Wednesday, November 17, 2010

Nurse Leaders as Change Agents, Are We Up to the Challenge? By Beth Boynton, RN, MS

Nurse Leaders as Change Agents




11.02.2010 09:26 PM

Are We Up to the Challenge?

By Beth Boynton, RN, MS

Most of the work I do as a consultant, author and teacher is grounded in my belief that nurses are intelligent, capable and compassionate professionals who have a huge potential and daunting responsibility to improve healthcare. I believe that efforts to communicate respectfully and create respectful work environments will directly and indirectly lead to providing safe, quality care and experiencing long-term rewarding career paths in nursing. In fact, (at the time of this writing) I am working on a keynote address that focuses on this message for the ANA-WA leadership conference in September.

Yet, there are times when I work as a per diem staff nurse, I feel frustrated, powerless and despairing. I have one hundred urgent things to do and time to do about 60 of them if I am going to follow protocols and take the time to listen respectfully to all parties. I can take short cuts and do about 80 of them. Add to that an environment with chair alarms, bed alarms, exit-seeking alarms, endless interruptions, new problems and wasted time looking for supplies, and by the end of my shift I am emotionally, physically and intellectually exhausted. And, I didn't do everything I should have.

Patients, families, physicians, colleagues and administrators have the right to expect skilled, timely and compassionate care, don't they? And I have a right to expect all of these stakeholders to contribute to positive or at least optimal outcomes, don't I? Yet horizontal and vertical violence are huge problems and many of our workplace relationships are dysfunctional. This keeps us fragmented and isolated. Collaboration seems like an obvious way to reclaim our power and have more impact on our system.

But when resources are not there, how far will respectful communication take us? Sometimes I feel so certain and sometimes I don't know. It seems far too easy for a microscopic view of one of those 100 things that I don't do or do incorrectly to reflect poorly on me rather than the very-broken system I am working in.

I love teaching assertiveness and facilitating tough discussions during workshops on effective communication, workplace violence, or inspiring nurse professionals. But in all honesty, when I practice what I teach, I realize how hard it is!

Not long ago I was faced with a situation where my work assignment was unsafe. At first I was stunned to find out I was supposed to be supervising a medication assistant on an adjacent unit. I had my hands full on my own unit and was angry and overwhelmed by this additional responsibility. It was an evening shift and I made it through, but went home exasperated.

I struggled with coming up with respectful language and process for addressing the issue. I felt some internal inadequacy that I could own and I also felt a sense of disrespect for the work I do coming from the organization. It felt like a set up and I did not sleep well.

The next morning I called the Nurse Manager and expressed my concerns. She advised me that it was part of my job expectation and encouraged me to talk with the Director of Nurses. I also called the scheduler and left a voicemail message that I did not feel safe supervising in that situation. I said I would be happy to discuss it, but that I would not accept an assignment in that capacity in the future. He didn't call me back, but when I went in several days later, he approached me and told me that he couldn't make any promises.

I took a deep breath and asked him whom I needed to talk with, as it was not an acceptable answer. He referred me to the DON and I took a deeper breath and knocked on her door. I felt heard and respected at this juncture and have not been placed in this position again. Has it impacted scheduling/staffing in other ways for me? I am not sure.

I am a national presenter, with a graduate degree and book published and I want you to know that the process of taking this concern up the ladder was extraordinarily challenging for me. In the trenches I see my colleagues and support staff working so hard. They have families to take care of, bills to pay, and hopelessness about their ability to change things.

I know that I am role modeling healthy communication skills, providing the best care I can and making a difference. I also know I am asking nurses to stretch in personal and professional growth areas that are extremely difficult.

More and more I see nurse leaders and educators in such critical positions as change agents. Safe and respectful work environments for our staff and patients are critical priorities. Role modeling effective communication, owning our contribution to problems, and providing transformational leadership is indeed, daunting. We need leaders who will help to slow things down and bring back a balance of caring and collaboration into healthcare. I do think we can and I do think we will, maybe not tomorrow, but eventually. And who knows, maybe our efforts will seep into other areas of our world that are moving too fast.

Beth Boynton is an organizational development consultant specializing in issues that impact nurses and other healthcare professionals. She is a coach, facilitator and trainer for topics related to communication, conflict management, teambuilding and leadership development, and author of the book Confident Voices: The Nurses’ Guide to Improving Communication & Creating Positive Workplaces. She is an adjunct faculty member with New England College’s graduate program in Healthcare Administration and contributing University of Florida faculty for the Forensic Science for Nurses certificate program. She has also taught for Antioch University and McIntosh College. She has published several professional articles and her newsletter, Confident Voices, has drawn audiences from across the nation for addressing communication, conflict and workplace dynamics. Her website — — offers more information.


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