Leadership and Management, Its Effect and Impact on Nurses and Patients - Essay Example

Introduction Nursing leadership is a difficult quality to establish among future nurses. Daly and colleagues (2004) emphasize the importance of nurses gaining such quality in order to be effective nurses and nurse managers. This essay will now discuss leadership and management, its effect and impact on nurses and patients. It will also consider the different elemental skills and qualities needed in order to achieve improved patient outcomes. Nurse leadership and management Kelly (2011) discusses that leadership and management are similar terms, often used interchangeably with each other. Clark (2008) also points out that leaders are those who take on authoritative roles, including the delivery of patient interventions, assisting other health professionals in the management of patients. Leadership is also a condition whereby the leader takes on skills like motivating and influencing in order to accomplish patient goals (Clark, 2008). An individual may possess strong leadership skills, but not necessarily be adept at managing. On the other hand, individuals can be strong managers but not possess effective leadership skills like emotional intelligence and decisiveness (Kelly, 2011). McBride (2011) also discusses that the qualities which leaders have often comes from their subordinates or members of their team. Leadership may therefore be derived from the qualities one exudes and eventually inspires from other people. Leadership can manifest in different ways and these methods represent the applications of the theories of leadership. Different nursing situations may require different nursing styles. Cummings, et.al., (2010) discusses that democratic types of leadership can be used in order to establish health communication with patients as well as promote the free discussion and exchange of ideas with other health professionals and team members. Sherring (2012) also discusses that the application of autocratic leadership may work well in emergency or trauma units and situations as the leader is called on to direct members of the team towards the speedy and efficient administration of care. Under these conditions, there is no time to apply the more democratic elements of leadership. On the other hand, activities and goals may be achieved better with the use of participative leadership where highly educated team members are involved (Cummings, 2012). Where there is a shared and coordinated leadership, the staff would feel more empowered and motivated; and they would also feel more satisfied in their work. As leaders may sometimes be thrust unintentionally into leadership positions, managers on the other hand, are often assigned to their task by other higher authorities in the health organization. Daniels (2004) points out that nursing management involves the challenge of carrying out responsibilities through other individuals by applying coordination skills which utilise the resources of the organization. The manager’s task is therefore to plan, organize, staff, and supervise the delivery of nursing care (Daniels, 2004). Such manager is also tasked with introducing changes, managing conflicts, protecting patient safety, and overseeing the acts of members. O’Brien (2010) highlights the fact that nurses already possess the skills and qualities to be nurses and managers. This is due to the fact that major modifications in the health practice now call for leaders and managers to be critical in their actions and healthcare decisions, and to portray active listening skills while communicating with patients and other health professionals. Moreover, Feldman and Greenberg (2005) declare that it is important for these nurses to build and improve their leadership and management skills in order to help fulfil the vision of nursing practice and to guarantee that others would also follow their lead. Critical event/incident The critical incident subject of analysis involves my actions on an uncooperative patient. This critical reflection will focus on the significance of consulting with other staff members in the decision-making process and also of efficiently delegating tasks. I will apply Driscoll’s (2007) reflective model which covers the guide questions: What? So What? and Now What? in order to evaluate the incident, my actions, and what my actions have taught me about the critical incident. The privacy and confidentiality of the patient and staff will be protected at all times, and so assumed names will be used for this essay (NMC, 2008). What One of the incidents which stand out in my memory during my clinical placement is an incident whereby I was asked to assist in the management of Mary, a 30 year old, depressed suicidal patient. With the patient requiring level 4 care, the nurses were short staffed and I was asked to assist in monitoring and observing the patient, as well as preventing incidents of self-harm and any aggressive actions against other patients and staff members. The patient was recently admitted to the inpatient unit after she cut her wrist in an attempt at suicide. She recently suffered a traumatic incident with the death of her 5 month old son. According to Higginbottom, et.al., (2011), nursing assessment is an important element of the nursing practice as it helps promote the accurate and timely management of patient needs. Nekanda-Trepka, et.al., (2011) discusses that depressed and suicidal patients must be placed under close observation in order to prevent further suicide attempts. Brim and colleagues (2012) recognize the fact that nursing assessment and observations can be used as a tool to prevent any self-harm among depressed patients. Mary was being managed under level 4 observation (within arm’s length) because she was unstable and showed signs of further attempts at suicide. Geddes, et.al., (2012) discusses different levels of observations for mental health patients. Level 1 refers to general observations, level 2 refers to more focused observation, level 3 refers to within sight observation, and level 4 to within arm’s length observation. This patient had to have a nurse with her at all times in order to prevent any further attempts at suicide and possible harm to the staff or other patients. Mary refused to get out of bed and refused all medications and other efforts to manage her depression. She also refused to socialize with the staff and the other patients. What little conversation engaged with her revealed that she just wanted to be left alone to die. Petrie, et.al., (2011) discuss that depressed patients can sometimes be suicidal especially as their emotional coping processes are compromised. The possibility of repeat suicide attempts is common among these patients (Petrie, et.al., 2011). The danger of further attempts usually happens in the hours or days following an attempt at suicide (Petrie, et.al., 2011). Hence, Mary was immediately placed under suicide watch after her initial suicide attempt. She needed to be strictly monitored because she was actively thinking and considering ways to commit suicide again. She made attempts at grabbing sharp objects, jumping off windows, and one time when she was left alone, she tried to hang herself with an electrical cord. Suicidal patients are also known to self-isolate, sometimes preferring to sleep for prolonged periods, and have no appetite or desire to eat or care for themselves (Lepine and Briley, 2011). During my time caring for the patient, her anti-depression medication was also due, but she refused to take it. One time, she also attempted to grab my pen in an apparent attempt to secure a sharp object. I then ended up not using any sharp objects near her. As she lost access to tools she can use to commit suicide, she then withdrew further into self-isolation. I attempted to engage her in conversation, but she hardly ever responded to me. After my fourth hour of caring for her however, she suddenly manifested a change in her demeanour, acting more cooperative and saying that she was doing better already. She also said she’ll take her medications and eat something as well. However, this demeanour was actually an attempt at finding another way to commit suicide. I observed that she attempted to hide the fork which was brought with her meal. When I caught her trying to hide it, she got angry and agitated as she refused to give back the utensil. I successfully retrieved the fork and she was back again to self-isolation. During my time with the patient, I referred the different incidents to my mentor in order to seek her assistance and guidance and also to ensure that my actions were within the standards of nursing care. At all times, at least one nursing staff was also within calling distance, available to assist in cases of physical violence or aggression from the patient. So What? My mentor assigned me to work with Mary because the nursing team was short staffed. Weng and colleagues (2010) and the NMC Code discuss that during the mentoring process, the nurses must also provide opportunities for the nursing students to learn and to apply nursing skills and interventions. I therefore agreed to the task and the application of skills in order to gain knowledge to support my continued development. I however also considered it important to participate in the decision-making processes in patient case. Fitzpatrick (2006) discuss that part of the leadership and management process for nurses is the ability to decide independent nursing care as an individual, as well as a member of the health care staff. In some ways, I felt that the staff was applying an autocratic form of leadership in simply ordering me to carry out nursing interventions. However, such type of leadership can work best during emergency settings only. It is an efficient leadership style during emergency conditions. There were moments with the patient, especially when she attempted to kill herself which were considered emergencies, and the autocratic style of leadership was appropriate then. However, there were also moments when the patient was calm when the situation did not amount to an emergency and other more consultative styles of leadership can instead be applied. I was nevertheless on my first day of placement when I was assigned the patient and I knew that I needed the assistance and guidance of the other health professionals in caring for the patient. Fitzpatrick (2006) indicates that it is important for student nurses to be guided in the process of care, applying appropriate leadership styles in order to help nurture and develop their skills as well as encourage their understanding of the nursing processes and its intricate demands. In reflecting back on the incident, I felt that I accepted the task with much trepidation, mostly because I felt that I did not possess the necessary skills as yet to manage a suicidal patient. I also feared that the patient would cause me harm or that I would fail to prevent the patient from committing suicide. Nevertheless, as my mentor was with me at all times, I felt motivated and confident in the task assigned to me. Within management principles, added support and supervision can provide greater motivation for individuals especially if the supervisor has greater authority and experience over them (Davies, et.al., 2011). The supervisory role can make individuals feel like they would be steered towards the right direction if ever they would encounter any difficulties. Flynn and Stack (2005) discuss that support refers to the emotional and physical encouragement and guidance which can be provided by other people in the administration of specific tasks. With the support of my mentor I felt that I was more empowered in my work. I felt however that I could not be left alone with the patient because she was at risk of harming herself and other people. Inasmuch as my mentor was with me at all times, I felt that other staff members should have been with us as well. My mentor was a capable nurse as well, however, she was not a mental health nurse and the skills of a mental health expert were needed in order to adequately manage the situation (Dunn, 2012). There were also moments when my mentor and I needed bathroom and meal breaks and we had difficulty securing the patient’s safety during these times. One of us had to stay with the patient at all times and I feared the moments when my mentor was not with me. Although other nurses were within calling distance, at most times, they were also busy with their own patients. The above situation indicates unsafe work and health conditions. These conditions can be unsatisfactory and dangerous for the staff and for the patient because the staff is overworked and limited in number. As discussed by Malouf and West (2011), inasmuch as patients must be prioritized in their care, they must also be motivated physiologically and psychologically in order to achieve other needs within their work environment and eventually their personal life. This is very much in keeping with Maslow’s Hierarchy of needs, which declares the need to satisfy physiological needs and other safety concerns before higher needs are secured (Malouf and West, 2011). As long as these needs are satisfied, a more engaged commitment to the work can be promoted. I attempted to dissuade Mary from committing suicide and I also sought to draw her out of her depression and self-isolation. It was however a difficult process. My mentor supervised my attempts and assisted me in efforts to stop Mary from committing suicide. These efforts made the patient more aggressive and at times more self-isolated. Lofmark, et.al. (2011) discusses that supervision is an essential element of nursing leadership. Powell (2011) points out that delegating a task to a person implies that the delegatee would also be observed and supervised at all times. In managing the patient and trying to dissuade her from committing suicide, I suggested that it may help the patient to have a calming influence or presence to stop her from attempting further to kill herself. Health managers are also those who are able to consider all possible options in caring for their patients, including a more holistic process in health management (Gillen and Graffin, 2010). Holistic care involves the application of various leadership skills, including communication (Gillen and Graffin, 2010). I tried to clearly communicate my suggestion to my mentor and she said that attempts at family intervention were already tried previously but the patient did not respond well to these efforts. For the moment, she emphasized, preventing the patient from committing suicide is the main concern. In the next few days when the patient is less anxious, further attempts at reaching the patient may be tried. She then emphasized the importance of being vigilant in our suicide watch (O’Brien, et.al., 2008). I felt however that we would be more effective in preventing the suicide if some form of emotional support from the patient’s family was also available. My mentor noted my suggestions and we sought to establish an understanding of the conflict and difference in opinion. Gillen and Graffin (2010) also discuss that there would be possible conflicts and difference in opinions between health professionals. The important consideration during these disagreements is to ensure that the communication lines are open at all times, with the welfare of the patient being paramount in the minds of the professionals (Brady, et.al., 2010). Differences in opinion can also be resolved through compromise as was seen in this case. My mentor and I agreed that the patient would likely benefit from family presence, and we therefore agreed to prevent any immediate suicide attempts first before trying to contact the patient’s family. There is a negotiation process which unfolded (Tomey, 2009). This allowed multiple goals to be achieved and allowed for a more open and democratic decision-making process to unfold. This is also win-win situation as my and my mentor’s suggestion was considered in the decision-making process; in the end, the welfare of the patient was the primary concern (Rogers, 2012). It is important for leaders to relinquish total control of the decision-making process, allowing a more collaborative effort to be applied. This collaborative process would allow the best decision to be applied for the patient, without allowing personal and selfish concerns to affect the delivery of patient care (Rogers, 2012). Now What? After collaborating and then negotiating with the mentor, my mentor agreed that once the patient has calmed down, we would contact the patient’s family for possible emotional patient support. Bondas (2010) discusses that it is important for nurse leaders to be open in their decision-making processes and to listen to the suggestions of others, especially of their team. Charles, et.al., (2011) discusses that active listening is crucial to the communication process for leaders. In this case, the mentor listened to my suggestion and agreed that the patient may indeed benefit from family presence. However, she was also firm in her belief that our primary concern first was to prevent any suicide attempts. There was a compromise in the situation which rendered a better decision in the care of the patient. This is a welcome change which can ultimately assist in managing patient’s emotional turmoil (Charles, et.al., 2011). The patient’s depression stems from her grieving and loss and her family also shares the loss with her. Being with people she cares about and who care about her would help start the healing process and eventually resolve the depression (Rosenberg, et.al., (2011). My mentor was concerned more about the patient’s current emotional state and the fact that the patient was actively seeking to kill herself, and having family present may produce a counterproductive response. Depressed patients can indeed be unpredictable and family presence may not necessarily be helpful. I sought to understand and listened well to my mentor’s concerns, especially as she had more experience and knowledge in the situation (Rosenberg, et.al., (2011). The conflict resolution in this case took on a greater significance, especially in relation to effective leadership and management. I realized the importance of making effective decisions, fully considering the impact of such decision to the patient and to the health care practice in general. Under these conditions, my mentor applied the democratic style of leadership, sharing the decision-making process with me (McBride and Snyder, 2011). Moreover, I also learned the importance of communication. Tourangeau, et.al., (2010) discusses that communication is the process of relating and narrating to other individuals, thoughts and feelings regarding a certain scenario or situation. It is a two-way process which requires the parties to listen to each other actively and to respect their right to express themselves (Tourangeau, et.al., 2010). For which reason, I realized that I needed to be open in my practice, to stand together with the other health professionals, and not to oppose them as members of the health care team. Anderson and colleagues (2010) discuss that where the communication process is not protected and ensured, errors in care may arise. Moreover, incidents of conflict may also emerge. There were moments of conflict with the mentor which almost compromised patient care however, as we both realized the importance of coordination and communication, we sought to resolve differences in our opinion. Conclusion I have learned through this incident that nurses are often thrust into situations which call for the application of leadership skills. In these situations, the importance of team work, coordination, and communication are highlighted. Conflicts between health professionals must be resolved through an effective communication process which seeks to consider all possible options objectively. This was applied for this patient, especially as my mentor and I eventually agreed to compromise and negotiate with each other for the sake of delivering the best and most effective care for the patient. As a result, the patient was prevented from committing suicide while in the height of her emotional turmoil; and she also gained her family’s support after she was more emotionally ready to consider her family. This collaborative process of leadership allowed for a shared understanding of the patient’s condition and effective health care delivery. References Anderson, B., Manno, M., OConnor, P., and Gallagher, E., 2010. Listening to nursing leaders: using national database of nursing quality indicators data to study excellence in nursing leadership. Journal of Nursing Administration, 40(4), p. 182. Bondas, T., 2010. Nursing leadership from the perspective of clinical group supervision: a paradoxical practice. Journal of nursing management, 18(4), pp. 477-486. Brady, G. and Cummings, P., 2010. The influence of nursing leadership on nurse performance: a systematic literature review. Journal of Nursing Management, 18(4), pp. 425-439. Brim, C., Cen, C., Halpern, J., Storer, A., 2012. Clinical practice guideline: Suicide risk Assessment. Charles, J., Odom, S., and Weaver, K., 2011. Servant leadership: A model for nurse leaders in the 21st century. London: Routledge. Clark, C., 2008. Creative nursing leadership and management. London: Jones & Bartlett Publishers. Cummings, G., MacGregor, T., Davey, M., Lee, H., et.al., 2010. Leadership styles and outcome patterns for the nursing workforce and work environment: a systematic review. International Journal of Nursing Studies, 47(3), pp. 363-385. Cummings, G., 2012. Editorial: Your leadership style–how are you working to achieve a preferred future?. Journal of Clinical Nursing, 21(23-24), pp. 3325-3327. Daly, J., Speedy, S. and Jackson, D., 2004. Nursing Leadership. London: Elsevier Health Sciences. Daniels, R., 2004. Nursing fundamentals: Caring & clinical decision making. London: Cengage Learning. Davis, N., Clark, A., O’Brien, M., Sumpton, K., et.al., 2011. Learning skills for nursing student. London: SAGE. Dunn, K., 2012. Mentoring within clinical education. Radiologic Technology, 83(4), pp. 401-404. Fitzpatrick, J., 2006. Encyclopedia of nursing research. London: Springer Publishing Company. Flynn, J. and Stack, M., 2005. The role of the preceptor: A guide for nurse educators, clinicians, and managers. London: Springer Publishing Company. Geddes, J., Price, J., and McKnight, R., 2012. Psychiatry. Oxford: Oxford University Press. Gillen, P. and Graffin, S., 2010. Nursing delegation in the United Kingdom. OJIN: The Online Journal of Issues in Nursing, 15(2). Greenberg, M., 2005. Educating nurses for leadership. London: Springer Publishing Company. Higginbottom, G., Richter, M., Mogale, R., Ortiz, L., et.al., 2011. Identification of nursing assessment models/tools validated in clinical practice for use with diverse ethno-cultural groups: an integrative review of the literature. BMC Nursing, 10(1), p. 16. Kelly, P., 2011. Nursing leadership & management. London: Cengage Learning. Lépine, J. and Briley, M., 2011. The increasing burden of depression. Neuropsychiatric disease and treatment, 7(Suppl 1), p. 3. Lofmark, A., Carlsson, M. and Wikblad, K., 2011. Student nurses perception of independence of supervision during clinical nursing practice. London: Routledge Malouf, N. and West, S., 2011. Fitting in: a pervasive new graduate nurse need. Nurse Education Today, 31(5), pp. 488-493. McBride, K. and Snyder, E., 2011. Dimensions of nursing process: The leadership cure. Advances in Neonatal Care, 11(4), pp. 268-271. Nekanda‐Trepka, C., Bishop, S., and Blackburn, I., 2011. Hopelessness and depression. British Journal of Clinical Psychology, 22(1), pp. 49-60. O’Brien, M., 2010. Servant leadership in nursing. London: Jones & Bartlett Publishers. O’Brien, P., Kennedy, W., and Ballard, K., 2008. Psychiatric mental health nursing: An introduction to theory and practice. London: Jones & Bartlett Publishers. Petrie, K. and Brook, R., 2011. Sense of coherence, self‐esteem, depression and hopelessness as correlates of reattempting suicide. British Journal of Clinical Psychology, 31(3), pp. 293-300. Powell, R., 2011. Improving students delegation skills. Nurse Educator, 36(1), p. 9. Rogers, R., 2012. Leadership communication styles: a descriptive analysis of health care professionals. Journal of Healthcare Leadership, 4, pp. 47-57. Rosenberg, S., Peterson, R., Hayes, J., Hatcher, J., et.al., 2011. Depression in medical in‐patients. British Journal of Medical Psychology, 61(3), pp. 245-254. Sherring, S., 2012. Nursing leadership within the NHS: an evolutionary perspective. British Journal of Nursing, 21(8), pp. 491-494. Tomey, A., 2009. Nursing leadership and management effects work environments. Journal of Nursing Management, 17(1), pp. 15-25. Tourangeau, A., Cranley, L., Laschinger, S., and Pachis, J., 2010. Relationships among leadership practices, work environments, staff communication and outcomes in long‐term care. Journal of Nursing Management, 18(8), pp. 1060-1072. Weng, R., Huang, C., Tsai, W., Chang, L., 2010. Exploring the impact of mentoring functions on job satisfaction and organizational commitment of new staff nurses. BMC Health Services Research, 10(1), p. 240. Read More