1. Hader, Richard RN, PhD, CNA, CHE, CPHQ, Editor-in-Chief

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Gazing out of the plane's window on a cross-country flight, I remembered an old leadership principle: View a situation from 37,000 feet. I saw distinct analogies between my perceptions of the terrain below and how I practice in my nurse leader role. The mountains correspond to challenges, the flat lands of the plains represent easy times, and the ambiguous depth of the water symbolizes uncertain situations.


With my parallel view of the sky, I could see other flying planes, which called to mind colleagues responsible for the hospital's support services. Those planes, like the colleagues, encountered the same terrain, experiencing similar challenges but embarking on different paths.


There was one view I couldn't catch from the plane - the sky above me. I realized that when I worked at ground level, I relied heavily on what took place higher up. As effective leaders, we need to not only know what's going on below us, but also next to us and above us. If we're dealt obstructions, we need to creatively find ways to obtain a better angle.


Lead your leaders

As we enter 2004, let's effectively influence events above us by applying the leadership strategy of managing upward. Too frequently we solely focus on guiding staff members, not spending enough time sharing staff concerns with our own managers. Situations exist where this can work as a disadvantage to those that lead us and those whom we lead.


Effective, honest, and open communication with your manager is essential to move forward with your organization's goals. Case in point: Two years ago, the hospital where I work implemented a major organizational change - the development of a service-line structure. As vice-president of nursing, I wasn't comfortable with this new structure, and feared the nursing department's mission would be fragmented and patient care would deteriorate.


My supervisor believed the medical center needed to focus on growth and productivity, and given the competition of the health care industry, this method would be the most beneficial to both the organization and the community. These conflicting views could've led to a poor outcome had we not handled the situation using effective leadership strategies.


Talk it out

By sharing issues and concerns, being forthright, negotiating, and respecting each other's positions, my manager and I implemented an effective plan, creating a service-line structure with nursing standards - one in which caregivers owned a central line of responsibility.


By managing upward, I became the strongest advocate for the new service-line structure, presented a unified commitment of the administrative staff, and helped to implement an initiative that's proven extremely instrumental to the organization's success.