34 May 2015 • Nursing Management
www.nursingmanagement.com
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
Helping leaders r
emerge from the bedside dsi By Guy Beck, MSN, RN; Dolores Puthoff, MSN, RN, NMF; and Gordon Lee Gillespie, PhD, PHCNS-BC, FAEN
F
or some people, the image of leadership may be a man dressed in a suit and tie, feet propped up on a high-gloss desk, barking orders to his employees. But our modern business environment isn’t conducive to such an image. Leadership has evolved. The current climate is filled with leaders like Mark Zuckerberg of Facebook, Liz Wiseman of The Wiseman Group, Kira Wampler of Lyft, and the late Steve Jobs of Apple. What do these leaders have in common? They foster innovation in their business culture.1-4 They placed innovative power into the hands of their employees. Nursing needs managers who place innovative power into the hands of clinical nurses. Clinical nurses need to learn the power of their job title, that they’re more than “just” clinical nurses.
www.nursingmanagement.com
There’s a need for bedside leadership in nursing, and leadership theory is essential to the successes of clinical nurses who can simultaneously evolve with this changing landscape. Two such theories contributing to nursing leadership are Theory X and Theory Y.
Two different approaches In most U.S. undergraduate business curriculums, there lies at least one lesson derived from The Human Side of Enterprise, which attempted to answer the age-old question: what makes a manager successful?4 Traversing through historical methods of leadership and scientific literature in the social sciences, McGregor, the book’s author, found inconsistencies in how management was viewed in modern U.S. industry. McGregor found many managers lead from an authoritarian perspective that’s more conducive for military leaders ordering troops, but Nursing Management • May 2015 35
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
Helping leaders emerge from the bedside
less conducive for leaders attempting to create employee-driven, innovative policies. Although The Human Side of Enterprise was published in 1960, McGregor’s message of managing via Theory Y (inclusive type) and avoiding Theory X (authoritarian type) management styles has stood the test of time. In fact, several modern business management authors are simply repackaging McGregor’s Theory Y content and delivering it
2. “Because of this human characteristic of dislike of work, most people must be coerced, controlled, directed, threatened with punishment to get them to put forth adequate effort toward the achievement of organizational objectives.”4 3. “The average human being prefers to be directed, wishes to avoid responsibility, has relatively little ambition, wants security above all.”4
Nursing needs managers who place innovative power into the hands of clinical nurses.
in a different manner. Managing via Theory Y is the most basic, yet important construct every manager should know. Some business experts assert Theory Y isn’t always the best model and that the authoritarian Theory X approach may be more appropriate. Perhaps a more appropriate view is that theories X and Y fall on a spectrum, and the type of industry will dictate the theory to which a manager should subscribe. Nurse leaders, as this article will argue, should fall heavily on the side of managing via Theory Y. If you want to instill innovative leadership abilities in clinical nurses, avoid Theory X.
Theory X The three tenets of Theory X are: 1. “The average human being has an inherent dislike of work and will avoid it if he [or she] can.”4 36 May 2015 • Nursing Management
In this model, clinical nurses have no autonomy in how they manage patient care and are forced to adhere to organizational policy and procedures. For example, as a result of having little ambition, nurse managers would consistently review nursing documentation to ensure nurses are implementing care in accordance with the organization’s view of how clinical nursing should be implemented. While overseeing documentation, managers will punish nurses who are noncompliant with documentation standards. Moreover, the policies and procedures shaped for clinical nurses would be based on a topdown approach that’s out of touch with the actual clinical environment. Further, these nurses may falsify documentation to appear compliant with organizational policies. If clinical nurses would
suggest novel approaches to streamline patient care, managers would nullify their suggestions since “management knows best.” Because nurse managers in the 1960s had less access to technology compared with managers today, the implementation of Theory X looked much different. Technology gives today’s clinical nurses autonomy in a way nurses couldn’t have experienced in generations past; however, technology has also given managers the ability to micromanage and observe adherence to organizational policies around the clock, even when away from the office. We recommend that nurse managers not play “big brother,” constantly monitoring clinical nurses’ care, because their actions could be viewed as authoritarian if not approached in an appropriate manner. This degree of observation squanders autonomy and innovation from the clinical nurse. In a way, technology has blurred the line between Theory X and Theory Y, making it difficult to implement Theory Y.
Theory Y The four tenets of Theory Y are: 1. “The expenditure of physical and mental effort in work is as natural as play or rest.”4 2. “External control and the threat of punishment are not the only means for bringing about effort.”4 3. “Commitment is a function of the rewards associated with their achievement.”4 4. “The capacity to exercise a relatively high degree of imagination, ingenuity, and creativity in the solution of organizational problems is widely, not narrowly, distributed in the population.”4 Nurse leaders who manage via Theory Y understand management doesn’t always know what’s best. www.nursingmanagement.com
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
Rather, leaders managing via Theory Y consistently defer many decisions to the expertise of the clinical nurse involved with patient care. Theory Y leaders should view the clinical nurse as an autonomous leader capable of innovatively influencing practice and policy. These managers understand external control and coercion aren’t means of motivation for nurses and that it often creates a hostile environment. So what does Theory Y look like in practice? A Theory Y nurse leader understands the necessity to monitor nursing documentation and patient care due to compliance requirements needed with The Joint Commission and Magnet® recognition standards, but Theory Y leaders convey this understanding to clinical nurses. When inconsistencies in practice or documentation are recognized, the nurse leader doesn’t punish or scold nurses and instead creates an open dialog with them to find barriers to compliance. When barriers are identified, the clinical nurse is encouraged to create innovative changes to practice and policy. A Theory Y nurse manager views the nurse as a bedside leader, capable of making independent decisions in accordance with his or her role as patient advocate.
Managing forces from the bedside People are actually motivated by autonomy, mastery, and purpose.5 When a leader is able to see and hear issues from a nurse’s point of view, the landscape changes. Nurses with the autonomy to make choices about what to do and how to do it develop clinical reasoning. They move away from the rote, task-based version of nursing toward the holistic picture, allowing them to integrate thinking into a more global perspective. www.nursingmanagement.com
When autonomy and creative knowledge are systematically removed from nurses, the nurses become puppets to tasks, going from one thing to another, missing the nuances, moving through the daily routine without really thinking about what they’re doing and why. We need clinical nurses who can creatively think about what they’re doing, why they’re doing it, and how it fits into the larger clinical picture. We want nurses to walk into a patient room and be able to predict what may happen based on what they know, what signs and symptoms could present, what interventions would be required, and what actions should be taken. Currently, three forces create the perfect environment to foster this leadership at the bedside: the Affordable Care Act (ACA), the Institute of Medicine’s report on the future of nursing, and the shared governance model.6,7 When clinical nurses realize the power potential these three forces create, they can take the initiative toward creating a new healthcare environment.
Affordable Care Act Several important aspects of the ACA directly affect clinical nursing practice. First, financial incentives are paid to hospitals based on the quality of patient care.6 Second, the number of persons with health insurance has increased, which has led to an increase in the number of patients seeking healthcare services.6 This will increase the need for bedside leaders. It’s important to encourage nurses to lead quality improvement projects that improve the quality of care essential to the ACA. When clinical nurses are totally engaged in what they’re doing, they forget themselves and focus on their
patients. If managers provide nurses with autonomy, mastery, and purpose, especially relative to quality conditions, the development of leadership at the bedside will demonstrate the reduction.
Future of nursing The second force is the IOM report on the future of nursing. It’s in no way a mistake that The Future of Nursing report was released in October 2010, the same year as the ACA. In essence, the report provided recommendations for how the nursing discipline can address the changes to be produced by the ACA. In the report, three recommendations directly or indirectly describe the need for nursing leadership. Recommendations two and seven relay the importance of clinical nurses being bedside leaders and directly relate to the quality improvement efforts previously discussed in relation to the ACA.7 Nurse managers and hospital executives should take seriously these proposed calls for nursing leadership. More specifically, managers should groom clinical nurses to take the lead on changes within the organization. This can be achieved by increasing the opportunities for nurses to initiate change through the cultivation of a shared governance program, as well as nursing students completing evidence-based practice projects as part of their nursing curricula. Recommendation four calls for a significant increase in the proportion of nurses with a baccalaureate degree. This increase in clinical nurses can increase the proportion of nurses capable of functioning as bedside leaders. Building partnerships between academia and organizations, as well as specific hospital units, can foster career Nursing Management • May 2015 37
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
Helping leaders emerge from the bedside
pathways for unlicensed assistive personnel to become baccalaureateprepared. Leaders can initiate and foster these relationships by building trust, developing accountabilities, and relating beneficial projects to both the academic and clinical arenas. In addition, creative programs engaging experienced clinical nurses to work within their facility as adjunct academic faculty allow strong expertise to remain at the bedside and share much needed knowledge with students while building bridges and networks into academia.
Shared governance The third force, the model of shared governance, is frequently instituted in hospital systems. Shared governance promotes the voices of clinical nurses within their given healthcare institution. When an organization truly embraces the shared governance model, very few clinical nursing decisions are instituted in a topdown approach. One of the most valuable resources in nursing is clinical nurses who have a daily pulse on patient acuity, clinical skills, barriers to quality, and suggestions to improve patient outcomes. Leaders should always defer to the person who possesses the expertise.8 The best opportunity for change in the future of nursing will be to listen to the expertise at the bedside. These bedside leaders know what does and doesn’t work. In the shared governance model, clinical nurses are enabled to create an idea for change on their specific unit and then develop proposals they can present to larger councils within their organization. It empowers them to implement the innovations of the bedside throughout the healthcare system. In essence, shared gover38 May 2015 • Nursing Management
nance transforms clinical nurses into bedside leaders because it empowers them to shape policy and procedures throughout the organization. As we look to lead changes in healthcare, it will be bedside leaders who must see and seize opportunities for transformation. We’re at a point where nursing must change while maintaining quality, and it will be the bedside leaders who can identify what can be done differently. Nurse leaders will truly reflect their leadership skills by listening to these nurses to initiate strong, substantial changes that can significantly impact nursing practice and patient outcomes.
Braving the storm Managers need to be able to cultivate leaders at the bedside so that clinical nurses become effective bedside leaders. Managing through Theory Y uses the assumption that employees exercise self-direction and build commitment through achievement.4 As leaders, we’re directed to two critical pieces of success: knowing one’s authentic self and understanding situations in a way allowing for creativity and change.9 Self-awareness is one of the most important foundations of leadership. Self-awareness, understanding one’s own strengths and opportunities for improvements, enables a leader to be better prepared to see the world. The ability to expand and see people, processes, and perspectives greater than the fragments is important to teams and organizations because each fit together analogous to a puzzle. Our success as an organization pivots on the ability to fit the pieces correctly, knowing when to flex our strengths and find out others’ strengths to help balance any missing essentials.
Self-awareness places a firm foundation for finding both the core of the puzzle and the complementary pieces that equalize the team perspective, allowing for maximum adaptability in a diverse world of creativity. There are many ways to develop leadership in clinical nurses. Passion, energy, and enthusiasm are incredible gifts in nursing. When you identify these attributes in nurses, reach out to them and provide mentoring. Some of the most incredible bedside leaders have been cultivated through coaching and mentoring. Spending time with these fresh minds is such an inspiration to the team and the organization. Providing expectations for professionalism, development, growth, guidance, and active listening, as well as support through learning, is also instrumental in building trusting relationships that lead to engagement and investment in bedside leadership. Encourage clinical nurses to base their nursing practice on science and evidence-based literature. Also encourage them to become involved in professional organizations and projects that allow them to give presentations. During discussions, support your clinical nurses in developing plans and solutions to motivate, inspire, and develop creativity. Facilitate, enable, encourage, and allow time for shared governance. Fostering creativity through brainstorming and promoting ideas through shared governance or when concerns arise have also brought bedside leaders to the forefront. For example, a clinical nurse became frustrated with a process and e-mailed the nurse leaders. As a result, the nurse’s concern was discussed, a task force was created, and a project was initiated to change the www.nursingmanagement.com
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
process throughout the organization. This is leadership at the bedside: one nurse affecting change in an organization where leadership listens and promotes bedside leadership.
Become the change In moments of crisis, the healthcare system needs leaders at the bedside who use effective clinical reasoning. We need managers who promote bedside leadership by growing, nurturing, cultivating, and planting seeds of potential in clinical nurses. Seek out clinical nurses who use their creative energy to spearhead innovative policy and practice changes, so that the future of our healthcare system may become more efficient and pragmatic. The time is now! Catalyze, encourage,
www.nursingmanagement.com
and energize potential bedside leaders. NM REFERENCES 1. Deneen S. The Facebook age: Mark Zuckerberg. http://www.success.com/article/thefacebook-age-mark-zuckerberg. 2. Fallows J. Brave thinkers. http://www. theatlantic.com/magazine/archive/2010/11/ elon-musk/308270/. 3. Gallo C. The 7 innovation secrets of Steve Jobs. http://www.forbes.com/sites/ carminegallo/2014/05/02/the-7-innovationsecrets-of-steve-jobs/. 4. Nagy E. The women leaders driving Lyft’s impressive growth. http://www.fastcompany. com/3041106/most-creative-people/thewomen-leaders-driving-lyfts-impressive-growth. 5. McGregor D. The Human Side of Enterprise. New York, NY: McGraw-Hill; 1960. 6. Pink DH. Drive: The Surprising Truth About What Motivates Us. New York, NY: Riverhead Books; 2009. 7. U.S. Department of Health and Human Services. The Affordable Care Act section by
section. http://www.hhs.gov/healthcare/ rights/law/index.html. 8. Institute of Medicine. The Future of Nursing: Leading Change, Advancing Health. Washington, DC: The National Academies Press; 2011. 9. Weick KE, Sutcliffe KM. Managing the Unexpected: Assuring High Performance in an Age of Complexity. San Francisco, CA: Jossey-Bass; 2001. 10. Carper B. Fundamental patterns of knowing in nursing. ANS Adv Nurs Sci. 1978;1 (1):13-23. At Cincinnati Children’s Hospital Medical Center in Ohio, Guy Beck is an education specialist II, and Dolores Puthoff is the nursing clinical director. Gordon Lee Gillespie is an associate professor and Robert Wood Johnson Foundation nurse faculty scholar at the University of Cincinnati. The authors have disclosed that they have no financial relationships related to this article. DOI-10.1097/01.NUMA.0000463883.61705.76
Nursing Management • May 2015 39
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
www.nursingmanagement.com
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
Helping leaders r
emerge from the bedside dsi By Guy Beck, MSN, RN; Dolores Puthoff, MSN, RN, NMF; and Gordon Lee Gillespie, PhD, PHCNS-BC, FAEN
F
or some people, the image of leadership may be a man dressed in a suit and tie, feet propped up on a high-gloss desk, barking orders to his employees. But our modern business environment isn’t conducive to such an image. Leadership has evolved. The current climate is filled with leaders like Mark Zuckerberg of Facebook, Liz Wiseman of The Wiseman Group, Kira Wampler of Lyft, and the late Steve Jobs of Apple. What do these leaders have in common? They foster innovation in their business culture.1-4 They placed innovative power into the hands of their employees. Nursing needs managers who place innovative power into the hands of clinical nurses. Clinical nurses need to learn the power of their job title, that they’re more than “just” clinical nurses.
www.nursingmanagement.com
There’s a need for bedside leadership in nursing, and leadership theory is essential to the successes of clinical nurses who can simultaneously evolve with this changing landscape. Two such theories contributing to nursing leadership are Theory X and Theory Y.
Two different approaches In most U.S. undergraduate business curriculums, there lies at least one lesson derived from The Human Side of Enterprise, which attempted to answer the age-old question: what makes a manager successful?4 Traversing through historical methods of leadership and scientific literature in the social sciences, McGregor, the book’s author, found inconsistencies in how management was viewed in modern U.S. industry. McGregor found many managers lead from an authoritarian perspective that’s more conducive for military leaders ordering troops, but Nursing Management • May 2015 35
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
Helping leaders emerge from the bedside
less conducive for leaders attempting to create employee-driven, innovative policies. Although The Human Side of Enterprise was published in 1960, McGregor’s message of managing via Theory Y (inclusive type) and avoiding Theory X (authoritarian type) management styles has stood the test of time. In fact, several modern business management authors are simply repackaging McGregor’s Theory Y content and delivering it
2. “Because of this human characteristic of dislike of work, most people must be coerced, controlled, directed, threatened with punishment to get them to put forth adequate effort toward the achievement of organizational objectives.”4 3. “The average human being prefers to be directed, wishes to avoid responsibility, has relatively little ambition, wants security above all.”4
Nursing needs managers who place innovative power into the hands of clinical nurses.
in a different manner. Managing via Theory Y is the most basic, yet important construct every manager should know. Some business experts assert Theory Y isn’t always the best model and that the authoritarian Theory X approach may be more appropriate. Perhaps a more appropriate view is that theories X and Y fall on a spectrum, and the type of industry will dictate the theory to which a manager should subscribe. Nurse leaders, as this article will argue, should fall heavily on the side of managing via Theory Y. If you want to instill innovative leadership abilities in clinical nurses, avoid Theory X.
Theory X The three tenets of Theory X are: 1. “The average human being has an inherent dislike of work and will avoid it if he [or she] can.”4 36 May 2015 • Nursing Management
In this model, clinical nurses have no autonomy in how they manage patient care and are forced to adhere to organizational policy and procedures. For example, as a result of having little ambition, nurse managers would consistently review nursing documentation to ensure nurses are implementing care in accordance with the organization’s view of how clinical nursing should be implemented. While overseeing documentation, managers will punish nurses who are noncompliant with documentation standards. Moreover, the policies and procedures shaped for clinical nurses would be based on a topdown approach that’s out of touch with the actual clinical environment. Further, these nurses may falsify documentation to appear compliant with organizational policies. If clinical nurses would
suggest novel approaches to streamline patient care, managers would nullify their suggestions since “management knows best.” Because nurse managers in the 1960s had less access to technology compared with managers today, the implementation of Theory X looked much different. Technology gives today’s clinical nurses autonomy in a way nurses couldn’t have experienced in generations past; however, technology has also given managers the ability to micromanage and observe adherence to organizational policies around the clock, even when away from the office. We recommend that nurse managers not play “big brother,” constantly monitoring clinical nurses’ care, because their actions could be viewed as authoritarian if not approached in an appropriate manner. This degree of observation squanders autonomy and innovation from the clinical nurse. In a way, technology has blurred the line between Theory X and Theory Y, making it difficult to implement Theory Y.
Theory Y The four tenets of Theory Y are: 1. “The expenditure of physical and mental effort in work is as natural as play or rest.”4 2. “External control and the threat of punishment are not the only means for bringing about effort.”4 3. “Commitment is a function of the rewards associated with their achievement.”4 4. “The capacity to exercise a relatively high degree of imagination, ingenuity, and creativity in the solution of organizational problems is widely, not narrowly, distributed in the population.”4 Nurse leaders who manage via Theory Y understand management doesn’t always know what’s best. www.nursingmanagement.com
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
Rather, leaders managing via Theory Y consistently defer many decisions to the expertise of the clinical nurse involved with patient care. Theory Y leaders should view the clinical nurse as an autonomous leader capable of innovatively influencing practice and policy. These managers understand external control and coercion aren’t means of motivation for nurses and that it often creates a hostile environment. So what does Theory Y look like in practice? A Theory Y nurse leader understands the necessity to monitor nursing documentation and patient care due to compliance requirements needed with The Joint Commission and Magnet® recognition standards, but Theory Y leaders convey this understanding to clinical nurses. When inconsistencies in practice or documentation are recognized, the nurse leader doesn’t punish or scold nurses and instead creates an open dialog with them to find barriers to compliance. When barriers are identified, the clinical nurse is encouraged to create innovative changes to practice and policy. A Theory Y nurse manager views the nurse as a bedside leader, capable of making independent decisions in accordance with his or her role as patient advocate.
Managing forces from the bedside People are actually motivated by autonomy, mastery, and purpose.5 When a leader is able to see and hear issues from a nurse’s point of view, the landscape changes. Nurses with the autonomy to make choices about what to do and how to do it develop clinical reasoning. They move away from the rote, task-based version of nursing toward the holistic picture, allowing them to integrate thinking into a more global perspective. www.nursingmanagement.com
When autonomy and creative knowledge are systematically removed from nurses, the nurses become puppets to tasks, going from one thing to another, missing the nuances, moving through the daily routine without really thinking about what they’re doing and why. We need clinical nurses who can creatively think about what they’re doing, why they’re doing it, and how it fits into the larger clinical picture. We want nurses to walk into a patient room and be able to predict what may happen based on what they know, what signs and symptoms could present, what interventions would be required, and what actions should be taken. Currently, three forces create the perfect environment to foster this leadership at the bedside: the Affordable Care Act (ACA), the Institute of Medicine’s report on the future of nursing, and the shared governance model.6,7 When clinical nurses realize the power potential these three forces create, they can take the initiative toward creating a new healthcare environment.
Affordable Care Act Several important aspects of the ACA directly affect clinical nursing practice. First, financial incentives are paid to hospitals based on the quality of patient care.6 Second, the number of persons with health insurance has increased, which has led to an increase in the number of patients seeking healthcare services.6 This will increase the need for bedside leaders. It’s important to encourage nurses to lead quality improvement projects that improve the quality of care essential to the ACA. When clinical nurses are totally engaged in what they’re doing, they forget themselves and focus on their
patients. If managers provide nurses with autonomy, mastery, and purpose, especially relative to quality conditions, the development of leadership at the bedside will demonstrate the reduction.
Future of nursing The second force is the IOM report on the future of nursing. It’s in no way a mistake that The Future of Nursing report was released in October 2010, the same year as the ACA. In essence, the report provided recommendations for how the nursing discipline can address the changes to be produced by the ACA. In the report, three recommendations directly or indirectly describe the need for nursing leadership. Recommendations two and seven relay the importance of clinical nurses being bedside leaders and directly relate to the quality improvement efforts previously discussed in relation to the ACA.7 Nurse managers and hospital executives should take seriously these proposed calls for nursing leadership. More specifically, managers should groom clinical nurses to take the lead on changes within the organization. This can be achieved by increasing the opportunities for nurses to initiate change through the cultivation of a shared governance program, as well as nursing students completing evidence-based practice projects as part of their nursing curricula. Recommendation four calls for a significant increase in the proportion of nurses with a baccalaureate degree. This increase in clinical nurses can increase the proportion of nurses capable of functioning as bedside leaders. Building partnerships between academia and organizations, as well as specific hospital units, can foster career Nursing Management • May 2015 37
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
Helping leaders emerge from the bedside
pathways for unlicensed assistive personnel to become baccalaureateprepared. Leaders can initiate and foster these relationships by building trust, developing accountabilities, and relating beneficial projects to both the academic and clinical arenas. In addition, creative programs engaging experienced clinical nurses to work within their facility as adjunct academic faculty allow strong expertise to remain at the bedside and share much needed knowledge with students while building bridges and networks into academia.
Shared governance The third force, the model of shared governance, is frequently instituted in hospital systems. Shared governance promotes the voices of clinical nurses within their given healthcare institution. When an organization truly embraces the shared governance model, very few clinical nursing decisions are instituted in a topdown approach. One of the most valuable resources in nursing is clinical nurses who have a daily pulse on patient acuity, clinical skills, barriers to quality, and suggestions to improve patient outcomes. Leaders should always defer to the person who possesses the expertise.8 The best opportunity for change in the future of nursing will be to listen to the expertise at the bedside. These bedside leaders know what does and doesn’t work. In the shared governance model, clinical nurses are enabled to create an idea for change on their specific unit and then develop proposals they can present to larger councils within their organization. It empowers them to implement the innovations of the bedside throughout the healthcare system. In essence, shared gover38 May 2015 • Nursing Management
nance transforms clinical nurses into bedside leaders because it empowers them to shape policy and procedures throughout the organization. As we look to lead changes in healthcare, it will be bedside leaders who must see and seize opportunities for transformation. We’re at a point where nursing must change while maintaining quality, and it will be the bedside leaders who can identify what can be done differently. Nurse leaders will truly reflect their leadership skills by listening to these nurses to initiate strong, substantial changes that can significantly impact nursing practice and patient outcomes.
Braving the storm Managers need to be able to cultivate leaders at the bedside so that clinical nurses become effective bedside leaders. Managing through Theory Y uses the assumption that employees exercise self-direction and build commitment through achievement.4 As leaders, we’re directed to two critical pieces of success: knowing one’s authentic self and understanding situations in a way allowing for creativity and change.9 Self-awareness is one of the most important foundations of leadership. Self-awareness, understanding one’s own strengths and opportunities for improvements, enables a leader to be better prepared to see the world. The ability to expand and see people, processes, and perspectives greater than the fragments is important to teams and organizations because each fit together analogous to a puzzle. Our success as an organization pivots on the ability to fit the pieces correctly, knowing when to flex our strengths and find out others’ strengths to help balance any missing essentials.
Self-awareness places a firm foundation for finding both the core of the puzzle and the complementary pieces that equalize the team perspective, allowing for maximum adaptability in a diverse world of creativity. There are many ways to develop leadership in clinical nurses. Passion, energy, and enthusiasm are incredible gifts in nursing. When you identify these attributes in nurses, reach out to them and provide mentoring. Some of the most incredible bedside leaders have been cultivated through coaching and mentoring. Spending time with these fresh minds is such an inspiration to the team and the organization. Providing expectations for professionalism, development, growth, guidance, and active listening, as well as support through learning, is also instrumental in building trusting relationships that lead to engagement and investment in bedside leadership. Encourage clinical nurses to base their nursing practice on science and evidence-based literature. Also encourage them to become involved in professional organizations and projects that allow them to give presentations. During discussions, support your clinical nurses in developing plans and solutions to motivate, inspire, and develop creativity. Facilitate, enable, encourage, and allow time for shared governance. Fostering creativity through brainstorming and promoting ideas through shared governance or when concerns arise have also brought bedside leaders to the forefront. For example, a clinical nurse became frustrated with a process and e-mailed the nurse leaders. As a result, the nurse’s concern was discussed, a task force was created, and a project was initiated to change the www.nursingmanagement.com
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
process throughout the organization. This is leadership at the bedside: one nurse affecting change in an organization where leadership listens and promotes bedside leadership.
Become the change In moments of crisis, the healthcare system needs leaders at the bedside who use effective clinical reasoning. We need managers who promote bedside leadership by growing, nurturing, cultivating, and planting seeds of potential in clinical nurses. Seek out clinical nurses who use their creative energy to spearhead innovative policy and practice changes, so that the future of our healthcare system may become more efficient and pragmatic. The time is now! Catalyze, encourage,
www.nursingmanagement.com
and energize potential bedside leaders. NM REFERENCES 1. Deneen S. The Facebook age: Mark Zuckerberg. http://www.success.com/article/thefacebook-age-mark-zuckerberg. 2. Fallows J. Brave thinkers. http://www. theatlantic.com/magazine/archive/2010/11/ elon-musk/308270/. 3. Gallo C. The 7 innovation secrets of Steve Jobs. http://www.forbes.com/sites/ carminegallo/2014/05/02/the-7-innovationsecrets-of-steve-jobs/. 4. Nagy E. The women leaders driving Lyft’s impressive growth. http://www.fastcompany. com/3041106/most-creative-people/thewomen-leaders-driving-lyfts-impressive-growth. 5. McGregor D. The Human Side of Enterprise. New York, NY: McGraw-Hill; 1960. 6. Pink DH. Drive: The Surprising Truth About What Motivates Us. New York, NY: Riverhead Books; 2009. 7. U.S. Department of Health and Human Services. The Affordable Care Act section by
section. http://www.hhs.gov/healthcare/ rights/law/index.html. 8. Institute of Medicine. The Future of Nursing: Leading Change, Advancing Health. Washington, DC: The National Academies Press; 2011. 9. Weick KE, Sutcliffe KM. Managing the Unexpected: Assuring High Performance in an Age of Complexity. San Francisco, CA: Jossey-Bass; 2001. 10. Carper B. Fundamental patterns of knowing in nursing. ANS Adv Nurs Sci. 1978;1 (1):13-23. At Cincinnati Children’s Hospital Medical Center in Ohio, Guy Beck is an education specialist II, and Dolores Puthoff is the nursing clinical director. Gordon Lee Gillespie is an associate professor and Robert Wood Johnson Foundation nurse faculty scholar at the University of Cincinnati. The authors have disclosed that they have no financial relationships related to this article. DOI-10.1097/01.NUMA.0000463883.61705.76
Nursing Management • May 2015 39
Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.
