I intentionally chose to be a “dependent practitioner” when I became a PA.  I have always enjoyed being a “right hand man.”  Working as a team, for me,  is more fun than working alone. The medical field is a hierarchy.  There is clearly a chain of command.  Physicians, PAs and NPs write orders.  Nurses, physical therapists, occupational therapists, speech therapists and other allied health members carry out orders.  Ultimately, the physician is responsible for all orders given by the NP or PA.  This chain of command is critically important.  But this hierarchy does not determine value.  I may order IV fluids, but the ER nurse with 20 years of experience is going to carry out this order far better than I will.  The occupational therapy assistant who transfers the patient from the shower to the toilet knows what he is doing.  We all have the opportunity to be excellent at our role.  We all have the opportunity to be a leader in our role.

Recently, I made rounds in a long term care facility.  This facility is challenging because of the residents it serves.  The secure unit serves demented patients with abnormal behaviors along side psychiatric patients with abnormal behaviors.  Nursing turn over is high due to the stress of the job.  In the last year, we have had 6 directors of nursing(DON) come and go through the facility. By law, DONs must be Registered Nurses (RN).  Most of the floor nurses are Licensed Vocational Nurses (LVN), an example of the hierarchy. One particular LVN began to recognize the challenges that led to staff turnover.  This LVN is a natural leader.  She is calm in crisis, professional in her interactions with patients, families and team members and she genuinely cares about the quality of her work.  She has been given the opportunity to serve as the assistant director of nurses (ADON).  Two weeks into this, the seas have calmed, attitudes have changed.  The whole culture of the facility has moved in a positive direction.

Here is my point: there is a hierarchy in the delivery of health care.  But this does not mean leadership only belongs at the top of the chain.  We all have the opportunity to lead in our domain.  And we all have the opportunity to appreciate leadership at every level in the chain of command.  The next time you see a leader leading well, take the time to acknowledge her.  It might be the very inspiration she needs to stay the course!

Leadership is a behavior, not a title!

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