Nursing Leadership

Nursing Leadership 26(2) June 2013 : 15-18.doi:10.12927/cjnl.2013.23453
Acen Update

Top 10 Words of Leadership Advice … or, Things Your Mother Never Told You!

Nancy Lefebre

Nursing leaders are in a unique position within the healthcare system. Today there is more emphasis on multidisciplinary care, cost containment and corporate accountability. Often this means that leaders have a unique connection with front-line providers, require a different set of skills and work with different stakeholders on ways to advance the system. In my role as president of ACEN, I have had the great opportunity to meet leaders from across Canada and to host a nurse executive conference that brought nursing leaders together to discuss these issues. Through this I have been inspired by the knowledge, innovation, wisdom and creativity of nursing leaders at a time when resources are tight, the system is complex and new technologies are developing faster than ever before.

In addition to Canadian leaders, I have also have had the good fortune of working with members of the American Organization of Nurse Executives (AONE), our US sister organization which has over 8,500 members ranging from front-line nursing managers to nurse executives. ACEN is currently in discussion with AONE with the aim of further collaboration, sharing of leadership best practices and exploring opportunities to advance nurse executive leadership internationally.

Recently, ACEN was invited to the AONE Annual General Meeting as a guest speaker to talk about the Canadian healthcare system. While our systems may be different, the passion, commitment and excitement about the future of nursing leadership is the same on both sides of the border.

Through my travels and meetings with many nurse executives within Canada and the United States, along with my own personal experiences with outstanding nursing leaders and mentors, I have reflected on some of the experiences I have had, the knowledge I have gained and the words of wisdom I have heard along the way. So, here is my list of Top 10 Words of Advice for nurse leaders – certainly not the things your mother told you!

1. Dance on the head of a pin

In today's environment, to keep ahead of the curve and be successful, leaders need to be agile and nimble to navigate the system and contend with competing demands, pressures and priorities. Like agile athletes, nurse leaders need to be able to respond quickly, act without losing their footing and move ahead with purpose and direction. Agile leaders ask difficult questions, involve others in making good decisions and learn as they go. It's important for today's leaders to understand their current agility index and ways they can develop their skills to bring more dexterity to the initiatives they undertake every day.

2. Run forward and backward

In order to remain agile, we need to view the world from a different perspective so that we can work differently, not just do the same thing in a different way. So the question really is, why run only forward when you can run backward too? Running backward not only uses different muscles, but gives us a different frame of reference; things are not just done by rote, but are energized by starting from a different vantage point.

3. Unleash the talent of yourself and others

As leaders we need to seek mentorship and opportunities to stretch our thinking, and to move outside our comfort zones – and do the same for other evolving leaders. We need to keep our eyes open for new, bright and promising young leaders and enable their inner leaders to emerge. As Liz Wiseman, author of Multipliers (2010) points out, leaders need to be Multipliers and Genius Makers, or people who amplify their teams to produce better results, not drain the capability from them.

4. Engage the heads, hearts and minds of those we lead

As nurse leaders, we need to tap into the power of our front-line staff, find ways to provide them with the gift of time and enable them to learn, grow and see themselves as leaders. Employee engagement is the foundation of achieving success, and leaders need to inspire their teams so that they deliver unparalleled value to patients and other healthcare consumers. In order to engage employees, you need to meet their basic intellectual and emotional needs, and if you do, they will perform at peak capacity. Their minds and hearts will be fully engaged, they will be energized and creative and they will keep patients, families and other healthcare consumers satisfied.

5. Create transformative changes that bring good value for the dollar

Nurse leaders of the past were more concerned with the clinical aspects of care than creating good value for the dollar. But in today's consumer-driven environment, it is important that we create a healthcare experience that not only meets consumers' expectations but provides more. In order to do this, leaders need to ensure they have well educated, accessible staff who can answer the tough questions, provide safe and high-quality care, and educate patients and their families to manage their care and navigate the healthcare system. We need to be constantly looking at new ways to do things that are both efficient and effective and that bring good value to the healthcare experience, both for our patients and for the healthcare system.

6. Be human beings, not just humans doing

Our schedules continue to be overbooked, and we seem to be working at warp speed. Everyone today seems to be working longer hours, taking fewer vacations, and feeling more hurried and stressed than ever before. These days we are pulled from one urgent situation to another, from cellphone to email and to meeting after meeting. The sheer volume of information keeps us in a state of high alert. We as leaders need to find a way to stop, reflect and take the time to think before doing things. This means allowing time to create a vision, plan the route and be strategic in order to lead the way.

7. Play in the grey

As nursing leaders, we need to play in the zone where no one has gone before, where things may not be crystal clear and solutions not always evident or evidence based. Playing in the grey requires courage to jump in and the commitment to stay the course when the results and the future are not clear. Playing in the grey is really the only way to create new ideas and transformative solutions.

8. Embrace failure

We need to fail quickly and smartly! So often, it is in failure that we learn the most. So we need to be able to embrace and address the inherent benefit of failure so that leaders can value it and let it inform their journey to success. True leaders make mistakes like others; what sets them apart is their ability to recognize their mistakes and see them as opportunities for learning and change. So let's not discard the gifts we receive in the valleys, for as Winston Churchill said, "Mountaintops inspire leaders, but valleys mature them."

9. Keep one eye down and the other looking ahead

Focus on what is happening within your organization, but also be in touch with what is happening within the broader health system and beyond in the world around us. Based on past patterns, it is clear that small, incremental changes have not been particularly effective in addressing or alleviating the core challenges facing healthcare. Therefore, we need a two-pronged approach – one that focuses on interventions to address the real and growing issues of today, and one that focuses on new approaches to realize the solutions of tomorrow. Part of this approach may mean looking outside of healthcare for alternative perspectives to stimulate new thoughts and enable innovation. In fact, there is a lot to be learned in the area of customer service, and the client experience, from organizations such as Disney or Apple. These businesses are not only well versed in creating new products, but have learned methods to engage people in a different way.

10. Take your work seriously but not yourself

In other words, have fun! Sometimes this is so hard to do because the work we do is serious in nature, and we are often moving at such a pace that we don't take time to slow down and look at the human side. We do recognize that what lies at the foundation of all we do is the "human factor" and the reality that we in healthcare are in fact in the human relationship business. A smile and a good laugh at yourself and the situation goes a long way towards putting things in perspective. Being a nurse leader is all about human interaction, and you need to remember to enjoy your work life and have some fun!

In closing …

I want to say that being the president of ACEN has been a wonderful experience and one that has afforded me some sage advice. The passion, wisdom and experience that people have shared with me has enriched my life and my role as a nurse leader. I want to thank all those who took the time to influence me along the way, not just the people with whom I work on a day-to-day basis but also those who have pushed me to view leadership in a different way through presentations or thought-provoking writing. To our current members, I wholeheartedly recommend the experience, and hope that you will encourage others to consider joining ACEN. I know that with new perspectives and a variety of starting points, nurse leaders will continue to take a fresh approach to healthcare, one that will enable the full potential of people, patients and the healthcare system.

About the Author(s)

Nancy Lefebre, RN, MScN, Chief Clinical Executive and Senior Vice President, Saint Elizabeth, President, Academy of Canadian Executive Nurses


Wiseman, L. 2010. Multipliers: How the Best Leaders Make Everyone Smarter. New York: HarperCollins.


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