Leading from where you stand

By Rose O. Sherman, EdD, RN, FAAN

“If your actions inspire others to dream more, learn more, do more and become more, you are a leader.” – John Quincy Adams

I cringe when I hear nurses say “I am just a staff nurse”. You don’t have to be a chief nursing officer or a nurse manager to “lead”. You can lead from wherever you are in the organization. If you manage your career around this concept, you will focus less on your linear progression up the career ladder and more on your own personal mastery and impact. Consider the profound difference that a registered nurse named Glenna Sue Kinnick was able to make on patient safety by leading from where she stood. G. Sue Kinnick is the reason that the Bar Code Medication Administration was developed in the 1990s. Working as a Registered Nurse at the Topeka, Kansas Veterans Affairs Medical Center, she was concerned about medication errors. In 1992 while visiting Seattle, Washington, she watched an attendant at a rental car check-in center scan a bar code on the vehicle she was returning. It occurred to her that a similar system at the bedside could improve patient safety by reducing medication errors.

Upon her return to work, she brought her idea to hospital administrators. She was relentless in her pushing her idea forward and in 1994 medication bar coding was piloted at the Topeka VA Medical Center. Kinnick could see the improvements in her own facility and so she did not stop there. She began a campaign to take bar coding to a national level in the VA. She captured the attention of the then Undersecretary of Veterans Affairs, Dr. Kenneth Kizer, who loved the idea. Kinnick died of breast cancer in 1997 without seeing the full impact of her idea and efforts. By 1999, Medication Bar Coding had been initiated in all 172 VA Medical Centers. In 2003, the Food and Drug Administration recommended that the Bar Code Medication Scanning System should be adopted by all hospitals in the United States. During the past decade, BCMA has been initiated at hospitals throughout the world and has become a standard of care.

Lessons Learned

G. Sue Kinnick proved that a staff nurse can make a significant difference by leading from where she stood. At the time she introduced her idea, it was estimated that drug-related mistakes contributed heavily to the medical errors that kill between 44,000 and 98,000 American annually. This is a great example of the kind of disruptive innovation that is needed in health care today. In the recently published Institute of Medicine Report on The Future of Nursing, it is noted in the report that strong leadership at every level is critical if the vision of a transformed health care system is to be realized, and nurses are to participate as full partners with physicians and other health professions. Being a full partner in care environments means that nurses are expected to take responsibility for identifying problems, to devise plans for improvement, to track improvement over time and to serve as strong patient advocates. While not many of us may have ideas for change that have the impact of Bar Code Medication Administration, it is likely that you see things every day in your practice environment that need to be improved to promote better quality patient care. G. Sue Kinnick believed enough in herself and her ability to influence others to push her idea forward despite the skeptics. Think about the difference that nurses could make in the health care system if we all committed to leading from where we stand in the organization.

Read to Lead

Institute of Medicine. (2010). The future of nursing: Leading change, advancing health. Washington DC: National Academies Press.

Wood, D. (2003). RN’s visionary bar code innovation helps medication errors. Click Here for Article