Staff nurses as clinical leaders

MedSurg Nursing, August, 2006 by Cecelia Grindel

Lately I have been puzzled by the recurring clinical issue being discussed among nursing leaders and managers. This issue is the lack of leadership on nursing units. The leadership they are talking about is not a line position, not a nurse manager position. It is a lack of leadership among staff nurses. Staff nurses are not stepping forward to lead activities that make a difference in patient care; they are not facilitating change that makes the unit run more smoothly; and, in many cases, they are refusing to mentor new nurses whose retention in nursing is affected by the guidance they receive during their first professional nursing experience.

Reflecting on this problem, I envisioned several reasons why staff nurses might not step forward to lead on the unit. They may feel that taking the lead on "change" activities will drive them away from their patients; they just do not have the time to spare. Maybe they perceive they cannot persuade others to participate in the planning and implementation of a project. If they do not feel that their leadership efforts are valued, they are unlikely to volunteer to participate. Maybe a past experience at leading a group was a failure; they do not want to relive that experience. Maybe they just are not willing to take on a task they are not sure they can handle. Or could it be that they just don't know how to go about facilitating, guiding, and leading? In many cases, medical-surgical nurses are not recognized as leaders and may be socialized to more passive roles. One or more of these reasons can stand in the way of talented nurses taking on leadership roles on the unit.

Coaching and Guidance Needed

Clearly most of these barriers to leadership could be countered with positive points of view. Patient care will improve if the unit is more efficient and effective. Unit managers can encourage, coach, and guide staff nurses in group facilitation and implementing a plan. Managers also can assure that the nurses know that this work is valuable to the patients and to the unit. On the other hand, many managers are not expert in these skills or do not have the time to coach and guide. Nurses' unwillingness to lead is not an easy barrier to overcome. However, watching peers successfully implement a project may instill confidence in others. Also, being passionate about an issue often promotes staff nurses to emerge as leaders.

Of all the barriers to clinical leadership, the lack of "know how" is the easiest to remedy if nurses take it upon themselves to learn leadership skills. Nurses can identify problems and propose effective strategies to manage these problems. With adequate knowledge and confidence, medical-surgical nurses can tackle major issues, such as patient care challenges, inefficient work processes, staffing shortages, and ineffective technology, and many more.

To be effective leaders, staff nurses must identify a team of supporters, formulate a proposal for the issue that is specific and thorough, understand the lines of communication and authority within the organization, address financial implications of the project, and be effective spokespersons for the proposal. They must understand how the organization works, how proposals for change are handled within the institution, and who the key players are in approving the project.

Talking the Talk

Talking the same language as administrators and other institution decision makers in the organization is essential for success. Administrators and decision makers will be impressed when nurse leaders demonstrate their knowledge of the challenges in today's health care systems. Leaders who can discuss the financial implications of the project will show decision makers they have considered many aspects of the project. Often nurses argue for action as patient advocates; however, discussion of the budgetary implications of the proposal is often lacking. All nurses need to understand and use financial terms specific to nursing. For example, to make an argument for additional staffing, nurses must understand the budget, FTEs, and scheduling. Clearly staff nurses do not have to manage the budget, but with some understanding of the terms they can make reasonable suggestions for change.

Other skills that are useful for clinical nurse leadership include communication and facilitation skills, organization, conflict resolution, and an ability to work with others. Student nurses are taught these skills during their education programs; however, they do not have the opportunity to use most of these skills during their education. And often these skills are not applied in the workplace when they enter the workforce. To be effective clinical leaders, medical-surgical nurses should avail themselves of opportunities to develop and use these skills.

Staff nurses are effective advocates for patients and can be change agents within the workplace. When they do assume leadership roles on the unit, they assure quality patient care. Being proactive is essential. Medical-surgical nurses do not need to wait for others to take action when change is needed. They do not need to live with the status quo when they can act to improve patient care in the workplace. Nursing practice needs clinical leadership at the staff nurse level. So much leadership talent is tucked away on medical-surgical units. Now is the time to expose that talent, and make a difference in patient care and the workplace environment.