I am a registered nurse going on 2 years in Wisconsin. For the first discussion post, I decided to reflect upon a leader I’m sure many can relate to, that being a physician that was incredibly harsh to his staff, but let me provide some context. During nursing school, I worked as a medical assistant in a private family practice outpatient clinic under many different physicians, but only one in particular gave me lessons and made me grow unlike the others. This experience was incredibly formative in ways that were both meaningful and, at times, genuinely difficult. This physician held exceptionally high standards, so much so that the staff suffered. It wasn’t enough to educate, it was reprimanding and felt belittling at times. But at the same time, during patient encounters, who I encountered was a thorough, clinically sharp, and communicative provider whose patients consistently sang his praises. He modeled meticulous assessments, thoughtful clinical reasoning, and clear, compassionate communication with patients of all ages, particularly the elderly population he served. I certainly respected him, and what I observed of him during these interactions reinforced in me a deep respect for clinical excellence and professionalism that I carry into my practice today.

However, his interactions with staff told a different story. His manner was stern to the point that several MAs before me had left the position entirely. I found myself frequently anxious and second-guessing my own competence, not because I was unprepared, but because the environment made mistakes feel catastrophic rather than educational. I grew…but the growth came at a real cost to my confidence and well-being during that time. I found a study, Labrague and Santos (2020), which notes that high-demand work environments without sufficient psychological safety are associated with increased anxiety and burnout among healthcare workers, which aligns closely with what I experienced.

Impact on the Practice Environment

The clinic environment reflected this duality. Patient care was excellent, but staff morale and retention suffered. The stress that characterized our interactions behind the scenes never crossed into the exam room, of course, which then speaks to a certain kind of professional discipline–but also meant that tension among staff went unaddressed. MAs didn’t want to work under him, and (apparently) he applauded me on different occasions to the manager, so I was typically the MA with him. But this disrupted workflow continuity, and the interpersonal strain made it difficult to ask questions freely or voice concerns. A culture of fear, even a subtle one, undermines the open communication that safe, high-quality care depends on (Cummings et al., 2021).

Analysis Using AONL Leadership Competencies

Analyzing this physician through the American Organization for Nursing Leadership (AONL) competency framework reveals a leader who excelled in some domains while falling short in others. Within the healthcare environment, he demonstrated strong clinical level expertise. His patient outcomes most definitely reflected his commitment to quality. However, the communication and relationship management competency, which emphasizes building trust, supporting staff development, and creating environments where team members feel valued, was practically ignored in his day to day interactions with staff (AONL, 2015). The professionalism domain also warrants consideration: while he modeled professional conduct impeccably for patients, modeling it consistently for the team he led is an equally important obligation of leadership.

Conclusion

The central lesson I carry forward into my advanced practice role is that clinical excellence alone is insufficient for effective leadership. High standards must be paired with psychological safety, emotional intelligence, and intentional communication. As a future nurse practitioner, I aim to model both clinical rigor and supportive leadership to foster environments that promote both patient outcomes and team well-being.

References: 

American Organization for Nursing Leadership. (2015). AONL nurse manager competencies. https://www.aonl.org/resources/nurse-manager-competenciesLinks to an external site.

Cummings, G. G., Lee, S., Tate, K., Penconek, T., Micaroni, S. P. M., Paananen, T., & Chatterjee, G. E. (2021). The essentials of nursing leadership: A systematic review of factors and educational interventions influencing nursing leadership. International Journal of Nursing Studies, 115, 103842. https://doi.org/10.1016/j.ijnurstu.2020.103842

Labrague, L. J., & Santos, J. A. A. D. L. (2020). COVID-19 anxiety among front-line nurses: Predictive role of organizational support, personal resilience, and social support. Journal of Nursing Management, 28(7), 1653–1661. https://doi.org/10.1111/jonm.13121Links to an external site.

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