The following is a guest editorial from Effie Amerson, Nurse Manager of the Neuro Science Center Intermediate Care Unit at the Medical University of South Carolina. Effie paints a story of the impact of a great leader. The author of First Break All the Rules and the One Thing You Need to Know says true leaders ensure staffs are performing in their "sweet spot," meaning the staff are fully engaged, they feel competent, focused, and confident (Buckingham, 2004). Effie was blessed with a manager who helped her find her "sweet spot" and this led her to become a successful leader today.

Let us all remember the "firsts" we experienced as new graduate nurses or "mature" nurses exploring a new specialty, and with patience, may we assist our employees and colleagues in finding their "sweet spot," moving them to greater heights. Buckingham, M. (2004). Be crystal clear. Executive Excellence, 21(9), 10-11. [Context Link]

-Marilyn Schaffner, MSN, RN, CGRN

Deapertment Editor

I have worked in the same organization for a number of years. I started as a graduate nurse in the intensive care unit. It was through the efforts of my leader that I had the courage to report to work each day. In addition to being my manager, she served as a teacher and mentor. Education could not have prepared me for that horrific experience.

The environment was unattractive and in my mind, barely adequate. Four beds were located in one room with curtains around the beds to provide patient privacy. I can still hear the alarms sounding from all the equipment in use and feel the intense heat on my face due to poor ventilation. I wondered, "How could anyone function in this environment?"

Patients and staff contributed to this frightening work environment. The patients were extremely sick and demanding. Even worse was the attitude of some of the nurses. There was one particular nurse who was overbearing in behaviors and attitude. She literally frightened me to death. She used shift report to intimidate and frighten me. After her report, I just wanted to run away.

My assignment was to change the linens on the bed with the assistance of my preceptor. This situation warranted a different strategy than the one I had employed in nursing school. I did not know how to maneuver between the ventilator, monitor, and intravenous (IV) pumps to get to the bedside. In addition, the patient had multiple lines, tubes, and drains. I saw the task as an impossible one. In fact, I did not understand, at this time, how the linen change could be important to this patient. The patient would require log rolling from side to side to accomplish this task. My first misstep was to become tangled in the IV tubing and rip it out. Certainly, my preceptor would want nothing more to do with me after that.

I was overwhelmed by the entire work environment. I saw patients actively bleeding from the mouth and nose. For one, a huge "red hose" was inserted through the patient's mouth into the esophagus and pressure applied by inflating the balloon on the catheter. An apparatus like a football helmet was placed on the patient's head to secure the tube.

Immediately, I was convinced nursing was the wrong profession for me. Nonetheless, my leader spent much quality time with me. She allayed my fears through education and patience and taught me to function in that perceived hostile environment. In addition, she recognized my potential to grow from novice to expert and was willing to do whatever it took to enable me to cultivate my clinical skills. She demonstrated confidence in my abilities. The unit orientation was restructured to meet my needs. My preceptor genuinely cared and used every spare minute to support my development.

Had it not been for the leader of my unit, I would have immediately given up and returned home. Being sensitive to my personal situation and my needs as a novice nurse, she took measures to isolate me from the overbearing nurse and fostered a nurturing environment. She used both her head and heart to guide my growth and development. She was a dedicated leader with the innate ability to lead, nurture, and balance strong personalities. My leader had the good sense to listen, resolve issues, and use the creativity of staff more than methodology to lead to more positive outcomes and accomplishments.

Leadership, when thoughtfully applied, works for everyone. It is a part of the character, ability, and willingness to learn from the success of others. Strong leadership and participative programs are management practices that impact retention of nurses. One reason nurses change employment is because the leader fails to listen and respond to the issues outlined by the nurse.

An awareness of employee and organizational needs must be balanced through sensitivity and compassion. I have found the best way to support the goals of my organization is to attract and retain competent and engaged workers. The organizational plan must be communicated to staff members in a way that promotes collaboration, accountability, and mutual respect. The leader must focus on outcomes instead of method, allowing staff the flexibility to use their own particular style. This approach fosters energy, enthusiasm, and commitment to work. It enables coworkers to function as teachers and mentors for the less experienced workers.

Nurses seek resolution of concerns and appreciation for their work. Respect, recognition, communication, and flexible staffing promote retention of nurses in the hospital work environment. Giving the nurse some control over the work schedule is an excellent way to enhance employee satisfaction. When the worker is listened to and treated as valuable, the result is a work environment that results in staff satisfaction.

The leader who is a teacher and mentor has the reputation for creating a culture of excellence and high performers. The staff plays an active role in recruiting and retaining other staff through practice. Such a team does not allow status quo, but inspires all team members to be productive.

Eventually, my leader, teacher, and mentor left the organization; however, she made a lasting impression on my practice. Her calm manner and confident demeanor in the worst of situations inspired me to want to be like her. She had a tremendous impact on my nursing practice in that she taught me to glean from the successes of others and incorporate people skills into my leadership style. Because of her, I have used a similar approach to mentor and teach my staff.