Have a Bias for Action in Your Leadership

By Rose O. Sherman, EdD, RN, NEA-BC, FAAN

When I conduct focus groups with young nurses for organizations, I repeatedly hear a theme: They don’t see any loops being closed on problems and challenges. It is one reason why many pull back from shared governance efforts. It is critical today that nurse leaders have a bias for action.

When a problem or challenge is within a leader’s circle of influence, nurses today expect you to act decisively and close the loop quickly. When you think about today’s fast-paced world, your nurses can order something from Amazon and see it delivered within hours in some areas. Yet, repairing equipment on units essential for care can take weeks. Decision-making in healthcare organizations is notoriously slow, and even simple policy or practice changes can take a long time to wind through multiple committees for approval. Too often, the loop on a decision is never closed. Baby boomers and Generation X tolerated attending meetings where you might see the same agenda item for discussion month after month, but younger staff will not. As one young nurse recently told me in a focus group – why should I waste my time when nothing happens with our input? He makes a good point.

Not all decisions leaders make have the same consequences, so they may not need the same level of contemplation. In Jeff Bezos’s book Invent and Wander, he points out that sometimes people think about all their decisions in the same way when they are not. He divides decisions into two categories. The first category is one-way-door decisions. These are critical decisions that are highly consequential and usually irreversible. To change one’s mind after the fact can lead to disaster. Bezos thinks these decisions should be thoroughly debated and analyzed from multiple angles.

There is a second type of decision, which Bezos calls a two-way-door decision. These decisions are reversible. If the decision proves to be wrong – you change. Two-way-door decisions require less debate because they are reversible. Most daily decisions that we make in nursing would fall into this category. Nurse leaders today should work to have a bias for action. If the decision can be easily undone, move quickly and make the decision. If the decision cannot easily be undone, take your time. In either case, the key action is to keep staff informed and close decision loops even if the decision is no. Remember that no decision is a decision, and indecisive leaders frustrate staff.

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