Having Courage as a Nurse Leader - Emerging Nurse Leader

By Rose O. Sherman, RN, EdD, FAAN

“One isn’t necessarily born with courage, but one is born with potential. Without courage, we cannot practice any other virtue with consistency. We can’t be kind, true, merciful, generous, or honest.”

Maya Angelou

Our current health care environment is full of uncertainty with a focus on reducing costs yet increasing quality. Nurse leaders are being asked to make difficult decisions about their budgets and appropriate levels of staffing. In the past, courage has not been recognized as an important attribute for nurse leaders. This is changing. In conversations with current nurse leaders about what our future nurse leaders will need, the ability to act courageously in advocating for patients and staff has become important.

Why Courage Matters

Without question, innovation is needed in health care systems globally. It is courage that makes change possible. Rosabeth Moss Kantor in a recent Harvard Business Review article wrote that ” moral courage enables people to stand up for principle rather than stand on the sidelines”. Consider in your own work all the times that staff may know something is wrong but don’t speak up. Margaret Heffernan in her widely watched TED talk in 2013 calls this “willful blindness” when people know better but don’t speak up.

In the November 2011 issue of Hospitals and Health Network magazine, Mark Classen the President of the Joint Commission Accrediting Organization in the United States estimated that there are still 40 wrong site surgeries a week being reported. This is in spite of numerous safety initiatives put in place throughout the country. In some of these situations, the surgical checklist was not followed or other shortcuts occurred and the nurses involved did not speak up. Truth-telling is an important part of patient safety that we often don’t discuss.

What is Courage in Leadership

Courage in leadership is doing what is right, despite being afraid or risking negative repercussions. Fear is the most common common reason that people give when they avoid being courageous. Think about how you feel when you watch a leader who demonstrates personal courage. Most likely, you will trust that leader more. Courage comes from feeling very deeply about important values and working to achieve goals that are consistent with those values. Although sticking to the status quo may be tempting, this is not how change occurs. Every leader ultimately has the choice to either lead with courage or lead without it. Taking a risk in situations where you feel passionately or a deep sense of purpose does not guarantee a successful outcome. But many leaders over the course of their careers have situations where they did not speak up and later deeply regret it.

Examples of Courageous Leadership Behaviors

Providing honest feedback in conversations and discussions.
Sharing alternative viewpoints to the rest of the team.
Speaking up rather than being compliant in silence.
Not settling for “we have always done it this way”.
Making decisions when you are in uncharted territory and the safe path is to do nothing.

Developing Courage

The first step to becoming a more courageous leader is to be very clear about your own vision and values. When you choose to be courageous, it is important to know what your goals are in the situation and what you hope to achieve. Scripting in advance what you are about to say can be helpful and anticipate the people who will disagree with your message most. To be courageous, you must also have the honesty to admit when you have made a mistake or took a wrong path. Telling staff that you were wrong in a situation is a powerful act of leadership courage as is the willingness to entertain new ideas and change your assumptions. Courage is a learned skill and all of us have the capacity to be courageous. To be courageous means stepping our of your comfort zone and taking the risk.

As we move into the future, we will need innovation in nursing and health care that is both ground-breaking and tradition defying. At the same time, we also need nurse leaders who are willing to tell the truth about the risks that may be involved in reducing staffing levels, not replacing needed equipment or failing to comply with evidence-based practices.

Read to Lead

American Hospital Association, (November 2011). Wrong-Site Surgery. Hospitals and Health Networks. p. 34.

Margaret Heffernan (March 2013). The Dangers of Willful Blindness. Ted Talk

Kantor, R.M. (2011). Courage in the C-Suite. Harvard Business Review. 89(12), 28.