Running head: NURSING LEADERSHIP

Nursing Leadership: An Analysis

Brandie Zimmerman
Ferris State University

Running head: NURSING LEADERSHIP

Nursing Leadership: An Analysis

Nursing leaders are professional nurses who supervise and guide other members of the
health care team (Yoder-Wise, 2011, pg. 5). Nursing leaders can be found at all levels in the
healthcare system and are responsible for decision making that supports the organizational
structure and desired clinical outcomes (Yoder-Wise, 2011, pg. 16). Nursing leaders are driven
to inspire, empower and engage other members of the healthcare team to create a healthy work
environment and ensure overall satisfaction of fellow employees and patients (Yoder-Wise,
2011, pg. 47). Nursing leadership can vary depending on the role of the leader and
responsibilities of that role. This assignment required an interview and analysis of a nurse in a
leadership role. The interview included a discussion about nursing leadership roles and asked the
participant questions about current roles, employment background and education. This paper will
discuss the analysis of the role and responsibilities of a specific nursing leader and include an
analysis of effective communication, knowledge of the healthcare environment, leadership,
professionalism and business skills as it pertains to the healthcare environment.
Background
The participant of this interview is Karl Koehler. He obtained a BA from Michigan State
University in 1984, a BSN from Oakland University in 1995 and a critical care certification
(CCRN) in 1999. Mr. Koehler has worked at several different facilities including: Emergency
Department at Detroit Receiving Hospital, Emergency Department at Sinai Grace Hospital,
Emergency Department at Beaumont Royal Oak, and Critical Care Pool at St. John Providence
Health System, Intensive Care Unit [ICU] at Munson Medical Center and Coronary Critical Care
[CCCU] at Munson Medical Center. Mr. Koehler is currently employed by Munson Medical
Center in the CCCU and on call in the Critical Care Pool at St. John Providence.

Running head: NURSING LEADERSHIP

Role and Responsibilities

Mr. Koehler is in a nursing leadership role at Munson Medical Center as a Charge Nurse
on the CCCU. Responsibilities for the role of Charge nurse at Munson Medical Center in the
CCCU include: managing the flow of the unit, managing staffing and patient placement, being a
resource person, a member of the medical response team [MRT], a member of the code team and
is responsible for relieving the telemetry technician for breaks. This role also requires Mr.
Koehler to attend bed meetings with the house supervisor and charge nurses from the other units.
The overall flow of the hospital is discussed, as well as, staffing needs for each unit and
incoming transfers or admissions.
Mr. Koehler is additionally employed by St. John Providence Health System in the
Critical Care Pool. This role places him in a leadership role by being a resource person for fellow
staff members and requires travel to all the facilities in the St. John Providence Health Systems
network. Mr. Koehler fills Critical Care needs on an as needed basis. The responsibilities for this
role include: all the responsibilities within a registered nurses scope of practice and management
of critically ill patients. This paper will focus on the leadership role of Mr. Koehler at Munson
Medical Center.
Organizational Structure
The term organizational structure refers to the arrangement of the organizations
workgroup (Yoder-Wise, 2011, pg.139). The organizational structure of Munson Medical Center
and St. John Providence is a combination of the bureaucratic structure and a flat structure. This
combination of structures is termed a matrix structure (Yoder-Wise, 2011, pg. 147). A matrix
structure creates an interdisciplinary team that collaborates together to function (Yoder-Wise,
2011, pg. 147-148). The staff nurses, nursing assistants, unit clerks and telemetry technicians

Running head: NURSING LEADERSHIP

report to the Charge Nurse of the unit. The Charge Nurse reports to the Nursing Manager of the
unit and the Nursing Manager reports to the Chief Nursing Officer [CNO]. The CNO reports the
Chief Executive Officer [CEO]. Munson Medical Center also uses Shared Governance in its
organizational structure. Shared Governance allows nurses to have more autonomy to govern
their practice and holds them accountable for decisions that they make (Yoder-Wise, 2011, pg.
150).
Philosophy
A philosophy statement outlines the vision and mission of a company (Yoder-Wise,
2011, pg. 282). A philosophy statement is used to guide the overall structure of an organization
in order to fulfill the mission and vision of the company (Yoder-Wise, 2011, pg. 282). Munson
Medical Center states, Munson Healthcare and its partners work together to provide superior
quality care and promote community health and a vision to become northern Michigan's
indispensable system of health care by driving collaboration and coordination that results in care
that is of the highest quality, easy to use, and close to home (Munson Healthcare, 2014). Mr.
Koehler states that he believes Munson Healthcare lives up to its mission and vision and is the
leading healthcare system in Northern Michigan.
Communication and Relationship-Building
Teamwork is an integral part of the healthcare system. Teams function effectively when
good communication and strong relationships are formed (Jones, ONeill, Waterman & Webb,
1997). Effective communication comes from both verbal and non-verbal cues and is essential in
avoiding high turnover rates and error reduction (Yoder-Wise, 2011, pg. 349). To build a trusting
and effective working relationship, nursing leaders must utilize effective communication skills
and work alongside other members of the team to establish goals, a plan for obtaining those

Running head: NURSING LEADERSHIP

goals, give the team a sense of identity and the power to make decisions (Yoder-Wise, 2011, pg.
363). Communication and relationship-building is an AONE (American Organization of Nurse
Executives) competency that includes: effective communication, relationship management,
influencing behaviors, diversity, community involvement, academic relationships and shared
decision-making (AONE, 2005). Munson Healthcare follows this outline by utilizing a Shared
Governance approach. This team approach allows nurses to become independent professionals
with a voice that influences changes and holds them accountable for those actions (Yoder-Wise,
2011, pg. 151). Shared Governance creates an effective communication environment and builds
stronger working relationships between staff members (Yoder-Wise, 2011, pg. 151-152).
Stronger working relationships and effective communication has been shown to improve overall
staff morale, better patient-staff interactions and improved outcomes for the patients, staff and
the organization as a whole (Jones, et al., 1997).
Knowledge of the Healthcare Environment
Knowledge of the healthcare environment is an AONE competency and focuses on the
knowledge of current nursing practice, roles and functions (AONE, 2005). This competency
ensures that the nursing leader maintains an up to date approach and knowledge of the ever
changing field of nursing. It is important for nursing leaders to understand the healthcare system
and the environment in which they function (Garman, 2006). Garman (2006) describes
healthcare as a relationship business that must understand the deeper challenges that healthcare
employees face in order to truly understand the healthcare environment. Understanding the
healthcare environment will assist the nurse leader to be an advocate for both patients and staff
and will encourage a happier work and healing environment (Garman, 2006). A nursing leader
must also be aware of the community and how it affects the healthcare system (Garman, 2006).

Running head: NURSING LEADERSHIP

Garman (2006) states that a clear knowledge of the how the healthcare system functions will
assist with gaining proper funding and re-imbursements and become more cost effective.
Leadership
Leadership provides a framework for others to follow and is an AONE competency that
addresses foundational thinking, systems thinking, planning and change management (AONE,
2005). It is a process that requires decisions to be made and actions to be taken when complex
issues arise (Yoder-Wise, 2011, pg. 5). Effective leadership is one that engages and guides others
through situations by developing strategies based on evidence based practices and experience to
obtain desired outcomes (Yoder-Wise, 2011, pg. 5). Yoder-Wise (2011) states that good nursing
leadership helps employees meet the organizational mission and subsequently improves patient
satisfaction and overall outcomes through expertly guided nursing care (pg. 5).
Professionalism
The term professionalism is a term used to describe a complex set of criteria. It is an
AONE competency that demands personal and professional accountability, career planning,
ethical principles and advocacy (AONE, 2005). Nursing is a profession and meets the criteria set
forth by Abraham Flexner. Flexners criteria for professionalism states that a profession is
intellectual in nature with a high degree of responsibility, it is based on scientifically derived
evidence, it is practical and theoretical, it is taught through specialized professional education, it
has internal organization and group oriented and it is comprised of those who practice altruism
(as cited in Chitty & Black, 2011, pg. 60-61). Nurses are professionally prepared and oriented to
the beliefs, core competencies and mannerisms expected of the profession of nursing (Chitty &
Black, 2011, pg. 63).

Running head: NURSING LEADERSHIP

Nursing was not always considered a profession. Nurses have been working toward
meeting the criteria for professionalism for many years. In the past, nurses were essentially
diploma prepared nurses that were essentially taught on the job and the occupation was not
recognized as a profession. Nurses are now trained at institutes of higher education by other
nurses that are typically masters or doctorate prepared. In fact, most organizations are now
requiring or encouraging associate prepared nurses to return to institutes of higher education to
obtain a higher degree level and a deeper understanding of professionalism (Chitty & Black,
2011, pg. 62-65). This deep understanding of professionalism and higher education creates a
safer environment for patients, assists organizations in achieving their mission and places
nursing into a higher professional category.
Business Skills
Nursing leaders must have a solid understanding of the business of healthcare. Business
skills are an AONE competency that describes how nursing leaders manage the business side of
health care (AONE, 2005). Nursing leaders play an integral role in managing the budget and
creating an efficient, cost effective environment (Yoder-Wise, 2011, pg. 229-231). Nursing
managers are typically responsible for budgeting and planning, while other nursing leaders are
responsible for ensuring that members of the healthcare team are utilizing resources responsibly
and not wastefully (Yoder-Wise, 2011, pg. 232). Proper business skills improve the overall
performance of an organization through cost effective practices and knowledge of
reimbursement practices (Yoder-Wise, 2011, pg. 235). Cost effective practices and business
skills allow for improved patient outcomes by ensuring that funds are spent to improve patient
care and not wasted as a result of poor business skills (Yoder-Wise, 2011, pg. 235).
Conclusion

Running head: NURSING LEADERSHIP

Nursing leadership is a complex role that varies depending on where the leader falls on
the organizational chart. Nursing leaders have various roles and responsibilities that require
effective communication, knowledge of the healthcare environment and business skills. The
AONE competencies ensure that nursing leaders provide scaffolding for other members of the
healthcare team and are engaged in complex problem solving and decision making that is
patient-centered and business savvy (Yoder-Wise, 2011, pg. 229-246). Nursing is a profession
and nursing leaders are professional nurses with a high level of education that are taught to
critically think and practice using scientifically derived evidence that is based on theory. The
AONE competencies assist nursing leaders understand and operate from the business side of
health care (AONE, 2005). This paper identified a nursing leader, described the role and
responsibilities of that leader and discussed communication, knowledge of the healthcare
environment, leadership, and professionalism and business skills as it pertains to the healthcare
environment.

Running head: NURSING LEADERSHIP

References
American Organization of Nurse Executives. (2005). The AONE Nurse Executive Competencies
[PDF]. Retrieved November 20, 2014, from
http://www.aone.org/resources/leadership%20tools/nursecomp.shtml
Chitty K. K. & Black, B. P. (2011). Professional Nursing: Concepts & Challenges (6th ed).
Maryland Heights: Saunders Elsevier.
Garman, A. N. (2006). Knowledge of the healthcare environment. Journal of Healthcare
Management [electronic version], 51(3), 152-155.
Jones, M., ONeill, P., Waterman, H. & Webb, C. (1997). Building a relationship:
Communications and relationships between staff and stroke patients on a rehabilitation
ward. Journal of Advanced Nursing [electronic version], 26, 101-110.
MMC: Mission & Vision (2014), Munson Healthcare. Retrieved September 28, 2014, from
http://www.munsonhealthcare.org/?id=493&sid=1
Yoder-Wise, P. S. (2011). Leading and Managing in Nursing (5th ed). St. Louis: Elsevier Mosby.