What does it mean to be a Health Care Leader?

What does it mean to be a Health Care Leader?

A commentary from your state president.

Historically, physicians have assumed the role of the leader on the health care team. They were educated and trained in that role. However, then came along the advanced practiced nurse (APN) role. The nurse administrator, the clinical nurse specialist, the nurse practitioner- all with advanced education and specialties. The APN's role being never to usurp the physician but to add to the efficacy of the health care team. 

Whereas the physician may lack experience or knowledge in certain areas as in the business and political sides of health care, the APN may possess such expertse and can lead the health care team in such areas, thus assuming the leadership role on the team.
The word "leadership" has many different meanings. A leader in one area is not automatically a leader in another area. Requisite skill sets vary greatly for various situations.
In determining what is medically appropriate for a patient, we rely on a certitude that exists. But when it comes to dealing with the massive changes now facing in health care delivery that has been brought upon us by payers and the ACA including population health management, quality metrics, and patient satisfaction, all of a sudden our clinical confidence may swain. 
The dollars and cents and the nuts and bolts of health care have shifted dramatically. It seems as if it's no longer sufficient to be an excellent clinician. Now one also has to become a financial wizard, a efficiency expert, a technology expert, a business individual, and an entrepreneur, but not just for ourselves, but for our livelihood.
Being a leader in these settings requires not only the accumulation of a vast amount of new and ever-changing knowledge, but the development of new interpersonal skills that get our voices heard without being domineering, and thus, shut out of the conversation.

It also requires a certain degree of humility as well as an abandonment of the "me cowboy (or cow girl) you indian" mentality. The new paradigm in health care delivery demands a new way of being. It's all about teamwork, and there are a lot of captains. This will require a collaborative, cooperative, listenig and validating approach for success. Simply stated, we need to be respectful and practice the "Golden Rule" in being humans. For many, I believe this isn't going to be easy.

In becoming an effective leader in health care, one of the biggest hurdles to overcome will not be our neighbors but our own self. This will require us to step outside of our comfortable routines and commit the time and energy it takes to become a leader in the new health care delivery system. For many, this is frightening and uncomfortable. Its uncharted territory, but the initial step it is obligatory. I always refer to it as a "professional leap" as when you try to do this, you are adding to your already existing knowledge base that is ultimately going to result in your professional advancement.

However, allow me to be clear in stating that there are no clear, concise steps involved that serves as the panacea for everyone; nor do I believe that there exists a wholesale review of a step-by-step process required to become a leader. Thus, to be quite frank and direct- I believe a defined step-by-step process for becoming a leader. It simply does not exist. But there are hundreds of articles, books, and conferences on "leadership" that do exist and play a vital role in one's "professional leap" efforts. I believe those resources serve as the important "second step" in becoming an effective leader. The first step MUST originate from within our own selves. We must approach leadership development and commit to it in a similar way that we did when we committed to returning to graduate and/or post graduate school realizing that it takes time, energy, investment, and collaboration with others. Then and only then, will we be able to step out of our warm and cozy comfort zone into the unknown uncharted areas in our professional leap process. (Remember, if becoming an effective leader were easy, all of us would already be one!)

Those who know me well know that mantras, inspirational sayings, and quotations are very important to me. They provide great comfort and clarity during times of self-doubt and frustration. Quotations can be inspirational as well as educational. Here are a few that resonate with me and reinforce the message I want to get across about becoming an effective leader in health care in this new era:
1. "The difference between a successful person and others is not a lack of strength, not a lack of knowledge, but rather a lack in will." 2. "The journey of a thousand miles begins with a vision." 3. "Attach yourself to those who advise you rather than praise you." 4. "If you take risks, you may fail. But if you don't take risks, you will surely fail. The greatest risk of all is to do nothing."

Maybe summing things up most succinctly is a quote from President John F. Kennedy, "Leadership and learning are indispensable to each other." Simply being placed or stepping into a leadership position is not enough. It requires a mental paradigm shift within ourselves first and foremost. This is the humility aspect that is paramount to becoming an effective leader. Going from expert to novice takes and requires an act of the highest degree of humility. It also requires a great deal of education to stay current and this requires additional time to an already packed professional work day. Yet, it is essential and establishes creditability. 

Being a leader requires a positive mindset. It requires you to be encouraging of others as we know "nurses love to eat our own". As Napoleon Bonaparte noted, "A leader is a dealer in hope." Those in the trenches who never look up at the sky seldom see the bright side. Remain optimistic. People will always need health care, it's just going to be delivered and paid for differently. It becomes essential for APNs to fight for how we believe the delivery of healthcare should be done.

Once one does take on a leadership role, one likely will see a different, maybe hidden, side about him/herself that he/she didn't even know existed. It can become addictive. In many people, the more they have, the more they want. Or as Zig Ziglar positively put it, "When you catch a glimpse of your potential, that's when passion is born." When you step outside of yourself and see that you can make things happen, it reinforces the desire to do more. When one begins to see that he/she can make a difference for him/herself and others as an effective leader in health care, a snowball effect with those around may take place.

As President John Quincy Adams observed, "If your actions inspire others to dream more, learn more, do more and become more, you are a leader." Simply stated- one becomes the catalyst for a domino effect that builds in many directions. Thus, evidence in becoming an insirational and effective leader.

In summary, who in the past century has exhibited more courage and leadership when faced with adversity, self-doubt, and fear than one of my favorite all-time role models, Winston Churchill? He pointed out that, "Success is not final, failure is not fatal: it is the courage to continue that counts."

Health care and the role of the APN have experienced so much changes lately that it can take the wind out of our sails, can gut the joy of why each of us became APNs, and can suck the life out of us routinely. However, there exists very few options. Either we allow the train to pass us by or we hop on that train and make our way to becoming the engineer of that train and decide for ourselves where that train is going. This requires courage and bravery, humility, participation and engagement, and making our voices heard.

That is the meaning of a health care leader!

James F. Lawrence, Ph.D. APRN BC CHPN CPS FAANP

State UAPRN President