Acute and Critical Care Clinical Leadership

This article discusses the importance of clinical leadership in improving the quality of care services provided to patients in acute and critical care settings. It also covers the significance of effective communication skills and ethical principles in nursing practice. The article includes personal experiences and examples of good leadership and communication skills in the workplace.

Acute and Critical Care
Clinical Leadership

Activity 1
Health care being a complex industry will always have a scope for improvement in the
services provided to the service users. The nurses are the integral part of this improvement in the
health care services. But in order to be a part of this improvement, the nurses need to practice
sound leadership skills, which allow them to contribute their part in the improvement of the
quality of the services provided to the patients. Practising transformational leadership allows the
nurses to bring about positive and valuable changes in individual as well as social system which
result in making the care services more apt and safe from patient point of view.
Time out 1
One of my colleagues at the workplace does practices the characteristics of
transformational leadership. He is always motivating towards the other colleagues and always
focuses on practising team work while dealing with a case. He is always supportive to other co
workers and respond very respectfully to all other employees be it the leader of the team or any
other team member. One behaviour that I do not find effective is, though he is very motivating in
nature but he does not guide the other colleagues in any tasks.
Time out 2
I always try to practice professional behaviour with my other colleagues at the workplace
and always keep in mind to talk respectfully and humbly with others. When talking about my
attitude while providing care to the patients I always keep it positive as this will help to remove
all the negativity from the care providing as well as working environment. Keeping my
behaviour has helped me to build good relations with my colleagues as well as with my patients.
Being optimistic also helps me to keep myself motivated throughout the care providing process.
Time out 3
As any other workplace, mine also has a presence of a person who tries to take the credit
for other's work. To avoid this to happen in my team, I try to promote team work among the
members of my team. The task assigned to our team is broke down into small tasks which are
then assigned to the team members according to their area of speciality. Through this the credit
of good outcome remains with the worthy one and also skill development is ensured for all.

Time out 4
The area of leadership I would like to develop in myself is trait of looking for peoples
positive attributes and assuming the best intentions for others even when they behave in ways I
do not understand or like. I will try to incorporate it in my care providing practice by practising
it on a daily basis. Also I will analyse myself and also take the help of the leader of my team to
re-evaluate the development of this leadership trait on me. For knowing that if any changes have
occurred I will take assistance of my seniors at the work place by seeking feedbacks from them
about my behavioural changes. I will keep reminding myself for practising the change by setting
short interval realistic goals for noticing positive attributes of people. For re-evaluation myself I
will keep track on my behaviour by maintaining a diary about the positive attributes I observed
in various people during my entire day.
Time out 5
A leadership development plan s necessary in order to achieve the objective of self
development of the required leadership skills. It helps in leadership skill development by
reminding is of the plan at various points and also helps to evaluate the progress of development.
Area of growth Objective Learning activity Timeline
To incorporate
openness to new
thinking pattern on
care providing process
I will track my
improvement by
asking for feedbacks
in my behaviour from
my colleagues and will
also ask the patients if
they are satisfied from
my behaviour
Completion of survey
of assessment and
providing the
supervisors with
assessment report.
3 months
Ensure new thinking
patterns for making the
care providing process
more effective for by
practising it in daily
routine.
Multiple assessments
after every month
Activity 2
Effective communication is the key to ensure effective care providing to the service
users as through effective communication the care providing staff will be able to build a healthy

and good relation with the service users. Building a good relation with the patients allows the
care providers to understand the care and health related needs of the patients and thus will allow
the care providers to make the services more safe and patient oriented for the patients. Practising
good communication skills by the care staff with the patients will be helpful in retrieving all the
information that is necessary for deciding the treatment regime of the patient. If the care
providing staff is able to gain an understanding of the care and health needs of the patients, then
it would become easy for the staff to achieve satisfaction of the service user. Effective
communication not only makes the care services safe and effective for the patients but also helps
in promoting non- stressful conditions among the employees of the workplace. Effective
communication amongst the employees ensure an unhindered flow of important patients related
information making it easy to achieve positive outcomes. Unhindered flow patient's care
requirement related information results in making the treatment regime safe and even more
effective for the service user. If all the employees practice good communication skills in the
workplace, a healthy working condition will be promoted at he work place.
Being a novice nurse leader, I was learning to manage my entire team as efficiently as
possible. As a nurse leader it is my responsibility to manage my team and take responsibility of
assigning them the tasks and keeping track of their performance. As a novice leader I faced
certain difficulties in keeping my team updated about the tasks that I have assigned to them as I
was less familiar with them initially. Ineffective communication skills might act as a hindrance
to the flow of important information related to the patient's health which might result in
decreased quality of care services being received by the patients. Thus being a novice nurse
leader I need to work on my communication skills in order to contribute to positive health
outcomes. As I made very less conversation with my team members , I was not able to build
good relations with them due to which I was not able to manage the team properly. My
ineffective communication with my team members also affected the relations amongst them. As I
used to be busy in my work all day, they also started practising the same thing and did not
communicate with each other. Therefore, I need to better my communication skills which can be
done by conducting regular team meetings before starting the work every say. This would help
me to know my team members better and would help me to build good relations with them. This
would also help in increasing familiarity among the team members. Also I can conduct mid day
meetings to discuss the issues that my team members are having while taking care of the patients

to ensure that quality services are being provided to the patients. All this efforts will ultimately
have positive effects on the consumer outcomes and will also promote work force harmony.
Activity 3
The Nursing and midwifery standards of practice for registered nurses mentions 7
standards that need to be fulfilled by the registered nurses. According to these standards a
registered nurse should think critically of the nursing practice, maintain professional and
therapeutic relationship, maintain his or her practice capabilities, conduct the assessments
comprehensively, take responsibility for providing safe and apt treatment to the patients etc.
While providing care services to patient I kept in mind to follow the NMBA standards.
For instance taking an example of the second standard, as a registered nurse I tried to build
healthy relations with the patient having cardiac disorder in order to understand his care and
health needs in a better way and provide the patient with good quality care services. But I made
sure that the boundary between the professional and personal relationship was maintained. I
practised good communication skills with the patients while keeping in mind to always address
the patient with respect and empathy in order to avoid hurting the patient's dignity, and cultural
values and beliefs. I never spoke to the patient in ill manner and never demeaned him in any
way. I always keep in mind to respect the life experiences of people and never judge them for the
condition they are in. I provided the family members of the patients with the guidance about the
resources they might require to take care of the patient effectively. Also I told them about ways
that would make the care taking process a bit easy for them. I also delegated the other care takers
of the patients about their roles and supervised them towards positive outcomes.
AMSN is another set of standards that are required to be fulfilled by the Medical-
surgical nurses who are in such a position that they have to demonstrate leadership skills on a
daily basis. Though it is not only the responsibility of the surgical nurses but of all the nurses to
influence the decision making process to provide it a direction towards enhancement of
effectiveness of the inter professional team. It is also necessary for us nurses to practice authentic
leadership and team building theories for providing quality guidance to the subordinate care
providers. While working in a health care setting we are required to build and promote healthy
working environment that is devoid of all sort of negativities. We also practice good
communication skills with the other staff members and other health care professionals. As a

nurse we also practice the skills of understanding the dynamics of point of care and accordingly
adjust the working conditions.
Activity 4
The code of conduct mentions the principles that are required for determining and
evaluating the process of client care. The seven ethical principles that are provided by the code
of ethics are Beneficence, non maleficence, justice, accountability, autonomy, fidelity and
veracity. When specifically talking in context of the nurses the code of ethics stated also include
respecting the patients individuality and rights. In addition to that the social policies provided by
the NMBA help the care professionals to understand the expectations and requirements of
NMBA and also provide pathways for the professionals to meet them along with the policies
pubic protection and safety of patients.
While being in a profession of health care nurse, one has to develop good relationships
with the patients in order to gain better understanding of the health and care needs of the patients
which is necessary to provide them with quality care. But it is also necessary for the care
professionals to keep that relationship good but yet professional. While providing are to the
patients the nurses should keep in mind to maintain the professional boundaries with the patients.
The nurses should never get so much attached with the patients that it starts affecting their
process of decision. As the nurses enter in a therapeutic relationship with the patients due to
which they get access to a lot of personal information about the patients but the nurses should
always keep in mind the rules and policies regarding the privacy of the patient. The nurses
should never showcase the feeling or their actions should not depict feelings of disinterest, cold
behaviour and negligence towards the patient. The nurses are not allowed to get sexually
involved or conduct any sexual violations with the patients as it is considered to be a serious
violation. The nurses are required to maintain professional boundaries and relations with their
patients.
My post would say “Challenging day at work today, with patiences and
understanding I can still care for those in need”. My post for sharing my experience of
a bad day will be including the hardships of the situation that I was in while providing care
services to a patient. The post will be about the challenges that the patient posed for me. The post
will mention the amount of patience and efforts it took me to finally build good relations with the
patient and how come I overcome the behavioural challenges of the patient at the end of the day.

In addition to that I will also tell about the techniques that I used to gain the faith of my patient.
My post will tell about the patient being rude to me and not having faith in the care I was
providing him which made it difficult for me to provide him the required therapeutic services.
The patient kept asking for the doctor even for minor things as he was very afraid pertaining to
his health condition. But still I stayed calm and tried to fulfil the health and care requirements of
the patient.
The things that my post is completely not allowed to contain is the information about the
identity of the patient. The post can also not contain any insensitive content regarding the patient
or the condition of the patient. The information about the name of the health care organisation
can also not be mentioned in the post.
If any such post has been observed by me which consist of the personal information
about the patient or the organisation then I would try to get that post deleted as soon as possible
and will report to the higher officials about the colleague who posted such content.
If I observe an inappropriate post on the social media by a colleague I would immediately
contact that person to remove that post as soon as possible and will tell him or her about the
things that can not be shared out on social media.
Activity 5
In a workplace there are colleagues that showcase good leadership and communication
skills and other qualities that have a positive impact on the other colleagues and staff members.
There is also the presence of certain employees that do not showcase any such good skills that
can have any positive impact on the other employees. From such employees, no one can learn
anything, also such people are not wanted as a part of the workplace by other staff members.
There was also presence of such employees in the health care setting I work in. there was an
employees who was a nurse in the radiology department and was responsible for leading the
entire nursing staff in the radiology section. As the radiology department is a very challenging
department to work in as the radiations poses a variety of serious threats to the patients as well as
to the hospital staff. It was a major responsibility for that colleague to manage that department in
such a way that it causes minimum damage to the health of the entire nursing staff. He always
remained composed, never panicked and effectively managed the entire radiology team. For this
he divided the entire day duties among the staff members in shifts so that every person does not
have to work in radiation environment for long. He was very considerate towards his team

members and had good relations with each of them. For this he practised good communication
skills and ensures proper communication about the duties and shifts that have been assigned to
various members. He also had a very caring behaviour and cared about all his team members. All
these characteristics of his gained him the respect of all his team members and the members of
all other department wanted a leader like him. As a result of this we had to face many problems
in the cardiac ward due to delay in the lab reports. On the other hand,
Another colleague was a part of my workplace who was completely opposite from the
colleague mentioned above. He was a leader of the pathology department. He was responsible
for supervising the working of all the members of the pathology department of health care
setting. He was a very clumsy leader which lead to improper and haphazard functioning of the
department. He had very less interaction with his team members which impacted the relations
between the staff members as well. The staff just like their leader did not practice effective
communication skills and this even have caused incidences of delay in the the reports of the
patients in cardiac ward that were required on urgent basis. Thus it can be said that a leader who
lacks proper leadership skills does not only affect the working of a department of health care
setting but also affects the level of quality of care services being provided at that healthcare
setting.
I learnt a lot from the leader of the radiology department about how a leader should
behave to promote effective team work and what is the importance of practising good
communication skills in the health industry. From the leader of the pathology department I learnt
that how the lack of good leadership and communication skills can impact the working of the
department and how can it be a negative point for the care services provided by the health care
setting.
Activity 6
The nursing and midwifery decision making framework is set of guidelines that provides
a framework for the nurses for practising efficient decision making skills that can satisfy the
service users and also does not defies any of the health care practice guidelines, codes and
standards. It consists of structural concepts and principles that integrates economic, social, legal
and ecological aspects of decision making. The points that need to be considered while making
decisions are the legislative restrictions on professional practice, standards for professional

practice, evidences available for various practices, individual scope of practice, use of delegation
in decision making and support for practice from organisation's side.
I joined the health care setting on the position of a registered nurse. At that time I was in
my learning phase and was learning about the responsibilities of the role as which I joined the
health care centre. In the starting I was not given all the responsibilities rather I was assigned
with them step by step. In my initial months I was not allowed to provide support and advice to
the cardiac patients. Advising the patients is a major responsibility as the patients have blind
faith on the care professionals due to which they consider their advices seriously. Therefore, it is
necessary for the care professionals to be sure of the advices they give to their patients. But after
a span of one six to seven months I was slowly given the of responsibilities of providing support
and advice to the patients bit by bit. For ensuring that I should get considered for being assigned
with this responsibility, I observed the other nurses carefully. I observed the way in which those
nurses dealt with the patients and how they communicated with them in order to build good
relations with them. I also noticed that what advices and in what context did the nurses provided
the patients with an advice. Now I can provide the patients with basic health advices and advices
for the administration of different medications. For future I want myself to be assigned with the
responsibility of handling the entire case of a patient by myself from the point of admission in
the general ward till the patient's discharge. For ensuring that I have the scope of practice that I
want to have in future I will seek the help of other experienced nurses for the purpose of learning
and also for evaluating my skills on daily basis.
Activity 7
The profession of nursing requires critical thinking skills along with other medical and
behavioural skills. A nurse should be skilled in critically analysing the situation and then making
apt decisions which are beneficial for the patient. This is the requirement of the role of nurse to
critically analyse a situation and then make judgements for tackling that unfavourable situation.
But the skill of critical thinking comes with experience and continuous practice, therefore a nurse
should practice strategies for building critical thinking skills like practising thinking ahead or
anticipating and practising reflection or questioning or comparison.
In the initial months of starting my role as a registered nurse I did not have effective
critical thinking skills but while practising mu role I understood the importance of incorporating
this skill in my daily practice. In the early days of commencement of my role as a nurse I

experienced a situation that required critical thinking. It was a situation in which the patient who
was unconscious suddenly started losing breath. At that time I did not knew that in this condition
the patient needs intubation and instead I directly called the doctor who was in charge of the
case. This was lack of my skills to act in a stressful situation and critical think of a solution for
the situation. But with time I incorporated certain strategies in my daily practice in order to
develop my critical thinking skills. Through these strategies I practised the seven steps of the
process of critical thinking. I learned how to comprehend the significance of the situation, hoe to
analyse the situation for evaluating the situation and then finally deduce a reasonable conclusion
for the situation on the basis of the information received from the situation. Then providing an
explanation for justifying the reasoning behind the decisions made for the actions to be taken for
managing the situation.
Following these steps daily in my nursing practice resulted in me being skilled with
critical thinking. Now I successfully manage the situations that require critical thinking skills.
For instance while taking care of a patient in the cardiac ward who was suffering from major
hypertension. The patient was prescribed with a combination of drug including anti hypertensive
drugs, alpha and beta blockers drugs and diuretics as well. So when I saw that the blood pressure
reading of the patient was coming in controllable or acceptable range, I critically thought of the
situation I reached to a conclusion that one of the category of drug can be discontinued for the
patient. So I informed the doctor about the patient's blood pressure readings and consulted the
doctor if one of the category of drugs can be discontinued for the patient which was then
approved by the doctor and the patient was relieved from one category of medication.
Activity 8
The concept of situation awareness provides an insight on the perception development skills of a
person and then analysing the situation comprehensively for deciding the tasks that is required to
be taken in the context of this situation. Nurturing the skills of situational awareness can even
result in reducing the chances of medical errors in a health care setting as through this the care
professional can learn better ways of collecting the information from the environment and to
comprehend that information to reach to a conclusive decision about the tasks that are needed to
be performed.
An incident during which I observed myself to be lacking in situational awareness skills
was when I was taking care . The emergency department of cardiac ward of the hospital is an

area that requires the skill of situational awareness the most. As I was newly assigned in the
emergency cardiac department where every action has to be quick and precise as all the patients
are of emergency case. Therefore, starting from the collection of vitals to making decisions of
the treatment action all the tasks have to be done with utmost situation awareness. While
working I realised that I lack this skill and need to work on the betterment of my situational
awareness. I observed that lack of this specific skills can lead to a person missing an important
information related to the health of a person which can increase the chances of medical errors
and can even result in gap in communication between the care professionals. This would
ultimately result in hampering the aptness of the medical decision made by the care providers
and also reduce the levels of quality of care services provided at the health centre. Therefore, it is
very important for all the health care professionals to practice sound situation awareness skills.
There are various strategies that can help an individual to improve his situational awareness
skills. An individual can practice assessing the probable stressors that can negatively affect the
cognitive skills and learn to manage these effectively. The individual can also introduce the habit
of reassessing the actions and sequence of the task every time before resuming the task. Using
checklist method, regular self assessment, checking and updating the current mental model and
conducting huddle meetings etc. can help in improving this non technical skill. Introducing
training sessions for situational awareness can also help health care professionals to be efficient
in providing quality care services.
Reading 9
In a profession of a care provider where you have to deal with patients who are in a
vulnerable state makes it necessary for the care professionals to have complete control over their
emotions. The care professionals always have to keep a check on their feelings and the words
they use while providing care services. Knowledge of emotional intelligence can help a care
professional to understand own emotions and give them the ability to analyse own emotions
before delivering it to the patient. The care professional can showcase good emotional
intelligence skills by being more of a good listener than a verbalising person. This would allow
the care providers to build good relations with the service users which will ultimately result in
increasing the quality of care services. Therefore, skills related to emotional intelligence can be
helpful in effectively analysing and managing one's emotions in their daily practice of care
providing thus making them a better care provider.

Activity 9
There have been many incidences in my nursing career so far that made me realise the
importance of practising emotional intelligence in my profession. But there was one incident that
made me feel that I severely lack in emotional intelligence skills which is when I was assigned
with a patient of Cardiac arrest who got admitted into the hospital. He also had the issue of Binge
eating disorder which was the reason for his condition of atherosclerosis. He was a stubborn kind
of patient and did not gave any importance to the advices given to him by the care professionals.
He had a recurring history of hospital admission but he still did not try to manage his eating
habit. He was the first patient of mine who practised so much negligence towards his own health.
Though I was supposed to control my feelings while providing care to that patient but still his
behaviour made me feel enraged every time I saw him eating food ordered from outside the
hospital. Once while having a small conversation with him, his talks made me angry to a level
where I lost my temper and I talked back to him in a irritated and angry tone. Being a care nurse
I was not supposed to talk with a patient in this manner and I realised this the moment I
completed my sentence. I then quickly composed myself back to a humble tone and apologised
for my behaviour with the patient. After that incident I always try to practice emotional
intelligence skills and never loose my temper while providing care to the service users.
Activity 10
This module was indeed helpful in changing my nursing practice skills towards
betterment. This module helped me to gain a better understanding on the importance of
practising sound behavioural and non technical skills while providing health related care to the
service users. Through the activities of this module I learnt the importance of practising
leadership skills, situational awareness skills, emotional intelligence, critical thinking skills etc
and using nursing and midwifery decision making framework and code of conduct principles in
order to become an efficient care provider. This module made me realise my drawbacks and
helped me to find out areas where I lack as a care professional. All these skills can also be
helpful for me in providing care services for management of diabetes. Maintaining professional
relations with the patient.
Personal development plan
Skills Present rating out Expected rating Time frame Improvement

of 10 out of 10 measures
Leadership skills 6 9 3 months By introducing
systemic
behaviour in my
daily practice and
by improving my
communication
skills
Communication
skills
7 10 3 months By making small
conversations
with all the
employees and
building good
relations with
them and
practising it on
daily basis
Situational
awareness
6 9 6 months By practising skill
of situational
awareness during
nursing practice
and getting
feedbacks on
display of this
skill by other
professionals
Emotional
intelligence
7 8 6 months By practising this
skill on daily
basis and
assessing the

development of
this skill by
receiving
feedback on the
skills.
Development of the above mentioned skills will help me to provide efficient care services
to a diabetes patient. Good communication skills will allow me to provide the patient with
information about the need and administration of an insulin injection. Good emotional
intelligence will help me to build healthy relations with the patients. Situational awareness will
help me to analyse the condition of the patient and to accordingly make decisions about his
treatment regime. And good leadership skills will help me to guide my team members regarding
taking care of the diabetes patients and ultimately providing quality care services to all the
patients.