Leadership in Clinical Practice

Introduction to Leadership

Leadership is an important aspect of all the sectors and plays a crucial role in the development of the organisation as a whole (Simiyu 2015). Similarly, in the healthcare sector also, leadership has a significant role (Al-Dossary 2017). For the proper team functioning in the healthcare sector, including the nursing team, effective leadership and effective communication between the leader and the team members is necessary. This ensures the delivery of quality care to the patients as the patients are the primary stakeholders in any healthcare setting and thus every measure taken by the care team should be patient-centred, with the primary goal of fulfilling the needs of the patients (Deravin, Francis, Nielsen and Anderson 2017). This paper aims at identifying and describing the role of a registered nurse (RN) in the given clinical scenario. Furthermore, the role of an RN in planning, prioritising, delegating and supervising in the given scenario will also be discussed.

The Leadership Role of A Registered Nurse

According to the practice standards set for the registered nurses by NMBA (2016b), a registered nurse is obliged to engage in both professional and therapeutic relationships, adequately plan for nursing practices, conduct comprehensive assessments, while maintaining the ability to practice to provide quality nursing care practices, which are both responsive and appropriate for the patients (NMBA 2016b). A registered nurse leader, to ensure the adequate outcomes of the nursing practices, needs to have a clear vision of motivating and empowering the staff to accomplish the goal of providing best possible care to the patients (Al-Dossary 2017). An RN leader is expected to have qualities such as confidence, ability to value others and to build teams efficiently. An RN is required to have effectively communicating skills to attain the aforementioned goals and to lead interprofessional team members in healthcare settings. Moreover, a registered nurse as a leader directs and supports, motivates, collaborates and coordinates with other team members, while advocating for achieving the goal of getting optimum patient outcomes. As a nurse leader has followers, he/she needs to show their followers the correct way of doing things by guiding them in the required course of actions (Al-Dossary 2017). Nursing is an autonomous profession and nurses need to take responsibility and accountability of their actions. Therefore, a clinical nurse leader is expected to focus more on the patients and healthcare teams than the formal leadership arrangements (Al-Dossary 2017).

Role of An RN in Delegation and Supervision Processes

The decision-making framework (DMF) for nurses and midwives guides nurses and midwives to practice making decisions in the horizon of nursing practices, delegating and supervising (NMBA 2020). This framework states that the registered nurse is the primary delegator and is the one accountable for deciding who is the best healthcare worker to delegate a specific task (delegatee). Thus, the registered nurse leader (delegator) assigns the aspects of nursing-related practices or tasks in a healthcare setting to another equally or lesser qualified person, preceded by conduction of proper risk assessment, i.e. determination of the appropriate delegate for the required task (NMBA 2020). Furthermore, the delegates, for instance, enrolled nurses or nurse assistants, work under the supervision of their delegators i.e. the registered nurse practitioners, who cannot be substituted or replaced by any other professional. Therefore, an RN is required to be accountable for the supervision and coordination of/to the people assisting them in providing care to the patients. This ensures the provision of continuous patient-centred care, along with the development of the sense of responsibility in all the team members (Deravin, Francis, Nielsen and Anderson 2017). In the given clinical scenario, four members in the nursing team, including the registered nurse leader and six patients are present during a morning shift. The delegation and the supervision will thus be done according to the DMF for nurses and midwives.

Prioritisation and Delegation of The Patients-Related Work

Tim Hawks

The priority of the nursing team will be to address the patient Tim Hawks, who was diagnosed with acute appendicitis and also scheduled for surgery on the same day on an emergency list. As appendicitis, if not treated on time, can give rise to numerous complications by making the appendix burst. This leads to the spillage of bacteria into the entire abdominal cavity. This can be serious and can even be fatal sometimes (NHS 2019). Furthermore, according to Tim’s SBAR and ADL’s, he needs assistance with pre-op preparations, including washing/sponging. These responsibilities will be assigned to Jody, who is the nursing assistant (AIN) in the given clinical scenario. Tim also needs IV antibiotics every even hour; this duty will be assigned to Sarah, who is the clinical nurse in the same ward. These assigning of duties will be done by the Registered nurse who is the leader of the nursing team in the given scenario (NMBA 2020).

John Smith

Next priority will be given to the patient John Smith, who has been presented in the emergency department the previous day and is diagnosed with unstable angina. As an unstable angina attack can lead to many serious complications such as heart attack, irregular rhythms in the heart (arrhythmias) and even heart failure, unstable angina should be considered an emergency and immediate care should be provided to the patient (American Heart Association 2015). As John needs a registered nurse escort in the exercise cardiac stress test, I will accompany him myself to the EST as there is a possibility of some rare complications during the test such as reduced blood pressure leading to John feeling dizzy or even fainting (Mayo Clinic 2018).

Patrick Morgan

The third patient on the prioritisation of the nursing team will be Patrick Morgan, who is diagnosed with a cardiovascular accident (CVA), which is another term used for "stroke". As Patrick needs assistance from two people to transfer him, the duty of providing care to him will be assigned to Jody and Sarah. Jody will help him with his hygiene care first and Sarah will impart him his medications, including the medications in his nasogastric tube (NGT) and antibiotics in the IV. Furthermore, Jody and Sarah will help him have his chest X-ray, which is scheduled at 10 am and if everything turns out fine, Sarah and Jody can proceed with Patrick’s discharge planning.

Florence Boyle

Next priority of the nursing team members will be to address the patient Florence Boyle, who has had her revised surgery for total hip replacement and needs two people’s assistance during her physiotherapist’s review today. Since she also needs full assistance with PAC and sponging today, this duty will be assigned to Jody along with the duty of giving Florence her oral medications. I, as a registered nurse, will give Florence her IV medicines, following which Jody, along with Maxine, who is the enrolled nurse in the same ward (NMBA 2016a), will take Florence to the physiotherapy review. After all this, Jody will be assigned for proceeding with Florence’s discharge initiation.

Edward Mason

The second last on the priority list of the nursing team will be the patient Edwards Mason, who is diagnosed with right lower lobe pneumonia. As per Edward's activities of daily lives (ADL's), he needs full-time nursing assistance, hence his responsibility will be delegated to Maxine. All the duties including giving Edwards his oral medicines and IV antibiotics and giving him care (PAC, eye care and peri care) will thus be carried out by Maxine. Edward has a meeting with his family in the palliative care department, where I will accompany him as the registered nurse is required in the palliative care, which will be given to Edwards and his family to relieve them from distress and pain (WHO n.d.).

Robert Jones

Following Edwards, the next priority will be to address Robert Jones, who has had his transurethral prostate resection the previous day. Robert needs close blood pressure monitoring, along with monitoring of his bladder irrigations. Furthermore, he needs assistance with shower and PAC provision; these tasks will be assigned to Jody. He also needs assistance from 2 people for transferring him from bed to chair and has to be encouraged to stay out of the bed. Sarah and Jody will be assigned to take care of this and Sarah will be delegated with the responsibility of giving Robert his IV antibiotics at 2 pm. Lastly, Sarah will proceed with Robert’s discharge.

Conclusion on Leadership in Clinical Practice

Leadership plays an important role in all the sectors, including the nursing and healthcare sector. A leader is expected to have certain qualities such as effective communication skills that will ensure their effective leadership resulting in optimum outcomes. A registered nurse as a leader is obliged to follow specific measures to ensure the provision of appropriate patient-centred care by all the team members. This requires adequate planning, prioritising, delegating followed by supervising all the actions taken by the team members. The presented clinical scenario included the delegation of six patient-related tasks to the appropriate delegatees among the other three team members present during the shift, by the leader RN, while supervising the proper patient-care provision. The delegation and supervision were done based on the prioritisation of the patients' needs to ensure the provision of equitable and beneficial care to all the patients who were present in the morning shift.

References for Leadership in Clinical Practice

Al-Dossary, R. N. 2017. Leadership in nursing. Contemporary Leadership Challenges. http://dx.doi.org/10.5772/65308

American Heart Association. 2015. Unstable angina. [Online]. Available at: https://www.heart.org/en/health-topics/heart-attack/angina-chest-pain/unstable-angina [Accessed on June 13, 2020].

Deravin, L., Francis, K., Nielsen, S., and Anderson, J. 2017. Nursing stress and satisfaction outcomes resulting from implementing a team nursing model of care in a rural setting. Journal of Hospital Administration, 6(1), pp. 60. http://dx.doi.org/10.5430/jha.v6n1p60 Mayo Clinic. 2018. Stress test. [Online]. Available at: https://www.mayoclinic.org/tests-procedures/stress-test/about/pac-20385234#:~:text=A%20stress%20test%20is%20generally,to%20feel%20dizzy%20or%20faint. [Accessed on June 13, 2020].

NHS. 2019. Appendicitis. [Online]. Available at: https://www.nhs.uk/conditions/appendicitis/complications/ [Accessed on June 13, 2020].

NMBA. 2016a. Enrolled nurse standards for practice. [Online]. Available at: https://www.nursingmidwiferyboard.gov.au/Codes-GuidelinesStatements/Professional-standards/enrolled-nurse-standards-for-practice.aspx [Accessed on June 13, 2020].

NMBA. 2016b. Registered nurses standards for practice. [Online]. Available at: https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Professional-standards/registered-nurse-standards-for-practice.aspx [Accessed on June 13, 2020].

NMBA. 2020. Decision-making framework for nursing and midwifery. [Online]. Available at: https://www.nursingmidwiferyboard.gov.au/Codes-Guidelines-Statements/Frameworks.aspx [Accessed on June 13, 2020].

Simiyu, A. 2015. Role of leadership in organizational development. Journal of Management Studies. [Online]. Available at: https://www.researchgate.net/publication/273766248_ROLE_OF_LEADERSHIP_IN_ORGANIZATIONAL_DEVELOPMENT [Accessed on June 13, 2020].

WHO. n.d. WHO definition of palliative care. [Online]. Available at: https://www.who.int/cancer/palliative/definition/en/ [Accessed on June 13, 2020].

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