Preface

Ididn't always perceive myself as a leader. I knew I wanted to make a difference in the world and in the profession I loved but was far less clear about the path I might take to make that happen. Indeed, my passion, genuine caring for others, propensity for risk-taking, and willingness to work hard far exceeded any formal leadership training or skills I had. As a result, my personal leadership journey was filled with unexpected twists and turns; missed chances, as well as incredible opportunities; and disappointments as well as successes. In other words, it was hard. It was also amazing and life-altering. The knowledge I gained from incredible mentors and role models, as well as experience, provided me with the tools I needed to succeed in multiple leadership roles. The lessons I learned along the journey resulted in extensive personal growth and self-discovery that have changed my life forever.

My guess is that many nurses want to become leaders but feel overwhelmed and are not sure where to begin. I wrote this book for them. It examines the need for leadership development in nursing, discusses what leadership means—including how it means different things in different situations and with different people—and emphasizes the importance of good followers to the leadership equation.

The book is organized with nine sections detailing valuable leadership lessons I learned along my own leadership journey. I learned many of these lessons the hard way and have purposely shared stories where I encountered frustration and failure as a leader. My hope in sharing these stories and suggestions is that readers will gain confidence in their own ability to lead, reflect on their own leadership strengths and weaknesses, and establish new goals and a plan for their future leadership development.

The nine leadership lessons I've learned along my own leadership journey are:

1. Find a Mentor and Positive Role Models to Share Your Journey

2. Be Self-Aware and Authentic

3. Be Able to Laugh at Yourself and Leave Your Ego at Home in a Jar

4. Be Visionary, Take Risks, and Ask for Permission Only When Necessary

5. Maintain Personal Power: Keep Gas in the Tank and Money in the Bank

6. Choose Your Battles Carefully

7. Perfect the "Art" of Communication

8. Appreciate and Empower Followers

9. Set Priorities and Enjoy the Journey

I would also argue that developing leadership skills is no longer optional for nurses. Healthcare is big business, and nurse leaders are now expected to have expertise in budgeting, finance, and marketing. They're also expected to be skilled communicators and team builders and to be visionary and proactive in preparing for new threats we didn't think much about several decades ago, such as terrorism, biological warfare, and emerging global pandemics.

At the organizational level, nurse leaders are expected to address high staff turnover, staffing shortages, limited resources, quality mandates, and interpersonal conflicts that all too often result in unhealthy workplace cultures and incivility. Nurse leaders are also challenged to balance the "human element" with rapidly emerging healthcare technologies and to ensure that both the art and science of nursing are maintained in our patient care. The contemporary leadership expectations of nurses, then, are extremely high.

Unfortunately, as I have traveled the world, many nurses have told me they believe their leadership skills are inadequately developed for the roles they already hold. In some cases, it's because they had inadequate formal education or training in leadership and management. Others had such training but didn't really pay attention, believing they would never hold a formal leadership role. Still others have shared that they were taught basic leadership principles but weren't prepared for how quickly they would be expected to assume leadership positions as new nurses.

Fortunately, most nurses have better leadership skills than they give themselves credit for. Many of these nurses have had to learn these skills the hard way—by trial and error. When we're talking about human lives, the consequences of doing so can be costly.

I personally believe that all nurses can and must be leaders. I also believe that leadership is a choice. Although early leadership theorists suggested that the propensity for leadership was inborn, most contemporary theorists argue that one can choose to be a leader or a follower.

Some people do have certain characteristics or personality traits that may make it easier for them to lead. For example, some people, even at very young ages, are more fearless. Others are naturally more outgoing; they're more curious and take more risks. But not all leaders need to be gregarious by nature; there is a lot of room for quiet leadership. In fact, some of the most effective leaders I know are individuals who didn't seek out that role—they simply grew into it because they stepped forth to do what had to be done when no one else would.

Being a nurse leader, however, is difficult when resources are limited, performance expectations are high, and obligations to patients, employers, and self are in conflict. It also takes time to develop the skills and self-confidence that are an important part of the leadership role. Author Malcolm Gladwell (as cited in Bradberry, 2017) suggests that mastery of anything requires 10,000 hours of tireless focus. Thus, development of leadership skills typically requires time, energy, and willingness to assume the role.

Unfortunately, many people are promoted into leadership positions without having demonstrated even a slight ability to lead (Keating, 2016). Instead, these promotions occurred because an individual demonstrated some ability to manage people or tasks. Jenkins (2017) agrees, noting that the way it works in most organizations is that people who are good at their jobs receive a promotion and suddenly find themselves in a leadership position without having any experience in that role.

Leadership and management, however, are not the same thing. Leaders are individuals who are out front—moving forward, taking risks, and challenging the status quo. They have vision as well as the energy to create a better future. In contrast, managers have a certain amount of status, power, and authority due to the formal position they hold. In other words, subordinates must follow managers, because it's an expectation of their job.

Kerr (2015, para. 2) also differentiates between leadership and management: "Leaders look forward and imagine the possibilities that the future may bring in order to set direction. Managers monitor and adjust today's work, regularly looking backward to ensure that current goals and objectives are being met."

Leadership, then, does not come from position or title; leaders accomplish things because others follow them willingly. Indeed, Keating (2016) suggests that the only thing that makes you a leader is leading. Rockwell (2016) concurs, noting that authority, position, and title won't make you a leader. Instead of worrying about being a leader, Rockwell suggests that an individual should worry about being a person worthy of being followed—because all it takes to stop being a leader is to have your followers choose to stop following you.

The reality is that all nurses need well-developed leadership skills to address the complexities of 21st-century healthcare. The Institute of Medicine (IOM, 2010, p. 221) agrees: "Although the public is not used to viewing nurses as leaders, and not all nurses begin their careers with thoughts of becoming a leader, all nurses must be leaders in the design, implementation, and evaluation of—as well as advocacy for—the ongoing reforms to the system that will be needed." The IOM (p. 225) goes on to say:

Melnyk, Malloch, and Gallagher-Ford (2017, p. 30) outline qualities of effective nurse leaders:

Nurses can no longer argue that only nurses in formal management positions need leadership skills. All nurses can be nurse leaders, and part of their professional responsibility is to gain the skills needed to successfully assume that role.