NR 446 Week 6 Democratic Leadership Style Analysis Example

Leading by Asking: A Democratic Leadership Style Tested on a Medication Pass and a Stalled Safety Check

Student Name

College of Nursing, Chamberlain University

NR 446: Collaborative Healthcare

Instructor Name

Month Day, Year

Leading by Asking: A Democratic Leadership Style Tested on a Medication Pass and a Stalled Safety Check

The Claim

I lead from a staff nurse position in a democratic style: when I want something on my unit to change, I ask the people who will have to do it how it should work, and I build the change out of their answers. This paper defends that description with two situations from the past year, one where the style worked and one where it cost my patients time, and it ends with what the style buys and what it gives up.

Three Styles, Defined by What They Do Under Pressure

The classic studies by Lewin et al. (1939) compared three leadership climates in groups of children and found that each produced a different kind of group under strain. In an autocratic climate the leader decided alone; work got done quickly while the leader was present and fell off when the leader left. In a democratic climate the leader involved the group in decisions; work was slower to start but continued without the leader and produced less hostility. In a laissez-faire climate the leader gave little direction, and the group produced the least. Marquis and Huston (2021) translate these into nursing terms: autocratic leadership is efficient in a crisis and costly to morale over time, democratic leadership builds commitment and takes time, and laissez-faire leadership can suit a highly skilled, self-directed team but fails when a team needs direction. For a staff nurse without authority to direct peers, the useful comparison is between the first two, because a staff nurse can try to tell or can try to ask.

Where the Style Worked: The 2100 Medication Pass

Last spring our unit's medication error reports showed that most errors happened during the 2100 medication pass, when nurses were interrupted repeatedly by call lights, phone calls and questions. Westbrook et al. (2010) found that each interruption during medication administration was associated with a higher risk of error, and our reports fit that pattern. I wanted to reduce interruptions, but I had no authority to change anyone's work. Rather than bring a finished plan to the staff meeting, I asked every nurse on nights, over two weeks, the same three questions at the end of their shift: what interrupted you tonight, which of those interruptions could have waited, and what would make it easier for people to wait?

The answers shaped the plan. The nursing assistants said they interrupted because they did not know which nurse was in the middle of a medication pass. The unit clerk said she forwarded calls because she had no way to hold them. The nurses said they did not want to wear the red vests used on another unit because patients found them alarming. The plan we built together used a small sign clipped to the medication cart that said medication pass in progress, a rule that the clerk would hold nonurgent calls for 15 minutes, and a list agreed with the nursing assistants of what counts as urgent. Because the plan was theirs, people used it. Over the next three months the night shift reported fewer interruptions in a weekly two-night tally, and the nurses who had helped design it corrected colleagues who forgot the sign. The style worked because the change depended on the cooperation of people I could not direct, and asking them first made the change theirs.

Where the Style Did Not Work: The Heparin Double Check

In the fall, a near miss on our unit involved a heparin infusion started at the wrong rate; a second nurse caught it at the next hourly check. Our policy already required an independent double check at the bedside for every heparin rate change, but I knew from watching that the check was often done at the medication room computer rather than at the pump. I took the same approach as with the medication pass. I asked colleagues why the bedside check was skipped and how to make it easier. The conversations took three weeks. People had thoughtful answers, mostly about how long it took to find a second nurse, and I began building a plan around a buddy system for heparin checks.

During those three weeks, the check kept being skipped, and a second heparin rate error reached a patient, who needed an extra partial thromboplastin time check and a paused infusion but was not harmed. Looking back, this was not a situation for building consensus. The bedside double check was already policy, the evidence for it was not in question, and the gap was compliance with a safety rule. What the situation needed from me was to say plainly, at the next huddle and to the charge nurse, that the check was being done in the wrong place and that it had to be done at the pump starting that night, and then to ask for ideas about making it faster. I reversed the order because my style prefers asking, and patients waited while I asked.

What My Style Costs

Democratic leadership buys commitment. People follow a change they helped design, and they keep following it when I am not on shift, which is what Lewin et al. (1939) observed decades ago. It pays for that commitment with time and with clarity. When the answer is already known, consultation delays it and can make a firm rule sound negotiable. Bass and Riggio (2006) describe effective leaders as able to move between approaches depending on the situation, and the heparin check showed me that I do not move easily. My tendency is to ask even when I should tell, partly because I am more comfortable asking and partly because, as a staff nurse, telling a peer what to do feels like claiming authority I do not have. That discomfort is real, but a safety rule does not become optional because the person reminding others of it is a peer.

Two Behaviors to Develop

First, when a problem involves an existing safety policy that is not being followed, I will state the expectation at the next huddle before asking for ideas, using a sentence that begins with the policy and ends with starting tonight. The test will come the next time I see a required check skipped. Second, when I do choose to consult, I will set a deadline at the start, for example asking for input for one week and then deciding, so that consultation does not become open-ended. I will know whether I kept both commitments by writing down, for each change I lead in the next six months, which approach I chose, when I decided and how long it took, and reviewing that list with my charge nurse at my next evaluation.

References

Bass, B. M., & Riggio, R. E. (2006). Transformational leadership (2nd ed.). Lawrence Erlbaum Associates.

Lewin, K., Lippitt, R., & White, R. K. (1939). Patterns of aggressive behavior in experimentally created "social climates." Journal of Social Psychology, 10(2), 269-299. https://doi.org/10.1080/00224545.1939.9713366

Marquis, B. L., & Huston, C. J. (2021). Leadership roles and management functions in nursing: Theory and application (10th ed.). Wolters Kluwer.

Westbrook, J. I., Woods, A., Rob, M. I., Dunsmuir, W. T. M., & Day, R. O. (2010). Association of interruptions with an increased risk and severity of medication administration errors. Archives of Internal Medicine, 170(8), 683-690. https://doi.org/10.1001/archinternmed.2010.65