1. Autrey, Pamela S. PhD, MBA, MSN, RN

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Pearls of Wisdom From Nurse Leaders

Stringing Pearls,1 edited by Leslie Furlow, is a compilation of career trajectories and experiences written by nurse leaders from across the nation. The analogy and visualization of the construction of a pearl necklace set the direction for the book from first stringing the pearls, to polishing the pearls, to the final addition of the clasp. At first glance, the book appears to be best suited for new nurse leaders such as charge nurses or nurse managers. However, the lessons learned may reinforce past or current experiences of seasoned nurse leaders and executives, validating their own struggles, challenges, and successes while conveying the fact that they are not alone, nor are their stories unique. The book reads like a novel, weaving the many varied stories of very successful nurse leaders.


The Profound Impact of Childhood Events

Stories begin with childhood events that had a profound impact on the authors' desires to enter the profession of nursing. A father's care by nurses after trauma surgery is featured, and one nurse in particular, gave the father reassurance that he would survive. As a total stranger, that nurse impacted not only the father's recovery, but also his daughter's desire to help people even as strangers. The intertwining of family visits to hospitals and clinics, a "nurse kit" at the age of 3, working as a candy striper in the fourth grade, taking health careers as an elective in high school, and participating in a residential, on-campus nursing experience created a thirst for science behind the caring of nursing. Cherry Ames novels (younger students will have to look this one up!), membership in the Future Nurses Club, and being the eldest of 5 children (ages 2-11 years) grew into a passion for not only the profession of nursing, but also for leadership that includes generational gaps as well.


A Road Less Traveled[horizontal ellipsis]

Many of the authors took different roads to reach their current destination. One path is described as a 3-prong approach to a professional career in nursing: education, employment, and service. Another path is through a timeline of a journey as a new CNO from resistance to success, while another career path can be described as taking the scenic route in terms of both education and job opportunities. Encouraging new nurses to seize opportunities, network, and step outside the comfort zone through entrepreneurship can be both rewarding and stressful, requiring tremendous self-discipline and the ability to complete projects without someone else detailing every step or deadline. While many nurse leaders progress from one level to another in different institutions and even cities, advancement from staff nurse in an ICU to CNO in a span of 15 years in the same institution is quite uncommon in today's mobile professional society. Other professional routes occurred through academia, working with students described as "many diamonds in the rough,"1(p218) or a variety of experiences in different settings of care including clinical nursing, long-term care, consulting, sales and program implementation, and research. Finally, nontraditional roles in leadership may include authorship, mentorship, partnership, and trusteeship.


Facing Adversity Head-on

Many interesting stories revolve around worse-case scenarios. One author incorporates lessons learned from the 1982 and 1986 Tylenol-tampering events into the management of a care delivery error in her own organization, both from a crisis management of media and public opinion perspective. Her advice for full disclosure, ethical and legal imperatives, and moral and professional obligations sets the tone for communications with the public through the media, while continuing patient care delivery operations. She states "determining what is told to who, and by whom, is the most difficult part of the communication strategy."1(p33)


In 1996, the healthcare company slogan was "see it, do it, own it," and the author reveals how the slogan was translated by disenfranchised staff as "don't see it, don't do it, or you will own it[horizontal ellipsis] and then the problem is yours and yours alone to solve."1(p115) But mantras do not change low achievers acting as bullies, and teams become gangs, running off the high achievers. The end result is poor quality of care and poor staff attitudes. The approach is described in turning the nursing staff around through progressive discipline and rewarding good behavior. Although somewhat demoralizing as they occur, another author reinforces powerful motivators to learn can come from past professional decisions that end up being counterproductive. He delineates 7 leadership behavior factors that enhance high-quality leadership skills.


The Looking Glass

Looking through a different lens can apply to regulatory issues and organizations. For example, the mission of the Joint Commission is to "continuously improve the safety and quality of care provided to the public[horizontal ellipsis]."1(p51) and is not the enemy. Managing and most importantly surviving a site visit are written from a dual role as both a part-time Joint Commission surveyor and as director of Standards and Clinical Processes for Adventist Health. The 2 authors remind us that we must not get so wrapped up in the regulatory and reporting aspects of nursing leadership, but believe in the power of caring for others. As we are called to do by Florence Nightingale, the work at the end of the day is about the patient and the nurse at the bedside. The authors implemented this calling through the ideals of Jean Watson's CARING model.


The looking glass itself still has a ceiling, and professional obstacles include gender bias. Generally in nursing, we think of men when we think of gender bias. However, in the corporate world of healthcare and nurse executives (the majority of whom are women), the glass ceiling is still there. As she reflects on the many examples of women bumping their heads on the glass, the author shares her belief that the silence in the room when gender slurs are made, intentionally or not, is a lack of courage probably as a result of fear. She states: "[horizontal ellipsis]I have learned over the years that when one's mind is made up, this diminishes fear; knowing what must be done does away with fear."1(p107) She also quotes Martin Luther King Jr in her quest to have nurses do the right thing and speak up when right is right: "Our lives begin to end the day we become silent about things that matter[horizontal ellipsis]. I have made a commitment to never become silent again about things that matter."1(p109)


(Nursing) Leadership Is not for Everyone

A self-analysis is provided in the book and aids in answering the question: "Is leadership for me?" In times of economic turmoil and rightsizing, dealing with the downsizing of an organization requires coping on a personal level and an understanding of the elements of a divestment of an organization at the corporate level. One of the most intriguing chapters concerns the perils of a newly appointed neophyte nurse manager of a busy emergency department. Two authors eloquently describe the nightmare of an academic medical center CNO who had to deal with the severe shortcomings of the nationally recruited new manager. Cultures and leadership styles clash, as the military background of the new manager leads to distrust, paranoia, and hostility among the staff, including physicians. Swallowing her pride and admitting a mistake had been made, the CNO dismisses the new manager and writes a letter of apology to the staff to heal and get back on track to a better emergency department. The letter includes the authors' philosophy:


[horizontal ellipsis]to deal effectively with problems is by raising them, acknowledging them, and working together to resolve them. If people feel afraid to talk about what's wrong, situations will only deteriorate, people will become demoralized, and everyone will suffer. Stifling discussion is not a leadership strategy; it's a prescription for disaster.1(p93)


Closing the loop, or, in this case, the string of pearls, the editor of the book found out at a young age that being the oldest, therefore the boss, does not always prepare you for leadership later in life. She paraphrases the father of modern management guru, Peter Drucker, to emphasize her point: "[horizontal ellipsis]Telling people what to do isn't the same as being an effective executive."1(p255)


We can probably all relate and learn from that one simple rule for excellence in leadership.



The book is suitable for graduate students at the master's level, especially for those in nursing administration programs, providing the impetus for discussion and examples of reflective practice. The reviewer's only criticism is the title. Given the increase of men in nursing and as nurse leaders, the title may not be appealing to them. And as a woman, I honestly was not interested in the book because of the title; once I read it though, the book was very informative, enlightening, and engaging.




1. Furlow L, ed. Stringing Pearls. Eau Claire, WI: PESI HealthCare; 2008. [Context Link]