What Makes a Leader? It Might Not Be What You Think

ONS member Marlon Garzo Saria, PhD, RN, FAAN, is a major in the U.S. Air Force, serving as the assistant chief of nursing services at the 452nd Aerospace Medicine Squadron in the March Air Reserve Base in California. He’s held many leadership roles in ONS, including chapter president; ONS Congress^TM planning team, Steering Council, and Oncology Nursing Certification Corporation nominating committee member; and secretary for the Board of Directors, and he currently serves as a Leadership Development Committee (LDC) member.

“I have always thought of leadership as the art and science of influencing individuals. Since joining the military, I have added mission accomplishment to that definition,” Saria, director of clinical education and professional practice at Providence Saint John’s Health Center in Santa Monica, CA, and member of the Greater Los Angeles and South Bay ONS chapters, said. “In nursing, the mission could include organizational metrics like quality measures or individualized patient goals like gradual increase in exercise to manage cancer-related fatigue.”

ONS member Anna Liza Rodriguez, MSN, MHA, RN, OCN^®, NEA-BC, chief nursing officer and vice president of nursing and patient care services at Fox Chase Cancer Center in Philadelphia, PA, and member of the Middle Tennessee ONS Chapter, agreed. And she’s put thought into practice through ONS too, as an outgoing LDC member and in 2019’s Leadership Development Think Tank.

“Leadership to me is the ability to inspire, motivate, and lead the team toward achieving a common purpose or goal,” Rodriguez said. “Nurse leaders must not only have clinical skills and expertise but also competencies in operations, business, and financial management. They need to be comfortable holding teams accountable to departmental clinical performance and key business indicators.”

Other crucial traits for nursing leadership are attention to detail, commitment to excellence, and disposition to care and serve, Rodriguez and Saria added.

It’s About Skills, Not Letters

“Many nurses assume that you need an MBA, MSN, or MHA degree to be a leader,” Saria said. But both research and practice have shown that’s not true.

Core competencies for leadership development include strategic thinking, time management, decision making, conflict resolution, and performance enhancement. However, those skills are imbedded in undergraduate nursing curricula, and action learning—hands-on experience in interprofessional teams—hones them in both academic and clinical settings.

“Aspiring nurses might view nursing leadership as strictly administrative, but nurses can be leaders in academia and patient advocacy and education. Nurses can also assume clinical leadership roles like lead advance practice provider,” Rodriguez said. “Another common misconception is that nurse leaders are not operators. From my perspective, nurse leaders are very capable in business operations. However, business management is one competency that nurses need to develop and intentionally seek training opportunities for.”

ONS’s Leadership Competencies define skills that oncology nurses need as leaders at the individual, group, and governance level. The American Organization for Nursing Leadership has additional competencies to help nurses navigate the executive side of health care.

Start Your Leadership Journey

In clinical practice, mentoring creates leaders. Mentorship prepares nurses for future leadership positions, promotes an environment where nurses’ voices are heard, and increases retention of both leaders and the staff they lead.

“Just because you are working on your own goals doesn’t mean you can’t guide and be a mentor to others,” Saria said. “When you are on track to get where you want to be, look for potential leaders, especially from underrepresented groups, and help them start their journey.”

Saria and Rodriguez both said that nurses should identify career goals, conduct self-assessments, and seek feedback from their mentors or supervisors.

“Nurses interested in leadership must map out a plan for growth and pursue opportunities that can showcase and develop their leadership strengths,” Rodriguez said. “Experiences gained through roles like preceptor, charge nurse, educator, or clinical coordinator build foundational leadership and management skills. From there, nurses can intentionally plan for the next career milestone or progression.”

“I am a traditional learner, and I have always planned my career decisions,” Saria said. “Nurses need to have regular check-ins with their supervisors. If it’s not part of your annual evaluation, ask your manager or human resources representative to implement evaluations. Those discussions should cover short- and long-term goals.”

Leaders Must Represent the Diversity of Their Community

A diverse nursing leadership begins with diverse student bodies in nursing programs. Health leadership groups have identified a need for more culturally competent nurses to reduce health disparities, but the number of minority students graduating from nursing programs remains disproportionately low.

“I came to the United States three years after completing my BSN,” Rodriguez said. “The process to practice as a foreign graduate nurse in the United States was rigorous and required successful passing of several examinations.”

To enhance leadership diversity, ethnic nursing organizations (ENOs) are developing their members for leadership positions. ENOs provide connection, support, comfort, and community when growing leaders face isolation and racism, which are crucial sources of motivation when pursuing professional development.

“Through these organizations nurses can find individualized leadership resources that fit their values and culture,” Saria said. “In my case, I have learned about leadership among Philippine-born Americans through my membership with the Philippine Nurses Association of America.”

Saria is a double minority in nursing: male nurses experience a unique set of challenges to professional growth, such as sociocultural views, professional acceptance, and patient and family perceptions. However, male nurses often turn those barriers into facilitators for professional growth and development. Organizations like the American Association for Men in Nursing support male leadership in nursing and advancements in men’s health.

How to Hone Your Leadership Potential

Regardless of demographics, Saria said, nurses need to lift themselves and each other up.

“Define your purpose in life and learn to work well with others, because leadership does not occur in a vacuum,” Saria said. “The path to leadership is not easy, so give yourself grace but don’t quit.”

Publishing and presenting at national and international conferences are two opportunities that quickly build a leadership portfolio, Rodriguez said.

“I purposely approached a published colleague and offered to assist with future articles. Within a few months, I was the first author for a stem cell transplant journal article,” she said. “I also reached out to an editor colleague with an offer to assist with any book chapter revisions. After a few months, I was invited to help with a chapter in an oncology nursing textbook.” Rodriguez has since published several peer-reviewed articles and book chapters and was invited to be a guest editor for an issue of Seminars in Oncology Nursing.

The Clinical Journal of Oncology Nursing offers a mentorship program for nurses interested in publication, and nurses can explore other volunteer opportunities through the ONS Communities. ONS also has an abstract writing mentoring program for nurses seeking to share their programs, practices, and research findings at national and international conferences.

And Don’t Avoid Advocacy

Advocating for patients from the institutional level to local, state, and national policy is critical to improving safety, quality of life, and outcomes. However, only one-third of nurses reported engaging in health policy activity.

“I have learned that nurses need to be reminded that they are the experts in caring science,” Saria said. “But many nurses fall into the imposter syndrome trap. Advocating for something does not mean you have completed a dissertation on the topic. Nurses need to speak about their experiences and share patients’ stories about financial toxicity and caregiver strain. These are the tools to successful reform.”

Local advocacy efforts can lead to national policy changes, and it’s an approachable way for nurses to raise their voice in leadership. Grassroots activism is the most basic level of advocacy. It relies on individuals who are willing to incite change from the ground up, and “it’s important to initiate change at the local level by engaging community members,” Rodriguez said.

Saria quoted former U.S. Representative and Speaker of the House Tip O’Neil (D-MA) in that “‘all politics is local.’ Nurses understand the issues that affect them, their organizations, and their community,” he said. “That being said, reform must come from within. Then, local-level changes can be scaled up to reform national policies.”

Advocacy is one of ONS’s core values. Learn about ONS’s health policy and advocacy efforts and how you can get involved at voice.ons.org/advocacy/get-involved-in-onss-health-policy-advocacy.

“One of the lines from a trusted mentor and good friend that I will always remember is that life, leadership, and success are all about relationships,” Saria said. “Learn as much as you can from others. Life is too short to keep learning from your own mistakes. That being said, it also important to not be afraid of making mistakes.”

“Work hard to be the best leader you can be. Be compassionate and empathetic,” Rodriguez said. “If you had great mentor, pay it forward and provide opportunities for your team’s growth and development. You will find that exceptional outcomes will follow when you inspire your teams. Your reputation will always precede you and will be able to successfully create a space for your goals at the local, regional, or national level.”