Nurse Leaders' Role in Promoting Autonomy and Accountability

Rebecca Hendren, for HealthLeaders Media , February 16, 2010

"My job is to help them understand; it's not necessarily my job to help them like it," says Dohmann. "But my job is to help them understand and then give them the autonomy. I say to my nurses all the time, 'keep it legal and keep it safe. Those are the rules. So figure it out.' Nurses at the bedside in our hospital don't want me making decisions about how they practice nursing at the bedside. I don't do it. They do it. I see my job is letting them know what the confines are that they have to live within, and the rest of my job is making sure that I get any barriers out of the way so they can do what they need to do."

Nurses treating one another poorly is nothing new. Dohmann says nurse leaders play a huge role in creating the environment that does not allow bullying. Leaders have to set expectations and hold people to those expectations.

"When you talk about behaviors and how people feel and accountability and autonomy, you have to give people permission to be accountable and autonomous," Dohmann says. "People don't feel autonomous unless you create an environment and give them permission to feel that way."

Nursing leaders must cultivate an environment where nurses can tell them what is working and what is not.

"I want people to tell me what's not going well. I can't advocate for you if you don't tell me what's going on," says Dohmann. "We have to be willing to listen and we have to be willing to hear. More importantly, we have to be willing to do something about what we hear."

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Rebecca Hendren is a senior managing editor at HCPro, Inc. in Danvers, MA. She edits and manages The Leaders' Lounge blog for nurse managers. Email her at

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