Nursing Leadership: Reflective Analysis of Management Roles

Introduction: Identifying Management Strengths and Weaknesses

Using the "Check Your Effectiveness" self-assessment instrument (Facts, 1997), my highest score of 58 was in the Mentor Role, while my lowest score of 48 was shared equally between the Initiator Role and the Service/Care Provider Role (Facts, 1997). The following reflective analyses examine significant clinical experiences that illustrate each of these roles, followed by an analysis of a management event using the full eight-role management framework developed by Quinn et al. (2003).

Reflective Analysis of the Mentor Role

When writing a reflective analysis of myself in the Mentor Role, I recognize that a key competence of this role is to understand myself as well as others. I have a positive self-image and see myself as intelligent and respectable, and I treat others accordingly. I know myself well, am confident, and hold high expectations of myself. I would never set standards for someone else to achieve if I am unable to achieve them myself. I would like to say that I understand my peers, although I do not always agree with their decisions.

In terms of interpersonal communication, being an effective leader requires excellent communication and interpersonal skills. I speak with a European accent, and my communication may be perceived differently because of this, sometimes leading to misinterpretation of my message. I consciously speak slowly and enunciate words with a non-European accent when giving instructions and guidance. Since facial expression and body language constitute a large part of communication, I always strive to use a receptive facial expression and non-threatening body language. Communication is the most important factor that reflects who we are, how we react, and how we approach and interpret problems.

Developing subordinates as a mentor requires not only patience but also the ability to listen actively and the willingness to teach. It requires clinical expertise and, most certainly, the establishment of a trusting rapport with the mentee to optimize learning. As Vestal (1999) states: "We need to work together, as a nursing profession, as a healthcare profession, and as a society, and we need to understand each other's perspectives." I enjoy mentoring because I love to share the knowledge I have acquired. Teaching a skill to a new nurse is rewarding because of my personal mastery and self-assurance. The mentee will be successful if they implement newly learned techniques and work to perfect them.

I am employed as a Registered Nurse on a general 12-bed Pediatric Ward, primarily in a charge nurse capacity. I assign patient care based on acuity and according to education, training, and skill level. Compared to other units in our hospital—excluding the Neonatal Intensive Care Unit (NICU) and the Intensive Care Unit (ICU), where the patient-to-nurse ratio is six to seven patients per nurse—our floor seldom exceeds two patients per nurse. As charge nurse, my duties include establishing acuities, interpreting lab results, managing telephone calls, solving problems, taking a patient census, and orienting new nurses. I often take on my own patient load to ensure a consistent patient-to-nurse ratio and to provide the highest level of patient care. Overall, my staff—consisting of Licensed Vocational Nurses (LVNs) and Certified Nursing Assistants (CNAs)—demonstrate professionalism by providing compassionate care to our pediatric patients and their parents.

One of my most challenging experiences as a mentor involved an LVN who had been on staff for 17 months. I experienced an internal struggle to challenge and develop her. Her average skill level determines her daily assignments, which are often less demanding than others. She demonstrates negativity—verbally or through body language—by displaying a non-team-playing attitude. She complains about her assignment or makes comments about admissions, though this has not yet disrupted our daily routine.

My observations of her at the nurses' station include not responding to a call light unless it belongs to her patient, and even then she often has to be reminded. She frequently seeks a second opinion before making permanent entries in the patient's chart, suggesting significant insecurity about her assessment findings. On many occasions, her failure to maintain a patient's IV site through regular flushes necessitates starting a new IV, which is always traumatic for young patients and their parents. Most concerning is her disregard for our "Safe Haven" policy, and her habit of delegating minor tasks to CNAs—such as emptying a urinal she is already holding—vividly demonstrates poor task planning.

All of this makes me feel annoyed, irritated, and frustrated. As a leader, I must maintain calm, remain rational (Nursing, 2003), analyze the full picture, and respond with a productive and reasonable intervention. I am often successful, but there are times when I fall short. I express my frustration by performing assessments myself—both for reassurance and because my time is limited. I find it particularly frustrating when a nurse is unable to count manual respirations or interpret lung sounds, as these are fundamental skills taught in every entry-level nursing program. Because I hold a charge nurse position, neglect or inadequate patient care would burden me professionally and ultimately reflect on my staff and my licensure.

Aware of the potential for daily mishaps, I plan my schedule with additional time built in. After morning report and delegation of assignments, I ask my staff to work together and wish them a good shift. I make morning rounds, introduce myself to patients and parents, and make myself available for questions. I also follow up with nurses about their assessment findings, which may warrant a call to the resident or physician before grand rounds. In casual conversations with this particular LVN, I have tried to understand her as a person, hoping it might explain her behavior. However, I find myself immediately put off by what seem to me like unreasonable justifications, and I struggle to empathize with her position. I have come to believe that her work ethic is lacking. I self-talk, framing her behavior as representing "a lot of growing and learning to do," and though I sometimes feel like raising my voice, I control my emotions. I would prefer not to have her on my shift, but after discussing the matter with my head nurse, I understand that we cannot choose our colleagues. I cannot change her as a person, and so it is easier to accept her as she is and hope she adapts and learns.

As I self-evaluate, I realize I do not fully know how others perceive my leadership. Although I have read and learned about various leadership styles, I am as unique as anyone else, particularly in my approach to patient care. This is a continuing path of professional and personal growth, and only practice will perfect it—if it can ever truly be perfected. The key competencies for the successful mentor are "to understand myself and others," "to develop others," and to demonstrate "interpersonal communication" (Quinn, Faerman, Thompson, & McGrath, 2003), which prompts me to reconsider my approach. After studying this management module, I recognize that I need to spend considerably more time analyzing my strengths and weaknesses. I make it a daily effort to adapt to various leadership styles and to find a productive balance. Although I always believed I was well-balanced, my study of this module suggests that may not be the case.

Management Event: Implementing the Alcohol-Based Hand Gel Policy

As an active member of the infection control committee, I was asked to implement an alcohol-based hand gel on our ward by a deadline of January 31, 2004. The hand gel was intended primarily as a cost-saving measure to replace existing soap and lotion dispensers. It had been approved by the Centers for Disease Control and Prevention and was supported by evidence demonstrating a decrease in nosocomial infections nationwide. Our ward, along with the Neonatal Intensive Care Unit, was selected for early implementation given that our unit treats Acute Gastroenteritis (AGE) and Respiratory Syncytial Virus (RSV) patients. It was my responsibility to introduce the product, educate staff and physicians on its purpose and proper use, monitor compliance, and report findings back to the committee.

Initially, I encountered little resistance when discussing the new product. However, upon the product's arrival I was met with a large group of resistant nurses and staff physicians. Everyone refused to comply and was unwilling to accept the new policy. I faced a continuous stream of arguments and justifications: claims that soap and water was superior, complaints about dry and cracking hands, and objections to the smell of the gel. The Chief of the Infection Control Committee requested weekly progress reports during the implementation phase, which added considerable stress. I felt unsupported by my peers, and I feared the results would reflect my failure. Though it was just a hand wash, I had anticipated an easy rollout and was caught off guard by the resistance. I was ready to resign from the infection control committee after only a few days into the implementation phase.

Recognizing that I needed a more productive approach, I arranged for maintenance work orders to install the dispensers and consulted the in-house Safety Team to ensure the dispensers were mounted in appropriate, safe locations out of patients' reach. This process took several weeks before we were ready to proceed with the alcohol-based hand wash rollout.