Nurses Week 2018 CNO Roundtable

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Nurses Week 2018 CNO Roundtable

Discussing ethical challenges, future shock, the Yelp Effect and the next generation of nursing leaders

By Working Nurse
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Mind-boggling technological change. Steep staff turnover rates. New ethical dilemmas. Near-instantaneous patient feedback, both good and bad. If nursing leadership in today’s healthcare environment were a video game, the difficulty level would be stuck on “high.” Those same dilemmas face nurses at every point in their careers, both in their practice and at their workplaces.

For our annual Working Nurse CNO roundtable, we asked 18 local nursing leaders for their insights on these pressing issues — and on the ongoing challenge of cultivating the next generation of leaders.

Meet our esteemed panel (left to right, top to bottom): Susan J. Brown, Jerome M. Dayao, Lauren Spilsbury, Karen T. Descent, Debra Duran, Patricia Stone, Bonnie Bilitch, Suzie Reinsvold, David Bailey, Susan Flaming, Isabel Milan, Linda Burnes Bolton, Helen Staples-Evans, Gudrun Moll, Derek S. Drake, Gloria M. Sanchez-Rico, Bobbie McCaffrey, Jennifer R. Castaldo.


Topic #1: Onboarding and Retention
Nurse turnover is high throughout the industry, with many nurses leaving their jobs (and sometimes the profession) within the first two years. What can nursing leaders do to improve nurse retention, provide better onboarding and reduce the rapid turnover of new hires?

David Bailey, RN, MSN, MBA, CCRN-K, NEA-BC, FACHE Chief Nursing Officer UCLA Health, Santa Monica
It starts with providing excellent training for new nurses. We have a yearlong residency program with mentorship, monthly classes, formal graduation and a program where new nurses design and implement projects to improve care on their units. Some of these projects result in new protocols and practice changes. Our nursing leadership also takes the time to engage with new nurses on a personal level, asking why they became nurses and what parts of nursing they’re most passionate about. We use their answers to help strengthen their commitment. Positive leadership in these areas is why our retention level is much better than the industry average.

Susan J. Brown, RN, Ph.D., MSN Sr. VP of Patient Care Services and Chief Nursing Officer City of Hope National Medical Center
One reason retention is still a huge issue for nursing is that we frequently eat our young. I once had a staff nurse ask what I was going to do about the turnover of new grads. I turned the question back to them and said, “What are you going to do?” The new grads are not leaving because of me; they are often leaving because of the way they are treated on the unit. I believe everyone on a unit needs to feel ownership of the goal of retaining employees. It requires role-modeling by managers of appropriate interactions with new nurses and it requires us to deal with incivility and bullying in the workplace, which has been tolerated for too long.

Linda Burnes Bolton, RN, DrPH, FAAN VP for Nursing, CNO and Director of Nursing Research Cedars-Sinai
Nurse leaders need to allow enough space and flexibility to make the jobs attractive for all kinds of nurses, whether they are at the beginning of their careers or at the end. We all need to feel that the work we are doing is of value, which sometimes means giving individuals the opportunity to do a different type of work. However, not a lot of institutions are able to accommodate that. Throughout my career, I’ve had the opportunity to acquire knowledge and skills to prepare me for the next professional entrée. That’s what our organizations need to do to keep interest levels in the profession high and find ways to reinvigorate the talent. Nurse leaders have a responsibility to create that as an expectation for managers.

Jerome M. Dayao, RN, MSN, NEA-BC Chief Nursing Officer Arrowhead Regional Medical Center (ARMC)
I believe that people stay in organizations where they can thrive and actualize their professional roles, which means practicing to the full extent of their licenses and being treated with respect as members of the primary care team. If possible, the organization must have a formalized program to onboard new nurses. At ARMC, we are starting a new residency program for our perinatal nurses. This yearlong program will provide a structured onboarding and a supportive environment with regular check-ins.

Karen T. Descent, RN, MSN, CEN Chief Nursing Officer Parkview Community Hospital Medical Center
New nurses need to feel secure in their environment and embraced by their coworkers. Retention improves if people are happy where they work. Nurse leaders also need to ensure that our organizations promote employee engagement. We need to be out on the floor, engaging with staff and leading staff recognition. Promoting a positive, collaborative relationship between nurses, physicians and ancillary staff is also key.

Debra Duran, RN, MBA/HCA, BSN Chief Nursing Officer, Ambulatory Care Network L.A. County Department of Health Services
It helps if you select candidates who are good fits for the organization. In addition, having a mentor to go to with questions, thoughts and ideas helps a new nurse stay engaged and build relationships. An engaged nurse is a lot less likely to leave even when other opportunities present themselves.

Bobbie McCaffrey, RN, M.A., NEA-BC Vice President and Chief Nursing Officer Methodist Hospital of Southern California
Our efforts to counteract the trend to high nurse turnover have been twofold: First, we use behavioral interviewing techniques to assess candidates’ proper fit and potential success in available positions. We also have a panel interview process that involves existing employees in the hiring process. Second, we have revamped our orientation programs to emphasize quality, safety and service excellence and help employees to integrate into a new culture. We have also strengthened our preceptor training program to better enable experienced nurses to serve as mentors to new RNs and increased the number and variety of classes and in-services to promote a learning environment.

Isabel Milan, RN, MBA Chief Nursing Officer LAC+USC Medical Center
We can never neglect staff recognition, which is­ a great way to increase staff morale. Staff want to hear positive feedback and celebrate the team’s accomplishments. Promoting employee wellness and rejuvenation is also important for preventing burnout. Staff members are often affected by the loss of a patient or other negative experiences in their work environment. We recently initiated the “Helping Healers Heal” program, which provides support for staff members who are having difficulty dealing with a traumatic patient care situation.

Gudrun Moll, RN, MSN, MBA, NEA-BC, CPPS Clinical Services/Chief Nursing and Patient Safety Officer San Antonio Regional Hospital
As nursing leaders, we must start by clearly defining which clinical and soft skills (e.g., initiative or taking ownership) are important for our organization and ensuring that those needs are integrated into the interview process.In addition, we need to expect that new nurses will feel overwhelmed or struggle at some points. An ongoing dialogue with educators and immediate supervisors is critical to identifying and addressing issues or concerns early on. Forums for nurses also provide opportunities to share thoughts within the peer group.

Suzie Reinsvold, RN, MSN Chief Nursing Officer and Chief Operating Officer Martin Luther King, Jr. Community Hospital
Nurse leaders should provide the structure, training, support and creative problem-solving necessary for effective new nurse onboarding.  This has helped us to retain the talent we have attracted.  We recently partnered with Versant to launch a competency-based residency program for our new graduates. It entails a rigorous competency assessment that identifies opportunities to develop skills. The new nurses we select are then paired with a preceptor who provides them with the support and training they need to feel confident in their new roles.  To help us retain experienced nurses, we have instituted a transition fellowship program, also through our partnership with Versant. This has enabled us to provide training for experienced nurses who want to move into a specialty area. We offer all our nurses continuing education, tuition reimbursement and advancement opportunities within the hospital so they can grow their skills and careers while continuing to work at MLKCH. According to a recent article in The Harvard Business Review, matching the goals and interests of employees with the content and quality of the job makes a big difference in retention. We do exactly that. We have adjusted current jobs and even created new ones to match an individual nurse’s interests with our hospital’s strategy. That allows us to retain talent and better apply that talent to our organization’s mission—a winning solution for all.

Lauren Spilsbury, RN, MSN Vice President, Patient Care Services Redlands Community Hospital
We learned in school that everyone has a different learning curve, and yet we often forget to individualize our teaching approach when onboarding new employees. Some people may need a longer orientation while others feel constrained if onboarding takes too long. It helps to keep in contact with each new hire and make sure there are solid connections between them and other members of the team. Appointing a “buddy” who is responsible for integrating the new person into the unit culture will decrease the stress of being new and help improve retention.

 

Topic #2: Facing Future Shock
Today’s nurses must constantly adapt to new technologies, new procedures and even new roles. How can nurse leaders prepare their teams to be resilient and to adapt to ever-present change?

Bonnie Bilitch, RN, MSN Chief Nursing Officer Olive View-UCLA Medical Center To thrive in today’s dynamic healthcare environment, nurse leaders must be trustworthy and compassionate, provide stability and create hope. In my experience, when these fundamental needs are met, staff will always go the extra mile and exceed expectations.

Susan J. Brown, RN, Ph.D., MSN Sr. VP of Patient Care Services and Chief Nursing Officer City of Hope National Medical Center
Whenever possible, we need to limit the number of changes occurring at any one time. Part of the concern is the burden accompanying each change — and the fact that we often throw the proverbial spaghetti at the wall to see what sticks. If we throw too much change at any one time, then we will never be able to follow through on each change before moving on to the next initiative. Prioritizing changes is one of the hardest things I have to do. I see so much opportunity every day to improve the care we deliver that I have to stop and think about the impact on staff and other leaders. Then, I work to wisely choose those changes and initiatives that can have the greatest impact and cause the least stress.

Derek S. Drake, RN, DNP, NE-BC, CNML, CNL Chief Nursing Officer St. Francis Medical Center
We cannot expect our teams to fully embrace and implement change, no matter how big or small, unless they completely understand why the change is necessary, what it entails, who it affects, when it will occur and its benefits or ramifications. Throughout the process, nurse leaders must always remain positive and role-model the acceptance of change. I do not ask my team for changes that I don’t agree with or would not do myself. I try to always be the first one to roll up my sleeves and demonstrate the benefits the requested change has for staff and patients alike.

Debra Duran, RN, MBA/HCA, BSN Chief Nursing Officer, Ambulatory Care Network L.A. County Department of Health Services
This is not as much of an ever-present challenge in the ambulatory care setting as it is in inpatient care. Nevertheless, our nurses do need to keep up with the latest evidence-based practices.  Nurse leaders can support this effort by developing a comprehensive education program that is flexible enough to change as technologies, programs and standards of care evolve.

Gudrun Moll, RN, MSN, MBA, NEA-BC, CPPS VP Clinical Services/Chief Nursing and Patient Safety Officer San Antonio Regional Hospital Nurses need to be aware of upcoming changes, have the opportunity to provide input if they are stakeholders and be given the rationale for why the change needs to happen now. At San Antonio Regional Hospital, I have created an annual nursing project timeline to proactively communicate changes to staff, showcase activities and schedule projects according to priority.

Suzie Reinsvold, RN, MSN Chief Nursing Officer and Chief Operating Officer Martin Luther King, Jr. Community Hospital
Identifying nurses with a special affinity for technology and great communication skills can help bridge the technological aspects of future shock. Many nurses born in the past 30–35 years are perfectly positioned to lead the profession in adopting and adapting to new technologies. This is also an example of how we can enrich jobs by matching the interests and skills of our staff. Finding ways to recognize and promote nurses who convey and role-model a sense of enthusiasm and a can-do/get-it-done attitude in embracing change will help promote an innovative environment.

Gloria M. Sanchez-Rico, RN, BSN, MBA, NEA-BC Sr. VP and Chief Nurse Officer Huntington Hospital          
As a Magnet hospital, we know from experience that nurse input and involvement — at all points in the change-management process — results in better outcomes for our patients. Our shared decision-making model ensures that our direct care nurses are involved in the introduction of new technologies, practice changes and the development of policies and procedures that impact care delivery.

Patricia Stone, RN, MSN Sr. VP and Chief Nursing OfficerAdventist Health White Memorial
Nurse leaders can prepare their teams to be resilient by fostering an environment of transparency and trust. Communication is key to developing trust.  Leaders also need to teach their teams self-care, such as stress management, mindfulness and reflective practice.Another key is working as a team. Nursing is a team sport. We do not care for our patients alone and we always have support available when there is a need.

 

Topic #3: The "Yelp Effect" 
Patient satisfaction scores and online reviews are changing the traditional provider-patient relationship and placing new demands on clinicians. How does this “Yelp Effect” affect nursing practice? 

Jerome M. Dayao, RN, MSN, NEA-BC Chief Nursing Officer Arrowhead Regional Medical Center (ARMC)
We live in an age of social media, where every action we do is either actively or passively recorded. We cannot change the times we live in, but we can adapt. To relieve the pressure of the “Yelp Effect,” I think we must commit to always doing the right thing whether or not someone is looking.

Karen T. Descent, RN, MSN, CEN Chief Nursing Officer Parkview Community Hospital Medical Center
One of my old bosses once told me to wait 24 hours before responding to something that had upset me to ensure that what I said was really how I felt. I feel the “Yelp Effect,” like texting, decreases accountability in personal interaction because nothing is face-to-face. We no longer talk out our issues or work toward a common goal. Nurses may be complimented for the care they give, but at the same time, they are not given the opportunity to fix any misconceptions or talk out issues. Frequent rounding and engaging our patients and families in conversations is important to ensure the “Yelp Effect” is a positive one.

Susan Flaming, RN, MSN, FNP Chief Nursing Officer Casa Colina Hospital and Centers for Healthcare
The transformation of healthcare into a real-time, customer-service-oriented industry gives some nurses anxiety and can be misused, but I think it’s generally a good thing for nursing. We don’t have to see this as a threat. It reminds us that the patients are at the center of all we do and their perceptions are their reality. It also reminds us that we need to be clear and kind and act with integrity. If we fall short, we should look at ways to improve our processes and relationships.

Bobbie McCaffrey, RN, M.A., NEA-BC Vice President and Chief Nursing Officer Methodist Hospital of Southern California
Improving patient feedback to employees can increase caregiver engagement levels. To that end, we have begun using our own patient feedback system, called WAMBI, which uses elements such as scoring points and earning trophies. This real-time patient and family feedback allows employees to adjust how they are performing and how well their patient encounters are perceived. Although in its early stages, this technology seems to be contributing to staff engagement, which is linked to employee retention.

Gloria M. Sanchez-Rico, RN, BSN, MBA, NEA-BC Sr. VP and Chief Nurse Officer Huntington Hospital
Our nurses understand that patients and their families need more than just excellent medical care — they also need compassion and responsiveness to their needs.  Increased visibility of the patient experience is a good thing for everyone. Even when a review falls short of our goals, we use it to learn how we can improve.  Ideally, we want to connect with our patients while they are still in the hospital so we can address their concerns immediately. Our patient relations and patient experience teams report directly to me to ensure that nurses on the front lines can address issues as they arise.

 

Topic #4: A Question of Ethics
What do you consider the biggest ethical challenge facing nurses today?

Linda Burnes Bolton, RN, DrPH, FAAN VP for Nursing, CNO and Director of Nursing Research Cedars-Sinai
We have an interdisciplinary bioethics committee that’s led by a trained health ethicist and that includes nurses, physicians, dieticians, social workers and others. The committee meets every other week. In addition, anyone can call a member of the committee and ask for a professional consult so they can talk through their ethical conflict. For the last decade, Cedars-Sinai, UCLA and City of Hope have cosponsored an annual educational intensive around nursing ethics and ethical issues. As a result of that conference, we have individuals on staff who can serve as peer experts, helping staff think through ethical concerns — and be willing to bring them up. You can’t address ethical concerns unless you’re aware of those issues.

Helen Staples-Evans, RN, DNP, NE-BC Chief Nursing OfficerLoma Linda University Children’s Hospital (LLUCH)
These are some of the situations I often see: Artificial hydration and nutrition are among the hardest conversations for patients, families and staff to have. Situations like placing a feeding tube in a patient with end-stage dementia, not placing a gastronomy tube based on a patient’s advance directive or deciding not to give artificial nutrition and hydration to a dying patient can be very difficult for everyone involved, especially in the pediatric setting.Some nurses struggle with the fear of administering opioids to patients at the end of life, afraid of being the one to give “the last dose” to a dying person. We also see nurses reluctant to give pain medication or advocate for their patients in pain out of concern for addiction, which poses an ethical dilemma of its own. One patient asked me recently, “Do they want to see how much pain a person can take around here?”A third common dilemma arises when nurses must compromise the patient’s comfort. Often, unrealistic expectations of patients, family members or the medical team are what put nurses in this position. For example, a nurse might not administer opioids or benzodiazapines to a dying patient because the patient equates comfort care with euthanasia.

Bonnie Bilitch, RN, MSN Chief Nursing OfficerOlive View-UCLA Medical Center
An important question facing nursing leaders today is balancing patient advocacy with the pressures to collect more publicly reported data, which are often a source of financial penalties or incentives.  This raises a challenging question: Do the reputation or financial survival of the whole institution supersede the individual patient’s right to autonomy and quality care?To bridge this gap, we must understand the inherent value of publicly reported data, pursue meaningful process improvement and empower our staff to do the right thing for patients and their families. This requires brave, innovative thinking with a willingness to respectfully challenge other members of the leadership team. 

Susan Flaming, RN, MSN, FNP Chief Nursing Officer Casa Colina Hospital and Centers for Healthcare
One trend that I work hard to combat is the underreporting of safety events, whether it is a fall, near-miss, medication error or other safety concern. To avoid underreporting and keep eyes on incidents that might cause harm, it is crucial to develop a supportive, non-punitive environment that focuses on well-functioning systems and clear expectations. Having those goals foremost in mind keeps our staff sharp and our patients safe.

Suzie Reinsvold, RN, MSN Chief Nursing Officer and Chief Operating Officer Martin Luther King, Jr. Community Hospital
Nurses today need to be cautious about patient privacy and social media. It is critical that nurses not comment on or reveal private patient information in such ways. Nurses need to understand the ramifications both for themselves as professionals and for the organization, no matter their intent.

Jennifer R. Castaldo, RN, MSHA, BSN, NEA-BC Vice President and Chief Nursing Officer Henry Mayo Newhall Hospital
Informed consent is a major issue. Nurses are often faced with situations in which patients and their families have not been fully informed about their treatment plan or prognosis. End-of-life discussions can be particularly difficult. A related issue is disclosure. For example, families may request that patients not be told about their diagnosis. In those cases, the nurse must consider the patient’s right to know and weigh whether what the family is saying is true or reasonable.

Lauren Spilsbury, RN, MSN Vice President, Patient Care Services Redlands Community Hospital
I think it is very hard for bedside nurses to care for patients receiving futile care. It can be challenging when the nurse believes the care plan is ineffectual or causing harm. When a nurse feels unable to advocate for their patient, it causes a great deal of moral distress, which, over time, can erode feelings of self-worth and create a crisis of conscience. Strong communication among the healthcare team is vitally important to resolving ethical conflicts as well as avoiding nurse burnout and emotional exhaustion. Another powerful tool at the unit level is expressing caring and empathy to a nurse who is involved in a difficult clinical situation. We have to remember that therapeutic strategies work for us too!

 

What’s your approach to helping your nursing staff navigate ethical conflicts? What advice would you give young nurses about becoming an ethical nurse?

Susan Flaming, RN, MSN, FNP Chief Nursing Officer Casa Colina Hospital and Centers for Healthcare
When I was training as an ER nurse, one of my mentors told me to imagine myself on the witness stand, explaining under oath what I did any particular scenario. Cultivating that sense of accountability goes a long way towards helping us remember that we are licensed professionals, handling people’s lives and documenting what we do in a legal record.

Helen Staples-Evans, RN, DNP, NE-BC Chief Nursing Officer Loma Linda University Children’s Hospital (LLUCH)
When our nurses face an ethical dilemma, I often ask them, “What are the goals of the patient/family?” Our role is to help them meet those goals, not convince them otherwise. Will the treatment you’re concerned about meet patient/family goals? If the answer is yes, the treatment should continue; if not, the treatment shouldn’t be administered. Even if we think an intervention is or isn’t appropriate, we must respect the patient’s wishes. Patients have the right to discontinue a treatment at any time. Conversely, they have the right to continue with an offered intervention even if we wouldn’t make the same decision. In these situations, we want to make it clear that our nurses are not alone and we stand behind them. LLUCH has a resource called the Ethics Team that a nurse can consult if they’re uncomfortable about patient care decisions. Nurses can also attend weekly clinical ethics case conferences to learn more about ethical decision-making.


Topic #5: Finding Tomorrow’s Leaders
A recent survey from AMN Healthcare reports that 55 percent of Millennials and 58 percent of Gen X nurses have no interest in taking on leadership roles. How can nursing leaders create a supportive culture where nurses are prepared and encouraged to become the nursing leaders of tomorrow?

David Bailey, RN, MSN, MBA, CCRN-K, NEA-BC, FACHE Chief Nursing Officer UCLA Health, Santa Monica
Good leaders identify strengths that nurses don’t know they have and then build on those strengths, giving nurses a path where they can learn the skills necessary to become effective leaders. Once they’re promoted, we assign a mentor at the same level and another a level or two above them so they have the support they need to transition into their new roles. When you create this kind of culture, satisfaction rates go up among nurses and that translates into good patient care.

Susan J. Brown, RN, Ph.D., MSN Sr. VP of Patient Care Services and Chief Nursing Officer City of Hope National Medical Center
I believe that one of the reasons nurses do not want to move into management roles is that they see how hard it is to do the manager’s job. As nursing leaders, we need to look at how we can make things easier for those managers and change the perception of the staff who watch them. First, we need to engage, educate, empower and support the unit managers. We also need to encourage manager autonomy at the unit level. We need to create opportunities for our frontline managers to fix problems identified by staff. Finally, managers need to know that the directors and CNOs have their back.

Linda Burnes Bolton, RN, DrPH, FAAN VP for Nursing, CNO and Director of Nursing Research Cedars-Sinai
We have a program called Rising Stars, for individuals who are not in leadership roles now, but who might want to be a leader someday. During the course of the program, they get all kinds of experience and are able to try out whether engaging in a leadership role is something they want to do. Some of our brightest nurse managers came from that Rising Stars program.

Jennifer R. Castaldo, RN, MSHA, BSN, NEA-BC Vice President and Chief Nursing Officer Henry Mayo Newhall Hospital
One of the skills required of today’s nursing leaders is “talent scout.” In my position, I need to look for nurses who show leadership ability or who have demonstrated leadership in other settings and then give them the educational, human and financial resources needed to support their career growth. This may include encouraging nurses to attend leadership seminars, involving potential leaders in special projects and committees, providing feedback on strengths and areas for improvement, providing mentors and discussing issues that can derail a nursing career.

Jerome M. Dayao, RN, MSN, NEA-BC Chief Nursing Officer Arrowhead Regional Medical Center (ARMC)
To create more leaders than followers, the environment must create a culture of leadership curiosity and give younger nurses the ability to experience how it is to lead. Succeeding in smaller endeavors like shared governance creates the desire to lead and make a difference at a larger scale. When I was at the bedside, I was given the opportunity to chair our unit practice council, nurse-physician collaborative and other clinical practice committees. Now, as CNO, I promote those same activities at ARMC. I believe that shared governance is the breeding ground for the leaders of the future.

Derek S. Drake, RN, DNP, NE-BC, CNML, CNL Chief Nursing Officer St. Francis Medical Center
As with most Millennials, I had no intention of becoming a leader, let alone a CNO. I literally fell into my first leadership role when I was “forced” to take on a charge nurse role eight months out of a nursing school. Somehow, I made it through that shift and absolutely fell in love with the role and responsibilities. When I identify a potential leader, I give him or her the same opportunities for growth and advancement that my great mentors have given me throughout my career. We can inspire potential and aspiring leaders by empowering them to experience leadership and the fulfillment we gain as leaders.

Debra Duran, RN, MBA/HCA, BSN Chief Nursing Officer, Ambulatory Care Network L.A. County Department of Health Services
I have witnessed nurses who had no intention of being leaders participate in improvement efforts and just completely surprise themselves with their ability to lead and influence change. I believe that if we foster a supportive environment and provide knowledge, tools and opportunity, the nurses we lead can discover leadership abilities they didn’t even know they had.

Isabel Milan, RN, MBA Chief Nursing Officer LAC+USC Medical Center
While making leadership opportunities available, we also need to provide formal leadership classes as well as individual coaching. Mentorship is a key component in grooming our next generation of leaders.

Gudrun Moll, RN, MSN, MBA, NEA-BC, CPPS VP, Clinical Services/Chief Nursing and Patient Safety Officer San Antonio Regional Hospital
In our professional practice forum, I have found many of the Millennial nurses to be very active, articulate and engaged. They do a lot of background research, are not afraid to speak up and very appropriately challenge existing processes. They are committed to their patients, their peers and their own work-life balance. I believe that as leaders, we need to challenge ourselves in how we approach leadership development for Gen X and Millennial nurses. Our existing leadership practices may no longer be appropriate for engaging the new generations. In the same way we individualize care plans for our patients, we need to adjust our approaches to younger nurses so that all of us benefit.

Patricia Stone, RN, MSN Sr. VP and Chief Nursing Officer Adventist Health White Memorial
Leadership is not for everyone, but leadership in nursing does not only mean management. It can be attained through many different paths: education, research and clinical bedside care. We all have our gifts and talents. No matter what leadership path a nurse may take, they must develop high moral standards, self-awareness, transparency, the ability to balance work and life (both for themselves and others) and a deep humility. We should foster these qualities in all nurses as part of the professional development process.

 

This article is from workingnurse.com.

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