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“Today’s professional nurses assume leadership and management responsibilities regardless of the activity in which they are involved” (Koernig-Blais, Hayes, Kozier, & Erb, 2006, p. 2). D. Martin. is the nurse manager for The Spirit Medical Transportation Services (Spirit) of Saint Joseph’s Children’s Hospital in Marshfield, Wisconsin. She started her career as an ICU nurse, and from there moved into medical transportation. She worked as a staff flight nurse in three different programs, including Spirit, for 15 years before assuming the assistant nurse manager role for Spirit, and in the past year moved into the position of manager.
In an interview with D. Martin she discussed achieving of a position of leadership in our nursing community. The interview included questions about her background, and the role she has today.
D. Martin (personal communication, March 6, 2008) describes a leader as someone who is able to work effectively with other people and facilitate getting the job done. She further discusses the leader needing to have interactive communication skills. These skills she describes as two parts; first is active listening, making eye contact and giving full attention to the person speaking; the second is being able to talk and make a point with sounding condescending.
Through her examples, D.Martin has a democratic or participative leadership style. Leaders with a democratic style act as a catalyst or facilitator to guide the group towards achieving group goals (Koernig-Blais et al, 2006). Democratic leadership may be less efficient than other types of leadership, but it does allow for a spirit of collaboration and creativity from group members. This type of leadership can be extremely effective in the healthcare setting (Tappen, 2001, p. 26)Personal Philosophy and Important Qualities of Leadership
When questioned about important qualities or characteristics of a leader, D. Martin (personal communication, March 6, 2008) again emphasized the importance of interactive communication. D. Martin (personal communication, March 6, 2008) stated that an effective leader needs to respect their staff, or whomever they are leading. That a leader needs to learn how to be politically correct in all settings, and the leader as manager needs to learn how to delegate, and to be aware of the fiscal responsibilities within the institution, and balance those requirements with the needs of the department they are managing.
Sullivan and Decker, 2005 p. 44 state that “all good managers are also good leaders.” D. Martin talked interchangeably of leaders and managers, because she views herself as a leader first, and a manager second. Her views are that as a staff nurse, she was viewed as a leader among the flight crew, and now as a manager, she is still that leader, but with the responsibilities of management (D. Martin personal communication, March 6, 2008). A manager is responsible and accountable to the organization for accomplishing the goals of the organization (Sullivan & Decker, 2005).
When D. Martin was questioned about her personal philosophy of leadership she replied that “you are never going to please everyone all of the time, and that the most important thing to remember is that you have to be able to live with your decisions, legally and ethically” (D. Martin, personal communication, March 6, 2008). According to D. Martin (personal communication, March 6, 2008), quality and safety should be ranked equally at number one in consideration for what can and should be done. She believes that as a manager, she needs to be the mother tiger looking out for her cubs; that she has to protect the staffs’ interests. D. Martin also believes that an effective manager should have come up through the ranks.
A manager should not ask the staff to do something she has not done, or would not do. Another aspect of an effective manager is that the manager should have been a clinical leader first, that they have been there, done that for years. The manager may not always be able to keep up those clinical skills, and be able to perform the clinical aspects of the job, but if they have done it for years, they will understand the concepts when the staff needs someone to talk to (D. Martin, personal communication, March 6, 2008)Learning Experiences that have Influenced Growth as a LeaderD. Martin believes that her own clinical experiences and what she has done have had the most influence on her personal development. Her bedside clinical experience in an ICU prepared her for her role as a transport nurse (personal communication, March 6, 2008).
She was involved in the start-up of two different transport services, and her third experience was a transport nurse on a well established service. The first transport service she was part of was a load and go team with one of the first mobile ICU’s in Wisconsin. Her belief is that being on the ground floor of two services, the personal growth from those experiences as the service went through it’s growing pains, makes her better prepared for the growing pains of going from peer to boss. She also emphasized that managers should not take things for granted, if they have not been where they are asking their staff to go, she feel strongly that she brings a “been there, done that” style to her leadership (D. Martin, personal communication, March 6, 2008).
Evolution of Nursing Leadership in Healthcare TodayThe interview continued with the question of how she sees leadership evolving in nursing today. Her first response was disappointed. When she first started out in nursing, many registered nurses were from an associates program, and the recommendation for a management position, or to teach was someone with a bachelor’s degree in nursing. Once she had achieved her bachelor’s, the bar had been raised with the recommendation that managers have their master’s degree, in nursing or in business, and that nursing instructors have their PhD in nursing or education (D. Martin, personal communication, March 6, 2008).
Her thought is that with the requirement of that much schooling, the people managing departments, and teaching new nurses, are so far removed from the clinical aspects of nursing, that they are not as effective as someone who has recently been a clinical nurse. She feels nursing needs instructors that have “been there,” and instructors should not be “only those with the highest degrees.” There needs to be opportunities for nurses to move up through the ranks through independent nursing practice, and recognition needs to be given to the clinical experts at the bedside. The advanced degree should not be more important than clinical expertise in a given field (D. Martin, personal communication, March 6, 2008).
Challenges Facing Leaders in Today’s Healthcare SystemsD. Martin (personal communication, March 6, 2008), believes that the most challenging issues in her current position are the need to have a more global perspective, and having an appreciation for it. She described one aspect of that global perspective in terms of the hospital budget. Finding out what the hospital budget is, and that it comes down from the top of the corporation, not just the top of our individual hospital. Patients are important, but from a business standpoint, money is the bottom line (D. Martin, personal communication, March 6, 2008).
Healthcare is a business, and needs to be run as a business. She states that the biggest passion she had to give up was that the patient comes first. She had to learn how to facilitate the system, within the budget given, and with the resources available to her. Management cannot give the staff everything they are asking for, the money, and decisions come from the top down. “Management would be easy if you didn’t have to deal with the people” (D. Martin, personal communication, March 6, 2008).
The Impact of a Mentor on Leadership StyleD. Martin (personal communication, March 6, 2008) states that she has had three mentors in her career. Each is unique and she is grateful to them. Her first was her nurse manager of her first flight service. She states that he too came up through the ranks. He taught her the importance of creating a balance between management and work.
Her next mentor was her first nurse manager when she started at Saint Joseph’s, Terri. Terri was her mentor through her master’s program, and taught her the importance of being politically correct and fair. That, as a manager, you might not agree with what is being said, but you need to have enough self control to not let them see you do not agree with the company line, or to never let them see you sweat (D. Martin, personal communication, March 6, 2008).
Her third mentor was her nurse manager for the 11 years she was a flight nurse with Spirit. Through him she learned that different management styles are okay, and that an open door policy was what she respected most about his style. He also taught her the importance of credibility, and to not make
promises you may not be able to keep (D. Martin, personal communication, March 6, 2008).
Advice to Someone Interested in LeadershipD. Martin (personal communication, March 6, 2008) discussed the difficulty going from peer to boss. Her recommendation would be for anyone in that position to take a class on effective leadership to learn more on how to delegate, find resources and about fiscal responsibility. She did inform me that Saint Joseph’s Children’s Hospital does offer a two day seminar to employees on this topic, and she further recommends all Neonatal Intensive Care Transport Nurses take this class, as they all function in a leadership role (D. Martin, personal communication, March 6, 2008).
Her other advice was to be ready to put in long hours. To be passionate about whom you want to lead. Be clinically competent, and have confidence in yourself, and your knowledge. Stand up for yourself and your staff. Learn to take risks, and trust your instincts (D. Martin, personal communication, March 6, 2008).
Leadership and management are the responsibility of all professional nurses. Effective leadership and management is a learned process. Mentors can have a positive impact on the personal and professional growth of a nurse. Personal integrity, honesty, and a concern for human dignity should guide all leadership and management decisions (Koernig-Blais et. al, 2006).
Koernig-Blais, K., Hayes, J., Kozier, B., & Erb, G. (2006). Professional Nursing Practice: Concepts and Perspectives (5th ed.). Upper Saddle River, NJ: Pearson Education, Inc.
Sullivan, E. J., & Decker, P. J., (2005). Effective Leadership and Management in Nursing (6th ed.). Upper Saddle River, NJ: Prentice Hall HealthTappen, R. M., (2001). Nursing Leadership and Management: Concepts and Practice (4th ed.). Philadelphia: F.A. Davis.