Thursday, 26 May 2016

Sexual expression in long-term care

Roger Watson, Editor-in-Chief

Sexual expression among older people remains a taboo subject and sexual expression among older people in long-term care is virtually ignored.  Yet, as nurses, part of our regular assessment of patients - young and old - is about sexuality; a line we often simply leave blank in assessment forms.

This study from the USA by Syme et al. (2016) titled: 'Recommendations for sexual  management in long-term care: a qualitative needs assessment' and published in JAN aims: 'To conduct a qualitative needs assessment of Directors of Nursing  regarding challenges and recommendations for addressing sexual expression and consent.'  Twenty Directors of Nursing across a range of long-term care facilities were interviewed.  The topics they discussed were  around raising awareness of the issue, educating staff and actually carrying out initial assessments of sexuality.  They also said that national guidelines were required.  One interviewee said: 'I think that level of connection with another human being changes a lot about your demeanor and how you move through life and long-term care is so isolating to begin with. You’ve left your home, you’ve  just enough belongings in a box to take up half of only an 80  foot room and so, so many things are lost and disconnected.  But if we had a better way to maintain intimate relationships with people, that would change the perception of long-term care to some.'  Another said: 'We have to realize that the residents that we have are our primary focus. Family is second. We have to stand our ground when it  comes to what the residents wants versus what the family wants. And at facilities we have to have that ability to stand our ground. To know that, even if somebody took us to court, we have a better chance of winning because we are meeting the needs of the resident.'

As explained by the authors: 'Despite numerous challenges identified, all DONs interviewed in this study were supportive of sexual expression, and they had many suggestions to successfully tackle these challenges, both locally and system-wide. First and foremost is the need to address sexual expression and consent openly in LTC, which has been largely ignored due to issues such as stigma and legal worries.'  In conclusion, they state: 'Sexual expression and consent among LTC residents
can no longer be ignored.'

You can listen to this as a podcast.


SYME M.L., LICHTENBERG P. & MOYE J . (2016) Recommendations for sexual expression management in long-term care: a qualitative needs assessment. Journal of Advanced Nursing doi: 10.1111/jan.13005

Tuesday, 24 May 2016

Recommendations for sexual expression management in long-term care

Maggie L. Syme, PhD, MPH
Peter Lichtenberg, PhD, ABPP
Jennifer Moye, PhD

Syme M.L., Lichtenberg P. & Moye J. (2016) Recommendations for sexual expression management in long-term care: a qualitative needs assessment. Journal of Advanced Nursing. DOI: 10.1111/jan.13005

Intimacy and sexual expression in later life is consistently reported as important to older adults. Also, we continue to engage in intimate and sexual activities across the lifespan, and it continues to provide physical, psychological, and social benefits, regardless of how old you are, where you live, or if you have physical and/or cognitive limitations (DeLamater 2012, Doll 2013, Nay 1992, Syme et al. 2015). Unfortunately, the privileged, and often limited, way in which Western values have framed sexuality has many individuals, healthcare providers, and older adults themselves believing that sexual activity is not for the aged (Bouman et al. 2006, Hinchliff & Gott 2011, Hillman 2012).

Nowhere is this a bigger reality than in nursing home settings. Sex is even more taboo for older adults living in long-term care (LTC) with dementia, and the sexual rights of elderly LTC residents are often unacknowledged (Roach 2004, Frankowski & Clark 2009). This is partially due to difficulties reported in managing sexual expression among LTC residents (Elias & Ryan 2011, Lester et al. 2015). Sexual expression management among long-term care residents is a complex issue for nursing home staff, and there is little to no guidance available for many wanting to follow a person-centered approach. Policies and procedures are needed, and must be usable across long-term care settings.

Balancing challenges of supporting sexual and intimate expression with residents’ rights and autonomy is an ongoing struggle for homes. The purpose of this study is to explore both the challenges LTC facilities face in addressing sexual expression and consent and their subsequent recommendations for improving care.

A qualitative design was followed, with semi-structured interviews were conducted with 20 Directors of Nursing in the spring and summer of 2013. Interview questions prompted them to identify recommendations that address their key challenges to improving sexual expression management within long-term care settings.

Comparative thematic analysis resulted in several codes, which were grouped into eight overall categories. Recommendation categories that addressed key challenges included: address the issue, make environmental changes, identify staff expertise, provide education and training, assess sexuality initially and recurrently, establish policies/procedures for sexual expression management, develop assessment tools for sexual expression and consent, and clarify legal issues. The recommendation to develop national guidelines was observed across categories.

Directors of Nursing report several challenges to sexual expression management within their facilities, and perceive their current methods to be ad hoc versus proactive. They report that residents’ sexual rights should be seen as important, and recommend that more training and tools be provided from the top (e.g., national organization such as Centers for Medicare and Medicaid in the US) down to the local homes.


Bouman W.P., Arcelus J. & Benbow S.M. (2006) Nottingham Study of Sexuality & Aging (NoSSA I). Attitudes regarding sexuality and older people: a review of the literature. Sexual and Relationship Therapy 21(2), 149–161. DOI:10.1080/14681990600618879

DeLamater J. (2012) Sexual expression in later life: a review and synthesis. Journal of Sex Research 49(2–3), 125–141. doi:10.1080/00224499.2011.603168.

Doll G.M. (2013) Sexuality in nursing homes: practice and policy. Journal of Gerontological Nursing 39(7), 30–37. doi:10.3928/00989134-20130418-01.

Elias J. & Ryan A. (2011) A review and commentary on the factors that influence expressions of sexuality by older people in care homes. Journal of Clinical Nursing 20, 1668–1676. DOI: 10.1111/j.1365-2702.2010.03409.x

Frankowski A.C. & Clark L.J. (2009) Sexuality and intimacy in assisted living: residents' perspectives and experiences. Sexuality Research and Social Policy 6(4), 25–37. DOI: 10.1525/srsp.2009.6.4.25

Hillman J. (2012) Sexuality and Aging: Clinical Perspectives. Springer, New York, NY.
Hinchliff S. & Gott M. (2011) Seeking medical help for sexual concerns in mid- and later life: a review of the literature. Journal of Sex Research 48(2–3), 106–117. doi:10.1080/00224499.2010.548610.

Lester P.E., Kohen I., Stefanacci R.G. & Feuerman M. (2015) Sex in nursing homes: a survey of nursing home policies governing resident sexual activity. Journal of the American Medical Directors Association 000, 1–4. doi:10.1016/j.jamda.2015.08.013.

Nay R. (1992) Sexuality and aged women in nursing homes. Geriatric Nursing 13(6), 312–314.

Roach S. (2004) Sexual behavior of nursing home residents: staff perceptions and responses. Journal of Advanced Nursing 48(4),371–379. DOI: 10.1111/j.1365-2648.2004.03206.x

Syme M.L., Cordes C.C., Cameron R.P. & Mona L.R. (2015) Sexual health and well-being in the context of aging. In: APA Handbook of Clinical Geropsychology (Lichtenberg P.A. & Carpenter B., eds), American Psychological Association, Washington, DC, pp.395–412.

Friday, 20 May 2016

Multidimensional symptom clusters: An exploratory factor analysis in advanced chronic kidney disease

Robyn Gallagher, Editor

One of the hallmarks of  chronic diseases is the presence of multiple symptoms, the severity of which increases as the disease progresses or exacerbation occurs. In chronic disease these symptoms often occur together in a relatively predictable way, yet research persistently focusses on single entities such as breathlessness or pain for example. However, the patient experience is of a cluster of symptoms, and it is this cluster that can impact their lives profoundly. In the study by  Almatury et al., the most common clusters of symptoms are identified in patients who have chronic kidney disease and the relative influence of severity, distress and frequency. They found that while some symptoms clustered around distinct aspects of the underlying disease process, such as excess fluid volume, there were other symptoms, such as fatigue, sleep disturbance and restless legs, that were present in several of the clusters. Symptoms did not occur in isolation. This means that clusters of symptoms should not only be assessed comprehensively, and that treatments should aim to by synergistic so that multiple benefits can be experienced. Finally, as patients with chronic disease, as in this study, often have concurrent conditions, treatment of symptom clusters may also benefit patients' experience of other conditions.


Almutary H, Douglas C, Bonner A (2016) Multidimensional symptom clusters: An exploratory factor analysis in advanced chronic kidney disease Journal of Advanced Nursing doi: 10.1111/jan.12997

Wednesday, 18 May 2016

Commentary on Empathy and stress in nurses working in haemodialysis

Comment on: Vioulac C., Aubree C., Massy Z.A. & Untas A. (2016) Empathy and stress in nurses working in haemodialysis: a qualitative study. Journal of Advanced Nursing 72(5), 1075–1085

Nakisha Ice, BSN, RN
The University of Texas at Arlington

The article by Vioiulac et al. (2016) was eye-opening and very true to the past and current issues in the field of dialysis. The chronic haemodialysis setting continues to suffer from increased nurse burnout and turnover due to the demands of the work environment. As an eleven-year dialysis nurse, I have experienced burnout personally and have been impacted by increased rates of nursing turnover. Böhmert et al. (2011) discuss how the lack of knowledge and education related to dialysis contributes to the increased turnover rate of dialysis nurses. Nurses want to be comfortable in their role and feel they are providing safe care to their patients. The field of dialysis has experienced such high rates of nursing turnover the education and orientation to dialysis is little to be desired. The inability to troubleshoot the technical issues and have adequate training on how to handle emergent situations in the dialysis setting increases the stress level of dialysis nurses (Vioulac et al. 2016).

The rising demands and expectations set forth by regulatory entities continue to increase the already heavy workload of haemodialysis nurses. Researching and investigating the demands of companies’ expectations to manage a successful, profitable business while striving to meet the stringent guidelines of federal and state regulations, as well as following a strict budget that requires the dialysis team to provide exceptional quality care based on the bundled reimbursement rate will be beneficial to the field of dialysis. The federal and state guidelines are necessary for quality patient care; however, the implementation and continuous improvement comes with a price. The cost of living fluctuates as does the cost of adequately caring for the end-stage renal disease population. Medication costs increase, employee salaries increase and the overall cost to operate a facility continues to rise. While so many aspects of the business are becoming more costly the expectation of caring for more patients with limited resources tends to be the accepted norm.


Vioulac, C., Aubree, C., Massy, Z. A., & Untas, A. (2016). Empathy and stress in nurses working in haemodialysis: A qualitative study. Journal of Advanced Nursing, 72, 1075-1085. doi:10.1111/jan.1289

Böhmert, M., Kuhnert, S., & Nienhaus, A. (2011). Psychological stress and strain in dialysis staff‐a systematic review. Journal of Renal Care, 37, 178-189. doi:10.1111/j.1755-6686.2011.00236.x

Wednesday, 11 May 2016

Thoughts on International Nurses Day

Cathy Catrambone PhD, RN
President, The Honor Society of Nursing, Sigma Theta Tau International

As a lifelong nurse and nurse educator, I have always respected Nurses Week and International Nurses Day. Throughout my career, I have taken advantage of that day each year to celebrate my profession and the impact it has made on world health. This year continues the theme of Nurses: A Force for Change. And while the official theme concentrates on improving health systems resilience, I think of that in terms of influence.

In my current role as President of the Honor Society of Nursing, Sigma Theta Tau International (STTI), International Nurses Day takes on additional significance. As all STTI presidents before me, I created a Presidential Call to Action to guide my biennium of service; the theme of that Call to Action is Influence to Advance Global Health and Nursing. In my call, I identified four ways that nurses can develop influence through advocacy, policy, philanthropy, and lifelong learning. I believe the theme of influence is relevant to today’s celebration of International Nurses Day, and relevance, when it comes to nurses, can be traced back to one woman.

We celebrate International Nurses Day on Florence Nightingale’s birthday. If you want an example of influence in its purest form, look no further. Florence Nightingale was a woman whose life, work, and writings transformed the profession of nursing and forever impacted healthcare. She was so influential that the humble utilitarian lamp most associated with her has become a time-honored icon of the nursing profession, with its image on countless logos and seals of nursing schools and organizations. If one person can have that kind of influence, imagine the possible influence of millions of nurses today. That’s right – millions. The World Health Organization estimates that there are 19.3 million nurses and midwives woven into every element of healthcare worldwide.
One of the great gifts that my STTI leadership position has afforded me is the opportunity to travel to many regions of the world, from Asia to the Middle East to Europe and Latin America. This summer, I will add South Africa and Australia to that growing list. In every one of my travels, no matter the cultural differences, I have been thrilled to meet passionate, masterful nurses and midwives who care deeply about their profession and their colleagues, but most importantly, about the lives and health of those they serve. They are influencing nursing and healthcare in their own way every day.

Given the global nature of our work, I am delighted to share a new publication that provides a definition of global health and global nursing. I hope this will be useful in providing a framework to guide your work in the many arenas in which we practice and influence.

As I consider the impact that Florence Nightingale made on an entire profession and the world, I think about the vast number of nurses serving in various roles today. I will repeat here what I say in my Call to Action: Now is the time for nurses to leverage our expertise to influence the health of the world’s people and to advance the profession. Happy International Nurses Day!

Residents who thrive in nursing homes

Roger Watson, Editor-in-Chief

We tend to hold negative perceptions of nursing homes and, generally, envisage them as places where older people go simply to die and where there is little hope for them. However, this is not always the case; some older people thrive in nursing homes as this study from Sweden by Patomella et al. (2016) titled: 'Characteristics of residents who thrive in nursing home environments: a cross-sectional study' and published in JAN shows.

The aim of the study was to: 'describe what characterizes residents with higher levels compared with
those with lower levels of thriving in nursing homes using the Thriving of Older People Assessment Scale.'  The study involved 191 older people in one large Swedish nursing home.  They were divided into those with higher and those with lower scores on the thriving scale. Gender and age had no influence on thriving but, as explained by the authors: 'the characteristics of residents reported to have higher levels of thriving in relation to those with lower levels of thriving, it was found that residents with higher levels of thriving were more independent in their ADLs (activities of daily living), had a higher quality of life and had less psychological and behavioural symptoms.'

The authors conclude: 'The study show that independence in ADL, higher quality of life, shorter lengths of stay, ability to walk and spend time outdoors are potential characteristics of residents who thrive in nursing home environments. The study contributes to existing knowledge by showing that the experience of thriving in nursing homes seems to be related to residents’ level of functioning and thereby their possibilities to have a varied everyday life in the nursing home. The findings also contribute by highlighting the characteristics of residents with lower levels of thriving. The findings have some clinical implications. The results can be used by nursing home staff to identify residents in risk of not thriving and also be used to initiate interventions such as outside walks, everyday activities, etc. that can improve the level of thriving in residents.

You can also listen to this as a podcast.


PATOMELLA A.-H., SANDMAN P.-O., BERGLAND A. & EDVARDSSON D. (2016) Characteristics of residents who thrive in nursing home environments: a cross-sectional study. Journal of Advanced Nursing doi: 10.1111/jan.12991

Green gardens are important to older people in residential homes

Roger Watson, Editor-in-Chief

Does it matter if a residential home has a garden? How does that affect the quality of life of residents? In the background to this study the authors say: 'Access to a green outdoor environment may enable psychological distance, engage effortless attention, encourage more frequent visitation and promote resident health.' This study by Dahlkvist et al. (2106) comes from Sweden and is titled 'Garden greenery and the health of older people in residential care facilities: a multi-level cross-sectional study' and published in JAN and aimed to: 'test the relationship between greenery in gardens at residential facilities for older people and the self-perceived health of residents, mediated by experiences of being away and fascination when in the garden and the frequency of visitation there. To examine how these indirect effects vary with the number of physical barriers to visiting the garden.'

Nearly 300 residents in 72 residential homes were questioned about their experiences of gardens and their health. While the effects were moderate, the use of gardens and green spaces increased the feelings in older people of 'being away' and the extent to which older people benefited from green spaces was inversely related to the barriers to access to those spaces. In conclusion, the authors say: 'This study suggests that having more greenery and other natural elements in outdoor spaces at residential facilities for older people will promote experiences of being away and fascination when residents’ go outdoors and that this in turn will promote more frequent visitation and better health. It also appears, however, that such advantages will not be fully realized if residents face multiple barriers to going outdoors. It is therefore important that staff in residential facilities for older people know how residents can realize psychological and physical activity benefits from their garden visits and how barriers to visitation can disallow or reduce those benefits. Moreover, the siting and design of residential facilities should consider the amount of greenery as an important aspect of outdoor space provisions.'

You can listen to this as a podcast.


DAHLKVIST E., HARTIG T., NILSSON A., HӦGBERG H., SKOVDAHL K. & ENGSTRӦM M. (2016) Garden greenery and the health of older people in residential care facilities: a multi-level cross-sectional study. Journal of Advanced Nursing doi: 10.1111/jan.12968

Can e-learning help with medication calculations?

Roger Watson, Editor-in-Chief

Drug miscalculations cost lives.  Nursing students in the UK seem to struggle with drug calculations because they struggle with maths and basic arithmetic.  This may be the result of new schooling methods or simply the demographics of the entrants to nursing programmes, but it has necessitated a great deal of effort by nursing lecturers to set entrance tests for nursing students and to provide remedial support in calculation skills during nursing programmes.

This study from Belgium by Van Lancker et al. (2016) titled 'The effectiveness of an e-learning course on medication calculation in nursing students: a clustered quasi-experimental study' and published in JAN investigates the use of e-learning to help nursing students with drug calculations. The aim of the study was: 'To evaluate the effectiveness of an e-learning course compared with a
face-to-face lecture on medication calculation' and over 400 nursing students were involved and divided between those receiving e-learning and those receiving face-to-face tuition.

The outcome will be disappointing for advocates of e-learning (which is commonly used to support calculation skills) because, while both groups improved, the face-to-face teaching was more effective.  However, there was an interesting observation regarding the type of student: 'The nursing degree was shown to be a predictor of medications calculation skills prior to the course and immediately after the course. Bachelor nursing students had higher skills compared with vocational-level nursing students, which indicates that more efforts need to be made in the vocational-level nursing programme concerning the provision of a medication calculation course, to obtain the same level of final competencies in medication calculation skills in nursing students.'

The authors concluded: 'Both medication calculation courses had a positive effect on medication calculation skills. Students in the control group received a face-to-face lecture and improved significantly more than the students receiving the e-learning program. Further research could focus on the improvement of the medication calculation e-learning programs by including strategies such as repetition, practice exercises, provision of feedback and interactivity.'

You can listen to this as a podcast.


VAN LANCKER A., BALDEWIJNS K., VERHAEGHE R., ROBAYS H., BUYLE F., COLMAN R. & VAN HECKE A. (2016) The effectiveness of an e-learning course on medication calculation in nursing students: a clustered quasi-experimental study. Journal of Advanced Nursing doi: 10.1111/jan.12967

Blog Contest Winner: Emergency nursing leadership shouldn't be traumatic

We were very impressed with the submissions we received to our JAN interactive blog contest on praise and leadership in nursing. Today we are posting the winning entry.

Emergency nursing leadership shouldn't be traumatic
Anna Ballantyne

I clearly remember my first shift in emergency. The nurse in charge greeted me by name and with a warm smile. She said that she would look out for me and affirmed my nursing background as desirable in emergency… she ‘had me at hello’.

When I think about leadership impact, it is the actions and/or words that show trust, belief and respect - these are the things that inspire me, these are the things that ‘keep me going’, and these have had a pivotal impetus in my career. Granted, I was always interested in emergency. Possibly, I am made for it and it for me. The nurses who directly or indirectly said, 'you are good at this', have shaped where and who I am in nursing today.

Soon after that first shift, I was working permanently in the bustling ED. As a junior there, I remember a late shift from hell during which a 6-foot plus aggressive man stepped well into my personal space. Before he had finished his angry rant, before I said a word in response, the team leader stepped in. Literally. He stepped in between the angry man and me and clearly outlined the expected behaviour towards "his" staff. I could have defended my care, but I didn’t have to. This action spoke volumes to me. He trusted my character and my care. I felt protected, encouraged and relieved!

Life is not all roses. A manager once verbally tore strips off me in the front of the team. For my break that afternoon - I snuck outside and privately shed some hot little tears (then wiped my face and returned with my chin up). What was the outcome of that meeting? I knew that the manager hadn’t listened. I realised that it was her stress, thrown at the nearest member of the team. I then tried to avoid having to approach her at all. She lost, in that moment, the opportunity to contribute to my development as a nurse.

Not that leadership avoids the difficult decisions. I have been on both sides of challenging conversations. I have seen recipients of a difficult conversation return to learn more so they can continue bettering their skills. It is so simple when embedded in trust. I remember listening to one of my mentors, amused at his assurance of my ability. In a later discussion, that same nurse made a comment to me regarding care, “that’s not best practice” he said and then kept talking. I thought, ‘he is right’ and changed my practice. I respect the clinical care he gives and I know that he encourages my best in nursing, whether that is in progress or best practice.

I now induct staff into emergency and general nursing. I welcome them warmly. I also teach 'my' team leaders to protect and encourage their team. These people are great nurses who are capable of great things - this is my baseline for leadership and I have learned it from many inspiring colleagues.

Anna Ballantyne is a Clinical Nurse / Clinical Coach specialising in emergency nursing. She mentors nursing staff as they navigate their way through the crazy, exciting world of emergency critical care. Drawing from a career spanning 20 years, Anna reflects that showing kindness in all you do takes great strength and builds strength in yourself and those around you.

Tuesday, 10 May 2016

Blog Contest Finalist: How many nurses does it take to change a lightbulb?

We were very impressed with the submissions we received to our JAN interactive blog contest on praise and leadership in nursing. And we have decided that we will post the top three entries this week. The winner will be posted this Wednesday. We hope you enjoy these posts and are inspired by them.

How many nurses does it take to change a lightbulb?
Liz Charalambous

If you light a lamp for someone else, it will also brighten your path.

I wonder how many nurses does it take to change a lightbulb?

Does it even matter?

In today’s busy healthcare environment, it seems that the most crucial thing is to get the job done, no matter what. Yet teamwork and the support of our colleagues are vital for success. Having started off in nursing over 30 years ago, I have seen leadership styles vary wildly, from autocracy to laissez faire, but two constants that facilitated and enabled me to work at my best, were good leadership and praise. Years ago I would hide in the sluice whenever I heard the clickety-clack of matron’s heels marching down the ward. Such behaviour is hardly surprising when, as a student nurse in theatres, we were routinely ignored and no one spoke up to defend us when the gynaecology surgeons would pause, mid operation, to throw a freshly removed and soggy ovarian cyst our way just for ‘fun’.

Today it is different, with fresh new perspectives. For example, shared governance takes a bottom up democratic approach to leadership and managing change. Instead of working alone in the dark, we can work together to harness bright ideas and take them from ‘ward to board’ where nurses at the front line have become empowered to work with managers to create meaningful change.

We have recently revised the hospital policy to allow open visiting at our Trust. This was in response to the needs of patients and staff, but it would never have happened without the good leadership, praise and kind encouragement of others. It took two years for the glimmer of an idea to be nurtured and kindled by others to burst from a spark to a flame.

Good leadership and praise promote a strong organisational culture and creates a positive climate of confidence. A virtuous circle emerges where engaged and satisfied staff can encourage others to do their best for patients, and in doing so improve care. The team approach ensures that change happens at all layers of the organisation. There is a good chance that involved and happy staff lead to happy and contented patients.

So, how many nurses does it take to change a lightbulb?

The answer is ‘all of them’.

Because by working as a team and breaking down barriers and hierarchical boundaries something magical happens. By encouraging nurses to shine, not only do we become dazzled and motivated by their brilliance, but by working together we can intensify our efforts and so improve the quality of care for patients.

Liz Charalambous is a qualified nurse on a female, acute medical HCOP (Health Care for Older People) ward at Queen’s Medical Centre, Nottingham University Hospital Trust. She is currently working on a doctoral thesis researching volunteerism in dementia and acute hospitals. She tweets as @lizcharalambou

Monday, 9 May 2016

Blog Contest Finalist: Out with the old, in with the new!

We are very impressed with the submissions we received to our JAN interactive blog contest on praise and leadership in nursing. And we have decided that we will post the top three entries this week. The winner will be posted this Wednesday. We hope you enjoy these posts and are inspired by them.

Out with the old, in with the new!
Marci Andrejko

It’s 7:30 am; I greet the night shift with a smile and a chipper “Good Morning”! I am confident and I am ready to start the day, proudly providing care to oncology patients. But no more than a few minutes of attending morning shift report, I quickly become deflated and feel defeated.

I remember my jaw dropping, mostly in disappointment, as our nursing leader sat at the morning shift report table, eagerly ready to point out the unit’s unmet outcomes, with a blind eye to all of the hard work we had done. This strategy was used as way to motivate staff. We, the staff, thought it was offensive. This leader was concerned with only day-to-day operations and how the unit affected her leadership position within the organization. Over time, this leader and the selected motivating style, led to a struggle among staff and teamwork.

The unit was falling apart. Staff was negative and drained. And the health care organization now the viewed the unit as a problem, but recognized that there was a need for change. This recognition created a buzz of talk among staff regarding the possibility of positive change. After patiently waiting, I remember rejoicing upon receiving the news that our unit would soon be welcoming a new leader! My heart felt light with joy, also heavy because this unit was so disconnected.

Our new leader came with hopes for improvement. One-on-one staff meetings were arranged in order to gain an understanding of each individual’s vision for the unit. Goals and barriers were discussed, attitudes were explored, and ideas for the future were shared. Monthly staff meetings were started as way to share the vision and decision-making, as well as the opportunity to reward staff for hard work. Trust was gained and the nursing unit’s environment became positive.

Burns (1978) originally developed the concept of transformational leadership, defined as a process where leaders and followers engage in a mutual process to inspire and raise each other up (Marshall, 2011). This nursing leader came to the unit at a time of crisis with the ability to inspire, instil trust, and successfully share a vision. The nurse leader was able engage staff to follow the change and to become an active part in what was to become something greater. The leader displayed commitment, support, and empathy during the difficult time on the unit. The characteristics of transformational leadership played an important role in the change that was created.

I have become empowered to be a transformational leader. I have now gone beyond my bedside nursing duties by becoming involved in professional organizations and furthering my education through the pursuit of a doctorate of nursing practice (DNP). It’s 7:30 am; I greet everyone I meet with a chipper “Good Morning”! I will not be deflated or defeated!

Marci Andrejko is an Oncology Certified Nurse OCN® She is currently a full-time student attending The Catholic University of America (CUA) in Washington, DC pursing a Masters of Nursing (MSN), Family Nurse Practitioner (FNP) and Doctorate of Nursing (DNP). Prior to attending CUA, Ms. Andrejko worked as a clinical research nurse at the National Institutes of Health (NIH) Clinical Center in Bethesda, MD.


Burns J.M. (1978). Leadership. New York: Harper & Row.

Marshall, E. S. (2011). 'Expert clinician to transformational leader in a complex healthcare organization'. In E. S. Marshall (Ed.), Transformational Leadership in Nursing: From Expert Clinician to Influential Leader (pp. 1-26). New York: Springer.