectively, unprecedented change has occurred in the health care industry (Rogers, 2014). In response to these changes, many organizations are re-examining their strategic plans, setting new patient care goals, and are considering technology upgrades and expansion to serve more people while still delivering a quality product.
In addition, enhancements to nursing leadership and management teams are being made to ensure the clinical, service, and operational success of these organizations. An example of this effort to enhance nursing leadership and make operational improvements by recruiting an experienced emergency room management professional was recently made by a large urban hospital in Miami, FL. The following is a summary of an interview with this health care leader to discuss her background, leadership style, and the roles and responsibilities of leadership and management. Brief Introduction
J.E. has been a nurse for thirty-six years and has a master’s degree in nursing with a sub-specialty in forensics from Fitchburgh State College. She moved to Miami, FL during the summer of 2014 from Boston, MA where she spent 14 years working in the emergency department of UMass Memorial University Hospital, an academic-medical center with a Level 1 adult and pediatric trauma center that is STEMI and STROKE certified, similar to the one where she has been recruited to work. Background and Role She Has TodayJ. E. begins the interview by providing a reverse chronological history of the various positions she held while working at UMass Memorial University Hospital.
The last position she held was that of Director of Patient Flow and Capacity Management; prior to that she was Director of the Emergency Department for approximately fourteen years. J. E. was also a critical care and emergency department educator for about five years, a Nurse Manager in the coronary care unit, and Director of the medical intensive care unit. J. E. also fondly recalls that she began her career as a staff nurse on a medical-surgical floor (J. Ellis, personal communication, Jan. 19, 2015). Her current role is that of Director of Nursing for the Emergency Department at Jackson Memorial Hospital. She manages the nurses who work in triage and in the four treatment areas (ER A, B, C and F), as well as the Advanced Practice Nurse Practitioners who work in the express care/fast-track treatment area (ER-F). Description of a Leader
According to the American Nurses Association (2015) “Leaders do more than delegate, dictate, and direct. Leaders help others achieve their highest potential” (para. 1). When asked how she would describe a leader, J. E. stated “A leader is a visionary, a team player with good people skills who is action oriented, has the ability to accept responsibility, and approaches problems head on. In addition, a leader has confidence in his or her ability to solve problems as well as the capacity to motivate people” (J. Ellis, personal communication, January 19, 2015). Because leaders often have to make tough or split second decisions, J. E. also believes that leaders must have confidence in their decision making ability, and know they will make the right decisions when needed. Important Qualities or Characteristics of a Leader
According to Whitehead, Weiss, and Tappen (2007), qualities of an effective leader are “Integrity, courage, initiative, energy, optimism, perseverance, balance, ability to handle stress, and self-awareness” (p. 9). To this list J. E. adds honesty, assertiveness, creativity, flexibility, and above average self-confidence. Because she believes a leader should inspire and motivate people, in reference to the quality of assertiveness, J.E. stated “a leader should be assertive but not pushy or aggressive” (J. Ellis, personal communication, January 19, 2015). Thus a good leader should know how to be assertive and firm without being intimidating or autocratic. Personal Philosophy of Leadership
J. E. believes that leaders are people who want to do the right thing and are passionate about their job and the people they serve. She equates a leader to the captain of a ship who sets the course on a map and plans the direction of where he or she wants the staff to go. The goal is to inspire and elevate staff to a different level, and to guide them towards a shared and positive vision of the future. J. E. also believes it is a leader’s responsibility to be the person who unites the team and gets them to accomplish a particular goal (J. Ellis, personal communication, January 19, 2015). Leadership Experience That Influenced Personal Leadership Development
Soon after completing her master’s degree, J.E. became a critical care and emergency department educator for five years. Though she found it interesting and exciting to teach adults, he soon discovered her passion was not in teaching but in management. According to Sullivan (2013) “Managers focus on coordinating and integrating resources, using the functions of planning, organizing, supervising, staffing, evaluating, negotiating and representing” (p. 41). However, management has its own challenges. In management one must gather data to justify the allocation of resources. J.E. states that it was difficult at first to learn how to find and gather the data she needed, and then put in into a format that would convince administration to give her what she needed. Without having a business degree, learning the business aspect of health care, such as learning how to perform a gap analysis, was the hardest part of her personal leadership development (J. Ellis, personal communication, January 19, 2015). Views on How Leadership is Evolving in Nursing Today
J.E. is excited about the evolution of the “participatory management structure” she sees in health care today (J. Ellis, personal communication, January 19, 2015). She believes shared leadership committees and unit based councils give nurses a voice in the decision-making process that affects their practice. She sees more organizations moving away from the medical model where physicians are in the forefront to a more collaborative practice seen in the Magnet-designated hospitals (J. Ellis, personal communication, January 19, 2015). As Rogers (2014) stated “The outcome of this collaboration is partnership, equity, accountability, and ownership on the part of all participants” (p. 43). Most Challenging Issues in Current Position
As noted previously, J.E. is new to Jackson Memorial Hospital and its complex structure. Though she comes from a similar type of facility, and has managed a large emergency department in the past, she is not yet used to the chain of command and is having difficulty maneuvering through the system (J. Ellis, personal communication, January 19, 2015). She often finds that even simple tasks such as getting a new badge is hard because she does not know where to go or what the type of paperwork is required. Though she has a vision of what she would like to accomplish in this new position, there are still a lot of problems she needs to fix and obstacles she must overcome. Leadership Mentor and Influence on Leadership StyleJ.E. states that very early in her career when she was a young staff nurse, the director of a new intensive care unit at the hospital where she worked was an older diploma nurse who was a visionary leader and way ahead of her time in the way she managed her staff.
This nurse allowed her staff to offer suggestions for improvement and participate in how the unit was run. She was adept at reading people and knew when someone was ready for more responsibility. This nurse began to mentor J.E. and groomed her into a director and eventually a management position in the unit. J.E. states that her fondest memory of this nurse was that she inspired and motivated her staff to be better people and better nurses; they never wanted to do anything to disappoint her. This person made a profound impact on J.E.’s future management style (J. Ellis, personal communication, January 19, 2015). Advice to Someone Aspiring to a Leadership Position
J.E. suggests starting out small and learning how to be a good manager of a small department or unit at first. She also suggests trying different management styles until one feels comfortable and is effective in accomplishing the goals and demands of upper management. J.E. also suggests not being afraid to make mistakes because everyone makes mistakes. One must own any mistakes or failures, learn from them and move on. Her last bit of advice was to actively seek out older or more experienced nurses to work with and learn from; as any one of them could eventually become a good mentor. Conclusion
J.E. brings over 36 years of experience to this new position. She has a wealth of knowledge about nursing, management, education, and leadership. Thus far her management style is participatory and collaborative, she is not intimidating and knows how to motivate and inspire her staff to do above and beyond what is expected of them. She is role model in her field, and can be a good resource for persons aspiring to be nurse leaders in the future.
American Nurses Association. (2015). Leadership. Retrieved from http://www.nursingworld.org/MainMenuCategories/ThePracticeofProfessionalNursing/Leadership?css=print Rogers, J. K. (2014, April). Reinventing shared leadership to support nursing’s evolving role in healthcare. Nurse Leader, 12(2), 29-33, 43. Retrieved from http://dx.doi.org/10.1016/j.mnl.2014.01.010 Sullivan, E. J. (2013). Effective leadership and management in nursing (8th ed.). Boston, MA: Pearson/Prentice Hall. Whitehead, D. K., Weiss, S. A., & Tappen, R. M. (2007). Essentials of nursing leadership and management (4th ed.). Philadelphia, PA: F. A. Davis Company.