Appreciation goes a long way

I appreciated the editorial "The Power of Appreciation" by Richard Hader, PhD, NE-BC, RN, CHE, CPHQ, FAAN, in the March issue. I know that recognition and appreciation of staff is very much at the forefront, especially for hospitals seeking Magnet^(R) status. I would add another factor that has helped me show appreciation for my staff-the power of personal presence, of getting to know the people you're called to lead. I'm not talking about needing to be personal friends or socializing, but just getting to know who they are, their strengths, their challenges, the issues that affect them, and the things they can cope with easily. Obviously, this requires a certain time commitment, but it also requires that you consider spending time with the night crew and those working weekends or evenings.

Healthcare is a 24-hour business, and all our staff members have to be treated equally and with respect and appreciation. This means we plan meetings and educational sessions in such a way that all staff members can attend at a time that's suitable to them. Those of us in leadership are the ones who need to be flexible. We need to have regular huddles with staff on those "off-rotations." More than once, I've heard an employee say, "I never met my previous manager, I only saw him or her once a year for my evaluation."

To appreciate people, you have to get to know them and be willing to listen, respond, and follow up on the issues raised, regardless of whether you can provide a good answer. The key is being present as much as possible.

Transition plan a must

I very much enjoyed reading "Transitioning New Leaders: Seven Steps for Success" by Shelley Cohen, MSN, RN, CEN, in the February issue. I became a nurse after 15 years in business and finance and have been a nurse and nurse leader for 12 years. As a nurse, I've witnessed firsthand the turnover of many clinically excellent nurses who were promoted to leadership positions. Too often their lack of success is related to a lack of professional development, training, support, and clear expectations and guidelines. So, developing and implementing a clear transition plan such as Cohen's is imperative.

According to Cohen, leadership principles are shared across industry and service lines. It's beneficial to leverage available knowledge about leadership and leadership development that's readily available either from the Internet or from local bookstores. A quick search of the New York Times Business Book Bestseller List can offer current books on leadership and management. After all, as nurse leaders, we're charged with running a business, right?

With my business and finance background, I was surprised at the lack of focus on developing the business side of nursing leadership. It's time to make a business case for successful transition planning. The average estimated cost of replacing a nurse is between $22,000 and $64,000. In addition to the monetary loss, there's an impact on patient loyalty and satisfaction, as well as patient safety. As the nursing shortage increases, it's in the best interest of our business to attract and retain talented nurses and develop plans to make our future leaders successful.

Are we missing something?

As an experienced nurse leader who's passionate about evidence-based leadership and practice, the February article "Stop Going in Circles! Break the Barriers to Hourly Rounding" by Leslee H. Shepard, EdD, MSN, RN, CMSRN, grabbed my attention. After reading it, I began thinking about other barriers nurses might encounter when performing hourly rounding or other evidence-based tactics aimed at getting nurses to the bedside.

My nurses have done well with the practice of hourly rounding. This is evidenced by improved patient satisfaction scores, reduced fall rates, and decreased call lights. Yet, there still seems to be something missing. I considered all the other changes and technology we've implemented to get nurses to the patient, such as bar code medication scanning, point-of-care testing, and workstations on wheels. All of these changes are aimed at providing safe, effective care. Nevertheless, as I observed nurses working on a busy unit, I noticed that, although nurses were using the tactics and technology as recommended, they were hurriedly returning to the nurses' station to document, make phone calls, and socialize instead of staying at the bedside with the patient to complete their tasks. As nurse leaders, have we missed something?

Perhaps we should consider the unintended consequences of these practices and technology, and ask ourselves if we've made it possible for nurses to be the center of the care they provide. Are we hardwiring the task and the script, but overlooking the core culture? If the focus in healthcare today is patient-centered care, and as leaders our focus is to make it easier for nurses to do the right thing and harder to do the wrong thing, isn't it time to start leading that way?

We know that an evidence-based practice such as hourly rounding makes a difference because it drives nurse-patient interaction, but are we doing enough to equip nurses with the culture needed to practice patient-centered care and practice it well? It's something to consider.

CNL or CNS: Is there really a difference?

After reading "A Closer Look At Hybrid Nurses" by Cindy Rivet, MS, RN-BC, CNL; Susan Steeves, MS, RN, CCRN, CNL; Denise Brennan, MS, RN, CNL; Michele Creamer, MS, RN-BC, CNL; and Marsha Haverly, MS, RN, CPAN, in the February issue, I still fail to see how the clinical nurse leader (CNL) role differs from a systems savvy clinical nurse specialist (CNS). In the article, it's noted that one CNL is the director of the ED. How's this clinician different from a master's-prepared certified emergency nurse who manages the ED? I admire the organization's commitment to utilizing RNs with graduate degrees to improve quality outcomes. But is it this facility's commitment to having the RN actually in the position or the new CNL role that gets the job done?

Leadership reinvigorated

As a nurse manager of a large telemetry unit, I have some concerns about the critical thinking skills of some of the RN staff on the unit. I read with great interest the August (2012) article "A Critical Look at Critical Thinking: What are RN Perceptions of Leadership Skills?" by Susan J. Bodin, EdD, RN-BC. This article reported the results of a study that compared nurse manger transformational leadership traits with their staff members' critical thinking skills.

I was aware of the many positive aspects of transformational leadership, including quality patient care and staff job satisfaction. The relationship between transformational leaders and the critical thinking skills of their staff members is quite interesting and one I hadn't considered. These leaders do motivate and empower their staff, so this relationship does seem very feasible.

Although the study didn't confirm a correlation between transformational leadership traits and the critical thinking skills of staff, it has reinvigorated me to continue to strive in my quest for high quality leadership skills. Our patients need competent, caring nurses with excellent critical thinking skills. As a nurse leader, it's my job and my desire to provide high quality staff to meet these needs. Thank you for renewing my enthusiasm!

Anne Neethling, MSN, RN

Robin D. Britton, BSN, RN

Brandi Crow, BSN, RN

Robert J. Abel, DNP, PMHNP-BC

Robin A. Larghi, BSN, RN, CCRN