CUTTING-EDGE DISCUSSIONS OF MANAGEMENT,POLICY, AND PROGRAM ISSUES IN

EMERGENCY CARE

Authors: Jeff Solheim, RN, CEN, CFRN, FAEN, and AnnMarie Papa, MSN, RN, CEN,CAN, FAEN, Keizer, OR, and Doylestown, PA

Nursing leadership is a challenging and difficult task,especially in these tough economic times. Leaders strug-gle with competing challenges ranging from nursingshortages to budget shortfalls and increasing regulatoryoversight. Many nurses have risen to the challenge andprovide outstanding leadership in the face of these adver-sities. We would like to highlight one of those nurses inthis month’s column. Bev Crum was honored in Balti-more with the Nurse Manager Award. We recently hada chance to speak with Bev and gain some insight intoher journey through nursing leadership and some of thereasons she was selected for this honorable award.—Jeff and AnnMarie

Question:Tell us about your journey through nursing that ultimatelyled you to your current position in leadership.

Bev Crum:I am originally from Ohio, but many years ago, I came toKetchikan, Alaska, to visit a friend. I was immediatelystruck by the scenic landscape and the beauty of the area,including the mountains and the water. At the time,Ketchikan was a small community of only 6000 people,although today it has grown to more than 14,000 people(and that population swells when the cruise ships arrive inthe port). I also fell in love with the community, the wayeveryone cared for one another.

I returned to Ohio but applied for a job in Ketchikanand soon found myself living there. I worked at the localhospital, starting in long-term care, then moving to the

medical-surgical area. In 1979, the emergency departmentwas growing and they needed a manager, so I took the role.I have been working as the ED manager since 1979.

Question:Tell us a bit about the hospital you work in, your depart-ment, the staff you work with, and your typical clientele.

Bev:I work in a critical access hospital in Ketchikan Alaska. Theemergency department has 9 beds, and we have approxi-mately 10,000 visits every year in our department. We havea 29-bed long-term care unit associated with our facility aswell as home health services. We are the only hospital inour community. Currently 18 staff members are workingin the emergency department with me.

Question:What is the greatest challenge that you see facing nursingleaders today from your standpoint?

Bev:As new generations join nursing, one of our challenges is try-ing to understand each other. I am challenged trying to helpthe younger generations become motivated to carry on nur-sing to what I know it to be. When I got into nursing, it wasthere to help people. Nursing has changed today, and helpmeans something different than it used to.We no longer justhelp with a patient’s physical needs; we now have to helpwith education, help triage them to the right spot, and per-formmany other tasks. I am afraid some of the younger gen-erations have lost that original “help”mentality and see whatthey do as a Monday to Friday job.

My role is to help new nurses to see nursing at a dif-ferent level—to help them see frequent flyers and difficultpatients from a different light. I want to help nurses thinkabout how they would want their own families to be caredfor. Ultimately, I want nurses to be proud of what they doand say “I am the nurse in the department and I want tohelp you.”

The opinions expressed are those of the respondents and should not beconstrued as the official position of the institution, ENA, or the Journal.

J Emerg Nurs 2010;36:71-3.

Available online 8 November 2009.0099-1767/$36.00

Copyright © 2010 Emergency Nurses Association. Published by Elsevier Inc.All rights reserved.

doi: 10.1016/j.jen.2009.10.009

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Aside from influencing nursing attitudes, the othergreat challenge we face is being able to provide the servicesthat we want. In the current economy, with challengessuch as pandemic flu, it is difficult to spread out theresources we have to be able to provide the resources wewant. In my department, we not only have to service ourED patients, but we also are responsible for employeehealth, disaster management, and a variety of other areasof responsibility.

Question:What do you believe is the top factor that led to your suc-cess as a nursing leader?

Bev:I do not come to work in a business suit, I wear scrubs. Istill do clinical shifts, help out to relieve lunch breaks,and cover sick calls. The staff appreciates that. I am a dif-ferent level of management. I am still responsible for theactions of the staff, for duties such as hiring, firing, men-toring, and other management duties, but I get to do it ata different level.

Question:Anyone who has been in nursing leadership knows that itcan take a personal toll. What is one secret you can sharethat has helped you maintain your personal identity andlife amongst the challenges of your leadership role?

Bev:I look for the good in everyone. Everyone has somethinggood somewhere. I create a work environment where peo-ple want to work. We have parties for birthdays, we cele-brated when our staff got their Certified EmergencyNurse (CEN) designation. It is a job, but I enjoy comingto work.

Question:Do you have any words of wisdom for nurses who areinterested in pursuing a nursing leadership role?

Bev:Have common sense. It helps not to get tied up in a knotover things. Instead, you have to be able to look at the bigpicture rather than get sucked up into individual things.

Help everyone else see the big picture. I am up frontwith my staff and do not hold any secrets. In turn, Iexpect the same from my staff. They are expected to tellme what is going on so we can work on commonground. For example, if our goal is to have 100% ofour registered nurses obtain their CEN status, I need

to know what we need to do to get there. How can Ihelp the staff get there?

(Note: In 2007, Bev coordinated with the Board ofCertification of Emergency Nursing to bring onsite testingto the community of Ketchikan. She also facilitatedattendance of some of her staff at national ENA annualmeetings to take their CEN examination. As a result, manyof the staff in the Ketchikan emergency department arecurrently certified in emergency nursing, and the goal of100% may soon be realized.)

Question:

What do you personally do to mentor new and upcomingleaders within your department?

Bev:I still wear scrubs and work on the unit when I can. I par-ticipate in new staff orientation regularly. I touch base withthe staff, especially new staff members, to see how thingsare going.

Thanks to the efforts of our local college, we are ableto take 2-year nursing students into our department andkeep a close eye on their development, which has helpedus recruit new nurses.

Question:Do you have any words of wisdom for other nursing lea-ders who are looking to promote professionalism withintheir department?

Bev:Be up front, be confident, and be happy with where youare in your own career. If you are confident and feel goodabout what you have done for patients and staff, it makesyou and the rest of nursing look more professional.

It helps to say, “I am a nurse, I make a difference inmy department, I am the manager.” I feel good and proudabout saying that I am the manager for our department.

Question:Do you have any words of wisdom for other nursing lea-ders who are looking to promote accountability withintheir department?

Bev:Set a standard in the department, share that with the chargenurses and other staff, and have them strive for the stan-dard. Share the significance of why you want to achievesomething, not just that it needs to be done.

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Take charge audits, for example. Communicate that itis more than just checking boxes, but instead explain whythe activity is important and how it will make a difference.Sharing knowledge with others will help with the leader-ship role.

Question:Do you have any words of wisdom for other nursing lea-ders who struggle to complete the demanding workloadassociated with nursing leadership?

Bev:Learn to say “no.” Be able to accept that you can’t alwaysget the job done. Prioritize. I just have to hope that myboss understands that I have competing priorities.

Question:Do you use any sources (on the Internet, books, supportgroups, etc) to assist you in your success as a nursing leader?

Bev:I have belonged to ENA since the early 1980s. I joined justafter I started in the emergency department full time. I

have always looked to the Association and its membersfor help over the years.

Question:If you could say anything you wanted to the staff whoworks with you, what would that be?

Bev:I would like to thank them for all of their hard work, theirdedication, their loyalty, and their eagerness and enthu-siasm to come to work every day. I also want to recognizetheir willingness to be part of the team, to move forward,and to be flexible.

Finally, I want to thank them for the nomination forthe Manager’s award!

Jeff and AnnMarie:Bev, congratulations on your selection for the NurseManager Award, an honor well deserved. It is our hope thatwe can learn from your successes as we strive to improve inour own practice and become the great leaders who willcontinue to take nursing to new heights.

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