Demystifying nurse management and leadership for the new nurse

May 6, 2021

Rachael Judge

Healthcare transformation is being accelerated in front of our very eyes.  How we deliver care is changing, and how we interact as care delivery teams must also continue to evolve.  Managing relationships and juggling challenging dynamics are 2 key parts of nursing, and they are key skills that are not usually found in nursing curricula.  

The dynamics between nursing leadership and staff nurses is one that is crucial to the functioning of individual nursing units and health systems as a whole.  Assisting the new nurse— and even some more seasoned practitioners— in truly understanding the role of nurse leaders is an integral part of demystifying these roles and relationships. 

The dyad model and its usefulness in care delivery 

According to an industry survey, and my own experience, nursing leadership is generally split into a dyad model which consists of a nurse manager and a nurse clinician.  The nurse manager is responsible for the general resource mobilization related to the unit and staff.  The nurse clinician is responsible for the delivery and monitoring of staff education.  By separating the administrative from the instructional roles, the leadership team can more clearly support  staff from these individual positions.   

The dyad model has been praised by experts for its ability to clearly define roles within organization’s structure. Clarity of structure and clinical expectations is crucial at any point in your nursing career, but perhaps is felt most acutely in the earlier stages. The dyad model can elevate the stress of uncertainty here.

Management and leadership relationships are bi-directional 

Understanding the function of each of these formal leaders can then help you, as a staff nurse, to grasp your piece of the bi-directional relationship better.  If a nurse feels they needs more support with training, would like to expand their scope of competencies, or has a practice challenge, this must be voiced clearly and quickly to the nurse clinician.  If a nurse has an administrative issue, including relationship issues with other staff, or a system process -related concern, they should present these concerns in a professional manner to the nurse manager.  A universal truth for all members of the leadership team is that they cannot assist with challenges that they are unaware of, so the staff nurse must accept that he or she has both the right and the responsibility to raise questions and concerns, and also to present ideas for improvement, when these arise.    

A key function of your nursing leadership is evaluation  

A function of nursing leadership is to continually assess and evaluate their staff. The staff nurse can improve this process, by first accepting that this is a key function and responsibility of their leadership, and then by openly welcoming this feedback and improvement process for the benefit of the patients in their care. 

Depending on the delivery, receiving and accepting feedback can be a challenge. In a 2017 survey, interpersonal skills were ranked high by participants.  As care transformation evolves and healthcare leaders are held to higher standards of emotional intelligence, I believe we will see a phasing out of unconstructive methods and authoritarian styles.  That said, your management is responsible for its words and actions.  As a professional, you are responsible for the ability to decipher the lesson to improve your care delivery, even if the way the lesson was given was less than constructive.   

Leadership doesn’t come from a degree, it comes from attitudes and actions 

The nurse manager and nurse clinician have other shared duties as well.  Relationship building, strategic planning, performance analysis, maintaining mutual respect, and culture building are universal leadership tasks that are also key for individual nurses to be mindful of and nurture. 

In addition to your formal unit managers, you will interact with several informal leaders throughout the course of your patient care.  More seasoned nurses will play these roles, which may also be held by allied health colleagues.     

Leadership is actions, attitudes, respect, and responsibility to and for yourself, and those on your team. 

Depending on the model the unit employs, nursing has both a high level of autonomy and a high level of collaboration.  In the best of cases, allowing these informal leaders to offer guidance and mentorship can provide the mentor with the satisfaction of providing what is known as — the giveback of nursing, helping another nurse understand just how impactful and important they are to the mission of providing high quality, compassionate patient care.  

From the first day of your nursing career, you can position yourself as an informal leader.  How a nurse presents themselves professionally, interacts with co-workers, patients, and leadership, and exhibits an eagerness and willingness to learn and provide a high standard of patient care, are all examples of proficiencies that would place someone in an informal leadership light.   

The New England Journal of Medicine 2017 survey highlighted the attitude that interpersonal skills, and the deployment of these within a team, is a key mark of leadership.  Leadership does not come from the conferral of a degree, nor does it come after attending a conference, or becoming a member of a professional organization.  Leadership does not even come from being placed in a managerial position.  Leadership is actions, attitudes, respect, and responsibility to and for yourself, and those on your team.   

Emotional intelligence, or, how we get there 

These interpersonal skills generally come down to the construct of emotional intelligence (EI), which is recognized as being the counterpart to general intelligence, measured through IQ. EI is  the ability to recognize and identify your own emotions and those of others, and to then apply those emotions to a given job; skills such as problem solving, relationship building, and strategic planning.  Lastly, the capacity to manage your emotions is relevant to this construct.  Being aware of the emotion, applying it in a useful manner, and managing the positives and negatives of those feelings are all key.  There are suggestions that a high EQ (emotional quotient) is linked to improved job performance.   

Emotional intelligence is important in nursing and healthcare at all levels.  Healthcare professionals deal closely with patients and their families, often in  their most trying times, and EI can be helpful in allowing the bedside nurse to stay present, while preventing them from becoming empathetic to the point of self-pity or moral distress.  Some healthcare providers are naturally more empathetic than others— it is a matter of personal programming— and to be aware of this trait is to exhibit a stronger EI.   

So what is EI at the bedside and beyond?  

Emotional intelligence does not suggest that you have to be less or more of any trait than you naturally exhibit. It does suggest that by understanding your natural tendencies,  you can improve your  interpersonal connections and your own self-preservation.   

Emotional intelligence is what  drives a nurse to pause, sit, and hold a patient’s hand. It is what is behind a nurse encouraging a family member to go enjoy the outdoor serenity garden, thereby allowing them to step away from their loved one when they can’t seem to allow this of themselves.  It is knowing when to hug a colleague after a stressful situation and knowing when to accept that despite everything we know how to do, sometimes medicine is simply not enough.  

Stepping away from the bedside, EI is also needed from nursing leadership and healthcare administrators.  Being in tune with their own triumphs and struggles, and those of their team, allows for better interpersonal connections, and for more productive problem solving and strategic planning.  Seeing the hardships and joys of the individual team members is an enormous asset to nurse leaders.     

Work continues to be done on the correlations between EI, IQ, success, and performance.  Nursing schools and healthcare leadership councils are continuing to invest more time and resources in these ideas, and you can expect to hear more about EI in relation to your work as an individual nurse and within your organization as a whole.  This may even be a topic that you are asked about during your interview.  

Style versus substance 

If you watch a popular British baking show, you will have undoubtably heard one of the judges and several contestants toil over the dreaded occurrence of style over substance.  Leadership can often suffer the same issue. Some leaders get so caught up with how they are going to lead, what style they are going to use, that they forget about the need for substance.   

Leaders may have their own style of leadership — transformation, autocratic, democratic, laissez-faire, etc. — yet be required to adapt to meet the needs of the organization.  For example, your unit manager may find it best to lead with a transformational or laissez-faire style, while the nurse clinician may find a newer group of nurses are best trained using an autocratic style, and a more seasoned group of nurses are better served being taught with a democratic style.   

What are they doing in the office all day?  

Nursing managers and nurse clinicians have several behind the scenes responsibilities and functions that keep a nursing unit functioning within the larger organization.  Managers are responsible for budgets, staffing changes, quality audits, and unit goal-setting.  The clinical educator is constantly tracking unit-based competencies, formulating education and action plans for staff members, and tracking professional certifications.   

The interaction of unit leadership goes beyond unit doors, and extends up and down clinical service line, into cross-functional teams, and even into procedural areas depending on the unit’s scope of practice.  If this is the first time you’re considering concepts such as service line, scope of practice, and cross functional teams, you are not alone.   

New nurses tend to focus strictly on mastering their nursing practice at the bedside.  Once you are able to take a breath after the initial flooding of knowledge that is coming your way, allow yourself to see your work and your unit through this bigger lens, and your interactions with management and nursing leadership will transform.   

Speaking up and actively participating with the bi-directional feedback process can be intimidating to newer nurses.  Remembering that your nurse manager and nurse clinician were new nurses too at one point can help. So too can being aware that nursing leaders are also susceptible to role strain like burnout and poor work-life balance.  

As with many things in your career, interacting with your nursing leadership takes practice. The more you do it, the more they will come to you for feedback, and better patient care outcomes will result.      

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