Nursing Leadership

Running head: NURSING LEADERSHIP
Nursing Leadership
Name of the Student
Name of the University
Author Note

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Introduction
Nursing is dynamic yet challenging profession that requires engaging yet inspiring
role models. At present, the healthcare environment is ever changing and this it is important
to identify and the develop leaders in order to promote safety and quality of care in nursing
profession. The concept of leadership in nursing profession is complex and requires a
multidimensional approach (Scully, 2015). A multidimensional leadership approach helps to
bring refinement in the nursing practice. The following paper aims to identify practice issues
prevalent in intensive care unit that decrease the overall of patients’ care. The paper will
highlight why these issues are alarming, how his gaps in practice evolves. This will be
followed by an explanation of the role of transformational leaders in overcoming the barriers
and implementing change in practice. The papers will highlight the traits of a
transformational leader that are helping to bring change in practice. At the end, the paper will
highlight how the change implemented in practice will be evaluated. The overall paper will
help in understanding how leadership style can help to bring a positive change in nursing
practice.
Issue and the context
The intensive care unit are critical care units in the hospitals. It has a huge inflow of
the patients at any point of time within the day and requires round of clock monitoring of the
patients as majority of the patients who resides under the intensive care units (ICU) are
critical. The number of nurses operating in the intensive care units are also less as only
handful of nurses who specialised in critical care, get selected for the ICU nurses. However,
this poor strength of the nurses in comparison to the strength patients’ increase in the level of
nursing work pressure and stress along with extended shift timings. The shortages of the
staffs increase the work burden over the existing nurses leading to the generation of

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compassion fatigue, brain draining and burn out. These exhausted nurses are more likely to
commit medication errors. Medication errors that are frequently encountered under the ICU
setting are administration of the medication in in-correct tome, incorrect dosage of
medication and omission error (Sawe et al., 2014). Salmasi et al. (2015) highlighted in their
study that shortages of the nurses, heavy workload, and lack of proper support from the
leaders and mis-interpretation of the medication or prescription charts or lack of proper
communication among the change of shift nurses are the main identified reasons behind the
medication errors in the ICU. The systematic review conducted by Metsälä and Vaherkoski
(2014) highlighted that the medication errors in the ICU is mainly attributable to prescription
or the patient-related errors, lack of proper organisation of the nursing workforce, lack of
proper training and guidance of the nursing professionals in operating the pressure and
computerised physicians based order entry (CPOE) and lack of proper co-ordination among
the nurses and lack of proper organisational safety culture. The patients who are admitted in
the ICU units are in their critical physiological state and any medication error can lead to fatal
outcomes. Starmer et al. (2014) reported that increase in the tendency of medication errors
under the ICU settings increase the overall rate of mortality and morbidity and at the same
time increase the overall length of stay at the hospital and increase in the overall cost of care.
The study performed by Wittich, Burkle and Lanier (2014) highlighted the increase rate of
occurrence of the medication errors are a symbol of poor nursing practice and it endangers
patients’ health and safety. However, Wittich, Burkle and Lanier (2014) stated that
medication errors can be preventable. In ICU there is also increased prevalence of noscomial
infection that also leads to poor health outcomes and is attributable to improper adherence of
the hand hygiene protocol by the nurses as they receive proper guidance (Pronovost et al.,
2016).

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Analysis of the issue and why change is required
The impact of the hospital acquired infection and medication error is equally
detrimental for the life of the patient as it increases the rate of mortality and morbidity,
increase in the cost of care and increase in the length of the overall stay at the hospital.
Hospital acquired infection (HAIs) or nosocomial infection increase the overall disease
burden as it promotes the spread of the multidrug resistant bacteria making the overall
treatment procedure complicated and expensive (Cornejo-Juárez et al., 2015). The patients
who are in the intensive care units are more prone towards getting affected with the HAIs as
they are weak and immune-compromised and thus endangering the patients; safety quotient
further (Cornejo-Juárez et al., 2015). As per the nursing professionals code of conduct
published by the Nursing and the Midwifery Board of Australia (NMBA), it is the duty of a
nursing professional to practice safely, effective and collaboratively within their clinical
practice (standard 1) in order to improve the patients’ safety quotients and overall outcome of
patients’ care. Thus the nursing practice guidelines in the ICU must be changed in order to
reduce the chances of the medication errors and HAIs and thereby helping to increase the
level of patients’ safety. NMBA mainly recommends to practice as per the guidelines of the
evidence based practice in order to improve the bar of patients’ safety.
Barriers of Change
The development and subsequent implementation of the nursing care practices erected
over the stringent research evidences is the principal key towards the provision of safe,
effective and improved quality of care of the healthcare service users. However, inspite of
having an international and globally acclaimed guidelines of safe practice standards, it can
take more than a decade for the health research findings to get actually implemented in the
routine clinical practice. This significant gap between the research evidences and the clinical