The life of a nurse leader is an interesting one that provides all sorts of stimulating challenges. Many people do not know that nurse leaders are a key part of the decision-making hierarchy within a hospital or clinic. While some people may assume that it is only doctors and hospital administrators who make those all-important decisions about the allocation of resources and the safety of patients, it’s actually the case that nursing leaders is are also an integral part of the effective operations of healthcare systems.
Nurse leaders work on the front lines in hospitals and clinics. They are responsible for important decision-making and crucial healthcare tasks, such as recording a patient’s medical history, taking comprehensive notes regarding a patient’s situation, and ensuring that the dispensary of the patient’s medicine is both legal and ethical. For those nurses who might be interested in progressing, or anyone who might be considering a career in nursing leadership, it is vital to create a detailed and engaging plan that will allow you to gain the skills and knowledge needed for the position.
Working with others
Due to the hierarchal nature of leadership, it is always the case that the decisions of leaders will affect their employees, or anyone that they are leading. This also applies to nurse leaders: nurse leaders make decisions every day about what should happen in the care environments for which they are responsible, whether it is the allocation of staff time resources or the safe dispensation of medication.
Despite the name of ‘leader’, the prevalent trend in nursing leadership does not necessarily follow the path of more traditional hierarchical management. Nurse leaders increasingly engage in collaborative, shared-leadership approaches—gathering and listening to input from staff, rather than simply instructing them on how to work. One benefit in utilizing this approach is that, by expressing their thoughts and opinions, team members often provide solutions to problems that may have otherwise been missed. This management style can also have a positive potential impact on staff retention. When a staff member is heard, they are more likely to remain in their positions for longer periods of time because they feel valued. Furthermore, this type of situation is likely to spread positivity throughout the team and may even encourage outsiders to want to be employed at an institution with such a good feedback system.
Incorporating the views of employees into decision-making can occur in a few different ways. Some nurse leaders may hold meetings or other collective experiences in order to gauge the views of those they work with staff members, then make an informed decision on the team’s behalf. Others will delegate their power during the decision-making process. For example, instead of making a decision about nursing staff allocation themselves, a nurse leader might provide a staff member with coaching in decision-making, allowing them to develop the skills to make choices. This type of leadership is akin to mentorship, which is vital for nurses. The role can seem nebulous and scary, but if someone is assisting them and showing them the right way to do things, encouraging them, it is far better. Therefore, not only retention will be affected by excellent leadership, but feedback beyond the team and into the wider employment circle.
This type of skill can be learned in DNP courses at respected institutions, such as Spring Arbor University. But what is a DNP? A DNP is a “doctor of nursing practice”—a degree that provides nurses with the training necessary to practice nursing at a high level and helps them gain competencies such as leadership skills. By enrolling in a DNP program, which is flexible and highly informative, nurses can advance their nursing careers, while continuing to work as qualified nurses. The course at Spring Arbor University provides its students with all the adequate knowledge to progress well in this role, and to embrace a strong and meaningful career.
In line with the law – and ethics
While it’s the case that many nurses find it ideal to collaborate with other people, it’s also the case that nurses across the board have to follow the law and the ethical code that is placed upon their profession. Nurses generally believe that laws and ethics are the most important component of one’s nursing career. Laws and ethics adhered to by nurses are used to indicate to patients, colleagues, and society that they are safe to practice.
In the United States, the Code of Ethics for Nurses with Interpretive Statements is the primary document followed by those in the nursing sector. It covers a wide range of issues, including the four ethical principles that will be familiar to those working in many other parts of the healthcare field – beneficence, non-maleficence, justice, and autonomy. But a more pertinent point for those who are considering a career in nursing leadership is how this can be applied to the decision-making process of every nurse leader.
One way in which a nurse leader can use this to make decisions by reading the guidance associated with each principle., including the longer-form pieces exploring what it means to be – for example – autonomy-focused. For example, a nurse leader might encounter a patient who is insisting that they do not want to take their prescribed medication. A nurse leader may apply the principle of autonomy to their decision-making process by having a discussion with the patient. They could gently ask the patient to share more information about their resistance to taking the medication. By doing so, the patient can express their fears or worries in a safe context. The patient is now involved in the decision-making process, as they are contributing to the discussion about taking the medication, rather than having information passed down to the didactically by a nurse leader in a position of power.
It is not always possible for nurse leaders to make significant decisions simply by looking at the rule book; sometimes ethical rules compete. For example, in this case, a nurse leader is torn between the principles of autonomy and beneficence: A physician has advised that certain medications or interventions are necessary to protect the patient’s life, but the patient does not wish to take them or engage in discussion about it. High-level problems could result, such as the patient removing intravenous lines. In this scenario, the patient is entitled to autonomy but also to a nurse leader that acts in their best interest. The nurse leader may struggle to reconcile these competing pressures.
It’s important to not ascribe a lack of decision-making capacity here to the limits of any one particular nurse’s skills; on the contrary, it’s often the case that a nurse leader wants to make a decision but feels unable to do so. As a result of this situation, many healthcare institutions have developed what are known as “ethics committees”. This allows a nurse leader to refer upwards a situation in which they feel they can’t make effective ethical choices in order to get a broader range of viewpoints. Using ethics committees is not always appropriate, as sometimes fast choices need to be made (as outlined below). But what is definitely the case is that ethics committees can help a nurse leader faced with difficult decisions to feel supported; many nurse leader report that the presence of an ethics committee as an institutional backstop is a useful one as it helps them to know that in the event of any problems, they are not alone.
As they go along
The ways of viewing nursing leadership decisions that have been outlined above are certainly some of the most common and are definitely attractive in theory. But as anyone who has worked in the nursing profession for any length of time will know, it’s often the case that the best laid plans in theory go out of the window in a complex, fast-moving, and emergency situation – and this is the sort of situation a nurse leader will regularly need to face. It’s not always predictable when an emergency will arise, and it’s certainly not within the nurse leader’s control – so perhaps the first decision-making method here is to be sure that, as a nurse leader, you’re able to react swiftly and dynamically to situations as they unfold, and not desire control over every outcome.
That’s why practical, clear-headed thinking and an ability to work under pressure are essential components of the nurse leader’s skillset. Nurse leaders regularly have to make choices quickly and need to factor in the different parts of their knowledge: their knowledge of the law, of ethics, and of what they believe their teams would want them to do. There may not always be time to look at the rule book or hold a team meeting when there’s a serious emergency room incident or a patient having a complicated response to some medication; instead, a nurse leader will be expected to use their discretion – in conjunction with physicians and other team members – to allocate staff resource, administer medication and do what they can to boost patient outcomes quickly and correctly.
In these scenarios, nurse leaders should ask the following questions: Is there a threat to life? If not, could acting or not acting in this situation create a threat to life? Is the patient’s health at serious risk? This process is known as a “decision tree,” and requires nurse leaders to amend and adapt their responses based on the issues being addressed.
A nurse leader’s ability to engage in quick thinking is honed over time. Nurse leaders are not expected to utilize this high-pressure skillset immediately; it is developed in a nurse leadership training program through classroom lessons and placements. This is partly taught through classroom lessons, and also through placements. This is why it is so important to ensure that the nurse leadership training course you do either includes a placement or includes support of some type for a placement.
In short, it’s clear that the nursing profession is a career that encompasses more than so much more than bedside manners and immediate and practical care for patients – it is a highly intelligent, hard-working career. Due to increasing funding challenges for many healthcare organizations that result in less senior hospital management, many nurses are feeling the pressure of being the decision-makers in the ward. As this article has shown, then, nurses’ decision-making is becoming increasingly crucial – and it’s vital for nurses to ensure they collaborate with others in their terms, work within the bounds of the law and the ethical codes that relate to their roles. Help is at hand, though: if you’re a nurse considering a move into a leadership role, you might want to ensure that you take the steps necessary to receive the best possible training to further your career advancement.
