Clinical Leadership in Nursing

This report highlights a conflict scenario in a geriatric ward and discusses the measures taken to resolve the situation. It also explores the leadership style used to improve patient outcomes.

Running head: CLINICAL LEADERSHIP IN NURSING
Clinical Leadership in Nursing
Name of the Student
Name of the University
Author Note

CLINICAL LEADERSHIP IN NURSING
Introduction
I work as a registered nurse in the night shift of a nursing home since 2006. I work in
the geriatric unit with 25 old frail patients. The following report aims to highlight one conflict
scenario that I have came across during my duty in my practice settings. This will be
followed by the measures that I have employed in order to resolve the situation. The report
will also highlight the leadership employed by me for the proper management of the satiation
and subsequent resolving of the conflict. At the report I will discuss the how my leadership
style helped to improve the overall health-related outcome of the patients. At the end
recommendations will be given in order to state the chances that are required to be
implemented under the healthcare settings so that similar instances can be avoided in the
future. The overall paper will focus on how proper leadership style helps to overcome the
conflict situation and thereby helping to improve the health-related outcome of the patients.
Overview of the geriatric ward
Within the geriatric clinical settings, new graduate nurses are exposed to numerous
formal protocol, norms, expectations rules and regulations. In this scenario of array and
despair, the support given to these novice nurses by the organisation or the senior nurses is
insufficient. The initial years of these graduates is thus regarded as the main years of hurdles
or obstacles as it results in the generation of many conflicts within the workplace settings.
The pressure to follow the prevailing workplace norms is outlines by strict routines of the
wards which the novice nurses may regard ineffective but then they are compelled to follow
those rules by their senior nurses. This results in the generation of conflict with the senior
nurses. Patients especially the patients in the geriatric wards who are unable to accomplish
their daily living activities have high expectations regarding how they want to be handled
with and taken care off. This increase the pressure over the novice nurses along with

CLINICAL LEADERSHIP IN NURSING
congruency in perceptions pertinent to patient-care issues and results in the generation of
conflict with both the patients and their family members. The generation of conflict hampers
the overall process of care.
Events resulting in the generation of the conflict
Under my practice settings, from my 23 years of experience, I have seen that, there is
a increasing tendency of generation of the conflict with the night shift nurses and the day shift
nurses. The night shift nurses are of the opinion that the day shift nurses work in a
disorganised manner, leaving the workplace in a confusing and in a chaotic state. In contrary,
the daytime nurses remains upset as they thinks that their duties are more demanding than
those working in the night shift. These differences in understanding of the job role or
prioritising duties act as the main basement for the generation of conflict. Three days before,
a new RN nurses joined as night RN under by workplace settings (geriatric care) for giving
care to the frail patients. On day 2 of her duty, I have seen that the new RN nurse has
indulged in a conflict with a senior nurse in the middle of the night. The main issue was
difference in the opinion in the prioritising tasks. The new RN nurse was consoling one
geriatric frail patient he was suffering from extreme emotional breakdown like he was
missing his wife. On the other hand, the senior nurse complained that, “this new RN who have
attained training under the morning shift nurses have no idea how to work in an organised
manner”.. She also reported that, “ Patient X was about to fall from his bed and I was unable
to held him straight , but the new RN nurse preferred consoling the patient Y who was
suffering from emotional breakdown”.. “It was such an act of irresponsibility, I any how
managed but it might have lead to the generation of accidental fall”. The new RN nurses
complained that, “the patient Y was crying profusely, he was missing his wife and was telling
that he want to die and do not want to live. If I felt extremely bad for him and thus went on

CLINICAL LEADERSHIP IN NURSING
consoling him”. The new RN was crying telling, “ I don’t know what to do, my seniors
criticise me, I feel stressed and depressed working here”.
My position in the work
I work as the nurse leader in the geriatric ward that gives care to 25 old frail patients.
My duty is to supervise the work done by my subordinate nurses while taking detail
consideration of the mental and physical health-related quality of life of the patients. As a
nurse leader, I also belief that, it is important to look after the mental health and well-being of
the nursing professionals. Tajvar et al. (2015) are of the opinion that nurse have reported of
experiencing occupational stress under the workplace settings. Stress, under stressful
workplace events hamper the nursing behaviour in the hospital wards. Taking care of the
mental health status of the nurses through effective leadership approaches and through
comprehensive healthcare program helps to reduce the occupational stress and increases the
overall mental health status. A nurse who is free from occupational stress is more likely to
perform better under complex healthcare settings.
Measures applied to seek immediate solutions
I saw that the newly appointed RN was crying profusely and was telling to call-off the
duty while the senior nurses were refusing to corporate with the new RN. I found that the
current situation is extremely detrimental for the healthcare of the patients. I found that the
patients are looking paranoid having witnessed this conflict. Dzierzewski, Rodriguez Tapia
and Alessi (2017) stated that sound sleep at night for the old frail patients is extremely
important in order to improve their overall health status. Paranoia or mental health distress
hampers the quality of sleep at night and thus hampering overall health status. So in order to
manage the situation immediately, I call in the defaulter new RN nurses and the complaining
senior nurses in the conference room. This helped me to reduce the gossips or the negativity

CLINICAL LEADERSHIP IN NURSING
in the ward. In the conference room I listen to all their concerns with utmost patience. First I
converse separately in one to one basis and then conserved with them together. I praised both
of them for their doings in the ward like I praised the new RN for giving emotional support to
the patients and also the senior nurse regarding how she handled the entire situation alone.
After rewarding them I made them understood the gaps in the practice. Like in case of the
RN, there is a lag in her decision making process in order to understand the priority of care.
For example, fall of another patient (patient X) resulted hampering the ethical principle of
beneficence. As per the medical ethics, it is the duty of the clinicians to refrain themselves
from causing harm to the patients (Cocanour, 2016). It is also the duty of the healthcare
professionals to improve the healthcare situations. Thus her act of not helping the senior
nurse in the time of the crisis situation might harm the patients. Thus going forward it would
be her duty to understand the priority of care while taking part in the decision making
process. Non-malefience deals with causing least possible harm in order to reach the
beneficial outcome (Cocanour, 2016). However, accusing the junior nurse has increased the
chances of harm to the patients as well as the nurses so it would be her duty to train the junior
nurse as per her best knowledge in spite of accusing.
Leadership style used to handle the conflict
The main leadership style used my me in order to handle the conflict is
transformational leadership. Traditionally nurses are over-managed and are led inadequately
and thus they experiences unprecedented challenges and opportunities. The healthcare
organisation also constantly experiences changes and this requires flexible and adaptive
leadership style. One of the adaptive leadership styles is known as transformational
leadership. This leadership style mainly upheld the concept of shared responsibilities in the
healthcare sectors that influence new approaches of knowledge development. The

CLINICAL LEADERSHIP IN NURSING
transformational leaders motivate the followers by appealing to innovative ideas and high
moral values. The transformational leaders also have a deep set of internal values and ideas.
This helps the followers acting to bear the greater good of the patients rather than giving
importance to their own interests. The generation of supportive environment help in the
generation of shared responsibility and accountability. The role of a transformational leader is
to inspire, motivate and to intellectually stimulate their subordinates (Ross et al., 2014). In
this scenario I first rewarded or encouraged the nurses about their acts, this is followed by
highlighting the gaps in their practice in a friendly manner. The rewarding and motivation
helps to create a supportive environment that helps to implement the change in practice. The
main skill executed by a transformational leader is the use of the effective communication
skills (Shaughnessy et al., 2018). The use of the effective communication skills helped the
senior nurse to understand her fault and thereby increasing the sense of accountability and the
tendency to generate supportive environment.
The leadership style executed by me was transformational elderships because I belief
that leadership is a process through which an individual can influence group or can influence
or motivate the groups in order to achieve the common goal in the healthcare profession.
There is a positive association between the transformational behaviours and the beliefs of the
healthcare professionals in the practice style for the promotion of the healthcare related
activities. The motivation, reward and the supportive environment facilitated by the
transformational leadership style helps in highlighting of the errors and thereby helping to
implement the change in practice (Stone et al., 2017). I favour transformational leadership
apart from the other leadership style this is because, Saeed et al. (2014) stated that the
managers who perceived to practice transformational leadership style mainly tend to adopt
integrating and obliging style for the management of conflict. Whereas transactional

CLINICAL LEADERSHIP IN NURSING
leadership style mainly compromise the process of conflict management. The laissez-faire
leadership also avoids managing conflict with the subordinates.
Outcome of patients and staff
Transformational leaders stimulate their subordinates in order to share a vision and to
use goals for the purpose of the inspirational motivation. Under the transformational
leadership style, a subordinate is encouraged to think about the old problems in a new ways.
Moreover, the subordinates are influenced by the transformational leaders and this help in the
generation of trustworthy leadership with the leaders and thus helping to increase the level of
dedication. By using transformational leadership style, a leader can deal with complex and
rapidly changing working environment (Lin et al., 2015). The use of the transformational
leadership style helped me to generate a trustworthy relationship with the new RN and at the
same time it helped to increase the sense of dedication among the senior nurses. The nurses
understood their respective faults and at the same time acknowledgement of their job role,
motivated them, this helped to improved the overall mental state of the nurses and at the same
time helped to increase the supportive environment under the workplace settings where both
senior and junior nurses work in unison. The novice RN was feeling stressed and depressed
because of the assault she received from the senior nurse. However, execution of the
transformation leadership style helped the novice nurse to overcome the compassion fatigue
and occupational stress. McCay, Lyles and Larkey (2018) are of the opinion that relational
leadership traits contribute to the generation of nurse satisfaction on the other hand task-
oriented style decrease the difference the level of nurse satisfaction. McCay, Lyles and
Larkey (2018) further highlighted the increase in the level of nurse satisfaction helps to
improve the overall health outcome of the patients. Upon discussing and with the two nurses,
when the both the nurses came out of the conference room with happy faces, the all the

CLINICAL LEADERSHIP IN NURSING
patients felt relaxed and secured. The senior nurse first attended the patient who was
suffering the emotional breakdown in association with the junior RN. The collaborative
counseling helped the patient to recover from his emotional breakdown and thus helping to
improve his mental state. The senior nurse then guided the junior nurse with the priority of
the patients’ care under the geriatric settings of the frail older adults. I found that junior nurse
is feeling more relaxed and comfortable in working with the senior nurses and thus helping to
improve the overall practice standards.
Change in the workplace settings
The effect of the transformational leadership in the organisation outcome and
development of the organisational culture can be defined under the teachable competencies
(Fischer, 2016). The role of the transformational leader is to stimulate, inspire and to
motivate the followers. The transformational leaders mainly belief in the development of the
relationships with the subordinates and generating change in the practice through
emphasizing the vales (Giddens, 2018). Thus application of the transformational leadership
style helped me to see that senior nurses are extending their hands in order help the novice of
nurses. This helped the novice nurses to understand the priority of the care under the geriatric
healthcare settings. Kojima (2015) stated that the frail older adults are prone to accidental fall
due to problem in the gait balance, complex neurological disorder (dementia), problem in the
eye sight and poor hand-eye co-ordination. Thus the priority of care will be prevention of
accidental fall among the frail older adult. The chances of reducing accidental fall reduce the
chance of physical injury and thus helping to improve the overall quality of life. The mental
health also holds prime importance under the geriatric settings how priority must be given to
restrict the accidental fall during vulnerable situations. I also found that the novice nurses is

CLINICAL LEADERSHIP IN NURSING
also seeking help from the senior nurses in pro-active manner, she was also trying to
implement the rules and regulation of geriatric practice.
Recommendation
The recommendation for improving the overall outcome of care and for increasing the
co-ordination among the healthcare staffs, I recommend to conduct weekly group discussions
where the concerns and the gaps in practice will be highlighted by the nursing professionals.
This will help to highlight the errors or gaps in practice and to design the training session
accordingly. The group discussion will also deal with giving rewards and recognition to the
nurses in to order to keep them motivates.
Conclusion
Thus from the above explanation of my clinical experience in my practice settings, I
would like to state that use of the transformational leadership style helped me in conflict
management. Proper execution of the conflict management helped me to improve the overall
quality of care of the patients. Moreover the use of the transformational leadership styles
helped to motivate the nursing professionals. A motivated nursing professional is less likely
to experience compassion fatigue and occupational stress or burnout.

CLINICAL LEADERSHIP IN NURSING
References
Cocanour, C. S. (2016). Ethics and the emergency care of the seriously ill and injured elderly
patient. Current Geriatrics Reports, 5(1), 55-61.
Dzierzewski, J. M., Rodriguez Tapia, J. C., & Alessi, C. A. (2017). Synopsis of geriatric
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Fischer, S. A. (2016). Transformational leadership in nursing: a concept analysis. Journal of
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Giddens, J. (2018). Transformational leadership: What every nursing dean should
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Kojima, G. (2015). Frailty as a predictor of future falls among community-dwelling older
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