N496 Module 6 assignment: qualities of a nurse leader shadowing and interview paper, a full sample

Leadership in the Hallway: What Shadowing an Oncology Unit Manager Revealed About the Qualities of a Nurse Leader

Student Name

RN to BSN Program, Aspen University

N496: Nursing Leadership and Management

Instructor Name

Month Day, Year

Leadership in the Hallway: What Shadowing an Oncology Unit Manager Revealed About the Qualities of a Nurse Leader

Leadership is easy to describe in the abstract and harder to recognize in a working day. For this assignment I spent a day shadowing and interviewing the nurse manager of a 28-bed inpatient oncology unit, whom I will call Ms. R.; to protect her privacy and the organization's, the details below are generalized and some are combined from other conversations, so the portrait is a composite. This paper describes what I observed, summarizes the interview, identifies the qualities that stood out, compares them with leadership theory and research, and reflects on what they mean for my own development.

Observations

Ms. R. began the day at the 7 a.m. huddle, where she reviewed staffing, two patients at high risk of falling, and a new chemotherapy protocol, then asked each nurse whether anything was worrying them. A new graduate mentioned a family that was angry about a delayed discharge; Ms. R. said she would visit the room with her after huddle, and she did. Much of the morning was spent walking the unit. She stopped at the bedside of a patient in her third admission for neutropenic fever, knew the patient's name and her daughter's, and asked about her pain before asking about anything else.

Midmorning she met with the pharmacist and the charge nurse about a near miss involving a chemotherapy dose calculation. She asked what the nurse involved had noticed and what made the error possible, and the discussion ended with a change to the double-check process rather than a reprimand. In the afternoon she worked on the schedule, answered a call from the director about overtime costs, and spent 20 minutes with a nurse returning from maternity leave. Very little of what I saw fit a job description, yet all of it was leadership.

The Interview

I asked Ms. R. how she defines her job. She said her first responsibility is to make it possible for nurses to give the care they were trained to give, and that most of her work is removing obstacles. Asked about the hardest part of the role, she named the gap between what her staff need and what the budget allows, and said the most useful thing she has learned is to explain that gap honestly rather than pretend it does not exist. When I asked how she handles errors, she said she learned early that punishing people for honest mistakes teaches them to hide the next one. Asked what makes a good leader, she answered, "Being present, telling the truth, and remembering what it was like at the bedside."

She described her own development as accidental at first. She became a charge nurse because no one else wanted to, discovered that she liked solving problems for a team, and later completed a graduate degree in nursing leadership. She meets monthly with a mentor, a retired chief nursing officer, and said she still learns something at every meeting.

Qualities That Stood Out

Four qualities stood out. The first was presence: Ms. R. spent much of her day on the unit rather than in her office, and staff approached her freely. The second was honesty, evident in how she described budget limits and in her insistence on telling the truth about constraints. The third was a just approach to errors, focused on systems rather than blame, which encourages reporting. The fourth was genuine interest in individuals, from the patient's daughter to the nurse returning from leave. Each of these behaviors was small; together they created a unit where people spoke up.

Challenges the Leader Faces

The day also showed the pressures that test these qualities. The call from the director about overtime was tense. The unit had exceeded its overtime budget for three consecutive pay periods because of two vacancies and a rise in patient acuity, and the director wanted a plan. Ms. R. did not argue or promise what she could not deliver. She explained the vacancies, described the acuity data she had been tracking, proposed filling one position with an experienced float nurse while recruiting, and asked for help getting the second position posted faster. Afterward she told me that her job is to translate between the unit and the organization, and that both sides trust her only if she tells each the truth about the other.

Retention was her other constant concern. Oncology nursing is emotionally demanding, and she had lost two experienced nurses in the past year, one to burnout and one to a day-shift position elsewhere. In response she had worked with the chaplain to start a monthly remembrance gathering for patients who had died, protected time for nurses to attend oncology certification courses, and began asking in every annual review what would make each nurse want to stay another year. She was candid that none of these fully offset heavy assignments, but she believed that nurses who felt known were more likely to stay through hard seasons.

Watching her handle these pressures showed me that leadership qualities are most visible when they are costly. Honesty with a director about budget overruns carries risk, and so does admitting to staff that some problems cannot be solved quickly. Her consistency in both directions seemed to be the source of the trust I saw on the unit.

Comparison With Theory and Research

These qualities align closely with transformational leadership, which Bass and Riggio (2006) describe through four components: idealized influence, in which leaders act as role models who are trusted and respected; inspirational motivation, which communicates a shared purpose; intellectual stimulation, which invites followers to question assumptions and solve problems; and individualized consideration, which attends to each follower's needs and growth. Ms. R.'s presence and honesty reflect idealized influence, her framing of the job as removing obstacles to good care conveys a shared purpose, her near-miss discussion invited staff to redesign the process themselves, and her time with individual nurses is individualized consideration in practice.

Research supports the importance of these behaviors. A systematic review of 20 studies found that relational leadership styles in nurse leaders were associated with higher patient satisfaction and with lower patient mortality, medication errors, restraint use, and hospital-acquired infections (Wong et al., 2013). A larger review of leadership styles and the nursing workforce found that relational styles were consistently associated with better nurse job satisfaction and work environments, while leadership focused only on tasks was associated with worse outcomes (Cummings et al., 2018). What I watched on the oncology unit was the mechanism behind those findings: a leader whose attention to people made errors easier to report and nurses more willing to stay.

Reflection on My Own Development

Before the shadowing I had assumed that a nurse manager's most important skills were clinical expertise and organization. Both mattered, but neither was what staff sought her out for. When the new graduate needed help with an angry family, what she needed was someone willing to stand in the room with her. When the pharmacist and charge nurse brought the near miss, what they needed was a leader who would treat the error as information rather than as a verdict on a colleague. The skills in those moments were listening, steadiness, and fairness, which I had thought of as personality traits rather than skills a nurse develops deliberately. Ms. R. described them as habits she built over years, and several of the habits, such as ending every huddle with a question and never discussing an error until she had heard from the person involved, are things I can start practicing now as a staff nurse and relief charge nurse.

Shadowing Ms. R. changed my idea of what leadership looks like. I had pictured it in meetings and decisions; I saw it mostly in a manager's willingness to walk the unit and ask questions. I also noticed how much of her effectiveness came from honesty about hard limits, something I tend to avoid by softening bad news. Two goals follow. First, I will adopt her huddle question, "Is anything worrying you?", when I serve as charge nurse, and follow through on what I hear. Second, I will seek a mentor, as she did, because her monthly conversations with an experienced leader appeared to be one of the quiet sources of her judgment.

Conclusion

A day with an oncology unit manager showed that the qualities of a nurse leader are visible in ordinary moments: a question at huddle, a visit to a worried family, a near-miss discussion that fixes a process instead of blaming a person. Presence, honesty, a just response to error, and interest in individuals map onto transformational leadership and onto research linking relational leadership to better outcomes for patients and nurses. The lesson for a future leader is that these qualities are practiced one interaction at a time.

References

Bass, B. M., & Riggio, R. E. (2006). Transformational leadership (2nd ed.). Lawrence Erlbaum Associates.

Cummings, G. G., Tate, K., Lee, S., Wong, C. A., Paananen, T., Micaroni, S. P. M., & Chatterjee, G. E. (2018). Leadership styles and outcome patterns for the nursing workforce and work environment: A systematic review. International Journal of Nursing Studies, 85, 19-60. https://doi.org/10.1016/j.ijnurstu.2018.04.016

Wong, C. A., Cummings, G. G., & Ducharme, L. (2013). The relationship between nursing leadership and patient outcomes: A systematic review update. Journal of Nursing Management, 21(5), 709-724. https://doi.org/10.1111/jonm.12116