Leadership and Nursing Practices

This assignment delves into the crucial role of leadership in nursing. It requires a comprehensive analysis of provided research articles that examine various leadership theories and their practical applications within healthcare settings. The focus is on understanding how different leadership styles influence patient outcomes, safety, and organizational effectiveness. Key aspects to consider include transformational leadership, transactional leadership, and self-leadership, along with their impact on nurse-patient communication and interprofessional collaboration.

Running head: NURSING CLINICAL LEADERSHIP
Reflections on leadership and clinical governance
Student Name-
Student number-
Word Count- 2110

1NURSING CLINICAL LEADERSHIP
Globally, there has been a recent increase in escalating costs and demands across all
healthcare organizations. The major challenges faced by caregivers and health professionals
working in a healthcare setting are a fiscal constraints, increased demand for access to health
resources, high client expectations, and issues that violate patient safety and quality of care being
provided (Mannix, Wilkes & Daly, 2013). Thus, effective governance is imperative to maximize
appropriate care delivery services. This is achieved by demonstrating clinical leadership that
ensures high quality health care system.
To achieve positive health outcomes, clinical leaders need to demonstrate adequate
competence and skills, which will help them to communicate with the multidisciplinary clinical
groups existing in a healthcare unit (Hutchinson & Jackson, 2013). This essay will illustrate the
effects of effective communication by nurses on patient safety and will also reflect on an incident
that will demonstrate the adverse events that occurred due to miscommunication with a patient.
Impact of effective communication on patient safety- Nurses often act as the forefront of
healthcare delivery system by being directly involved in providing a holistic and client-centered
care to them. Thus, they play a crucial role in identifying the health status of patients, supporting
them and preventing the occurrence of any adverse events. Nurse leaders are therefore
responsible for building alliances and connections across the healthcare setting by fostering
effective communication among the patients, family, caregivers, key stakeholders and the
administration (Cousin et al., 2012). The positive effects of communication skills on the capacity
of patient’s to cope up with chronic disorders and show better outcomes have been demonstrated
by several research evidences conducted in the past decades (Cooper et al., 2012).

2NURSING CLINICAL LEADERSHIP
The ability of a nursing leader to listen, explain, and empathise with the client creates
deep-rooted impacts on the health outcomes and patient satisfaction. Most studies have provided
evidence that the ineffective communication acts as the major cause of inadvertent patient harm.
Failure to communicate appropriately leads to transfer of inadequate and ambiguous information,
faulty exchanges and lack of effective information exchange (Daly, Speedy & Jackson, 2015).
Thus, improving communication is considered to be of utmost priority for enhancing patient care
quality (Radtke, 2013). It has been proved by studies that effective interaction between team
members leads to an increased work efficiency and clinical outcomes, reduction in workloads
and adverse drug events, elimination of chances of medication errors, lowering of patient
morbidity, and improved satisfaction of both the nurses and their clients.
Communication skills are essential for nurses because they spend a considerable amount
of time with their clients (Bramhall, 2014). It is integral to develop rapport with patients in order
to promote holistic patient care. Efficient communication leads to the establishment of
supportive relationships. This view has also been supported by other study, which states that
active listening, demonstration of compassion towards patients are more likely to increase
positive patient experiences (Shirley & Sanders, 2013). Evidences for the positive impacts of
communication skills on patient outcomes were demonstrated by another mixed methods study
that evaluated the effects of the SAGE and THYME foundation level workshop (Connolly et al.,
2014). SAGE and THYME refers to a mnemonic that helps in structured conversation with
distressed people. SAGE stands for setting, ask, gather, and empathy. It brings the person into
the conversation. THYME encompasses talk, help, you, me, and end. It helps in bringing them
out of the conversation. The results demonstrated that non-verbal communication skills,

3NURSING CLINICAL LEADERSHIP
structured conversations and verbal behavior were successful in eliciting positive patient
responses.
The positive impacts of communication on patient safety were also supported by a study
that suggested communication failures often lead to negative health outcomes due to medication
errors (Brock et al., 2013). Adequate training of inter-professional healthcare teams helps in
increasing positive attitudes and knowledge among the patients and reduces incidence of adverse
health outcomes among patients suffering from asthma, tachycardia, congestive heart failure and
seizures.
A similar view was opined by authors of another study who considered communication to
be the hallmark of safe delivery in perinatal units (Lyndon et al., 2011). Nursing leaders, who are
attentive, respectful towards patients and competent to communicate with the physicians,
efficiently prevent chances of errors in care delivery and help to safeguard a patient. Hierarchical
differences, lack of administrative support and weak collaboration among professionals are some
of the challenges to effective inter-professional communication (Doyle, Lennox & Bell, 2013).
Data from other studies also state that lack of proper framework to facilitate verbal
communication, differing opinions among nurses and frequent distractions also violate patient
safety (Coelho & Galan, 2012).
Intimidating behaviours are responsible for causing errors in mediation, adverse health
outcomes and poor patient satisfaction. This in turn increases hospitalisation costs and creates
dissatisfaction among the patients and their family members (Cummings et al., 2010).
Reflection on an incident related to ineffective communication- In this part I intend to
reflect on a situation that occurred during the first year of my clinical practice, which gave me

4NURSING CLINICAL LEADERSHIP
the opportunity to understand the importance of effective communication in patient care. This
incident occurred when an elderly patient Mandy (pseudonym) was admitted to the ward where I
was assisting my mentor and involved miscommunication between the nurse-in-charge and the
patient. The concerned nurse failed to demonstrate adequate communication skills, which created
difficulties for Mandy to perform tasks such as toileting, undressing and self-feeding. Failure of
the nurse to identify the non-verbal gestures shown by the patient made her restless and she
suffered a fall from the bed. This led to several bruises on the latter’s arms and legs.
To prevent occurrence of this incident in near future the nurse-in-charge put up a patient
bed side board. This facilitated easy communication between the patient, her family members
and the concerned staff in the ward. The RN started to communicate about all events that
happened during that shift by writing instructions on the board. She reassured Mandy that proper
care would be taken by holding the latter’s hands and putting an arm around her shoulder (Daly,
Speedy & Jackson, 2015). She further used simple, short sentences, maintained a low voice
pitch, an eye contact and paid attention to the cues that suggested that Mandy was overwhelmed
by the caring behaviour shown towards her.
Styles and characteristics of clinical leadership- All nurses are expected to exhibit
powerful leadership skills in a hospital setting that helps them to achieve their goals. There are
several recognised styles of clinical leadership. For instance, the transactional leadership makes
the senior nurses promote compliance to the followers, generally the junior staff by punishments
and rewards (McCleskey, 2014). A transactional leader focuses on organisation, supervision and
team performance. They pay attention to all staff in order to find flaws and deviations. This
leadership style proves effective in crisis situations. The transformational leadership style
focuses on building relationships with staff and motivating them through a shared vision. Such

5NURSING CLINICAL LEADERSHIP
leaders increase the confidence and inspire the workers to improve their performances (García-
Morales, Jiménez-Barrionuevo & Gutiérrez-Gutiérrez, 2012). This helps them to earn the loyalty
and respect of the staff. However, they often overlook the job details. A democratic leader
encourages open discussion and participation of all nursing staff during the decision making
process. The staffs are entitled with the responsibility of giving feedback on clinical
performance. They emphasise on quality improvement of the patient care. Although it leads to a
slower decision-making process, this leadership increases job satisfaction (Bhatti et al., 2012).
On the other hand, the authoritarian leaders rely on personal knowledge and make
decisions without considering staff input. This result in negative reinforcement and the leaders
do not tolerate mistakes. They blame individuals for any faults in the nursing care and withheld
critical information from the team (Schuh, Zhang & Tian, 2013). However, the positive aspect of
this leadership is its role in controlling emergency situations. Conversely, an emotionally
intelligent leader is self-aware and exhibits empathy, social skills, motivates the staff, and is able
to regulate personal feelings (Heckemann, Schols & Halfens, 2015). Such leaders are able to stay
in control and assess any emergency situation in a calm manner. They do not blame others for
any mistakes and rather hold themselves accountable for any adverse incidents in the care
setting. Providing empathy to the team and giving constructive feedback helps them to earn
respect. Similarly, charismatic leaders are noted for their ability to motivate and inspire the staff
to show commitment towards the organisation and perform better (Vlachos, Panagopoulos &
Rapp, 2013). This form of leadership relies on the persuasiveness of the leaders and they share
similarities with the transformational leaders. On the other hand, the Laissez-faire leadership
style makes the leaders provide negligible direction or supervision to the staff. They take a
hands-off approach and rarely make decisions. Thus, the staff are left to meet their goals without

6NURSING CLINICAL LEADERSHIP
any assistance and it is often manifested by leaders who area about to end their careers (Furtner,
Baldegger & Rauthmann, 2013).
Clinical leaders need to exhibit certain characteristics that will help them improve the
team performance. They should be respectful and fair towards the staff and should treat them in
an equitable manner. Enforcing cooperation and assisting the workers in their individual work
also promotes team work (Mannix, Wilkes & Daly, 2013). The leaders should be compassionate,
and should exhibit the qualities of humility, courage, honesty, commitment, passion and
sincerity. This helps them to earn respect and become a good leader. These observable attributes
help them to listen, consult and involve all workers while implementing a plan and establishes
rapport with the team members (Leggat & Balding, 2013). Thus, confronting conflicts, using
shared decision-making and developing effective communication networks helps in building a
good working environment.
Thus, my experience at the ward helped me understand that the nurse had initially
displayed a lack of communication skills, which eventually led to violation of the patient safety.
I understood that our nursing profession requires us to be responsible for the person who are ill
and are unable to advocate for themselves. Therefore, we need to effectively utilize our
interpersonal communication skills in order to support the emotional, spiritual and psychological
development and needs of our patients (Daly, Speedy & Jackson, 2015). The incident helped me
to gain an understanding of the fact that a display of poor communication can directly lead to the
occurrence of avoidable medical errors, as was seen in the aforementioned incident. I also
understood that such errors increase stress, burnouts and poor job satisfaction among nurses
(Boldy et al., 2013). The nurse in this case was a democratic leader. It was quite effective as we
all felt valued and attempted to give our best in future practice. Furthermore, she displayed

7NURSING CLINICAL LEADERSHIP
honesty in recognising the flaws and showed commitment towards providing the patient positive
health outcomes. I will talk openly about the cultural taboos that might contribute to reluctance
of clients to share their difficulties. I will learn how to respectfully disagree to the decisions of a
client and his/her family members and will maintain composure in all situations.
I will recognise my strengths and weakness and will negotiate different tasks based on
individual interests and strengths. This will increase my problem solving capability (Radtke,
2013). I will also try to become an active listener and ply close attention to what my patients say.
Avoiding unwanted interruptions in the conversation and showing empathy towards them will
facilitate easy management of the patient. I also wish to improve my understanding of non-verbal
cues such as, body language and facial expression that will assist me to better connect with my
patients and provide them holistic care. Taking regular feedback from the patients and their
family will also help me to identify any wrong practices that have been followed and will
provide me with an opportunity for future improvement (Cousin et al., 2012).
To summarise, it can be stated that effective communication is critical to patient safety. A
failure to communicate with patients efficiently, creates harmful effects on their health status,
increases risks of adverse events and leads to poor patient outcomes. This creates difficulties in
maintaining patient safety. The accurate and unbroken transmission of important information is
therefore essential in healthcare settings. A communication initiative must be successfully
implemented in order to promote patient safety.
This can be achieved by the exhibition of clinical leadership skills by nurses, which
depends on integration of leadership practice and clinical expertise. Clinical leaders help in
facilitating strong collaboration and communication with the patients, as well as the

8NURSING CLINICAL LEADERSHIP
multidisciplinary teams operating in a healthcare setting. Thus, it can be concluded that good
communication skills create positive relationships, prevent adverse events and help in
safeguarding a patient.

9NURSING CLINICAL LEADERSHIP
References
Bhatti, N., Maitlo, G. M., Shaikh, N., Hashmi, M. A., & Shaikh, F. M. (2012). The impact of
autocratic and democratic leadership style on job satisfaction. International Business
Research, 5(2), 192.
Boldy, D., Della, P., Michael, R., Jones, M., & Gower, S. (2013). Attributes for effective nurse
management within the health services of Western Australia, Singapore and
Tanzania. Australian Health Review, 37(2), 268-274.
Bramhall, E. (2014). Effective communication skills in nursing practice. Nursing
standard, 29(14), 53-59.
Brock, D., Abu-Rish, E., Chiu, C. R., Hammer, D., Wilson, S., Vorvick, L., ... & Zierler, B.
(2013). Interprofessional education in team communication: working together to improve
patient safety. BMJ Qual Saf, 22(5), 414-423.
Coelho, K. R., & Galan, C. (2012). Physician cross-cultural nonverbal communication skills,
patient satisfaction and health outcomes in the physician-patient
relationship. International journal of family medicine, 2012.
Connolly, M., Thomas, J. M., Orford, J. A., Schofield, N., Whiteside, S., Morris, J., & Heaven,
C. (2014). The impact of the SAGE & THYME foundation level workshop on factors
influencing communication skills in health care professionals. Journal of Continuing
Education in the Health Professions, 34(1), 37-46.

10NURSING CLINICAL LEADERSHIP
Cooper, L. A., Roter, D. L., Carson, K. A., Beach, M. C., Sabin, J. A., Greenwald, A. G., & Inui,
T. S. (2012). The associations of clinicians’ implicit attitudes about race with medical
visit communication and patient ratings of interpersonal care. American journal of public
health, 102(5), 979-987.
Cousin, G., Mast, M. S., Roter, D. L., & Hall, J. A. (2012). Concordance between physician
communication style and patient attitudes predicts patient satisfaction. Patient education
and counseling, 87(2), 193-197.
Cummings, G. G., MacGregor, T., Davey, M., Lee, H., Wong, C. A., Lo, E., ... & Stafford, E.
(2010). Leadership styles and outcome patterns for the nursing workforce and work
environment: a systematic review. International journal of nursing studies, 47(3), 363-
385.
Daly, J., Speedy, S., & Jackson, D. (2015). Leadership and Nursing: Contemporary
Perspectives. Elsevier Health Sciences, 1-19.
Doyle, C., Lennox, L., & Bell, D. (2013). A systematic review of evidence on the links between
patient experience and clinical safety and effectiveness. BMJ open, 3(1), 001570.
Furtner, M. R., Baldegger, U., & Rauthmann, J. F. (2013). Leading yourself and leading others:
Linking self-leadership to transformational, transactional, and laissez-faire
leadership. European Journal of Work and Organizational Psychology, 22(4), 436-449.
García-Morales, V. J., Jiménez-Barrionuevo, M. M., & Gutiérrez-Gutiérrez, L. (2012).
Transformational leadership influence on organizational performance through
organizational learning and innovation. Journal of business research, 65(7), 1040-1050.

11NURSING CLINICAL LEADERSHIP
Heckemann, B., Schols, J. M., & Halfens, R. J. (2015). A reflective framework to foster
emotionally intelligent leadership in nursing. Journal of nursing management, 23(6),
744-753.
Hutchinson, M., & Jackson, D. (2013). Transformational leadership in nursing: towards a more
critical interpretation. Nursing inquiry, 20(1), 11-22.
Leggat, S. G., & Balding, C. (2013). Achieving organisational competence for clinical
leadership: the role of high performance work systems. Journal of health organization
and management, 27(3), 312-329.
Lyndon, A., Zlatnik, M. G., & Wachter, R. M. (2011). Effective physician-nurse communication:
a patient safety essential for labor and delivery. American journal of obstetrics and
gynecology, 205(2), 91-96.
Mannix, J., Wilkes, L., & Daly, J. (2013). Attributes of clinical leadership in contemporary
nursing: an integrative review. Contemporary nurse, 45(1), 10-21.
McCleskey, J. A. (2014). Situational, transformational, and transactional leadership and
leadership development. Journal of Business Studies Quarterly, 5(4), 117.
Radtke, K. (2013). Improving patient satisfaction with nursing communication using bedside
shift report. Clinical Nurse Specialist, 27(1), 19-25.
Schuh, S. C., Zhang, X. A., & Tian, P. (2013). For the good or the bad? Interactive effects of
transformational leadership with moral and authoritarian leadership behaviors. Journal of
Business Ethics, 116(3), 629-640.

12NURSING CLINICAL LEADERSHIP
Shirley, E. D., & Sanders, J. O. (2013). Patient satisfaction: implications and predictors of
success. JBJS, 95(10), e69.
Vlachos, P. A., Panagopoulos, N. G., & Rapp, A. A. (2013). Feeling good by doing good:
Employee CSR-induced attributions, job satisfaction, and the role of charismatic
leadership. Journal of business ethics, 118(3), 577-588.