Recently I was approached by a veteran director of nursing who asked, “Am I really a nurse executive? I've never thought of myself as such.” I'm sure I responded with surprise because I truly consider long-term care nurses who hold administrative positions of leadership to be nurse executives! Webster's Dictionary defines an executive as an individual who exercises administrative or managerial control, or who holds a directing or controlling office within the organization. That certainly fits the description of a director of nursing. If you are still not convinced, consider just a few of the executive duties that are routine functions of a director of nursing:
Directing and supervising the hiring, training, performance review, and wage administration, on average, of more than 100 employees
Managing a fiscal budget often in excess of $2 million, determining the distribution of dollars, and recommending future budgetary allocations
Supporting the organization's commitment to its mission, values, and goals
Collaborating with other facility and community leaders to maximize opportunities for growth and success
Ensuring compliance of federal and state laws, regulations, organizational policies and procedures, and sound clinical practices
Ensuring that monitoring systems to track compliance are in place and functional, and that outcomes meet standards of practice
Directing risk management programs designed to safeguard residents' health and safety
Working with the administrator, medical director, and other departments to identify facility needs, plan new programs, or revise existing practices; and overseeing and improving policies and procedures that directly affect high-quality care.
The nurse executive bears a distinctive presence—an authority and charisma that is conveyed in his/her appearance, speech, patience, integrity, and service to every member of the nursing home community. The nurse leader who portrays this effective and purposeful leadership, global mentorship, ethical management, and an honest desire to help others achieve personal and professional goals, creates a culture that ensures high quality care and life for residents.
Too often, nurse executives are not aware of the impact they have by positively modeling, conveying, and facilitating a culture of caring and leadership across the organization. For example, nurse executives benevolently and consistently find ways to manage the quality of life for residents who live with multiple complex cognitive and physical issues in bodies with failing organs. And although long-term care facilities have become one of the most regulated fields in the nation, nurse leaders continue to respond to ever-expanding requirements by implementing quality improvement strategies to meet resident needs. Nurse executives have advanced the long-term care field by championing such causes as residents' rights, restraint reduction, and individualized assessment and care planning, to name just a few.
In addition, nursing executives deal with hour-to-hour staffing challenges; respond to resident and family member expectations; monitor program compliance; respond to organizational or corporate needs; and still have the might and drive to soothe, support, mentor, educate, and guide residents, families, and staff members. Successful nurse leaders recognize the value of creating trusting and effective partnerships with all members of the nursing facility community. Most succeed through sheer determination and because giving up is not an option.
Developing a leadership plan
The nurse executive understands the importance of developing a leadership plan with a focus on doing well and bringing about superior quality of care for each resident, staff member, and the organization. In his book, The Effective Executive, Peter Drucker emphasizes that “to be effective is the job of the executive,” and “an effective executive is the person who focuses on making a contribution.” The nurse executive focuses on contributing to the organization; its mission, its services, the quality of its programs, its standards, and the impact each of these areas has on its residents. Nurse executives are results-driven and do not shy away from taking responsibility for facility outcomes. A study completed by the Hays group, a management consulting firm that specializes in helping clients achieve strategy through people, examined more than 75 key components of employee satisfaction and found that trust and confidence in top leadership were the most reliable predictors of employee satisfaction. Effective nurse executives become adept at building trust and earning the loyalty of the facility's residents, families, and staff members.
Nurse executives are crucial in creating compelling visions and goals and providing consistent feedback on the accomplishments relative to those goals. As Socrates once said, “Let him who would move the world, first move himself.” Before nurses can become true leaders, they must distinguish themselves, and with confidence, step into the shoes of the executive. So whether you are an assistant director of nursing, a director of nursing, or a clinical or corporate nurse consultant, recognize that the qualities and responsibilities of your position meet and often exceed the definition of a nurse executive. The shoes do fit, so wear them proudly.
Jan Bennet RN, NHA, C-NE, is the Executive Vice President of the American Association of Nurse Executives (AANEX).
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