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Creating Emotionally Intelligent Nurses

Increased empowerment and involvement develops leaders at all levels.

To achieve a healthy work environment, facilities require emotionally intelligent nursing leadership at all levels of the organization, especially at the point of care. The 2010 Institute of Medicine report on the future of nursing urges full partnership of nurses with other health professionals.1 Full partnership requires a unique set of skills, including coordination of services, integration of skills, and facilitation of team efforts. Nurses must devise and implement appropriate change strategies to increase quality, access and value.1

Cary Medical Center
Enter Cary Medical Center in Caribou, Maine. A 65-bed acute care hospital in rural northern New England that is well known for its patient-centered services, Cary has won numerous state and national awards for customer service and clinical performance. In addition, Cary Medical Center is fortunate to have the progressive leadership of a nurse CEO who understands the importance of supporting and encouraging the development of nurse leaders.

Cary has set a precedent that has begun transforming its nursing care from departmentalized treatment to integrated collaboration. This model calls for a "super manager" on the inpatient side to oversee the operations of each unit. This manager is a primary charge nurse. At daily huddles, nurses analyze bed counts and determine the availability of discharges to compare with the anticipated admissions for that day. Nurses from all units are present for the huddle and make recommendations for patient placement, including staffing coverage. While all nurses have a home, all are available and ready to cover patients in any other part of the hospital.

This model, which has been in place for 5 years, has created a cohesive, collaborative family of nurses who share integrated offices, make decisions together, cover for one another, and who feel re-energized about being at the helm of patient care decision making. As this model has evolved, the advancement of ideas for better patient care has become the norm of discussions among all staff. With increased empowerment and involvement, one of the key elements of growth has become developing leaders at all levels of the nursing of nurses

Cary Medical Center initiated the Charge Nurse Leadership Institute (CNLI), a leadership development program for charge nurses, in January 2013. The intent of the program is to identify key informal leaders from among the charge nurse pool. Each unit nominates peers who possess leadership qualities. The nominees are then chosen to participate in a yearlong Institute that convenes once per month to explore a leadership development topic. The four overarching themes are key qualities of emotional intelligence: self-knowledge, self-management, understanding of others, and mastering the management of others.

Psychologists use the term "metacognition" to describe an awareness of thought process.2 The term "metamood" means awareness of personal emotions.2 Self-knowledge requires a thorough understanding of feelings and thoughts and how both are expressed in words, body language and behaviors. Emotions that simmer underneath awareness can affect perceptions and reactions. For example, someone who is annoyed by a rude encounter early in the day may be peevish for hours afterward. He or she may take affront where none is intended and snap at people for no real reason. Once this emotion registers, he or she can evaluate things anew, decide to shrug off the distasteful experience, and change outlook and mood. Emotional self-awareness is the building block of the next principle of emotional intelligence: managing self.2

The charge nurses in each CNLI spend a significant amount of class time becoming self-aware. A personality profile allows participants to assess themselves throughout the program and activate a specific awareness that can inform better situation analysis, thought processes, communication, expressions and behaviors.

Self-management is more than managing impulses. It includes a full awareness of the stimulus-response transactions that occur in the brain. Stimuli don't disappear because we ignore them. Often, we are stimulated by an event or comment and respond with a knee-jerk reaction. No thought was necessary and no analysis preceded the stimulus. What is delivered is an undressed, emotionally-driven response.

Becoming increasingly discriminate in response to stimuli is one of the hallmarks of successful self-management. As informal leaders and aspiring formal leaders, charge nurses in this program learn to practice ways to introduce a moment of consideration between the stimulus and the response. This moment allows the evolving self-aware nurse to analyze the situation, filter out unacceptable responses, and choose from among a more appropriate group of options before delivering a reasoned response. The charge nurse has altered his or her presentation to represent the professional leader within.

Understanding of Others
An awareness of differences pervades the Institute so that an understanding and acceptance of differences can inform the development of productive, seasoned relationships. Every nurse in every hospital can attest to the difficulties and unease with which charge is taken after assignment. Peers aren't always waiting with baited breath to hear the wisdom imparted by the charge for the day. How can the charge nurse motivate others to do what they should do when they should do it? Motivation cannot easily be imposed from an external source-it must be directed from within. The charge nurse must know what motivates his or her team.

While personality profiles cannot be administered to the entire nursing staff and the ancillary supports that integrate with nursing, charge nurses in the CNLI learn to observe the baseline behaviors of others and, with greater accuracy, determine the best way to stimulate their motivation. Recognizing a mood or attitude can help the charge nurse choose a way of speaking or acting that will be effective. Learning how to respond to anger or hostility (patients and their families included) from an unemotional position, or disallowing irrational banter from continuing, or keeping another on track with the conversation, are products of self-awareness and self-management.

SEE ALSO: Earn CE: Nurse Leadership and Staff Satisfaction

Managing Others
Positive self-regard and subsequent management of that regard exert a powerful force on people who work directly with the leader who has them. Leaders who have become skilled enough to recognize the relational power of their roles achieve a level of emotional wisdom. Emotional wisdom reflects itself in the way staff members relate to others. Bennis3 provides direction for achieving emotional wisdom. CNLI promotes awareness of ways to move into that state. For example, the ability to accept people as they are, not as you would like them to be, is a basic principle that underlies the concept. Approaching relationships and problems in terms of present rather than past forces a focus in the here and now, empowering others to problem solve on their own.

Working collaboratively among various support services, numerous nursing units, and with patients and their families requires high-level skills based on a foundation of respect for others and establishing trust. Often, we become complacent around coworkers. Because we see and listen to them on a regular basis, we can lose our ability to listen to what they are really saying, or to appreciate the quality of what they are doing. Selective attention leads to misunderstandings, misconceptions and mistakes. Extending trust and respect to colleagues results in contributions to the overall health of the organization.

Future of CNLI
Cary Medical Center leans on the graduates of the CNLI to mentor staff, teach new participants and guide creative efforts to define and redefine patient-centered care. Measurement of progress will, no doubt, be evident in patient satisfaction and staff satisfaction.

When I began to consult with Cary Medical Center 22 years ago, units did not communicate with each other, floating was viewed as a train wreck, and nurse managers protected their turfs. Today, all charge nurses talk daily about issues. Huddles provide the problem-solving forum for the day's activities. The idea of "that unit's patients" has been replaced with "Cary patients." A remarkable transition has occurred.

The goal continues to be individual and organizational development. This nursing model's success depends on the ongoing attention and dedication to the development of every nurse whose responsibility it becomes to "take charge."


1. Institute of Medicine. The Future of Nursing: Leading Change, Advancing Healthcare. 2010.

2. Goleman D. Emotional Intelligence. New York: Bantam Books; 1995: 46-50.

3. Bennis WG. Why Leaders Can't Lead: The Unconscious Conspiracy Continues. San Francisco: Jossey-Bass; 1989.

Margaret Palmer is an organizational psychologist who supports the well-being of healthcare professionals and their hospitals through her consulting firm, DocExecutive.

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