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.
This series takes a look at the stories appearing in The Rebel Nurse Handbook, which features inspiring nurses who push the boundaries of healthcare and the nursing profession. This installment focuses on Brittany Molkenthin and the pivotal moment of her innovative nursing career.
In her junior year of nursing school, Brittany Molkenthin envisioned a new premise for a major maternal healthcare innovation. While shadowing a Lactation Consultant in the maternity ward, she encountered a mother attempting to breastfeed for the first time. What should have been a beautiful and life-affirming experience quickly went south. After months of planning to breastfeed her first-born child, multiple classes, and a volume of research, she had continuous trouble with positioning the baby, each time unable to get the right latch. The few times it worked, neither the mother nor the attending staff had any way of gauging how much milk the baby was receiving. After the numerous attempts that afternoon, an overall exasperation filled the room, accompanied by tears running down both the baby’s and the mother’s face. Desperate for her baby to eat, she asked for formula and a bottle.
Brittany replayed the incident over and over, throughout the
day and later that night. As a student, she was directly exposed to the concept
of innovation and the pain point/solution mindset through her school’s
Healthcare Innovations Program. Musing upon the dilemma, she identified the
pain point as the inability to register how much milk a baby was receiving from
its mother. A solution, she surmised, would be to develop “a device that
accurately calculated the amount of breast milk that infants receive during
After working with a team of biomedical engineers to develop
a working prototype, Brittany was ready to enter in her university’s “Shark
Tank” event. Although she did not win the competition, she was undeterred.
Brittany reached out to one of the event’s judges to discuss plans for her
device further and, thereafter, push forward with her startup. The year after
graduation, she filed a provisional patent and launched into a flurry of
networking, pitch decks, and attendance at innovation events.
While applying for startup business grants and working to
keep her nascent company alive, Brittany had her hands full: employed as a
bedside RN in pediatric intensive care and simultaneously studying to become a
pediatric primary care NP. Her breastmilk gauging device, Manoula, is designed to inform
“mothers and providers how much breastmilk a baby has consumed” and share the
data via wireless technology. The product is moving toward its alpha prototype
and is expected to enter the market in 2021.
DailyNurse asked Brittany: What was the hardest part
of starting your LLC and creating a new medical device? And what was the most
She responded, “the hardest part about starting an LLC and
creating a medical device was the mere fact of starting with no previous
medical device development, business, or entrepreneurial background. I thought
I was going to be a nurse, that was it… I never imagined it would get this
far. The most rewarding aspect is seeing how far the company and the device has
come since that drawing of my “vision” started as a Crayola picture
and a school project. It is amazing to think this device will be in the hands
of breastfeeding mothers someday.”
Brittany also has some advice for any nurse who has an innovative idea and is interested in turning it into a new product: “Find a team. Team is essential to the success of any startup or any innovative idea. A team that shares your passion, drive, and vision can help bring an innovative idea to fruition.”
All nurses should
invest in malpractice insurance, but for nurse
entrepreneurs who want to operate their own practice, malpractice coverage is essential.
If you are planning to venture out on your own and create a healthcare business,
you need to protect yourself from potential claims by selecting the right insurance
carrier based on the type of practice model you intend to deliver.
Finding insurance companies that recognize standard brick-and-mortar practice options is not hard, but if you want to incorporate the growing field of telehealth into your practice, you should take a close look at the options offered by different malpractice insurance carriers. While each company adopts the same state guidelines (e.g. nurses located in MA cannot provide telehealth services to a patient in FL unless first seeing them for an in-person visit) coverage can vary on the ratio of allowable in-person to telehealth visits. If you already have a malpractice carrier and are thinking about including telehealth within your practice, be sure to assess your plans in this area, consult with your current carrier, and shop around, as coverage varies considerably.
If you’re not yet
insured and are just starting to make your business plan, here’s what you can
expect regarding coverage: if you are a self-employed individual registered
nurse who a) doesn’t work in a correctional facility, b) doesn’t provide
cosmetic or medical aesthetics procedures, and c) has not been subject to a
medical malpractice claim or disciplinary board action within the last 5 years,
your coverage should come to around $250 per year. Such a policy should cover
$1 million per incident and $3 million in aggregate. If you are providing a walk-in clinic-type experience where you are
seeing most patients in-person, providing services like physicals, blood
pressure monitoring, wellness checks, wound care, suture removal, etc. this
type of standard coverage ought to fit your needs. However, if you are interested
in expanding into telemedicine, keep in mind that many carriers place a
limitation on in-person to telehealth visits of 75:25, where three-quarters of
your patient visits need to be in-person.
If you intend to
provide telehealth services that might include consultations, outpatient
visits, nutrition therapy, smoking cessation services, alcohol misuse
screening, depression screening, advanced care programs, and annual wellness
visits, your malpractice insurance is going to be higher than it would be for
an all bricks-and-mortar practice or a practice with limited telehealth options.
For a telehealth-focused practice, you can expect your insurance to cost approximately
$400 per year. This insurance ought to cover $1 million per incident and $6
million in aggregate coverage. Thus, for that additional $150 per year, your
insurer should provide for $3 million of additional aggregate liability, and impose
no limitations regarding the ratio of in-person to telehealth visits that are
required for an individual policy.
If you are just
starting to plot out the parameters of your business, now is the time to decide
whether telehealth is a good fit for yourself and your prospective patients. With
no end in sight to the nursing shortage and our aging population, telemedicine is
no longer just for rural districts; it’s an expanding field no matter where you
work and live. For many, the flexibility it offers is highly attractive as
telemedicine allows you to work from home and other sites outside a
conventional brick-and-mortar office. If you expect to work with patients
remotely, estimate what proportion of your practice you want to devote to
telehealth, what your expected ratio of in-person-to-virtual visits will be,
and start making inquiries among malpractice insurers.
Goodall, MBA is managing director of AlyxHealth. A 20-year financial services
industry veteran, Rob is the head of sales and principal financial
modeling strategist at AlyxHealth. He provides guidance on fiscal analyses,
strategic partnerships, product design, development, and launch. Within this
role, he also provides a cost savings analysis to expand profitability and
revenue growth for clients and the firm.
More information on
AlyxHealth can be found on their website, www.alyxhealth.com. Click here
to join the AlyxHealth Community.
I have always had an interest in owning my own business but what could I do independently as a nurse? Without having a clue as to where to start, I conducted a general search, and found a book about starting a nursing agency. Thinking to myself, “I could do that!” I bought the book, but when I started reading, I realized the information was very generic. There were no specific “how-to” details; instead, it provided a very basic outline.
After finishing the book, I realized there was no blueprint for me to follow to start my own business. I would have to start down the path of becoming a nurse entrepreneur completely in the dark and form my agency on my own.
My Journey to Becoming a Nurse Entrepreneur
I first determined what expenses I would incur, made a budget, and then a business plan. At first, I felt lost in this process as my professional experience was strictly in the nursing world where I would care for patients without involvement on the business side of healthcare. I tried to seek help from friends who had gone through this process in different industries, but it became abundantly clear that my situation was unique. They were able to offer little support because starting an independent nurse-led business was a relatively novel concept. Undeterred, I persisted and found my way. I decided upon a name for my agency and determined the type of legal entity my company would be, went to the state office and registered my new business!
At this point I knew it was time to begin marketing activities.
I had brochures and business cards made and mailed to prospective facilities. I
asked my nursing colleagues to refer their friends who wanted to have per diem
opportunities. I continued the process by building a website, figured out
payroll processing, and just kept trying to move forward.
The whole experience of starting a business took me approximately
one year, dedicating a lot of research, time and expenses. There were
some bumps along the way, but resiliency was key to my progress. Shaping my
company is still an ongoing process, with lessons learned almost daily, but
after eight years of continued success I feel that every year gets better and
better and the lessons learned are teaching opportunities to improve!
I want to share my story to help other nurses realize they too can become nurse entrepreneurs. Nurses should feel empowered to conquer their fears and begin down the path to becoming independent business owners. Navigating the process was not easy for me because I had no business experience and no idea where to start. Providing nurses with the tools they need and guiding them through the process of building and running a business, is a huge gap in the industry today. I was thrilled when I was introduced to the team and concepts being developed at AlyxHealth. Dedicated to helping nurses thrive, AlyxHealth would have provided me with the tools I did not have at my disposal back when I started my own nurse-led business.
Why would a nurse want to start a business?
Nurses today work harder than ever, many times in understaffed
and unsafe situations to care for their patients. With more new nurses leaving
the profession than ever due to these situations, this has to stop! I want to
be sure that all patients are taken care of by a nurse—now, and in the future—and
if the number of job vacancies keeps rising, we will have no one left to care
for our sick and injured!
When talking with prospective nurse entrepreneurs who have expressed interest in starting their own businesses, I hear the same common concerns including:
- lack of confidence in themselves; nurses are great at caring for people but are often intimidated by the financial aspect of healthcare.
- lack of support (financial and emotional) and not knowing who to ask for help.
- lack of expertise and fear of the unknown.
What kind of a business can a Registered Nurse run independently?
- Patient coaching (for example, a Critical Care Nurse can teach heart health techniques for patients that are post-heart attack)
- Diabetic management – Education
- Wound care
- Foot Care – Assessment
- Private Duty Nursing Care – patient advocate, patient administration, wellness check
- Dementia Care Therapy for private patients or facility educators
What kind of a business can an Advanced Practice Registered Nurse run?
In 23 US states, an APRN can practice INDEPENDENTLY from a
physician (with more and more states changing their guidelines).
Walk-In Clinic concept practices, such as:
- School/work/camp physicals
- Cuts/wound care
- Cough and Cold symptoms
- Medication management
- General practitioner care
More Specialized APRN degrees can also include practices in:
- General Practice
The more RNs and APRNs providing care in the communities, the better the care will be!
About the Author
Karen O’Donnell is a Registered Nurse and the owner of Caring Nurses Staffing Agency LLC. More recently, Karen has taken on the role of Senior Director of Clinical Solutions and Practitioner Success at First Matrix Health, the creator of the AlyxHealth platform. AlyxHealth allows nurses to personalize their services and fees, set their own business hours, and choose where to deliver care. More information can be found on their website, www.alyxhealth.com.
Have you noticed that nurse practitioners are becoming more
common in this country?
We are providing patients with essential medical services. We, as nurse practitioners, are able to offer diagnostic and treatment services for a wide range of illnesses. While many nurse practitioners might be happy at an office that is run by someone else, there are some who consider becoming an entrepreneur.
Starting your own nurse practitioner practice can be
lucrative and gives you an opportunity to help those patients in need, but you
should understand what you are getting into. I personally have been providing
patients with care at my clinic for many years and the knowledge I
have acquired is invaluable. If you are considering becoming a nurse
entrepreneur, be sure to learn more about the top characteristics that others
in the industry possess. This way, you can do a more thorough analysis of
1. The Ability To Be In Control
In one scientific publication, it was found that one of
the most important traits for a nurse entrepreneur is the ability to be and
remain in control over any type of situation. When you become an entrepreneur
and start your own nurse practice, you need to be in charge of various aspects
all at once. You need to be a leader and have the ability to recognize
situations that may spiral out of control quickly – and then take charge to
avoid such problems. For me, the ability to act fast and be in control at all
times is critical to the success of my practice.
2. The Ability To Analyze A
Situation And Know When It’s Okay To Take A Risk
Another critical characteristic lies in your ability to take
risks at the right times. There are many risks that have to be taken to succeed
in the business world. Understanding how these risks will play out and when it
is appropriate to take such a risk is critical. I often find myself taking
risks, but only when I am able to understand how my decisions might play out.
3. A Need For Achievement
You should have a desire for achievement. Once you have
established your new office, you need to recognize the fact that there is
always room to grow. You should know how to set goals – both short term and long-term
goals. You should also know how to continue striving toward those goals,
ultimately ensuring a consistency in achievements reached.
Innovation – the ability to adapt to new things – is a characteristic that is now more critical than ever before in a nurse practitioner. You should be able to adapt to the latest technological advancements that have been made. Plus, you need to be able to accept new changes in the industry and ensure you always have the latest treatments for patients.
5. Ambiguity Tolerance
Finally, ambiguity tolerance is another characteristic that
you definitely need. As a nurse practitioner, there will be times where the
result of something you strived for turns out as a disappointment. You should
be able to bounce back and avoid thinking negatively about such events.
As a nurse entrepreneur, I have a lot
of responsibilities. Understanding what it takes is important. I believe that
the characteristics outlined in this post are crucial to nurse practitioners
who are looking to take the entrepreneurial route.