The Role of Nursing Leadership

Running head: LEADERSHIP IN A NURSING TEAM
LEADERSHIP IN A NURSING TEAM
Name of the Student
Name of the University
Author Note

1
LEADERSHIP IN A NURSING TEAM
Executive Summary
With the increase in the number of diseased individuals globally, it has become a necessary
thing to build a well-developed infrastructure in the ground of health and disease. Apart from
doctors, nurses with cognitive skills are an essential part of this system. In this study, there
are two scenarios where the nursing leaders efficiently tackle all the jobs with immense hard
work and team-plan. The nurses provide all the patient with the personalized treatment that
might help in their plight. Leadership in nursing is a paramount quality that should be taught
in a broader aspect to build a strong sense of clinical reasoning as well.

2
LEADERSHIP IN A NURSING TEAM
TABLE OF CONTENTS
INTRODUCTION......................................................................................................................3
CLINICAL SCENARIO 1.........................................................................................................3
CLINICAL SCENARIO 2.........................................................................................................6
CONCLUSION..........................................................................................................................8
REFERENCES.........................................................................................................................10

3
LEADERSHIP IN A NURSING TEAM
INTRODUCTION
The Registered Nurses take care of the patients according to the prescription of the
doctor in charge (Lee et al. 2014). The Principle of Leadership in Nursing includes the
following: Aspiring nurses should practice their education and training rigorously; should
work hand in hand with medical physicians to ease the process of treatment; should also
assess, plan, diagnose and evaluate the problems (Flanagan, Cortese-Rubino and Fick 2014).
After studying the case studies, this paper is written to shed light on both the cases
concerning the leadership roles using clinical reasoning cycle, decision-making framework
and National Midwifery Board of Australia standards of practice.
CLINICAL SCENARIO 1
In the first scenario, Aarya the graduate nurse should act by following the clinical
reasoning cycle (Clinical Reasoning 2020) and NMBA standard of Decision Making
Framework (Decision Making Framework 2020) which is as follows:
 Patient Situation Consideration: During this phase, Aarya should note the condition
of the patients. Mr Lannister is having rashes on his back. A patient is attached to a
Percutaneous Endoscopic Gastrostomy (PEG) feeding tube, and his schedule would
get over at 8 PM. Five patients are suspected of flu, and are on a four hourly
observation, including their vital checkup. Two patients are on insulin, and their blood
glucose level needs to be checked before dinner along with administration of insulin.
Mrs Snow, another patient with an Indwelling Urinary Catheter (IDC), was to be
changed on that day but could not be changed as she went out. There are five cases of
simple dressing, and two other cases of complex dressing. Greg Clegane is having
trouble to settle in and requires continence assessment. Three monthly care plan of
two other patients are left. There are four patients on S8 drugs who require medication
at two different times. Aarya received a call at night informing her that Mrs
Targaryen, a patient, was found on the floor of her room with a laceration on her
head.
 Collection of Information: This phase is for collecting all the information about the
patients, including reviewing their current condition, gathering new information and
recalling the knowledge the nurses have accumulated during their education. Aarya,
during this phase, would check all the patients under her charge and gather new

4
LEADERSHIP IN A NURSING TEAM
information about them, along with ordering some tests to be done on various patients
to get more details on the cases.
 Information Processing: During this phase, Aarya should interpret and analyze all
the patient scenarios by collecting all the information. By checking the diagnostic test
reports, she should be able to identify the problems and anomalies in each patients’
systems. She should identify the reasons for the back rash of Mr Lannister and plan
the treatment proceedings after Dr Greyjoy has checked the reports and the conditions
himself. The patient with a PEG feeding tube should be removed from the tube at 8
PM and she should plan the proceedings of her team members by keeping all the
involvements in mind. The vitals of the flu suspecting patients that are noted should
be studied by Aarya to come to a possible interpretation of their condition and the
path in which the treatment should proceed. She should also remember to change the
ICD device attached to Mrs Snow once she comes back from lunch. Aarya should
also gather information about Mr Stark and Mr Littlefinger and plan out the care plan
review. She should also be fast to reach Mrs Targaryen once she learns about the
situation of her laceration.
 Identification of the Problem: In this stage, Aarya should chalk out all the
procedures she should perform to diagnose the complications of the patients
accurately so that she may proceed with the treatment. Aarya should check the
diagnostic test reports for identification of the condition Mr Lannister is suffering
from, the blood glucose level of the two patients under insulin treatment. She should
also determine by the vital chek up of the flu suspected patients if they are at all
suffering from the flu or not.
 Goal Establishment: This stage is all about setting a goal and to achieve the target of
curing the patients by providing appropriate treatment. Aarya should set a goal to cure
the back rash of Mr Targaryan, detach the PEG feeding tube from the patient at 8 PM,
plan out the treatment of the flu suspected patients according to their report of vitals,
apply the insulin treatment to the two patients having diabetes and plan their meals
accordingly, change the IDC of Mrs Snow, initiate the continence assessment for
Greg Clegane, create a care plan for Mr Stark and Mr Littlefinger and the steps she
should take the treat the laceration of Mrs Targaryen.
 Taking Action: During this phase, Aarya should remember the NMBA Decision
Making Framework while delegating the duties to the team members under her
leadership. She should use Standard 6 of the NMBA standards which directs to

5
LEADERSHIP IN A NURSING TEAM
provide safe, responsive and appropriate quality nursing practice (Nursing and
Midwifery Board of Australia 2020). Aarya should apply the proper ointments to Mr
Targaryen according to his test results which might be due to immunological
hypersensitivity and can be reduced by maintaining hygiene. She should delegate one
of the carers to take his care as the procedure of his treatment does not require quite
much knowledge but under the supervision of Aarya (Pichler et al. 2017). Aarya
herself should remove the PEG feeding tube of the patient as it requires expertise and
also there are chances of infection which should also be avoided (Malhi 2017). To
check the vitals of the flu-suspected patients, Aarya should assign two carers The
patients who have diabetes should be incorporated with insulin which the enrolled
nurse can do, maintaining the dosage as she should be knowing these things being an
enrolled nurse. The patients requiring dressing can be managed with the help of three
carers and the enrolled nurse as they know dressing procedure. She should also
prepare the plans for Mr Stark and Mr Littlefinger. Aarya herself should take care of
the four patients under S8 drugs as this medication requires expertise (Hua, Shen, and
Ge 2015). When she is informed about the laceration of Mrs Targaryen, she should
reach out to her and do the needful.
 Evaluation: This stage should be done by following Standard 7 of the NMBA
standards. During this stage, Aarya should evaluate the expected progress and
outcomes of the treatment. She might also re-evaluate her plans if any of the cases are
not showing the desired progress.
 Reflection: This is the last phase of clinical reasoning cycle during which Aarya
should comprehend her learnings from the cases and the successes or failures she met
with.
CLINICAL SCENARIO 2
Ebony, the nursing team leader, in this case, should follow the clinical reasoning cycle
and NMBA standard Decision Making Framework, which is as follows:
 Patient Situation Consideration: During this phase, Ebony should know about the
situation of all the eight patients under her. All the patients have a variety of
complications and should be treated by following standard 4 of the NMBA guidelines
which state conducting Comprehensive Assessment. Kay White is a patient who has
undergone appendicectomy and also has diabetes. Mark Black is the patient who has

6
LEADERSHIP IN A NURSING TEAM
undergone a knee replacement surgery buzzes the ringer as he feels the need for
defaecation. Jan Green is the individual who had an ileostomy and her stoma has
stopped functioning correctly along with the stump turning black. Jock Grey is
another patient who is suffering from Chronic Obstructive Pulmonary Disorder and
feels a sharp pain in his chest. Another patient, named Pippa Blue has undergone
Mastectomy. A bellovac drain has been put following the surgery and it needs
changing as it has got filled with haemoserous fluid. Tanya Pinkstone, another patient
who met with a motor vehicle accident and needs a chest X-Ray to be done. The next
patient is Tom Purple, who has undergone a knee replacement surgery ten days ago.
He needs to be shifted to another rehabilitation hospital with Quality Assisted
Survival at around 9 AM. The last patient is Stacey Yellow, who is suffering from
Acute Pancreatitis.
 Collection of Information: During this phase, Ebony should follow standard 5 of the
NMBA guidelines in developing a plan for nursing. She should review all the
patients’ conditions, gather newer information and recall the problems and the
solutions that can be derived according to their educational courses.
 Information Processing: During this stage, Ebony should process all the information
and things to be done to cure the patients. She should process the information
according to the urgency and the requirement. Kay White should be on a free fluid
diet devoid of any substance that might increase the glucose level in her blood; Mark
Black should be helped to defaecate. Jan Green’s stoma is turning black and it’s
getting more problematic; Jock Grey feels a pain in his chest and et not shifted to the
respiratory ward; Pippa Blue’s bellovac drain should be cleared; Tanya Pinkstone’s
X-Ray is to bed one to initiate the treatment; Tom Purple’s discharge procedure along
with the removal of the staples in his bandages and Stacey Yellow’s urge to smoke-
these all things should be processed by Ebony and work accordingly and delegate
duties to her team members.
 Identification of the Problem: This phase is for identifying the issue with every
patient. The major problems among the eight patients include Kay White’s issues are
diabetes and post-operative care; Jan Green’s stoma turning black is also a rising
concern and might be turning black because of lack of oxygen supply to that portion;
Jock Grey, suffering from Chronic Obstructive Pulmonary Disorder (COPD) is
having a sharp pain which might hint towards a respiratory problem and need for
oxygen; immediate need for the draining of bellovac drain of Pippa Blue; urgent need

7
LEADERSHIP IN A NURSING TEAM
for Tanya Pinkstone’s X-Ray; Tom Purple’s discharge and the formalities before
discharging him and lastly Stacey Yellow’s continuous urge for smoking.
 Goal Establishment: In this stage, Ebony should set the desired outcome and time
required for it. She should also think about the delegations she would be giving for
duty and the reasons for choosing that particular individual for that duty.
 Taking Action: Ebony should take action following standard 6 of the NMBA
guideline. Aarya should delegate duties among team containing Jade, a postgrad
registered nurse, Olive, an enrolled nurse, Ash, an Assistant in Nursing and Hunter,
third year student registered nurse doing an internship. For Kay White, her free fluid
diet should be without any glucose increasing substance (JDRF, the type 1 diabetes
charity 2020). Ebony should delegate Ash with the duty of taking care of her diet as
being an assistant in nursing he is an expert in assisting people with personalized
attention (Assisstant in Nursing 2020). In the case of Mark Black, Ebony should
delegate Ash who can help him in defaecating. Jan Green’s stoma turning black hints
toward lack of oxygen and it needs care (Memorial Sloan Kettering Cancer Center
2020). Ebony should assign Olive an Enrolled Nurse as she is experienced and should
assign Jade for supervision as she is a registered nurse. Jock Grey has a pain in his
chest that might be due to lack of oxygen (Bordoni et al. 2018). Ebony should assign
Jade to apply for oxygen support if the condition worsens. As Pippa Blue’s bellovac
drain is on the full with haemoserous fluid, it needs to be emptied and Ebony might
delegate Hunter to make him aware of such scenarios and Ebony herself should
instruct while Hunter is working (Yue et al. 2015). Tanya Pinkstone’s X-Ray should
be done to start the treatment and Ash can be delegated. Tom Purple has undergone a
knee replacement surgery and needs to be shifted to another rehabilitation hospital at
9 AM. So all the surgical staples should be removed from his body and bandages
should also be applied in wounds and this job can be delegated tp Olive, the surgical
enrolled nurse. All the discharge paperwork should be done by Ebony being the team
leader and has the authority (Alper et al. 2017). All the necessary vitals including
blood pressure, blood glucose should be checked before his discharge. Stacey Yellow
is suffering from pancreatitis and wants to smoke. As tobacco in this condition is
derogatory and can prove fatal, Ebony should not agree to her demands (Majumder
and Chari 2016).

8
LEADERSHIP IN A NURSING TEAM
 Evaluation: Ebony should evaluate the scenario by following the standard 7 of the
NMBA standard. She should asses the possible progress and outcomes and re-check if
anything might not work as it was expected to be.
 Reflection: During this phase, Ebony should look back and assess everything and
learn from the experiences.
CONCLUSION
To be a capable nursing leader, the principle of clinical leadership should be followed
by registered nurses. The nurses should follow the clinical reasoning cycle, NMBA Decision
Making Framework minutely to be successful in providing the care. The principle includes
seven points that include thinking and analysing critically; engagement in professional and
therapeutic relationship; maintaining practice capability; conducting assessment
comprehension; planning of nursing practice; providing responsive, safe and appropriate
nursing practice and evaluation of the outcome along with gaining experience.

9
LEADERSHIP IN A NURSING TEAM
REFERENCES
Alper, E., O’Malley, T.A., Greenwald, J., Aronson, M.D. and Park, L., 2017. Hospital
discharge and readmission. UpToDate, Waltham, MA.(Accessed on September 16, 2016.).
Assisstant in Nursing. (2020). Assisstant in Nursing [Ebook]. Australian College of Nursing.
Retrieved 2 March 2020, from
https://acn.edu.au/wp-content/uploads/2018/02/ps_assistants_in_nursing_c5.pdf.
Bordoni, B., Marelli, F., Morabito, B. and Castagna, R., 2018. Chest pain in patients with
COPD: the fascia’s subtle silence. International journal of chronic obstructive pulmonary
disease, 13, p.1157.
Clinical Reasoning. (2020). Clinical Reasoning [Ebook]. School of Nursing and Midwifery
Faculty of Health, University of Newcastle. Retrieved 2 March 2020, from
https://www.utas.edu.au/__data/assets/pdf_file/0003/263487/Clinical-Reasoning-Instructor-
Resources.pdf.
Decision Making Framework. (2020). Decision Making Framework [Ebook]. NMBA.
Retrieved 2 March 2020, from http://file:///C:/Users/LAPTOP_MP358/Downloads/Nursing-
and-Midwifery-Board---Framework---Framework-for-assessing-standards-for-practice-for-
registered-nurses--enrolled-nurses-and-midwives.PDF.
Flanagan, N., Cortese-Rubino, M. and Fick, D.M., 2014. Nursing leadership in skilled
nursing: A journey to clinical excellence. Journal of gerontological nursing, 40(11), pp.3-5.
Hua, A.C., Shen, F. and Ge, X., 2015. State-based legal requirements for Schedule 8
prescriptions: why so complicated?. The Medical Journal of Australia, 203(2), pp.64-66.
JDRF, the type 1 diabetes charity (2020). Food and diet with type 1 diabetes - JDRF. [online]
JDRF, the type 1 diabetes charity. Available at: https://jdrf.org.uk/information-support/living-
with-type-1-diabetes/everyday-life/food/ [Accessed 8 Feb. 2020].
Lee, J., Lee, Y.J., Bae, J. and Seo, M., 2016. Registered nurses' clinical reasoning skills and
reasoning process: a think-aloud study. Nurse education today, 46, pp.75-80.
Majumder, S. and Chari, S.T., 2016. Chronic pancreatitis. The Lancet, 387(10031), pp.1957-
1966.

10
LEADERSHIP IN A NURSING TEAM
Malhi, H., 2017. Enteral tube feeding: using good practice to prevent infection. British
Journal of Nursing, 26(1), pp.8-14.
Memorial Sloan Kettering Cancer Center (2020). Caring for Your Ileostomy or Colostomy.
[online] Memorial Sloan Kettering Cancer Center. Available at:
https://www.mskcc.org/cancer-care/patient-education/caring-for-your-ileostomy-colostomy
[Accessed 8 Feb. 2020].
Nursing and Midwifery Board of Australia. (2020). Nursing and Midwifery Board of
Australia - Registered nurse standards for practice. Nursingmidwiferyboard.gov.au.
Retrieved 2 March 2020, from https://www.nursingmidwiferyboard.gov.au/Codes-
Guidelines-Statements/Professional-standards/registered-nurse-standards-for-practice.aspx.
Pichler, W.J., Srinoulprasert, Y., Yun, J. and Hausmann, O., 2017. Multiple drug
hypersensitivity. International archives of allergy and immunology, 172(3), pp.129-138.