Five years ago, while working in leadership I had a pivotal conversation with my superior regarding the need to "stop thinking like a bedside nurse". My instincts told me this was wrong as I had always believed that leaders were supposed to know what was happening at the bedside in order to improve the process for the bedside nurse, thus providing the best possible care to patients and families.
That conversation was the launching point to once again pursue the role in nursing that created and stimulated my passion for the nursing profession and provided me with the necessary skills to explore other avenues within that profession. Along with that decision it occurred to me that the roles and responsibilities placed on the bedside nurse are a working laboratory that provide direction for nursing leaders to enhance their performance.
To understand what leaders can learn from the bedside nurse, it’s important to understand the competencies expected from the bedside nurse.
First: intentional presence, or in other words, presence with a purpose. The bedside nurse must be present for patients to understand their illness, how that illness impacts their lives, and what the road blocks are to healing for their patient.
Intentional presence for leaders means visibility within their respective units, which allows them to assess for barriers that impedes the ability of bedside nurses to be successful with their care. Presence is visible, not via email or cell phone.
Second: communication or developing a plan of care with their patients. The bedside nurse must communicate with patients and involve them in the plan of care so they can master their illness and be successful with their healing.
Leaders must develop and communicate their vision of success with the bedside nurse to develop a mutual working relationship based on trust and respect. Decisions regarding the bedside nurse’s practice, must not be imposed upon the nurse, but rather developed together with the nurse so there is a clear understanding of how these decisions impact the flow of care at the bedside. Bedside nurses do not just "want to be managed;" they want to be part of something bigger then themselves.
Third: feedback, or receiving information from their patients that the plan of care is on target or needs to be revised. Leaders need to ask for feedback on their performance from the bedside nurse so they can assess whether they are meeting the needs of nurses providing direct patient care at the bedside. To be sure, it is not easy to receive feedback from those you supervise, but leaders serve those whom they lead, so this type of feedback is crucial to the success of the leader.
Fourth: acknowledgement from their patients that they understand what is expected of them, and that they can reiterate or demonstrate those expectations in order for them to be successful. Leaders needs to provide bedside nurses with acknowledgement that they are successful in implementing their job. This type of acknowledgement needs to be meaningful and in a form that respects the bedside nurse’s professional practice.
Nurses love their profession and want to be recognized as an important contributor to it. Too often the dollar sign is more important as a measure of success then what the bedside nurse has contributed within their profession.
For the bedside nurse, the focus of their success is the ability to empower the patient and family in maintaining their own healthy lifestyle. Leaders need to accomplish the same type of empowerment related to their nursing practice. Bedside nurses are not about "what I have done to help the patient" but rather, "how we have done this together". Leaders need to embrace this philosophy and not become an outsider who simply directs the team. They must become active participants of the team and "walk the talk". Leaders must influence those they lead by modeling the behaviors that are expected of the bedside nurse.
Of course, bedside nurses need to support their leaders too, although that is a topic for another article. When both nursing leaders and bedside nurses are dedicated to supporting each other in their respective roles, they strengthen each other’s ability to create and maintain a profession of understanding, trust and respect.
Jody A. Holland is a charge nurse for neonatal ICU and pediatrics at St. Charles Medical Center in Bend, Oregon.
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