Leadership Competencies: Knowledge, Skills, and Aptitudes Nurses Need to Lead Organizations Effectively

The healthcare workplace is comparable to what a person sees when looking through a kaleidoscope: as the moments pass, an endless variety of patterns emerges. Undesirable patterns that have materialized include the widely publicized shortage of nurses in the workforce and the high rates of turnover among nurses. Healthcare organizations increasingly depend on recruitment and retention of nurse-managers to reverse these trends.Critical care nurses become leaders through a variety of routes, many of which do not include formal managerial training or education. To produce positive results, critical care leaders need effective strategies to manage departmental operations and inspire staff. One strategy used by chief nursing officers, professional nursing associations, and employers is to design and implement formalized critical care leadership and managerial training programs that are evidence based and results oriented. In “Leadership Research in Business and Health Care,” Vance and Larson1 report an underuse of evidence-based research in the development of healthcare leaders. The evidence-based research that is available is largely descriptive and is poorly translated into healthcare.In this article, I provide a compilation of practical managerial skills for critical care nurses in formalized managerial roles, as well as leadership skills that are useful for all nurses. These skills are based on my managerial and leadership experience, the findings of numerous experts, and healthcare and business resources.The highly divergent and dynamic leadership skills described herein mirror the responsibilities of critical care managers. The skills also illustrate the need for open-minded leaders who collaborate with colleagues and peers to prepare for and respond to the multifaceted challenges that arise every day. For purposes of clarity, the leadership skills are grouped into 4 main categories:Included in each of these categories are key skills and abilities that make leaders effective. Although the categories are an artificial separation of skills that intertwine and overlap, the skills are discussed separately for the purpose of explaining each skill and demonstrating its applicability. Despite the expansive nature of this topic, the examples are brief; the references cited provide additional information and resources.Administrative teams can use these leadership skills as the foundation to create competency-based job descriptions and development programs for nurse-leaders. Table 1 summarizes the skills reviewed in the following paragraphs.Healthcare businesses can benefit from examples of other successful organizations. The book Built to Last,2 a study of successful corporate habits, indicates that continuity of leaders and ongoing leadership development contribute significantly to the success of an organization. Organizations and their shareholders benefit if employees are taught to manage time, information, human resources, change, revenue and expenses, information technology, and equipment. In a follow-up research book, Good to Great, Collins3 describes a level 5 leader as one who builds enduring greatness through the use of personal humility and professional will to mentor others to do the right thing, one who takes responsibility for failures while giving credit to others for their success, and one who relies on inspired standards to motivate others. He states that level 5 leadership is one of the key determinants of organizational greatness. The essence of “great” leadership is effective management of oneself and others in response to a variety of situations. Therefore it is essential that leaders learn to manage their emotional response to a variety of situations and others’ actions.How staff members perceive nurse-managers is critical to recruitment and retention efforts. Wieck et al4 suggest areas for the betterment of current and future leaders. They indicate that the entrenched and emerging workforce wants leaders who demonstrate honesty, integrity, and optimism. Workers want good communicators who are receptive to others and who are motivational, fair, approachable, and empowering.4 Results of “Reversing the Flight of Talent,” a survey of 1600 staff nurses conducted by the Advisory Board’s Nurse Executive Center, indicate that nurses want to work for effective nurse-leaders.5 Of the nurses surveyed, 84% had considered leaving their jobs because of dissatisfaction with their direct managers; however, only 43% of nurses surveyed who were very satisfied with their managers had still considered leaving nursing.5 Incorporating research findings on healthcare and business leadership into educational programs for nurse-leaders will expand and enhance their leadership skills.Effective leaders use successful strategies for time management. Often leaders allow minutes and hours to be wasted on nonessential tasks such as opening mail, filing, and responding to noncritical requests from others. Effective leaders use self-discipline to organize these tasks and assign priority to projects that produce results. By learning from management experts such as Stephen Covey, nurses can perfect their time management skills. In his book, The 7 Habits of Highly Effective People,6 Covey eloquently describes a time management matrix that provides a guide for understanding the relationship between important, not important, urgent, and nonurgent activities (Table 2). This tool encourages leaders to focus most of their time on nonurgent activities (quadrant II).6 For example, a director’s budget (quadrant II planning and quadrant I deadline-driven projects) is due in 3 days and a friend calls to get advice on vacation plans. The director correctly responds by asking the person (quadrant III interruptions and quadrant IV some phone calls) to call the director in the evening at home. If a leader participates in activities in the upper right corner of the top part of the table, the results outlined in the upper right corner of the lower part of the table will ensue. Planning will result in vision and perspective; whereas the continual management of crises will result in stress and burnout (Table 2). A leader can use this matrix to prioritize tasks and responsibilities, reducing time wasted on nonurgent activities. This example is an easy distinction; however, managers face much more subtle choices, making the disciplined use of the matrix even more important.A leader can use time efficiently while building staff members’ self-esteem, as exemplified by the concept of 1-minute praise described in the One Minute Manager.7 Finding creative, quick, and individual ways to thank staff members, colleagues, and customers is an important leadership skill. Effective time managers find easy ways to acknowledge staff, such as keeping thank-you cards tucked in their organizer or putting reminders in their personal digital assistant. While waiting for meetings to start, leaders write thank-you notes to staff members and others who exhibit exceptional behavior and mentoring activities. The personal acknowledgment of staff members builds morale and improves retention.8Delegation skills are critical to a leader’s ability to manage time. Leaders do not have to do everything. Their role is to ensure completion, monitor ongoing progress, and affirm that interventions produce results.9 A leader’s effectiveness is maximized by assigning appropriate tasks and projects to staff nurses and other administrative support personnel. Ales10 describes a 4-step process that guides readers through the art and science of delegation: choosing a task that can be delegated, assigning it to the right person, communicating clear instructions, and soliciting feedback.10Managing information is critical to a leader’s success.9 Without timely statistics and outcomes data, managing in accordance with budget targets and performance measurements is difficult. Effective leaders are able to share statistical and outcomes data with staff members to gain the members’ participation in meeting budget targets. Additionally, comparing internal (benchmark) data with data from similar organizations is helpful. Resources such as the National Database of Nursing Quality Indicators11 provide data on a variety of benchmarks such as nursing skill mix, nursing hours per patient day, pressure ulcers, and falls. The Advisory Board12 is another resource that showcases a variety of best practices. Collaborating with colleagues, with peers, and within professional organizations is another way to gather information about trends and successful solutions to operational dilemmas. Critical care nurses manage large amounts of complex data about patients, and nurse-managers are required to do the same with operational data.An enormous part of the nurse-leader’s role is the management of human resources, specifically nursing resources. Considerable attention is paid to the complexities of understanding people, because just as with a disease, it is easier to implement interventions if the diagnosis is known. Geddes et al13 conclude that a need exists for fiscal accountability, quality-enhancing management strategies, and personnel management. How to involve and engage critical care nurses should be included in the training of nurse-leaders. Kouzes and Posner14 concluded that genuine caring for people (critical care nurses) is at the heart of effective leadership. How critical care nurses interact with patients and with colleagues directly affects not only satisfaction among customers and employees but also the safety of patients. Therefore, teaching critical care leaders how to manage human resources is vital to an organization’s success.The human resources department and hospital policies guide nurse-leaders in decision making. The current nursing shortage and high turnover rates indicate a need for collaboration and close working relationships with human resources professionals. Those professionals can track the reasons for high turnover, vacancies, and/or excellent retention of critical care nurses. Mark and Critten15 suggest that the future focus of human resources departments should be organizational central intelligence and the facilitation of organizational learning and creativity.Siddiqui and Kleiner16 reviewed human resources operational management and concluded that health-care organizations should adapt the latest methods used by human resources professionals. These methods include encouraging diversity in the workplace, promoting from within the company, and cross-training personnel whenever possible.16 Ridenour17 reports that leadership competencies influence patients’ outcomes, continuous learning, relationships with customers, use of resources, strategic planning, and compliance. How employees are treated and mentored is critical to retention efforts; therefore, management training should include interpersonal skills and strategies for responding to different personalities.Leaders learn strategies to create a culture of understanding through the use of personality-profiling tools. Effective profiling tools are non-judgmental, accurate, applicable, and easy to understand. One of the best-known tools is the Myers Briggs Type Indicator.18 This tool is an instrument for measuring a person’s preferences by using 4 basic scales:Combinations of the different preferences can result in 16 personality types. An understanding of the personality type is crucial to a leader’s ability to empathize with another person and what that person may be experiencing.The Keirsey Temperament Sorter19 is a profiling tool based on the theory that every personality has 2 sides. Temperament is partially inherent at birth, whereas character is a set of learned habits or skills. 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