This paper outlines a philosophy of nursing leadership grounded in four interconnected principles: mentorship, leading by example, accountability, and professional self-perception. It argues that leadership in nursing is not confined to formal managerial roles but must be cultivated at every level of practice. The paper addresses the damaging effects of horizontal violence on new nurses and professional cohesion, emphasizes the charge nurse's dual role as communicator and role model, and calls for nurses to internalize a sense of professional identity and moral responsibility. Drawing on nursing literature, the paper makes the case that a culture of genuine leadership begins with generosity toward colleagues and patients alike.
When nursing was first conceptualized as a profession, it was often defined in terms of its "helping" capacity for doctors as well as patients. Today, however, nurses have been increasingly called upon to fulfill leadership roles as managers, and also to assume many of the tasks once performed by physicians. "Leadership does not rest merely with administrators and high-level managers, but also can be developed and implemented at the bedside. Nursing has a responsibility to encourage and support new members of the profession as they become competent clinicians. Nursing must also make them competent leaders" (Valentine, 2002). Mentorship of younger nurses, leading by example at all levels of the organization, and creating a culture of accountability and responsibility are the cornerstones of fostering an environment that promotes leadership among nurses, regardless of the practice setting.
Mentoring and receiving mentorship are critical aspects of creating nursing leaders. Yet all too often, nurses find themselves locked in adversarial relationships with one another rather than ones that promote leadership. "Many authors have examined the pervasive phenomenon in the practice of nursing that is widely known as 'nurses eating their young.' The literature reports that a staggering number of registered nurses are leaving professional nursing practice due to feelings of stress, inadequacy, anxiety, oppression, and disempowerment, often a result of horizontal violence" (Bally, 2007). Horizontal violence — the disdainful, intimidating, and even abusive treatment of new nurses — is counterproductive on several levels. First, the stresses caused by overburdened nurses at understaffed hospitals are compounded when nurses do not encourage others to remain in the profession. High attrition creates more stress. Horizontal violence also makes it more difficult for nurses to organize and advocate for their rights from administrators. It additionally impedes communication and thus negatively impacts patient care.
True leadership means mentoring less-experienced nurses. "Long-term, evidence-based solutions such as those strategies aimed at fostering collegial relationships, enhancing nurses' sense of self, promoting professional development, and encouraging feelings of professional worth are required … mentoring programs are exciting avenues for stimulating professional growth, career development, staff morale, and quality within nursing workplaces" (Bally, 2007). True leadership also demands occasionally subordinating the interests of the self and one's own ego to the needs of the collective — including resisting the impulse to take out one's frustrations on new nurses.
As well as actively mentoring younger nurses, all nurses can act as role models to other healthcare practitioners. By treating patients with dignity and respect, and by being conscientious and mindful of others' needs, the nurse encourages all organizational members to do the same. A nurse leader must be "visible, identifiable, accessible, approachable, and authoritative to not only your staff but your customers as well. The charge nurse is the conduit for information provided from management to staff and from staff to management" (Cintron, 2011). The care nurses demonstrate for patients — and their sensitivity to patients' psychological and social needs — must serve as an example for the healthcare profession as a whole, given the unique contribution nursing can make in improving patient outcomes and the experiences of patients and families with healthcare.
Nurses with formal leadership responsibilities must ensure that these obligations are met in a timely fashion. For example, charge nurses must ensure that their subordinates' assignments are completed and covered; that staff schedules are complete and that conflicts or potentially unfair policies are addressed; that tasks are delegated effectively and fairly; and, above all, that patient health is never compromised (Cintron, 2011). Leaders show sensitivity to the needs of different nurses — taking into consideration the lack of experience of some staff members, or the situation of nurses who have been subjected to routinely difficult shifts and more overtime than their colleagues. Leaders do not play favorites or misuse their position to pursue personal vendettas. Leaders who fail to fulfill their own responsibilities will lack the moral authority to hold others to the same standard.
"Formal and informal accountability as leadership foundations"
"Nurses overcoming self-perception barriers to leadership"
A philosophy of nursing is based upon generosity — generosity of mentorship to younger nurses as well as to patients. A nurse-leader has high standards for him or herself, as well as high standards for others. He or she takes responsibility and holds him or herself accountable for his or her actions, as well as holds others accountable. And while formal nurse-leaders may have specific, additional tasks, all nurses can act as leaders in promoting the health of patients and the integrity of the profession.
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