Concluding Insights

 

            Dinner time at my house as a child is a memory I cherish. It was a time of creativity and laughter. I was a latchkey kid, my dad worked nights and mom would get home about 5:30 pm and immediately start cooking dinner before she had to run us to practices, help with homework, or some last minute project only because we just told her about it and it was due the next day. LOL! Opps! Don’t worry, my children have repaid the favor. Coming home from school for me meant doing homework and any chores I had. But when mom got home my studies would move to the kitchen bar top. My mom did not just cook dinner she performed dinner. Dinner could be a lesson in math when I struggled with fractions but that was not what made it so memorable. It was the voice in which she talked, and she talked the entire time, telling us everything she was doing. The voice was that of Julia Childs and the meal prep included commercial breaks. My mother had a way of taking any situation and making it an adventure or more enjoyable and at the same time educational or a learning opportunity. My mother is someone who inspires me to this day. She literally has a genius IQ but has been able to relate to others and connect with others in ways that I have never seen. She was a force to be reckoned with also. Never get on the wrong side of that woman! Back to her IQ, she told me that there was a question on the test that had 9 dots and you had to draw 5 lines and connect the dots without lifting the pencil. The only way to do this was by drawing outside of the box. The lesson she gave me was that you have to think outside of the box. For that matter, my mother never knew and to this day does not know there is a box and if she saw a box, she would use it as a stage.

            I have carried this lesson along with many other lessons she has given me throughout my life. When I graduated high school, I remember her telling me, “Cole, if you can dream it, you can do it! Now go out and fly!”

           

In this age of Quantum Leadership and the changing landscape of healthcare we have to think outside of the box and change how we see leadership. Rose O. Sherman has been one of my inspirations for my leadership. She authored and published a book called, The Nurse Leader Coach: Become the Boss No One Wants to Leave. The tools and ideas within this book are invaluable. I want to be that type of leader. I want to coach, encourage and empower people to create the work environment that we want and desire. This is a great dream, but how do we get there? How do I aspire to make a difference and still be a leader that people enjoy working for, where they feel safe, supported, and create the environment themselves? Having dreams is great, but without clearly defined and communicated goals they are just dreams. I had to be willing to first go on a journey to learning who I am and why I wanted to become a leader. Rose O. Sherman said (2019) said, “Wise leaders recognize that when the needs of the workforce change, they must adopt new leadership strategies to become employers of choice.” I wanted people to choose to work for me. I started my journey by taking every leadership course that my organization offered. That is what inspired me to also go back to school in my mid forties and get my degree for health care administration. If I wanted to be different and change, I had to go on a quest for knowledge and that has always been my, why of what I do. It has been my thirst for knowledge that drives me.

            Becoming a leader is a journey, one that starts with learning about yourself and then discovering what you like and don’t like about other leaders that have provided the most valuable guide to becoming the leader, I am transforming into and aspire to daily.

Survival skills are creativity at work…to maintain our sanity. ~Frank X. Walker

            It is in the creativity and innovation we see, movement forward. Leaders cannot be afraid of change if they want to change. Sounds crazy to say, but so profound. We have held tight to tradition for so long and it isn’t until leadership allowed failures to guide us and change and questioning to be our compass that we have seen the valuable changes that are occurring in health care leadership.

            Marquet in his video spoke to how we need to move the authority to where the information is. This is how he received the highest mark for inspection than ever before in the history of the Navy. We cannot micromanage or control people into high-value quality healthcare. 

    Discovering my ‘why’ in leadership also showed me how to more effectively lead. I have always encouraged and empowered people with knowledge. This goes back to when I was a bedside nurse. Patients were inclined to be compliant with health care treatment and prescription when they understood the why of what they needed to do. Simply providing them with knowledge and then asking them what they thought they should then do and how they could make it feasible to their lifestyle gave them the psychological ownership that Marquet describes in shifting the power and authority to where the information is. I have seen this time and time again.

There is a song from Dan Fogarty that say, ‘Put me in Coach, I am ready to play’ that reminds me of this. 

As I have developed more of a coaching mindset, encouraging the staff that they know what is the safe and right thing to do, they just started doing it. My desire is that when anyone walks into our department, they do not know who the “leader” is because they are leaders. That is the sign that I have not only inspired and coached the staff to be leaders but they are now effectively changing the lives of the ones they care for.

Leaders are selected for their position because they demonstrate great problem-solving abilities and when you take the position you want to be the ‘fixer’ of problems. This does not encourage growth and leadership. The nursing workforce is changing, “only 23% of new graduates look forward to going to work each day and close to 62% plan to leave within two years” (Sherman, 2019). Turnover is high in healthcare and nursing school enrollment has been down. Coaching is a collaborative relationship where Sherman (2019) says to focus on:

ü professional growth and development

ü provide frequent feedback

ü build upon strengths

ü ask, what can we do together?

Not all people want to be coached either. There must be time a leader takes in getting to know their staff, developing a relationship, and earning their trust. I was given great advice, yet again, from my mother, to take my time in implementing any changes even. Learn the department, understand all processes, ask questions of the staff. Show them you want to understand so you can truly meet the needs of the department. Once you learn your staff, always be willing to give coaching feedback for behaviors that need to be addressed if they are discovered. Framing was always the way she stated it. Frame what you say, provide them a different lens to see their behavior through, or ask a question that will get them to think about that behavior.

      This has truly been some of the best advice in dealing with people, as that has truly been the biggest hurdle to overcome in leadership. Listening more than you speak, asking how you can be helpful, and don’t assume a staff member needs to be “fixed”, are coaching mistakes to avoid (Sherman, 2019). Talking too much was definitely something I struggled with in the beginning. Those awkward silences were deafening. Marquet (2014), really stated it best in saying, giving control creates leaders! Great leaders inspire more greatness. If you are always talking and providing the answers you start removing their ability to think, solve and be creative on their own. This so reminds me of how I allowed my children even to handle issues between themselves or navigate issues or obstacles in life. I would listen and ask questions to encourage them to come to their own ideas and solutions or conclusions. This prepared them for life as I would not always be there for them, like when they go off to school for the first time, or when they leave for college, or where ever they go off to in life. The same psychology is also true for the workplace. You want people to be able to think for themselves and not always need you. As Marquet said, you can’t always be the answer man because you are not there 24/7.

In the chaotic and complex atmosphere of healthcare we need leaders at all times of the day and night. Health care organizations are made up of smaller units and they all interact with each other to sustain or provide high-quality care. Leaders cannot be the ones to have all of the knowledge because they are not always there, or can they be everywhere at once to give the answers so it is imperative to give knowledge to all and then encourage them to also know they are the expert in their job. Deference to expertise, which is the one doing the work and also has the information. They are the best to troubleshoot the issues as they arise.

If you have created a team of people to lead from where the information is and make the changes and adjustments as they come, because they will come, then you have a successful team driving value (Albert et al., 2022)

In developing as a leader, you learn that your emotional intelligence is your biggest asset. You can inspire more change through EQ than you can by providing all of the information in the world. From hiring emotionally intelligent people to dealing with conflict mediation and resolution. Being able to understand each individual communicates differently serves you well. 

We are all operating toward the same goal in healthcare, providing high-quality care to our patients. This means we all have to learn to communicate effectively our needs to navigate safely this complex environment. Communication is known to be a major area where adverse events are avoidable. The same can be said for navigating and developing a strong healthcare team. That is where the use of crucial conversations really benefits a nurse leader. Do not be afraid to have those needed and difficult conversations. 

Learning the 3W’s has been a saving grace that allowed me to frame a conversation that was needed but maintain a therapeutic and safe environment to reach the end goal. Improve a behavior or ensure safe practices were being met.

We all want to be able to do our job and this requires a great deal of detailed communication in a high-stress environment. Providing staff with scripted dialogue even for the SBART of bedside reporting has provided safe catches and opened an avenue of holding each other accountable for their responsibilities. One staff dissatisfier is when the previous shift staff member did not complete everything or missed some vital information, as the change of shift is very busy and chaotic with added stressors of interruptions from providers and call lights. So this time of protecting communication time and giving them scripted dialogue and a standard workflow for SBART has improved satisfaction. I have even had some report back that they didn’t follow it and it came back to bite them and they vowed they would not stray from that again.

Again, as a leader, it is not my job to know all of the answers or do all of the work but give authority to those that do the work, so they can guide and lead from where they are. They are the ones with the answers and they are the ones that will lead us and guide change for a healthier and brighter tomorrow.

 

References

Albert, N., Pappas, S., Porter-O’Grady, T. & Malloch, K. (2022). Quantum leadership: Creating sustainable value in health care (6^th ed.). Burlington, MA: Jones & Bartlett Learning, LLC.

Marquest, D. (2014, May 17). What is leadership? [Video]. Youtube. https://www.youtube.com/watch?v=pYKH2uSax8U&t=11s

Sherman, R. O. (2019). The nurse leader coach: Become the boss no one wants to leave. Rose O. Sherman.

Walker, F.X. (2014, March 17). Creative solutions to life’s challenges. [Online forum post]. This I Believe. https://thisibelieve.org/essay/21253/