Clinical Leadership in Nursing: Delegation and Supervision in NUR302

This case study examines the leadership role of a registered nurse (RN) in two clinical scenarios, focusing on delegation and supervision within a nursing team. The first scenario presents Aarya, a graduate nurse in an aged care facility, managing a team of one enrolled nurse and six carers, highlighting the challenges of prioritizing patient needs and delegating tasks effectively. The second scenario involves a registered nurse in a hospital setting dealing with diverse patient needs post-surgery and with chronic conditions, emphasizing the application of NMBA standards for safe and quality care, including the assessment of patient needs, scope of practice, and risk management. The analysis considers the application of the NMBA Standards of Practice, including critical thinking, planning, and providing safe, appropriate, and responsive care. The document highlights the importance of effective delegation, supervision, and communication to ensure optimal patient outcomes and a balanced workload for the nursing team. Both scenarios stress the need for the RN to make informed decisions, prioritize tasks, and adhere to ethical guidelines to deliver high-quality patient care.

Running head: NURSE
NURSE
Name of the Student
Name of the University
Author Note

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Introduction
Clinical leadership can be defined as the leading a healthcare team to deliver high quality care to
the patients along with motivating the team members to provide effective health care that is safe
as well as satisfying for the patient. Registered nurses are considered to be nurse leaders and
hence they are stipulated to provide effective guidance to the nurses so that high quality care as
well as patient satisfaction can be ensured (Nagle and Vogt 2018). Effective clinical leaders need
personal qualities which reflect positive attitudes towards their own profession along with the
courage as well as capacity to challenge the status quo. Not only this, according to the principal
of clinical leadership, registered nurses should effectively address the quality issues along with
getting engaged in reflective practice.
Clinical Scenario 1
Identification and description of the leadership role of the RN in providing safe and quality care
the chef role of a registered nurse is to oversee the integration of the patient care that includes
development of the treatments plans, collecting as well as evaluating the treatment result of the
healthcare service providers as well as to manage the medical teams (Nagle et al. 2017).Along
with this health promotion as well as disease prevention efforts can also be considered as a chief
responsibilities of the Registered Nurse. From the given scenario it can be clearly understood
that Aarya whose responsibility is to take care of 50 residents of the Winterfell wing of the
Westeros Aged care, needs to manage the medical team efficiently in order to address all the
requirements of the healthcare service users in an effective way. It has been found that a good
number of patients of the aged care home need effective services within a limited amount of tie.
Considering the fact that Aarya as a nurse leader is leading a team of one enrolled nurse as well

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as 6 carers, as a nurse leader it is her responsibility to delegate tasks to her team in a way that all
the patients can be taken care of in an efficient way. On the other hand as a registered nurse, it is
her responsibility to ensure effective work life balance of her team members. For instance,
considering that fact that one of her carer complained to Aarya that she is feeling unwell and
need to get home as soon as possible, Aarya being a nurse leader granted her leave in order to
ensure effective workplace value.
Implementing Decision making framework for considering responsibilities of delegation
and supervision
Delegation phase Action
1. Assessment to determine appropriate
delegation
To maintain a high standard of care while
delegating activities, the chief responsibility of
Aarya will include
Assessing the needs of the healthcare service
users before delegating his or her care to a
specific provider. Considering the fact that
Aarya manage a team of one Enrolled Nurse
and six carers, he needs to allocate the nurses
keeping in mind the number of patients to be
taken care of. One carer will be delegated the
task of PEG feeling the resident. For five
residents who are on regular 4 hourly
observation (vitals) as they have been noted to
be having flu like symptoms, 1 carer will

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delegated to take care of them. In order to deal
with the two residents who are on insulin and
need to get their BGL checked before dinner,
one carer will be delegated for them. Insulin
and need to get their BGL There are five
simple dressings and two complex dressings to
be done for the shift. For them 1 carer will be
delegated. For taking care of Greg Cleign who
arrived 3 days ago and is having some trouble
settling in, one carer will be delegated.
Considering the fact that one of the carer left
the workplace after half shift, one carer will be
delegated to three monthly care plan review for
two of Aarya’s residents, Edward Stark and
Ted Littlefinger. The enrolled nurse will be
delegated to take care of Mrs Targaryen who
has been found on the floor of her bedroom
and has a laceration to her head.
2. Responsibilities when delegating Considering the fact that enrolled nurse possess
the knowledge of assessing critical condition of
the patient, providing care to Mrs. Targaryen
has been delegated to the enrolled nurse. Apart
from these, the carers are assigned with tasks

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that will not require the skill of assessing the
condition of the patient (Fisher 2017).
3. Supervision of delegation In order to monitor the degree to which the
carers and the enrolled nurse, the performance
of the same will tracked on the basis of the
NMBA standard (Cashin et al. 2017). Apart
from this feedback will be taken from the
health care service users.
Application of the NMBA standards
The NMBA standard of practice that is relevant to the leadership responsibilities of Aarya are as
follows:
NMBA Standard 1: Think critically and analyze the nursing practice
In order to effectively delegate the responsibilities within the team members, RNs are found to
be using a good variety of thinking strategies along with the best available evidences for making
decision along with providing a safe, quality nursing practice within a person centered and
evidenced based framework (Wilson et al. 2019).
NMBA Standard 5: Develops a plan for nursing practice
Aarya as a RN is also responsible for developing effective planning and communication for
ensuring high quality nursing practices. For this, it is highly crucial for her to develop
partnership with the team members. They are based on the RNs appraisal of comprehensive,
relevant information, and evidence that is documented and communicated.
NMBA Standard 6: Provide safe, appropriate and responsive quality nursing practice

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It is highly crucial for Aarya as a RN to provide as well as delegate quality and ethical goal-
directed actions. In order to perform this, Aarya needs to conduct comprehensive as well as
systematic assessment along with the best available evidence for achieving planned as well as
agreed outcomes.

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Clinical scenario 2
Clinical Scenario 2
Identification of the needs of the patients
Delegation of the staff nurses is an important duty of the nurse leaders (Daly, Speedy and
Jackson 2015). Successful leaders or the managers are those who heads up a team and all the
skills that are present in the team are used to the full extent. Delegation of the tasks is not about
the shifting of the responsibilities, but is about the identification of the tasks that a leader would
not do and rather would appoint some one competent enough to do the task (Daly, Speedy and
Jackson 2015). In this case, the identified needs that has to be addressed are of the patient who
have had a mastectomy for breast cancer. It should be remembered that there are several
consequences of mastectomy, hence it is required to take care of this patient at first. Next, it is
needed to take care of the patient who had suffered from a fractured sternum and who had been
preparing for the discharge and needs a check for the CXR. It is necessary for the nurses to
assess for an increased risk of pulmonary injuries, rib fractures and pericardial effusions. Some
of the other cases that required constant attention is the person, who have had a knee fracture.
Similarly, there are some patients who need a proper discharge planning and proper referrals, so
that they get a better life after discharge.
Scope of practice and nursing practice standards
According to the NMBA standards (6) of nursing, nurses are accountable to provide a
safe and appropriate nursing care. This can only be done by practising within the scope of
practice. A nurse leaders should be able to delegate aspects of practice to the enrolled nurses

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(Daly, Speed and Jackson 2015). It is evident from the case study, that in bed 7, it is necessary to
attend Tom Purple as he should need his staples to be removed and transferred to a private rehab
hospital. The removal of the staples and wound dressing needs to be done under the supervision
of the registered nurse. Removal of the sutures and staples should be done carefully. A nurse
should be careful about the factors like maintaining aseptic techniques during the removal of the
staples. One needs to be careful about the application of the wound strips for preventing
dehiscence (Eskander, Morsy and Elfeky 2013). The patient having COPD exacerbations needs
to be attended immediately. According to the NMBA standards of nursing, a registered nurse
should be able to use a range of assessment techniques for the collection of systematically
relevant and accurate data. It is necessary to monitor the oxygen saturation level of the patient
after every 2-4 hours. In case of severely low oxygen saturation level, oxygen can be given to the
patient with the help of nasal cannula. The assistant nurse is not delegated to provide
supplementary oxygen to patients. However, can help the registered nurse to set up the
apparatus. Analgesics can be given to treat pain in COPD. The nurses needs to be cognizant of
the complications, before, during and after the creation of stoma. Adequate measures should be
taken to prevent infections. Colour changes in stoma can become black which can be a sign, that
the surrounding tissues are not getting enough blood supply. There is a chance of skin infection
surrounding the stoma. Hence, nurses should monitor for any such signs of infection (Lee et al.
2015). It should be noted that follow up is the act of making contact with the patient and the
caregiver. The registered nurses should be careful followed by proper referrals for the patients.
Context of practice, governance and identification of risk, governance and practice
It is necessary to conduct a risk assessment on the basis of which delegation of tasks can
be done. In general, a patient centred care needs to be provided. Shortage of the nurses can be

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managed only by the delegation of the duty cleverly and to prioritize the tasks. It is necessary
that the patients with deteriorated condition needs to be attended first. The registered who has
been appointed here should be the aware of the extent of delegation. Both the patients family and
the physician should agree to the level of clinical supervision, that is required.
Delegation of care
It is necessary to maintain a high quality of care while delegating the task. It is the
responsibility of the registered nurse to make a comprehensive, collaborative assessment of the
need of the person who had been receiving care (Mueller and Vogelsmeier 2013). Before the
delegation, it is necessary to make sure that the person to whom the delegation is to ne made
understands the accountability and is confident to take the delegations (National Council of State
Boards of Nursing 2016). An enrolled nurse should surely be kept for medical outlier who had
been waiting to be treated in the emergency ward. The AIN should be primarily delegated to
attend the person having a mastectomy. The patient who have had a knee replacement surgery
will be attended after this. Next, the patient with the ileostomy formation needs to be assessed for
further improvement and deterioration. The person after the knee replacement surgery needs to
be prepared to be sent to the rehab. Before making the discharge planning, it is necessary to
identify the potential hazards and the risks. One of the most important task in the delegation of
the duty is to participate in the evaluation of the delegation of the tasks.
Conclusion
In conclusion, it can be stated the leadership qualities in nursing includes proper
assessment of the patients, followed by prompt identification of the symptoms. In case of there is
a shortage of staffs. Then it is necessary to prioritize the tasks and then hand them over to

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responsible person. In case the nurses are not trained enough to work in such situation. Then they
shall be trained to manage critical patients and identify any sorts of deterioration in the patients.

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