 Donna Ernst, DNP, RN, NEA-BC, CNL, Department Editor Received 2020 Jul 14; Accepted 2020 Jul 29. Copyright © 2020 Society of Gastroenterology Nurses and Associates. This article is made available via the PMC Open Access Subset for unrestricted re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the COVID-19 pandemic or until permissions are revoked in writing. Upon expiration of these permissions, PMC is granted a perpetual license to make this article available via PMC and Europe PMC, consistent with existing copyright protections.
How do we manage and lead in a time where there is so much uncertainty? We have all been challenged with the most recent health pandemic both personally and professionally. Daily, we are reading new conditions of the virus and how we should be living our lives, following guidelines, and making decisions based on what information we are given. In particular, the pandemic has had great impact on all aspects of our healthcare environment and if you are in healthcare leadership or management, your staff is looking to you for decisive leadership, guidance, and trust. Leading your team and managing within any healthcare crisis can be overwhelming to the “most seasoned” leader. During this current crisis, leaders are challenge to make smart decisions based on the best information provided at that moment, while guiding and supporting their team. A great deal has been written about leadership, with many suggestions on how it should be done, but leading in a crisis brings unexpected challenges as the situation requires strategic planning with sometimes “on-the-spot” decision-making. Leaders must also keep patient care at the forefront, providing safe care that results in positive patient outcomes. Leaders are expected to know and follow all of the current guidelines, policies, and protocols from multiple sources while overseeing all aspects of their healthcare setting. State and territorial public health officials—along with their partners at the local, regional, and federal levels—face unprecedented leadership challenges in their attempt to mitigate the virus spread (Fraser, 2020). With this comes overwhelming demands for leaders to sort out what is real and best for their own environment. Leadership during crisis requires a readiness for action. Leaders need not to wait to be told what to do; rather, they work proactively to identify what is most needed in the moment and they try to anticipate what will be required next (Anderson, 2018). They must balance their intuitiveness and expertise while they act decisively when urgency requires it, sometimes going on a leap of faith. Crises come in all forms, from natural disasters (hurricanes, tornados, etc.) to human-caused crisis (health pandemic, fire, air/water contamination, war, etc.). As a result of globalization, population, and technology, crisis can quickly escalate in scale or scope beyond their origins (Edmonson, Sumagaysay, Cueman, & Chappell, 2016). Word of the pandemic began in the fall of 2019 and quickly escalated worldwide with little time to plan. Managing through a crisis situation will depend on the type of crisis at hand, with some crisis situations managed quickly with resolution coming easily. Other crisis situations, as in this current pandemic, could be ongoing for some time. How does a leader withstand the long-term demands? A great deal has been written about leadership; transitional, situational, democratic, transformational, and servant leadership are a few styles described in literature. Each comes with its own set of traits and characteristics and thoughts about when the particular style should be adopted and why. At times leaders unknowingly adopt one style of leadership in the hopes that it will serve all situations and needs of the organization, when in fact the chosen style, theory, or model may address only one aspect of leadership (Porter-O'Grady & Malloch, 2018). No one type or style of leadership is absolute for every situation. In fact, most leaders use a combination of leadership styles based on their own personalities, priorities, and values. Leading through a crisis requires understanding of the type of situation at hand and relying on available resources to manage through the challenges it brings. It requires authenticity. In reality, the success of the leader is more closely linked to personal authenticity, self-awareness, and genuineness than to a particular leadership style (Porter-O'Grady & Malloch, 2018). A person who leads authentically is said to lead according to his or her true self based upon his or her values. The values of the authentic leader are shaped by personal beliefs and developed through personal experience. Authentic leaders are not afraid to show vulnerability and their true self. This type of leaders must also be vulnerable in knowing their own limits both physically and mentally. They must be completely transparent in their leadership approach and accept personal faults as well as strengths. Authentic leaders are not afraid to ask for help from colleagues and admit they do not have all of the answers. It is impossible for one person to lead in our current complex healthcare system, and the leader needs to rely on others for success. Integrity is part of authenticity. The concept of integrity has several meanings. Leaders with integrity are consistent in their behaviors during all situations. Integrity means doing the right thing, even when it is difficult, and it takes courage. Leaders must understand their own moral and ethical principles to guide their behaviors and decisions. Telling the truth shows integrity. When leaders “talk the talk, walk the walk,” they will create that sense of trust between the leaders and their followers. Nothing will change a staff member's perception of the leader quicker than a leader who does not follow through in what he or she is saying. What develops is mistrust. An ongoing crisis such as the COVID 19 pandemic will potentially affect the outcomes of the patients involved unless safe, well-thought-out decisions are made as needed. Your staff must understand the details of the current situation and how the decisions are being made by their leaders. If the leader is unable to accommodate the critical variables embedded in the crisis, followers will be no more successful in confronting the demand to change and adapt to the situation it brings (Porter-O'Grady & Malloch, 2018). As authentic leaders, ensuring that our nursing teams trust us and know that we are communicating with them authentically is more important than ever (Kellish, 2020). Successful leaders understand the critical role communication plays in their daily work (Fraser, 2020). Communication is the most important component of daily activities and is essential to clinical practice, to building teams, and to leadership (Yoder-Wise, 2014). As leaders, we know that effective communication is essential to delivery of safe patient care and outcomes. We have all learned that communication is a two-way process, with the communicator and the receiver. Both verbal communication and nonverbal communication are important when sending a message. In the time of crisis, it is important to maintain calmness and a sense of community, togetherness, and trust. Staff may exhibit fear. Your staff need to feel they are safe and the situation is under control and decisions made by you are based upon true facts. Your staff is looking to you for clarity, confidence, and a feeling of safety and you must communicate this to them. Modeling such behaviors will go a long way. There is a plethora of ways to communicate and update your healthcare staff during a crisis and the manner and the number of ways you communicate will be determined by the type of event and the extent of the crisis. With COVID 19, we are continually hearing from higher level leaders such as our mayors, governors, and health officials, but equally important is the communication within the organization you serve. Does the communication coming from your organization match what officials are saying? If there is any discrepancy in what is being communicated by various sources, you, as the leader, must sort out the true facts. What is important is that the communication is continual, clear and concise, truthful, and from reliable sources. Crisis requires leaders to demonstrate confidence in their decisions even when they may feel the most vulnerable and maintain vision for others when their own line of sight is obscured (Anderson, 2018). According to Baker, Irwin, and Matthews (2020), there are several questions you can ask when contemplating delivering a message or communicating especially in a time of crisis. These are as follows:
These statements will help sort out what is most important to convey and what can wait. Too much information presented at one time can be overwhelming and confusing. The staff must have time to “digest” each piece of information and synthesize its meaning for themselves. How will this new information affect me? How am I involved in this communication? Do I understand all that is meant? Ways to communicate could be in the form of daily “huddles,” which are one concept taken from Team STEPPs, where the team comes together “to regroup” periodically during the workday to review their current situation. You may also create a daily briefing report to update the staff on the current crisis situation. The daily briefing report could include such things as current status of employees, current status of the patients, planned changes in processes or protocols, up and coming new information, meetings, comments, or communication from others, or any other items you would like to communicate to the staff. It may be a physical paper as well as sent electronically to the staff. Using e-mail and group texting also offers communication means. Texting could be especially effective in trying to get immediate information sent, as in locating someone, or asking for assistance. New technology such as ZOOM can bring staff together for current updates. Whiteboards or communication boards may be used as well and could address less urgent essential information. Signage and flyers could be made to show explicit directions and information as well. These can also be helpful to your patients and family members, helping them understand and keeping them safe as well. Do not forget your staff meetings to discuss all details of the current situation, plan, and goals. Leaders need to have genuine concern for employees during a crisis. It is important that the staff must realize their value and that leaders care about them as individuals. Allow empowerment where the staff can make decisions when possible. This gives the staff some sense of control and this will go a long way. They want to be part of the decision-making process. They must feel they are heard and that their concerns are real and valid. During a crisis, emotions can be escalated with the overwhelming circumstances presented. Understanding that not all staff members will react to the crisis in the same manner is important, and the slightest change or new challenge could heighten emotions for certain individuals. Leaders must have empathy for their staff. Showing true sincerity and caring for the staff during this time of uncertainty will lower anxiety. Provide one-on-one time with each staff member if possible. Allow them to vent their feelings and tell their stories if needed. Leaders must listen to and understand each perspective and consider their feelings and needs. Focus on the positive. Generally, people want to do the right thing and they want to feel they are contributing to finding the solutions. During any crisis, the collective energy of the workforce will be drained and stretched to the limit. As a result, leaders will be called on to monitor their own energy level and that of team members. According to Baker et al. (2020), leaders should focus on asking the right questions, rather than having all the answers. Build on the relationships developed with your staff and rely upon them to share the burden and work together (Anderson, 2018). Continue your daily work as normal as possible. This may sound a bit crazy, but having a sense of normalcy will help the staff go about their daily work. Remember, this particular crisis could be with us for a time and when leading your organization and staff, you will have your good days and your bad days. Celebrate the successes and recognize good work done. Some organizations have a recognition board where the staff is recognized for good work. Celebrations could be done each week to celebrate your successes. Recognize professional and personal milestones such as birthdays, work anniversaries, unit benchmarks, or goals met. Your healthcare organization/facility is part of the community and you have an obligation to serve. People like to help, and contributing and helping others in time of need can be very rewarding. How can your organization best serve the community? What do the people in your area need? Depending on the crisis, collaborate with your community leaders on their needs. It does not have to been on a grand scale; the smallest act of kindness is appreciated. Assisting and collaborating in the time of need will build long-lasting community relationships. Leading during crisis requires a situational awareness and not only understanding the current situation but also having an intuition of knowing what may be “coming around the corner” are important. Active decision-making that is based upon true facts is imperative. Use your experience and expertise when making decisions and determine what needs to be done immediately and what can wait. Prioritize the work and share the responsibilities when you can. Conserve your energy for the long haul, as you may be leading your team through the challenges for a good while. Promote self-care for yourself and your staff. This is the moment for strong leaders to apply these values by being present and “in the trenches” with their teams, providing clear, honest, and open communication to offset fears and the unknown (Luis & Vance, 2020). Leaders should be publically seen and heard—They do not simply make decisions behind closed doors and communicate directives (Anderson, 2018). Become inspired by the collegial teamwork, the camaraderie, and clinical adaptation that happens with your leadership. Draw on the collective knowledge and skills of your staff and create a strong team to weather the storm.
THE OFFICIAL JOURNAL OF THE SOCIETY OF GASTROENTEROLOGY NURSES AND ASSOCIATES, INC. AND THE CANADIAN SOCIETY OF GASTROENTEROLOGY NURSES AND ASSOCIATES DEDICATED TO THE SAFE AND EFFECTIVE PRACTICE OF GASTROENTEROLOGY AND ENDOSCOPY NURSING The author declares no conflicts of interest.
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