A Critical Analysis of Leadership in Nursing

A Critical Analysis of Leadership
An excellent nurse leader is always striving to be the best he/she can be. Nursing leaders are located across the organization from the Director of Nurses, Nurse educators, Charge Nurses, to individual bedside nurses and great leader promotes a positive work environment. A nurse leader is not necessarily an authoritative nurse, but a nurse who exemplifies excellence and challenges others to do the same. “There are several key qualities that nurses seek in their leaders, such as commitment to excellence, clear vision and strategic force, reliability, accessibility, respect and commitment to the development of their employees”, (Sherman, 2012).

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I have worked at Villa Colombo for 14 weeks with amazing staffs including physiotherapists, nurses, doctors, nutritionist, etc. as my first placement. And in week 2, I was assigned to a patient who was admitted in the long-term care facility due to complications of immobility which needs a passive assistant to do his daily activities. The patient(A) is being cared for in the Long-term care facility because of chronic complication, but I was worried about his future self-care management. I was really nervous doing the peri-care and ADL (activities of daily living) in the morning because I didn’t have any experience to change their brief, put on the clothes for an immobile patient. And sometimes my shift doesn’t go according to plan because one time I couldn’t get him ready before breakfast and the policy of the unit where I work was to get the patient ready by the table before breakfast. That day, I couldn’t get him ready because when I went to his room to do the morning routine, he told me that he didn’t sleep well the last night and wants to sleep more. So, I just let him sleep for a while, thus making him late for breakfast and I was accountable for that.
After week 8, I was assigned another patient(B) that I have to take care of it. So, it’s an opportunity for me to use time management skills. Time management in nursing is primarily anecdotal, with a number of tips on how to manage time and descriptions of processes or strategies (Waterworth, 2003). In order not to make the same mistake as I did before, I use the prioritization method which helped me a lot in my first clinical placement. For instance, I did ADL to my second patient(B) first because he is mobile and needs minimal assistance. So, by the time I finish doing my care to my second patient(B), my previous patient(A) tends to be awake in bed. Another reason is that it doesn’t take much time to finish morning care to my second patient(B) whereas, if I do my care to the previous patient(A) and if I didn’t make it up on time then both of my patients will be late for breakfast. And, Prioritization also helps me in decision-making skills because every time I get an assignment on my patients, I prioritize both of them and check which one is more important and which one I should do the care first. For example; my patient(B) had a shower that day and the patient(A) doesn’t. So, I prioritize them to see which one I should do it first. And, I chose the patient(A) who doesn’t have the shower because it is much easier and doesn’t take much time to do the morning care than giving a shower. And it’s not only that I have to do the shower, but I also have to make their bed, change their sheet, etc. So, I finished the care for my patient(A) with no shower first. Also, Prioritization is a prerequisite for efficient work performance and is an expected strategy. The assumption is that priorities and decisions on what is most important can be determined and that appropriate nursing measures can be followed (Waterworth, 2003).
I also engaged in conversation with the patient(A) son-in-law because he was the primary care provider at home, and he comes to visit him more than twice a week. However, I think I should have focused more on my patient(A) although he was not vocal about his feeling. Because I was a complete stranger for him on the beginning and there were other PCA (patient care assistant) who takes care of him before me. ((CNO), 2006) mentions that the nurse can use a different source of communication method to accommodate the learning needs of an individual. However, the client’s own voice may be missing when the family members are used. But after week 4 he started talking to me as I was helping him to do his care. I think I should have taken more time to communicate with my patient to build professional intimacy. “It is inherent in the type of care and services that nurses provide such as bathing, feeding that nurses perform for, and with, the client that creates closeness”, (CNO, Practice Standard, 2006).  In nursing, communication is really important because it allows you to know your patient behavior, gather assessment data, to teach and encourage, gain trust and to express caring and comfort (Kozier, Erb, & Berman, 2018).  Despite being in Italian long-term care where 75% of the patients don’t speak English, I understood most of my patients from their nonverbal communication like affirmative head nodding, smiling, shouting, etc. while taking their vitals sign. The good thing about Nonverbal communication is that we can often tell others more about what a person is feeling than what is actually said (Kozier, Erb, & Berman, 2018).
From this event, the positive experience was that I was able to understand my patient’s situation and see it through the patient’s perspective because there are only a few patients who speak English well including my patients. And, I was able to understand the effect of the social determinants of health on my patient’s health. And, I was able to provide cultural care by being non- judgmental and respecting the patient’s choice. Nurses must strive to improve their ability to provide patient-centered care by considering how the culture, values, and beliefs of their patient and the patient affect the relationship between nurse and patient, (CNO, 2019).
My position as a student nurse at Villa Colombo holds many roles such as being a caregiver, teacher, and a leader. According to Registered Nurses Association of Ontario ((RNAO), 2010)”Nurses can provide education for self-management techniques such as self-monitoring blood pressure, keeping diaries and logs to monitor the effect as of medication and complication”. The delivery of self-management care also requires the nurse to incorporate the patient’s culture, social and economic context. I learned about the individual and self-management theory and I can see the connection between theory guiding my clinical practice. It gives me the general idea of what to expect in certain situation as what to anticipates and assess. Self-management teaching requires an assessment of the patient’s self-efficacy level and the psychological assessment of the patient’s ability to self-manage his/her care.

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And, each week our clinical instructor assigned one student as a leader from the group. When I was a leader, I tried to finish my work earlier and tried to help my colleague as much as I can within my practice scope. As a student nurse, I am self-aware of my strengths, weakness, and limitations. My strengths include communication, problem-solving, decision making and using critical thinking skills. I am not afraid to ask for input from my colleague as well as from my clinical instructor or the staff members. I value other’s feedback and learn from my colleagues, instructor and unit staff. First, I learned that sometimes nurses rely on the family members to get the information about the patient; however, nurses must respect the patient autonomy regardless of the patient’s ability to communicate. Second, I learned that to focus on small details because one time I put the wheelchair near to my patient bed while I transferred him from wheelchair to bed and later on, I saw him sitting on his wheelchair without any assistance. On that day, if he had a fall then I will be accountable. From that moment I didn’t put his wheelchair near to the bed. And, it requires constant monitoring and management of the complexity for my patient.
If I come across a similar situation in the future, I will always assess the patient’s situation and provide education based on the assessment. I can also use therapeutic communication skills to build a good rapport with my patient to gain his/her trust and assess their knowledge regarding his/her diagnosis and self-management of the disease progress. I also felt that along with the physical assessment, the psychosocial aspect of the patient must be assessed in order to evaluate the patient’s ability to manage his condition and the attitude regarding condition management. I have learned about self-management theory; therefore, I will use the theory to guide my clinical practice to provide quality of care. I will also use the RNAO guidelines and CNO practice standard to help me with interventions based on current evidence-based research practice. I will also improve my leadership role in providing a self- management teaching by reading the RNAO, best practice guidelines on self-management support. I will also look into an ongoing evaluation of my patient’s self-efficacy to evaluate the effect of the intervention. The patient will have higher self-efficacy and better management of the chronic condition. I will engage in to build trust by making a therapeutic nurse-client relationship and by reading the Practice standard from CNO.
In conclusion, this was an excellent opportunity for self-reflection and assess my strengths, weakness, and limitations. I have always been compassionate when providing care and aware of the delivery of holistic care. And I can see some changes in the way that the theory, school-lab, and real-life practices were somewhat different. Nevertheless, clinical placements are considered essential to benefit sense to the theory and to shape our identity, as they helped student nurses to experience their future professional reality and to compare it with what we had been taught in theoretical and academic classes (Maranon & Pera, 2015). It reflects on knowledge of nursing theories to deepen one’s philosophy of nursing care and guide practice. And, it begins to develop leadership skills to advocate for patients and families with other health professionals as well. In the future, I will be more open and available to engage in conversation and practice more on interpersonal skills regarding interviewing skills and nursing skills. I believe that if a leader wants respect, he/she must respect his followers and show that he/she has the organization’s best interests and followers in mind. A great leader inspires, strengthens and encourages. Leadership is successful only when it inspires followers to do their best and strive for excellence.
References

(CNO), C. o. (2006). Therapeutic Nurse-Client Relationship. Practice Standard, 3.
CNO. (2006). Practice Standard. Therapeutic Nurse-Client Relationship, 3.
CNO. (2019). Culturally Sensitive Care. Retrieved from www.cno.org: http://www.cno.org/en/learn-about-standards-guidelines/educational-tools/ask-practice/culturally-sensitive-care/
Grossman, V. S. (2013). Nursing leadership management of leadership styles. The New Leadership Challenge Creating the Future of Nursing.
Kozier, B., Erb, G., & Berman, A. (2018). Fundamentals of Canadian Nursing. Don Mills, Ontario, Canada: Pearson Canada.
Maranon, A. A., & Pera, M. P. (2015, 07). Theory and practice in the construction of professional identity in nursing students: a qualitative study. Nurse Education Today, 35(7), 859-863.
Registered Nurses’ Association of Ontario. (2002, July). Nursing best practice guideline: Client-centered care. Toronto: Author.
 (RNAO), R. N. (2010). Strategies to support self-management in chronic conditions: Collaboration with clients. Clinical best practice guidelines, 1.2 e.
Sherman, R. (2012). What followers want in their nurse leaders. American Nursing Today.
Waterworth, S. (2003, August 14). Time management strategies in nursing practice. Journal of Advanced Nursing, 43(5), 432-440.