Leadership and Influence

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Great thinkers of the 17th century, such as Immanuel Kant, are widely recognized for their contributions to philosophy, particularly regarding ethics and morals. It is said that some set their timepieces accordingly to learn from him during what is known as the Philosophers Walk, perhaps hoping to grasp his ideas (Hutchins, 1952). One notable concept comes from a German saying found in his work: “Nihil appetimus nisi sub ratione boni; Nihil aversamur nisi sub ratione mali.” from his work on Critique of Practical Reason (Hutchins, 1952, p. 315). In English, this translates to: “We desire nothing except under the principle of good; we are not averse to anything except under the principle of evil.”

To simplify this concept, this nurse leader interprets it as meaning that people generally seek what is good and tend to avoid what is evil. As often is the case, this nurse leader intentionally tries to connect these ideas with current leadership styles adapted from others and military experience to influence the healthcare delivery team in a cardiac services environment. Broadening the discussion comes from experiences. As a nurse leader, promoting beneficence while avoiding and extinguishing maleficience in healthcare delivery is a standard aimed wholeheartedly by all healthcare professionals.

Leadership has become increasingly popular in academia, and much information is available online. A simple Google search for “leadership” will yield countless resources. The smartphone and advances in social media platforms like Facebook, Instagram, and TikTok offer a variety of leadership advice and philosophies. As Christensen et al. (2018) have discussed, anyone born in the mid-nineties can attest that these platforms are well-known to younger generations who have grown up using these technologies. As such, it is postulated that the platforms influence how leadership is expected to look, especially for younger people.

Many individuals have valuable insights about leadership, and this nurse leader will only contribute to the ongoing dialogue and extensive pool of information on the subject. Should it provide practical insights to strengthen, encourage, and empower readers, whether in leadership roles or those aspiring to be leaders, that has yet to be discovered?

Distilling scholarly insight on leadership from other professionals will contribute to the discussion. Categorically, the leadership styles are as Marquis & Huston (2018) identified those who are born to lead or philosophies theorized by Aristotle, autocratic, egalitarian, and noninterference ways of leadership, to name a few. For context, the leadership style that best suits this nurse leader is the servant-leader approach to operation and organizational efficiency. More on servant leadership style and practice are to follow.

Recall that soda cans are frequently sold in six-packs. In that case, there are six critical areas for leadership and management in healthcare to spotlight: personnel, patients, products, competence, teamwork, and behavior. This hexad serves as a common framework for daily operations in a healthcare setting. These six areas will saturate the following paragraphs.

Personnel

The individuals who carry out the daily activities in healthcare are the heart and soul of our medical delivery system. In a department focused on cardiac procedures, professional team members who support patients include doctors, nurses, radiological technologists and cardiovascular technologists, dedicated licensed practitioners, nonlicensed personnel, administrative support staff, industry representatives, and hospital computer and information technology engineers. Everyone is vital in ensuring that healthcare services are delivered with care and skill. Recognizing the fortitude required to have all these dedicated individuals on site, ready to meet the needs of those seeking medical assistance, can not be minimized. Their presence makes all the difference for patients and families.

Patients

Patient care is the focus of healthcare delivery. Many areas of healthcare delivery involve numerous services available to patients. Cardiac specialty care is an area that this nurse leader has first-hand experience with, as mentioned uniquely, the cardiac services offered in the cardiac catheterization laboratory. Several treatments for patients with cardiovascular abnormalities can be performed in a minimally invasive procedure site, such as the cardiac catheterization lab, which is often a practical alternative to more invasive cardiac procedures involving surgical intervention.

Sometimes, seconds and minutes are the difference between life and death. In the cardiac cath lab, when treating life-threatening STEMI events (Suneja et al., 2020), patients in critical condition are rushed into the procedure room, where cutting-edge imaging technology reveals the inner workings of their hearts. Skilled doctors expertly navigate small catheters through blood vessels to restore vital blood flow to the heart muscle.

As the heart beats, electrical signals captured on the patient’s electrocardiogram reveal a chain of events within the ST segment, a crucial moment just after a heartbeat. When these signals surge above the baseline, it signals a grave cardiac event—the onset of what is commonly known as a heart attack.

Reperfusion is the process of regaining blood flow in arteries. Specialty-trained doctors who have completed fellowship programs have learned skills to perform artery-opening procedures, which restore circulation and instantly transform the patient’s condition. The cardiac cath lab is often a stressful environment. However, patients’ lives are saved when doctors can demonstrate modern medicine’s incredible power, medical professionals’ nurses’ resolute duty to others, and radiological technologists’ resolute duty to others.

Products

In the thrilling environment of the catheterization laboratory, a world of cutting-edge technology awaits as specialists deliver life-saving heart therapies. Dependable X-ray machines seamlessly integrated with advanced monitors can transform invisible heart details into real-time images. These monitors allow cardiologists to spot blockages and identify heart dysfunctions with remarkable clarity, significantly when enhanced by contrast medicine. The procedure table described by Sorajja et al. (2020) is where patients lie down, ready for the doctor to insert a small catheter in the veins and arteries near the patient’s groin. The patient is surrounded by technologically advanced imaging equipment that rotates around them in a 180-degree spectrum. The illusion unfolds as cardiologists capture the beat-by-beat visuals of the heart’s inner workings. While the patient remains immobile, doctors work to revascularize the patient’s arteries and veins.

Competence

In the fast-paced world of healthcare, competence is the driving force behind exceptional patient care, especially in the cardiac catheterization laboratory. Fineout-Overholt et al. (2019) believe clinical expertise is built upon a triad of medical knowledge, methodological skills, and managerial finesse. Healthcare professionals apply the triad by delivering top-notch care.

Teamwork and Behavior

Partnership is essential for the effective delivery of healthcare services. As a fundamental aspect of organizational leadership, industry experts like Steiner (2024) highlight leaders’ crucial role in uniting teams and fostering collaborative performance. Steiner (2024) articulates concepts that resonate deeply with individuals; it is not merely a suggestion that everyone has an inherent desire to feel valued within their team, to belong to a cohesive unit, and to receive recognition and praise for their contributions, which most people desire. These elements are vital for unlocking a team’s full potential. A better question to contemplate, which is widely debated amongst all leadership points of view, is whether the leadership style applies to fostering the goals of effective teams. The viewpoint and opinion of this nurse leader that we revisit without exaggeration is that the servant leadership style is consummate to bring about the desired results of great performing teams.

What is servant leadership? Academics specializing in team improvement recommend a “service over self” attitude and behavior that positively impacts team members, drives change, and fosters empowerment and engagement. Rose Sherman, a notable industry representative, and prolific writer, describes the qualities of a servant leader as someone who listens more and speaks less, prioritizes others, encourages self-care among team members, helps individuals view conflicts as opportunities, promotes personal and professional growth, and strives to unite others by finding common ground amidst differences (Sherman, 2019).

As we look ahead, the evolving healthcare landscape presents challenges and opportunities. The future promises to be complex and dynamic, like the insights shared here. Various leadership traits can be implemented in a leader’s toolbox.

Healthcare delivery has a paramount focus on developing and improving teamwork. Part of the daily challenges in delivering patient care is ensuring that equipment and supplies are readily available. In addition, using best practices and maintaining skills and sharpening abilities contributes to improved patient outcomes. Moreover, organizational citizenship behaviors will gain even more prominence as this nurse leader prepares to navigate and shape future experiences within the healthcare environment.

References:

Christensen, S. S., Wilson, B. L., & Edelman, L. S. (2018). Can I relate? A review and guide for Nurse Managers in leading generations. Journal of Nursing Management, 26(6), 689–695. https://doi.org/10.1111/jonm.12601

Fineout-Overholt, E., Long, L. E., & Gallagher-Ford, L. (2019). Integration of patient preferences and values and clinical expertise into evidence-based decision making. In Melnyk, B. M., & Fineout-Overholt, E (4th Eds.), Evidence-based practice in nursing and healthcare (pp. 219-232). Wolters Kluwer.

Hutchins, R. M. (1952). Kant. In Great Books of the Western World (Vol. 42, pp. 315). Encyclopedia Britannica.

Kern, M. J., Sorajja, P., & Lim, M. J. (2020). Kern’s cardiac Catheterization Handbook. Elsevier.

Marquis, B. L., & Huston, C. J. (2021). Leadership roles and management functions in nursing: Theory and application (10th ed.). Wolters Kluwer Health.

Sherman, R. O. (2019). The case for servant leadership. Nurse Leader, 17(2), 86–87. https://doi.org/10.1016/j.mnl.2018.12.001

Steiner, K. B. (2024). Team building in a multigenerational workforce. Nurse Leader, 22(4), 458–461. https://doi.org/10.1016/j.mnl.2023.11.019

Suneja, M., Szot, J. F., LeBlond, R. F., & Brown, D. D. (2020). DeGowin’s diagnostic examination (11th ed.). McGraw Hill.

3 Things I Wish I Knew Then As a Nurse That I Know Now

 

As life unfolds and the years pass, I learned many lessons as a nurse that I wish I had known when I first entered the critical care unit. I was timid, afraid, and filled with insecurity and doubt. Yet, I held a license to carry out physician orders and assist in caring for patients admitted to the hospital with cardiovascular disease, specifically in a unit caring for patients waiting for heart transplants and caring for patients who were recipients of a heart transplant but were in rejection. 

Medicine has come a long way in managing situations after an organ has been transplanted to minimize the incidence of the body responding adversely to the newly transplanted organ by administering particular medications to patients to prevent what Mehra (2018) defined as cellular non-acceptance. However, in worst cases, when a patient presents with a swift onset of organ rejection, patients can deteriorate rapidly, and what we call in critical care circles patients sometimes "crash and burn." 

The learning curve in the unit was steep, but reflecting on it now, I realize I could have been potentially dangerous enough to make someone worse, but I persevered in becoming a competent nurse through blood, sweat, and tears. Nearly two decades have passed since those early experiences, and now I can reflect on them and share at least three insights I wish I had known as a new graduate. Although these thoughts have no specific order, they have all become prominent over time.

Chronic Illness

Number one is understanding the severity and impact on adults with chronic illness in the United States. For Americans, these are cardiovascular disease, kidney failure, strokes, uncontrolled diabetes, obesity and disorders of metabolism, and cancer (CDC, n.d.). They are prevalent and affect adults with an unprejudiced advance on human health. When left untreated or poorly managed, they can be debilitating at the least and increase all-cause mortality. 

As a cardiovascular care provider, heart failure management is the disorder that I am most familiar with, and in caring for patients with heart disease, patients become weakened, especially when untreated. When the heart is sick or failing, it affects all other body systems, notably breathing and respiration. Imagine the difficulty one has when not able to get a whole gasp of air into the lungs or the inability to walk up stairs because of being short of breath.

Not All Doctors Are The Same

Doctors rely on you to be knowledgeable about your patient. Early in my career as a nurse, I believed that medical doctors were the pinnacle of healthcare management, clinical diagnoses, and treatment expertise—and they are. However, as a new graduate in an academic institution, I did not fully comprehend the heterogeneity of medical training: internship, residency, fellowship, and attending levels of our physician providers. Their skill set and privileges perplexed me. 

On average, a patient could have numerous physicians on the healthcare team involved in the treatment plan. As the patient's nurse, you are tasked with interpreting all of their notes, prescriptions, and diagnostic tests that they have ordered. Additionally, I was slow to learn the necessity of all the diagnostic tests and procedures they would order, but they are clear to me now.

I gradually realized that while medical students are bright, enthusiastic, and eager to apply their knowledge, they are still academically differentiated from their peers who are interns. Mark & Wong (2018) explain that there is a distinction between general and specialty knowledge in physician training. While interns are on their path to becoming proficient residents, their hierarchy continues to evolve even as a first-year resident has fewer experiences than a second-year resident. Often, they will graduate and become general practitioners, and some will continue their training through specialty fellowship programs. Fellows need to gain specialized knowledge, training, and experience, particularly when they become attending physicians and join a physician group practice, for they will be the ones calling the shots.

Importance of Self-Care

Finally, I needed to learn how critical self-care is. In the hospital, nurses are presented with first-hand experiential, in-vivo observation of the practice of medicine. In simple terms, you can see how medicine works on patients at the moment they are administered. For instance, when titrating doses of medications that affect heart rate and blood pressure, you can observe the intended effect of certain medications or the pharmacological mechanism of action. In addition, and to conclude my point about self-care, seeing what poor self-care can deteriorate into and, by extension, the effects on patients from nonadherence and non-compliance will wrap up the article.

The American Heart Association has established guidelines for a heart-healthy lifestyle. Following these recommendations as Lloyd-Jones & McKibbin (2018) describe efforts to manage food choices and portion sizes, incorporate daily exercise, maintain a healthy weight, quit smoking, monitor blood pressure, and keep cholesterol and blood sugar levels in check—can contribute to increased longevity and improved quality of life. Navigating health challenges can be incredibly tough, and I remember being a young healthcare provider, feeling somewhat naive about the struggles individuals face in managing their well-being. 

My time in the hospital has deeply influenced my understanding, echoing what Atul Gawande (2014) articulately expresses: our approach to self-care is often shaped by our awareness of the time we have left to live. I recall my experience in my twenties, serving in the Marine Corps, where I felt invincible, almost bulletproof. Yet, now, at fifty, I've realized how profoundly my perceptions of the years ahead affect how I care for my body. It's a journey that many of us experience, where our views on life can inspire us to treat ourselves by making healthy choices or continue to plague ourselves from some of our poor decisions in terms of those modifiable risk factors such as not smoking, for example. 

References:

Centers for Disease Control and Prevention. (n.d.). Fast facts: Health and economic costs of chronic conditions. Centers for Disease Control and Prevention. https://www.cdc.gov/chronic-disease/data-research/facts-stats/index.html

Gawande, A. (2014). Being mortal: medicine and what matters in the end. Picador.

Lloyd-Jones, D. M. & McKibbin, K. M. (2018). Promoting Good Health. In J. Larry Jameson & Anthony S. Fauci & Dennis L. Kasper & Stephen L. Hauser & Dan L. Longo & Joseph Loscalzo (20th Eds., Vol. 1), Harrison's Principles of Internal Medicine (pp. 8-13). McGraw-Hill Education. 

Mark, Daniel B., & Wong, John B. (2018). Decision-Making in Clinical Practice. In J. Larry Jameson & Anthony S. Fauci & Dennis L. Kasper & Stephen L. Hauser & Dan L. Longo & Joseph Loscalzo (20th Eds., Vol. 1), Harrison's Principles of Internal Medicine (pp. 13-22). McGraw-Hill Education. 

Mehra, Mandeep R. (2018). Cardiac Transplantation and Prolonged Assisted Circulation. In J. Larry Jameson & Anthony S. Fauci & Dennis L. Kasper & Stephen L. Hauser & Dan L. Longo & Joseph Loscalzo (20th Eds., Vol. 2), Harrison's Principles of Internal Medicine (pp. 1797-1801). McGraw-Hill Education. 

Tips for Securing Your Next Role

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There is much talk about VUCA in our current healthcare industry. From one point of view, as a nurse manager, the healthcare business has volatility, married to day-to-day uncertainty and complexity, all topped by the ambiguity in delivering evidence-based practice to patients (Sherman, 2024). In short, it is everchanging, evolving, and moving at a pace and rhythm that is hard to keep up with.

One area of the VUCA challenge is keeping up with the uncertainty of staffing shortages that all healthcare systems face from daily operational needs. Additionally, employee absences, vacations, non-paid time off, and extended leaves of absence influence fluctuations in daily staffing to meet core needs. At a basic level, it is a supply and demand model, and backfilling when staff absences exceed the ability to deliver safe care with appropriate patient-to-provider ratios contributes to the challenge.

Operational efficiency and patient care are the normal state of affairs in any hospital. However, suppose you are a new grad nurse or an experienced veteran looking to be the solution to your next employer's staffing dilemma. In that case, the following are some tokens and tributes your next employer is looking for.

Competency

Let us distill the qualities and traits into three for focus: competencies, behavior, and teamwork. First, competency is congruent with clinical expertise. Fineout-Overholt et al. (2019) described the professional nurse's expertise as possessing the techniques, education, and proficiency combined with best practice knowledge to care for patients. As a hiring manager, articulating your career experience and discussing your abilities and competence in caring for patients can help fortify your opportunity and be the linchpin in securing your presence in the minds of the interviewing staff.

Attitude

Second, but no less critical, is behavior, undifferentiated from professionalism. Scholars have divulged and distilled concepts surrounding professionalism. Gathered from Hood (2018), elements of a professional include but are not limited to the following.

• Committed focus on patients
• Caring about the work that helps patients and team members
• Demonstrating empathy to patients
• Having self-confidence
• Acquiring and displaying competence
• Possessing technique
• Ability to communicate clearly
• Applying critical thinking skills
• Capacity to be resilient in uncertainty and change

Collaboration

Last is teamwork, or organizational citizenship. It is often understood as the ability to cooperate with others for a common purpose and to put oneself behind the mission. These character qualities, or the soft skills of personal relationships and communication, are as critical as your skills, abilities, and academic achievements. Character, attitude, and behavior are in high demand.

As highlighted by Jim Collins (2001), concepts of high-performing organizations boil down to who will do the organization's work rather than what must be done in an institution. It is often heard in organizational circles, "This is how company XYZ is?" or "This is the company's way of doing things!" An organization's heartbeat, rhythm, and culture are the people, not the tools, equipment, walls, and foundation.

No matter the task, having the best team members steers any organization in the right direction. A company may have a great mission statement, but what can be expected if the wrong people work for the company? This continues to be a subject of undying debate.

So, if you are searching for that next role, promotion, or simple change, remember to keep abreast of current trends and educational endeavors to keep your skills and career fitness up to speed. As mentioned, behavior and teamwork attributes are desirable and coveted. Although autonomy, self-determination, and independence are qualities that harmonize with most working professionals, working together, collaborating, and sharing organizational commitment is the currency of high-performing organizations.

References:

Collins, J. C. (2001). Good to great. Harper Collins Publishers Inc.

Fineout-Overholt, E., Long, L. E., & Gallagher-Ford, L. (2019). Integration of patient preferences and values and clinician expertise into evidence-based decision-making. In Melnyk, B. M., & Fineout-Overholt, E (4th Eds.), Evidence-based practice in nursing and healthcare (pp. 219-232). Wolters Kluwer.

Hood, L. J. (2018). Leddy & Pepper's professional nursing (9th ed.). Wolters Kluwer. 

Sherman, R. O. (2024). Upskilling your nurse leaders. Nurse Leader, 22(5), 484–485. https://doi.org/10.1016/j.mnl.2024.07.007