This paper presents findings from an interview with a clinical nurse leader responsible for orienting new nurses and communicating organizational changes. The author analyzes the interviewee's leadership philosophy, identifying her approach as primarily transformational yet flexible, incorporating situational and coaching elements. Key themes include the importance of vision and mission, empowerment of staff, self-reflection, emotional intelligence, and communication skills. The paper emphasizes how effective clinical nurse leaders balance providing direction with respecting nurse autonomy, creating environments where shared leadership responsibilities strengthen patient care and organizational culture.
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 on new organizational changes. I selected her based on her position and, equally important, her attitude. I was not disappointed in the interview; I was impressed by the professionalism and maturity she demonstrated throughout, even when coping with significant challenges. Although charged with considerable responsibility, she showed very little egotism or bitterness, even when discussing the most difficult aspects of workplace dynamics.
One aspect of the nurse leader's demeanor that particularly struck me was her accessibility and willingness to conduct the interview in such a free and open manner. She was willing to answer anything I asked and did not appear uncomfortable, even with 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. This openness and self-awareness foreshadowed the reflective, adaptive approach that would emerge throughout our conversation.
According to Bamford-Wade and 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 that treats individuals with cancer, the mission of preserving patient dignity and making uncomfortable treatment as comfortable as possible might be the common, shared vision. In the nurse's 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 percent every day. Nursing is a highly stressful occupation, particularly given the long hours, overnight shifts, and the ongoing 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 challenges, although she also recognized that leadership must work to solve any intractable issues causing nursing burnout, attrition, or compromising patient care.
Vision and mission sustain the organization in the long run, but there is still a need for short-term solutions. The nurse understood this balance and addressed both dimensions of effective organizational leadership.
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 showing them how to act independently—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 the intention. A singular vision can sometimes lead the leader to adopt 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 such by the nurse, she 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, and Wong (2008) on emotional intelligent leadership and staff nurse empowerment. Individuals need a sense of control over their own actions. Nurses are professionals who 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 define patient care, and leaders must always have respect for the actions of nurses in the field.
Part of this attitude, the nurse made clear, was shaped by the attitude of the institution. She summed it up best as "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 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 with more bureaucracy to manage than patients to serve.
This observation adds another dimension to the "lead by 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, 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 managers. There is often a sense that someone cannot really "know what it is like" to be a nurse 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. It is always tempting to wonder "what could I have done better?" The nurse leader stated that she always tries to think about what she could improve 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 institute, there can be an unwillingness among the leadership to reconsider a change in the face of evidence that it has not worked out as desired. The nurse's flexibility and willingness to admit that problems do occur and must be remedied was clearly a reason for her effectiveness.
This ties in with the fact that the nurse's fields of expertise were not purely medically related. This nurse had 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 meet the needs of the listener is vital. The healthcare environment is increasingly diverse, not simply with respect to the patients served, but also in terms of the nurses themselves. The nurse was proud of the fact that her team members would listen to her and share any questions or concerns about issues that arose. In modeling good communication skills, the other nurses learned by her example and were able to get along with one another through 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—something often overlooked by those who view leadership as a top-down construct. If something is not functioning as planned, a good leader will engage in dialogue with followers to determine why. Leaders should not assume that 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 approaches might be needed based on the personalities of the ward and the tasks to be completed that day.
When asked to characterize her primary function, the leader identified it as "education." This was significant because education implies that the leader is teaching something to others, who then go out and perform what they have learned themselves. The autonomy of the followers was not a threat to this leader; in fact, given that the healthcare system is constantly undergoing change, responding well to change on a daily basis in workers' personal interactions with others is essential.
I would personally characterize this nurse's approach in many ways as that of a coach as well as a leader (Budhoo and Spurgeon, 2012). A coach, unlike a traditional leader, gives the skills to the "team players" to function well, knowing that it is the players who will ultimately be out there performing. The coach understands how problematic it will be if he or she tries to play for the players on a daily basis in practice, since this is impossible when the members are tested in the field. Coaching also implies making an investment in various personnel on a personal basis. Professional development is encouraged, and the unique skills and qualities of employees are honored. That is why continuing professional education for nurses at all levels is essential. Not only does it improve patient care, but it also shows that the institution is willing to invest in its nurses as people. I would characterize this nurse as highly empathetic and emotionally intelligent, two critical components of effective nurse-coaches (Horton-Deutsch and Sherwood, 2008). She understood that nurses must constantly learn and sharpen their skills and that leadership exists to support these efforts.
The nurse's attitude toward change seemed to be a critically important part of her positive demeanor. Many people see change as a threat unless they can control it completely. This nurse welcomed change, recognizing that changes in technology and other aspects of healthcare have vastly improved nursing efficiency and patient care. Nurses need to learn to respond to change independently as well as accept directives from above. Additionally, if nurses are not convinced of the need for change, they will not be enthusiastic in promoting and upholding it.
This nurse was successful because she regarded all of those in the organization not just as nurses but as potential leaders. Rather than seeing leadership as something finite which must be carefully guarded by those in charge, everyone functions better when leadership responsibilities are shared in a positive manner. The modern healthcare environment can be extremely stressful: recent government changes to healthcare bureaucracy, changes in technology, and a shortage of nurses can leave providers with a sense that there are not enough hours in the day. Self-directed leadership and accountability for one's practice enables individual nurses to meet these challenges and contribute meaningfully to organizational success.
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