So I have been asked to write a few words on how leadership skills are used by myself and the hundreds of A&E nurses throughout the UK.

I have been a qualified nurse for the best part of 11 years. I started my nursing life on a trauma and orthopaedic (broken bones) ward. It was back here that I properly witnessed some of the best and worst leadership styles of my career. As a brand new nurse and a new London person I was eager to soak up everything that was taught to me. I was very eager to learn and to please others…it was here that I witnessed how poor leadership can have a devastating effect on both patients and staff members!

I have never been the kind of person to be “scared of people.” Well back then I was very, very scared of the system! At my peril I learnt very quickly that humiliating people isn’t the way to lead a team or me. It might work on a very superficial surface; sure everyone tells the sister they are “happy” but as soon as she walks away the actual truth was very different.

At this stage of my career I never dreamed of being a leader as I had no intention of ever screaming down the ward or making people cry on a regular basis. That’s what I had seen others do, and I decided if that’s what it is to be a leader then I wasn’t having any of it.

I left one ward after being screamed at (again) after deciding to wash a patient’s hair. This poor lady had been in a fatal car crash; her husband died at the scene. She was in hospital 6 weeks before I met her and she hadn’t had her hair washed. So I took it upon myself to wash her hair, despite having been told hundreds and hundreds of times that wasn’t important enough for me to be doing. Needless to say I wasn’t going to let that stop me and so I washed her hair and actually I was the one out of the two of us that started to cry. I often think about this patient and wish I could see her again. At 7am on this very busy and chaotic ward it was her who taught me all about leadership. She was the one who said that what I had witnessed for the last year wasn’t leadership but was bullying. It was an aha moment… she told me that I was to dry her hair and get a piece of paper and together we wrote my resignation! Now I have to admit I did get myself another job before handing it in!

My next job was where I met a fantastic leader and one of the best nurses/ bosses I have ever had the privilege to work with and for. The contrast was so very different. I’ve now known David 9 years and am still to hear him shout. He taught me that you get a lot more out of people if you give them “carrots not sticks” which is why our A&E team became so strong. The team were given a lot of freedom to grow and to decide on their own path, but also expected to meet the targets and to work when needed. It’s here I learned all about the “swings and roundabouts” and why allowing people to have fun is just so very, very important.

David in fact started off a lot of “fun” as he knows we all learn through play… I’ve tried to keep this model for when I am in charge and will often if possible start a water fight with syringes. (I’ve also been known to try and almost get away with plastering up some consultant’s brief case!)

So here are my 10 leadership points I’ve learnt over 11 years and what I try my best to do in my current leadership role:

1) Respect each and every person who is in your team. For instance in some cases the porters are more valuable then the A&E consultants. It’s the porters who stop the breaches, collect the blood for sick patients, and allow us to meet the targets by moving patients up to the wards to and from X-ray.

2) Let people know what you require from them early. It’s much better to keep people in the loop and give them chances to change then before it becomes a problem for me and them.

3) Allow people to manage their own case load and don’t interfere with “their” system. We all know there are 10 thousand ways to skin a cat. As long as the work gets done and the patients are safe then that’s all good with me.

4) Being assertive never ever involves shouting; that’s bullying and doesn’t have a place in the workplace.

5) Allow people to have fun… actively encourage harmless fun when appropriate. It doesn’t have to be much but I got people making a Christmas tree out of hospital supplies… the whole on call teams of hospitals contributed something… the surgical register made me some thing from theatres. This has built our relationship and we are very informal with each other which means I can ask for informal advice about sick patients. Having fun with people breaks down boundaries.

6) Find out who can help with what and how – it’s important to know who can assist you with things and who is the best person to do so. And it’s just as important to know who not to ask to help/ rely on. This though comes with practice and by giving people a chance in the first place.

7) Build up the skills of the team. It’s important that everyone can do everyone’s job… we need to make sure that I am able to understand the frustrations of a junior nurse as much as they understand why I sit at a white board looking at and managing times and targets.

8) Understand and acknowledge that people make mistakes. Learning how to deal with the fallout from this can be a hard lesson. I try to use my own mistakes to tell people it does and will happen. I’m also open and honest with people about the potential consequences if it’s something more serious or is repeated more than should be expected.

9) Support team members in front of a patient’s relatives, even if you know they could be not quite correct. After the incident I then take them aside alone and discuss as needed, explaining that for me to correct them in front of the patient looks unprofessional and only builds a mistrusting relationship.

10) Allow time to play on the swings. Let people go for extra coffee or smokes as allowed. That way they are more likely to stay an extra 10-15 mins when it’s really busy!

This post was written by an A&E nurse who wishes to remain anonymous, but learned valuable leadership lessons from being on the ward.

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