Recently I had an interaction with a person that lead me to think about the leadership styles and management that I have encountered throughout my nursing career.

As a nurse, we are expected to grow and learn throughout our careers. As a novice nurse we focus on building our practice experiences and work on our theory to practice integration. Once we are more experienced, we are expected to start taking on a leadership role and are often given the assignment of charge nurse (often way before we are ready). And as we continue our growth, we often take on preceptor students, apply for more permanent leadership positions such as Patient Care Coordinators (PCC) or in the USA this role was often call Assistant Nurse Manager (ANM), or we may even seek a higher stature like manager.

Although as nurses we have the above expectations, not everyone is made of the same cloth and some struggle more with leadership than others. In order for me to demonstrate my point it’s important to review the definitions of leadership and management. Leadership according to Webster’s dictionary “ molds individuals into a team” whereas management is defined as “those who manage or direct”. The definitions are significantly different with each eliciting different outcomes and although both may have a place or time they are used or effective, there are some nurses who only possess a “management” style; and whether this is inherent or a learned trait is to be determined at another time.

A prime example of when management may be necessary is when you have a busy department and things are going a little sideways, sometimes you may have to breakout the management style to get things done and facilitate flow or movement throughout the department. When management is required, the person in charge is actually only managing movement of patients, they are not managing staff, they are “telling” them what/when/how to do their job in order to empty and fill beds. This is very different than leadership but does at times serve a purpose.

Leadership can in fact have the same goals as management, however; through leading people to critically think and facilitate movement throughout the department it not only aids in development of staff, builds critical thinking, leads to accountability to the department, it also reduces the workload and stress of the leader. Trust is formed between leaders and nurses and an overall boost in moral is evident when a leader is present! I’m sure you see which direction I lean.

While on some travel assignments, I experienced varying levels of “managers”. I’ve even been “micro-managed”! When a ANM/PCC asks you “why haven’t you hung those IV fluids on patient A?”, many thoughts run through my mind. Mostly, why are you scouring through my patients charts and double checking what I have or have not done (yes, defensive). In this instance, although the fluids were ordered, there were many factors as to why it wasn’t done, and none of those reason were due to incompetence or laziness. In fact, after assessing the patient, discussing the issue with the MD, and critically thinking about the repercussions of the fluids, the MD and I collaboratively decided to wait before giving the fluids. This example demonstrates a manager, task focused, without enquiry, and punitive in their approach. This style of management is overly evident in nursing and directly contributes to attrition rates and job satisfaction. I could tell many stories with similar approaches; the stories are from both sides of the border and amongst many different departments. More recently I was told “if you had just moved your patients you would have reduced your workload”. Although I cannot convey tone, I can assure you this statement came with a tone that implied ignorance. Additionally, the reason the PCC/ANM wished for me to move my patients was in no way to reduce my workload, if fact she wanted to readily fill those beds with patients, some of which may have been actually more work than the 2 I had just finished completing all tasks for!

Now a leader is a different story. The best statement I’ve heard from a leader in a busy department is “what can I do to help facilitate those moves?”. This person recognizes many facets of the department, including that there are somethings that may need to be done (or not) to get the patient going where they need. There will be no “push back” or resistance from a nurse when the AMN/PCC asks enquiry questions, the nurse is empowered to ask for assistance or decline, critical thinking is developed, and the department moves along…

Obviously, we can’t make leaders out of all managers as some just don’t have the insight into their leadership style; however, when people in positions of leadership recognize these “managers” it is important to have those tough conversations and perhaps even review their position within the department. Task focused micro-managers can be toxic to a department…

What style of leadership does your department have? I’d love to hear your perspective in the comments!

 Trudi~A hopeful leader