Utilising models of leadership and decision-making, critically analyse an experience in practice

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The student who is discussed in this essay, is on a placement in a rehabilitation ward. Her supervisor, a band six nurse has tasked the student with managing a bay of six patients with varying health conditions. The band six nurse supported and supervised the student nurse by making shared decision when applicable.
Supervision can have a positive impact on service users by safeguarding and raising practise standards, explains Health Care and Professions Council [HCPC] (2021) This is further backed up by (NMC, “Standards for Student Supervision and Assessment”2019), who set out expectations for the learning, support and supervision of students in the practice environment.

The student nurse was also supported by two other members of staff, both Health care assistants [HCA]. There was an admission and a discharge during the shift as well as staff conflicts to resolve. The student nurse was nervous and concerned that she would not be able to manage her time effectively. The student is aware of how important organisation and prioritising work load can be and it’s impact on the wider team.

As per NMC code of conduct (2018), patient and staff identity and information have been anonymised to maintain confidentiality. 

Situational awareness [SA] is knowing where you are, and what is going on around you, allowing team members to be aware and up-to-date and make better decisions. On the ward, this means the student nurse is aware of where team members are, their assigned duties, and potential risks.

Situational awareness is important to prevent confusion, lack of communication and errors that impact on patients and team members' safety. Being SA allows the student nurse to observe the bay, while managing details and issues as they evolve.

The nurse ensured she was SA by encouraging feedback from team members during hand over and huddles.

To better prepare for the task, the nurse reflected on the Myers-Briggs Type Indicator assessment, a questionnaire indicating differing psychological preferences in how individuals understand the world and make decisions. The assessment is categorised into four dimensions of personality: extraversion or introversion, sensing and intuition.

Research suggests that when we see ourselves clearly, we are more confident and more creative. We make better decisions, build ethical relationships, and communicate more effectively, Eurich (2018). The nurse considers herself to fall under the category of Logistician personality type (ISTJ), someone with the Introverted, Observant, Thinking, and Judging personality traits. Logisticians pride themselves on their integrity. People with this personality type mean what they say, and when they commit to doing something, they make sure to follow through (Neris 2013). Truity, (2019) corroborated that as leaders, ISTJs are clear about expectations and procedures. They are action-oriented and practical, and lead their teams to achieve specified outcomes within clear time frames. A possible leadership weakness of ISTJs is they can tend to prefer order and rules, which mean they can sometimes be stubborn and stuck in their ways. It also means that they resist trying new things or looking for alternative solutions to problems (Cherry, 2019 [online]).

 The nurse naturally adopted a servant-leadership style. Leaders with this styles tend to place the needs of others first, creating an environment for followers growth. servant leaders may find themselves in situations, where their self interest is set aside for the betterment of the team (Maglione and Neville 2021). “Followers satisfaction with the leader is vital to organisational success” (scarpello and vandenberg, 1987) Jit et al., (2017) stated that servant leaders demonstrate compassion and altruistic traits, which build a strong workforce. The student demonstrated this leadership style whilst supporting the HCAs with washes, blood sugars and feeds. This positively impacted on the team as the HCAs felt supported and patients were holistically cared for in a timely manner. The nurse further demonstrated servant leadership by encouraging her team members to take their breaks before her to insure the well being of her team. The nurse also demonstrated compassion by considering her teams members well being, she showed this by offering regular drink breaks.

Literature suggests that good leadership is accompanied by an individual with a strong sense of emotional intelligence. Having emotional intelligence is essential for leadership effectiveness (Mindtools|home 2022)

Quain (2012) suggests that a problem with individuals with a servant leadership style, is that they tend to step in and fix problems as they happen, and this may include completing tasks that a team member failed to finish. The nurse observed this to be true as she completed HCAs tasks, such as completing patients menus. This had a direct influence of the the nurses other duties and thus impacted on patient care.  Another criticism of Whiteside (2003) about this leadership style is that When team members see their manager catering to their needs in a extreme manner, they are less likely see them as an authoritative figure. The student noticed she wasn’t being listened too, which caused a lack of confidence when the need arose for her to assert herself.

Perhaps a transformational leadership style would have been more productive to the situation. “Transformational leadership is an approach that focuses on the attributes and behaviours of the leader required to empower and motivate team members” Colins et al (2016) The nurse could have educated and empowered the HCA who was struggling to complete her tasks by coaching the HCA to be creative in how she completes the role and look for ways to improve her time management skills. This will empower the team member, resulting in her being better equipped for new challenges and responsibilities.  However, implementing this leadership style into practice may prove difficult for the student nurse as she is lacking in confidence. Perhaps with experience she could adapt and utilise this style , if a similar situation should arise.  Literature suggest that a weakness of transformational leadership is that it lacks task focus and some team members need more structured procedure to guide them through their duties (Thompson, 2019[online]). In comparison  to the servant leadership style, both have the lack of instruction in common. This can be detrimental to a team, especially if some members of the team are inexperienced and need more direct and structured guidance.

It could be argued that Healthcare leaders should be able to adjust their leadership styles in order to adapt to the inevitable changes in ward environments.”Adaptability is about having ready access to a range of behaviours that enable leaders to shift and experiment as things change”(Center for Creative Leadership 2014 [online]) Reflecting and developing leadership styles could enable individuals to respond quickly to both threats and opportunities. This reiterated the importance for newly qualified and student nurses to receive feed back from peers, patients and colleagues, as well as regular appraisals so that the nurse can reflect on her leadership style adapt accordingly.

The student is aware that while delegating roles, she “is responsible and accountable for individual nursing practice, and determines the appropriate delegation of tasks consistent with the nurse’s obligation to provide optimum patient care” (ANA’s Principles for Practice Principles for Delegation, 2012). Delegation is the process by which you (the delegator) allocate clinical or no-clinical treatment or care to a competent person (the delegate) NHS 2010.

First and foremost, the student nurse needed to evaluate when deciding on what tasks to delegate to her staff members. The student nurse must take into account whether the task is appropriate to be delegated. There are five ‘Right’ principles of delegation to consider while deciding staff members’ tasks, they are, the right circumstances, the right person, the right communication, the right task, and the right supervision (Mcpheat, 2016).

Whilst considering the delegation of roles, the student nurse drew upon Belbin (2010), a theorist who describes a team role as “a tendency to behave, contribute and interrelate with others in a particular way.  Belbin identified nine team roles and then organised them into three groups: action-oriented, people-oriented, and thought oriented.  Many members usually have more than one role within the team, and they can change frequently during a shift, depending on the task load and environment.

Using this theory aided the student nurse to realise her team members strengths and weaknesses and utilise them for the benefit of person centred care. Acknowledging team individuals strengths promotes morale and working relationship.

The nurse tasked one of the HCAs with the discharge of a patient, as this HCA had what the nurse considered to be, a person oriented personality, they had also spent more time with the patient, building a rapport. Relationships characterised by trust and rapport, not only contribute to better care experiences, but they can also alleviate possible anxiety and distress the patient maybe feeling about returning home (Dang et al.2017). Evidence suggest that involvement of patients and families in the preparations for discharge is determined by the extent to which care providers are willing and able to accommodate patients’ and families’ capabilities, needs and preferences (Hesselink et al.2012).

The student nurse used core skills of clinical decision making, to aid her in delegating roles. Good, effective clinical skills include, learning from experience, being open-minded, and recognising personal attitudes, bias and being able to evaluate the evidence. The student nurse also used an analytical decision making theory, that’s sits under the information processing model, a four stage process (Elstein, 1978). He suggests that clinical decision making can be broken up in to four steps, these are, cue acquisition, hypothesis generation, cue interpretation, hypothesis evaluation. In practise the nurse utilised this theory regularly, an example of this would be redressing a pressure sore. In concordance with the care plan, the wound required changing every 5 days. Upon inspection, the student nurse found stripping on the gauzed and used initiative to re dress the wound before the dressing was scheduled to be changed. The draw back in using this theory is that it tends to be a slow process when effective time management is essential in a busy ward environment. This is when schons (1991) reflective model could be more beneficial. Schons (1991) discusses that there may not always be time to reflect before an action and in-fact in reflecting in an intense, busy environment, the action may stop or it may effect what is happening  with the intervention.  The theorist also mentions automatic or habitual actions, such as nurses washing their hand multiple time throughout a shift, he refers to this as knowing thought actions. One limitation of this theory that the nurse found was that if over used, deliberate reflection-in-action-may immobilise individuals and take away from the task in hand.

The student nurse found team work to be invaluable during the time on placement. Often the shift would be short staffed, however by working together the student nurse was able to organise work load and help her colleagues. Being short staffed can create strain which can lead to miscommunication within a team, this could result in poor time management and inadequate person centred care. By working as a team and sharing the work load can reduce the risk of human error, research has found “that working together reduces the number of medical errors and increases patient safety”  IntraHealth Librarian (2017[Online).

The importance of team work was made clear during an admission of a patient. The student nurse used communication skills to converse with the ward where the patient was being transferred from, this is to ensure a detailed patient history was received and an up-to-date report on the patients current condition, to better plan their person centred care. The information gathered is vital, it is used to build a care plan and a treatment plan that can be shared within the Multidisciplinary team [MDT] during a hand over.

The student nurse was also tasked during this placement to give a handover. A handover is where MDT liaise to discuss roles and responsibilities to ensure a continuation of care during the working day and shift changes. It allows all members of the team to be up-to-date and informed on the current care plan in place for each patient. This benefits the patient and the organization as a whole as it ensures patient care is prioritised and provided smoothly whilst adhering to local policies and procedures.

To be effective in any area of leadership or people management, it is important to have  a strong sense of who you are, and of the personalities and the abilities in your team (Ellis and Abbot, 2009). A good leader is someone who people want to follow (Huczynski and Buchanan 1991). They need the ability to influence people’s actions and behaviours without using threats or violence. Communication is a key component of leadership and management. Some theorists state that leadership is innate and that some characteristics of a leader’s personality, such as intelligence, initiative and confidence were what created leaders (Goffee et al, 2000). Other theorists dispute this, and reason that leadership and management styles are perceptible and ascertainable through study and practice Kouzes and Posner (2002).

(Likert, 1961; McGregor, 1960) suggests that a workforce that is given autonomy in their work, tends to have job satisfaction leading to more productivity and have better motivation. Evidenced through out this essay is the need to adapt leadership styles to support team members when necessary.