The Leader

From Scrubs to Strategy · Ch. 047 min

The Leader

Monica D. Cutia, BSN, RN, PHN, COS‑C

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Chapter One was about the houses. Chapter Two was about the people I found inside them. Chapter Three turned the camera toward the nurse carrying the bag.

This chapter asked the question the whole publication has been walking toward: what happens when that nurse becomes responsible for the people, decisions, and systems that make the care possible?

I told it in seven stories: the meeting, the promotion, the empty office, the hard conversation, the decision, the team, the culture. And because I’m a nurse, I’m not going to ask you to take my word for what they taught me. I brought documentation.

What the room does to you

The meeting taught me where my voice came from. Early in my transition into operations, I sat in a room where everyone spoke the language of business and I was still learning it, thinking about a home visit that was one number on a productivity report and so much more than that inside the home. I almost stayed quiet. Then I realized I wasn’t in that room despite my bedside experience. I was there because of it. You don’t have to leave the nurse outside the conference room to become a leader. Bring her in.

The promotion taught me what the title changes. Not my responsibilities first, but how people experienced me. Conversations became more careful. Someone who once would have told me exactly what they thought now said, “Whatever you think is best.”

Here is the documentation on that moment, because it is not a personality quirk. It is one of the most replicated findings in organizational research. James Detert and Ethan Burris, who have spent years studying employee voice, found that people systematically withhold ideas and concerns from those above them, and that leaders consistently believe their door is more open than their people experience it to be. The silence is not apathy. It is a calculation about risk that the title itself creates. Which means a leader who wants the truth cannot wait for it to arrive. She has to go get it, prove it is safe to hand over, and notice who has quietly stopped offering it.

And the empty office taught me about the critic who stays after everyone goes home. I learned the difference between reflecting on a decision and punishing myself for having to make one. The pressure doesn’t always come from the people around us. Sometimes the expectations we place on ourselves are far greater than anything anyone else is asking.

You don’t have to leave the nurse outside the conference room to become a leader. Bring her in.

What the role asks of you

The hard conversation taught me that compassion and accountability aren’t competing values. When I softened a message too much, I wasn’t protecting the relationship. I was creating confusion. And I learned that someone can leave a conversation disappointed and still have been treated fairly.

That last sentence has documentation of its own. Decades of procedural justice research, led by psychologist Tom Tyler, show that people’s acceptance of an outcome depends less on whether they got what they wanted than on whether the process felt fair: were they heard, was the reasoning explained, were they treated with respect. People can live with decisions they disagree with when the process honors them. It is why informed refusal works at the bedside, and it is why a fair hard conversation protects a relationship better than a soft one.

The decision taught me the same discipline from the other side. The hardest choices weren’t between right and wrong but between two options that both carried consequences. So I run the checklist I first ran in a patient’s kitchen: Do I understand the facts? Have I considered the people affected? Have I listened to perspectives that challenge my own? Can I explain why? Am I willing to take responsibility for the outcome? Because the real measure of a decision isn’t how confidently it was announced. It’s what happens to the people who have to live with it.

What you leave behind

The team taught me that leadership was never meant to be a solo effort. I learned it first in a patient’s home when a visit turned complicated and the people around me stepped in, and I have relearned it in every season since. I don’t want to be the smartest person in every room. I want to be surrounded by people who know things I don’t. HealthView’s success will never be one person’s story. It’s ours.

And the culture taught me what all of it adds up to. Culture isn’t proven by what an organization says about itself. It’s proven by what people experience when they’re part of it. Keeping people isn’t about convincing them to stay; it’s about giving them reasons to want to. Our commitment is simple. We stay committed when the work gets difficult. We stay accountable to the standards we’ve established. We stay invested in our people. We Stay.

The translation

Put the seven stories in one paragraph and you have the operating manual the bedside wrote for me.

Bring your whole history into the room, because it is why you’re there. Assume your title is filtering the truth, and go get it anyway. Reflect without punishing yourself. Deliver hard messages with facts and fairness, because a fair process is what people can live with. Decide with a checklist, then own what follows. Build a team that doesn’t need you in every room. And measure the culture by what people experience, not by what the wall says.

None of that came from a boardroom. All of it walked in from the bedside.

The end of the road, and the point of it

Four chapters. The houses, the people, the nurse, the leader. One road from the bedside to the executive seat, written down so the next nurse spends less time wondering whether the road exists.

Becoming a leader didn’t make me any less of a nurse. It gave me a different way to advocate for everything nursing taught me to care about.

So I’ll leave you with the question this whole chapter asks.

What would change in how you lead tomorrow if you brought the very beginning of your career into the room with you?