When Sue Fitzsimons, then the chief nursing officer at Yale-New Haven Hospital, gave the commencement address to the Yale School of Nursing Class of 2013, she told her new colleagues: “Rejoice in your work; never lose sight of the nursing leader you are now and the nursing leader you will become.
”Indeed, nurses are leaders. It begins with our training when we are taught that we are the ones who take care of the whole patient. The American Nurses Association (ANA) charges us with ensuring coordination of care and always advocating on behalf of our patients. That is embedded in our social contract. President Barak Obama drove this point home in his address to the ANA in 2010, when he said, “Nurses are the beating heart of our medical system.”
What does it take to be a nurse leader? It takes someone who understands all the variables and all the disciplines that are involved in a care decision or intervention. It takes someone with the knowledge and presence of mind to draw all the different parts together to bring about a positive response or patient outcome. It requires the awareness to assess not only the patient but the situation when making choices. So often, only the nurse sees the initial benefit or risk of a particular intervention to a patient. A physician may order pain medication following surgery but the nurse in the post-acute recovery area is the one who will see how that patient responds as he or she is waking up. We are the surveillance system, the eyes, the ears and the hands tasked with recognizing potential issues and taking proper steps to address them. In some ways, I liken the role of a nurse to that of Vishnu, the Hindu god of preservation. His many arms maintain, preserve and protect all in the universe. Like him, we must manage many tasks at once to making us the preserver and protector of our patients to secure the best outcome for them.
At UCLA, we recognize that nursing is both highly technical and highly intimate — high-tech and high-touch. The high-tech piece is relatively easy; we have the most sophisticated machines available anywhere on earth, the training to use them and the educational resources to continually boost our skills. High-touch — that is not as straightforward, but it is equally necessary. Alleviating suffering and delivering acts of kindness are essential to our mission, and so compassion is as important as clinical intervention.
Nursing is knowing when to step forward to respond to a potential issue. Being hesitant to act when a situation calls for it can create the opening for a medical error. None of us wants that. As advocates, it is incumbent upon us all to be mindful of our environment and our interactions and to be vigilant to situations as they arise, to anticipate our patients’ needs and to remove roadblocks to their care. So leadership, whether at the bedside or in the board room, requires situational awareness, confidence in your practice, engagement with colleagues and the ability to advocate for those for whom you care.
It is incumbent upon us all to be leaders.