Leadership in Clinical Practice

Nurses lie in the frontline in providing health care services to the patients and are responsible for the patient’s health. Therefore, the leadership qualities in nurses are of prime importance as these ensure the direct participation of people in health care so that improved quality of clinical care is delivered. According to Lowe and Plummer (2019), there are few nursing leadership styles like transformational, democratic, autocratic, and many others. These styles have importance as their strong leadership styles encourage collaborative and strong interdisciplinary skills as well. Nurse leaders bridge the gap between the practice and the policies by ensuring that all the healthcare team members obey the protocols that result in the safety of the patient and effective care services. The latter sections will discuss the leadership role of the registered nurse in the case study, its responsibilities in prioritizing care, and NMBA Registered Nurse Standards for Practice.

In this case study, the moment Jody heard a loud noise she immediately rushed to check for the safety of her patients. Jody also asked the patient about her health the moment she arrived in her room and found that the patient was alert and actively responding. However, as Jody was told in the patient’s ISBAR handover that she had her indwelling urinary catheter (IDC) but still she was left alone in the room with measures for her urinary discharge. Moreover, Jody was also told that she needs assistance for peeing and going to the washroom as well, still, the patient was left unattended that exposed a great risk to her health. The registered nurse also did not ask any other health official staff member to stay in/near the patient’s room so that the moment she rings the bell, assistance, or medical care can be provided to her. However, as the patient started to walk for peeing towards the washroom she fell and injured herself. Thus, it showed that the leadership role of the registered nurse was not executed effectively. According to Mather et al. (2018), post-catheter removal care is provided to the patient who undergoes IDC removal.

As per the protocol, such patients are taken to the toilet every 2-4 hours for urination, assessments are made for their voiding pattern, provided with bedside commode, and many other medical services and assistance. However, in this case, the registered nurse Jody showed no such leadership roles and the patient had been admitted for sepsis for which no effective role was played by the nurse to prevent the severity of the health condition. According to Sfantou et al. (2017), a patient admitted for sepsis should be taught about hygiene, sterile techniques should be maintained, visible signs assessments should be investigated, vaginal or oral sections should be checked for infection, and many others. The presence of leadership nursing in the healthcare workplace is important for – reduced medication errors, restraint use, reduced patient mortality risks, and many others (Lega et al. 2017). However, the leadership role of the registered nurse, in this case, failed in providing effective and safe care to the patient.

In this case, Jody’s role is very important as she can play a very important role in prioritizing care. Jody assisted with her other team leader in delivering quality care to the patient and after her leader went to the other case to attend Jody stayed with the patient. She had failed as a nurse in the supervision of her patient because she left the patient unattended. The patient was also not attended since morning for her urination issues and other assessments. The patient is admitted for sepsis also still she was not assessed for infections and pain. However, after arriving in the patient’s room she stayed with her until another nurse came to assist her for the patient’s medical care. According to Ryder et al. (2019), a patient with IDC removal and sepsis health issues should be provided with complete supervision. The delegation is nursing is also important as it improves efficiency, reduces the stress, and allows nurses to focus on prime roles and priorities.

In this case, Jody was in her 5th nursing program still she tried her best to put her efforts in the nursing team by collaborating with her co-workers and she also waited for another co-worker to assist her after the leader went for another code to attend. In case of prioritizing care, Jody somehow did a nice job as she immediately rushed to check her patient along with her leader but she did not effectively do her responsibilities as the patient’s clinical needs were not meet and she got injured due to an unattended fall. This ensures that in the nursing team Jody did not effectively perform her roles and responsibilities towards the patent. According to Parker and Hill (2017), the registered nurse must set the conditions as per the needs of the patient to prevent illness and injury so that care is prioritized to ensure holistic care services. The 5 rights in delegation in nursing are – right supervision/evaluation, right person, right circumstances, right task, and right communication. In this case, although Jody reached late on the site that led to the fall of the patient, she tried to communicate to the patient to assess her state and followed the orders of her leader as well.

According to the Nursing and Midwifery Board (2020), there are following standards that ensure safety and quality care: provide safe, appropriate and responsive nursing care, develop plans for nursing practice, conduction of assessments comprehensively, engagement in professional relationships, and few others. The leader should ensure that the co-workers/mentees are ensuring the following: the patient should be provided effective care by ensuring that the health professional exhibit accountability and professional responsibility and there should also be collaboration among the different health professionals so that multidisciplinary care is ensured to be delivered for safe and quality care of the patients. If there is effective communication with the patients and other associated health care providers then a strong trust will build in the nursing relationship. So the leader should ask the mentees to have effective collaborative involvement. The leader should ask the nurses that they should always practice within their scope of practice and strictly obey the guidelines and policies so that safe and quality care is ensured.

As in this case, the patient is having sepsis issues and recently had IDC removal, so care was not accordingly provided to her that resulted in her fall and bleeding hand. According to Harris and Moya (2018), effective nursing leadership is very important to point in the nursing workplace because of the following: encourage the healthcare providers to work as a team, treating the patients and nurses with dignity and respect, thinking critically for improved results, and many others. The leader should ensure that the nurses perform effective practices in the healthcare workplace and ensure that others are also encouraged to do the delivery safe and quality care services to the patient. The leader should monitor and evaluate the patient’s and staff's concerns, prioritize the safety, increase responding to co-workers and patients and support the efforts for safe medical care and monitoring of the progress and negative outcomes. Thus, with effective leadership, the outcomes will be monitored and evaluated and positive outcomes will be more. According to Edmonds et al. (2016), clinical medical design should be evaluated for the prevention of injury and/or illness, health protection, or services for health promotion. The relationships should be maintained with the people by explaining the patients about their treatments, management plans, teaching and mentoring the mentees or other staff about the guidelines and policies, and training them, whenever needed.

The nurses are very important in providing safe and quality care to the patient and with the help of effective nursing leadership, the outcomes becomes even better. A registered nurse can follow any of the leadership styles to ensure the safety and quality care services by encouraging the professionalism and accountability of the co-workers and other associated staff. The effective supervision, delegation, and prioritizing of care in case of patients in nursing is also important as it improves efficiency, reduces the stress, and allow nurses to focus on prime roles and priorities. The NMBA standards are always strictly followed by the nurses to ensure that the patients’ needs are met and the leaders are performing their roles and duties within the policies and guidelines. These standards also help in generating an environment in the healthcare workplace where a safe environment id created and quality medical/clinical care is delivered.

References for Nursing Leadership in Healthcare

Edmonds, L., Cashin, A. and Heartfield, M., 2016. Comparison of Australian specialty nurse standards with registered nurse standards. International Nursing Review63(2), pp.162-179. https://doi.org/10.1111/inr.12235

Harris, J. and Mayo, P. 2018. Taking a case study approach to assessing alternative leadership models in health care. British Journal of Nursing, vol. 27, no. 11, pp.608-613. Retrieved from: https://www.magonlinelibrary.com/doi/abs/10.12968/bjon.2018.27.11.608

Lega, F., Prenestini, A. and Rosso, M. 2017. Leadership research in healthcare: A realist review. Health Services Management Research, vol. 30, no. 2, pp.94-104. https://doi.org/10.1177%2F0951484817708915

Lowe, G. and Plummer, V. 2019. Advanced practice in nursing and midwifery: The contribution to healthcare in Australia. Advanced Practice in Healthcare, pp.51-63. https://doi.org/10.1002/9781119439165.ch4

Mather, C.A., Cummings, E.A. and Gale, F. 2018. Advancing mobile learning in Australian healthcare environments: Nursing profession organisation perspectives and leadership challenges. BMC Nursing, vol. 17, no. 1, pp.44. https://doi.org/10.1186/s12912-018-0313-z

Nursing and Midwifery Board. 2020. Registered nurse standards. Retrieved from: https://www.nursingmidwiferyboard.gov.au/codes-guidelines-statements/professional-standards/registered-nurse-standards-for-practice.aspx

Parker, J.M. and Hill, M.N., 2017. A review of advanced practice nursing in the United States, Canada, Australia and Hong Kong special administrative region (SAR), China. International Journal of Nursing Sciences4(2), pp.196-204. https://doi.org/10.1016/j.ijnss.2017.01.002

Ryder, M., Jacob, E. and Hendricks, J., 2019. An inductive qualitative approach to explore nurse practitioners views on leadership and research: An international perspective. Journal of Clinical Nursing28(13-14), pp.2644-2658. https://doi.org/10.1111/jocn.14853

Sfantou, D.F., Laliotis, A., Patelarou, A.E., Sifaki-Pistolla, D., Matalliotakis, M. and Patelarou, E. 2017. Importance of leadership style towards quality of care measures in healthcare settings: A systematic review. Healthcare, vol. 5, no. 4, pp. 73. https://www.mdpi.com/2227-9032/5/4/73#

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