Nursing leadership is an important competency that all nurses should develop and continually improve just as they do with other skills and proficiencies that support their work. Nurses hold different positions in practice, such as charge nurse, staff nurse, manager, director, or educator. Therefore, they are expected to exhibit leadership in whatever situation or position they occupy. They should develop the necessary skills and competencies that can help them to positively influence patient care and ensure the provision of safe and quality care. Nurse leaders play a critical role in motivating others to work efficiently and achieve organizational goals and objectives. Motivation and team building skills develop a productive working culture and environment for people to work together to achieve a positive patient outcome and organizational results (Martin, Furr, Hayes Lane, & Bramlett, 2016). Effective leadership approaches support various aspects, including organizational communication, conflict management, collaboration, and engagement in negotiation, which comply with rules and regulations. Effective leaders influence others to achieve positive results regardless of the challenges inherent in their workplace.
The interviewed leader is a charge nurse working during a night shift in an ER. She is a master’s educated nurse who assumes the role of a leader but remains involved in the active care of patients. She has a point-of-care leadership role because she works in the direct care of patients in the ER. The leader has a responsibility of ensuring that the quality of care for individual patients and groups is met through coordinated services based on EBP to support safety and quality, using improvement measures and managing complex health challenges using hospital resources efficiently. The nurse is placed in the ER and assumes an essential place in the hospital’s organizational chart because she is involved in decision-making and active running of the facility. The nurse leader has worked in two other hospitals as a nurse and in the same hospital in other departments before becoming the charge leader in the ER. She considers other seasoned nurses as her mentors who enhance her progress in her career and leadership responsibility. She is also prepared to continue advancing her education to gain experience as a nurse leader.
The Leadership Role
The nurse leader I interviewed gave me a story of her leadership experience when working as a charge nurse during the overnight shift in the Emergency Room. In the department, patients had to wait between four and six hours before receiving services from an ER physician. During one of the night shifts, she encountered a patient who had an impact on her career and leadership role.
The situation with the patient portrayed a high level of emotional intelligence on the part of the nurse. The occurrence suggests the ability of an individual to control personal and emotions of other people the leader is responsible for. The leader encountered a patient in the ER on a stretcher and in obvious pain. He had remained in the situation for some time without being attended by the ER doctor. He portrayed signs of anxiety and frustration after waiting for hours before being treated. He kept interrupting and calling the nurse to receive some attention. He kept asking, “where is the Doctor? I need to see the Doctor now.” The situation needed leadership, which my interviewee provided. Besides, the setup required an individual who rated highly in emotional intelligence to understand the emotions of the patient and personal feelings to respond appropriately to the situation.
Ethics of Leadership
Ethical leadership is an important concept in nursing, which is a caring profession. It is about enabling others to do what is right in all circumstances, especially when working in a highly demanding environment such as in the ER. The ethical leader lives up to principles of conduct, which are important to the leader and the outcomes such as safety and quality of care (Martin, Furr, Hayes Lane, & Bramlett, 2016). It is imperative for nurse leaders to lead ethically by asking critical questions regarding the right and wrong. The nurse I interviewed responded to the patient who was already upset. She believed that a timely response to prevent further agitation was the most ethical decision in the situation. She approached the patient to assess the situation and avoid escalating his anger and frustration. She understood the right way to address the situation and acted ethically when interacting with and serving the patients. The leader made the right call in the case.
Nurses provide care in a conflict-filled environment. They experience a great deal of violence in their workplaces. For example, they deal with many youths who experience violence, and health care providers come to their rescue, especially when they come to the ER or seek primary care from healthcare organizations. Therefore, nurse leaders should understand the most effective ways of providing care to victims of violence. They should engage in in-service training to ensure that they have the competence to provide care in conflict-oriented environments (Jooste & Ekole, 2015). The interview with the nurse leader revealed a high level of violence and the role of a leader in resolving such situations.
In the situation involving the nurse, when she went to the patient, he reached for his bag and pulled out a gun. Her response to the case made much difference in the ability of the leader to respond to the crisis and resolve the conflict. She even attempted to speak to the patient who was pointing the gun at her. The patient kept yelling inquiring about the doctor who was to examine him. He yelled, “where is the Doctor? I have been here in pain for too long I can’t take it anymore; go get me the Doctor right now.” She agreed to his demands and walked backward as if to call the doctor. The incidence revealed a significant level of competence in conflict management.
Team building is an important skill for nurse leaders. It is a revolutionary role that is critical to achieving organizational objectives in the workplace. Leaders should facilitate the development of teamworking skills to enable collaboration (Reddy & Jooste, 2015). Notably, working in health care settings is complicated; hence, nurse leaders should collaborate to support safe and quality care to all patients. In the situation my interviewee was involved in, the aspect of teamwork is evident. The nurses and other personnel in the ER understood the right action to take depending on the situation. When the nurse leader yelled to warn others about the gun threat, the secretary understood the right action to take. The leader was scared, but she remained strong to control the situation and to lead others to the right decision. Although it seemed as if hours had passed before the VA police arrived, it was only two minutes. When the police arrived, the patient dropped the gun and was handcuffed. The timely response was possible because the nurses and other personnel in the ER worked together as a team.
Communication enables teamwork, which enhances effective service to patients. Leaders should facilitate information sharing to support collaborative efforts to provide quality care (Reddy & Jooste, 2015). The nurse leader effectively communicated in the situation where the patient drew out the gun and pointed it at her. She yelled out, “he has a gun.” The secretary heard the warning and pushed the button for a code silver, which is a warning regarding a gun threat. The notification alerts the VA police to the code silver. The nurses are required to vacate the danger area as a protocol. However, the life of my interviewee was in obvious danger. The situation reveals the ability of a leader to communicate in a dangerous situation and warn others to take appropriate action to save lives and maintain safety. Nurse leaders should always be prepared to initiate the right step to interact with others, depending on the needs of the situation.
The nurse leader in the situation revealed strong leadership in the crisis. Some people are effective in managing difficult situations and influencing others to take the appropriate action to overcome challenges and achieve individual and organizational objectives. Transformational leadership is one of the commonly applied in nursing leadership contexts (Alves et al., 2018). The nurse leader interviewed revealed some traits of transformational leadership. The style of leadership involves the ability to engage others in decision-making to encourage them to become leaders and support the achievement of common objectives, such as quality patient care. The leader believes in the ability of the followers to make proper decisions that affect their work and the achievement of organizational goals. They believe in shared values, beliefs, and cultures that add value to individuals and groups. The leader could be strong but capitalize on the input of others to improve effectiveness in their work.
Transformational leadership in nursing adds value to the workplace and motivates others to focus on the greater good of the patients and colleagues. They support the development of their organizations to continue meeting their objectives, including providing safe and quality care to patients. The style acknowledges human values and the means for developing the institution, as well as the ability to influence and motivate subordinates taking advantage of an individual’s potential to grow. Leaders create a shared decision-making environment to solve problems such as patient conditions in an effective environment (Alves et al., 2018). The interviewee revealed a case of effective transformational leadership in her approach to deal with the gun threat and violence perpetrated by patients. The review of the situation indicated strong leadership in a crisis because the nurse analyzed the situation and sounded a warning, by yelling, which saved the lives of many patients and health care providers. The nurse leader trusted in the ability of others in the ER to make the right decision in dealing with the threat and saving the lives of patients and hospital personnel.
The nurse leader had a strong position of authority within the workplace. Nurse leaders are believed to play a crucial role in the implementation of best practice and EBP in their workplaces. They support the delivery of quality care because they assume a prominent position between the executives and clinicians (Shuman, Liu, Aebersold, Tschannen, Banaszak-Holl, & Titler, 2018). Ideally, they are placed in an important position to influence the work-related outcomes in the health care setting. They create a supportive environment where others can work effectively to achieve patient and organizational outcomes. They supervise their units to improve the quality of the work that is conducted to promote patient safety. Strong leadership determines the level of performance of others in the organization. They motivate other employees to act accordingly in different situations. That nature of leadership is evident in the case of the interviewed nurse leader.
The nurse leader created an environment where other members of the ER staff could adequately react to a dangerous situation. She was part of training through drills that are conducted in the ER quite often. Besides, being the nurse in charge of the ER that night, it was necessary to ensure that everything was operating efficiently. She was placed in a situation where she ensured that others were working appropriately to ensure safety and quality of care. As a result, she effectively communicated the distressful situation by yelling to alert others. In turn, she cascaded the events that initiated the code silver. Other nurses had also received similar training and knew what actions to take during the incident, including hiding with their patients out of the potential shooter’s sight and remaining calm while hiding. Nurse leaders are responsible for the training of competent nurses (Eaton, Sharples, & Buys, 2018). The interviewee still recollects the actions of that night and feels like it was a nightmare. However, she took an important position to save lives. She was able to work in coordinated efforts to deal with the threat.
The leader shares most of my leadership philosophy and style. Although I find it hard to work in highly risky situations, I gain strength in the knowledge that the lives of others depend on my judgment. Therefore, I believe in the need to make a speedy and timely judgment to solve problems and prevent unnecessary damage to life or property. Thus, from the interview, I realize that we are both risk-takers. Leadership is about taking the necessary risk to ensure that things are working right and that people are safe and protected (Horton-Deutsch, Pardue, Young, Morales, Halstead, & Pearsall, 2014). The nurse leader took a calculated risk in trying to calm the situation even though her life was in danger. For instance, she decided to calm the patient and assured him that he would be treated. Her efforts were aimed at distracting him as they waited for the arrival of the VA police.
Another point of convergence of our leadership skills is the need for coordination of activities to achieve positive results. The coordination reform is an essential event in the health care setting because of the role it plays in addressing complex patient conditions and improving care outcomes at the individual and institutional level (Glette, Røise, Kringeland, Churruca, Braithwaite, & Wiig, 2018). It would have been impossible for the nurse to work alone to stop the threat and protect lives in the ER following the gun threat. Had I been in a similar situation, I would have made a similar judgment and make the same decision the nurse leader in the ER made. Her actions were the most appropriate at the time. She is a model of strong leadership in adversity, including the need for coordinated efforts to prevent detrimental outcomes in a life and death situation.
From an analysis of the interview, the nurse leader provided a model of strong ethical leadership. For example, she revealed the ability to put the need of others over her own. She was the first to respond to the patient who was in obvious pain and who turned out to be a threat to her safety. She was prepared to help even after knowing that her life was in danger. She proved a high level of leadership development and competence necessary to provide quality care (Perez, Mason, Harden, Cortes, 2018). Some of the strengths of the leader are ethical and transformational leadership tendencies, strong communication skills, collaboration and teamworking, and the ability to coordinate operations. She was successful in stopping a significant threat to the safety of patients and colleagues through timely decision-making and proper judgment. Nurse leaders are responsible for ensuring that their patients are safe (Larsson & Sahlsten, 2016). The nurse leader was successful in influencing others to react appropriately in a risky situation.
However, there were challenges involved in the leadership role played by the nurse leader in the ER. For example, the leader was afraid of the risk involved in dealing with the violent patient but still approached her. Even after realizing that the patient was armed, she continued to engage and convince him to drop the gun to receive medical attention. The nurse was not a trained crime control expert and might not understand how to deal with the violent client. She could have become a victim of a violent patient. The nurse leader has some weaknesses in her leadership role. For example, she took the time to talk to the patient until she became so annoyed and violent. She might have prevented the risky action if she immediately responded to the patient who was in obvious pain. She was working in an ER where patients had to wait between four and six hours before seeing the ER physician. Therefore, a need for change is paramount to improve patient care and safety at the ER, including during the night shift.
Leadership in nursing is critical and plays a vital role in the safety and quality care provided to patients. All healthcare organizations engage nurse leaders who perform diverse functions, such as charge nurse, staff nurse, manager, director, or educator. The leader is expected to influence other nurses and hospital personnel to coordinate care to achieve positive patient and organizational outcomes. I interviewed a nurse leader working in the ER during a night shift. Although the leader faced a challenge and risky situation caused by a violent patient, she used strong leadership style and competence to overcome the crisis and save the lives of patients and colleagues. Her leadership aligns with the transformational style, in which leaders work together in an organization to achieve positive outcomes.