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Vol. 23, No. 4, APRIL 2006

President's Note
Engage and Transform: There Are Many Ways to Lead

By Debbie Brinker, RN, MSN, CCRN, CCNS
President, AACN

The little book with the catchy title, Everyone Leads, caught my eye. I bought it and ran to catch my flight. The concept sounded utterly chaotic to me at first. Then I read what author Don Zadra was proposing: the notion of team leadership, drawing from the description of Great Northern geese flying in the familiar V-formation, each bird contributing a unique dimension of leadership to the team effort.

As I read, I revisited previous chats with many of you after presentations or during hospital visits while I crisscrossed the country during the past year. Those conversations helped me make sense of the lessons Zadra presented. Here’s how:

Everyone Is Aligned
Values are in sync with individuals and their organizations. The perfect V-formation of Great Northern geese flying thousands of miles holds a valuable secret. As each bird moves its great wings, it creates an uplift for the bird following. Formation flying is 70 percent more efficient than flying alone.

Earlier this year an open heart patient arrived just as I reached a surgical ICU. I relished the opportunity of standing aside to watch the beautiful choreography. Everyone knew exactly when and how to engage in the familiar admission process—except for the new nurse, whom I didn’t notice at first because a preceptor effortlessly brought her into the dance in an assistant role. Admission completed, the preceptor skillfully debriefed the new nurse about the knowledge and skills exhibited as the team stabilized the patient en route from the OR. That was an aligned team.

Everyone Leads
From a distance, the flock appears to be guided by a single leader. The lead bird does in fact drive the formation, winging smoothly and confidently through the oncoming elements. If the lead bird tires, however, it rotates back into formation, and another bird moves quickly to the point position. Leadership is willingly shared, and each bird knows exactly where the entire group is headed.

I toured a health system experiencing a transition in senior management—something that could have caused chaos. I found just the opposite. The vision of creating and sustaining a healthy work environment where nurses are valued leaders in the healthcare team was so embedded in the organization’s culture that everyone seemed focused on maintaining the momentum. Staff nurses talked about quality improvement successes. A clinical nurse specialist proudly described zero incidences of ventilator-associated pneumonia during the past quarter and fewer sternal wound infections partly because of a computerized bedside glucose control regimen. It is a culture where everyone leads.

Everyone Inspires
Each flock inspires its own unique rhythm and spirit. The pulsating sound of the huge wings beating together excites and energizes the entire formation. The geese enthusiastically honk from behind to encourage those up front to keep up their speed.

I met the pioneers who were first in their unit to become CCRN or PCCN certified. In turn, these leaders inspired, mentored, encouraged and supported others to achieve this distinction. It might have been one or two determined individuals seeking to validate their proficiency and commitment to excellence. Or a manager who set the goal of 65% certified staff to align with the Beacon Award for Critical Care Excellence criteria. Inspiration led to energy. Certification became a shared priority as did teaching in review courses, coaching study groups, celebrating new certificants and, of equal importance, supporting those who needed to retake the exam.

Everyone Cares
In good times or bad, Great Northern geese stand by each other. When a member of the flock gets sick, wounded or shot down, two geese drop out of formation and follow it down to help and protect it. They stay with it until it is able to fly again.

Do bad times make you uneasy? Times when you have witnessed or been the target of verbal onslaughts, or the equally damaging silent treatment or lack of help from others on your team? Respect for and from everyone is a right, not a privilege. That includes patients and families. Nurses. Physicians. Other team members. New graduates. Older nurses. Even fatigued nurses struggling with consecutive 12-hour shifts. For me, these bad times cause great moral distress. Yet, good times can bring compassion. Like the nurse whose family struggles made her less sharp at work. Her manager set the tone by starting the conversation with, “I value you as a nurse.” The nurse ended up taking a family leave bolstered by frequent support calls from her colleagues. She returned to nursing with a new confidence and awareness that “I know I’m valuable to my unit. We show the same compassion to each other as we do our patients.”

A Different Take on Leadership
Did you notice how all these examples demonstrate leadership—perhaps not as traditionally defined, but leadership nonetheless? When your values are in sync with those of your colleagues and your organization, you lead. When you engage in achieving a shared vision, you lead. When you inspire excellence, you lead. When you care in good times and bad, you lead. And when everyone contributes to leading, everyone excels.

During an interview just before this year’s Academy Awards, best actor nominee Terrence Howard—who happens to hold a degree in chemical engineering—shared an interesting observation. “You work in films developed within your community,” he explained. “They may not be as high quality as those developed in other communities, so you're automatically working under the radar. But you keep jumping higher and higher, hoping that someday, someone will notice you. One day you do get noticed. And you learn that you weren’t jumping higher at all or doing anything different. You were noticed because of all those people who are holding you up.”

Who is holding you up by their leadership example? Who are you holding up? Please share your stories. Send me an e-mail at debbie.brinker@aacn.org.


Healthy Work Environments Standards Applauded
I am writing to commend the work of AACN regarding its standards for establishing and sustaining healthy work environments. I am especially supportive of “true collaboration,” which AACN defines as “a process not an event.” As you know, collaboration requires a continuous team effort and a culture in which decision making and communication between nurses and doctors is routine.

In my four-year career as a nurse, I have seen a lack of collaborative effort in healthcare, especially in the OR. Adhering to AACN’s new standards will allow healthcare staff members to grow and learn in an organized way. I believe that adhering to these healthy work standards will keep nurses loyal to their teams, departments, hospitals and, most of all, to the profession of nursing. I look forward to sharing these standards with our OR team to promote healthy work environments.

I congratulate AACN for investing time and energy in bringing such comprehensive standards to the nursing field and enhancing the careers of nurses in the future.

Manmohan K. Gill, RN, BSN
Herndon, Va.

Send your letters to AACN News, 101 Columbia, Aliso Viejo, CA 92656; aacnnews@aacn.org.
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