Running head: LEADING AND MANAGING IN THE NURSING FIELD

Leading and Managing in the Nursing Field

Lindsay Bolhuis
Gail Luskin
Ferris State University

LEADING AND MANAGING IN THE NURSING FIELD

Leading and Managing in the Nursing Field

A nurse is someone who welcomes the life of a newborn child, holds the hand of
someone awaiting death, motivates the weary, cleanses the downtrodden, advocates for the
voiceless, and puts the patients needs above their own. Nurses can focus their practices on
becoming managers or leaders, however it takes a strong nurse to be both. Managers meet their
goals by organizing, staffing, controlling, and solving problems, while leaders, build a culture
of teamwork, set a direction, develop a vision, and communicate that direction to staff (YoderWise, 2015, p.55). In other words, managers plan for the worst case scenario while leaders help
us through the worst case scenario. Deborah Wahr is a nurse who has had an extensive career as
both a leader and a manager. This paper addresses her achievements and lifes work in patient
care in the end stages of life.
Background
Deborah Wahr started on her path to leadership by becoming a certified nurse aide.
During this introductory experience, she was able to work both on a patient floor and in an
operating room. Deb attributes this first nursing role as the start of her journey to become a
leader in the field of nursing. To successfully become a leader as a CNA, she needed to go above
and beyond what was expected of her and raise herself to a higher standard. Deb went above and
beyond in her role as a CNA by doing more than what was expected of her in regards to cleaning
and patient care. She then went on to receive her associates in nursing from West Shore
Community College. Her first job as a registered nurse proved to be very challenging. Deb
worked on a medical-surgical floor where she was required to diagnose patients and do things
that would usually be done by a physician. Her training as a nurse did not prepare her for the

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responsibilities this job required. Deborah was fired from this first nursing job, but she was able
to make it a learning experience and learned what she could and could not do in patient care.
Job Duties
Debs current position is at Oakview Medical Care Facility in Ludington, Michigan. As a
staff nurse at Oakview, Deb, along with two other staff nurses, is responsible for a total of
seventy-six patients. When working as a staff nurse, Deb is responsible for all aspects of nursing
care including assessments, medication administration, wound care, education, family
communication, and documentation. Deb also works as a charge nurse at Sutter Living Center
which is an affiliate of Oakview. When she is on duty at Sutter, she is responsible for twenty
patients who each have some form of dementia or Alzheimers disease related diagnosis. Deb is
responsible for creating and maintaining a safe and therapeutic environment for all staff
members and residents. During the interview, Deb stated, I am in charge of the physical
building and each resident in the facility. It is Debs responsibility to take charge if an
emergency situation arises and provide direction where needed. Deb is stationed behind the front
desk going through orders, taking calls, calling physicians, overseeing staff, and making sure the
whole facility is running smoothly.
Collaboration
According to Deb, one of the most important aspects of being a leader or manager is
communication. In Oakview and Sutter, Deb works with other nurses, certified nurse aides,
physicians, physical therapists, receptionists, maintenance workers, social workers, Medicare and
Medicaid billers, and resident families. She wanted us to know that we are not just taking care
of a resident, we are taking care of their families as well. On a daily basis, Deb tries to meet
with everyone directly involved in resident care to maintain consistency. Once a month, Deborah

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meets with each residents family to keep them informed on their loved ones progress.
Communication is key when working with other people because if there is a gap in
communication the patients safety and life can be at risk. Teamwork is essential in order to
ensure proper communication between each department. It is not possible for one nurse to take
on the responsibility of others and perform their job to the best of their ability. Part of being a
leader is making sure that you and those around you follow the American Nurses Association:
Code of Standards; if you do not, you will not be providing optimal patient care.
Legal and Ethical Issues
There are several different legal and ethical issues that Deb is required to deal with on a
daily basis. Under the Standards of Professional Performance in Nursing: Scope and Standards of
Practice, the RN delivers care in a manner that preserves and protects healthcare consumer
autonomy, dignity, rights, values, and beliefs (American Nurses Association, 2010, p.47). Deb
believes that we go into nursing because we have the innate desire to better the lives of others.
We can only do this if we look into health as a holistic manner instead of a single identity. It is
also the responsibility of the RN to take appropriate action regarding instances of illegal,
unethical, or inappropriate behavior that can endanger or jeopardize the best interests of the
healthcare consumer or situation (American Nurses Association, 2010, p.47). During the
interview, Deb made it a point to say that you cant allow abuse, it is your job to speak up. Deb
values the life of each and every patient under her care and is not afraid to step in when the
integrity of patient care is compromised.
Power and Influence
As a leader and manager, Deb has the ability to exert both power and influence over her
employees. In 2011, Vessey et al. described horizontal violence (HV) within the nursing field.

LEADING AND MANAGING IN THE NURSING FIELD

An evaluation of the prevalence of HV reveals that new nurses are more likely to be targeted by
HV due to their lack of experience, insecurity in role, and lack of awareness of units cultural
norms (Forsythe, 2013, p.16). When speaking with Deb Wahr, she stated that she loves working
with new nurses because they bring so much energy and excitement into the nursing field. She
believes that older nurses are responsible for taking the young under their wings and teaching
them the way things operate in the specific setting. As a manager, Deb has the ability to be a
model of example to other seasoned nurses when working with younger nurses. In turn, new
nurses can teach the older nurses current evidence based practice and different ways to think.
Deb thinks that the days of nurses eating their young are gone and a new day of collaboration
is here.
Decision Making and Problem-Solving
Deb is required as a leader and a manager to solve many types of problems and make
very important decisions which can affect a patients outcome drastically. According to the
Journal of Nursing Management, a strong sense of trust between managers and employees is
very important in order to create a healthy and effective work environment (Hyrkas & Wiggins,
2011, p.1). As a leader, Deb needs to trust that the nurses she is working with will make the best
decisions in regards to their patients care. On the other hand, the nurses need to trust that Deb
will make the best decisions regarding the nurses she is leading. Nurses need to be able to make
educated decisions regarding the care their patients receive. However, they also need to know
when the situation is above their scope of practice and when to get a leader like Deb involved.
When nurses combine their knowledge of evidence based practice, patient care thrives.
Resolution of Conflict

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Deb is continuously dealing with tension in the workplace that requires her to come to a
resolution that will satisfy those on both sides of the issue. She does not allow abuse to occur in
the workplace when she is managing. Deborah encourages fellow nurses to speak up if they are
experiencing abuse or bullying so that she can address the issue right away. It is possible that the
employee is mistaking constructive criticism for horizontal violence so it is important that
everyone is on the same page when it comes to what is acceptable in regards to communication.
According to the Journal of Nursing Management, healthy and effective work environments
involve respectful and fair treatment of employees (Hyrkas & Wiggins, 2011, p.1). When you
create a healthy and effective work environment the employees and the patients have higher
satisfaction for the organization as a whole.
Conclusion
The importance of young nurses exploring the roles of leaders and managers is
immeasurable. Deborah Wahr is an exceptional nurse who has shown compassion and
understanding in her care of the elderly. Gails grandfather is in Oakview Medical Care Facility
and she has personally experienced the quality nursing care of Deb and the other amazing staff
employed there. A leader has the ability to work with others to get through any type of situation
that arises. A manager is taught to prepare their team for specific situations and make sure the
facility is equipped to handle these situations. Deb has shown the ability to be both a leader and a
manager in the field of geriatric nursing and it has been a pleasure interviewing her for this
project.

LEADING AND MANAGING IN THE NURSING FIELD

References
American Nurses Association. (2010). Nursing: Scope and standards of practice (2nd ed.).
Silver Spring, MD: Author.
Anno, L., Nuechterlein, A., Dyette, A., & Bonie, J. (2013). Eating Their Young: Prevention of
Horizontal Violence in Acute Care Nursing. Nevada RNformation, 22(3), 16.
Hyrkas, K., Wiggins, M.S. (2011). Achieving Excellence in Nursing Management. Journal of
Nursing Management, 19(1).
Yoder-Wise, P. S. (2015). Leading and Managing in Nursing (6th ed., p. 55). St. Louis, MO:
Elsevier.