1. Politsky, Susan PhD, RN, NE-BC

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There are many ways for critical care nurse leaders to maximize the effectiveness of their roles. In healthcare, almost everything today is metrics-driven. But are metrics the only way nurse leaders should monitor their leadership assessment? The answer is no. Nursing, and critical care in particular, has many other tools that can provide a snapshot of leadership potential. This arsenal includes evaluation, which is the vehicle that nurse leaders should incorporate into their own self-appraisal to help identify strengths and opportunities to become even better nurse leaders.


The importance of evaluation

More and more, critical care nurses with less than 5 years' experience are being hired into nurse leader roles, specifically as nurse managers or directors. Often, these new nurse leaders have already demonstrated leadership capabilities, such as chairing their unit-based shared governance councils, or going back to school for an advanced degree. These leaders can be very influential, especially when creating nurse resident opportunities in the critical care environment, because not too long ago, they were new themselves. Other leaders in the organization see their potential and encourage this transition in roles.


However, when they are asked to consider transitioning from a clinical nurse to nurse leader, they are often concerned about not being effective. They may have never seen themselves as leaders-but the literature demonstrates that when there are vacancies in nurse leadership, metrics have the potential to deteriorate; specifically, higher medical errors can occur.1 Therefore, it is very important to maintain qualified nurse managers in these roles.


Critical care nurse leaders can strive to meet the needs of these advanced nursing positions with tools such as evaluation. Experienced nurse leaders conduct self-appraisals of their skill sets to identify areas of strength and opportunities to grow.


Evaluation resources

Nurses have a professional responsibility to ensure that professional standards of practice are defined, implemented, and maintained.2 Recently, the American Nurses Association (ANA) published the ANA Leadership Institute Competency Model that suggests professional leadership competencies can be defined, measured, and evaluated through self-assessment and internal and external reviews.3


Some evaluation tools to consider using include the Center for Creative Leadership's 360 Assessment, the American Association of Critical-Care Nurses Standards for Establishing Healthy Work Environments (HWE), and the Nurse Manager Inventory Tool.


Other evaluation tools not discussed in this article include the Myers-Briggs Type Indicator, Kouzes and Posner's Leadership Practices Inventory, and the Thomas-Kilmann Conflict Mode Instrument.4-6


360-degree evaluation. In general, the 360-degree evaluation is one way to assess a leader's effectiveness.7 A 360-degree evaluation can provide insight into coworkers' perspectives about the evaluatee's abilities as a nurse leader. Individuals who can contribute to a leader's 360-degree evaluation include any individual who collaborates with the nurse leader frequently. This type of evaluation is most effective when the nurse leader has emotional intelligence (the ability to accurately identify, understand, and manage emotion) and self-awareness.8 Without this quality, the 360-degree feedback may not be considered reliable and behaviors may remain unchanged.


Nurses participating in a 360-degree evaluation should realize that the evaluatee has selected them to provide meaningful feedback. Evaluatees are placing themselves in a vulnerable position, allowing others to identify both their strong attributes and areas that may require further development. Evaluators should be professional with word choice and not make generalizations. Feedback should be as specific as possible and include examples. Typically, feedback is reviewed by the evaluatees and their immediate supervisors, so professionalism is a must.


Standards for establishing HWE. This document contains six evidence-based standards that critical care nurses should cultivate within their practice.9 They include skilled communication, true collaboration, effective decision-making, appropriate staffing, meaningful recognition, and authentic leadership.9 It provides the latest data correlating unhealthy work environments and medical errors, delivery-of-care issues, and the primary reasons nurses are leaving the profession.


The HWE standards are a "functional yardstick for performance and development of individuals, units, organizations, and systems."9 As nurse leaders in critical care, consider using these standards to assess professional leadership competency. Nurse leaders should reflect on the critical elements for each of the six standards to help gauge their effectiveness and identify their leadership gaps. For example, when contemplating Standard 3, Effective Decision-Making, nurse leaders must reflect on whether they have fostered strong and collaborative relationships with physician partners and brought other critical care nurses to the table when decisions about patient care are made. Having frontline staff involved in the decision-making process is paramount.9


Nurse Manager Inventory Tool. This tool comprises three sections: 1) managing the business, 2) leading the people, and 3) creating the leader in you.10 Managing the business has seven subscales that include financial management, human resource management, performance improvement, foundational thinking skills, technology, strategic management, and appropriate clinical practice knowledge. Leading the people has four subscales that include human resource leadership skills, relationship management and influencing behaviors, diversity, and shared decision-making. And the last section, creating the leader in you, also has four subscales that include personal and professional accountability, career planning, personal journey disciplines, and reflective practice reference behaviors.10


The Nurse Manager Inventory Tool is a self-evaluation tool for nurse managers who can participate in self-reflection of the various items then rate their skill level based on a 5-point scale from Novice (1) to Expert (5). This evaluation should be collaborative; nurse managers should also ask their supervisors to complete this tool because reviewing both sets of results together can identify the highest-priority subscales requiring further development. Use the results to create a developmental plan of how best to reach expert skill levels the specific items. When creating this plan, identify goals, craft ways to accomplish them, and set timelines.



Nurse leaders should start where they are and aim high. During inevitable setbacks, assess how to move forward and how to get the metrics back on track using whatever form of evaluation is best suited to individual needs.




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