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The word “organization” implies that there is in fact leadership. For an organization to achieve its institutional goals, the leaders must be capable of guiding and inspiring the members. Without effective leadership a group may simply form endless committees that accomplish little. One cynical definition of a committee is a group of people who as individuals can do nothing, but as a committee can decide that nothing can be done!

Alternatively, if well-led, those same individuals can participate in a focused group of loyal and highly motivated individuals capable of achieving a common goal. Managers instruct people how to do things right. Leaders inspire their followers to do the right thing to achieve the “vision.” Such inspiration can occur as a result of personal example, attention to morale, and fostering and maintaining a learning and expectation-driven environment.

Nowhere is the need for effective leadership more evident than in the daily turmoil of a busy emergency department (ED). The ED leadership structure is unique as the physician and nurse directors work closely together with frontline staff with a degree of visibility not found in other areas of the hospital. The goal of the MD/RN directors is to achieve a team leadership approach in which each influence and guide the unit in tandem with overlapping responsibilities. Similar to the heads of a family, it is necessary for the ED leaders to substantially agree to “be on the same page.” Effective nurse-physician leadership teams are in many respects viewed more as single entities than as a pair of individuals.

There are at least 3 groups that benefit from such solid leadership—patients, staff, and hospital.


First and foremost, the patients (who are thrust into what is often an overwhelming and daunting environment) achieve better outcomes and have a better experience when the team strives toward the common goals and utilize shared methodology and tactics. The ED is a unique work environment. It is fast paced, cares for patients in various stages of illness, provides an intense front-end initial work effort, proceeds with multiple handoffs between diagnostic areas, and often exists on the verge of chaos.

A coordinated leadership team leads to a similarly coordinated frontline ED care team. When physicians and nurses work together efficiently without friction,

  • LOS (length of stay) is shortened
  • Diagnoses and treatments are more readily achieved
  • Patient perceives that a team that works well together and is focused on his or her needs is caring for him or her
  • Patient satisfaction surveys usually reflect the confidence and trust in the care team


The staff (including all who care for patients and the environment, housekeepers, secretaries, security, nurses, and physicians) is the second group to benefit from effective leadership. When the directors are “in-synch,” job satisfaction and morale increase. The results include reduced burnout and turnover and ...

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