Nursing leadership has no single definition. It has been characterized in relation to principles a nurse leader should strive for: commitment to excellence, focusing on employee satisfaction and building individual accountability. Other depictions target skills necessary to be an effective nurse leader ? organizational management, communication, analysis/strategy and creation/vision.
Regardless of the definition espoused and regardless of your position ? staff nurse, nurse manager, clinical nurse leader or chief nursing officer ? you are a nurse leader in some capacity. As a nurse manager, you are given the responsibilities to manage your unit effectively and competently. As a staff nurse, you lead your patient?s learning about a new treatment regimen that now must be followed. As a clinical nurse leader, your advanced generalist duties require you to manage the integration of care for specific patients. And, as the chief nursing officer of a healthcare delivery entity, one of your leadership roles is to ensure consistency in the standard of nursing practice across all clinical settings.
Aside from the specific responsibilities of a particular role as a nurse leader, your obligations require you to carry them out ethically and legally. Ethics and the law are two vital components of your armament as a nurse leader in fulfilling your various obligations. As examples, your ethical principles include truth-telling, preserving human dignity and respect for autonomy. Legal principles applicable to your role might be adequate staffing, anti-discrimination and conformity with wage and hour laws.
Most of you carry out your leadership with ethics and law at the forefront of your decisions. Some nurse leaders do not, however. Consider the following examples of situations expressed by staff nurses concerning the conduct of a nurse leader they experienced firsthand:
? Changing staff nurse documentation
? Being treated in a harassing manner in front of other staff
? Being required to take a lunch break regardless of patient staffing and the patient?s condition or be fired
? Not granted overtime pay when required under state or federal law
? Not allowing another person to accompany a staff nurse when admitting a verbally abusive patient
? Tolerating harassing behavior toward nurses by physicians
? Ignoring requests for more nursing staff when patient-staff ratios are inadequate
? Not following established policies and procedures
? Favoring one or more staff members over others
? Not informing newly hired nurses the truth about units they are hired onto (e.g., staffing, conditions of the unit, security coverage)
? Tolerating patient care that does not meet basic standards of nursing practice
? Making discriminatory decisions concerning hiring, firing, promotions
These are just a few examples of poor nursing leadership that can, and do, lead to legal liability and breaches of ethical principles. In Elles v. CCA of Tennessee LLC, several nurses sued their former employer, a privately operated jail, under Title VII, alleging racial discrimination and a hostile work environment. Cason-Merenda v. Detroit Medical Center, a class action suit filed by two nurses on behalf of themselves and a class of other nurses against eight Detroit hospitals, listed as one of their allegations that the hospitals conspired among themselves and with other local hospitals to hold down the wages of RNs employed by the institutions. And, in Texarkana Nursing and Health Center v. Lyle, the guardian of a deceased resident who was assaulted by an LPN and later died, sued the center alleging negligent supervision of nursing staff, negligent hiring of nursing staff, failure to hire and promote sufficient nursing staff, and failure to provide a safe environment for its patients.
All of the above cases involved nurses and obviously not all of the nurses were good leaders, neither in the practice of nursing nor in their adherence to the mandates of their legal and ethical responsibilities as nurse leaders. Abraham Lincoln once said ?Whatever you are, be a good one.? Good nursing leadership is demanding. You must constantly meet those demands with the qualities, characteristics and attributes to which your staff and your patients are entitled.
