School of Nursing & Midwifery

Assignment Cover Sheet Academic Year 2015-2016

Student ID number: 15101835

Programme: Post Graduate Infection Prevention and

Control

Module: Advanced Leadership- Clinical and

Practical

Submission Due 16th November 2015

Date:

Date submitted: 15th November 2015

Word Count: 4,000

By uploading this assignment electronically, I hereby certify that this

material, which I now submit for assessment for the module above is
entirely my own work and has not been submitted as an exercise for
assessment at this or any other University

I consent

Sarah-Jane Byrne
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Using a theoretical framework, critically evaluate your current

leadership role in nursing and explore how you could develop

your leadership skills to enhance patient care.

An assignment submitted in part fulfilment of the Post Graduate

Diploma in Infection Control and Prevention, Faculty of Nursing &
Midwifery, Royal College of Surgeons in Ireland, Dublin.

Student number: 15101835

Date of submission: 15th November 2015

Module: Advanced Leadership- Clinical and Practical

Module Co-Ordinator: Ms Chanel Watson

Word count: 4000

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In this assignment, I will discuss my current role in my clinical setting as a one year qualified

staff nurse on a busy neuromedical ward. I will identify my leadership role with regards to

patients, student nurses, healthcare assistants and fellow colleagues and identify my

leadership style as a transformational leader. I will critically evaluate my current leadership

role in nursing at present and I will discuss how I can develop my leadership skills to enhance

patient care. Throughout this assignment, I will use pseudonyms when referring to

individuals, so as to protect the confidentiality of my workplace and individuals referred to.

Leadership can be defined as the ability to influence and encourage individuals

through motivation to achieve a group vision or goal (Curtis et al. 2011 and Sullivan and

Garland 2010). It is not without challenges however as Curtis et al. (2011) identified financial

limitations, constantly evolving newer technologies, cultural diversity and active participation

from individuals, as barriers to effective leadership. Sullivan and Garland (2010) suggest that

leadership in nursing is not an optional role; however it is pertinent to the delivery of safe,

effective care delivered to a high standard. This can be identified in nursing in Ireland at

present. In 2002, pre-registration nursing education in Ireland was implemented as a degree

programme, elevating the status of the nursing profession, as recommended in the Report on

the Commission of Nursing (Government of Ireland 1998). The Nursing and Midwifery

Board of Ireland is the statutory body that regulates the nursing and midwifery profession.

This regulatory body ensures that nurses and midwives are fit to practice and are competent,

accountable, responsible and effective delegators which are all important aspects of the scope

of nursing and midwifery framework, being an outcome of the 1985 Nurses Act (An Bord

Altranais 2000). The scope of practice for nurses and midwifery in Ireland has since been

revised and published in November 2015, by the Nursing and Midwifery Board of Ireland

(2015).

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 I am a staff nurse on a busy neuromedical ward in large urban hospital. I received my

qualification one year ago and began working in this ward immediately afterwards.

Throughout my four year training and one year qualified as a staff nurse, I have witnessed

effective leaders, who I identified as fellow staff nurses on the frontline of patient care. The

main difference I have recognised between managers and leaders is in their behaviour. In my

opinion, my experience of managers is that they deal with administration, maintaining control

of the ward and patient flow. Leaders on the other hand provide motivation for both

colleagues and students, inspire them and encourage them to achieve goals. This view is

reflected in literature by Marquis and Huston (2009); Marriner Tomey (2009); Parkin (2009);

Roussel et al. (2009); Sullivan and Decker (2009) and Hughes et al. (2006). I have never

considered myself as a leader, however researching the literature, I realise I am a leader

throughout my day, mainly in regards to healthcare assistants and student nurses as they are

junior colleagues.

As a result of an online nursing leadership style quiz, I scored 62 out of 80 which

implies that I take a transformational approach as my leadership style (Dawes 2015).

Cummings et al. (2010) suggests that transformational leadership approach is positively

linked with increased productivity and effectiveness and minimises fear and stress in the

nursing context. Transformational leadership was originally described by Burns (1978) who

examined the characteristics of political leaders and determined that the difference between

managers and leaders was in the behaviours and actions of the leaders. This concept was

further developed by Avolio and Bass (1988) and Bass (1999) as a form of leadership where

individuals motivate, encourage and are in turn respected by their followers. The traits

associated with a successful transformational leader are dynamism, self-confidence,

inspiration, emotional intelligence and symbolism (Lee et al. 2011 and Derckz De Casterle et

al. 2008).
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 Reading these traits of transformational leadership in the literature, it took me a long

time to reflect on these qualities and find situations where I could apply these traits to myself.

Through this reflection, I believe that transformational leadership style is what I implement in

my working day. I constantly solicit the opinions of my work colleagues, for example if I am

assigned to a six bed area with a healthcare assistant, I will ask for the opinion of the

healthcare assistant and link in with them throughout the day, acting as a democratic team.

Doody and Doody (2012) state that one important characteristic of a transformational leader

is that they have a democratic view in conducting their work. I believe I show dynamism

through my work as I can effectively and productively manage my patient caseload in a high

dependency setting, working under time constraints with a strong passion as I enjoy my work.

When I first qualified, I found it took six months until I built up my self-confidence to the

point where I really started to believe in myself. This was transitioning from a student nurse

to a staff nurse and the process of changing uniform also played its part in building up my

confidence. I felt an integral part of a team with the support of my colleagues and considered

myself on an equal level to them, where I could question decisions made by the medical team

and the multidisciplinary team and give my opinion relating to patient care. I also had the

responsibility of working alongside junior members of the team and ensuring that they felt

supported and encouraged.

In one particular situation, I feel that I used these qualities of emotional intelligence

which I feel supports transformational leadership. I was assigned to a six bed section with a

healthcare assistant, Mary. Mary is a pseudonym to protect the ward and healthcare

assistants identity and maintain confidentiality. On that day, my mood was positive; it was a

Saturday, so I felt we did not have the pressures of medical team rounds and that we could

provide more attention to our patients. Mary said she was also in good spirits. We had a

productive morning; we interacted well and communicated clearly with each other. I was
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delegating tasks to Mary such as carrying out oral hygiene on patients and assisting patients

with their meals as this was within her capabilities. One of our patients, John, deteriorated

quickly and we had to call his family to come in to the hospital. When they arrived, they

came to wait in the day room. The day room is a public room where other patients relatives

gather and arrange to visit. Mary asked me could we let Johns family use a private

conference room as they were upset and it would be more private for the family members. I

said yes to this and Mary went to tell Johns family. Mary was gone for ten minutes and I

wondered was everything okay. Mary came back to me ten minutes later visibly upset and

crying. When Mary approached Johns wife regarding using the conference room, Johns

wife stated that Mary was not in a position of authority to ask her to move as she was not a

nurse, that she was nobody.

As Mary was visibly upset, I brought her to a quiet private space to calm her down

and ensure that she was okay. I reassured Mary and reaffirmed to her that she was part of the

team on the ward and that she was not in the wrong for making this offer to Johns family. At

this time, I was also reflecting on my decision to delegate this task to Mary. I felt that this

was in Marys capabilities however I could not predict the familys reaction. I felt it was

unfair of Johns wife to react to Mary in this way, however I understood and empathised that

this was a stressful time for them. I discussed with Mary the possible reason for Johns wifes

reaction and I reassured Mary that she had done nothing wrong and that I would take over the

situation. I explained to Johns wife that Mary was offering the use of the private conference

room out of compassion for their situation and she did not mean to offend anyone. Johns

wife stated she had just reacted and did not mean to cause Mary upset. Johns wife

apologised to Mary and the situation was resolved. Due to my assessment of the situation and

understanding of the emotions at play, as a leader I used this emotional information which led

to the successful de-escalation of this potential conflict or crisis.

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 Throughout this situation I felt emotional intelligence complimented my transactional

leadership approach. Emotional intelligence has been suggested to improve the management

of interpersonal relationships and emotionally competent nurse leadership (Cummings et al.

2005, Lucas et al. 2008, Feather 2009, Horton-Deutsch & Sherwood 2008). Goleman (2006)

suggested a mixed model approach which includes personality traits while Salovey and

Mayer (1990) suggest an ability approach where an individual perceives, uses, understands

and manages emotion.

Throughout the available literature, individuals with a transformational leadership

style are described as individuals who implement idealised influence, inspirational motivation

and intellectual stimulation, individual consideration to their followers (Hutchinson and

Jackson 2013, Lee et al. 2011 and Derckz De Casterle et al. 2008). A healthcare leadership

model developed by the NHS (2013) I believe is a model which supports my leadership style

of transformational leadership. There are nine elements to this model, Inspiring Shared

Purpose, Leading with Care, Evaluating Information, Connecting Service, Sharing the

Vision, Holding to Account, Developing Capability, Influencing for Results (National Health

Service Academy 2013).

As a transformational leader, I believe that I implement the concept of idealised

influence as I promote the vision and values of the healthcare organisation I work in. This is

linked to the healthcare leadership model (National Health Service Academy 2013) element

Inspiring Shared Purpose. One of the core aims of the organisation I work in, is the goal of

delivering the highest quality of care to the patients in a safe manner. I believe that I act as a

role model to students, health care assistants and fellow colleagues by aspiring to achieve

high quality of safe care delivered to patients. This is evident through my work encouraging

and motivating those in different roles, such as healthcare assistants and student nurses, to

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behave in a way which reflects the ethos of the organisation thereby delivering benefits for

the patients and their families (Northouse 2010 and Carney 2011). This can be challenging at

times when trying to provide the highest quality care to patients through this shared vision. It

can be blocked by leaders higher up in the organisation who are focused on strategic and

organisational issues at a higher level and may leave care compromised due to a budget

constraint for example (Doody and Doody 2012).

A situation that is often encountered by staff nurses and I on our ward are patients

who require further rehabilitation who end up being discharged home before they reach their

rehabilitation centre. This is due to the need for the acute patients bed on the ward, and the

unavailability of a bed in a rehabilitation centre for the patient to transition to. On one

occasion a patient under my care was going to be discharged home without being sent to the

rehabilitation centre. Their mobility was not yet at a safe level for them to function

independently at home. As I was leading this patients care, I knew it was unsafe for this

patient to be sent home on this occasion, thus advocating, on behalf of this patient, for them

to stay in hospital as they needed supervision on mobilising. I linked in with the

multidisciplinary team, relaying my concerns that it would not be safe for the patient to be

discharged home. I also liaised with my clinical nurse manager, understanding that hospital

management required the bed for an acute patient however expressing my concerns from a

patient safety point of view. I also discussed other options such as discharging the patient

home with a home care package, finding an intermediate care bed in a step-down facility,

transferring the patient to another hospital, and which would be the most financially viable

option. At the end of my shift, I handed over to another colleague working for the same

shared vision of patient safety who would continue to advocate on behalf of the patient also.

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 I believe it is important that morale is high in the workplace and to encourage fellow

colleagues and also to encourage myself to achieve my own aims (Bally 2007). My aim at

present is to successfully complete my post graduate diploma in infection prevention and

control. This concept of inspirational motivation in transformational leadership links in with

the Leading with care element in the healthcare leadership model (National Health Service

Leadership Academy 2013). I can motivate and encourage student nurses with linking their

theory and practice of the undergraduate programme. Therefore, I am showing leadership

through facilitating the students through learning opportunities and being cognisant of their

needs and what is required to fulfil those needs. For example, when I am on duty with a third

year student nurse and a patient requires a subcutaneous injection, it is within the scope of

practice (Nursing and Midwifery Board of Ireland 2015) that the third year nursing student

may carry out the administration of the subcutaneous injection under direct supervision by

me, the staff nurse. It is important for me to first teach the student nurse the theory

surrounding the skill of carrying out the subcutaneous injection. I would demonstrate to the

student the correct way to carry out the skill step by step, so that the student is observing. I

would encourage the student to have an active participation while observing, and I would not

discourage the student if they had any questions. It is important that the student nurse would

see me as a positive role model, providing safe and effective care for the benefit and safety of

the patient. I would be cognisant that the student nurse may feel scared and overwhelmed by

this task. I would ask the student questions to ensure they know the theory underpinning the

skill while also providing guidance and reassurance that they are fully capable of mastering

this skill. I would then observe the student carrying out the injection and provide constructive

feedback which is important to the students continuous education development (Doody and

Doody 2012).

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 In order to develop my leadership skills in relation to assessing a student nurses

competency carrying out nursing skills, I undertook a preceptorship course. This is related to

the Developing Capability element of the healthcare leadership model (National Health

Service Leadership Academy 2013) as I advocate for the students to develop their acquisition

of knowledge and skills in order to meet the future needs of the healthcare service and the

patients they will look after. The preceptorship course allowed me to develop my skills in

assessing and judging students ability to carry out skills effectively and safely, in accordance

with the Code of Professional Conduct and Ethics for Nurses and Midwives (Nursing and

Midwifery Board of Ireland 2014). I think that being an effective leader through

preceptorship is relating to the student nurses. As I am continuing my professional

educational development and am currently a postgraduate student, I can relate to the student

nurses that I preceptor in the undergraduate programme. I am a leader to them in how I

manage my work on the ward and my college work and find the balance between the two. I

feel that I can offer advice and support to them, especially as I have only graduated a year

ago from the undergraduate programme, I know how stressful it can be trying to manage

placement on the ward, college work and a part time job. Therefore I believe I show

understanding and empathy towards the student nurses and I am in a position to provide the

leadership and guidance they require.

The aspect of Individualised Consideration in relation to transformational leadership I

believe is linked in with the element of Influencing for Results in the healthcare leadership

model (National Health Service 2013). It also follows on from Idealised Influence as I

support, encourage and advise student nurses to achieve their learning objectives while on

placement, therefore aiding them to achieve self-actualisation (Northouse 2010). This is

achieved when the student and I work together as a team and organise their three interviews

throughout the placement. Doody and Doody (2012) suggest that it is important that leaders
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are there for their staff in a positive way, Riahi (2011) and Weberg (2010) further state that

providing constructive criticism also leads to increased productivity. I achieve this by setting

a time and date with the student to discuss their progress throughout the placement, this is

done in a private setting such as the clinical nurse managers office or the conference room on

the ward. During these meetings with students I discuss with them their learning objectives

and the progress made on achieving these, how they feel they are coping with their assigned

patient caseload and how they feel as part of the ward team. I find these meetings with

students to be of utmost importance as they provide me with opportunities to assess in detail

how they are developing as nurses and how supported they feel on the ward. Oftentimes it is

during these meetings that students have discussed with me feelings of stress and of being

overwhelmed by the acuity of the patients on the ward. I felt privileged that the students felt

able to communicate these feelings with me and that my leadership and communication skills

had contributed to this. Although these meetings are crucial to assessing the students

progress, organising them can be challenging due to time constraints and if the private rooms

are not available. Doody and Doody (2012) have identified these two barriers as being

counterproductive to the evaluation process and personal development.

In line with the Scope of Nursing and Midwifery Practice Framework (Nursing and

Midwifery Board of Ireland 2015) it is the responsibility of the staff nurse to engage in

continuous professional development in order to enhance my professional standards and

provide safe care to patients. The National Clinical Leadership Development Framework

(Health Service Executive 2015) would support my continuous professional development as I

could develop my leadership skills by undertaking an e-learning programme and e-portfolio. I

would develop competencies in self-awareness, decision-making, communication, teamwork,

quality and safety, advocacy and empowerment (Health Service Executive 2015). Developing

competencies in these areas is important as a leader to enhance patient care and safety. I can
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also continue to link in with The National Leadership and Innovation Centre for Nursing and

Midwifery as they will enable me to access leadership resources and thereby provide safe

care to patients (Health Service Executive 2015).

The competencies developed in this leadership programme would enable an evolution

towards inter-professional practice. This would involve a change in organisational culture as

historically we have implemented multidisciplinary practice (Barwell et al. 2013). This could

be potentially challenging for me to achieve on my own. As a transformational leader,

although I can see the positive effect that incorporating inter-professional practice would

have on improving standards and patient outcomes on the ward I work on, I may face

resistance to change. I would also have to consider the financial implications to bring about

such change as training would be necessary and while I am not directly in charge of finances,

I am cognisant of budgetary constraints. However I would be using my leadership to bring

about change in the organisational culture for the benefit of both patients and staff.

Examining the current multidisciplinary team approach, I consider that every

professional has their own role, set of skills and responsibilities when it comes to providing

patient care. The implementation of inter-professional practice would enable individuals to

understand their own professional distinctiveness while also allowing them to better

understand the roles of fellow healthcare professionals on the team. In my current role as a

junior staff nurse, at present I am not in a position to implement inter-professional practice in

the ward where I work. However, as I gain experience in my field of work, with my goal

being to progress into infection prevention and control, I may find it to be applicable to that

work environment.

Throughout this assignment, I have discovered that leadership in relation to nursing is

about working together as part of a team including individuals in other healthcare roles.

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Through the use of a theoretical framework, I have realised that I am a leader in my current

role both to colleagues, student nurses and patients. As I have identified that I am a

transactional leader, I believe that the leadership skills that I possess will continue to develop

over time and perhaps further on in my career I may implement a different leadership style. I

believe that leadership does affect patient outcomes. While each healthcare professional aims

to improve and provide safe patient care, it is important that they amalgamate their

knowledge to achieve excellence in patient care and to encourage, motivate and support

colleagues. Currently a multidisciplinary approach is taken in healthcare systems in Ireland

however I believe that an interdisciplinary team approach has a position in the future of

healthcare in Ireland. Implementation of interdisciplinary training would be paramount to

support this vision. It is not without challenges to implement leadership changes in the health

system today; budgetary constraints are recognised as a barrier to professional integration but

should not be insurmountable.

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