Despite the fact that unintentional injury is the leading cause of death in the United States for ages 1-44 years from 1981 to 2019 (Centers for Disease Control and Prevention, 2021), many trauma programs continue to struggle with limited resources or "buy-in" from leadership, administration, and staff needed to maintain an optimal trauma system. There are many roles within the trauma system that deliver a range of care for injured patients. Each person is important and has the potential to be impactful along the continuum of trauma care. The trauma program nurse coordinator or manager and the trauma medical director are often viewed as leaders in their institution. Do these titles mean they have the power to effect change, to ensure care is delivered built on evidence-based guidelines, or to make certain that subspecialty liaisons are engaged and active in developing the system? What does it take to get someone to be invested and to act beyond their defined clinical role?
Power is the ability to act or produce an effect (Merriam-Webster, n.d.-b). The concept of leading with power alone generates short-term results. The outcome is either positive or negative. "If you don't arrive within 15 minutes of the patient's admission to the trauma room then (insert threat)." Many have been the recipient of this type of message. The outcome only leads to compliance. There is more to having power and authority as a leader.
Influence is the capacity to cause an effect in indirect or intangible ways (Merriam-Webster, n.d.-a). It is the ability to change how someone else behaves or thinks based on meaningful and positive persuasion instead of authority. It does not directly impact an action or behavior just by telling someone to do something. It is influencing others to change the way they behave, think, or act and is done by persuasion and inspiration.
So which is better, power or influence? Both are important as one thinks about how to generate results. There are times when both power and influence are needed to achieve a positive outcome. There are other times when only one will work better than the other. Ultimately, a person needs to have some power to be able to influence. However, power is a perception. One example is of an identified leader who can bestow a positive or negative outcome on a person. Another is someone who has experience and knowledge, so believed to be an expert. A person who is seen as an expert in their role is someone who is listened to and, in turn, can influence. Both have power.
The goal is to facilitate positive outcomes. Building and developing relationships throughout the trauma system promote cohesiveness, effective communication, and motivation to achieve a common goal. These relationships will have an effect on influence. When a positive relationship is based on trust with peers, a leader's actions and behaviors will be more likely to influence (Wooll, 2021). The relationship between leadership, administration, trauma nurses, and physicians across the continuum, and the trauma program leaders, affords several examples. Leaders who affect meaningful influence lead by example. They present research or are involved in organizations nationally and therefore recognized as experts by hospital leadership and peers. They involve the multidisciplinary team in developing guidelines and protocols that build trust, collaboration, and ownership. A leader who uses influence cultivates a culture of pride and acknowledgment for the trauma nurse across the continuum of care, from the emergency department to bedside, and rehabilitation, which shapes behaviors and beliefs. A trauma team that is cohesive, engaged, and whose actions are to provide trauma care that is derived from within, creates a positive and lasting effect that touches the whole system.
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