Nursing Leadership and the Power of Framing

By Rose O. Sherman, EdD, RN, FAAN

“Leaders manage meaning when others are unable.” Gail T. Fairhurst

Last week, I had the opportunity to spend time with a very seasoned nurse manager. I asked her about the most challenging part of her job in today’s health care environment. Without hesitation, she answered that it was helping her staff to cope with and remain optimistic in an atmosphere of uncertainty. With proposed changes that will accompany health care reform and the declining reimbursements that agencies are already experiencing, there is reason for concern. Nursing staff wonder if their organizations are in crisis and whether they should be worried about job security. Staff are depending on their leaders to help them understand the meaning of the changes that are being discussed.

Gail Fairhurst in her book The Power of Framing: Creating the Language of Leadership, suggests that one of the most important but least talked about leadership communication skills is that of “framing”. How leaders use language to frame people, situations, and events has important consequences for the way individuals make sense of the world and their actions. Not all leaders think about this when they communicate but it is important especially during turbulent times.

Case Example

Maria Sanchez is a nurse manager on a 30 Bed Telemetry Unit. At a recent town hall meeting, the CEO of her hospital talked with staff about the implementation of a new care transition program. With changes in Medicare reimbursement, the hospital now will need to work hard to reduce the readmissions of patients diagnosed with Congestive Heart Failure. He noted that 25% of the admissions to telemetry were readmissions within 30 days. The goal of the care transition program would be to reduce readmissions by 50% within the first 6 months. He predicted this would have a significant impact on the census in the telemetry unit. Some of Maria’s staff came back from this meeting very upset about the future of the unit. Maria who had also attended the meeting recognized that it was important for her to frame the issue for staff. In thinking about her presentation to her staff the next day at a staff meeting, Maria used the six following rules recommended by Fairhurst:

1. Control the Context

Maria did not minimize the facts that were presented at the meeting but sought to give staff the background about the health policy changes that were driving the changes in medicare reimbursement.

2. Define the Situation

Maria talked about the Care Transition Program , the timeline and how it could potentially impact the unit census.

3. Apply Ethics

Maria talked about how she would evaluate the impact of the program on census. She spoke about the core values of the organization and how employees are critical to the mission. She also discussed her plans not to fill any unit positions until she could get a better sense of the impact.

4. Interpret the Uncertainty

Maria acknowledged the uncertainty about the impact but asked the staff not to over-react until they had more information. She also promised to keep them informed.

5. Design the Response

Maria carefully thought through how she would discuss her own reaction to the situation with staff. She told them that the change was in fact needed and was the right thing to do for patients. She said she looked forward to having their help and suggestions with the Care Transition Program as it was an opportunity to do something very innovative. Maria also discussed with staff how in the future more care would move to the community. They would be on the front lines of this change.

6. Control Spontaneity

After the town meeting, Maria made the decision not to talk with staff about what was discussed until the next day. She gave herself time to think about what she would say. She decided not to make any promises or predictions about what would happen but to keep her response as factual as possible.

The response of leaders to change or turbulence has a powerful effect on their staff. Leaders who remain calm, truthful and optimistic in their communications help to prevent the spread of misinformation and reduce staff anxiety. The words of leaders can be very powerful in a positive or a negative way. While the skill of framing may not be easy, it can improve our ability to be effective communicators during times when staff depend on their leaders.

Read to Lead

Fairhurst, G.T. (2010). The Power of Framing: Creating the lanuage of leadership. San Francisco: Jossey-Bass.

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