Understanding Nursing Leadership

by | Feb 5, 2019 | Podcasts, Nursing School and NCLEX® | 0 comments

This podcast is available on Apple Podcasts, Stitcher, PlayerFM, iHeartRadio, Libsyn, Spotify, and Amazon Music.

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Who You’ll Hear

Kati Kleber, MSN RN– Nurse educator, former cardiac med-surg/stepdown and neurocritical care nurse, author, and speaker.

Melissa Stafford, BSN RN CCRN SCRN – highly experienced and currently practicing nationally certified neurocritical care nurse.

Megan Brunson, MSN RN CNL CCRN-CSC, former President of the  American Association of Critical Care Nurses (AACN)

What You’ll Learn

  • Introduction
  • Role of a Supervisor
  • Chain of Command
  • Advice for New Nurses
  • Conflict with Physician
  • Encourgement
  • Night Shift Supervisor

Understanding Nursing Leadership

Ever wonder about how the bedside nurses work with nursing leadership? We interview Megan Brunson, a current practicing nursing supervisor, and discuss how the bedside nurse can leverage leadership in various patient situations.

Please note, in this episode, we talk about the AACN a lot – this stands for the American Association of Critical-Care Nurses.

The Role of A Supervisor

This can be different at different facilities. This is generally what this role means:

  • Some hospitals call them assistant managers
  • Many facilities have an assistant manager for the day shift and another for the night shift
  • Then there  is a manager over the entire unit
  • A supervisor or assistant manager helps manage the nurses by:
    • Scheduling
    • Helping with clinical needs
  • Primary responsibilities:
    • Offer clinical support by answering questions
    • Offer support to help pull up or reposition a patient
    • Offer support listening to nurses that need someone to talk to about job-related questions and problems
  • In the night shift, leadership presence isn’t always there for nurses.
  • Works a 12-hour shift
  • Paid hourly, not salary
  • Having a supervisor that understands both the clinical side and management side is critical to providing excellent support to both the nurses and the upper management.
  • The hardest job in health care is a nurse manager.
  • Best way to be a nursing supervisor is to remember details about the nurses in your care
    • Create an intimate rapport with them
    • This increases their trust in you as a leader
    • It helps the leader build the team so they know how to use their talents best

Chain of Command

Next we discuss exactly what chain of command means to a new nurse, and how to enact it in the most politically correct way possible.

  • There is a reality in hospitals that you have to follow the process of the chain of command.
  • Chain of command essentially means that you’re hitting a roadblock with someone and you need to escalate the concern
    • For example, you have a concern about a patient and the resident does not agree. Escalating that would mean speaking directly with the chief resident or the attending.
    • Another example is that you have a conflict with your colleague and attempt to discuss it with them and they are non-responsive, then you go to your supervisor, then your manager, etc.
  • Following the chain of command process protects you as a nurse and it protects the managers and administration
  • On the night shift, the night shift supervisor or charge nurse is a nurse’s first step
    • Communication is key. Sometimes the person a nurse is having a conflict with doesn’t even know.
    • It is important and part of a nurse’s role to give them a shot and be honest about the things that bother or upset them.
    • If they are not receptive or they lash out, then they are accountable for their behavior and you can go to the next level.
  • The direct method for handling conflict is always the best way.
    • It leaves your vulnerable and it is scary.
    • It avoids a triangular situation where you don’t know if the person was told about your conflict or if it was ever resolved.
  • Another option is to pull someone in and go together to resolve the conflict.
    • Other experienced nurses have experience with these crucial conversations and can be a huge support system.
  • Sometimes a nurse has to go around the chain of command because the direct supervisor is physically not there.
  • It is a good idea to pause, write down what bothered you, and think it through before going up to the next supervisor.
    • This helps you sort through your thoughts and put them together professionally.
    • Do not have an emotionally-driven conversation
  • When looking for support, be selective with whom you let into your circle of trust
    • Don’t foster drama or encourage gossip
    • It can create a very unhealthy environment within which to work

Advice for New Nurses

Advice from a night shift supervisor to new nurses that might be facing issues with their manager or direct supervisor.

How to navigate issues with direct supervisors or managers:

  • AACN has valuable resources such as Healthy Work Environment Standards which covers:
    • Staffing
    • Communication
    • Creating a healthy culture within the unit
    • New nurses should read these standards
  • If you have a problem with a new nurse manager or a nursing preceptor, try this:
    • Set the expectation correctly –
      • Take a moment to say to the preceptor, “This is where I am coming from. This is the kind of patient care I’m looking for. This is the experience that I need. I’m concerned because I’m really having trouble with ______.”
    • Set expectations with how you like to learn, too.
      • “I’m a very visual person.”
    • If you set the expectations clearly, there won’t be any surprises when you have a dialog later on.
    • It helps foster trust at the start of your shift.
    • It’s ok to say “we are not clicking.” It doesn’t necessarily offend the preceptor.
    • It does take courage to come forward and ask to change preceptors.

Advice for Nurse who Has Conflict with Physicians about Patient Care

If you have a new nurse that has a concern about a patient, calls the physician and doesn’t receive an appropriate response for the issue, this is what they should do:

  • Always go with your gut, but don’t do it in a silo.
  • The senior staff knows the physicians really well – walk through the situation with them
  • As a new nurse, you have a responsibility to build trust with that physician too.
  • Bring in your charge nurse or an experienced nurse.
  • Before you call the physician, write down on a piece of paper what you want to say.
  • Sometimes with a physician, it isn’t what you said it is how you said it.
  • Unless it is something like a completely inappropriate medication, do what the doctor says, but then call them right back.
  • There is a chain of command with physicians.
    • It doesn’t happen very often where you have to go to that physician’s chain of command.
    • In that instance, you would pull in the overall house supervisor.
  • Be assertive and clearly communicate details when you discuss patient care with physicians.
  • If you need to call back, as the charge nurse to listen on the other line.
    • It wakes up the situation
    • Charge nurse can help clear up miscommunications

Encouragement for Nurses With Barriers to Leadership Support

Helpful tips for new nurses that have actual or perceived barriers to leadership support.

  • As a nurse, recognize that you are a leader.
    • Even as a day-1 nurse, you are a leader in that unit because you are setting the tone for that unit.
  • When you say you have perceived barriers with leadership some of it might just be not knowing that person.
    • You might not have any personal connection to them.
    • You might not know their clinical background experience
  • Don’t be so task-oriented that you overlook getting to know your team.
  • Come in 10 minutes early and stay 10 minutes late. When you are getting your assignment, have a discussion with the buddy you will be working with all night, such as:
    • Learn basic personal details (“what did you do this weekend?”)
    • Build rapport
  • When you are in critical situations with patients, you have the rapport and established relationship that will help you navigate it easier.
    • It makes escalated conversations more comfortable.

Night Shift Supervisor Soapbox

A few last words from Megan Brunson to brand new nurses.

  • For night shift nurses – don’t mess around with your sleep.
    • Map it out
    • When new nurses come to the night shift, they don’t take into account their sleep and they make appointments during the day when they should be sleeping.
    • How much sleep you get affects the health of the patients and your entire mindset at work.
  • From a leadership perspective, build trust with the people around you.
    • This includes the day shift too.
    • They will have your back as well as you have theirs.
  • Get to know the leadership in your unit.
    • Whether that is the charge nurse or the experienced nurse
    • Find out who has the listening ear. You will get frustrated. These are normal feelings and you need someone with whom you can talk about it.
  • Never use the night shift as an excuse to not get involved.
    • I ask people to speak up for the shift
    • A meeting in the afternoon won’t work, but I want to be involved in that committee, can we meet at 4:30 p.m. or 7 a.m.?
    • Your professional development ultimately feeds back into the patient care you are giving.

More Resources

Picture of Kati Kleber, founder of FRESHRN

Hi, I’m Kati.

Kati Kleber, MSN RN is a nurse educator, author, national speaker, host of the FreshRN® Podcast, and owner of FreshRN® – an online platform created to educate, encourage, and motivate newly licensed nurses in innovative ways.

Connect with her on YouTube, Pinterest, TikTok, Instagram, and Facebook, and sign-up for her free email newsletter for new nurses.


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