The image of nursing has changed since the days of its founder, Florence Nightingale; however, the devotion is the same. Nursing as a profession, coupled with the men and women who make up its numbers, function as the first line of defense for their patients. Therefore, stewardship, governance, and advocacy for the profession must be employed by nursing leaders for its protection and progression.
Importance of Stewardship
The nursing profession is a vital component in functioning society, and nurses fill the roles of an educator, facilitator of care, administrator, counselor, and advocate. Nursing leaders have a pivotal role in the process of progress and change for the profession. They are the representatives and the face of their departments. They must exercise stewardship at the point of service while working to advocate for respectful interactions with patients and promote a just culture (Murphy, 2009). Stewardship is a concept that includes the philosophy of practical analysis and practice of serving others in such a way as to provide leadership while observing the shared values of the staff for which they are in charge. The staff is the intrinsic force in a department; therefore, its steward’s goal is to serve, protect, and perpetuate its growth and function (Murphy, 2009).
The steward at the point of service must be aware of challenges and differences while cultivating these aspects into objective and impartial practices. Nurse leaders and staff members can promote their practice while creating change by the effective communication of ideas and observations made on patient care. Further, the transformation of current practice into a more efficient delivery of care can be facilitated by open collaboration with nursing leaders and physicians. A realization that we are all in this together would serve to impact nursing in such a positive way.
Improving Nursing Through Shared Governance
Shared governance is a term that was introduced over twenty years ago and was used to provide actionable strategies to provide nurses with power over their practice. Shared governance is a collaborative strategy used by organizations to encourage nursing staff to manage their practice with a high level of commitment to practice (Green & Jordan, 2004). Further, the process of shared governance works to stimulate workplace advocacy, which operates at the local, state, and national levels of government. Without nurse leaders, staff participation, and the use of collective knowledge of patient care implications related to poor staffing ratios, policies will not change. Simply put, shared governance provides nursing with a vehicle to promote their collective voice.
The Leader and Advocacy
Nurses and nursing leaders are already aware that health care reform is needed. They are the first to see a breakdown in the efficiency and efficacy of patient care; therefore, it is the nursing profession’s collective responsibility to promote change (Abood, 2007). Further, to be an effective advocate for change, one must possess the desire, will, time, and energy required to engage in reform at the legislative level. There are a growing number of uninsured patients, a rise in the costs associated with providing quality care, and a continual decrease in the healthcare workforce. These problems impose a great strain on the nurses currently in practice. The strain further imposes the numbers of those who choose to be involved in reform. The current workforce is under excessive stress, which directly corresponds to a lack of interest in representing themselves or sharing their collective voice. Work stress aside, Abood asserts that nurses find it difficult to leave the comfort of their practice to engage in the battle to be heard by their legislators (Abood, 2007). However, without representation from the nursing leadership in practice, policies cannot be changed. It is the combined knowledge and field experience held by the nursing profession that is needed to influence those who make policies for change to occur.
Nursing leadership will encounter greater challenges in the near future. The management of human capital, digital technology advancement, and cost control are three of the major challenges and opportunities that nursing leaders will face in the 21st Century (Lee, Daugherty, and Hamelin, 2017). Nursing leaders will play a critical role in transforming healthcare through active participation on the nursing units and in executive boardrooms. Critical issues, such as an aging population and the nursing shortage, continue to be prevalent in the United States and globally. Therefore, nursing leaders will need to address issues that affect retention and create new ways to promote the profession.
Nursing leaders need to expand upon the foundation created by nursing pioneers such as Florence Nightingale. The integration of shared governance into the workplace begins with the nursing leader. There also needs to be a collective effort to revise and reform policies at all levels of administration within an institution and our state and national governing bodies. There is a legacy to uphold. By joining state nursing associations and showing solidarity, the profession can serve the public in a much larger capacity. The nurse leader has many challenges ahead. In taking pride at the bedside, the nurse has the power to impact not just those that he or she serves, but to the families, administrators, and peers alike. Our presence can be our voice, as well.
Abood, S. (2007). Influencing health care in the legislative arena. The online journal of issues in nursing, 12(1).Retrieved September 14, 2020 from http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume122007/No1Jan07/tpc32_216091.aspx
Alexander, K. L. (2019). Florence Nightingale. Retrieved September 14, 2020 from https://www.womenshistory.org/education-resources/biographies/florence-nightingale
Green, A. & Jordan, C. (2004). Common denominators: Shared governance and workplace advocacy – strategies for nurses to gain control over their practice. The online journal of issues in nursing, 9(1). Retrieved September 14, 2020 from http://ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Volume92004/No1Jan04/SharedGovernanceandWorkPlaceAdvocacy.html
Lee, E., Daugherty, J., & Hamelin, T. (2019). Reimagine health care leadership, challenges and opportunities in the 21st Century. Journal of PeriAnesthesia Nursing, 34(1), 27–38. https://doi-org.ezproxy.umgc.edu/10.1016/j.jopan.2017.11.007
Murphy N. S. (2009). Nurse leaders as stewards: the beginning of change. The open nursing journal, 3, 39–44. https://doi.org/10.2174/1874434600903010039. Retrieved September 14, 2020 from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2737121/
Nightingale, F. (1946). Notes on nursing: What it is, and what it is not. Philadelphia: J.B. Lippincott.
Summers, S. J. & Summers, H. J. (2004). Media ‘nursing’: Retiring the handmaiden. Retrieved from https://www.nursingcenter.com/pdfjournal?AID=483200&an=00000446-200402000-00002&Journal_ID=54030&Issue_ID=483197
The importance of nursing leadership and nursing’s response to COVID-19 are two dynamics reflected in the theme for International Nurses Day 2021 (IND2021). The main theme for IND2021, announced by the International Council of Nurses (ICN), is “Nurses: A Voice to Lead.” The sub-theme is “A Vision for Future Healthcare.”
International Nurses Day is celebrated worldwide on May 12, the anniversary of Florence Nightingale’s birth. ICN celebrates the day by choosing a theme and producing resources.
The main theme of “A Voice to Lead” has been used for the past few years, notes Howard Catton, RN, ICN Chief Executive Officer, based in Geneva, Switzerland. “Clearly it speaks to the importance of nursing leadership, and the issues and problems around the world that we know that we’ve had with nursing voices not being heard or included at the high tables for health systems and policy decision-making,” Catton says.
The national nurse associations that make up the ICN felt the theme was strong and “resonated, reflected, and aligned with the work that very many of them are doing in their countries,” he says. The theme also connects with the “State of the World’s Nursing 2020,” a report developed by the World Health Organization in partnership with ICN and the Nursing Now campaign.
“A Vision for Future Healthcare”
The sub-theme of “A Vision for Future Healthcare” relates to nursing leadership coming to the fore in many countries during the pandemic, notes Catton. “I think the world is seeing the value of nursing in a way that perhaps it hasn’t before because of the response to the pandemic.”
Catton stresses that the central role played by nursing in the pandemic needs to be maintained in the design of future health systems, as well as discussions on policy and decision making. “Models of care could be much more nurse-led,” he notes. The “hand of the nurse,” he says, should be “on the architect’s pen, drawing, designing the future.” The nursing response to COVID-19 “means that we legitimately own a seat” at the table for health systems policy and decision making.
Nurses, Catton says, not only save lives during the pandemic, but also save and support families and communities. “They are changing the world in terms of what they’re doing in their daily practice.”
The ICN is a federation of more than 130 national nurses associations worldwide. For IND2021, nurses can share their stories in the form of a 1,000-word case study to be a part of the event. Guidelines and templates on how to submit a case study can be found here.
In the second part of the DailyNurse interview with Marion Broome (Ph.D, RN, FAAN), Dean of the Duke School of Nursing and author of Transformational Leadership in Nursing, Dr. Broome talks about what it takes to be a leader, team-building, changing trends in leadership, and more.
Communication is an essential part of the leader’s toolkit
Marion Broome: Communication is number one. It doesn’t mean you have to be super-articulate. I’ve watched people who weren’t incredibly articulate but they use humor, and use humility… I’ll tell you who’s amazing at this is Coach Kay at Duke. He uses humor, and he catches you off-guard while doing an interview, and it makes [a leader] seem so much more human. I have to force myself to do that; I’m not naturally very good with humor, but if I can, I’ve taken the opportunity to do that. It relaxes people almost immediately: “oh, she’s just like me.”
Can you build a team before you’re actually a leader?
MB: Oh, yes! You can. And you probably should, because every course that’s taught, every unit that is managing patients, every community agency that employs staff nurses and cares for families—all of those have very complex challenges to deal with. Everyone sees the challenges in their particular job, and if we each attack it with our own solutions, nothing’s going to happen. But if we together work with other people like us, and say, “have you ever noticed that… Have you ever seen—I have this family, and they do this, and I don’t really know what to do. I’ve tried this and this and this?” And if you get a bunch of nurses around the table, there’s no problem they can’t solve. Because they will all have good ideas.
If you get a bunch of nurses around the table, there’s no problem they can’t solve. Because they will all have good ideas.
There will be somebody in that group—you get into a little group of five or six people, and there will be some natural leadership or organizational strengths that will come forward. Somebody’s always good at taking notes, and somebody else will say “oh, I’ll report out on it.” Some people like to put everything into a chart, you know, that helps everybody see it more clearly. That’s all about team building. And the role of the senior leader lies in pulling those young folks together and saying, “what do you all think?” The leader will be helping to shape, because sometimes in small groups, you’ll get people who try to take over everything—there’s always insecurity driving some of that—and the facilitator, the more formal leader, needs to mentor everybody and make sure everybody is sharing their ideas.
The leader as mentor
MB: The word “mentor” is kind of overused now. You know, I get a lot of requests from people to be their mentor and have learned to ask questions first. I mentor Ph.D and DNP students, which is pretty structured, and early on, you have to figure out a communications style that works for that person, and a work style that works for both me and that person. I’ve learned to say to people, when they ask me to be a mentor, “you tell me; what would you like out of this relationship?” “What’s going to work best for you?” [For example] is it face-to-face meetings? Would you rather talk on the phone? What kind of things do you think you need help with? And how can I be of most use to you?
I’ve learned to say to people, when they ask me to be a mentor, “you tell me; what would you like out of this relationship?”
So, to me you could call that a “sponsor,” you could call that a “coach,” or you could call it a “mentor.” But it’s someone for whom I’m willing to invest the time it takes to help them achieve their goal. I’m willing to take the time as long as I know I’ve got what they need. If they need somebody that’s just going to “rah-rah-rah,” then I’m not the best person for that. I will “rah-rah” when it’s appropriate, but I will also share some observations that they may not want to hear. It takes a couple of meetings with people to figure out if you’re the best person for them or if you should recommend somebody else. It’s good to get to know each other, and figure out if I really have what they want, and also, sometimes—and this is really hard—I find out a couple of meetings later that I’m not the best person, because frankly, I can’t connect with them. We’re so different; our personality styles are so different, that I have to say, “you know, I really think you’d probably work better with someone else.”
The humble leaders
MB: When I think of the millennial leaders I know, who are clearly emerging leaders, I find they’re focused, they’re organized… Some of them are very quiet individuals from a personality standpoint, but because they’re so competent and so people-focused, others are just totally drawn to them. It’s amazing to watch, because our society has changed. You think of the leader—at least in nursing—as strong and opinionated, articulate and verbal. Now that doesn’t seem to work as well as it used to. Or, it just isn’t as valued as at one time was. So, there are young people now who are coming up and I am very clear with them about what I think are their strengths, and often they’re just so humble. But humility is important – if you read the book Good to Great: Why Some Companies Make the Leap… and Others Don’t – you’ll find a study about top organizations that have moved from being a really good organization to being a great organization—and they’re all headed by really humble leaders.
What is a servant-leader?
MB: There is an organization that is devoted to the study of an education about servant-leadership—the Greenleaf Foundation. But in my own case, I was an Army nurse—and unbeknownst to me, that was where my training began in leadership. In that setting, the officer is responsible for everyone under their command. If you’re a nurse, you have medics working with you, along with other, lower-rank nurses, and you’re the last one who goes to dinner. You make sure that everybody else goes. And no matter what happens on ward or unit, it’s your problem. And if somebody’s having family issues, you’re expected to pay attention to that. You’re expected to uncover that and to talk to that person, and see how you can help. So, unconsciously, I think that really made an impact on me, and I think that servant-leaders never forget where they came from. To me, that’s what servant-leadership is: remembering why you’re getting paid, what your responsible for and why you’re here.
Leading as Dean of the Duke School of Nursing
MB: Now, I probably have one of the greatest jobs in nursing, and my
job is to lead that school [the Duke School of Nursing], and to do it
in a way that it’s a community. That’s how good organizations
thrive. [Good organizations] are communities of very diverse talent
and diverse perspectives, diverse jobs. You have to keep everybody
moving in the right direction. We’re serving our students; that’s
why we’re there. None of us would have jobs if our students didn’t
want to be nurses. I’m in this job to make sure that the Duke
School of Nursing continues to provide the best education possible at
all levels- BSN to PhD. We have a heavy responsibility, as we’re
one of the top-ten schools [ed. Note: Duke is listed as No. 1 on the
recent Nurse.org top
10 nursing schools list].
It’s my responsibility as leader to remind us that we, with all of the resources we have, comes a big, big responsibility. And we’re up to it. I have the most incredible faculty and staff that have pulled together, all the time, especially in crisis. It’s very gratifying when it works, and it has worked very well!
Leaders and leadership play a key role in nursing at all times and are absolutely vital in a period of crisis. DailyNurse spoke with leadership expert Dr. Marion Broome (Ph.D, RN, FAAN), Dean of the Duke University School of Nursing and co-editor of Transformational Leadership in Nursing, to find out what it is that makes someone a leader, what leaders do, and how people can develop their own leadership qualities.
What it means to be a “transformational” leader
Marion Broome: I think it’s a perfect time to talk about this.
First, all leaders, ie. transformative leaders, transactional
leaders, can be found throughout any organization. If you’re a
bedside nurse you can see them throughout the entire organization,
including among your colleagues and yourself. Transformative leaders
tend to be those who can see themselves taking charge of a situation.
And I don’t mean in terms of authority, but in realizing how a
situation is affecting other people, using their talents and skills
to reach out to other people to help them to communicate, and
help them listen to other people. They help people to reframe
if things are getting very negative; help individuals to see their
own strengths, and mobilize those strengths to deal with whatever
situations people are dealing with. Transformational leadership is
about investing in others. And it’s never been more important than
when times get hard—such as the time we’re living through now.
Transformational leaders will look at different opportunities. They’ll see ways that they can improve things. They’ll see the gaps, they’ll see the needs, and they’ll point those out, but they’ll also try to encourage other people to use their talents to address those and thereby build their own leadership strengths.
Finding your strengths
MB: People don’t really understand what their own strengths are many times. [Some leaders] just think that anybody can be good with other people—and that could not be less true! I coached this one young leader-nurse, and she was very high on the emotional intelligence level. She was always supporting other people, and always gathering information to share with other people—and people looked to her—they really reached out to her when they wanted to get “the truth,” or when everybody was saying “what are you going to do about this?” Everybody is not like that. If everybody was like that, nobody would be reaching out to you as a leader.
There are so many strengths that people can bring to the table, and not only people who are in a leadership position. That’s a big misconception: that leaders are leaders only because they are in a formal position.
I probably spend
half my time with young leaders pointing out their strengths. I use
the StrengthsFinder, in fact (the book
by Tom Rath) with young leaders, emerging leaders, so they can take a
quick assessment, find their Top 5 CliftonStrengths, and it usually
resonates with them. And they’ll say — these are Ph.D. students,
DNP students — “I never thought about that before. I never knew
that I’m (for instance) a lifelong learner, or that I’m a
visionary; I never thought that about myself.” Someone, when
they’re first starting out, should spend time getting insight about
themselves, their strengths, and areas in which they’re perhaps not
so strong. There are so many strengths that people can bring to the
table, and not only people who are in a leadership position. That’s
a big misconception: that leaders are leaders only because they are
in a formal position.
We all have examples
of people who are in leadership positions who don’t really know how
to lead other people. Who don’t know how to be empathetic; don’t
know how to think strategically; don’t know how to reach out and
communicate with others. We have seen instance upon instance of this.
People can act as leaders, even when they’re not in leadership positions
MB: We all know them. Whether you’re working on a hospital unit, or in a community or an agency—they are the go-to person. As I mentioned earlier that’s the person who everybody goes to get information. It’s the person they go to to make sense of that information, and the person that they trust to share their own information or their own response to whatever is going on. Those are the informal (yet strong) leaders in the organization. And those leaders oftentimes don’t want an official leadership position. They are not necessarily comfortable with communicating to large groups. They’re not necessarily comfortable with being focused on as the leader, but they are so powerful in organizations. And formal leaders really need to make sure they know who those people are, so they can work with them and leverage their skills and networks.
Making use of other people’s abilities and leadership skills
MB: To me, leadership is all about the people; it’s not
about the person (ie the formal leader). And I think that
where some leaders get into trouble, when they are threatened by
other strong leaders they work with. It is as if , when they work
with a really strong leader who has complemental skills, they feel
“less than.” For instance, I have a leader on my executive team
who has a remarkable ability to bring people along to new ideas, new
ways of seeing things and doing things—even when they don’t want
to come along! And, at the same time, as they think and try on new
things they change the way they’re framing things. It’s just
remarkable. When I listen to her, how she talks to people, or read
her emails, I think, “that is amazing!” It’s not me; I do
different things in different ways as a leader—but wow—do you
want somebody like that on your team? Without question. And the
reason you want somebody like that on the team is that they really
support other people and bring them along, and grow them…
The reality is, when that person and I agree about the concept/message we’re trying to put out, then we each have to do our part. She’s got to communicate it in her way, and I’ll communicate it in mine. And we have to back each other up. How she does it is very awe-inspiring to watch, and I don’t feel like it makes me any less of a leader. In fact, I think it strengthens peoples’ perception of all the formal leaders in the organization. I have ten other leaders as well, with different strengths. You can’t do it all! You just simply cannot do it all in any organization. You have to share, and you have to give and get input—what I know is any idea I’ve ever come up with is better once I get input and recraft it.
First step toward leadership: learn to know yourself
MB: There’s so much focus now on developing new leaders, because the former leaders (ie like me) are all getting older. [To develop as a leader,] the number one thing is to get to know yourself. Know what you do well; know what you don’t do so well. When I was younger, I was very, very direct. Now I’m still known for my directness and my honesty, and most people frame it as refreshing—that they always know what I’m thinking– but when I was younger, I didn’t give as much thought to how I said something, or when I said something, or to whom I said it. And I had some very honest and straightforward mentors who were wonderful to me, but who gently—and sometimes, not so gently—said to me, “you really need to take a look at how you’re saying things and what you’re saying. Because you have great ideas, but people can’t hear them.” They said, “people may be listening, but they’re not going to really hear what you’re saying, and they’re not going to be able to take it in, because it’s too threatening.”
The number one thing is to get to know yourself. Know what you do well; know what you don’t do so well.
I was always good with people one-to-one, but I questioned the system. ALL the time. The reality is, though, once you question a system, saying things like, “why are we still doing this this way?” or “there’s a better way of doing this.,” you’re indirectly affecting the people who do it, you’re indirectly criticizing them. So the advice I got was so valuable for me—I was in my late 20s—so valuable. And all you have to do is make some little change in how you say or do things, and you can get such positive feedback. That’s what I’ve always kind of focused on: learning all you can about yourself. You don’t have to be strong in everything. If you watch yourself and observe yourself, you’ll know what you’re really, really good at, and if you share what you think with other people or [share] their strengths, you’ll be building a team.
End of Part One. Part Two of this interview with Dean Broome will appear next Thursday, April 23.
Our Nurse of the Week is Laurie Badzek, LLM, JD,
MS, RN, FNAP, FAAN, dean of the College
of Nursing at Penn State, who has been honored with the American Nurses
Association’s (ANA) Leadership in Ethics Award. ANA created the award to
recognize registered nurses who have authentically demonstrated the highest
standards of ethics and leadership in their daily practice, served as an
ethical role model, and promoted ethical dialogue and scholarship.
career, Badzek has held the roles of nurse, attorney, researcher, and educator.
She brings experience in genomics, health care ethics and law, nursing
practice, and end-of-life care and decision-making to her work, and her
commitment to ethical leadership led her to serve as director of the American
Nurses Association Center for Ethics and Human Rights where she was
instrumental in revising the ANA Code of Ethics for Nurses.
Nick Jones, executive vice president and provost, tells news.psu.edu, “In 2018, we selected Laurie to be dean of Penn State’s College of Nursing in part because of her exemplary leadership on ethical and human rights issues and advocacy regarding nursing education, practice and policy. I consider Laurie a role model for ethical leadership at the University, so I’m thrilled that she received this much-deserved award from the ANA. I congratulate and thank Laurie for her commitment to excellence.”
began her role as dean of the Penn State College of Nursing in July 2018 where
she oversees the undergraduate and graduate programs at 12 commonwealth
campuses and online. Her role also enables her to be a champion of using genomics
in nursing to enhance patient care, and her research in genomics has been
funded by the National Council of the State Boards of Nursing, National
Institutes of Health, National Human Genome Research Institute, and National
Cancer Institute. Badzek is also a member of the American Association of
College of Nursing Deans and Sigma Theta Tau International Honor Society of
Nursing, and a fellow of the National Academies of Practice and more.
learn more about Laurie Badzek, dean of the
College of Nursing at Penn State, who has been honored with the American Nurses
Association’s Leadership in Ethics Award, visit here.