The Caring Role of Nurse Leaders

The challenges facing nursing leaders in every healthcare practice and setting today are remarkable. There are more conversations today than I remember hearing even 5 years ago about succession planning and encouraging nurses to consider leadership and management roles as a career track. A recurring theme at nursing leadership conferences is, "Who will do this work in the future" How can we recruit and develop future nursing leaders and managers? One key approach is to highlight the important role that caring plays in the relationship between leaders and staff. This guiding principle of caring for the staff and nurses caring for each other needs to be paramount in our leadership beliefs, values, and practices.

As clinicians we can easily draw the connection to the key role of caring for our patients. It is interesting to me that there is at times a notable lack of consciousness about how we demonstrate caring practices toward each other: nurse to nurse and nursing leaders with staff. This plays itself out in both subtle and covert expressions of intergroup conflict, petty negativity, and an "us against them" tension that of itself further creates divisiveness. This has been referred to as horizontal violence, or lashing out where it is perceived to be "safe" to do so and meeting one's self-esteem needs at another's expense. This can become the culture of both the clinical nurses and nursing leaders within a unit or an organization and become a self-fulfilling cycle of negativity. These characteristics are often symbolic of a lack of caring and lack of attention to a supportive professional practice environment. I wonder sometimes if the fear of tackling this negative energy is one reason that holds back potential leaders and managers from stepping forward.

Today's nurses and nursing leaders can transform and ensure a culture based on caring and positive regard. We can avoid the trap of speaking of each other in judgmental way. We can cut one another some slack and speak with each other directly and from a framework of caring about concerns and issues by reaching out and trying to understand different perspectives. We can be conscious of the power imbalances in relationship and aware of the impact this can have on honesty, trust, and fear. These are caring practices that effective leaders and managers bring to their role every day. And, often these are the same skill sets we use with patients and families.

In their hallmark book, The Primacy of Caring, Patricia Benner and Judith Wrubel make the case that "caring sets up what counts as stressful and what coping options are available."^1p(1) When caring comes first, nursing leaders bother to notice the hidden story, the untold reality, the underlying issue. The nurses we are leading can sense this caring from a mile away.

Phil Authier and I were delighted that this topic generated so much interest and outstanding articles. A common theme that emerges in this edition is that the most successful and happy nursing leaders and clinical nurses have found a way to hold on to their caring ethic with the support of the right environment, resources, knowledge, and skills. We hope you will find a gem in here that gives you some support or inspiration for your complex and challenging role.

Lois Napier Skillings, MS, RN, CNAA, BC

Guest Editor Vice President Nursing and Patient Care Services Mid Coast Hospital Brunswick, Me

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