Running head: LEADERSHIP IN A COMPLEX SYSTEM
Being a Nurse Practitioner in a Complex Adaptive System
Maria-Idalia O. Lens, RN, PHN, MSN, NP-C
University of San Francisco
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Running head: LEADERSHIP IN A COMPLEX SYSTEM
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Being a Nurse Practitioner in a Complex Adaptive System
Gastroenterology Suite
The gastroenterology suite comprises of three sedation rooms for colonoscopy and upper
endoscopy procedures and two non-sedation rooms for sigmoidoscopy along with two exam
rooms. The department has four gastroenterologists, one nurse practitioner (myself), twelve
registered nurses, three licensed vocational nurses, and six medical assistants. As you enter in
the department in the morning it is calm and quiet, however, as the day progresses it becomes
chaotic. In this department there are two different kinds of models for working style. One group
of people works as a team. This group gets along well and have the same type of mentality and
work ethics. They come to work on time, work collaboratively, and respect each other. The
other group is in team me; they do things their own way, show no respect for certain individuals,
express anger frequently, and decreased job satisfaction. These types of working models go with
how the ambience is in the department. It is very noticeable who is part of the team and who not.
Both of these groups sometimes collide and the end result is conflict. When the team feels
abused from individuals who are not part of the team, they get annoyed and start ignoring each
other people and it happens in front of members of the organization as well as other employees.
The gastroenterology suite is a small area with many people, that when chaotic times arise we
have these different personalities collide that can affect or workflow.
The gastroenterology suite is a very complex adaptive system. We recently have hired a
new manager, and the manager wants to bring in change but does not involve the keys players to
make any suggestions. If any suggestion is not the managers than it is wrong and our ideas are
not considered. For instance, we are trying to figure out why we have high cancellation rates.
We have concluded as a group that it is the co-payment as well as the preparation for the exam.
Running head: LEADERSHIP IN A COMPLEX SYSTEM
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We wanted to pilot a preparation that is used at other facilities within our organization to see if
this improved the high cancellation rates. However, the manager shot down our idea quickly.
We were confused because we were asked to brainstorm but not allowed to try at least a change.
I found this to be conflicting since we are expected to grow and change along with healthcare but
we are being halted the minute we try because it is not the manager’s idea but ours. This brings
us down and makes us loose any hope we had to make any changes and be a part of it.
Model of what the top-level key players do, and what it looks like at our facility. We do not
work together as we should. Orders come from above and then down the chain of command.
I wish that we had a different model like the spider web where everyone is connected and
intertwined. I wish that everyone liked chaos, because as Whealty (2006) stated in her book
Leadership and the New Science, “Chaos has always partnered with order-a concept that
contradicts our common definition of chaos”. This is very true, older generations like the baby
boomers are set in stone, while younger generations like the Y and X generation have been more
Running head: LEADERSHIP IN A COMPLEX SYSTEM
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laid back and has learned to adapt. People who are strange attracters are the people who grab my
attention are the people who are the opposite of me. They are the people who talk to the team and
the others who are not part of it. They are energetic and full of life and can always make anyone
laugh. They act silly when appropriate and are never stressed out. They sort of roll with the
punches as they come. I am attracted to people who are different as well the team players in the
department.
There are different systems in place since there are different leaders. We have a manager,
the chief of the department, and the charge nurse which all have different leadership styles. A
common reaction from the leadership style, which is an authoritative one, leads to an abuse of
power as stated in Porter-O’Gardy and Malloch’s (2007) book Quantum Leadership. Abuse of
power is toxic and makes everything crumble. It is also very transactional, just because one
person is being paid it does not mean we do anything that is asked of us. We get asked to jobs
that are not part of our job description and at times hear that other people get asked to do things
out of their scope of practice. One nurse has retired from the gastroenterology department,
another nurse has transferred to another facility, and another nurse has refused to work extra
anymore. Team members leaving has caused a decrease in morale in the department and nurses
are stating they feel burnt out since they have to pick up the pace and do more work since the
positions that were vacated have not been filled. When employees feel belittled or not respected
then they will leave and it will make our department suffer. However, our chief of the
department is the opposite of our manager, very energetic and open to suggestions and to at least
try new ideas before giving up. He is authentic and transformational he is willing to listen to
new ideas and talk it out. The chief has been able to show that he cares he was excited to write a
recommendation letter for me for the doctorate nursing program and also expressed hi empathy
Running head: LEADERSHIP IN A COMPLEX SYSTEM
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when I was injured from my shoulder. The charge nurse’s leadership style is to be avoidant. She
says that she has given up trying because it is not worth it anymore. It makes me upset that
someone has started to dislike their job because certain leaders decreased their morale.
Herzlinger (2006) points out in her article healthcare is being run through a business model when
it should not because we are dealing with people’s lives not products, also all the players we
have involved everyone has an idea on what should happen and how it will happen. In addition,
with the latest economic downturn money has halted a lot of projects.
During lunch we talk and gossip about our manager, everyone does even our chief, we
have a hard time giving her any trust because we notice her leadership style and her lack of
authenticity. I was told that I am not allowed to drink or eat in my office even though it is not a
patient care area and was told previously that it was okay to eat and drink in my office from the
director of nursing. During meetings we talk about the same issues every month, when are we
going to replace the nurses who left or transferred? We recently found out that the positions
were not allowed to be posted. This affected the nurses’ moral, because they want us to increase
productivity with fewer nurses than before. We all understand that this is not the managers fault
but we are starting to feel unappreciated.
In our department I see different networks and relationships. Many have been able to
build friendships beyond work including myself. We go out to eat, movies and socialize. The
nurses usually stay friends with each other and the medical assistants with each other as well.
On the other hand I have been able to build relationships with both groups. I try to be respectful
of other peoples job and not let it be about hierarchy.
Running head: LEADERSHIP IN A COMPLEX SYSTEM
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Complexity Science
Linearity is an enormous issue in or department. Top leaders believe that everything will
go in sequence when it clearly does not. There is more than one way to get an end result.
Another issue is the idea of tribalism. This type of thought or behavior has been around for as
long as humans been alive. People separate themselves at work from one another according to
job classes. Administrators with administrators, nurses with nurse, and etc… This behavior
should change but has never occurred, it is something that everyone falls into. Something that
has also lead to issues is the outbreak of an epidemic, H1N1 lead to crucial contact precautions in
all health care institutions. It led to the education of many members of the organization and the
staff itself. However, it also led to panic among many providers, because employees were
wearing masks and walking around everywhere with these masks, a great emphasis was put on
correct proper hand hygiene and increase use of antibacterial products. As mentioned by Bennis,
it takes four things that impact and change leadership which is threats to stability, pandemics,
tribalism, and leadership styles. After looking over the Burns (2001) article I do not believe
there are any leadership principles in my workplace, we are not given any authority to make
decisions, there is a vision but not the same vision for everyone, people do not see chaos as a
positive contributor to change, and our leadership is set in one direction which is from the top
down. I plan to adapt to change and see the world through a lens of complexity and use the
McDaniel model, where things are unpredictable and unknowable. I plan to tune the edge by
mixing our groups at work, have everyone work collaboratively. I have already set myself in the
world of the director of nursing at work and have managed not to burn bridges with her but build
them. All these principles will build on each other and lead to overlap and hopefully unity.
Running head: LEADERSHIP IN A COMPLEX SYSTEM
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Leadership Skills
I see how our chief of the department has a vision of being able to target everyone and
has a strategy plan to tackle colon cancer screening. By seeing his enthusiasm he has drawn me
in and has made me a key player by putting in referrals for members who have not been screened
or missed by their primary care providers. I see a leader that has committed him self to a task
and therefore I have decided to commit as well. By joining the nurse practitioner committee I
have seen the chair of the committee show how encouraging she is, she shows how much she
cares about her patients in the pediatrics department. She is also chair of the California nurse
practitioners association. This has shown me how committed she is to the profession and how
dedicated she is in taking time of to go to capitol hill and testify on behalf of nurse practitioners
so our practice can be expanded. This inspires me and also makes me feel elated that nurse
practitioners that are working care about their job and it is not only a job to pay their bills but
part of them. Her vision inspires me to be more passionate about what I would like to see in the
future.
At work I plan to model the way, by being able to show that I can work with management
to get something that I clearly care about. I met with the director of nursing practice and have
joined the quality committee at work to show that I do care about safety and quality because it
does impact all of us. I plan on being honest with my committee peers and how we can stand out
as a group. I have expressed my desires to do more for the facility and to tackle the dreaded
medication reconciliation debate and press how primary care providers can benefit from this and
how easy it can be with the new upgrades to our electronic medical records. I hope that I am
able to inspire my shared vision. Through my shared vision I have been able to enable others to
act. The committee chair and the regional committee member are excited to start on this new
Running head: LEADERSHIP IN A COMPLEX SYSTEM
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project and have agreed to be part of it. By showing my honesty with the group I believe it has
encouraged others to also be more open to a new member in the committee and open to try new
things. “Leadership is the art of mobilizing others to want to struggle for shared aspirations” as
stated by Kouzes and Posner in the book, The Leadership Challenge (2008).
Summary and Evaluation
This class has changed who I am and I have learned to be more calm and be able to
accept things the way they are. I have decided to share my vision and was able to build a
relationship with my director of nursing practice at my organization. I am learning to work on
projects more collaboratively then before and have noticed changes. More doors have opened
up. The most frustrating thing about this experience is being able to see leadership styles that do
not work and the consequences from it. Many staff members as mentioned before have
transferred or retired. I wish they can do more but as an employee it is hard to change old ways I
am only one person. My best moment in this class was that no matter what organizations you
work for they all have the same problems. All of these problems are related to different systems
and leadership styles. Employees are not given much room to be creative and be innovative even
though we live in an innovative era. We need to establish trust and confidence in people and
then we will be able to see change, improvement, and an increase in morale.
Running head: LEADERSHIP IN A COMPLEX SYSTEM
References
Bennis, W. (2007). The challenges of leadership in the modern world. American
Psychologist, 62(1), 2-5.
Burns, J. (2001). Complexity science and leadership in health care. Journal of Nursing
Administration, 31(10), 474-482.
Herzlinger, R. (2006). Why innovation in health care is so hard. Harvard Business Review, 5866.
Kouzes, J.M. & Posner, B. Z. (2008). The leadership challenge 4th ed. San Francisco: JosseyBass.
Porter-O’Grady, T. M., K. (2007). Quantum Leadership: A resource for health care innovation
(2nd ed.). Sudbury, Massachusetts: Jones and Bartlett Publishers.
Wheatly, M. J. (2006). Leadership and the new science: Discovering order in a chaotic world
(3rd ed.). San Francisco, CA: Berrett-Koeler Publishers.
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