“Leadership” is a term that has always evoked, from my perspective, images of great, inspirational people who were set apart from the rest of the world because they were chosen by destiny to do and achieve great things. However, through my personal experiences as a nurse and a student, I know that leaders are not just born but can be developed, and; they may even often operate unseen while others receive recognition for accomplishments they were more responsible for than they are willing to acknowledge. I think the field of nursing has many of these “unsung heroes” that we work with everyday and who inspire and motivate others to develop the leaders in themselves as well. As noted in Finkleman (2012), there are differences between nurse managers and nurse leaders that truly set the two entities apart. Generally speaking, it is the leader who shares vision, develops others, challenges the status quo, has a longer perspective, inspires trust, innovates, and has their focus on effectiveness (p. 15). These previously mentioned qualities of leadership are just a few of the many aspects of leadership we engaged in during our didactic discussion of Nursing Leadership. While the didactic aspect of leadership training was certainly useful towards self-reflective internal development, there were other practical experiences during our Nursing Leadership curriculum that also stand out as being valuable and are worthy of reflection.

     During the course of the Nursing Leadership class, we developed a final leadership project compiled from a kaleidoscope of assorted work with the purpose, as I considered it to be, of helping us think of the bigger picture, our place in the leadership hierarchy, and how to develop ourselves as nurse leaders. One of the more basic components of the leadership project was exploring the hierarchy of the institution where I work, where I developed flowchart to depict our organizational structure. To complement that project, we were then asked to consider ten people within our institution who could have an effect on our growth, what our relationship was like with them, and strategies to help us develop better relationships with them. While being very utilitarian in its focus, I thought these two assignments allowed for some introspection into my own personality style, who I find myself most engaged with already, and where relationships need to be further developed if I decide that leadership is a path I wish to pursue within the institution where I now work. While personal development was certainly an important aspect of Nursing Leadership there was the aspect of how we can use our honed leadership skills to give to others.

     As an example of using leadership skills towards the benefit of others, another of the projects I worked on was taking an outdated unit policy and updating it with evidence-based research. The policy that I chose was open and closed endo-tracheal suctioning. The policy had not been updated for several years and it appeared as though many changes were required to provide safer patient care. Although performing the research to substantiate the change needed for this policy was important, I also learned how to use a tool to help with the implementation of the new policy: the RACI model. I thought the RACI model was a good tool to use because it clearly defines the roles of all the players in making a policy change a reality, while helping the person developing the policy a working timeline to offer stakeholders. Overall, I though the experience of developing the unit policy change with the use of the RACI model of development and implementation was very helpful towards the development of my career and towards thinking about how to proceed with developing better care for my patients.

     Reflecting on the RACI model also makes me consider that changes at the unit level or institutional level are rarely brought about by a single person. While it is important to develop personal leadership skills and use our talents to serve others, often times we need to think of ourselves within the context of a team, which brings me to the last of the projects which composed my final leadership project and presentation: Kaizen. Kaizen is a philosophy, developed by Toyota Motors, that embraces ‘continuous change for the better’, (Tocco, Hageman, and Shirley, 2015) and empowers workers to make changes to increase ‘lean’ and efficiency. I, in turn, see opportunity in the hospital setting to use Kaizen in many areas of patient care. Using the previously developed paradigm of Kaizen, I found a way to improve one thing in the hospital setting- interdisciplinary rounding (IDR). Through my research and the application of Kaizen, I found that not only is IDR a safer practice for patient care, but it can also be used to ‘lean up’ patient care in general. In this process, all members of the IDR have the opportunity to engage in a discussion regarding their patient’s plan of care on a daily basis. This further means that when all members are present, more knowledge is shared and orders can be given directly at the point of care. This can cut out the middle man, so to speak, and allow every provider an opportunity to see a more holistic picture of the patient overall.    

     The Nursing Leadership project was a large part of the course experience and, upon reflection, had a large impact on how I perceive the role of leadership in healthcare; however, there was also another part of the project that was closely tied to a separate experience that I would be remiss to exclude from this reflection. While we were instructed to develop a mock job announcement for a nursing position, we also shared a unique experience which placed us, through simulation, in the position of a unit manager interviewing a prospective employee. For this ‘interview’ experience I developed a number of questions and was asked to choose a handful of those for two of our instructors. It was an odd sensation to be sitting on the other side of the table interviewing as it were, but I felt that this was invaluable because while I discovered the hirable qualities of these two excellent candidates, I also learned something about myself: through practice, I have developed excellent active listening skills. In the end, we were asked to choose between the two candidates and, reluctantly, I chose who I perceived to be the better of the two. Overall, the interview experience was engaging, fun, educational, and showed me an aspect of myself I was not fully aware of at the time.

     In conclusion, the Nursing Leadership course was much more to me than a series of activities and assignments that reviewed leadership concepts; it was also a practical course that encouraged me to reflect throughout and think about how my unique personality can be used towards initiating and sustaining change as a leader. One of the most important things I learned through the course is that one does not just become a leader overnight. I think it takes consistent efforts on the part of the individual to develop themselves while inspiring others to do the same and needs to be treated with respect. For my part, I look forward to continuing my own personal development of leadership and going from being at times a “natural” leader to being a “de facto” where I can share my vision for patient care and help others develop into the nursing leaders of tomorrow.
 
References
Finkleman, A. (2012). Leadership and management for nurses: Core competencies for quality care. Upper Saddle River, NJ: Pearson.
Tocco, S. B., Hageman, M. A., & Shirley, D. (2015). The magic of kaizen. American Nurse Today (10) 5.