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.

Understanding Nursing Leadership

Who You’ll Hear

What You’ll Learn