Introduction Clinical Leadership

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

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Introduction
Clinical leadership plays an important role towards ensuring the quality of patient care
and generating a safe and healthy clinical work environment. Low-quality of patient's care
process along with adverse events is reported in the healthcare sectors around the world
prompted the healthcare administrator to call for strong clinical leadership (Mianda & Voce
2017). Principles of the clinical leadership in the registered nursing professionals include
critical thinking skills, active decision-making process, taking action on behalf of the team
members and conducting advocacy for the patients in order to provide informed consent (AL-
Dossary,2017).
Case Study 1
Considering the situation of Mr. Lannister and through collection of the information,
it can be stated that Mr. Lannister was suffering from rash in his back for three days and the
same was reported by his family members but the team of professionals in Westeros Aged
Care failed to take the necessary actions. Aarya reported the Dr. Greyjoy immediately after
commencing the duty. As per the principle of the decision making framework for the nurses
and midwives in Australia proposed by the Nursing and Midwifery Board of Australia
(NMBA) (2019) it is the duty of the nurse and the midwives to take rightful decision about
everyday practice and invite in changes to time in order to meet health needs of the patients.
Thus under the perspective of the clinical leadership it is the duty of nursing professionals to
take immediate action depending upon the clinical priority. Here the reporting RN nurse has
taken the rightful steps to understanding the link between the sub-optimal care, abuse and
neglect (Whitby, 2019). However, according to the NMBA decision making framework for
nurses and midwives (2019), it is also the duty of the RN under clinical leadership to report
any gaps in practice and thus helping to improve the overall quality of care. Thus Aarya must
also investigate why the issue of Lannister was not reported on time resulting in unnecessary
delay. This fall under the duty of the supervision of clinical leadership in registered nursing
profession. The analysis of the overall case study highlighted that Aarya being a graduate
nurse, she is entitled to conduct a large range of responsibilities and also require to oversee
the operation of the entire unit. She is thus expected to plan, lead and to direct the entire
execution of the work in her assigned wing of the Westeros Aged Care. She is also expected
to develop the workflow in nursing, taking vital signs of the patients, tracking patients’

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progress and is also require report the doctor about the any negative or positive progress in
patients’ health (Martin and Milne 2018). The case study highlights that the duty of Aarya in
the Aged care ward of Westeros deal with PEG feeding of one of the patient, insulin
injection, tracking the blood glucose level of the diabetic patient before dinner, catheter
insertion, continence assessment and completion of two round of medication within her shift.
Hence as a clinical RN leader she is required to provide support, direction, motivation while
promoting collaboration and effective communication in order to promote optimal health
related outcome (Stanley & Stanley, 2018).
In the next stage of the scenario, it can be reported that in spite of having such a tough
schedule in the wing of the Westeros Aged Care, Aarya allowed one carer to leave for the day
as she was feeling unwell. Reduction in one carer from the team of nursing professionals
helped in increase in the nurse to patient ratio. Thus at present there are 50 residents in the
Winterfell Wing with one enrolled nurse and 5 carers (initially there were 6 carers) along
with Aarya as a graduate nurse. Jember et al. (2018) stated that increase in the nurse to
patient ratio increase the chances of error in the therapy planning and therapy
implementation. In order to maintain a standard nurse to patient ratio for increasing the
outcome of patients’ care, it is the duty of a clinical leader in nursing to conduct proper
delegation of the work-force (Kendall et al., 2018). Alternatively, Hughes, Kirk and Dixon
(2017) delegation in the healthcare sectors is comprises of having sound understanding of the
accountability, responsibility and authority of the patients’ health. Thus in this case the main
responsibility of delegation will include replacing the sick nurse with a healthy nurse in order
to maintain a standard nurse to patient ratio. This will help to address all the patients’ queries
and concern with utmost precision. Delegation also entails assigning task to the team of
nursing professionals must depend on required skill and expertise. In this way, there are
minimal chances of error under healthcare settings. Execution of effective communication
and practice of the transformational leadership will help to promote trustworthy relationship
with the team of professionals and thus helping in proper delegation of the work-force
depending of the clinical expertise (Kendall et al., 2018)
According to NMBA professional standards of practice (2016), it is the duty of the
nursing professional to provide safe and effective care to the patient. Reducing nurse to
patient ratio by recruiting nursing and midwifery professional will help to increase the safety
quotient of health of the patient. This falls under adequate staffing of nurses in the in-patient
unit. The decision making process of NMBA states that it is the duty of the clinical nurse

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leader to plan the duty of care based on the clinical priority. Conduction of the duty by a
clinical leader must be followed by proper supervision of the work as this will help to
highlight the disease prognosis. Souza et al. (2016) stated that supervision in the clinical
leadership is executed when there exists a collaborative working alliance between the
registered nursing professionals and the nurses under them as team. Apart from supervision
of the patients’ disease prognosis, supervision of the work culture and work pattern of the
subordinate nurses are also important. According to NMBA (2016), professional code of
conduct, it is the duty of the nursing professionals to generate opportunities for the junior or
subordinate nurses by attaining feedback based training from the clinical nurse leaders. A
team of trained nursing professional will be skilled and competent enough to deliver right
care at right time while execution of the critical thinking skills.
Case Study 2
The growing body of evidence suggest that clinical leadership in nursing in health and
social care is critical in the continuum of recent times. The clinical leadership role a RN is
accredited to fact that the majority of the RNs are experience extreme hurdle for execution of
their standard professional duties as they come across several complications that require
immediate attention. Under such circumstances, the RNs are required to execute their critical
thinking skills as part of the clinical leadership quality (Liu, Chen & Jin, 2017). The analysis
of the case study suggests that Jade, a second year, post graduate RN is enrolled to execute
conduct supervision of a surgical ward after being transferred from the ICU unit. It has been
highlighted by the NMBA professional code of conduct (2016), it is the duty of the nursing
professional to effectively communicate with the patient and their family members and other
team of professionals and discuss in detail about prognosis of patients’ care. Based on the
description of the patients’ scenario in the case study, it can be stated that Jade is actually
playing the role of a clinical leader in the surgical settings. A clinical leader in RN profession
is expected to execute clinical proficiency in a speciality area while utilization of the inter-
personal communication skills for the delegation of work (Ruhs, White & Schmitt, 2017).
The work setting under which Jade is assigned is different from that of Jade. Jade
used to work in the ICU set-up that was quite and organised however, she was transferred to
surgical care unit that is noisy. Thus in order to develop the proficiency to work under this
healthcare setup it is important for Jade to conduct reflective practice. According to NMBA
professional code of conduct (2016), it is the duty of the nursing professionals to conduct

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reflective practice and this helps to work on their flaws and gaps in their practice and thus
helping to bring refinement in nursing skills. NMBA (2016) professional code of conduct for
nurses in Australia also states that it is the duty of the nursing professional to create scope of
the continuous professional development and thus helping to increase the knowledge and
skills in the nursing professionals. Apart from skill development, delegation and supervision
also hold an important aspect in nursing. The total patient load in the surgical ward, under
which Jade is assigned to execute work over 8 patients and each of the patients is subjected to
different types of surgical procedure like fractured sternum, appendectomy, knee replacement
and hemicolectomy. Thus the nature of care, delegation and the nature of supervision of each
of the patient will be different. Ruhs, White and Schmitt (2017) stated that clinical leaders
when giving care to a diverse group of patient having different healthcare needs, the
delegation of the work-force must be done based on the nursing skills and expertise of team
mates.
While functioning as a supervisor in the surgical ward, Jade is expected to oversee
and to monitor the care that is being delivered by Hunter who is still a student. Jade is also
attributable to conduct several activities for eight different patient who are admitted in the
surgical ward. Some of the activities that must be conducted at an urgent basis include
infection control of the surgical patients at surgical site and medication management of the
patient like giving proper sedation at desired dosage, route and time. Apart from this, Jade is
also attributable to mental health management (psychological support) of the surgical patient
by executing effective communication skill while helping patient to gradually indulge in
activities of daily living. The duties are exhaustive for James and thus this surgical ward
demands immediate support coming from human resource (Liu, Chen & Jin, 2017). Ruhs,
White and Schmitt (2017) stated that it the duty of the clinical leaders in RN position to work
in collaboration with the colleagues and this is known as intra-professional skills. In this case
study, Jade is required to work under the collaboration of Olive, an experienced surgical ward
EN. Working with Olive and seeking Olive’s suggestion while executing care for the patients
in the surgical ward will help to increase Jade’s knowledge and perception about surgical
ward nursing. Jade must also use decision making framework of the NMBA (2020) in order
to identify the clinical priority of the 8 patient admitted in the surgical ward and thereby
helping to deliver the care plan according. It might be problematic for Jade under certain
instances to finish the work time however, proper yet smart management of the nursing

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resources and delegation of the resource in appropriate places will help to increase the overall
scope of practice of the clinical leadership while helping to finish the work on time.
Other NMBA standards that Jade must keep into consideration while delegating
duties and conducting supervision showing respect to the decision-making capacity of the
patients and their family member (standard 2.5) and fostering culturally safe practice (2.7).
The Jade must also execute planned actions while delegating the human resources against
each of the patient (standard 5.5) and conducting proper negotiation in a planned manner for
avoiding any unwanted medical complication in the care process (standard 5.4).
Conclusion
Thus from the above discussion it can be stated that clinical nursing leadership help in
proper co-ordination of the work-process while making proper delegation of the duties to the
skilled professionals and making proper human resource management. Proper delegation of
duties and conducting work supervision and maintaining proper communication skills will
help to improve the overall outcome of care while decreasing the cost of care and length of
stay of the patient in the hospital. However, the clinical leader must also keep scope for the
continuous professional development and conducting reflective practice in nursing. Both the
RN Aarya and Jade must adherence NMBA decision making process and NMBA
professional standards of nursing in order to improve the outcome of care.

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