Professional Practice Improvement Episode - Literature review Example

Professional Practice Improvement Episode (PPIE) Introduction This paper presents a review of literature on five key areas discussed in an interview with a critical care nurse working in public tertiary referral health center which offers services such as; mental health care, aged care, rehabilitation, general medical and surgical services. During the interview, some of the key issues discussed revolved around; the attributes of effective clinical leaders and how they contribute in improving patient service, leadership styles used by effective clinical leadership, clinical expertise, development of expertise in the workplace, the challenges faced by clinical leaders (See appendix). This paper critically reviews literature surrounding these areas and subsequently presents a personal plan on how I as an aspiring clinical leader would develop the qualities of effective clinical leadership discussed during the interview. Attributes of Effective Clinical Leaders One of the questions asked in the course of the interview with the critical care nurse, sought to establish what attributes do effective clinical leader possess and how these attributes contribute to the improvement of patient care services. The nurse interviewed offered some invaluable insights that are also echoed in a number of literature sources. Firstly, the interviewee pointed out that one of the common attributes that an effective clinical leader posses is a passion for change. According to him, effective clinical leaders have passion for positive change and improvement of patient service. Similarly, Cook (2001), Lett (2002) and Stanley (2006) note that effective clinical leaders often have a drive for change. It is this drive that often compels them to be agents and champions for change within their area of practice. A passion for change compels clinical leaders to identify challenges and opportunities for change, apply their knowledge and utilize evidence in finding suitable ways of initiating changes that will help to improve the quality of clinical practice in different contexts. As a result of their passion for change, they are also prompted to participate in setting quality and safety agenda. They also play a substantial role in determining resource allocation priorities to support best practice (Victorian Quality Council, 2005). Secondly, the interview noted that effective clinical leaders posses good communication skills. Poor communication skills is reported to be a major contributing factor in medical errors and unintentional patient harm. Therefore, it is crucial for clinical leaders to posses effective communication skills in order for them to effectively facilitate professional practice improvements. Similar to what the interviewee indicated in the course of the interview, a number of literature also support the notion that effective clinical leaders have good communication skills. For instance, Stanley (2006) observes that effective clinical leaders posses effective communication and interpersonal skills. They are good listeners and are able to articulate themselves clearly and understandably to patients and staff at different levels and exert influence. Effective communication and interpersonal skills enables clinical leaders to openly and clearly communicate and report safety and quality issues and collaborate with other staff in the clinical setting in developing suitable solutions (Victorian Quality Council 2005). In addition to this, a considerable number of studies have also established a positive correlation between good communication skills among clinical staff and professional practice improvement (Leonard, Graham & Bonacum, 2004; O’Daniel & Rosenstein, 2008). Leadership styles used by effective clinical leaders The interview with the critical care nurse also sought to establish the approach or style to leadership that effective clinical leaders use. The interviewee revealed that there is no definite or standard style of leadership that he uses rather, he tends to focus on empowering and motivating other clinical staff to continuously work towards professional improvement and development. A critical look at various relevant literatures on leadership, it is apparent that there are different perspectives on effective leadership. Generally, most literature sources categories leadership into authoritarian, laissez-faire and transformational leadership styles. It is worth questioning which of these leadership styles can be effectively used by clinical leaders to promote professional practice improvement. Martindale (2011) an autocratic leadership style in often characterised by direct supervision, strict regulations, hierarchical power relationships and little or no consultation. Moore (2007), argues that an autocratic style of leadership may have detrimental impact on staff professional development since it does not meet the motivational needs of employees and provides little room staff input. Thus using this style of leadership clinical staff may feel unmotivated to continuously work towards professional improvement and development. Conversely Northouse (2007) argues that, although an autocratic style of leadership may not motivate staff members to take up initiatives towards the improvement of their practice, this approach to leadership can contribute to work effectiveness. Since staff members are supervised closely and governed by strict rules, they are less likely to “slack off”, resources are efficiently utilised and time wasting is avoided (Northouse, 2007). On the other hand, Johnson& Hackman (2003) observe that a laissez-faire style of leadership is characterised by flexibility, autonomy , delegative and “hands-off” approach towards managing staff. Murugan (2007) notes that, some of the benefits of this leadership approach is that it instills a high sense of responsibility and commitment on staff members. It also encourages innovativeness and compels staff members to take personal initiative towards their professional improvement and development. Nevertheless, Daniels (2003) points out that this style of leadership tends to evoke passivity, low productivity, inefficiency, chaos and aimless behaviour since it provides unregulated staff autonomy. A number of literatures in the nursing field seem to suggest that transformational leadership style is the most suitable approach for enhancing professional practice improvement within the clinical settings (Bamford-Wade & Moss 2010; Stanely 2006). For instance, Bamford-Wade & Moss (2010), illustrate that principles of transformative leadership such as personal values, capacity building, recognition, responsibility and autonomy promote culture change in nursing. They further note that, transformational leadership challenges the existing structures and evokes innovation that could lead to professional practice improvement. Bamford-Wade & Moss (2010) also establish that in the nursing workforce, transformational leadership outcomes include competency, continuous learning, commitment to practice and professional respect for others. Clinical Expertise The interview with the critical care nurse also sought to establish what clinical expertise entails. The interviewee revealed that clinical expertise is another important quality of effective clinical leaders. It entails being experienced and knowledgeable in ones field of practice, being an effective leader and decision maker. Lett (2002) also concurs that in order for clinical leaders to be effective in facilitating professional practice improvements, they must have clinical expertise. According to Scholes (2006), clinical expertise entails possessing solid knowledge, skills and experience in providing a wide range of medical interventions. It also encompasses the ability to exhibit effective leadership and decision making in complex situations. Nurses who possess clinical expertise often act as mentors by enhancing the professional development of other nursing staff and developing a supportive work environment (Benner et al. 2009). Similarly, Selinger & Crease (2006) observes that a clinical expert is a clinician who possesses extensive knowledge and skills that enables them to respond effectively to various challenging situations. In essence, clinical expertise is the ability to know what to do, how to do it and when to do it (Benner et al 2009; Dreyfus 2008). Stage of developing clinical expertise During the interview it was established that the ultimate goal of professional practice improvement is to achieve clinical expertise. One of the questions asked during the interview sought to establish what stages nurses have to go through in order to realise clinical expertise. The interviewee pointed out that, effectively developing expertise among nurses involves five key stages namely; the novice stage, advanced beginner stage, competent stage, proficient stage and the expert stage. Since critical care nurses are qualified and possess the required clinical knowledge and skills the emphasis is placed on the competent, proficient and the expert stages of developing clinical expertise. During the competent stage, nurses gradually develop solid knowledge and experience in working with their colleagues, patients and their families. As a result, they are able to apply their clinical knowledge and skills towards the provision of interventions that promote the overall well being of patients. Moreover, during this stage nurses should be able to exhibit high standards of nursing care by employing up-to date and relevant approaches to patient care (Selinger & Crease 2006). On the other hand, Alspach (2008) observes that understanding patients’ needs is key to the delivery of quality clinical services. Therefore during the competent stage, nurse should be in a position to assess, identify and use appropriate measures to address patients’ medical needs. The interviewee also revealed that, during the proficiency stage nurses are expected to effectively carry out patient assessment, diagnose patients and administer suitable medical and therapeutic interventions. They should also be able to engage in research based practices geared toward improving the quality of patient care services (Wyckoff et al 2009). Challenges faced by Clinical Leaders Stanley (2006) reveals that clinical leadership can be informal in nature. Clinical leaders do not have to be in senior management positions rather, any experienced nurse can take up the challenge of becoming a clinical leader. Nevertheless, this role is marred by numerous challenges. When asked, what is the major challenge that clinical leaders face as they attempt to promote professional practice improvements, the interviewee revealed that the organisational structure of most health care setting is a major challenge. The organisational structures of most health care settings are multilayered and complex, as a result there is no clear definition of roles. This in turn impacts on the process of learning and developing expertise. In most cases, nurses are required to perform different roles and work with physicians this in turn minimises their chance of fine tuning their expertise in a specific area of practice. Typically, in most health care settings a nurse is required to perform different tasks in the emergency room, patient wards, surgery division and ICU. This in turn makes it difficult for them to master a specific area of practice (Fulbrook 2003). It also makes it difficult to conduct clinical audits and effectively evaluate the progress they make in their professional practice (Benjamin 2008). Personal Plan and Reflection Following the interview with the critical care nurse, I gained invaluable insights on ways that I can develop clinical expertise and effective clinical leadership qualities. I learnt that nurses work in a dynamic and ever changing professional environment characterised with numerous challenges. Therefore, in order for nurses to deliver quality patient service, effective clinical leadership is essential. Clinical leadership entails a set of attributes and tasks that facilitate and lead to improvements in quality and safe health care practice. This interviewee helped me to understand that a clinical leader could be any nurse with clinical expertise in a specific nursing practice area and who employs their interpersonal skills to empower nurses to deliver quality patient care (Stanley 2006). In essence, clinical leaders use their expertise and skills to continuously improve patient care by influencing others (Cook 2001). Some of the key qualities I learnt that effective clinical leaders possess include; passion for change, effective communication and interpersonal and clinical expertise. In order to achieve these qualities, I intend to capitalise on Billet (2001) model of professional practice improvement and development of clinical expertise. Following direct investigation of expertise development in a wide range of industry sectors Billet (2001) proposes two major ways of professional practice improvement and development of expertise. Approach one: Direct Method This approach involves working under the tutelage and supervision of senior nurses who support my integration into the operations schedule and protocols of the hospital. This approach will also enable me to directly draw on the experiences of senior nurses in developing my own expertise. The direct approach also involves learning from co-workers. Through regular interactions and collaboration with nurses, doctors, surgeons and other specialised practitioners in the hospital, I can be able to gain significance on clinical leadership. They could provide advice on how to respond to unfamiliar scenarios and suggest areas improvements (Chaboyer and Patterson 2001). Moreover, regularly taking part in counseling and peer support sessions will help to stimulate reflective practice essential for developing effective clinical leadership qualities. (Bucknall 2000; Fulbrook 2003). Approach Two: Indirect Method This approach involves learning by careful listening and observing. It entails closely watching co-workers (senior nurses), doctors and surgeons perform their duties in the workplace and drawing lessons from them to build the individual expertise. It also involves learning through informal discussions that take place during off-duty hours regarding day’s experiences and challenges. This will help stimulate reflective practice that is essential for developing clinical expertise (Bucknall 2000; Fulbrook 2003). References Alspach, G. 2008, ‘Recognizing the primacy of competency and exposing the existence of incompetence’, Critical Care Nurse vol 28, no.4, pp. 12-14. Bamford-Wade, A. & Moss, C 2010, “Transformational leadership and shared governance: an action study”, Journal of Nursing Management vol 18, pp. 815–821. Benjamin, A 2008, “Audit: how to do it in practice” British Medical Journal vol 336, pp. 1241-1245. Benner, P., Benner, P.A, Tanner, C. A. & Chelsa, C.A. 2009, Expertise in Nursing Practice: Caring, Clinical Judgment & Ethics, Second Edition, Springer, New York. Billet, S. 2010, Learning through practice: models, traditions, orientations and approaches. Springer, Dordrecht. Bucknall, T. K.2000, Critical care nurses’ decision-making activities in the natural clinical setting, Journal of Clinical Nursing, vol 9, no .1, pp. 25–36 Cook, M 2001, “The attributes of effective clinical nurse leader”,Journal of Nursing Management vol 15, no.33,pp.33-36. Daniels, R 2003, Nursing Fundamentals: Caring and Clinical Decision Making, Thomson Learning, New York. Dreyfus, H. L. 2008, “What computers still can't do”. In Farrar, N. & Trorey, G. “Maxims, tacit knowledge and learning: Developing expertise in dry stone walling”, Journal of Vocational Education & Training vol 60, no. 1, pp. 35- 48. Fulbrook, P 2003, “Developing best practice in critical care nursing: knowledge, evidence and practice”. Nursing in Critical Care vol , 8, no 3, pp. 96-102. Johnson, C.E & Hackman, M.Z 2003, Leadership: A communication perspective (4ed), Waveland Press, London. Leonard, M., Graham, S., & Bonacum, D. 2004, “The human factor: the critical importance of effective teamwork and communication in providing safe care”. Quality Safe Health Care, vol 13, no.1, pp.85-90. Lett, M 2002, “The concept of clinical leadership”, Contemporary Nurse vol 12, no 1, pp. 16-20 Martindale, N 2011, ‘Leadership styles: How to handle the different personas,’ Strategic Communication Management vol 15, no.8, pp. 32-35. Moore, E. M 2007, The impact of leadership style on organizational effectiveness: Leadership in action United Way of America, Proquest, New York. Murugan, M.S 2007, Management Principles and Practices, New Age International, New York. Northouse, G 2007, Leadership theory and Practice, 3rd Ed, SAGE, California, Thousand Oaks. O’Daniel, M. & Rosenstein, A.H.(2008). Professional Communication and Team Collaboration, In R. G Hughes, Patient Safety and Quality: An Evidence-Based Handbook for Nurses, Agency for Healthcare Research and Quality, Rockville, MD. Scholes, J 2006, Developing Expertise in Critical Care Nursing, Wiley-Blackwell, New York. Selinger, E. & Crease, R.P. 2006, The Philosophy of Expertise, Columbia University Press, New York: Stanley, D 2006, “Recognizing and defining clinical nurse leaders”, British Journal of Nursing vol 15, no.2, pp. 108-111. Victorian Quality Council 2005, Developing the clinical leadership role in clinical governance: A guide for clinicians and health services, Department of Human Services, Victoria. Wyckoff, M., Houghton, D. & LePage, C. 2009, Critical Care: Concepts, Role and Practice for the Acute Care Nurse Practitioner, Springer, New York. Appendix 1 : Interview Questions 1. What attributes do effective clinical leader posses and how do these attributes contribute to the improvement of patient care services? 2. As a clinical leader, which leadership style or approach do you use? 3. Clinical expertise in an important quality that clinical leaders must possess in order to facilitate professional practice improvement of other. What do you think clinical expertise entails 4. What stages nurses have to novice or beginner nurses have to go through in order to realise clinical expertise? 5. What is the major challenge that clinical leaders face as they attempt to promote professional practice improvements? Read More