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What is the peer review of this paper Leadership is the method by which a person effects a group of others to accomplish a common goal (Cummings et al., 2018). The American Organization of Nurse Executives (AONE) breaks down nurse leadership into five competencies: Communication and relationship building, knowledge of the healthcare environment, leadership, professionalism, and business skills. All five of these are foundational for effective leadership. I believe Kylee, the Heart Vascular Unit manager at Medical City Denton, exhibits an effective nurse leader’s characteristics. I appreciate her relationships with the nurses on the unit. Effective communication and good relationship development are building blocks for any nurse leader. Communication takes on many forms, from body language to typed information, and dramatically affects the other nurse leader competencies of leadership and professionalism. Communication competency assists in governing conflicts, reducing emotional labor for nurses, reducing anger, and improving mental wellness while decreasing burnout and improving organizational commitment and job satisfaction (Yu & Ko, 2017). Nurses can enhance competency with curriculum and courses designed to train nurses in self-assertion and self-expression, especially for new nurses improving commitment to their facility and leaders (Yu & Ko, 2017). Nurse leaders should be able to assert their views without making others feel threatened or judged. The first description that I was given about my manager, Kylee, was that she was extremely approachable. As a newer nurse, those words meant a lot about her relationship with those she was managing and her communication skills, and how she would influence my behavior and the behavior of my peers. She built credibility by being timely and thorough with response times in personal communications with me. She also builds academic relationships with nursing programs by providing skilled nurses for students to learn from each week. Knowledge of the health care system involves leaders having knowledge in areas such as clinical practice, health care policy, evidence-based practice (EBP), patient safety, and risk management (AONE, 2015). Regarding EBP, Kylee regularly posts information such as central line-associated blood stream infection (CLABSI) rates in places that nurses and staff can see how the unit is collectively doing. For CLABSI prevention, our department does chlorhexidine baths for patients who have central lines at least every 24 hours because EBP has shown it reduces infection rates. Patient safety is also affected by the mental health of the nursing staff. The healthcare environment is improved when leadership is mindful of any intrapersonal strain of the unit’s nurses and staff. Patient safety and the quality of care provided by nurses can be affected by interpersonal stress among co-workers and managerial staff, causing adverse behavior modifications (Zaghini et al., 2020). Zaghini et al. also found that a nurse’s negative perception of their leadership correlates with cynicism, and the perception of patients’ quality care declines (Zaghini et al., 2020). Foundational thinking skills, personal journey disciplines, systems thinking, succession planning, and change management are vital parts of successful leadership (AONE, 2015). Leadership styles influence job satisfaction and burnout (Cummings et al., 2018). Kylee takes on a coaching model of leadership. She motivates her nurses to achieve goals, both as a unit and personally. I quickly learned that each shift might have one change nurse on the floor, but there are many others trained that can fulfill the position. My preceptor was recently trained in this role, not because there is a need to be filled, but because of the opportunity for her career growth. While she can adapt her leadership style to meet the unit’s situational needs, she excels in communication and allows others to take on new challenges. Personal and professional accountability, career planning, ethics, and advocacy are represented in the concept of professionalism (AONE, 2015). Overall, Hospital Corporation of America (HCA) seems to place a high value on professionalism, especially in education. HCA helps their nurses continue their education with tuition reimbursement plans and debt repayment for student loans. As nurses, we should never stop learning, but HCA promotes leadership with higher education incentives. Even though nurses are only required to achieve a bachelor’s degree in nursing, several nurses on my unit are in pursuit their masters or doctorate degrees. Promoting nurses in their professional growth fosters and maintains a healthy work culture and reduces nurse burnout, this reducing nurse turnover and increasing health care quality and patient safety (Wei et al.) The business skills competency consists of financial management, human resources management, strategic management, and information and technology management (AONE, 2015). “Contemporary health care leaders must juggle value-based care delivery priorities and patient satisfaction metrics, and conform to regulatory and contractual obligations while simultaneously meeting productivity targets” (Waxman and Massarweh). A lot of this balancing act is dictated by HCA to Kylee. Her largest budget item is nurse staffing, and that changes hour by hour. She keeps up with budgeting on a daily and monthly basis. The formula for calculating for staff is communicated to charge nurses as part of their training. They make adjustments for how many nurses should be staffing the floor and when to call someone in or send someone home. If transfers are anticipated from the intensive care unit or admissions from the emergency department, staffing will remain the same. If patients are being discharged but no transfers or admissions are anticipated, the patient care tech might go home, and an RN will carry out those duties. To be budget-conscious, nurses working overtime or from an agency go home first. Kylee also determines how many interns she can budget for training. The training lasts for three months. Interns are paid salaries similar to patient care techs, not RNs, to make their training more affordable. HCA is a for-profit business, so, understandably, they do not want to pay for more staffing than is necessary. As a coaching leader, Kylee is supportive and motivating. She also makes an exceptional mentor. She is also disarming and easy to talk to. This style of management works very well on our unit as a useful leadership model. I anticipate that is why the turnover rate is lower than in other areas of our hospital. Transactional forms of leadership that are more task-oriented would not be as effective. However, transactional leadership has been shown to correlate with improved job satisfaction and some areas of positive relations among staff (Cummings et al., 2018). My leadership assessment revealed that I am a democratic, participative leader. I am strong in goal setting, guiding team decisions, and making final decisions. I understand that everyone has valuable insight in to process and consult frequently. I struggle with conflict personally and professionally and should develop greater conflict resolution skills, which the coaching leadership more readily uses. With time, I would grow more confident as a leader. Confidence is something that Kylee already possesses. She is vested in understanding the motivations of her nurses. As an individual I want to understand other’s motivations as well, especially those that I work so closely with. I feel as though I am too new of a nurse to improve upon her leadership. One advantage that I do to offer is life experience. Kylee is younger than me, so she has not attained that yet. While that is not a leadership style, it could benefit any leadership style if you are still teachable. Nurses on our unit are very loyal to her and her leadership. There could potentially be a negative consequence of this loyalty that I have noticed. Some, not all, nurses do not take their lunch breaks the way they are intended. They eat lunch while working and then go clock out for half and keep working. I often use my lunch break for working on school. Last week, I was encouraged to go ahead and clock out for “lunch,” even though I never got a break. When I questioned the process, I was informed that it helped Kylee and her management of the unit. Hopefully, with experience, I will develop better time management, be quicker at my tasks, and take scheduled breaks without any issues. Currently, my pay is the same whether I clock out or not, so I did not affect that day’s budget, but soon I will be paid hourly.

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