Mark is an excellent neuroscience nurse who has practiced for three years in a university medical center neurosurgical intensive care unit. His specialty is stroke nursing and he recently passed the SCRN exam to become a stroke certified registered nurse. A strong proponent of patient- and family-centered care, Mark is loved by his patients and their families, and has consistently earned the respect of his peers. He is the go-to person on the unit when nurses are perplexed about how to make the plan of care work for a complex patient. Delighted when asked to replace the charge nurse who left the unit over differences with the CNO, Mark has been serving as charge nurse for six months. His initial enthusiasm for his increased responsibilities is waning as he discovers that excellent clinical skills dont necessarily translate into strong leadership capacities.
There seem to be two groups of nurses working in the unit those like Mark whose passion is patient care, and another group who shows up to do a job. You get paid the same for showing up to do a job as you do for working extremely hard to make a critical difference. Too late, Mark realizes he has alienated the latter group and is guilty of being partial to a few favorites with whom he can share his frustrations. When the chief patient safety officer called Mark to explore recent negative changes in his units safety dashboard, Mark became defensive, and upon reflection, realizes that he may be deficient in critical leadership competencies.
Code of Ethics
The ANA Scope and Standards of Practice Standard 12, Leadership, reads: The registered nurse demonstrates leadership in the professional practice setting and the profession (p. 55). Among the cited leadership competencies are the following:
Oversees the nursing care given by others while retaining accountability for the quality of care given to the healthcare consumer.
Mentors colleagues for the advancement of nursing practice, the profession and quality healthcare.
Seeks ways to advance nursing autonomy and accountability.
Provision 4 of the ANA Code of Ethics for Nurses (2015) makes clear that the nurse has authority, accountability, and responsibility for nursing practice and providing optimal care and elaborates on the particular responsibility of nurses in management and administration.
Scenario 1: Options from Marks perspective
With new insight into his own strengths and growth opportunities if he wants to be an effective nurse leader as his units charge nurse, Mark can 1) choose to seek the mentorship and development he needs to address deficiencies, 2) accept the status quo and watch morale and nursing performance on his unit continue to slide, or 3) go back to being a staff nurse on this or another unit and allow a new leader to be identified. Ideally, if Mark truly values excellent nursing practice and is confident in his leadership potential, he will seek the help he needs to succeed in his new leadership role. At the next meeting of the nurses leadership council, he might try sharing his experience and be surprised by the support he receives. Since his situation is far from unique, he also might be surprised at the many new, and not so new, charge nurses who can relate to his experience. A goal for the leadership council might be to identify the leadership competencies new charge nurses need and to explore how best to grow these competencies. Since the medical center has seasoned charge nurses who effectively lead their units while commanding respect from their nurses, a mentoring program may be a first step.
Scenario 2: Options from the Chief Nursing Officers perspective
Nursing is not unique in rewarding good performance with increased responsibilities for which a nurse may or may not be prepared. This seems especially true in places which lack clinical leaders to reward clinical excellence. At any rate, Marks experience is all too common. Marks CNO might watch Marks leadership with dismay, saddened that his excellence in clinical practice didnt translate into leadership excellence, goading him into better unit outcomes. Alternatively, an astute chief nursing officer might reflect on the reasons why Mark is floundering and begin to research this phenomenon which is far from unique. At a local American Organization of Nurse Executives meeting, the CNO might share this experience and ask what other nurse executives are doing to prepare charge nurses for their new leadership role. It seems ironic that we spend money and time on residency programs to orient newly graduated RNs, but expect new charge nurses to thrive.