Developing Clinical Leadership Skills for Effective Patient Care

Introduction

This assignment aims to develop self-awareness and a critical understanding of the qualities and strategies to lead the people effectively. Clinical leadership has many attributes, including negotiation, shared vision, critical thinking, and engaging with a high level of communication (Hamric et al., 2014). Furthermore, leadership is a set of skills and abilities that a person abides. A clinical leader is a person, who demonstrates and uses their skills and vision to engage others and share the vision through expert social, political, and economic trends, influencing healthcare (Nicol 2012). Although leadership is an expected role for a registered nurse and it is often considered to be a role, dependent in the profession (Scott and Miles, 2013). It is believed that, formal leaders are the people, involved with administration and management role and informal leaders are the nurses involved with clinical roles such as Nurses, Advanced Nurse practitioners and nurse specialists. As a cardiothoracic surgical support practice trainee, the view is to develop management skills and become a more effective leader in the future. This assignment will evaluate leadership review with the context of the improvement of safe, effective, and patient-centered care with a critical exploration of current leadership and management skills.

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Advancing Nursing practice

Advanced Nursing practice role evolved since 1980; it is a unique integration of nursing and medical knowledge and skills. There is a need to regulate this type of practice as it is involved with the team, well received by patients, and has shown safe, effective, and patient-centred care (Kindness and Gray 2016). Thus, the practitioners, working in this role, should know their boundaries, competencies, and ability to perform within a changing health care environment. (Best et al., 2012)

Therefore, a tool kit approach (Scottish Government, 2008) document has given to support the development of Advanced Nursing Practice with their role, educational framework, and regulatory bodies. This framework has set up goals, skills, and knowledge for further development to enhance the leadership role. Advanced Nursing Practice has four pillars (Scottish Government, 2008); one of these is leadership. In clinical nursing, leadership is not a new concept; it was based mostly on leading from top to down (West et al., 2015). The nurses are playing essential roles in delivering care, and they should have better equipped with support and education to become an effective leader (Hewitt-Taylor, 2013). Furthermore, Vision 2030 (Scottish Government 2017) shows the development of the nurses as the leaders and the care will be moving towards a nurse-led approach. Therefore, leadership is fundamental for the ANP role and should serve the goal with a precise vision, which they carry forward all the time (Scottish Government 2012). Hence, in order to achieve this, they should be supported, enabled, empowered, and listened to so that they will be able to lead the team effectively (Nursing 2030 vision). Now, moving onto discuss specific policies that cover the ANP role, leadership styles, and most appropriate style relevant to the practitioner role.

Policies

In the unit, many nursing care policies are created by the nurses, as they spend more time with service users. Nurses are direct caregivers; personal experience is a powerful tool for creating policy as it will illustrate the story to an issue. For the nurses to create policy, evidence-based practice is the gold standard of nursing advocacy (Fredrik, 2013). Furthermore, these policies are supported by research that gathers the evidence of decision making and how that affects the changes and outcome. It will attain the individual’s level knowledge, comfort with care moreover, it increases the value and opportunities in their career (Burke, 2016). There are policy experts, which is also available in the nursing organisation as resources to create a policy.

According to the 2020 vision for health care in Scotland, everyone can live longer, healthier at home, or homely settings. It has increased the value of nursing care involvement in the health care system. Thus, the health care system has integrated with social care by focusing on prevention, anticipation, and supported by self-management (Scottish Government, 2011). Studies proved that, there were improved positive patient experience, could be taken 30-40% of the workload in certain aspects such as home visit and out of hours care (Strachan and Hoskins, 2019). ANP role has been introduced in the UK since 1990. Over the years, with changing the health care system, it has been effective and efficient substitute care delivered by a primary doctor. Furthermore, ANP role has provided decreased hospital stay with service users, hospital-acquired infections, reduced waiting time, a higher level of patient satisfaction and on the other hand reduced cost-effectiveness(Randall et al. 2017:Bentley et al.2016). As we are moving onto the Nursing 2030 vision (Scottish Government, 2017) reflects on putting people at the centre of the health, delivering the right care at the right time and the right place. This is a shared vision process in the latter half of 2016, shaped by the nurses, student nurses, and stakeholders. Therefore, the 2020 vision emphasis the role of ANP should be enhanced by effective leadership, technology, educational support as the aging population is living longer, and they require different nursing approach (Scottish Government 2011). However, the workforce plan (Scottish Government 2017) has mentioned nursing aspects by higher demand on nursing staff by all service since 2012 as difficult to retain staff, higher education program, different specialties training, and demographic challenges. As a result, vision 2030 has suggested that, increasing the nursing training program by 4.7% to further up for a place for 1000. Hence, the workforce plan (Scottish Government 2017) transforming nursing roles to ANPs and further develops 500 ANPs by2021. Therefore, in order to deliver these goals, mentioned above required a strong leadership (Scottish Government 2008).

NHS Grampian has reviewed the ANP role with the Nursing and Midwifery Council clinical practice (Kindness and Gray 2016). There is some confusion in the terminology of ANP role in healthcare professionals and, more importantly, in the service users. Thus, NHS Grampian has created an educational framework to standardise the role of the ANP; among this, clinical leadership is an important one in four pillars of the ANP role (Scottish Government 2008, kindness and Gray, 2016). Although there are several policies to implement a leadership role, there were barriers to follow too (Haycock-Stewart and Kean, 2013). Lack of education, understaffing, the cultures within the team, lack of flexibility, and lack of teamwork all are barriers to a leadership role. It can be argued that the NHS staff often felt overwhelmed, as the task is unclear about the priorities leading to stress and poor-quality care (Dixon-woods et al., 2014). From the point of an ANP role, teamwork is essential, as it can contribute to an effective health care quality. Furthermore, the nursing staff and clinicians should respect and understand the role of an ANP as these will be beneficial to deliver high-quality care and mainly reduces the co morbidity (West and Lyubovnikova 2012).

There are a few theories to consider effective leadership. It can be based on the leadership competencies, behaviours, and dynamic approach, charismatic and transformational leadership. According to Yukl (2013), effective leadership is associated with core personality trait theory. The leader should have a high energy level and stress tolerance as they should work long hours and calmly to lead crises. Self-confidence and internal locus of control are essential to deal with difficult situations and to control events. However, overconfidence can lead to making the wrong decisions and risks (Yukl, 2013). Furthermore, emotional maturity, personal integrity, socialised power motivation, high achievement orientation, and low needs for affiliation also included in the theory. All these are considerable theory of context in health care professional’s leadership.

The leadership is proposed as five key cultural elements sustaining high-quality, compassionate care for patients (West, 2014; Dawson, 2011). Thus, to ensure a high-quality care, there should be an inspiring operational vision at every level. It can be achieved by clear, aligned objective teams, support, enabling people management, moreover, effective teamwork, and learning (West and Lyubovnikova 2014). There are several types of leadership styles, among all will discuss three of them as the purpose of this essay. Therefore, transformational leadership theory is the most influential for suitable health care culture (Wong et al., 2013). Research proved that, (Gilmartin and D'Aunno, 2007) transformational leadership links with staff satisfaction, teamwork, organisational climate, and turnover intentions. Moreover, the positive effects of this type of leadership demonstrated work-life balance, staff wellbeing, positive nursing outcomes, and patient safety (Wong et al., 2013).

Secondly, authentic leadership is the focus of a small number of studies in health care system. “It emphasises an important of building leader legitimacy through an honest relationship with followers by valuing their contributions and behaving ethically and transparently" (West et al., 2015). Thus, the nurses, who have a higher level of authentic leadership, also reported that the level of care, trust, work engagement, and quality of care are higher than others (Wong and Giallonardo 2013). Besides, this type of leader supports and encouraged nurses in their role; this will lead to an improvement in job performance. The crucial possible factor of quality improvement is the empowerment of nurse's decision making and expressing their core values openly (Wong and Laschinger, 2013).

Finally, situational leadership adapts the existing work environment and the needs of the organization (Giltinane, 2013). Moreover, it is not on the leader's skills; instead, the person will modify the style to suit the requirements. Indeed, it is the leader's position to build up knowledge; confidence followers experience (Grimm, 2010). It is believed that, situations could arise from simple tasks to teach newly qualified staff and complex emergencies. Situational leadership evolves clear communications and directions of different tasks to a different team (Grimm, 2010). However, Giltinane (2013) suggested that, adaptability is the most critical aspect of the whole situational leadership style. Therefore, it is evaluated that, the situational leadership style would apply to the Cardiothoracic Surgical Support Practice role, because the practitioners are the most senior member of the team with emergencies and expected to lead the team until the expert help arrived.

There are many other styles of leadership, and it could be related to the Advanced Nursing Practice role. When an Advanced Nurse described their leadership, it should be with the context of making changes at the level of the patient, nurses, and health care providers. Moreover, either it could be patient-focused leadership or organisation or system- focused leadership (Patrick et al., 2011).

ANP leadership should be clearly articulated so that it can be measured and understood (Kilpatrick et al., 2014; Kleinpell, 2013). Unfortunately, when professional abilities are not understood, they often underestimated, and their talents can be wasted. Therefore, the potential benefits of nurses, patients, health care providers, and the whole health care system can be lost. Now it will turn to discuss different styles of leadership.

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Mentoring and coaching

Mentoring and coaching is a part of a leadership role which involved in the ANPs developmental role. Transformational leadership are to develop an individual's knowledge in line with the organisation vision. Therefore, the development of others can be considered as coaching and mentoring of staff in the workplace. Clegg et al., 2016) defines “Coaching is a process of developing and enhancing, mentoring is the process of passing on the job expertise skills and knowledge in order to develop a portage”. Cardiac operations are involved with many equipment’s/ instruments. It is important that, cardiothoracic surgical practitioner has a key role with coaching as they are dealing much equipment’s such as ultrasound scanning machine for harvesting the vein. Furthermore, many techniques and tools are available for effective coaching, mainly advanced communications, listening carefully, responding thoughtfully and imposing your own solutions (Centre of Creative Leadership, 2016).

Leadership Tools

There are many tools available to examine and challenge our leading practice. Indeed, personal qualities, working with others in a leadership style, self-awareness, emotional intelligence, human factors and coaching all involved within the style. Thus, to develop our own ability as a leader and continue to progress in our career ,most valuable method is gathering feedback from peers, managers and relevant individuals that work with. Multi-source (360 degree) reviews are very beneficial and mostly used in the workplace. However, there are mixed results from this source (Seifert, 2014)

Significant Event Analysis (SEA) tool considered to be an essential tool as it improves the quality and safety of care by reflecting the adverse events (Evans 2012). It is also believed that SEA would increase the professional's confidence and competence. The stages of SEA works are, first to identify the event and collect data from all people who are involved when their memory is fresh. Then to meet the people in an open, non-threatening environment (Bowie, 2010). The final stage is to discuss the changes with the event, which can demonstrate as a reflection, monitor changes by creating a learning period, and implementation of the new changes. However, there are several drawbacks with this technique, as the meeting and reporting could feel threatening and emotionally challenging (Bowie 2010). Although, the tool has drawbacks, there was a beneficial outcome too. The staffs were open and honest, team culture established, commitment towards patient care increases. Also, using the SEA was very useful and highlighting to staff morale.

As a cardiothoracic surgical support practice trainee to achieve the desired vision of leadership, considering dealing with emergencies, the appropriate tool would be SAE.

Emotional Intelligence

In the health care system, EI has a powerful impact on leadership, and it improves workplace value (Daly et al., 2015). People’s problem often involves their emotions such as fear, anger, distrust, and anxiety. Emotional intelligence is a central part of nursing practice, and it also plays an integral role in defining the character (Marquis and Huston, 2009). This theory promotes the importance of an individual's feelings with their professional relationship (Wallis and Kennedy, 2013). Being emotionally intelligent involves the ability to monitor their own and other's emotions and to differentiate among themselves to guide one's thinking and actions (Wilson 2014). Studies (Heckemann et al., 2015) identified five essential components of emotional intelligence: they are self- awareness, self-regulation, social awareness, motion, and self-management.

Therefore, emotionally intelligent nurse leadership inspired by emotions, passion, and motion. They can demonstrate positive conflict styles, good team player, and can have higher job satisfaction (Codier, 2014). Furthermore, emotional maturity is more likely to have supportive behaviour, and it is a key feature to improve clinical outcomes (Hurley and Lindsey, 2012).

Human Factors

Human factors are very important in the health care system. Being a leader is not only responsible for our own actions but also involved with the team. Human error always happens, but to bring a decisive human factor to the team includes aware of the situations, leadership, and communication, listening, and accepting everyone in the team. Hence, the patient’s safety comes first; there are many levels to defence. As a cardiothoracic surgical support practitioner, the level of decision making for a procedure such as a line insertion, vein harvesting, marking a surgical site all involved with patient’s safety. Each step has involved with safe decision making and should consider choices. Moreover, communication with team members and team involvement is essential in this role. Communication barriers in leadership can lead to poor quality of care and patient’s outcome. The Swiss Cheese Model hypothesis (Reason, 1990) says the level of defence caused by inadequate training, lack of knowledge will make dynamic errors. Therefore, as a nurse practitioner, it is essential to have situational awareness; higher level of knowledge, aware of protocols, policies, and more over leading the team is crucial factor.

Conclusion

The challenges facing all NHS organisation is to continuously be improving high quality, safe compassionate care. The National Health and Social Care workforce plan and Nursing 2030 session requires strong nursing leadership, it is a new concept for nurse led departments and it can be challenging also. Both policies stressed out increased requirements of ANPs role too. The clinical leadership is one of the main pillars of the ANP role and it should be developed by knowledge and skills. Being able to learn the use of different leadership styles and apply them with relevant situations. Furthermore, understanding the importance of communication and listening skills improve my negotiation skills and valuing emotional intelligence to become an effective leader with improved leadership skills.

Reference

Patrick, A., Spence Lanchinger, H. K., Wong, C., & Finegan, J. (2011). Developing and testing a new measure of staff nurse clinical leadership: The clinical leadership survey. Journal of Nursing Management, 19, 449– 460.

Scott, E. S., & Miles, J. (2013). Advancing leadership capacity in nursing. Nursing Administration Quarterly, 37( 1), 77– 82.

Kleinpell, R. (2013). Measuring outcomes in advanced practice nursing. Outcome assessment in advanced practice nursing ( 3rd edn). (pp. 1– 45). New York: Springer Publishing Company.

Kilpatrick, K., Kaasalainen, S., Donald, F., Reid, K., Carter, N., Bryant‐Lukosius, D., … DiCenso, A. (2014). The effectiveness and cost effectiveness of clinical nurse specialists in outpatient roles: A systematic review. Journal of Evaluation in Clinical Practice, 20, July( 6), 1106– 1123.

Oestberg,Fredrik MSN,RN (2013) Getting involved in policy and politics.Nursing Critical Carevolume 8 – issue 3-p48.

Sheila A.Burke, (2016) Influence through policy: Nurses have a unique role. Reflection on Nursing Leadeship. Sigma nursing.

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