Frontline Executive

Peter Drucker explains individuals who are knowledge workers can be executives once they are expected to make decisions that will have a significant impact on performance or outcomes in the normal course of their work. (Peter Drucker, 2006)

Generally, the word executive is reserved for those individuals who have a “high level” position in an organization. However, the word itself can simply mean and can be used for those who make decisions with an impact.  If I were to refer to any one of the nurses on my teams as an executive, they would most likely tell me I have lost my mind. However, nurses make decisions and take meaningful actions throughout their shifts every day. 

Example: A nurse walks into a patient’s room. The patient appears lethargic and diaphoretic; based on knowledge, he or she recognises further investigation and treatment is required. On assessment and evaluation, it is identified the patient’s blood sugar is low. Understanding the consequences of low blood sugar, that nurse will take the necessary actions and the right interventions that will reverse the patient’s status.

This is just one example of the executive decisions nurses will make with consistency. Nurses on the frontlines of care do not consider themselves as executives, however they are. They are leaders, even though their leadership may not fall into the category of supervisor, manager or director. Regularly, we choose nurses to take leadership roles, yet we do not recognize them as leaders because of our traditional biases. We consider the managers responsible for the departments the leaders; but in actuality, so are our Charge Nurses.

If we identify our frontline team members as leaders and executives, what’s next? For effectiveness we need to build and shape our leaders in a manner that will yield the results we seek. However, many of us who hold formal leadership positions do not take the time to coach, mentor and build our teams. Adam Canwell and his colleagues outlined, “leadership remains the number-one talent issue facing organizations around the world. In Deloitte’s 2014 Human Capital Trends survey, 86% of respondents rated it as “urgent” or “important.” But only 13% of respondents said they do an excellent job of developing leaders at all levels—the largest “readiness gap” in our 2014 survey.” (Canwell, et. el, 2014)

Throughout my leadership career, it’s customary for me to reserve time to speak to nurses about considering becoming formal leaders, and continuously encourage them to think about their role in leading healthcare. Instinctively, they respond by saying they would not want to do my job; to which I will explain they can lead in every capacity, and formal leadership does not only mean being a manager or director. I will also share my belief in the importance of nurses leading nurses to help guide the future of the profession. As Canwell and his colleagues’(2014) work has outlined, we do not do a great job at succession planning; yet succession planning is essential for formulation of legacy and sustainability of the work place and workplace culture.

 My Story

 Some of the hospitals I have worked at have permanent Charge Nurses (CN) and those that do not, normally do not rotate the CNs, which do not allow others the opportunities of that experience. At one of the hospitals I worked, the CN or Resource Nurse as per that organization’s designation, had been in the role for many years despite the organization’s policy indicating a tenure of eighteen months to two years. As we approached summer vacations and the Resource Nurse’s scheduled vacation time, I asked one of our brilliant experienced nurses, if she had ever stepped into the Resource Nurse’s role when the incumbent was off, to which she said no. I suggested that she would be taking on the reign during that summer vacation period. She appeared excited but somewhat panicked. When I questioned what she was so concerned about, her response was, “I don’t know what to do, what if I make a mistake?” To which I responded, it’s highly unlikely she could hurt patients from that desk, however I would ensure she got oriented to the processes and routines and if she made a mistake, she and I would figure it out. She was exceptional in the role; her critical thinking skills were highlighted through that summer experience.

 Personally, I have a dislike for permanent or nonrotational CN positions. In my experience, many of the individuals in these situations, do not demonstrate growth or development, they become complacent.  I liken it to having a government in place for a long time or a permanent government, they become ineffective over time, and in healthcare, that is not in the best interest of the teams nor the patients.  After that summer, there was a noticeable positive difference in the team’s functionality. I transitioned to a rotating CN model, which resulted in a rejuvenation of the team, increased efficiency and overall performance of the team and the unit.  

This does not mean everyone with a long tenure in a position need to be replaced; however, I believe the questions that need answering include: is that individual(s) demonstrating growth and enhancement, are they influencing the work and the team positively to meet the outlined goals, and will coaching and mentoring alter behaviours?

 **Leadership Lesson**

I have learned that those of us in formal leadership positions need to ensure we evaluate our work culture, environments and teams, and never be afraid of making the changes that are required. Kouzes and Posner (2007) advises that we “Challenge the Process” meaning we look for new opportunities, we experiment, and we take risks; however, I believe we need to take calculated risks since every change has an impact. In order to be successful, we need to “Inspire a Shared Vision”. That is, we envision the future state, and we enlist and engage others, our teams, before carrying out that vision and we “Enable Others to Act”, i.e., utilize the skills, knowledge and talents of others and provide them with the autonomy to act. Change is inevitable; however, I believe successful change only occurs by engaging our teams.

For those on the frontlines, you have something to offer right where you are; you lead by being a positive example for your teammates, especially when mentoring new members. Continue to be engaged in your teams, your work, your work environment and your organization. By nature of your training, experience and the work you do, you are leaders and executives. Seek opportunities to contribute, since it will allow you to learn new things, to grow personally and professionally and it will help you to see your leadership abilities from the bedside and through natural progression you will determine your path and your worth.