Allow yourself to be surprised!

Excellence in management and leadership is determined by how successfully the unexpected is handled. Health care is never in a state of equilibrium. Health care is the most complicated business that anyone can imagine and has many dynamic forces that are always at work to create chaos and uncertainty. It is impossible to eliminate the element of surprise in our work. Instead, we should be judged on our ability to welcome surprise and astonishment and to help ourselves and our organizations grow and learn from the unexpected.     

The art of truth telling: handling failure with disclosure and apology

There are sentinel events and near misses associated with leadership and management, as well as the clinical process of health care. We should hold ourselves accountable to the same level of rigor and analysis of these events and near misses as we expect from clinicians. Research and analysis will continue to help us understand the science behind the power of truth telling and apology.     

The new millennium and leadership: evolution or entropy?

Health care in the new millennium will be different. We have a wonderful opportunity to live in a new paradigm of leadership and management that opens up myriad possibilities for innovations in health care and leadership. If leaders stand still and don't quickly adapt to the new demands, they will be killed as leaders in this new millennium. The next 20 years are only for those who can act and adapt quickly.     

Building a patient-focused unit: the nurse manager's challenge

Developing a patient-focused unit is necessary to attain the highest standards of patient care. It is only when we can view our unit through the eyes of a patient that we will be able to see ourselves as others see us. Professionally, we have committed ourselves to creating caring environments that promote healing. We cannot meet this goal until we make a commitment to be patient-focused and give up being nurse-focused or facility-focused.     

Leadership, civility, and the 'No Jerks' rule

Nursing organizations and hospitals are not immune from the ravages of incivility. Toxic behavior can range from the very serious bullying and sabotage of very destructive people to the annoying and hard to cope behavior of just plain jerks. When a unit does not have a clearly defined "No Jerk" rule and infrastructure to support healthy behavior, communication suffers and errors occur. Nurse leaders have the opportunity of changing the self-interest behavior of jerks in our communities of caring.     

Moving toward zero: the leader's mandate

Converting to a culture that strives for perfection and accepts no less than zero defects is the work of leadership in health care today. Some cultures are made up of people who believe that average is good enough. The challenge of the leader is to break up those beliefs and embed new models of "Yes We Can." The leader must communicate four very effective messages that must go along with the passion for the work: (a) evidence and "best practice" data trump local, opinion-based beliefs; (b) morphing from an internal view of best practice to a national/international view of practices within and outside health care; (c) transparency; and (d) KISS: "Keep It Simple, Stupid.'     

Courage, leadership, and end-of-life care: when courage counts

As leaders, we must feel a sense of moral obligation to implement evidence about end-of-life care in our practice setting. Nurse leaders can help patients and families orchestrate a beautiful experience that is an alternative to futile, expensive end-of-life care. Preparation is key in helping staff provide the best level of care. A plan built around the best care for patients can integrate with many diverse positions and people. Courageous nurse leaders are well adapted to maneuvering through political traps and advocating for patients and their families. Everyone benefits personally and financially, including our communities and nation, when courageous leaders advocate successfully for effective end-of-life care.     

The art of leading with grace

Uncivilized environments take their toll on people who work there. Cultures of distrust are created and there is no warmth, reverence, or love available for the healing work of health care. We can blame the staff, or we can look at ourselves and recognize that the staff is merely a reflection of ourselves. Gracious leaders create a gracious and loving staff who care for patients and their families in extraordinary ways.