The 7 Characteristics of a Nurse Leader Part 4 – Trust

We’ve been on a role this week digging into the characteristics of a clinical leader. We are going to dive into the glue of it all today. Trust. In any profession, there is a foundational need to build trust. In this article, we will discuss why trust is so important and how to get it.

If you haven’t caught the previous parts, please check them out below.

The 7 Characteristics of a Clinical Leader – Part 1 – Humility

The 7 Characteristics of a Clinical Leader – Part 2 – Confidence

The 7 Characteristics of a Clinical Leader – Part 3 – Resourcefulness

 

Trust

Trustworthy – deserving of trust or confidence; dependable;reliable: Dictionary.com 

As a clinical leader having others’ trust can make or break your career. I learned early on; trust is such a valuable yet fragile thing to have. The good news is you already have a leg up on every other profession just by being a nurse! In 2016 Nurses were ranked #1 in Honesty, and Ethical Standards per the Gallup Poll ratings done December 7-11, 2016. This is the 15th straight year topping this list with 84% of the public rating nurses as “High/Very high.” Compare this to members of Congress where 59% of Americans rated their Honesty, and Ethical Standards as “Low/Very Low.”

Find the full results here – Gallup Poll.

Why is that? What do nurses do to foster such a high rating?

In a recent article on boston.com Inna Khazan was cited as saying, “Nurses are the one you call if you need something. People tend to place more trust in those that are directly caring for them.”

As a clinical leader patients, families, staff, and co-workers all rely on your opinion. However, without trust your opinion means squat. I remember when it dawned on me how important this is and how we must continually work to gain it.

Around my first week as a supervisor, we had a new admit come in. I remember meeting them and introducing myself and right away they had a complaint. The room was too cold. “Oh, this is an easy one,” I thought to myself, I can fix this. I assured them I would take care of their problem.

Then I got a call. A patient had fallen, and I needed to respond. I ran to the scene and took over. We provided minor first aid to a small laceration, and luckily the patient was okay! Now around this time, my shift was coming to an end, so I finished out my day and took off. Completely forgetting about the new admits request. Oops. No big deal right?

The next day I went in to check on them, you know, make sure everyone was treating them well.

“Why is my room still freezing we asked you yesterday to fix this”!

“I am so sorry I don’t know why no one has fixed this yet,” I said as if I told someone to fix it.

About the time these words leave my mouth, in walks maintenance.

“We will have this fixed in no time thanks for calling us we had no one told us this wasn’t working.”

And… I had done it. They couldn’t prove that I hadn’t reported it, but they saw right through me. Trust was out the window.

This might seem like a minor thing at face value but fast forward a few months. Our relationship deteriorated. It didn’t matter what I said or what I did; it was wrong. I was having to explain myself at every step and often that wasn’t even good enough. This was one of the most challenging assignments I have ever had. Not because of the acuity or the complexity of the care, but because it was based on a foundation of mistrust. I had lied and crushed it from the beginning. What saved this one? Eventually, I walked into the room looked the patient and the family in the eyes and apologizing. I admitted my fault and took ownership. I told them I had forgotten to notify someone of the room and feel that led to a negative relationship and I apologize.

“When the trust account is high, communication is easy, instant, and effective.”
― Stephen R. CoveyThe 7 Habits of Highly Effective People: Powerful Lessons in Personal Change

So how do you go about building trust?

Building Trust

Build Trust by being honest

  1. Be honest

As you can probably guess by now. I learned my lesson. One of the first lessons I tell new nurses is this one. If you make a mistake come to me. Be honest, and we will do whatever needs to be done to fix it or make it right. But don’t lie, not even by omission. I don’t know a single nurse who has lost their license by accident. It is more often by trying to cover up mistakes than the actual mistake itself. Look, we all make mistakes. We all forget to do something. The only way to recover is to shine a light on it, apologize, and strive to do better. If you can’t be trustworthy in the little things, you can’t be trustworthy in the big things.

Build Trust by following Through

  1. Follow through

Nurses are pulled in dozens of directions every day. It is important to find a system to keep you on task and remind you to follow through. I figured out a long time ago if I don’t write something down I will never remember it. As a clinical leader, I have learned to treat my day as if I am at the bedside. Being bedside, we often have a scrap piece of paper that we took report on; for some reason as clinical leaders, we stop doing that.

I now have a notebook or laptop or sometimes even just my phone that I am constantly taking notes on and am a huge fan of running to-do lists. I start my day by making a list of things I need to accomplish and as the day goes on, I will add to this list or scratch things off. My last hour or so I take a minute to look at my list and triage what’s left. Anything that absolutely can’t wait, I do then. If it can be postponed till the next day, I will start my list for tomorrow and add these items to it.

The key here is communication if you can’t complete a task make sure you let the person relying on you know. Also, give them your deadline on when you will have it done. I usually say something like, “I had some things come up today and was not able to complete that task, I have it on my list for tomorrow and will have finished by this time. Does that work for you?” That way they know you didn’t blow them off.

Build Trust through Prioritizing

  1. Prioritize

We learned a lot about triage in nursing school. I propose you can take what you learned and apply this to your role as a clinical leader. Just like triaging patients takes practice, triaging interruptions takes practice as well. I find new nurse leaders usually start out one of two ways.

The first, take on everything as soon as it crosses their plate. These nurses are sitting with a patient doing an assessment, and someone walks in with a phone call. They excuse themselves and answer the call, going back to the patient to only have someone else interrupt. Once again, they excuse themselves and take care it. This cycle turns into a pattern for their work day. They are always stopping what they are doing and taking care of the next” emergency.”

The second group is very task orientated. They sit down to do the assessment, and someone comes with a phone call and before finding out who the caller is the nurse shoos them out the door. However, in this case, it was the doctor who is getting on a plane and needs to give them an order for the patient they are currently assessing.

Both of these leads to patients and families feeling that they can’t trust in your leadership. They may feel you are flighty and not listen or so busy you can never be bothered with their concerns. By learning to make quick triage decisions, you can learn to prioritize your day and your responses. Taking care of those critical situations while devoting your attention to the task at hand.

 

The 7 Characteristics of a Nurse Leader Part 3 – Resourcefulness

The 7 Characteristics of a Clinical Leader Part 3 – Resourcefulness

In Part 2 of our series, we looked at the essence of confidence. We discussed the inter-relationship of confidence and humility and learned that you could only grow confident through humility. Lastly, we discussed steps to boost confidence and develop as clinical leaders. Today, I wanted to talk about the resourcefulness of a clinical leader.

If you have not read the previous installments in this series, please take the time to go back and read those before moving forward.

You can find them here:

The 7 Characteristics of a Clinical Leader Part 1 – Humility

The 7 Characteristics of a Clinical Leader Part 2 – Confidence

Resourcefulness

 “able to deal skillfully and promptly with new situations, difficulties, etc.”                    http://www.dictionary.com/browse/resourceful?s=t

Being interviewed for a role, the interviewer asked me what trait stands out. I replied, “I am resourceful. I am not the most knowledgeable (still true today) or the most experienced (again, still true today) but I am an expert at finding solutions, seeking answers, and making things happen”.

In a recent article in Entrepreneur.com by Sherri Campbell, she states, “There is not a more useful or important trait to possess than resourcefulness in the pursuit of success.” https://www.entrepreneur.com/article/272171

During a training session, I often give all the information, tools, and resources needed to do a task. However, no amount of training can replace what you learn by “figuring things out.”

I remember working with a nurse on a system. We had gone through a significant amount of training, and I left her with some easy homework. “Get in the system poke around and see what you see.” A week later I came back to do some follow-up training and found she had not even logged in. I asked her why she said she didn’t remember how. Now compare that to another nurse in the training group. She pulled out a folder with the how to guides she printed up, some she found by reaching out to other nurses, and got right in. She learned the system quickly and efficiently. That nurse has grown and climbed the corporate ladder flawlessly since then.

In the Harvard Business Review John Baldoni addresses the importance of Resourcefulness in business leaders today, “The leader who steps up and says “yes we can do this” is one who can push colleagues to do things that some might consider impractical.” – https://hbr.org/2010/01/leaders-can-learn-to-make-do-a. A capable leader is one who seeks information and solutions. They take stock of all they have put it together and find results where others have already given up.

It’s not resources but resourcefulness that ultimately makes the difference – Tony Robbins

Being resourceful isn’t about having the answers it’s about having the drive to seek the answers. One of the biggest assets employers are seeking in candidates today are ones who are resourceful. As a clinical leader, it is imperative to learn this skill and utilize it.

 

3 Steps to becoming a resourceful leader

Women Figuring it out. Thinking of solutions and showing resourcefulness.

  1. Figure it out

When given a task, figure out how to do it! I am not saying don’t ask for help. Everyone needs help, and to be shown how to do things. But, seek the answers instead of sitting and waiting for someone to hand them to you. Many companies have a website or system with how-tos and knowledge guides, take the time to get acquainted with these. Pull your policy and procedures, state regulations, or go to your state nursing board website. Learn how to research!

Man Crushing Barriers as a means of resourcefulness.

  1. Crush barriers

Once you learn to research you will have the tools to figure out how to complete your task on your own. But, what about that time when an obstacle rears its ugly head right in the middle of your job. I have found there are two types of people here. Ones who throw their hand’s up and give up and ones who start getting creative. When you find yourself facing these obstacles, take a step back. If I am working on the computer, I will often print it out and go to another room to review. Just changing scenery can sometimes spark problem-solving juices and help find solutions. Go for a walk. Grab lunch. Go bounce things off, co-workers. The key word here is “GO” don’t wait for someone to find a solution for you.

Networking and working together show resourcefulness.

  1. Know people

Learn who the expert is. During my work in memory care, we had an admit coming in. The husband (primary care provider) had an emergency, and his wife needed our help. They had been turned down by many places and didn’t want to have to admit her into the hospital or psychiatric department. We reach out to a local doctor who could reach out to her primary and get all the information we needed. I grabbed a caregiver who was fantastic with memory care and off we went. We had this resident admitted and safe within an hour! I could never have made this happen, but because of my relationship with others we pulled together and moved mountains for this resident.

Always be building relationships and fostering them. Also, find ways to go out of your way to help others, and when the time comes more than likely, they will be there for you.

The 7 Characteristics of a Nurse Leader part 2 – Confidence

This is Part 2 of the 7 Characteristics of a Clinical Leader – Confidence

In part one we explored what I believe to be one of the most important parts of becoming a great clinical leader, Humility. We discussed how the humble person can step back and ask great questions and seek answers unashamed. The Importance of realizing you don’t know and can’t know everything, the need to step onto the ground floor and hip to hip with the front line, and how constantly comparing yourself to other’s may only hinder your improvement and not allow you to live up to your potential.  In Part two we will discuss what might look to be the antithesis to Humility and that is Confidence.

If you haven’t read part one I recommend clicking here and reading before going forward. 

Confidence

Per Dictionary.com, being confident is “Having a strong belief or full assurance; Sure;” http://www.dictionary.com/browse/confident?s=t

As I said, being confident might seem to be the opposite of being humble. When looking at a clinical leader, this is simply untrue, one can be both confident and humble. I have learned there is a time and place for everything. Can you be both confident and humble at the same time? I don’t know. But can you learn when to humble yourself and when to stand strong. Absolutely! In fact, in my opinion you can only grow confident through humility.

You know the term “fake it till you make it”, well that pretty much described my first step into leadership. I remember being terrified I was going to fail. Thinking I have never been a leader before why would someone follow my direction or take my advice.Putting on a poker face I would do my best to act like I knew what the heck I was doing! What I learned was to allowed myself to be humble and learn from everyone. I would ask questions and seek advice and took lots and lots of notes. For example, if I led an all staff meeting I would learn from what went right and what went wrong. Eventually I learned what worked and built confidence on a foundation of knowledge. What I found when doing this is that just like knowledge changes and new ways of doing things are being discovered when your confidence is based on knowledge you actually grow with it, learning not only how to do something but why.

Being confident is important in any leadership role. However, as a clinical leader your confidence may be the difference in someone living or dying. No pressure, right?

I had a fantastic nurse leader working with me in an assisted living setting. The nurse identified some wounds on a patient and reported to the patient’s provider. However, the provider did not address the wounds and they continued to get worse. The nurse became increasingly bothered by the look of the wounds and reported them multiple times asking for some intervention. When no intervention came, they decided enough was enough and sent the resident to the hospital for evaluation. The patient ended up having a major infection, and was becoming septic. This nurse truly saved the patients life by identifying the seriousness of wound and the systemic response the patient was going through. It was the nurse’s confidence that gave them the courage to disagree and be a patient advocate.  Have I done the same thing and been wrong? Absolutely! But I also learned when looking at something and my gut is screaming I better follow it because it might be wrong, but it also just might be right.

Abraham Lincoln in a letter to Major General Joseph Hooker wrote – “You have confidence in yourself, which is a valuable, if not an indispensable quality”. The letter was one of strengths and weaknesses he saw in Major General Joseph Hooker but I think his view of confidence as being indispensable is very true in leadership today nearly 150 years later. https://www.abrahamlincolnonline.org/lincoln/speeches/hooker.htm

Below you will find 3 steps to get you empowered and on your path to confidence.

1.       Body Language

Picture this, you are a nurse and a provider has given his patient a poor diagnosis and is talking about hospice. The family walks into the room very unsure with feelings of guilt and regret. The nurse offers the family to sit down and talk. She is very knowledgeable about hospice but unsure of herself. She sits behind her desk with legs crossed at the ankles her arms hugging her torso and her head tilted down making very little eye contact.  What you see here is very typical of those first conversations. The family often leaves feeling they have not gotten what they wanted from the conversation and continues to struggle.

This time the nurse asks the family sit down and pulls out her chair at a 45-degree angle. Her feet are on the floor and back is straight. Her arms at her sides and she is slightly leaning forward. She is confident with her information but knows it’s not about her and instead listens. The family explains how they are feeling and brings up some questions that she answers confidently. When the family becomes emotional she sits quietly and rests her hand on their forearm and maybe even cries with them.  They leave feeling they have been listened to by someone who knows what they are doing and one step closer to accepting their loved one’s diagnosis.

In a Ted Talk from 2012 Amy Cuddy described in her talk entitled “Your body language shapes who you are” how body language not only reveals much of ourselves to others but also internally sets us up to succeed or fail.She gives the advice to put yourself into the superman pose for 2 minutes prior to going into those interviews or tough conversations. This will change your mindset and put you in a place of confidence ready to take on any challenge.

Check out the full ted talk here:

 2.       Do your homework

One of the ways I learned to become confident was to dedicate myself to learning. I read books. Lots of them, read blogs like this one, and listen to lectures. I pick from what I read and stick it in my note book adding to my arsenal. Going into situations I like to look at as much of the background as possible. If I am meeting with a family or an associate I often research and get a feel for what’s going on before I even enter the situation. This allows me to step in with a game plan and often a 2nd and 3rd game plan just in case the first one doesn’t work. I remember in Nursing school they spoke about SBAR – you all remember SBAR right? Situation Background Assessment Recommendation. I have found this applies to leadership very well. Going into a situation I will often research the situation, find out some history, talk to those near the situation about what the current feelings are of those involved and ask for recommendations. I can gather this information and be ready as I step into that conversation. Then make confident decisions or recommendations.

3.       Positive thoughts and Affirmations

I remember something my grandma would say to me years ago. I would come home say something along the lines of ” I can’t do this grandma” or “I always do this wrong”. To which she would look me in the eyes and say, “You’re right.” I would give her this quizzical, thanks a lot for the encouragement look and she would proceed to tell me, “If you say you can’t, you’re right, if you say you will always do it wrong, you will keep doing it wrong. But when you begin to say you can, and say you will, that is when you will succeed.” I will remember that for the rest of my life. Once you begin speaking positive things into existence they begin to stick. Trust me on this one, you will feel pretty silly standing in front of that mirror saying how confident you are and well-spoken, but soon you will begin to believe it, and once you believe it, you become it. 

7 Characteristics of a Nurse Leader Part 1 – Humility

Becoming a Clinical Leader is a unique challenge and calling. Some of us nurses are called to be at the bed side, some behind a desk, and yet others to become managers and leaders in our industry. Whatever your calling in the nursing profession you can find your niche, one of the amazing rewards of being a nurse! However, if you are at the bedside, in the office, in the car visiting homes, we are all viewed as leaders. As nurses, we are looked up to, counted on for our expertise, and are a part of one of the most trusted professions in the world. As we go on this journey of discovery together. We will explore how to be better nurses, stronger leaders, and maybe even better people.

I have worked in many fields. However, since becoming a Clinical Leader I have discovered a glaring truth. There are many great nurses out there. There are few great nurse leaders. In the medical field, we love having nurses step into management rolls and be a part of the decision-making process. However, nurses are not always ready for this role. So as  a foundation I wanted to explore those characteristics that make a great clinical leader. We will break this into several parts as we explore these characteristics.

Copyright: <a href='http://www.123rf.com/profile_pixelsaway'>pixelsaway / 123RF Stock Photo</a>

Part 1. Humility 

“Humility- the quality or condition of being humble; modest opinion or estimate of one’s own importance, rank, etc.”
– vocabulary.com

In many areas, there is a misconception you have be the expert, all the time, to be a good leader. This is simply not true. I remember when I first got into my leadership role as a District Director with multiple communities reporting to me, I thought I had to know everything. In fact, it wasn’t until I had a fantastic boss (who has shown me a lot in leadership) that I realized it was ok not to know everything, it’s ok to say I don’t know.

Take for example nurse… we will call her Susie… I hired nurse Susie from a floor nurse position into a Health and Wellness Director position. She interviewed fantastic and was a great nurse. Then it came time to train her. While spending the first 5 minutes with her it became apparent she knew everything there was in her field and did not need my assistance. I spent weeks with her trying to get through a basic orientation. Fast forward 6 weeks and nurse Susie quit. Why? Because she didn’t feel she had the training to do her job and felt she was failing. It made me question, why? Nurse Susie was a fantastic nurse. She probably knew more in the clinical field than I did. I spent more time in training and in very much the same manner as some of my most successful HWD’s.

What went wrong here? What did I miss?

An article in the Economist states:

“If leadership has a secret sauce, it may well be humility. A humble boss understands that there are things he doesn’t know. He listens: not only to the other bigwigs in Davos, but also to the kind of people who don’t get invited, such as his customers.” 
The Economist, 26 Jan. 2013

She liked to flaunt what she knew to the point of being so consumed with proving her knowledge and how great she was, she never stopped to learn. Since then I have learned both to seek candidates willing to learn, humble in their career, and when I do get those that lack humility have the confidence to call them out on it and bring it into the light. The pressure as a nurse to never make a mistake (I mean it’s not like people’s lives are in our hands or anything) bleeds over into our role as a clinical leader making it hard for us to accept our faults. on my path, I have discovered only when I humble myself can I grow and become better.

“There is nothing noble in being superior to your fellow man; true nobility is being superior to your former self.”
 Ernest Hemingway

3 steps to a humble you:

  1. Realize you don’t know and can’t know everything.

  • Once you accept that you don’t know everything and can never know everything there is freedom. You can learn and not be ashamed, ask questions, and gain knowledge and inspiration from everything everywhere. You begin to seek knowledge to better yourself as a journey of growth rather than fasted route to destination.
  1. Step onto the ground floor

  • I love the show undercover boss. I love to see these CEO’s step into the shoes of their ground floor workers and learn what their company is about. By giving yourself time to step in and work hip to hip with caregivers, CNA’s and even housekeepers you often get a new perspective and yes, learn a thing or two from these valuable players. I worked as a Health and Wellness Director for a memory care unit and one day I decided to come in with the morning shift and work alongside the team. Not because we were short staffed, but because I wanted to learn. I learned more about my role and how it effects the residents and caregivers in that one day than all my orientation combined. To value my team and to listen to their vast knowledge and experience.
  1. Quit comparing yourself to others

  • Don’t get me wrong I love to read about my hero’s both in the fiction worlds and in biographical world. But I have learned to look at them for inspiration on how to become a better me rather than a mirror I am trying to reflect myself in. There is always someone better at something than you, but no one will ever be better at being you. You are your greatest attribute. Let your uniqueness shine and when someone comes along and does something better be humble enough to learn from them and you will grow beyond what you ever thought you could.

Part 2 Coming soon will provide link here.

Written By: Derek Di Camillo RN