Maceration is a common clinical complication that poses challenges in chronic wound treatment.1 Excessive moisture can be trapped on the wound surface, especially when occlusive dressings are overused or when nonbreathable cover dressings are applied for extended periods.
By Lydia Corum RN MSN CWCN
How many wound care coordinators have walked into a patient's room to check on a wound before the patient is discharged only to find that the same dressing originally ordered for the wound is still in place, or there is even no dressing at all? The patient and the family members are wondering what is happening, and the wound care coordinator needs to explain. This happens to wound care nurse coordinators, wound care nurses, and clinical managers all the time. The common problem for those nurses who love wound care is that many others do not share that love. In this blog, I'll be taking a look at nursing leadership and how this can help bring nurses together to form a wound care team.
Leadership Definitions in Nursing and Beyond
There is a large amount of research showing the need to increase the scope of nursing leadership. Nursing leadership is different in many ways to other types of business leadership. Many books have been written to describe leadership styles, how to lead, and what makes a good leader. The definitions for business leadership and nursing leadership can differ, however; according to one definition, "A good leader takes the lead. A good leader has personality, courage, clear vision with ambition to succeed. A good leader encourages the team to perform to their optimum all the time and drives organizational success."1
The definition above looks at a leader as someone with personality, courage, clear vision with ambition to succeed. Below, the definition changes, as a nurse leader is described: "A good nurse leader is someone who can inspire others to work together in pursuit of a common goal, such as enhanced patient care. An effective leader has a distinctive set of personal qualities: integrity, courage, initiative, and an ability to handle stress."2 The nurse leader is more focused on a common goal of patient satisfaction. The nurse leader must have integrity, courage, initiative, and an ability to handle stress. The most important quality for a nurse leader is being a team player.
Another definition that provides an even better understanding of nursing leadership comes from John Maxwell, one of today's top leadership thinkers: "Being a great leader is all about having a genuine willingness and a true commitment to lead others to achieve a common vision and goals through positive influence. No leader can ever achieve anything great or long-lasting all alone."3 The nurse leader needs to understand the importance of leadership and how this will affect not only the world of wound care, but also those nurses feeling the effects of bullying. The old saying, known to many nurses, "Nurses eat their young," is where much of the bullying comes from. Many nurses will refuse to accept new nurses until they have "paid their dues" and achieved what the older nurses determine to be an acceptable amount of experience. Nurse leaders need to work to change this hostile environment and ensure new nurses feel the support of administration as well as fellow nurses.
Creating Culture Change
The way to change an environment is to change yourself. When walking into a room, the wound care coordinator finds the same dressing on the patient from a week ago. She walks into another room and finds a dressing on the patient that is different from the one on the order. She keeps herself from screaming and becoming angry. The better action plan is realize it is the coordinator's job to add value to others. Take the time to ask, "What can I do to make this not happen next time?" Go to the nurse and work together on a plan of action; this could be adding to a shift report or simply printing out the order.
Wound care is a difficult entity to make important to all nurses. Taking the time to ask how to help make things better makes the other person feel valued. With each person feeling more valued, there is an increase in trust as well as the desire to do better. How many wound care nurses in every hospital, facility, and clinic do not feel valued? How many times has he or she felt, "No matter how many lives I change or save, it is not important to the administration"?
The importance of leadership to the nursing world is not often taught, and those nurses who move up to leadership positions often do not have the knowledge or skills to properly understand what is required from them in a leadership role. As John Maxwell has said in many of his seminars, we need to quit microwaving our leaders and start raising them.3 By helping to formulate answers to the question of how to make things better for the patient, the hospital and those that we work with will shine.
Team Creation and Effects
Teamwork in business is very important, and in health care it needs to be a prime order. Creating a team brings nurses together with their love of nursing and allows them to make a difference in policy making. Each employee brings talents, knowledge, and perception of how to improve the hospital or facility. It is always important as a team leader to look at how each member of the team can add value.
The wound care nurse doing her rounds checks the patient's room. When talking with the patient, she finds that the patient knows the type of dressing being used, where it is located, and the days when it will be changed. The wound care coordinator asks how the patient knows this, and the patient proudly says, "My nurse told me and wrote it on the board." When the wound care coordinator goes to the next room, she finds the same thing. What changed in this hospital is that the administration was happy to help the wound care coordinator. A wound care team was created, and the nurses were excited to join. The team discussed the problem and together came up with an action plan. Each member of the committee was happy to make the changes and teach others. A wound care team is not just meeting to learn about staging pressure ulcers or what a wound is—it is becoming active in making changes in the hospital and in each nurse who works there. It is solving problems and improving the lives of patients. Nursing leadership should be taught, encouraged, and promoted.
A nurse leader should be a primary resource for all nurses. As a wound care nurse leader and director, I see encouraging others to become certified and to grow in the love of wound care and the love of my fellow nurses as my goal in life. I hope many others join me in this quest.
1. Management Advisory Service. What Makes A Good Leader. http://www.mas.org.uk/management-advisory-service/what-makes-a-good-lead...
2. Meliniotis C. Effective Nursing Leadership. Elite Healthcare. https://www.elitecme.com/resource-center/nursing/effective-nursing-leade...
3. Maxwell JC. The 21 Irrefutable Laws of Leadership. Nashville, TN: Thomas Nelson; 2007.
Autry JA. The Servant Leader: How to Build a Creative Team, Develop Great Morale, and Improve Bottom-Line Performance. New York, NY: Three Rivers Press, division of Crown Publishing Group; 2004.
Bird D. The Leader's Guide to Emotional Intelligence: Understand and Develop Your EQ for Maximum Leadership Impact. Drew Bird (CreateSpace); 2016.
Covey SR. 7 Habits of Highly Effective People: Powerful Lessons in Personal Change. New York, NY: Simon & Schuster; 2020.
Dyess SM, Sherman RO, Pratt BA, Chiang-Hanisko L. Growing nurse leaders: their perspectives on nursing leadership and today's practice environment, Online Journal of Issues in Nursing. 2016;21(1). ojin.nursingworld.org/MainMenuCategories/ANAMarketplace/ANAPeriodicals/OJIN/TableofContents/Vol-21-2016/No1-Jan-2016/Articles-Previous-Topics/Growing-Nurse-Leaders.html. Accessed October 22, 2019.
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About the Author
Lydia Corum RN, MSN, CWCN has been in the nursing profession since 1996 and has been in wound care for over 15 years. Ms. Corum is currently a Wound Care Coordinator for West Hills Hospital & Medical Center. Having worked as a clinical manager in wound clinics and hyperbaric centers, she has developed a strong passion for education through her positions and within the wound care community at large. Ms. Corum currently has her Masters in Nursing from Keiser University. Her background in multiple care venues and educational roles professionally gives her expertise in a wide range of patient care situations. Her nursing philosophy to "heal wounds as quickly as possible" is the guiding force behind her educational pursuits, both as a teacher and a student.
The views and opinions expressed in this blog are solely those of the author, and do not represent the views of WoundSource, Kestrel Health Information, Inc., its affiliates, or subsidiary companies.