Situation with Leadership in Nursing: Critical Analysis

A nurse leader motivates people to do their best to achieve a desired result. It involves ‘developing and communicating a vision for the future, motivating people and gaining their engagement.’ (Armstrong 2009, p.4). Part of being a leader is knowing how to use power to reach a certain goal. When entering my second clinical placement I had an understanding that I was in a lower position of power. This brought on fear within me, especially coming into a new environment of a new unit. Despite this, belief in the system made me feel comfortable enough to trust the process and more importantly my clinical supervisor who would be a great influence on me. Using the theory of situational leadership, I will be analyzing this clinical experience critically and scrutinize how the use of situational leadership could have been employed.

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A situation that demonstrated leadership was during my clinical shadowing day. It was my second placement at the same hospital and my supervisor allowed us only to provide care with no documentation. Though it was a new rotation, the passwords and system of the hospital were still active. During my shadow shift, I was assisting my nurse care for one of her assignments by providing care. While I was in the patient’s room, I noticed that the patient was having a difficult time breathing. The patient had a diagnosis of COPD and dementia. In this situation communication was a barrier to care as the patient did not speak the same language as me. I adjusted the patient’s nasal prongs and ensured the oxygen was attached and set to the appropriate amount of five liters, however, the patient was still in distress. To assess the patient and ensure safety I quickly asked another student nurse to call for the nurse and a vital sign machine to check the patient’s oxygen saturation while providing comfort and reminding them to breath. In order to ensure the vitals were recorded into the system as this was a critical situation, I logged into my old user though my supervisor clearly instructed me not to. Shortly after the nurse arrived and completed necessary interventions. She thanked me for my help. Unbeknownst to me my supervisor was observing the situation and gave feedback about the situation at the end of the day with the other students. My clinical group was given a vague warning about following clear instructions. My supervisor then spoke to me independently. Though she agreed that I reacted quickly for the patient, the focus remained logging into the system. During my next week of placement as a follow up she told me she would be supervising me throughout the day while taking vitals and while documenting to ensure it was being done correctly for safety of the patient and to avoid errors.

My initial thoughts about this experience including my actions was that within this context ensuring patient safety was the most appropriate goal. Although I wasn’t well-versed in the patient’s condition, by doing what I was competent ensured that the patient was safe until further interventions could be done. I believe part of being a good leader is being prepared to adapt and be proactive in unexpected situations in order to lead those you are supporting. My supervisor did a good job at directing us students, but aspects of situational leadership such as coaching, supporting, and delegating were missing (cite Kelly 7Quinswell). She ensured I had detailed instructions on what I could and could not participate in throughout the day, and strongly enforced these rules to ensure structure was provided to us. However, as in most critical care situations, not everything goes according to plan and although there is certain protocol that must be followed under all circumstances, putting safety first should always be a top priority.

The clinical situation I had with my supervisor changed the way I view how nurses as leaders make decisions. It is not always that following preset guidelines will lead you to the right decision in all situations. Critical thinking in clinical experience is central especially in pressuring times. Through this experience, I understand that decision making is dependent the situation at hand. According to Burkett, 2016 understanding, the complexity of decision making is vital. In addition, everyone comes to their own decisions differently (Burkett, 2016). In my situation, I concluded that following protocol was not necessary as it was an urgent matter. According to …. (Critical thinking), clinical judgment is more influenced by what the nurse brings to the situation than objective data. The judgement one makes depends on the context in of a situation. (cite critical thinking) Another viewpoint could be that as important as it is to address the matter at hand, writing down the vitals instead of logging them in would be just. However, being that it was myself, the knowledge and previous experience with other supervisors who had an impact in my beliefs guided me to my individual decision. Factoring in that logging vitals into the system ensured that they would be recorded automatically led me to my decision making. In high stress situations, it can be easy to miss something. The nurse could have intervened but in a rush forgot to manually log in the vitals. Thinking ahead guided my decision-making process.

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Through this experience I was able to see that leadership involves not only power and leading, but being able to form connections with others in order to influence change. My supervisor employed an autocratic leadership style as the primary concern was ensuring that I did only the tasks I was assigned. However, because there was not a strong connection between us it would have been difficult for her to coach and support me in a meaningful way, especially during the second week. This also affected how other students responded to the upcoming changes the following week, most responded as a late majority (cite Kelly and quesdale). Being limited in the actions one can take affects how they see themselves as change makers. As opposed to being innovators excited about a new challenge, students felt resistance due to the warning they received the previous week. Leadership can be a powerful vehicle. Without passengers on board, there is no point, and the goal will never be met. (cite something on leadership, 1000) The connections a leader forms with others puts willing and motivated passengers on board. Within nursing, leaders are looked upon to make the way for change and improved quality care. It is not a one man job but a complex mission that involves moving pieces. Having a connection with others through referent power makes inconceivable task more conceivable.

Through this experience, I have learned that conflict management is a necessary skill to leaders. When working with others personalities, beliefs and reasoning can clash. The first step to a resolution is good conflict management. With colleagues, a situation like I had experienced could occur again. Though there is no single way of managing a conflict (cite Wiley online library), being aware and proactive in forming strategies through collaboration are good starting steps. (cite Wiley) In a case study done by …, many nursing use an avoidance approach to manage conflicts. Due to lack of time, fear of consequence nurses avoided a conflict related to management instead of communication and addressing the issue (cite…). Essentially, no active resolution of the conflict was initiated and the conflict was drawn out. As an upcoming nurse, to continue my competence learning about strategies and steps to take when resolving conflicts has become a personal goal. According to CNO, taking action to resolve conflict is a leadership standard all nurses must uphold. All nurses are leaders and taking the first step to adopt collaboration is key.

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