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Whether a nurse is designated a team leader, primary care nurse or total care nurse, his or her competency in leadership strongly influences patient outcomes, the work environment and job satisfaction of both the nurse and his or her colleagues.

When Dawn Payment, RN, reported to work one week at Harrison Memorial Hospital in Bremerton, Wash., she had a lot on her mind. Even before she took off her coat, she was planning the evening shift on her busy oncology unit. She was thinking about gathering information about her patients, orchestrating their care and assigning duties to her assistive personnel. She was mapping out the work that needed to be done and devising a plan for ensuring quality care in the midst of the controlled chaos that defines a hospital acute care unit. In short, Payment was practicing the leadership skills of a competent bedside nurse.

"I've never consciously thought about what I do as leadership," Payment said. "I just do what needs to be done to ensure my patients get quality care. If that's leadership, then every nurse is a leader."

Most staff nurses don't think about their organizational, team and delegation skills as leadership. That's exactly what they are, though. As Payment pointed out, every staff nurse is a leader.

Leadership is an integral part of professional nursing because the role of the nurse automatically places him or her in a position of authority or influence over others. Patients, visitors and other staff members look to the nurse for guidance, assurance and direction. It is most often the nurse who coordinates each patient's care.

Whether she or he is designated a team leader, primary care nurse or total care nurse, his or her competency in leadership strongly influences patient outcomes, the work environment and job satisfaction of both the nurse and his or her colleagues.

Sue Favero, RN, a surgical staff nurse from Phoenix, agrees that nurse leadership skills are important in the operating room. "When nurses aren't practicing good leadership skills in the OR, patient care can be compromised," she said. "Priorities can be affected, as other personnel don't know where to turn for help. Attitudes become less positive and the operating room takes on a negative atmosphere."

A lack of nurse leadership competency can cause problems for a nursing unit. Sandi McIntosh, MA, RN, director of emergency and medical/surgical care services at St. Luke's Hospital in Cedar Rapids, Iowa, has been amazed over the years at the variations in unit teamwork depending on the nursing leadership. "You know immediately when you walk onto a nursing unit and see who has the lead role for the shift," she said. "That tells you how smooth the shift will be."

So what are these staff nurse leadership skills that can make such a difference to patients and staff? Payment says they are communication, teaching and the ability to delegate appropriately after an assessment of team members' strengths and weaknesses. Favero emphasizes communication, good listening skills and the assertiveness needed to be a patient advocate.

Rumay Alexander, Ed.D., MSN, RN, of Nolensville, Tenn., works as a consultant on leadership and diversity issues. She sees the need for leadership throughout organizations and says the skills needed by staff nurses are the same as those for nurses in management positions. "Nurses have to solve problems for patients," she said, "so they need to know how to ask the right questions in order to get the best information for problem solving. They need to have critical thinking skills, coaching, counseling ability, negotiation skills and knowledge of consensus building."

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