Thoughts on Nursing Leadership

Leadership is how to be, not how to do. These words give leadership new meaning. The tendency is to define leaders by their actions, their accomplishments, not by who they are, whom they have inspired or motivated, whom they have supported or encouraged. A leader is self-aware. Self-awareness makes possible putting self second and others first and thus bringing out the best in both persons.

Nurses are leaders by virtue of who they are. The nurse is a visionary, always looking to “make things better” whether it is the health of the patient, the services and resources available, or support for colleagues in their pursuit of excellence. A leader takes charge and instigates change that promotes high standards. Nursing leaders enhance the development of others in their pursuit to become leaders. A nursing leader initiates ideas and works with other disciplines and public leaders to promote better health care. Other characteristics of being a leader include being a good communicator which entails being a good listener, having the foresight and willingness to compromise to move forward, and being willing to take risks for the improvement of patient care, student/staff education, research opportunities, and advancement of the profession.

To be a leader requires taking responsibility and using authority wisely.  Authority is necessary for change, but change must be introduced carefully and with adequate preparation of those involved. Leaders present new ideas positively and with excitement but also with the confidence and authority to implement them. Leaders know their limits as well as their strengths and resources. Leadership is a challenge and opportunity. It is exciting and fulfilling, but also requires work, preparation, endurance, patience, perseverance, and commitment.

To be a leader evidences strength of character and purpose. It means taking advantage of opportunities presented, and as noted above, being self-aware of one’s gifts and using them responsibly.

Sandra Mott, PhD, RNC is department chair and associate professor of maternal-child health.

Recently, I coached my students on how to introduce themselves: “Don’t introduce yourselves as ‘just a student’ or ‘just a nurse;’ introduce yourselves as an equal and essential member of the health care team.” Yet, throughout the day I overheard nurses initiating conversations with an apologetic  “just a nurse” qualifier.  I wonder which message my students heard?  I wonder what would have happened if Lillian Wald or Rita Kelleher or Barbara Hazard had introduced themselves as “just a nurse.”

It’s hard to exercise leadership from the position of “just a.” But the gendered and hierarchical structure of healthcare institutions, where nurses are employees and take orders, socializes nurses as subordinate workers. I prefer to see nurses as autonomous professionals, but in reality most of us are employees of institutions, following physician “orders” by virtue of our licensure.

Nurses must learn how to negotiate the power structures within health care institutions.  In this spirit, I offer some guidance: apologize for mistakes, but never apologize for your role or perspective; believe in your contribution to patient care; don’t confuse equality and subordinate status; ground your assessments in data; speak up and share your knowledge and experience; be proactive rather than reactive; learn the distinctions between capitulation, cooperation, and collaboration; establish collaborative relationships; build alliances and coalitions; learn the skill of brokering integrity—preserving compromise.

Learning to exercise leadership in nursing is a career-long process of “learning to get it right.”  Lillian Wald, Rita Kelleher and Barbara Hazard had to learn to negotiate relations of power and along the way learned from mistakes.  But I am quite confident that early in their careers each gave up—if they ever used the term in the first place—being “just a” nurse. 

Adele Pike, EdD, RN is clinical assistant professor of community health.