The Influence of Nursing Leadership on Nurse Performance - Literature review Example

Critical Reflection Student’s Name Institution Affiliation Critical Reflection Critical reflection is one of the learning strategies that continue to arouse a lot of interest from both scholars and management teams (Van Woerkom, 2010). Despite being widely accepted as a means of improving practice, it appears that there is no consensus definition. Rather, many scholars and management teams have defined it as per their understanding or practice (Lucas, 2012). Thus, critical reflection is associated with ideas such as transformative learning, reflective practices, and professional development. In nursing, critical reflection is believed to promote learning. Bulman, Lathlean and Gobbi (2011) conducted a study on critical reflection among nursing. They found out that the approach enabled nurses to assess their performance as well as highlight areas that require improvement. Therefore, the aim of this paper is to examine critically my professional experience through succinct analysis of my role as per the lead domain; as explained by the Australian Nurses Federation. To achieve this, my experience will be supported by relevant literature, which will enable logical comparison between theory and practical nursing. Also, the Gibbs reflective cycle will be adopted to ensure that the reflective process captures all the vital information that lead to increased learning and understanding of my professional experience. According to the Royal College of Nursing (2012), there has been a misuse of the term advanced nursing practitioner with some nurses taking up the title without the requisite academic qualifications. This confusion is attributed to the fact that there had been no authoritative definition of the term advanced nursing practitioner until recently when the International Nursing Council (ICN) developed one. Thus, according to the Advanced Nursing Practice Toolkit website (2012), ICN considers an individual an advanced nurse if he or she is: a registered nurse, has acquired the expert knowledge through formal training, possess excellent decision-making skills as well as clinical competencies as allowed within their jurisdiction, and possess Masters degree Johansson, Fogelberg, and Wandensten (2010) found out that the number of years in duty influenced the nurses ability to adopt evidence-based practices into their leadership activities. This finding demonstrates that advanced nurse practitioners do apply their professional experience to build professional competencies as advocated for in the lead domain. In addition, Lowe, Plummer, and Boyo (2012) point out that there is need to continue offering guidance on the roles of an advanced practice nurse since it has been ascertained that uncertainty and lack of clarity still loom around the title. To address this issue, the Australian Nursing Federation has managed to clarify the matter by highlighting the specific competency standards for an advanced nursed. Based on their guidelines, an advanced registered nurse must be registered and practicing, capable of taking responsibility for clinical, educational and managerial decisions, and can adopt and apply evidence-based practices (Australian Nursing Federation, 2005). The leads domain was created as a result of combination of resource and developing domains(Australian Nurses Federation,2005). Consequently, the merger of the two domains means that the leads domain is defined by the characteristic competencies of the combining domains. Therefore, under the leads domain, an advanced nurse is expected to fulfill the following: “Initiate improvements/ innovation in clinical practice”, “Act as a Mentor and role model for nurses and other health professionals”, contributes to development of nursing knowledge and standards thought engagement at the broader professional level” , ”act as resources for other nurses and members of the health care team”, “Resources others through their capacity to practice outside single contexts and episodes of practice” (Australian Nurses Federation, 2005, p.28) The leads domain consists of competencies that demonstrate an individual's ability apply one's leadership competencies to promote and improve the nursing practice (Australian Nursing Federation, 2005). The Leads practice domain focuses on the role of leadership in the nursing profession. Germain and Cummings (2010) point out that leadership is a critical aspect that affects nurse's performance and by increasing their autonomy and access to resources, one can begin witnessing better nursing management. Sherman and Pross (2010) note that the development of the right leadership skills within the nursing profession will take some time. Hence, the nurse-manager competency model is founded on a leadership and learning domain framework that constitutes of managerial science, group, and personal leadership (Sherman and Pross, 2010). Nurses are an integral part of any hospital; hence, their contributions are crucial regarding improving the quality of health services in hospitals. Therefore, nurses are expected to play a pivotal role in promoting and improving clinical practices within hospitals. Dogherty, Harrisona and Graham (2010) note that one way of improving the quality of services is by facilitating nurses. Facilitation involves targeting one’s individual role in a process so that through deliberate actions, patients can begin to experience better quality of services. Besides facilitation, mentorship is regarded highly within the leads domain. According to Weng, Huang and Tsai (2010), senior nurses acting as mentors contribute significantly towards improving the level of job satisfaction during teamwork. However, the mentorship role has not been without challenges (Huybrecht, Loeckx & Quaeyhaegens, 2011). There have been misperceptions regarding the role of mentorship in advanced nursing. Nonetheless, a good mentor is one who has a positive attitude, capable of providing feedback, as well as experience-based advice consistently despite the workloads and setbacks (Huybrecht, Loeckx & Quaeyhaegens, 2011). Based on the codes of ethics, nurses are expected to contribute towards the advancement of the profession by acting as role models and maintaining professional integrity (American Nursing Association, 2011). Specifically, provision 7.3 of the Code of Ethics for Nurses with Interpretative Statement states that nurses are expected to participate actively in scholarly inquiries to expand on the body of knowledge. Alligood and Raile (2013) notes that nurse theorists have contributed towards the advancement of knowledge. One of the famous nurse theorists was Florence Nightingale. According to Selanders and Crane (2012), Nightingale was one of the earliest nurse theorists to develop an advocacy model that would be used to advance knowledge and best practices within the nursing profession. The Gibbs reflection model was utilized in the course of this critical reflection process. The reflective process is cyclic and involves a series of individual phases that enable one to describe the positive and negative emotions experienced in each phase (Beam, O’Brien & Neal, 2010). Marliot (2012) notes that the reflective process enables one to avoid past mistakes, acknowledge lessons learnt, challenge existing knowledge; consequently leading to the development of new knowledge, promote awareness of our potentials as well as realize our biases. The reflective process takes different forms such as journaling, group discussions among others. In this case, journaling was opted for because it is an intimate way of assessing one's abilities without the fearing criticism and judgment from peers. Also, Bulman and Schultz (2013) state that reflective writing is one the strategies that one can use to link their experiences with theoretical knowledge. Furthermore, keeping a journal enables one to arrange their thoughts in an orderly manner; promotes the development of analytical and critical thinking skills, and promotes the development of new knowledge (Bulman & Schutz, 2013). During the journaling process, the first person narrative was used because it allows one to express himself or herself more candidly compared to the second or third person narrative. Therefore, the process was insightful as it assisted me to understand the limits of my understanding, as well as leadership competencies. Over the past one year, I have worked as in a general ward whereby the I have encountered different types of patients, thereby, giving me an opportunity to work with different teams of physicians, nurses and support staff. I took up journaling of my experiences because I wanted to document some of the best practices I had witnessed when handling patients and well as my team. This approach has been proven an effective way of gathering one's thoughts and ideas. I made entries into my journal twice a day. In the morning I wrote down the specific scenarios I expected to encounter and in the evening I reported on how I handled the earlier scenarios, as well as any new developments. Once a week, I used to look at the entries to assess my strengths and weaknesses as a leader and instructor. Consequently, I was able improve my practice since I was aware of what works and what doesn’t. According to the leads domain, it is important for an advanced nurse to able to contribute towards quality development processes(Australian Nurses Federation, 2005). The entries also formed the basis for providing feedback to colleagues especially in regard to improvement of processes. Lastly, the findings of the facilitated the education the health care team, as recommended within the leads practice domain. At one time, a young lady was admitted to the general ward after being diagnosed with nephropathy. The condition resulted from complications arising from diabetes. It was my fifth time to handle diabetic nephropathy, and I felt the overwhelming responsibility to ensure that the patient received the best possible treatment. Diabetic nephropathy is caused by endothelial dysfunction (Preedy, 2014). When we taking care of the young lady suffer from nephropathy I administered captopril or ramipiril. These drugs contain Angiotensin-convertng enzymes inhibitors. Another recommended treatment is the use of, candesartan, an angiotensin II receptor blocker. However, the doctors recommended that the patient’s treatment plan constitutes a combination of the two types of medication. According to WebMed (2015), combining the two types of medicines offers greater protection to the kidneys. This experience was a chance to practice evidence based treatment as advocated for by the Leads practice. Advanced nurses are expected to create time to listen to the professional concerns of his or her health team(Advanced Nurses Federation,2005). Therefore, every day I spent ten minutes with the interns and colleagues just listening to their experiences, concerns and questions. Through this action I realized that I was able to advise and provide constructive criticisms. Besides these forums, I ensured that I paired each nursing intern with an experienced member of staff as mentors to guide and mentor the interns on how to handle patients. The arrangement was adopted because it would teach the interns on the importance collaborative practices and how it improves patient outcomes. Burzotta and Noble (2011) note inter-professional approach is critical when caring for patients. Over the past one year, a lot of changes have occurred within the hospital. As I leader I felt that it was my responsibility to ensure that I prepared my team for the changes to come. The hospital management team gave a directive that nurses must accompany doctors during the ward rounds. Therefore, I decided to call for a meeting whereby the nurses and doctors agreed on how they will be work together. At the end of the meeting, the nurses and doctors were clear on their respective duties and responsibilities. On this particular issue, I was satisfied with the outcome of the meetings since I was successful at introducing new process that would lead to improvement of the quality of healthcare as advocated for in the leads domain. Also, I demonstrated ability to introduce and manage change; another critical aspect of the leads domain ( Australian Nursing Federation,2005). Another positive experiences working in the general ward involved addressing different challenges and complexities. As a leader, every day my problem solving, and decision-making abilities were continually tested. I recall one morning I walked into the general ward and found out that one of the patients suffering from Crohn disease. As an advanced nurse, it was my responsibility to educate the patient on ostomy care. Additionally, it was an opportunity to pass down knowledge on ostomy to my interns. That day, I demonstrated how to correctly change the ostomy pouch and avoid infections. The first step is to clean one’s hand with good soap, preferably with antibacterial soap, and water. After that, I proceeded to demonstrate how to gently press down the skin around the stoma with one hand while the other removes the seal. Once the pouch removed, it is safely disposed. Then the wound is cleaned and the pouch reattached to the ring seal using squirt stoma paste. Finally, close the pouch using a pouch clip and clean hands using the soap and water. My experiences working at the general ward have made me realize that I need to participate more in medical research projects. I arrived at this decision after recognizing that I need to adopt more evidence based practices as well as participate in forums that contribute to the advancement of my profession. These forums sharpen one’s ability to think outside the box and would expose me to latest information on how to manage different conditions and diseases. Moreover, they are an opportunity to advance my skill and increase knowledge. Therefore, based on these experiences I have decided to request for a transfer to a teaching and referral hospital. The new environment will expose me to newer experiences and advance my knowledge and skill. Additionally, it will a teaching and referral hospital will give me an opportunity to contribute towards contribute towards research as well as make professional submissions. The critical reflection process has been insightful. It has enabled me not only learn how to order my thoughts but also made me aware of my limitations. While I was working in the general ward, I learnt that as a leader I am required to do more than guide and motivate my team Many of my experiences are documented in a journal. I found this method to be an effective and insightful way of practicing critical reflection. Through my notes, I realized that I need to be a resource for both the patients and my team as advocated in the leads domain. Therefore, I decided that to achieve fully the competencies described within the lead domain I will have to transfer to teaching and referral hospital in order to gain more exposure. The reflection process has also made me understand the role of mentorship in nursing practice and the existing gaps. Based on my experiences I believe that there is a need to develop a better mentorship structure in order to ensure that undocumented knowledge and information is not lost. Nonetheless, the process was educative and raised my level of awareness about my limitations. References Advanced Nursing Practise ToolKit. (2012, May 22). Defining advanced practice. Retrieved from http://www.advancedpractice.scot.nhs.uk/definitions/defining-advanced-practice.aspx Alligood, & Martha Raile, M. (2013). Nursing Theorists and Their Work - Pageburst E-book on Kno Retail Access Card. Atlanta: Mosby Inc. American Nursing Association. (2011). Provision 7 | Code of Ethics for Nurses With Interpretive Statements. Retrieved from http://www.nursingworld.org/provision-7 Australian Nursing Federation. (2005). Competency standards for the advanced registered nurse An Australian Nursing Federation - Google Search. Retrieved from Australian Nursing Federation website: https://www.google.com/search?q=Competency+standards+for+the+advanced+registered+nurse+An+Australian+Nursing+Federation&oq=Competency+standards+for+the+advanced+registered+nurse+An+Australian+Nursing+Federation&aqs=chrome..69i57.1582j0j7&sourceid=chrome&es_sm=93&ie=UTF-8# Beam, R. J., O'Brien, R. A., & Neal, M. (2010). Reflective Practice Enhances Public Health Nurse Implementation of Nurse‐Family Partnership. Public Health Nursing, 27(2), 131-139. Bulman, C., Lathlean, J., & Gobbi, M. (2012). The concept of reflection in nursing: Qualitative findings on student and teacher perspectives. Nurse Education Today, 32(5), e8-e13. Bulman, C., & Schutz, S. (2013). Reflective practice in nursing. Hoboken: Wiley-Blackwell. Burzotta, L., & Noble, H. (2011). The dimensions of interprofessional practice. British Journal of Nursing, 20(5), 310-315. Dogherty, E. J., Harrison, M. B., & Graham, I. D. (2010). Facilitation as a Role and Process in Achieving Evidence‐Based Practice in Nursing: A Focused Review of Concept and Meaning. Worldviews on Evidence‐Based Nursing, 7(2), 76-89. Germain, P.B., & Cummings, G. G. (2010). The influence of nursing leadership on nurse performance: a systematic literature review. Journal of Nursing Management, 18(4), 425-439. Huybrecht, S., Loeckx, W., Quaeyhaegens, Y., De Tobel, D., & Mistiaen, W. (2011). Mentoring in nursing education: Perceived characteristics of mentors and the consequences of mentorship. Nurse Education Today, 31(3), 274-278 Johansson, B., Fogelberg M., & Wadensten, B. (2010). Evidence‐based practice: the importance of education and leadership. Journal of Nursing Management, 18(1), 70-77. Lowe, G., Plummer, V., O’Brien, A. P., & Boyd, L. (2012). Time to clarify–the value of advanced practice nursing roles in health care. Journal of Advanced Nursing, 68(3), 677-685. Lucas, P. (2012). Critical reflection. What do we really mean? In 2012 Australian Collaborative Education Network National Conference (p. 163) Marliott, S. (2012). The importance of reflection with improving care and improving standards and the 6cs. Retrieved from RCN website: http://www.rcn.org.uk/__.../ReflectivePractice.pdf Preedy, V. R. (2014). Diabetes: Oxidative stress and dietary antioxidant. Amsterdam: Elsevier Science. Royal College of Nursing. (2012). Advanced nurse practitioners. Retrieved from The Royal College of Nursing website: https://www.rcn.org.uk/__data/assets/pdf_file/0003/146478/003207.pdf Selanders, L., & Crane, P. C. (2012). The voice of Florence Nightingale on advocacy. Online Journal of Issues in Nursing, 17(1). Sherman, R., & Pross, E. (2010). Growing future nurse leaders to build and sustain healthy work environments at the unit level. The Online Journal of Issues in Nursing, 15(1). van Woerkom, M. (2010). Critical reflection as a rationalistic ideal. Adult Education Quarterly, 60(4), 339-356. WebMed. (2015). Diabetic nephropathy - treatment overview. Retrieved from http://www.webmd.com/diabetes/tc/diabetic-nephropathy-treatment-overview Weng, R. H., Huang, C. Y., Tsai, W. C., Chang, L. Y., Lin, S. E., & Lee, M. Y. (2010). Exploring the impact of mentoring functions on job satisfaction and organizational commitment of new staff nurses. BMC Health Services Research, 10(1), 240. Read More