Essential Components of Leadership for the Bedside Nurse

The purpose of this qualitative study was to identify the essential leadership components needed for generalist nurses to provide safe and effective nursing care at the bedside.  Current nursing practice over the last decade has faced many challenges that include shorter inpatient length of stay with a population of patients that have higher acuities with more complex health care needs, rapid advancement of technology, and health care reform effects.  All nurses are leaders in the context of their specific practice role.  In order to determine the essential leadership components, an interpretive phenomenological approach was used.  Participants in this study included practicing bedside nurses in acute care hospitals, nurse administrators with direct contact with bedside nurses, and nurse faculty teaching in an undergraduate program.  Participants were individually interviewed using a literature-based interview script.  Analysis of findings were used to develop a model of the generalist nurse as leader with three main components: (1) effective communicator at shift change, in patient-nurse relationships, and with health care team members, (2) accurate and safe clinical decision making, and (3) approach to care dispositions of integrity and openness to change.  However, since the bedside nurse participants in this study did not view themselves as a leader, there is a need to change the mindset of generalist nurses to recognize that leadership is an essential function of their practice role.  In order to make this transformative mindset change, undergraduate nursing programs may need to be more explicit o students regarding the specific educational experiences that are aimed to prepare them to function as leaders at the bedside.  Innovative learning strategies such as simulation, and service learning projects could assist in the development of effective communication, clinical decision making, and dispositions needed for safe effective nursing practice.  Additionally, health care institutions could provide entry-level nurse graduates with support to continue bedside leadership development.