Managing & Enhancing Care in Rapidly Changing & Complex Situations Leadership
Managing & Enhancing Care in Rapidly Changing & Complex Situations Leadership
Introduction to the folder of Evidence
This assignment is an analysis of my leadership development though my training, and to assist me to adapt from a student nurse to a staff nurse confidently. This, along with an action plan (appendix 1) is completed though out my module 8 placement in accident and emergency. My leadership skills are developed by shadowing my mentor whilst she is in charge of shifts for 3 weeks, as well as accurately and confidently handing over patients to other members of the multi-disciplinary team. In this setting, skills such as communication, decision making, prioritising care and time management are necessary, therefore this placement has assisted me in developing those skills. This assignment relates to learning outcome 2-Utilise a range of therapeutic approaches and problem solving skills when planning, implementing and evaluating care to enhance quality of life for patients and carers, 3-
Utilise effective coaching skills in the support of patients, carers and less experienced colleagues, and 4- Analyse and develop professional care, management and leadership roles within the context of multidisciplinary and collaborative care delivery in meeting health and social care needs for patients with increasing levels of dependency. (MSG, 2011) I will develop my leadership skills by shadowing her whilst she is triaging patients, in charge of shifts, and when she is handing over, along with accurate communication skills. Though out the placement, I will gain feedback from my mentor on my progress in order to help me to achieve sufficient leadership skills.
The aim of this reflective account is to analyse leadership skills that have been developed throughout my module 8 placement in Accident and Emergency. I will debate the motives for my choice of actions, and evaluate the extent which it has enabled me to improve my leadership skills. I will discuss what I have discovered about my leadership skills, how I’ve developed as a leader, and what effect this has on the care given to my patients. This assignment, in collaboration with the practise assessment document, will assist me in identifying skills developed, with significance to learning outcomes 2, 3, and 4. The identified skills along with leadership literature will be evaluated using the Gibbs Reflective Cycle (1988) which comprises of description, feelings, evaluation, analysis, conclusion, and action plan.
There are many definitions of leadership, such as being a ‘’function of knowing yourself, having a vision that is well communicated, building trust among colleagues, and taking effective action to realize your own leadership potential ‘’. (Bennis, 1959), ‘Leadership involves the use of interpersonal skills to influence others to accomplish a specific goal.’ (Sullivan and Garland, 2010). All of these definitions gave me a great idea of leadership, and allowed me to choose an aspect of leadership skills within my placement. This allowed me to focus on my leadership skills whilst making decisions in the clinical setting. Clinical decision-making is a process that nurses undertake on a daily basis when they make judgements about the care that they provide to patients and management issues. (Banning, 2007). NMC 2008 states that you must ‘‘Provide a high standard of practice and care at all times’’.
This reflective account is also based on my leadership skills whilst leading handover. Clinical handover refers to the transfer of information from one health care provider to another when a patient has a change of location or venue of care, and/or when the care of/responsibility for that patient shifts from one provider to another (ACSQHC, 2005). The NMC (2008) states that ‘’you should be aware of, and develop, your ability to communicate effectively within teams. The way you record information and communicate is crucial. Other people will rely on your records at key communication points, especially during handover, referral and in shared care.’’
Stage 1: Description of the event
Decision making plays an important role in the A&E department. This determines the care each patient receives. My mentor asked me to triage a patient in the minors department. No names are mentioned in this piece in order to respect dignity and privacy as stated by the NMC (2008). I began to triage a 29 year old female who presented with abdominal pain and vaginal bleeding. This patient was 7 weeks pregnant. As I was assessing the patient I noticed that she was hypotensive at a blood pressure of 95/65. Following this, I informed my mentor of my patient and my findings. Following a discussion with my mentor, we decided that this patient was high priority. Whilst my mentor inserted a cannula and took bloods, I was given the responsibility of allocating the patient to a bed. Following the discussion with my mentor, I felt that it was necessary to place the patient in majors, and on a monitor bed. As this was being put into action, my mentor and I noticed that all monitored beds were taken up.
I then had to liaise with the nurse in charge to decide if all patients on the monitored beds were required to stay on monitors. After organising a monitor bed for the patient, I then bleeped the gynecologist on call for further advice. After the patient was assessed by other members of the multi-disciplinary team, it was decided that the patient was to be admitted for further tests, as the gynecologist was querying an ectopic pregnancy. My mentor then allowed me to liaise with the bed manager to organise a bed on a suitable ward for the patient. After a bed was arranged, I then escorted the patient to the ward and gave a full handover to the nurses under my mentors supervision. Handover is another very important aspect of communication in the clinical setting, as it ensures the correct information is given to the nurse, and therefore, care for the patient will be organized accurately.
Stage 2: Feelings
When my mentor allocated me to triage patients, I felt that I was given a lot of responsibility. Porterfield (1999) states that empowering employees is an important part of employee development and can in turn produce a higher level of employee satisfaction. I questioned my ability to assess to as I was not used to this level of responsibility. I mentioned this to my mentor and she reassured me by discussing what assessment tools to use, and mentioning that she and the rest of the nursing team were there for any guidance throughout the assessment. Once the patient was assessed and allocated to majors, I felt quite confident in my decision making skills. My mentor mentioned that I had triaged the patient successfully and competently and this was very reassuring. As I continued care for the patient, I became to feel more confident in the care I was providing.
After a clinical decision was made and the patient was to be handed over to the nursing staff on the ward, I felt slightly nervous in regards to ensuring the correct and accurate information is being given to the staff, as well as the essential information in regards to the patient. As I proceeded to begin handover, I became more confident as I had been with this patient since the beginning, and had a good insight to the care that was given and the care that was to be given. I gave the nurses a full handover in regards to the patient, including what examinations were carried out and the results of the examinations, and what the patient is required in order to keep comfortable. I also mentioned that this was the patient’s first pregnancy and reassurance is vital. Following handover, my mentor gave me feedback on how I handed over the patient. We discussed my communication skills, and my mentor mentioned that I gave an accurate and well-spoken handover, and mentioned all relevant information in regards to the patient. After receiving that feedback, I felt that my style of leadership tailed was transformational.
Stage 3: Evaluation
Leaders are often described as being visionary, equipped with strategies, a plan and desire to direct their teams and services to a future goal (Mahoney, 2001). Decision making is a fundamental element of nursing, and is essential to understand. (Reilly, 2003). By my mentor allowing me to make clinical decisions on patient care, leadership skills whilst making decisions were put into practice. With the support of my mentor and all the staff, I was able to analyze clinical situations and make a decision based on best practice, as well as evidence based practice. By gaining feedback from peers, it allowed me to evaluate how effective my decision making and communication skills were.
Communication can be identified as a vast field with the nursing setting. (Donnelly and Neville, 2008). Throughout handover, my delivery of information was accurate and precise, and the level of communication between the nursing staff receiving handover from I was approached to in a professional manner. I feel that, throughout the experience, my confidence levels were low and adverse. Dao (2008) states that self-confidence is the fundamental basis from which leadership grows. Although, I received positive feedback from peers, being given such important tasks made me doubt my competency as a nurse. Stage 4: Analysis
The Gibbs et al (1988) reflective model encourages the analysis stage to break down the event into its components so they can be explored separately. In order to analyze, becoming aware of the variety of learning theories and styles will assist in evaluating. Timmins (2006) states that critical analysis should analyse current practice along with examining the research base of practice and exploring theories that update nursing. I feel by exploring various leadership styles, I achieved this throughout my placement. An effective leader should be able to adopt, either consciously or unconsciously, various leadership styles in various situations (Bennett et al. 2010). By approaching the range of leadership theories, I feel that I have obtained the transformational leadership technique. Transformational leadership style is made up of 4 elements, Idealized influence, Inspirational motivation, Intellectual stimulation, and Individual consideration.
In comparison, Transactional leadership style is made up of 2 elements, Contingent Reward and management by exception. Aarons (2006) states transformational leadership inspires and motivates followers, whereas transactional leadership is based more on reinforcement and exchanges. I feel that I built a professional relationship with not only my mentor, but with other colleagues in the department, and had the support necessary to assist me in making decisions and handing over. In terms of patient’s safety, accurate decision making and hand over is an essential. The NMC (2008) states that you must ‘’provide a high standard of practice and care at all times’’. By obtaining a transformational leadership style, this ensures that whilst decision making, that all decisions are made with rationale and in the best interest of the patient.
When handing information of care of patients over to colleagues, effective co-ordination and communication is essential. Clinical decision-making is a complex activity that requires practitioners to be knowledgeable in relevant aspects of nursing, To have access to reliable sources of information and appropriate patient care networks and to work in a supportive environment. (O’Neill, Dluhy & Chin, 2005). However, although being supervised whilst making decisions and handing over, I was expected to do these tasks independently and professionally, and based on the best interest of the patient. This allowed me to gain further insight to the transition of student nurse to staff nurse.
Stage 5: Conclusion
In conclusion I feel the time I spent working within the Accident and Emergency team facilitated greatly in assisting me to develop my leadership skills. The stated event reflected best shows how I incorporated two aspects of my new leadership skills. I feel by studying the styles and skills involved in leadership I gained a good knowledge of leadership styles which I presented during my time here. I received feedback from my mentors and colleagues in regards to the skills, which have given me confidence to practice these skills in the future as a staff nurse. I have come to realise that a variety of leadership styles of leading best work in a hospital setting. In the future I will strive to further develop my leadership skills.
Stage 6- Action Plan
I plan to continue developing my leadership skills by observing and taking part in handover throughout the rest of my placements. I also hope to continue developing my decision making skills by shadowing my mentor and other colleagues throughout triaging and deciding patient care. As a self-regulated learner, I plan to gain feedback from both mentors and colleagues and focus on areas of further development.
Aarons, G. (2006). Transformational and Transactional Leadership: Association With Attitudes Toward Evidence-Based Practice. . 57 (8), 1162-1169. ACSQHC- Passing the baton of care – a patient relay – May 2005. Available. http://www.sswahs.nsw.gov.au/pdf/policy/gl2007002.pdf. Last accessed 17 May 2012. Banning, M. (2007). A review of clinical decision making: models and current research. J. Clinical Nursing. Available at http://bura.brunel.ac.uk/bitstream/2438/1395/1/2005-0319%20R2.pdf. Accessed
26 May 2012. Bennett, C., Perry, J., Lapworth, T. (2010) Leadership skills for nurses working in the criminal justice system. Nursing Standard. 24 (40), p.35-40. Bennis WG (1959) Leadership Theory and Administrative Behavior: The Problem of Authority. Admin Sci Q 4(2): 259–301 Bennis W. (1999). The Leadership Advantage. Available: http://www.hr-newcorp.com/articles/bennis_Leaders.pdf. Last accessed 26th May 2012 Dao, F. (2008). Without Confidence, There is No Leadership. Available: http://www.inc.com/resources/leadership/articles/20080301/dao.html. Last accessed 29 May 2012. Donnelly, E, Neville, L. (2008) Communication and Interpersonal Skills, p4 Reflect Press Ltd Publishing.
Gibbs, G. (1998) Learning by doing: a guide to teaching and learning methods. Oxford centre for staff and learning development. London Further Education Unit. Polytechnic, Oxford Mahoney, J. (2001) Leadership skills for the 21st century. Journal of Nursing Management; 9: 5, 269-271. Nursing and Midwifery Council (2008) The Code: Standards of Conduct, Performance and Ethics for Nurses and Midwives. www.nmc-uk.org O’Neill, E.S., Dluhy, N.C. & Chun, E. (2005). Modelling novice clinical reasoning for a computerised decision support system. J. Advanced Nursing, 49, 1: 68-77 Potterfield, Thomas A. (1999) The Business of Employee Empowerment: Democracy and Ideology in the Workplace. Westport, CT: Greenwood Publishing Group. Riley, M. E. (2003), Removing chest drains – a critical reflection of a complex clinical decision. Nursing in Critical Care, 8: 212–221. Sullivan EJ, Garland G (2010), Practical Leadership and Management in Nursing. Pearson Education Limited,Harlow Timmins, F. (2006) Critical practice in nursing care: analysis, action and reflexivity. Nursing Standard, 20 (39), p.49-54.