1. Section Editor(s): Drake, Kirsten MSN, RN, NEA-BC, OCN

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Have you ever felt like everyone is watching you? I'll put your paranoia at ease-they are! As a leader, staff in your area and other areas, including other leaders, observe how you act, what you say, and how you make decisions. The role of nurse leader has evolved over the years. If you've been a unit manager for 15 years or more, you may remember a time when clocking in and routinely caring for patients were a normal part of your responsibilities. Now, decision making and producing improved outcomes are par for the course. For this reason, decision making is an essential leadership skill that nurse leaders must "own."

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Theodore Roosevelt once said, "In any moment of decision, the best thing you can do is the right thing, the next best thing is the wrong thing, and the worst thing you can do is nothing." How do you make decisions in your area? The answer may vary depending on your role within the organization, as well as the type of decision to be made. The process you choose may change based on the outcomes you need. There are influencing factors to every decision, including, but not limited to, the time available to make the decision, its impact, and the support needed to implement it. Be sure you're using a systematic approach when making decisions.


Start by creating a constructive environment. This entails having the right people at the table. Then discuss the level of commitment to the process. Using levels of authority allows team members to know how much of the decision they're responsible for executing. When team members are aware of how much input they have into decisions, they're generally more supportive. Team members will also be more likely to understand, with some explanation, when you have to make a decision on your own.


Next, start generating alternative answers to the problem. By using techniques such as brainstorming, many solid ideas will emerge. Looking at a situation or problem from another person's perspective can lead to other opportunities for strong alternatives. It's important to explore these alternatives for risks and potential consequences, as well as asking whether the option is adequate given your available resources. When choosing the best solution to the problem, check to make sure the decision makes sense to you; if it does, it will be easier to communicate. After you communicate the decision, it's time to take action!


How you choose to make decisions in your nursing leadership role is up to you, but remember to be consistent with your approach. Most important? Make a decision-don't avoid it and do nothing. Be the leader you are and make the best decision possible with, and for, your team.



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