Leadership Styles and Organizational Changes

The role of the professional nurse when implementing a change is to identify that there is a need for a change (Rubenfeld & Scheffer, 2014).  Once the need for a change is identified by the nurse, the next step is to implement a change in behaviors efficiently and with quality. When identifying the area specifically that needs the change, nurses need to be deliberate in stating the purpose for the change.  When speaking to the target group about making the change, it is important to keep their attention span with non-lecturing phrases.  As nurses we are not always in our comfort zone to explain why changes need to be implemented.  We should be prepared to explain why this change is needed and what improvements these changes will make.


Generally, people will always be resistant to change.  But as professional nurses, our focus is to build trust and credibility.  The goal is to acknowledge that the change is coming and that you empathize with the feelings of the upcoming change (Rubenfeld & Scheffer, 2014).

Where I used to work, they were very involved with ACHA (Agency for Healthcare Administration), because we held a state contract.  Evidenced based nursing was in a sense required as far as the patient care when our case managers were managing a case.  However on the same note, although our case managers were not performing hands on care, they were required to know about all their diagnoses and treatments.  We had social workers and nurses alike seeing the same types of members.  The issue with nurses and social workers seeing the same types of patients is that the social worker is not able to use his/her critical thinking skills in their area of expertise.   They were required to assist members who had complex medical issues for instance, on a ventilator or more complex medical problems.   A suggestion was made when I arrived at my work place to utilize the social workers in conjunction to the nurses to manage the social aspects of the patients, however the decision was denied.  It was noted that ACHA is not paying the company to rethink how cases were managed and by whom because it was not hands on care, it was case management.

There was very little nursing involved in my job role, it was primarily reports and meetings to talk about reports and how to fix these reports.  It was an ideal job for someone that had an interest in perfection of numbers and statistics.  Every other day, there was a new change that was being implemented. We often times questioned why there was a change, but what we were told was that the change was immediate and mandatory.  For the staff case managers, these changes were difficult because the staff was in the field.  They may receive an email about something that needed to be changed as soon as possible, however they may have just returned home at  5pm in the afternoon looking forward to the end of their day and they find  emails with deadlines on multiple items due.  These changes affect the staff because they have to work late hours to get the work completed timely. This kind of change caused many good nurses and social workers to resign.

As nurses or leaders we tend to fall in to the routine of lecturing due to the pressures that we are under.  However two of the six dimensions of dealing with complex dynamic changes are creativity and intuition.  As a leader we should not just teach our group something, we should implement a way to bring creativity in to the change and use intuition to know how to speak to your group.  The best way to implement a change is to get the group to commit to doing the new change and develop a smart goal with them that will allow them to measure their own goals.

The leadership theory that most resembles mine is the coaching leadership style.  The coaching leadership style allows me to work closely with the staff at different levels and  empower them to meet their goals and gain confidence of their strengths so that they can focus on them as they work on their weaknesses.  In my previous job, the leadership style could have been called a dictatorship, however for the purpose of the discussion here it will be stated as coercive.

My manager’s favorite phrase was, “I gave a directive and everyone needs to follow it, any questions (1 second wait) no, good.  It’s due by close of business.”  If questioned on how to juggle that with all the meetings and other directives, the reply was always as a manager makes it happen.  My manager always reminded me that she did not take lunch, breaks and basically had “no life” outside of work and she expected those under her to be like her. She was not a woman who read books as a matter of fact, she indicated that books were a waste of time, for fun she read the ACHA contract that was 350 plus pages because reading any other book was pointless (Barr & Dowding, 2012).



Barr, J., & Dowding, L. (2012). What makes a leader? In Leadership in healthcare (2nd ed., pp. 13-31). [Vital Source Bookshelf]. Retrieved from https://campus.capella.edu/web/library/home


Rubenfeld, M. G., & Scheffer, B. (2014). Critical thinking and patient-centered care. In Critical thinking tactics for nurses: achieving the IOM competencies (3rd ed., pp. 155-180). [Vital Source Bookshelf]. Retrieved from https://campus.capella.edu/web/library/home


Looking up to a Nurse

Have you ever thought about a nurse that you have worked with and looked up to?  What qualities do you admire?  The nurse that I would look up to would be someone who would be respected and trusted by her peers and her staff.


In every organization there are communication barriers, but overcoming them is part of being professional and respectful of others’ opinion.  Another barrier that is seen in management is the inability to show respect to other team members and allow a learning environment. I agree that it is important for leaders to obtain feedback not only from their staff but from their peers.  The leader must be able to deal with the different personalities of the team that he/she is managing without letting personal feelings get in the way.




A True Leader

A true leader  places their staff before themselves and will work the job that their staff does so that they are familiar with it.  When I first moved to Florida, my first boss here was named Patty and she said to me when I started that she is the supervisor but she said to me that she will do the same job that I do.  She taught me that being a good manager means knowing what your staff’s job is and how to do it.  The reason being is because if you have someone who is out sick and there is not coverage, you will be able to jump in and help.  When thinking about Patty, she was a great leader because she encouraged me in the decision making process (Baer, 2012).


As a nurse  I admire her because she followed Kouzes and Posner’s leadership model.  This model focuses on setting a vision, being a role model and enabling people to grow.


This is similar to John Kotter’s process for leading change in this day and age.




Baer, J. (2012). Theories of leadership. Leadership in health care (2nd ed., pp. 45-69). [Vital Source Bookshelf]. Retrieved from https://campus.capella.edu/web/library/home

Leadership Attributes

When a nurse leads by example and is not afraid to do the work that the  staff does, it makes for a strong leader. The people who follow that leader will know that although the nurse is in a position of higher authority, the nurse will still be humble enough to do the job the staff does and be able to explain it from their side and understand the position that they are in.  Knowing the staff’s job by example, allows the manager to know the timeliness of things that need to be accomplished and the ability of each worker’s caseload and what they can manage. A good leader will follow the  seven attributes to being a good leader vision, courage, integrity, humility, strategic planning, focus and cooperation (Baer, 2012).



Baer, J. (2012). Theories of leadership. In Leadership in health care (2nd ed., pp. 45-69). [Vital Source Bookshelf]. Retrieved from https://campus.capella.edu/web/library/home

Why is Leadership Important to Nursing

Nurses are not often recognized for their professional expertise.  I know that when Florence Nightingale started the very first school of nursing her goal was to change how people viewed nurses by educating the nurses (DeNisco & Barker, 2013).


Leadership is important to nursing because without it, there is not going to be anyone to educate new nurses.  The baby boomers are retiring and we will need new teachers that are prepared to teach new nursing students as well as students at the graduate level.  Recent studies show that nurses that are prepared with their bachelor’s in nursing experienced less pressure ulcers, deep vein thrombosis and hospital acquired infections in their patients. It was noted that although an associate’s degree is less costly and provides the care needed to a patient; by the year 2020 the goals are 80% of nurses will have their BSN and doubling for nurses with their doctorate.



There are organizations that provide nurses of higher education grants to conduct research and be able to make difference.  In order for these research projects to be done, it is required that the nurse be able to write a solid proposal request for the grant.  This may require the skill of a grant writer, but the nurse must be knowledgeable in the project and what it entails in order to help the grant writer correctly write the grant to fund the project that the nurse wants to do (Laden, 2013).

In Orlando, we have the Florida Nurses Association.  It is an organization that will support nurses from the student level through the advanced level.  The organization is involved in many things especially any that are legislative where a nurse wants to make a difference.  The Florida Nurse’s Association has subgroups called Special Interest Groups ( Sigs), these groups will benefit the members because they are formed to specialize in something that a particular group wants to see changed.  For example there is a group called Nurse Entrepreneur Special Interest Group, this groups supports nurses that have an entrepreneur business that they want to start or have started.  If there is a group that you want to start for a particular interest  that you have and it is not a group already listed here, then after speaking with leadership in the group, if they approve it, then you could start it.  The group is responsible for having ten members in it in order for the group to work. A master’s and beyond prepared nurse would be able to conduct research needed for any new programs that need to be implemented.




DeNisco, S. M., & Barker, A. M. (Eds.). (2013). The slow march to professional practice. Advanced Practice Nursing (2nd  ed., pp. 6-17). [Vital Source Bookshelf].

Ladden, M. D. (2013). The Case for Academic Progression: Why Nurses Should Advance Their Education and the Strategies that Make this Feasible. Retrieved from http://www.rwjf.org/content/dam/farm/reports/issue_briefs/2013/rwjf407597



Medication Error by Covering Nurse

I was recently speaking to a nurse about an incident that occurred at her hospital.  A nurse that was changing shifts asked another nurse to do her discharge teaching and administer a medication for her as she was busy.  This is a frequent thing that is seen amongst many different facilities. The covering nurse administered a medication to the patient and he had an adverse reaction to it, because it was the incorrect dose. It is a scary thought to think that this could happen to any of our families staying in a hospital or as a healthcare professional that it could happen to us.


In speaking with the nurse she proceeded to tell me that the nurse at her hospital was too busy to attend to her own patient to do the discharge planning.  She could have taken the patient herself and done a proper discharge planning and allow the new nurse coming on to take care of another patient, but instead she gave the nurse coming on shift her discharge. I would hope that in this day and age a nurse would not administer a medication or explain a medication that she is not familiar with.  In talking with the nurse, I felt that the covering nurse should have verified the medication if she had a doubt about it as that is her license on the line.


The covering nurse needed to be more information seeking and applying standards of care.  Regardless if the other nurse was busy, it is up to the covering nurse if she accepted the assignment to fulfill it correctly.  This means she needs to be able to follow the standards of care in that unit (Rubenfeld & Schaeffer, 2014).



Rubenfeld, M. G., & Scheffer, B. (2014). Critical Thinking Tactics for Nursing Achieving the IOM Competencies (3rd ed.). [P2BS-11]. http://dx.doi.org/

Quality and Safety at Well Baby Clinics

Recently, I was speaking with a health nurse at a clinic about the increase in babies being sick due to a lack of well baby check ups and vaccinations.  In speaking with the health nurse and in review of her concerns about her well-baby clinic, one of the critical dimensions that came to mind was inquisitiveness to determine whether offering immunizations at her clinic was working or not working to get the parents to come to the clinic.  If it is a well baby care clinic, are the parents bringing in the babies for any other check ups? For instance  are they coming in when a shot is not needed?


After our conversation, the health nurse decided to seek information about the mothers that were not coming and noticed that there was a drop in the amount of people who came because they did not have public transportation available for them, due to the distance that they lived from the clinic (she is in a rural area).  I suggested that there should be some creativity on the clinic’s part to establish a new way for the immunizations to get to the parents.


Creativity and inquisitiveness were two critical thinking dimensions that I identified in this well baby clinic scenario as I was speaking to the health nurse.  The structure is the routine immunizations that they provide to the parents at the clinic.  The process is based on the age of the infant and that will determine when they come in for their routine immunizations.  The outcomes are the hopes of reducing childhood illness, for instance measles (Rubenfeld & Scheffer, 2005).

In thinking, there are a few alternative ways that I think would help the well baby clinic and also help these families. First of all, finding out where the majority of the families that were affected by the lack of transportation live.  Once that is determined, locate a school, church or shopping center that will allow once per week or once per month depending on the amount of babies that need immunization, to set up an immunization clinic for those families affected by the bus system.  The schools, church and shopping centers are places that parents will need to go to if they have school age children or if they have to buy groceries or attend a church.   Even if they don’t attend the church, if it is in the community they have easy access to bring the baby for the immunizations.

school-clinic-1 school-clinic-2

Another alternative, is working with the resources available in the community.  Perhaps the clinic can find out if the transportation available to take people to doctor’s appointments would be available to bring the parents on a specified appointment day.   If the bus can pick up the parents where they used to take the city bus and bring them in to the clinic to get the shots, then go back to the bus stop once the group was done.


When the clinic presents these alternatives to the stakeholders making the decisions on what they will pay to make the clinic a success, it is important to share the benefits for doing the immunizations.  If presented in a narrative format, explaining first, the subpopulation that uses the clinic, then the treatment and frequency that they come as well as the consequences of the parents not coming.   Presenting the stakeholders with realistic facts if the babies are not immunized and that they can get a childhood illness like the measles, and how an epidemic can spread in the community, is an eye opener.  If there are complications from the illness without having proper care to the child or even an adult who was never immunized as a child, there can be an inpatient hospital stay.  The inpatient hospital stay would cost the tax payers and stake holders more money when simpler solutions could have been implemented.

In conclusion, education and preventative care is the basis of the well-baby clinic, but when the parent does not have the means to get to the one and only clinic, then an alternative to provide the same service has to be sought to keep the community healthy and avoid unnecessary inpatient hospital stays.



Rubenfeld, M. G., & Scheffer, B. K. (2015). Critical Thinking TACTICS for Nurses:Achieving the IOM Competencies (3rd ed.). [Vital Source BookShelf]. Retrieved from http://online.vitalsource.com/books/9781284059571