Questions to Ask Yourself as a Nurse Leader

By Rose O. Sherman, EdD, RN, FAAN

“It is necessary … for a man to go away by himself … to sit on a rock … and ask, ‘Who am I, where have I been, and where am I going?” – Carl Sandburg Poet

Getting honest feedback as a nurse leader can be challenging especially as you move into more senior positions. Many Chief Nursing Officers tell me that they miss the coaching and support that they received earlier in their careers. Some organizations have forms of 360 degree feedback where supervisors, staff and peers give input on your performance. But if your organization does not have this feedback loop, you will need to become more self-reflective and critical in viewing your work. Over time, all of us make mistakes and develop bad habits.

In a classic article published in January 2007 in the Harvard Business Review What to Ask the Person in the Mirror, Robert Kaplan outlined the 7 following questions that leaders should ask themselves on a periodic basis:

1. How often do I communicate a vision and key priorities to attain that vision?

Today’s health care environment is both complex and chaotic. Staff feels some uncertainty about the future. Having a leader who can clearly communicate where the organization is headed and how this fits in to the daily work of staff is important. You may not have all the answers but share what you do know.

2. Does the way I spend my time match my priorities?

Getting a clear sense of how you spend your time in your leadership role is important. We may value and talk about coaching and mentoring staff but spend very little time on this activity. We may recognize the need for our own leadership development but fail to take the time to avail ourselves of leadership development opportunties.

3. Do I give people timely and direct feedback that they can act on?

Staff will usually appreciate feedback if it is done in a timely and constructive manner. This is especially true for our young Generation Y nurses. It is important when giving feedback that you discuss how things should or could be done differently in the future. Leaders often tend to avoid unpleasant discussions. Dealing with problems in a timely way will help to avoid the escalation of behavioral problems.

4. Have I identified potential successors?

If asked the questions “who could take your place”, nurse leaders should be able to identify at least one or two high potential emerging leaders on their unit or in their department. It is distressing to hear leaders say that there is no one on their unit or in their department who could take their place. You may hear staff say that they don’t want your job but that does not mean that they don’t have the potential or could change their mind. If you truly lack staff with leadership potential then this should be a hiring priority.

5. Am I attuned to changes in health care that might require a shift in how we work?

This is an important question as we move into an era of disruptive health care reform. Think about your unit, specialty or department and how things might change if hospital 30 day readmissions were reduced by 75% in your organization. What if your hospital becomes an accountable care organization – could your role change to caring for patients across the continuum. How do demographics nationally and locally impact your work? I recently spoke with a nurse manager who told me that over time she had noted that a very high percentage of their paitents spoke Spanish and required translators.

6. How do I behave under pressure?

During times of crisis, staff will watch how you respond and mimic your behavior. If you are highly stressed under pressure and demonstrate behaviors such as losing your temper, blaming others, or becoming excessively negative, you send unintended messages to staff about how they should behave.

7. Does my leadership style reflect who I really am?

It is important that we stay true to ourselves as leaders. Have you adopted a style of being politically correct or hesitancy about expressing your views. Sometimes nurse leaders worry excessively about how they will be perceived when staff is really looking for authenticity.

Self-reflection is important in leadership. Even the most successful nurse leaders have periods where they struggle in their careers. To get back on track, you must take the time to gain perspective. These seven questions can be a great way to start that process.

Read to Lead

Kaplan, R. (2011). What to ask the person in the mirror: Critical questions for Becoming a More Effective Leader and Reaching your Potential. Harvard Business Review Press.