What Nurses Need from Their Leaders Now

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

COVID-19 has placed nursing in uncharted territory in so many settings across the United States. We are truly learning our way forward on this one. In just a few short weeks, we have seen the following changes become commonplace in practice settings:

Staff and nurse leader redeployment to clinical areas that are not their expertise.
Shortages of PPE and changes in infection control measures from past best practices to good enough.
The rise in patient acuity, patient deaths and length of stay.
Postponement of elective surgeries and procedures.
Conversion of many clinical areas into intensive care units.
Rapid-cycle education around ventilator management.
A movement from patient-centered care to a public health population management model.
Change in care delivery model from more of a primary approach to team nursing.
Playing celebratory music when COVID-19 patients are discharged.

Not surprisingly, these rapid changes are challenging for nurses. Dr. Cynda Rushton, a nursing ethics expert, notes in a recent article for Johns Hopkins Nursing, ” For nurses, our ethical framework has focused on the well-being of individual patients. Historically, decisions were made based on the autonomy of the patient’s preferences and values. As the pandemic worsens, these decisions will be made using triage protocols. We have to enlarge our ethical perspective to more fully integrate a public health framework that maximizes the good for more people and minimizes the harm so that people most likely to benefit from scarce resources receive them……. The gap between what they can do and what they believe they should do creates moral distress, a sense that they’re compromising their integrity. Nurses are grappling with questions like, “Am I potentially causing harm to my family by coming home from work every day?” and “How do I balance the needs of my loved ones with the endless needs of patients?”

Nurse leaders are struggling with how to best react to a chaotic and rapidly changing situation. Researchers from the Gallup Corporation has studied for decades what followers need from leaders even during crises. They contend that the four core universal needs of staff have not changed. They are as follows:

Trust – Gallup contends that a key predictor of low worry and high confidence is whether each employee believes, and experiences, that the organization is looking out for their best interest. Trust in leadership is key at this point in time. Clear and frequent communication is essential even when there are many unknown unknowns. Communicate the uncertainty. There will be many answers you don’t have, and that’s part of the process.
Stability – Gallup’s research work indicates that staff doesn’t expect their leaders to be able to predict the future. They do need them not to be erratic in their decision making. They need to see their leaders show up, in the same way, day after day.
Compassion – Showing you care and are appreciative is critical at this time. Staff is juggling new responsibilities, fears, and problems, and they need to hear their managers and leaders say out loud that they understand, are behind them, and that you’ll get through this new situation together. The compassion about their fears and anxiety is critical.
Hope – Napoleon once said that leaders are dealers in hope. This is especially true during a crisis situation. When we feel hope, we are more resilient, innovative and agile. Your confidence and ability to feel the fear but lead anyway will help your staff move through it. Otherwise, fear can be contagious.

These needs are especially urgent during crises. People look for these traits in their leaders as a signal that their life will be OK and that they can be part of the solution. We will move through this challenging time. Strong leadership has never been mattered more.

Read Rose Sherman’s new book – The Nurse Leader Coach: Become the Boss No One Wants to Leave