Emergency Nurse: Professional Identity and Stewardship

The interviewed subject works as a head nurse at a hospital emergency department. Her job is to direct any nursing services within the emergency room. Her responsibilities include delegation responsibilities to nursing staff, both emergency and auxiliary. It is also in her duties to maintain emergency room preparedness and supervise any preparation activities, including management of inventory and medical supplies.

Furthermore, she has administrative duties such maintaining patient records, filling out reports, monitoring staff performance, and managing day-to-day operations in the emergency room so that all department goals and budget requirements are met. Although a head nurse has full authority in the department, it is a high-pressure job since she must report directly to top management while balancing the needs of the staff in one of the most high-stress environments in medical care.

Professionalism is best exemplified by strictly adhering to established protocols and guidelines that are defined by nursing practice. This is especially critical in the emergency room where patients may become desperate and staff tremendously exhausted. It creates situations where emotions and conflicts may create barriers to professional care and overall quality of provided treatment. It is necessary to maintain professionalism under pressure so that each patient can be served with the proper attention and respect. Therefore, this aspect of professionalism significantly impacts daily work as it contributes to the attitude and approach that emergency room has to maintain to be efficient.

Leaders working in the hospital are all dedicated stewards of healthcare, from nurse administrators and department heads to the executives. Each leader has a unique set of responsibilities that brings a set of challenges that they are faced with on a daily basis. The interviewee mentioned that before becoming a head nurse, she had a completely different perspective on leadership. She believed that many of the leaders did not consider the needs of the staff or acted on their own accord. However, once acquiring a leadership position, one understands that sacrifices must be made in order to deliver the best care to patients within the strict regulations and the limited budget of the hospital.

It is crucial to balance leadership roles which do require a level of advocacy and authenticity as well as the exertion of influence to ensure things get done. Professional advocacy is required in order to promote the interests of the staff members and authenticity is helpful to form personal connections with the team, both of which are required to maintain a support structure within an organization. However, establishing a rapport with colleagues should not cause a discipline gap which naturally occurs if the staff does not feel the pressure to perform from their leader. A good leader will maintain a positive influence and practice advocacy but will also be able to use power in order to accomplish objectives.

The impression based on the leader’s responses revealed that there were many realities and challenges to leadership that one does not realize until being in that position of power. There is not only a fundamental desire to be an authentic and personable leader to the staff, but also a tremendous pressure to achieve performance targets. It was surprising to see a variation in responses of the peer nurse and the head nurse on the specific roles that professionalism and leadership play in day-to-day operations. Leadership has become a central part of nursing education, but it is rarely able to capture the intricate aspects of the position which goes beyond simple management and delegation of responsibilities.

Leadership, in its relationship to stewardship, is a complex relationship which incorporates a balance of power and partnerships (Grossman & Valiga, 2016). A leader must set expectations through the use of influence and power that seek to address critical multi-variable challenges in operations of the frontline staff. Without strict oversight, the fragmentation and a lack of readiness will result in a decreased quality of care (Armour & Kelley, 2017).


Armour, K. L., & Kelley, M. A. (2017). Enhancing patient throughput and the patient experience using the power of nursing leadership and team engagement. Journal of Obstetric, Gynecologic, & Neonatal Nursing, 46(3), S27. Web.

Grossman, S., & Valiga, T. (2016). The new leadership challenge: Creating the future of nursing. Philadelphia, PA: F.A. Davis.

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