An introduction to veterinary nursing leadership part one: getting to know yourself

Scenario

Helen had been working at a veterinary practice for 12 years. Three years ago, the practice was sold to a corporate organisation and Helen was offered the position of Head Veterinary Nurse. As she was eager to advance her career and focus her talents on improving patient care, Helen accepted the position. As a hard worker with a strong sense of right and wrong and a desire to bring about much needed change, she was excited about the position and had lots of ideas. After a few months however, Helen began to feel increasingly frustrated with how things were versus how she felt they should be. She asked for a meeting with the CEO of the company and expressed her dissatisfaction that a number of her colleagues did not know key elements of their job and that when she had mentioned this to them she was met with poor professional behaviour from people who were many years her senior. Despite airing her grievances with her superiors, Helen felt that her concerns were not taken seriously and she became increasingly incensed by this, becoming quite emotional when discussing her colleagues' ‘flaws’ and the effect this was having on her. Over time, some of Helen's peers started to complain about her behaviour; they now perceived her as whining and immature and suggested that she just ‘get over it and move on’. As a result of this, her once good working relationships began to suffer, and she started having trouble focusing on the new company initiatives. She knew she was not performing as she should be, but could not see a way out of her predicament. She was stuck and increasingly unhappy, as she was right and the CEOs were wrong, and she did not see that she could, or should, change herself when it was her colleagues who needed to change!

Adapted from Robinson-Walker (2018)

Perhaps you can relate to Helen's dilemma on some level — you may have asked yourself the question of ‘how can I maintain my high standards and continue to work productively when those who should know better fall short of my expectations?’ It is difficult to accept that other people do not always behave the way you think they should and even harder to acknowledge how this can adversely affect your own behaviour. What we need to remember according to Robinson-Walker (2018) is that we cannot change anyone but ourselves — we can try to influence, cajole, lecture, complain, but, ultimately, no one will improve or change anything about themselves unless they want to. Robinson-Walker (2018) suggested that as we mature, we can try better tactics, such as being assertive and asking for what we require from others clearly and without aggression, but even then, we cannot guarantee that they can or will meet our needs. In the end, we must acknowledge that we must attend to ourselves.

Back to Helen; as her complaining was only making matters worse for her, the next step was to acknowledge where she was placing all of her attention. Over time, she came to realise that instead of focusing on her own work and her own behaviour, she had become fixated on the actions and behaviours of others. Helen had fallen into the trap of many novice leaders in that she had inadvertently abdicated her power as a leader and as a competent professional by concentrating on the poor behaviour of colleagues instead of concentrating on herself (Robinson-Walker 2018). Over time, she came to see that her misplaced attention profoundly affected her productivity, work ethic, reputation and ultimately her happiness. Helen acknowledged that she needed to rededicate herself to focusing on her own work and to nurturing her potential to become the outstanding nurse leader she knew she could be. Again, you may recognise something of your own situation here — so how can this be achieved?

What is leadership?

Leadership conjures up a variety of thoughts, reflections and images. According to Curtis et al (2011) these may include power, influence, followership, dynamic personality, charisma, goals, autocratic behaviour, innovation, cleverness, warmth and kindness. Often we think about leaders we have worked with in the past, or are currently working with, and reflect on the qualities and behaviours they possess. Numerous definitions of leadership exist and it is beyond the scope of this article to discuss leadership theory in detail. A common theme, however, that runs through many definitions, is that leadership involves influencing the attitudes, beliefs, behaviours and feelings of other people (Spector, 2006). Sherman (2018a) suggested that influencing-building skills are critical in nurse leadership as nurse involvement in solving many of the important challenges in human healthcare today depends on the effectiveness of nurses influencing outcomes — it seems prudent to extrapolate such a statement to the field of veterinary nursing, which too faces ongoing challenges. According to Sherman (2018a) becoming truly influential takes time, dedication, and a strong sense of self. This leads us back to Helen and her realisation that it was herself that she needed to focus her attention on if she wished to succeed in her new role — but what exactly does focusing on ‘self’ entail?

Understanding self

According to Malik et al (2014) one of the attributes of being a great leader is having a deeper understanding of oneself. This includes a higher degree of self-awareness, a recognition and acknowledgement of one's strengths and weaknesses, along with a belief system that supports them. Malik et al (2014) suggested that how you think and behave will determine your effectiveness as a leader, further suggesting that it is therefore a useful investment of time to explore the way in which you operate — not only to assess your effectiveness from your external expression of yourself (your communication and behaviours), but also your internal self (thoughts/mind-set and beliefs). As a novice leader, if you work on getting the communication right with yourself, then you are far more likely to get your communication right with others. Everyone has an ‘internal voice’ and how you talk to yourself can have a large impact on your ability to function, your wellbeing and your decision making capacity.

It is likely that you entered the veterinary nursing profession due to a deep sense of caring for others. Have you ever stopped to consider that you are likely much harder on yourself than you would ever be on a client? If you were discussing injection technique with the owner of a dog newly diagnosed with diabetes, that individual would no doubt make mistakes at first and get things wrong during the practise injections into the model patient. As you would acknowledge that this was likely due to anxiety and a lack of underpinning knowledge, you would certainly not berate the client or make them feel foolish. With encouragement and coaching however, you would help to boost the client's confidence, step by step.

While an internal steely attitude to self, such as ‘just get on with it’, ‘stop complaining’ and ‘you really messed up this time’ can indeed galvanise a certain type of forward momentum, this may not be the most resourceful way to achieve the best results in practice. Whenever people chastise themselves for making a mistake, they are knocking away their own confidence, reaffirming any negative self-belief and limiting themselves as to what they may be truly capable of (Malik et al, 2014).

The exercise outlined in Table 1 may be useful for a novice leader to explore their sense of self.

Such an exercise is intended to help you slow down and change your mental chatter which may be taking you off focus. Robinson-Walker (2017) suggested as soon as you notice any negative thinking, try saying ‘stop!’ or change it to a positive expression (‘I can do this!’); then refocus back to the task in hand. When you think of your internal voice, talk to yourself as you would a client or a close friend; speak to yourself with respect, based on evidence and facts. Never underestimate the power of negative, or positive, self-talk for setting the tone for behaviour and success.

Moxom and Blinston (2014) suggested that an understanding of your enhanced self-awareness as a leader will encourage you to use that to create a vision that inspires you and that you can then use to inspire others.

A variety of different leadership self-awareness tools are freely available to access via the Internet. The author suggests the following ‘Authentic Leadership Self-Assessment’ questionnaire available from http://people.uncw.edu/not-tinghamj/documents/slides6/Northouse6e%;20Ch11%;20Authentic%;20Survey.pdf as a good starting point for aspiring/novice leaders to gain a little more insight into their own self-awareness. Of course, you need to underpin such resources with a positive self-belief and mind-set. This will give you the confidence to lead. The better you know yourself and trust yourself, the better you will understand why you operate the way you do and what motivates you. Understanding which core trait drives your decisions and attitude is what is most important for increasing the probability for success (Sherman, 2018b).

Personal values

We all have personal values, whether or not we are explicitly aware of them. Such values underpin so many of the judgements we make and the subsequent actions we take, forming our deep, unconscious belief system representing what is important to us. Lussier and Achua (2007) suggested that by understanding our value system, and how it relates to other aspects of our life, we can identify what motivates us and use that to be even more effective at what we do. One benefit of acknowledging our values is to enable us to create boundaries which we will not cross and recognise that we will be affected emotionally if these boundaries are crossed by other people, whether they are in our team, clients or other leaders. Moxom and Blinston (2014) suggested it is important for novice leaders to explore their personal values in order to contribute to a deeper sense of self-knowing, further suggesting that this is essential before we can relate to others — as a leader, a big part of the role involves relating to others.

Relating to others using values

As we can see above, as a leader, being aware of your own values is essential, however, it is also important to be aware of the values of the individuals within your team, and also the values of your organisation. It is likely that at some point in your career you have found yourself in a situation where a colleague or client says something and you experience immediate inner discomfort. Perhaps you found yourself wanting to react to their comment verbally, or you experienced inward mulling over of their words resulting in mixed emotions. You might have even acknowledged afterwards that your inner reaction was indeed disproportionate to the original trigger, which may, to the speaker, have simply been a throw away remark. Such value conflict happens to us all, but as a leader, it is essential that you recognise in these situations what is happening for you or for the person in your team who is experiencing this. Moxom and Blinston (2014) suggested that once there is an acknowledgement that the emotional reaction is being caused by values being challenged, then there are ways this can be overcome so that the conflict can be resolved, rather than being left to potentially fester and affect good working relationships, as was the scenario involving the head veterinary nurse Helen we looked at earlier. It is important to understand that colleagues will not always agree with each other; ideally the individual team member and organisational values will be congruent, however disagreements will always occur. Sometimes, just acknowledging that there has been a challenge to values in a particular relationship is enough. This may enable the persons who have experienced the emotional reaction to logically reason with themselves and understand what has caused the reaction — and then move on. Of course this will not always be the case and conflict management is a skill required by all leaders, however by being able to recognise that a deeper emotional response has arisen due to values being challenged, a leader and staff member may be able to negotiate their way around an issue by recognising that while they disagree on a specific point, there will likely be a bigger value on which they can both agree, which should be keeping the patient and organisational values at the heart of the solution. Conflict may also be avoided by a leader having a clear vision and well-defined outcomes, as this sets up a direction of travel and enables you to stay focused and achieve your goals. If you do not know where you are going, how will you realise when you get there and more importantly, how can you guide, enthuse and lead your team? Moxom and Blinston (2014) suggested that by leaders sharing their vision and staying focused on the well-defined outcomes, each member of the team will likely have an enhanced sense of purpose and teamwork and will be more likely to be fully engaged, working with you to achieve your goal.

A flexible attitude

Having a clear vision and well-defined goals does not mean however that we cannot deviate from this path; on the contrary, the demands of veterinary practice in the 21st century mean that we frequently need to adapt our capabilities and behaviours to meet with new policies, procedures and legislation. By implementing behavioural flexibility, you are better able to adapt and enable your team to adapt to ongoing changes (Lussier and Achua, 2007; Adair, 2009). An effective leader is one who is determined to do whatever it takes within their values framework to achieve success, and if something is not working, evaluate why not and be prepared to do it differently (Moxom and Blinston, 2014).

Change will always bring discontent to some team members, however if a leader respects and understands what is important to their team members, i.e. their values, uses language which motivates them, takes responsibility for the outcome without blaming others, shares their vision with enthusiasm and passion and finally respectfully acknowledges and considers any objections from team members, there is a greater chance of leading the team to success.

Ultimately there will always be occasions when a leader must be tough enough to make difficult decisions that go against public opinion or face strong resistance, but which best serve the overall needs of the organisation. While such decisions may be non-negotiable, they must still be made with sensitivity to the impact and consequences for others in the organisation — failure to do so can erode trust and corrode morale and motivation — at the very time you need it most (Bunker, 2006).

Qualities to look for in an aspiring leader

While some individuals have natural leadership ability, for most people, leadership skills need to be developed and formed over time. As previously discussed, some form of personality profile can be beneficial to provide you with some objective data to consider alongside your own personal values. The information contained in Table 2 is considered some of the core characteristics required in order to foster leadership development.

Qualities to avoid in an aspiring leader

Research conducted by Conners et al (2007) found that it is often the louder and more negative staff member who is given more influence than the quiet, positive leader. Further suggesting that such ‘pseudo-leaders’ demonstrate few of the traits found in positive leaders and as such have a negative influence on the team. Conners et al (2007) suggested such individuals were disorganised and inconsistent, with little follow through; yet they tend to be more vocal and may assemble their own group of followers. Unfortunately, these people are often mistaken for leaders because they influence and ultimately shape the actions of others. Selecting a potential leader with the right qualities is essential as a poor leader in an environment lacking strong positive forces can affect the cohesiveness of the team (Adair, 2015).

Support for aspiring leaders

Within the human medical profession, effective leadership has consistently been linked to improving organisational performance, such as ensuring the quality of care, patient safety and cost efficiency (Warren and Carnall, 2011). Within the veterinary profession, the Vet Futures Report Taking charge of our future (2015) has identified ‘exceptional leadership’ as a key ambition for long-term sustainability of the industry (Royal College of Veterinary Surgeons (RCVS), 2015). The transition to a leadership role can be stressful and difficult because of a lack of preparation or support. This is in congruence with the findings of a recent study undertaken by Pearson et al (2018) which investigated the experience of senior veterinary leaders. One of the findings that emerged from this research was around a lack of preparation and inadequate peer support during their transition into a leadership role. At the level of an individual workplace, there is a need for effective strategies for growing the next generation of leaders ‘in-house’. Effective mentoring programmes and the development of cultures of excellence are areas where managers can play an important role in nurturing and guiding aspiring nurse leaders (Scully, 2014). In response to concerns regarding the number and profile of veterinary nurses stepping forward for leadership roles, the VN Futures Report Taking charge of our future together (2016) identified the need to provide better, more effective training for nurses moving into managerial positions to ensure they have the knowledge and skillset required to meet the challenges this may bring (RCVS, 2016). The report identified the need for leaders to be confident and resilient and be able to galvanise the profession into embracing change. As a result of this, continuing professional development for veterinary nurse leaders is gaining in recognition with more leadership style courses now available. Within the UK, the Veterinary Defence Society has launched the Veterinary Nurse Leadership Programme designed to help people in or aspiring to leadership roles within the profession and the RCVS has developed a 3-year plan known as the ‘Leadership Initiative’ to encourage and support the development of leadership skills for veterinary professionals.

Conclusion

Much of a head nurse's role is to bridge between the business of veterinary practice and the profession of veterinary nursing. Bunker (2006) suggested that by creating a balanced approach to leadership, nurse leaders are in a position to influence the direction of change and the success of transition.

Flexibility and self-awareness equip leaders with the resources they need to ensure ongoing excellence in patient care, however the transition to a leadership role should not be a solo journey. Mentorship and support from management is key in identifying and nurturing the next generation of veterinary nursing leaders. The second part of this article will examine the need for, and the skills required to effectively lead a team.

KEY POINTS