Cutting-edge Discussions of Management, Policy, and Program Issues in Emergency Care

Nursing leadership is a challenging and difficult task, especially in these tough economic times. Leaders struggle with competing challenges ranging from nursing shortages to budget shortfalls and increasing regulatory oversight. Many nurses have risen to the challenge and provide outstanding leadership in the face of these adversities. We would like to highlight one of those nurses in this month's column. Bev Crum was honored in Baltimore with the Nurse Manager Award. We recently had a chance to speak with Bev and gain some insight into her journey through nursing leadership and some of the reasons she was selected for this honorable award.—Jeff and AnnMarie

Question:

Tell us about your journey through nursing that ultimately led you to your current position in leadership.

Bev Crum:

I am originally from Ohio, but many years ago, I came to Ketchikan, Alaska, to visit a friend. I was immediately struck by the scenic landscape and the beauty of the area, including the mountains and the water. At the time, Ketchikan was a small community of only 6000 people, although today it has grown to more than 14,000 people (and that population swells when the cruise ships arrive in the port). I also fell in love with the community, the way everyone cared for one another.

I returned to Ohio but applied for a job in Ketchikan and soon found myself living there. I worked at the local hospital, starting in long-term care, then moving to the medical-surgical area. In 1979, the emergency department was growing and they needed a manager, so I took the role. I have been working as the ED manager since 1979.

Question:

Tell us a bit about the hospital you work in, your department, the staff you work with, and your typical clientele.

Bev:

I work in a critical access hospital in Ketchikan Alaska. The emergency department has 9 beds, and we have approximately 10,000 visits every year in our department. We have a 29-bed long-term care unit associated with our facility as well as home health services. We are the only hospital in our community. Currently 18 staff members are working in the emergency department with me.

Question:

What is the greatest challenge that you see facing nursing leaders today from your standpoint?

Bev:

As new generations join nursing, one of our challenges is trying to understand each other. I am challenged trying to help the younger generations become motivated to carry on nursing to what I know it to be. When I got into nursing, it was there to help people. Nursing has changed today, and help means something different than it used to. We no longer just help with a patient's physical needs; we now have to help with education, help triage them to the right spot, and perform many other tasks. I am afraid some of the younger generations have lost that original “help” mentality and see what they do as a Monday to Friday job.

My role is to help new nurses to see nursing at a different level—to help them see frequent flyers and difficult patients from a different light. I want to help nurses think about how they would want their own families to be cared for. Ultimately, I want nurses to be proud of what they do and say “I am the nurse in the department and I want to help you.”

Aside from influencing nursing attitudes, the other great challenge we face is being able to provide the services that we want. In the current economy, with challenges such as pandemic flu, it is difficult to spread out the resources we have to be able to provide the resources we want. In my department, we not only have to service our ED patients, but we also are responsible for employee health, disaster management, and a variety of other areas of responsibility.

Question:

What do you believe is the top factor that led to your success as a nursing leader?

Bev:

I do not come to work in a business suit, I wear scrubs. I still do clinical shifts, help out to relieve lunch breaks, and cover sick calls. The staff appreciates that. I am a different level of management. I am still responsible for the actions of the staff, for duties such as hiring, firing, mentoring, and other management duties, but I get to do it at a different level.

Question:

Anyone who has been in nursing leadership knows that it can take a personal toll. What is one secret you can share that has helped you maintain your personal identity and life amongst the challenges of your leadership role?

Bev:

I look for the good in everyone. Everyone has something good somewhere. I create a work environment where people want to work. We have parties for birthdays, we celebrated when our staff got their Certified Emergency Nurse (CEN) designation. It is a job, but I enjoy coming to work.

Question:

Do you have any words of wisdom for nurses who are interested in pursuing a nursing leadership role?

Bev:

Have common sense. It helps not to get tied up in a knot over things. Instead, you have to be able to look at the big picture rather than get sucked up into individual things.

Help everyone else see the big picture. I am up front with my staff and do not hold any secrets. In turn, I expect the same from my staff. They are expected to tell me what is going on so we can work on common ground. For example, if our goal is to have 100% of our registered nurses obtain their CEN status, I need to know what we need to do to get there. How can I help the staff get there?

(Note: In 2007, Bev coordinated with the Board of Certification of Emergency Nursing to bring onsite testing to the community of Ketchikan. She also facilitated attendance of some of her staff at national ENA annual meetings to take their CEN examination. As a result, many of the staff in the Ketchikan emergency department are currently certified in emergency nursing, and the goal of 100% may soon be realized.)

Question:

What do you personally do to mentor new and upcoming leaders within your department?

Bev:

I still wear scrubs and work on the unit when I can. I participate in new staff orientation regularly. I touch base with the staff, especially new staff members, to see how things are going.

Thanks to the efforts of our local college, we are able to take 2-year nursing students into our department and keep a close eye on their development, which has helped us recruit new nurses.

Question:

Do you have any words of wisdom for other nursing leaders who are looking to promote professionalism within their department?

Bev:

Be up front, be confident, and be happy with where you are in your own career. If you are confident and feel good about what you have done for patients and staff, it makes you and the rest of nursing look more professional.

It helps to say, “I am a nurse, I make a difference in my department, I am the manager.” I feel good and proud about saying that I am the manager for our department.

Question:

Do you have any words of wisdom for other nursing leaders who are looking to promote accountability within their department?

Bev:

Set a standard in the department, share that with the charge nurses and other staff, and have them strive for the standard. Share the significance of why you want to achieve something, not just that it needs to be done.

Take charge audits, for example. Communicate that it is more than just checking boxes, but instead explain why the activity is important and how it will make a difference. Sharing knowledge with others will help with the leadership role.

Question:

Do you have any words of wisdom for other nursing leaders who struggle to complete the demanding workload associated with nursing leadership?

Bev:

Learn to say “no.” Be able to accept that you can't always get the job done. Prioritize. I just have to hope that my boss understands that I have competing priorities.

Question:

Do you use any sources (on the Internet, books, support groups, etc) to assist you in your success as a nursing leader?

Bev:

I have belonged to ENA since the early 1980s. I joined just after I started in the emergency department full time. I have always looked to the Association and its members for help over the years.

Question:

If you could say anything you wanted to the staff who works with you, what would that be?

Bev:

I would like to thank them for all of their hard work, their dedication, their loyalty, and their eagerness and enthusiasm to come to work every day. I also want to recognize their willingness to be part of the team, to move forward, and to be flexible.

Finally, I want to thank them for the nomination for the Manager's award!

Jeff and AnnMarie:

Bev, congratulations on your selection for the Nurse Manager Award, an honor well deserved. It is our hope that we can learn from your successes as we strive to improve in our own practice and become the great leaders who will continue to take nursing to new heights.