Analysis of Management and Leadership in Perioperative Nursing

This essay critically analyzes management issues arising in a perioperative environment, focusing on the role of a Clinical Coordinator (CC) in an operating suite. The scenario involves handling emergency surgery requests, highlighting gaps in practice related to communication, leadership, staffing, time management, and prioritization. The essay explores the CC's shortcomings in these areas, such as poor communication leading to complex management issues, lack of leadership skills hindering team coordination, inadequate staffing impacting patient safety, and deficiencies in critical thinking and time management. The analysis draws on relevant literature, including the importance of effective communication, leadership, and staffing in ensuring patient safety and efficient resource allocation. The essay emphasizes the need for improved leadership, communication strategies, and adherence to aseptic protocols to optimize patient outcomes and reduce errors in the perioperative setting. It also examines the implications of these issues on the quality of care, the importance of change management, and the role of the NUM in addressing these challenges.

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

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Introduction
The main duty of a clinical coordinator under the hospital settings to increase the overall
quality of care while decreasing the chances of error. Increase in the overall quality of care
helps to improve the overall health outcome of the patients while reducing the length of stay
in the hospital along with a decrease in the overall cost of care (Ignatavicius and Workman
2015). Integrating the urgent requirement of the emergency surgery is one of the most
common demands under the hospital settings. Though such emergency requisition increases
the level of stress among the healthcare professionals, but at the end of the day, proper tea
work, use of proper effective communication skills and critical thinking approach helps to
handle such urgent requisition effectively (Ignatavicius and Workman 2015). The following
will help to highlight gaps in practice of the clinical coordinators leading a errors in the
effective management under hospital settings. The paper is based on the critical analysis of a
case study of a clinical coordinator who is asked to handle an emergency requisition of a
surgery. The analysis of the role of the clinical coordinator will be undertaken based on the
time-management skills, critical thinking skills, prioritization of care and leadership skills.
Lack of proper communication skills
The scenario stated above, highlighted that the clinical co-ordinator (CC) lacked proper
communication skills and thus creating complex management issues. During the morning
shift, when the CC joined the work, he or she received two phone calls. First call came from a
vascular surgeon stating that a patient with a suspected case of ruptured AAA needs urgent
surgery and an estimated time of arrival was 20 to 40 minutes. After 10 minutes, Cc received
another call from emergency intake officer stated a patient is arriving in the emergency
within 30 minutes with ischaemic bowel complications. This highlights the gap in the
effective communication skills. Foronda, MacWilliams and McArthur (2016) stated that
effective communication skills are an important aspect of nursing practice. Gluyas (2015)
further highlighted that use of effective communication helps to increase the level of patients’
safety by reducing the chances of unwanted errors. Thus when the nursing professionals
received the second call from the emergency intake officer, the CC might have enquired
about the age of the person and the place from where the person is been communicated in the
hospital and the doctor who is referring the patient to the hospital. In this way, the CC might
have obtained a clue in order to understand whether both the patient is same. According to

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the Australian Commission on Safety and Quality in Health Care (ACSQHC) (2016), the
errors in communication of lack of effective communication is one of the major contributor
behind care related error under the hospital sentinel settings. It is also the common cause
behind the complaints raised against Australian healthcare system. The use of the prompt
enquiry by a nursing professional helps in the effective management of the prospective
emergencies that are common under the hospital settings.
The complex management issue and its relation with gap in proper communication skill can
also be highlighted in the domain of allocating proper operation room to the upcoming or
emergency patients. For example, there are 6 different operation suits in the hospital of which
only the cardiac unit was free and that too after 1300 hour or 1 pm. AAA is referred to as
symptomatic abdominal aortic aneurysm (AAA) and it leads to number of symptoms like
abdominal pain or limb ischemia. Chaikof et al. (2018) stated that the majority of the
patients’ who are suffering from AAA rupture, needs urgent surgery for subsequent repair
and the same has been referred by the vascular surgeon as well. According to the code of
conduct 3 of Nursing and Midwifery Board of Australia (NMBA) (2019) it is the duty of the
nursing professional to respond in a timely manner in order to uplift the health and well-being
of the patients. However, the CC nurse showed gap in practice in this domain as she failed to
respond in time manner for surgery room allocation. Code of conduct 5, effective
communication is important in order to develop a proper nursing care plan and to increase the
effective collaboration with the allied nursing professionals or the other healthcare
professionals of the multidisciplinary team (NMBA 2019). The CC nurse was rostered with
nurse unit manager (NUM) and thus effectively communicating the news of sudden
admission of two new patients might have helped in fetching effective ideas for man
management and allocation of the operation room.
Lack of proper leadership skills
According to Sfantou et al. (2017), effective leadership in nursing profession is important for
strengthening the quality and overall integration of care in the healthcare domain. Quality of
care is an important element for achieving high level of productivity while reducing the
chances of errors. The case study highlighted here showed gap in effective leadership skills
by the CC leading to the generation of the unwanted confusion and decrease in the overall
quality of care. The prospective AAA rupture patient who is being admitted for the surgery
will require assistance from the vascular health care professionals. However, the morning

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roster of the additional morning staff showed that the vascular healthcare professional is just
finishing one case and have fem-pop bypass next on the list. The all other professionals have
pre-scheduled work. Ellis (2018) has stated that leadership and team management are two
principal keys for nursing profession. Sarto and Veronesi (2016) further stated that proper
implementation of the clinical leadership in effective team management helps to maintain
proper work force allocation and thereby helping to overcome unwanted complications in the
healthcare sectors. The study conducted by Cogin, Ng and Lee (2016) based on the
Australian perspective has highlighted that in the Australian healthcare system, the nursing
leadership theory mainly follows the control-based people management approach. However,
there has been increased impetus of recommendations for the hospital nurse managers to
adopt commitment-based approach in order to manage the human resource. Under the
commitment based approach, the healthcare professionals work harder due to increased level
of involvement and commitment with the work and this in turn increases the level of
involvement in the work. Commitment-based approach also increases the positivity of the
overall social climate and thus increasing the level of trust and cooperation among the
employees and thus driving the overall performance (Cogin, Ng and Lee 2016). Form the
case study it can be seen that the general surgeon who is supposed to be in the operation room
is in the tea room and even the CC nurse who is supposed to be in the operation room is
somewhere else. This showed a gap in commitment in among the healthcare professionals.
There is also a gap in practice that can be easily highlighted with the NUM as she failed to
track the presence of the reporting resources. Van Rossum et al. (2016) stated that in order to
increase the efficacy and quality of healthcare proper change management principle must be
introduced by the nurse leaders. Like in this case change management must be directed
towards increase in awareness and work motivation in order to increase the level of
commitment among the healthcare professionals and thus helping to overcome their casual
approach in practice.
The CC failed to display proper transformational leadership skills under the use of the open
communication and collaborative decision making under the peri-operative environment
(Fischer 2016). Proper use of the effective communication, time management and allocation
of resources will help to promote collaborative decision making and thus helping to avoid
unwanted medical complications or emergencies. In order to increase the critical thinking the
collaborative practice, formal education program and training must be given to the novice CC
so that they can easily handle unique challenges (Fischer 2016).

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Lack of proper staffing
Bridges et al. (2019) stated that in the Australian healthcare system there is a lack of proper
staffing in the domain of nursing professionals and other healthcare professionals. This lack
of proper staffing hampers the overall outcome and efficacy of care. In the case study, it can
be easily highlighted that when the surgery commended, in the operation room there was one
general surgeon, anaesthetist (vascular room), one anaesthetics nurses, two circulating nurses,
one instrument nurse and one student nurse (placement) and one person who have brought the
patient up (pumping in fluid) along with the vascular surgeon. The entry within the operation
room is only permissible for the registered healthcare professionals and no other person in
civil dress. Loison et al. (2017) stated that operation room (OR) has special dress code that is
head cap, gloves and apron. All these clothes are sterilised and any person entering operation
room in civil dress can increase the risk of the patients by increasing the vulnerability of
developing nosocomial infection or hospital acquired infection (Loison et al. 2017). Slimings
et al. (2014) reported that in Australia there is an increased incidence of hospital-acquired
infection during the tenure of 2011 to 2012 and the number is increase and one of the main
reason behind this is gap inobservance of aseptic protocol. It is the duty of the CC or the
NUM to restrict the entry of the unknown person in civil dress inside the OR (Loison et al.
2017). However, the same is lacking in case study. In other words, it can be said that
presence of adequate healthcare professionals will help to avoid the requirement of a civilian
inside the operation theater doing pumping of fluids.
Lack of proper critical thinking time management and prioritization
Lack of proper critical thinking skill of the CC is reflected throughout the case study. For
example, the prioritization of the surgery was lacking in the CC. When the ambulance
coordinator notifies that there are no two patients and both the calls referred to the single
patient, the CC does nothing in order to address the concern. Christino et al. (2013) stated
that it is the duty of the nursing professionals, working as a clinical co-ordinator to book the
operation room. Proper documentation of the patients’ information and the health history
helps in highlighting priorities of care. Mere assumptions of the patient’s condition before
being taken inside the OR can lead to serious error. Under the Australia settings, increase in
the work lock among the nursing professionals creates an error in documentation of the
clinical priority of the patient leading to the generation of the numerous health errors.
Increase in the chances of the error under the hospitalized settings increase the overall cost of

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care and increase in the quality of care (Roughead, Semple and Rosenfeld 2016). ACSQHC
(2016) proposes under the standard one for quality improvement about the improvement in
the process of documentation and increase in the tendency of the clinical governance in order
to reduce the chances of error in practice. Understanding of the patients’ actual need might
have helped to overcome the situation under which the vascular surgeon required a substitute
for a general surgeon in order to conduct the ischaemic bowel surgery.
According to the Central Coast Local Health District (CCLHD) (2012), under the scenario of
booking under unplanned emergency cases, the allocation of the priority status must be done
by the surgeon or the other registered surgical professionals along with the anaesthetists.
NSW Emergency Surgery Guidelines also provide an exhaustive list of surgery that might
require urgent intervention (NSW Surgical Services Task force 2009). Under this case study
it can be said the prioritization system was not used and thus depending on the clinical
judgement of the CC solely to predict the surgical intervention created unnecessary
confusion.
In this scenario numerous members of the healthcare team were present in the OR. All of
them must have their own opinions for providing best care for the patient. However, selecting
the best decision must be based on the clinical priority of the patient and the available
resources (Kochenderfer 2015). However, the doctors and the nurses present within the OR in
this scenario failed to take the right decision for the patient and vouched help to CC who is
not directly related to the surgery. This caused unwanted delay in the surgical proceedings.
Proper critical thinking of the CC along with the other healthcare professionals might have
helped in ranging an addition physicians or a surgeon who can handle the bowel ischaemic
condition if required as it was already been reported that patient has a suspected cases of AA
rupture and ischaemic bowel disease. Proper arrangement of the healthcare physician or
checking the availability of the healthcare physicians will help to avoid the chances of
sacrificing health of other patients. Like in this case, the general surgeon agrees to conduct
the surgery for the ischaemic bowel disease and gangrene but cancel his last case which was
scheduled at 12:30 pm.
Towards the end of the case study, it can be seen that after two hours post this surgical
incident, Dennis Alan who underwent the surgery and is 68 years old is now in ICU and is
going through critical condition. However, the case study states that the shift time is about to
end. According to Mardis et al. (2017), during the end of the shift timings if the nursing

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professional find that the condition of the patient is critical and he or he she requires urgent
intervention then professional priority will be to look into the patient and not leaving the
duty. The health of the patient is the main priority under any circumstances. Under this
circumstances, the ACSQHC (2016) states that transferring the clinical handover during the
change of shift nurses is one of the important standards that must be followed in order to
improve the health and safety of care. Under this clinical handover, the detailed health history
of the patients must be explained to the change of shift nurses along with raising the medical
emergency call if required.
Conclusion
Thus from the analysis of the above case study and critically analysing role performed by the
clinical coordinator under the hospital setting, it can be concluded that there are gaps in the
effective management skills of the clinical coordinator (CC) as well as the nurse unit
manager. The main gaps in practice and the nursing skills that can be easily spotted from the
case study include lack of proper skills in order to prioritize the care process, lack of effective
communication skills and lack of proper leadership skills. These gaps in the nursing practice
lead to unnecessary complications under the healthcare setup. It also created gap in proper
management of the human resource in the emergency unit and in the operation room. The
case study also showed, how gaps in application of the critical thinking skills allowed person
in civil dress inside the operation room. Proper training of the nursing professionals in the
effective communication, critical thinking and leadership skills under the hospital setings and
that too under the supervision of the trained nursing professionals might help to avoid such
errors going forward.

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