Leading and Managing Nursing Care

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Leading and Managing Nursing Care In practice, nurses work in teams comprising of professionals from different specialities.

These teams provide a solid ground for consultation, decision-making and networking. This paper highlights a critical commentary on the relevance of team-working, delegation, and effective management and leadership to nursing. The commentary reflects on progress made in these areas since year 1. The commentary highlights the roles and responsibilities of multidisciplinary team members besides their contributions and scope of practice.

Further, it clarifies the importance of health information technology in quality care delivery. The commentary is fragmented into two sections, with the first section providing a brief description of leadership, nursing management and teamwork. The discussion section touches on the importance of leadership and a recent report recommending improving patient care outcomes. Notably, nurses use theories to formulate treatment plans and make decisions. Stanley (2017, p. 57) argued that theoretical concepts provide fundamental knowledge that enables nursing professionals to deliver quality care to their clients besides guiding their actions. This commentary summarises significant leadership theories within multi-disciplinary teams (MDTs) including the transformation and situational leadership theories.

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The discussion section also highlights the significance of delegation to nursing practice.

The core themes of the delegation have been elucidated together with tasks commonly delegated to nursing students. The second part of the commentary is a personal reflection highlighting a patient care situation witnessed during nursing practice placement. The role of MDTs and the lessons learnt in this incident have been clarified. The reflection section also captures details on personal experience from delegation.

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Part 1: Commentary Context Leadership, as defined by Korniewicz (2015, p.4), is an individual’s or group’s ability to influence and guide followers in an organisation. In the health care sector, leadership is defined as influencing team members to improve care quality besides participating in clinical care. In nursing, leadership entails setting up a clear vision to create an environment that keeps the staff motivated and empowered. Effective leadership is necessary to improve health outcomes for individuals and communities. It also ensures that the healthcare environment is safe for patients and professionals. Besides being advocates for patients and the profession nurse leaders collaborate with team members at all levels to promote a professional work environment (Korniewicz 2015, p. 5). Nursing management is also an essential aspect of nursing practice. It entails the performance of critical leadership functions including decision-making, governance, and motivating, organising and controlling available resources.

Nursing management tasks include recruitment, treatment planning, mentoring, case management, and discharge planning. These tasks are necessary to maintain a safe environment for patients, visitors and staff. They also help maintain the quality and standards of care, thus improving patient satisfaction. Although health care professionals are encouraged to develop skills that would enable them to practice independently, teamwork forms the foundation of all health care activities (Korniewicz 2015, p. 4).

Teamwork involves the interdependent interactions between professionals from similar or different specialities to accomplish a common goal. Working as teams helps nurse leaders to identify the skills and proficiency of team members, thus making it easier to delegate tasks. In the U.K, the NHS recognises the importance of compassionate leadership and management in nursing and health care. Pressure from the COVID 19 and the dynamics of healthcare have

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driven change into nursing practice. The NHS encourages nurse leaders to employ change models to achieve transformational and sustainable change in the industry (Shah et al., 2021). In cardiology units, nurse leaders are encouraged the implement UK general practice guidelines to improve health care outcomes and reduce the risk of poor outcomes.

Discussion a. The importance of leadership in healthcare Leadership is an integral element of healthcare and nursing practice. Research and reviews have shown the relevance of leadership in nursing practice and the health care industry.

Scully (2015, p. 439), for instance, linked effective leadership with decreased patient mortality, patient satisfaction, quality care and increased staff morale. Irrefutably, valuable leadership skills contribute immensely to professional performance, interpersonal interactions and productivity.

The leadership approach employed by nurses at different levels influences the atmosphere created at that level.

Leaders with quality skills create a safe healing environment that instils confidence, loyalty and trust in patients and families. Importantly, leaders acknowledge the importance of complying with new and existing policies besides integrating technology into patient care.

Undeniably, patient management, especially for those with cardiovascular conditions, is continuously progressing. Policies, research, guidelines and clinical trials continually expand the indications associated with managing decisions and treating these conditions. These advances offer crucial support to clinical practice for diagnosing and treating patients with cardiovascular conditions.

The GIRFT National Report for Cardiology, for instance, offers recommendations on how nurse leaders can improve care, safety and access to care services for patients with related

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cardiac conditions. This report describes the significance of digital transformation to improve access to care and integrate health care pathways to accomplish common goals (NHS 2021). The report clarifies that approximately 6.1m people have cardiovascular conditions in the U.K. The COVID-19 pandemic places these people at a higher risk of health complications and poor health outcomes than other populations. The report emphasises the need to implement effective interventions to close gaps in care provision, support clinical pathways, and make the most of the existing workforce. The proposed interventions include creating clinical cardiology networks to meet demands to capacity besides using available resources, improving the skills and retention rates of the workforce, and transforming outpatient care (NHS 2021). b. Relevant leadership theories within multi-disciplinary teams (MDTs) Understandably, nurse managers imbibe certain leadership skills to improve efficiency and productivity while leaders incorporate certain management skills to manage their followers effectively. These professionals utilise various leadership and management theories to accomplish specific tasks. These theories include the transformational leadership theory, trait theory of leadership and situational leadership theory. The transformational leadership theory is relevant to nursing practice, where leaders work with teams to identify needed change. This leadership theory involves inspiring followers through guidance and influence. The leader also executes identified changes in tandem with team members.

Transformational leadership is important in nursing since it enables the leader to nurture followers’ moral development and internalise principles and values that align with the health needs of the target patient population (Burkus 2021, p. 66). In cardiology, transformational leadership helps establish strong relations with professionals from different specialities and stimulate creativity besides integrating motivation and enthusiasm into practice.

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Situational leadership theory is also common in multidisciplinary settings. This theory helps leaders implement different leadership styles according to the situation (Burkus 2021, p.

66). Situational leadership theory is critical in cardiology settings since it adapts to the team’s needs and creates a base for “beneficial balance” for all parties. The leader identifies the best leadership tactics to ensure team members are given sufficient support and encouragement rather than suffocating and over-managing them. c. Leadership role in quality improvement in healthcare Effective leadership is the foundation of quality improvement in healthcare settings.

Guetterman et al. (2019, p. 917) clarified that leaders oversee hospitals whose primary responsibilities include policy development, resource allocation, performance monitoring and evaluation, and representation at different public relations functions. Soylu et al. (2021, p. 41), on the other hand, noted that the role of leadership in quality improvement in healthcare forms the fabric and backbone of all quality improvement strategies. Nursing leaders, for instance, interact with nursing team members, subsequently providing a unity of purpose. They also identify the direction the organisation should take to accomplish key goals and objectives.

Importantly, nurse leaders encourage team members to comply with existing policies and guidelines to achieve high-quality care outcomes and avoid legal suits. They help followers view the organisation’s prospects clearly and plan for unprecedented events. Effective leadership sets the base for ethical role models and common values within the organisation. They inspire team members to actively participate in quality management and improvement initiatives according to the core values. The leader also works in tandem with team members to create and maintain a safe internal environment. Soylu et al. (2021, p. 41) pointed out that leaders translate visions of quality into reality and help followers perfectly execute visions. Leaders strive to create a strong

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team driven by constantly changing clients’ demands and interrelated concepts and core values.

They understand and react proactively to fluctuations in the external environment. Guetterman et al. (2019, p. 918) argued that nurse leaders improve their followers understanding of how to improve care quality and patient satisfaction by teaching, training and coaching team members, d. Key theoretical concepts in team working within MDTs, Multidisciplinary teams (MDTs), as depicted by Taberna et al. (2020, p. 85), are the mechanism for organising, controlling, managing and coordinating health and care services to meet the complex care needs of individuals. The functions of the MDTs include care planning, coordination and implementing multiple strategies in line with the client’s needs, besides adapting team composition appropriately. Multidisciplinary teams comprise individuals from different specialities working together to attain a common outcome. The team employs different tactics to tackle an individual's health challenges (Taberna et al., 2020, p. 89). The key attributes of MDTs include collaborative practice, competent leadership, clear roles and responsibilities, clear communication and respect for competence. The values of effective MDTs, on the other hand, include coordination, improved satisfaction, efficient resource utilisation, improved health outcomes, time management, respect and trust. MDTs also support team members and recognise their experience and contribution to patient care. Unfortunately, MDTs are faced with challenges that hinder effective care delivery. These challenges include lack of clarity, ineffective communication, personality conflicts, interior competition and trust issues.

Role modelling is important in professional practice since it promotes consistency, sustainability and growth. The qualities of good role models include emotional intelligence, passion, commitment, selflessness and integrity (Korniewicz, 2015, p. 8). Leaders serve as role models to followers by demonstrating persistence, hope, optimism and integrity. They utilise

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self-awareness to develop positive qualities and improve their professional image. Role modelling plays an invaluable role in leadership development. It creates the base on which a new generation of leaders learn positive behaviours and interpersonal relations.

Networking is also a crucial theoretical concept in team working. It involves developing contacts and interacting with professionals at different levels. Khanum et al. (2016, p. 22) pointed out that networking skills are vital to MDTs since they help team members to develop new skills and enhance their proficiency in line with the industry trends. It also enables nurses to advance their careers besides increasing access to more job and growth opportunities. e. Delegation is a leadership and management tool for effective MDT working Delegating is a leadership and management style in which a leader empowers team members to exercise autonomy (Motacki & Burke 2017, p. 10). This approach involves providing individuals with the big picture, allocating resources and trusting team members to deliver projected outcomes. Delegating is an important leadership skill considering leaders cannot perform all duties independently. This tool supports professional growth and sustainability because it builds trust and empowers teams. Leaders also use delegation to identify the best ways to handle complex problems and tasks. In management, delegation involves dividing and allocating work to subordinates (Motacki & Burke 2017, p. 11). It creates a base for reducing the manager’s workload, thus, creating time to address other pressing needs, including planning, analysis and assessment.

When delegating, the leader must choose the employee with the best skills and traits to accomplish assigned tasks. The leader must also delegate the right tasks. Even though delegation is a reliable tool for teaching new skills to junior nurses, leaders must prioritise patient care quality and safety. Before delegating tasks, the leaders must ensure that the delegatee

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demonstrates a high level of confidence besides the skills to complete tasks correctly and safely.

The circumstances under which tasks are delegated must also be right (Motacki & Burke 2017, p. 21). For instance, the nurse leader should avoid delegating duties when the patient condition is critical and at risk of fluctuating. Communication and the right supervision are integral themes of delegation. They ensure that the leader provides the delegatee with sufficient information to execute tasks correctly. Unfortunately, delegation faces several barriers including low confidence, negative personal attitudes, poor communication, and fear of power loss. f. Digital data and information technology (IT) The digital era, as pointed out by Sayles and Kavanaugh-Burke (2018, p. 124), has seen an increase in the rate of health information technology integration into health care practices.

Consequently, professionals have coined new terms to refer to various aspects of health technology. The term digital data, for instance, describes all forms of data represented in different machine language systems. Health information technicians use different technologies to interpret this data. Digital data is stored in electronic devices in numbers or codes. Information technology is a broad term describing the development, installation, and use of computers and other electronic gadgets to communicate. Health care leaders acknowledge that information technology has revolutionised health care delivery. Health IT supports multidisciplinary teams by improving data storage, retrieval, sharing and decision-making (Sayles & Kavanaugh-Burke 2018, p. 124). In multidisciplinary practice, team members are granted access to patients’ information, thus, facilitating clinical decision-making, assessment, and follow-up. MDTs collaborate with health information specialists to identify the best technology to improve efficiency, support quality care and promote positive outcomes. Health leaders also use health technology to improve care coordination, patient education and health management.

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g. Clinical practice gaps Although health care professionals are highly committed to practice and quality care delivery, the projected goals and outcomes might be hampered by several practice gaps. These gaps include insufficient patient education tools, insufficient resources, and poor communication mechanisms. Inadequate patient education tools, for instance, affect nurses’ ability to inform their clients on how to manage critical conditions and prevent diseases. This practice gap requires improvement through innovation. The main steps in addressing this practice gap, as indicated in appendix 1, would include identifying the problem and the cause, developing learning objectives for the proposed educational intervention, designing an educational activity, and evaluating the proposed intervention to determine if it meets the primary objectives.

Part 2: Year 1 reflection Reflection on the situation from placement During my placement, I witnessed and participated in multidisciplinary tasks that helped me realise the importance of teamwork in health care settings. I also had an opportunity to interact with professionals from different specialities, including physiotherapists, cardiologists, nutritionists, surgeons, psychologists and radiologists. For instance, I was involved in an MDT care for a 67-year-old female patient with hypertension, diabetes, hyperlipidemia and severe angina scheduled for coronary angiography. Good angiographic results were achieved with direct stenting deployed using a “3 by 28” stent. However, after the stent dilatation, the patient developed cardiac arrest creating the need for cardio-pulmonary resuscitation and advanced cardiovascular life support (ACLS). The nurse in charge performed CPR, and the client was quickly intubated. The balloons from the lateral medial to the lateral anterior distal were inflated to eradicate the persistent severe spasms. The patient’s normal circulation was restored and a

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decision was made to stop stenting at that point. The in-charge nurse decided to transfer the client to the cardiac care unit under continuous vasopressor and dobutamine support. The client was weaned three days later with insignificant neurological defects.

This incident demonstrates the importance of teamwork in nursing practice. It reflects how health care professionals work as teams to improve care outcomes. Compliance with predefined CPR and ACLS protocols helped arrest the patient’s condition before progressing to critical phases. The interventional team, on the other hand, was actively involved in restoring the underlying coronary complications. The dietician developed a proper dietary plan to wean the patient without major fluctuations in blood glucose levels.

Reflection on experience from the delegated task Besides participating in MDTs, I have also tackled various nursing tasks delegated by my preceptor. The delegated tasks included assisting with hygiene, patient education, directing patient ambulation, and feeding patients. These tasks helped me realise that delegation is a complex task heavily dependent on skills, proficiency and attitude. The preceptor weighs specific patient needs against nurse students’ skills to determine the tasks to delegate. My preceptor once told me to develop a health education plan for diabetes and arthritis. I consulted with a dietician and a physical therapist to capture accurate details on a healthy lifestyle. The education plan contained information on meal planning, weight management, and decision-making.

Unfortunately, the plan did not highlight disease-specific nutrition counselling. Although the patient education goals and objectives were accomplished, the plan did not provide skills to selfmanage arthritis and diabetes. The educational outcomes would have been different if the patient had been actively involved in the process. The contribution of other health care professionals would also have provided further evidence on proper patient management. Family members

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inclusion in patient education helps facilitate social support and continuity of care. Although delegation is a complex process, it reflects the supervisor’s belief and confidence in the nurse’s skills. Delegation creates time for nurse leaders to handle emergency tasks and attend to patients with more pressing needs.

Conclusion Delegation, team-working, effective management and proper leadership are critical elements of nursing practice. They create the foundation for quality care, patient safety, better care outcomes and improved satisfaction. MDTs tackle patients health needs from different perspectives, thus improving better outcomes. Nurses employ nursing leadership and management theories to guide their actions and make decisions that align with patient needs and preferences. The delegation, on the other hand, supports continuity of leadership by empowering individuals, building trust, and assisting with professional development. The delegation also helps leaders identify individuals best suited to tackle specific tasks and projects. To achieve the projected delegation outcomes, the nurse leader should comply with the “rights” of delegation.

These clarify that the right tasks should be delegated to the right person with clear guidelines and communication. The right supervision and evaluation should accompany the delegation to achieve a successful eventuality. Nurse leaders should also improve teamwork by clarifying roles, serving as role models for other nurses, embracing transparency and promoting adaptability. Leaders should implement effective communication mechanisms to support interprofessional collaboration and develop dynamic teams.

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Bibliography Burkus, D 2021. Leading from anywhere: the essential guide to managing remote teams. Boston Houghton Mifflin Harcourt Guetterman, T.C., Kellenberg, J.E., Krein, S.L., Harrod, M., Lehrich, J.L., Iwashyna, T.J., Kronick, S.L., Girotra, S., Chan, P.S. and Nallamothu, B.K., 2019. Nursing roles for inhospital cardiac arrest response: higher versus lower-performing hospitals. BMJ quality & safety, 28(11), pp.916-924.

Khanum, S., Souza, M.D.L.D., Naz, N., Sasso, G.T.M.D., Brüggemann, O.M. and Heideman, I.T.S.B., 2016. The use of networking in nursing practice—An integrative review.

Societies, 6(3), p.22. https://www.mdpi.com/2075-4698/6/3/22/pdf Korniewicz, D. M. 2015. Nursing leadership and management: the advanced practice role.

DEStech Publications, Inc. Motacki, K., & Burke, K. (2017). Nursing delegation and management of patient care. Elsevier Health Science.

NHS 2021. Cardiology: GRRFT Programme National Specialty Report (September 2021). https://www.gettingitrightfirsttime.co.uk/medical-specialties/cardiology/ Sayles, N. B., & Kavanaugh-Burke, L. (2018). Introduction to information systems for health information technology. American Health Information Management Association.

Scully, N.J., 2015. Leadership in nursing: The importance of recognising inherent values and attributes to secure a positive future for the profession. Collegian, 22(4), pp.439-444.

Shah, A., Pereira, P. and Tuma, P., 2021. Quality improvement at times of crisis. BMJ, pp. 373. https://doi.org/10.1136/bmj.n928

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Soylu, T.G., Cuellar, A.E., Goldberg, D.G. and Kuzel, A.J., 2021. Engagement of small to medium-sized primary care practices in quality improvement efforts. The Journal of the American Board of Family Medicine, 34(1), pp.40-48.

Stanley, D. (2017). Clinical leadership in nursing and healthcare: values into action. Wiley Blackwell.

Taberna, M., Gil Moncayo, F., Jané-Salas, E., Antonio, M., Arribas, L., Vilajosana, E., Peralvez Torres, E. and Mesía, R., 2020. The multidisciplinary team (MDT) approach and quality of care. Frontiers in oncology, 10, p.85. https://dx.doi.org/10.3389%2Ffonc.2020.00085

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Appendices Appendix 1: Patient education action plan outline Step 1

Problem identification

Step 2

Developing learning objectives

Step 3

Designing educational activity

Step 4

Patient education tasks

Step 5

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Distribution of learning materials

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Discussion sessions

Evaluation