Critical Analysis of Nursing Leadership and Management

In healthcare, critical leadership is important to be expressed by the nurses as it makes them help to evolve and adapt to the constant changes in delivering quality care to the patient. Moreover, effective management leads the nurses to work as a group where quality care delivery is established through sharing of ideas and support as a unit by the nurses (Sfantou et al., 2017). The current essay is going to critically analyse the leadership and management knowledge and experience nurses gained whilst participating in the project work. This will also analyse the role as a nurse to show leadership and management knowledge in a situation experienced in practice or witnessed. This essay will further reflect on the how I participated in group work and how I delivered the task.

In accomplishing a good project, the presence of effective group working is essential for fulfilling the goals in timely and better way. This is because members within a group has different expertise and knowledge which leads them to take different responsibility and accomplish them effectively in meeting the key goal of the work with less barriers and strategic use of resources. It also ensures innovative use of ideas in accomplishing the work which leads in taking less time and ensure greater efficiency in accomplishing the work goals (Rosen et al., 2018). As argued by Gharaveis et al., (2018), lack of group work in project indicates it to be accomplished in a bad way. This is because the various expertise required in managing different aspects of the project are found to be lacking in the condition. Through group work, I clearly recognise my role characteristics, learn to develop my strong points and circumvent weaknesses in the group, and draw lessons and reflections on how to deal with emergencies happened in group work. Every member in the group has his or her role different from others.

The Belbin roles mentions that complete finisher have the weakness of executing unduly worrying of reaching the target goal and finish the project (Quinn, 2017). Similar attitude was seen in me where I acted in anxious way at the end out of being worried about finishing the task even though all the team members are found to have excellently played their roles and responsibilities. The other issue with being complete finisher is that the individuals avoid delegating task allocated to them even in tough situation because they are anxious regarding the efficiency of other in accomplishing the delegated role which is related to finishing the project (Quinn, 2017). This weakness was expressed by as I was reluctant in delegate my responsibility as I felt others may not be capable to meet them and it would lead to hinder finishing of the project which may lead to presence of increased gaps to be resolved later. It would make the project take more time to be completed and fail in meeting the deadline with success.

During the groupwork experience, I felt group work is not an easy job. In the evolve of team building, teamwork theory of four stages of group development helped me better understand and manage various problems or unexpected circumstances that might happen at different stages of team development (Miller, 2003). According to (Tuckman 2010), there are four phases in team evolve: forming, storming, norming and performing. During my experience from this groupwork, in the four different stages of group development, both positive and negative circumstances happened which are required to be cared and managed. The initial stage of group development is forming , in this stage, the group are not united well yet and it will be difficult to reach agreement. Each member is eager to find their place and hardly can feel a sense of belonging within the group (Scott, 2000).

In the forming stage, it was seen that since the members in our group have never worked together, all the individuals lacked to trust others and have no idea about the way to communicate in determining the purpose and focus of the group. In this context, a meeting was arranged in the library through Microsoft Teams application where all the individuals are alerted of the venue. However, Student A did not show up when everybody else were waiting for her appearance. She did not check email or WhatsApp group while the notice of meeting was spread within the group. This was an unhappy accident and we learnt to recheck for some unconfirmed uncertainties to avoid such accidents happening again. According to Clark (2021), in the forming stage, the approach is required to be working independently while trying to focus on developing work-related relationships with peers. It is argued by Ellis (2020), apart from focus on work-related relationships, overview regarding the scope of the team in fulfilling the work purpose and approach is to be informed. In this aspect, my leader illustrated the purpose of the group and group task to be accomplished.

The leader also informed different responsibilities to be played by each member along with informed way they can work with one another in executing the responsibilities in an enhanced. However, every one of us expressed reluctance to work with one another and worked independently but in time, we gradually came to know one another. As argued by Stoller (2021), teamwork cannot be established without providing space and time to the team members to explore their work and connect with one another. This is because time is required to know another and effective working environment allows the members to know each another to gradually form a trusting relationship which is necessary to work as a group. In the forming stage, the leader allocated the responsibilities to the team members based in their strengths and weakness of skills and knowledge so that each of the individual has personal expertise and efficiency in meeting the responsibility.

In the storming stage, each of us began to see ourselves as part of the group and sensed belonging and motivated to work together. In this stage each member can easily challenge each other due to individuals having different points of view towards the same thing. According to Tuckman (2010), conflict and contradiction are typically faced in the storming phase. This is because in storming phase, the brainstorming of idea from different team members are collectively gathered to be discussed where due to differences and disruption in opinion, the conflicts are raised. For example, when we were discussing in one of the meetings, Student A expressed his opinions with her standpoints which student B and me thought good and gave support. But others had quite different ideas, therefore conflict is unavoidable. If we vote to decide which idea will be adopted, the student A and others will feel unsatisfied and reduce groupwork initiative. I figured out that student A and other standpoints had some plus points if melted into students B ideas, so I tried to convince both sides to modify their ideas and harmonize a generally accepted scheme.

The storming stage being contentious makes the members who try to avoid conflict find the stage to be unpleasant and intend to leave. The existing conflict also causes motivation and effort to be lowered towards accomplishing task as all the attention is drawn towards conflict (Shirey et al., 2019). I also faced similar attitude where I though the storming stage is making us waste time, but my leader made me understand is the pillar for gradual formation of bonding as detection of conflicting ideas leads to discussion in reaching clarified purpose later. Thus, I remained focussed and we finally learnt the further meaning of groupwork and realized in a group the collective interests and group performance is above all.

In the storming stage, the group members are to harmonize their ideas and group leader plays important role to coordinate and help for decision making to the method of how to get the task done. Besides, each group member should not only learn independent thinking, but also to appreciate and respect others’ ideas and opinions, thus, to figure out some balance within the group and finish the group goal in a peaceful and beneficial way. The norming stage is a stage where group members start to trust more on each other and unite together to process the task with more groupwork with a growing sense of togetherness (Gersick, 1988). With the forming and storming stages, development, our group gradually grew more mature and groupwork was achieved more effectively and efficiently.

The stage of performing is the final stage which focused on task refreshing, implementing and completing. All groupwork combined to provide synergy for performance is delivered through people working effectively together (Tuckman, 2010). In this stage, many modifications regarding the task structure and manifestation is to be made by the group. Thus, the group members were allocated additional roles and responsibilities to be completed along with existing duties for the original task. A sudden issue was raised but was immediately managed ensuring no threat to final group performance. The conclusion of the task was assigned to completed by me. Through the four stages of group development, I learnt that good communication and discipline are important leadership qualities to make a group work more efficient and collaboratively. Besides, working with integrity, showing dedication towards achieving effective excellence in controlling team and collaboration building are additional leadership qualities to be presented in nurse to be good leader in promoting team working. Besides, mutual respects, trust development and coaching are to be established as they are also qualities of team leaders to support team members achieve a common goal.

The group experience led me to understand that for effective team management, enhanced conflict resolution and guidance skills are to be present among nursing managers. In the group project, the key qualities to manage team are also found to effective communication, commitment towards professional development and effective decision-making to be followed at the right time. As a registered nurse, the learned leadership and management skills such as conflict resolution from the group project is to be applied in future by remaining clam in the conflict situation and allowing all the members to inform their views which are to be discussed with one another in reaching mutual decision. In future, to promote teamwork as a registered nurse, I would initially mention the collaborative purpose to be achieved and direct coordination between team members to work collaboratively in leading and managing the care.

Furthermore, I will now reflect on my leadership and management role I have partaken in an aspect of care when I was in practice. According to (Rowe, 2019) leadership defines as striving to motivate and inspire staff to achieve shared goals. However, management entails planning and organising resources and staff to reach agreed organisational goals (Rowe, 2019). On this day, I came on a shift and the nurse in charge allocated me a men bay which consists of four men I should looked after on a long day shift. The aspect of care I have chosen will focus on managing a patient with a learning disability who have severe decreased nutritional intake leading to his weight loss and deteriorated health.

The presence of poor nutrition intake is a major issue among learning disability patients compared to general population. This is because they fail to have control over the nutritional intake as learning disability makes them unable to have effective cognitive efficiency in understanding the nutritional value of each food. It leads them to intake foods in hindered manner which makes them face moderate to severe intake of nutritional elements in the body (Grumstrup and Demchak, 2017). As argued by BDA (2018), people with learning disability often face issues with swallowing and eating along with require effective assistance during drinking and eating. The lack of effective assist in the eating environment leads them to develop severe decreased nutritional intake. Thus, the situation is to be explored to understand the way the care to the people having learning disability are to be led and managed to ensure them avoid facing severe decreased nutritional intake which is one of the common health problems faced by them. I have anonymised the patient to be referred as Kennedy, following the Nursing and Midwifery council (NMC, 2018) guidelines on confidentiality.

The healthcare leadership model (2013) is valuable in healthcare to understand how leadership behaviours affect the working environment. I will explore how my behaviour in this scenario is structured within the (HLM, 2013) leadership dimensions. The Healthcare Leadership model (2013) mentions that leaders are accountable to lead with care (NHS, 2013). This led me understand the leaders are accountable to have unique qualities in resolving issues faced by the team members or individuals to help them act with the team. In this context, I determined the issues leading Kennedy to experience decreased nutritional intake in the hospital. It is revealed that he is not comfortable in eating with others who are unknown to him and is skipping meals. The fact is unknown to the existing nurses in the ward who had been trying to feed Kennedy but has failed poorly. I personally communicated with Kennedy to determine his needs and he mentioned to eat alone in peace. As argued by Finset et al. (2020), hindered communication establishment by the leaders makes them unable to recognise the key reasons which is causing non-cooperative behaviour of the team members. This is because it creates lack of opportunity to recognise the needs and demands to be fulfilled for achieving collaboration. Thus, I also formed communication with the existing nurses who mentioned to lack effective ability in interacting with learning disability patients due to which they have not been able to identify the key reason behind the hindered behaviour of Kennedy not having food and facing decreased nutritional intake.

The NHS leadership model mentions that leaders have the duty to create shared purpose to engage the team in working collaboratively to achieve the goal (NHS, 2013). This is because shared purpose helps team members to have common work goals which they try to fulfil by coordinating with one another as a group for its easier accomplishment (Fernandez and Shaw, 2020). As argued by Aij and Rapsaniotis (2017), lack of shared purpose makes the leaders unable to achieve team working and effectively led the team. This is because without creation of shared purpose by the leaders, they are unable to collaboratively influence others and direct them in a unified way to achieve care goals. In the care scenario, I created a common purpose that Kennedy along with other patients in the ward are to be made healthy with effective contribution from nurses. For this purpose, I shared the vision of the way it can be achieved which is communicating with each patient and determine their habit and environment of eating comfortably so that according action can be taken by us as nurses to ensure effective nutrition for all as well as Kennedy.

The NHS leadership model mentions that informed that leaders are to be accountable for their actions and have capability in acting as a role model for others (NHS, 2013). This is because accountability makes the leaders effectively use time and effort in controlling activities and followers as they are concerned with executing their responsibility with efficiency (Ramalingam et al., 2020). As argued by Joshi (2017), failure of the leaders to act in an accountable way makes them get distracted from the goals in care to be achieved and provide unnecessary blame on others for their failure. Thus, while acting as leader in the care scenario, I held myself accountable for the decision of providing different eating environment as per patient’s comfort to ensure they take meals properly and avoid decreased nutritional intake. I also made clear to others about the expectations we are trying to reach for Kennedy as other patients in the ward by working collaboratively as a team which I am leading as per the condition been raised.

I will now explore my management role that occurred during my scenario and how clinical governance is associated within healthcare practice. According to (Rowe, 2019) clinical governance is a framework used within healthcare organisations to continually improve services, creating excellence in delivery of care and being accountable to patients. A few elements of clinical governance that was prominent within my scenario was patient involvement and some junior student and healthcare staff management, for example, I ensured I effectively communicated with Kennedy, discussing his needs and views to gain a better understanding of how to overcome his anxieties. I involved Kennedy throughout the entire shift of locating a suitable area to dine in, working in partnership with him and putting his interest first (NMC, 2018). I was able to identify the importance of gaining views from patients and involving them in the process, thus ensuring person centre care- the core of nursing care.

Another aspect of clinical governance was junior student nurses and healthcare staff management, where I actively discussed with them about Kennedy’s needs and plan of care. I encouraged sharing ideas and alternatives; however, I experienced some difficulty from couple of them perspectives of where Kennedy could have his designated dining area. I sought advice from the nurse in charge and the ward manager on area suitability within the ward setting. Enabling Kennedy to dine was a matter of urgency, to encourage his nutrition intake. I felt it necessary to seek advice to avoid conflict and misunderstanding, by being accountable for my decisions and equipped with the relevant information (Rowe, 2019). To develop my management skills, I need to gain more experience working within ward settings and recognising when to ask for support, this will enhance my confidence and build trust between team members. which are the key managers, creating trust and empowering others to achieve high quality care (mullarkey et al, 2011).

The aspect of care I critically analysed, focused on Kennedy’s overcoming his anxieties and supporting him to increase his appetite within the ward setting. My leadership styles of inspiring shared purpose and engaging the junior nursing student based upon the (HLM, 2013) was beneficial because it showed how group working is effective, allowing sharing of ideas and overcoming challenges to achieve the desired goal. Also, the importance of being self-aware allowed me to identify my strengths and areas I also need to develop for my future practice. Whereas my management style was helpful with patient involvement and junior student nurses , because this enabled my accountability. This also helped me to ensuring safety and quality of care for my own practice when I qualify and prepared me for future. This has equipped me to explore the impact of clinical governance and how culture shapes behaviours and values within organisations. As a student nurse, self-awareness is essential to understanding my own leadership and management styles and committing striving to improve patient outcomes, which ultimately delivers high quality and person-centred care and for my future practice.

In future, the learned leadership skills such as creating shared purpose, engaging team members, accountability and raising capability is to be implemented in inter-professional work. For instance, shared purpose of the care is to be created between the professionals to be involved in inter-professional practice and they are to coordinated to act as a team by avoiding conflict and forming mutual trust. The professional to be involved in the practice are to be trained regarding team working so that they develop the capability to work in the situation and manage barriers at work to reach successful care delivery. In regard to the management ability, in future, I am going to implement it in resolving conflicts and smooth operation of inter-professional working. For example, through management skill learned in this account, I would direct the way clinical governance is to be established through inter-professional practice in care.

References

Sfantou, D.F., Laliotis, A., Patelarou, A.E., Sifaki-Pistolla, D., Matalliotakis, M. and Patelarou, E., 2017, December. Importance of leadership style towards quality of care measures in healthcare settings: a systematic review. In Healthcare (Vol. 5, No. 4, p. 73). Multidisciplinary Digital Publishing Institute.

Rosen, M.A., DiazGranados, D., Dietz, A.S., Benishek, L.E., Thompson, D., Pronovost, P.J. and Weaver, S.J., 2018. Teamwork in healthcare: Key discoveries enabling safer, high-quality care. American Psychologist, 73(4), p.433.

Clark, W., 2021. Teamwork: A Multidisciplinary Review. Child and Adolescent Psychiatric Clinics, 30(4), pp.685-695.

Ellis, P., 2020. Team working (part 1): creating a team. Wounds UK, 16(1).pp.78-90.

Stoller, J.K., 2021. Building Teams in Health Care. Chest, 159(6), pp.2392-2398.

Shirey, M.R., White-Williams, C. and Hites, L., 2019. Integration of authentic leadership lens for building high performing interprofessional collaborative practice teams. Nursing administration quarterly, 43(2), pp.101-112.

BDA 2018, The Nutritional Care of Adults with a Learning Disability in Care Settings, Available at: https://hub.careinspectorate.com/media/2870/the-nutritional-care-of-adults-with-a-learning-disability-in-a-care-setting.pdf [Accessed on: 1 January 2022]

Grumstrup, B. and Demchak, M., 2017. Obesity, Nutrition, and Physical Activity for People with Significant Disabilities. Physical Disabilities: Education and Related Services, 36(1), pp.13-28.

Finset, A., Bosworth, H., Butow, P., Gulbrandsen, P., Hulsman, R.L., Pieterse, A.H., Street, R., Tschoetschel, R. and van Weert, J., 2020. Effective health communication–a key factor in fighting the COVID-19 pandemic. Patient education and counseling, 103(5), p.873.

NHS 2013, NHS Leadership Model, Available at: https://www.leadershipacademy.nhs.uk/wp-content/uploads/2014/10/NHSLeadership-LeadershipModel-colour.pdf [Accessed on: 1 January 2022]

Fernandez, A.A. and Shaw, G.P., 2020. Academic leadership in a time of crisis: The Coronavirus and COVID‐19. Journal of Leadership Studies, 14(1), pp.39-45.

Aij, K.H. and Rapsaniotis, S., 2017. Leadership requirements for Lean versus servant leadership in health care: a systematic review of the literature. Journal of Healthcare Leadership, 9, p.1.

Ramalingam, B., Nabarro, D., Oqubuy, A., Carnall, D. and Wild, L., 2020. Principles to guide adaptive leadership. Harvard Business Review.

Joshi, A., 2017. Legal empowerment and social accountability: complementary strategies toward rights-based development in health?. World Development, 99, pp.160-172.

Quinn, B., 2017. Role of nursing leadership in providing compassionate care. Nursing Standard (2014+), 32(16-19), p.53.

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