Clinical Leadership: Reflection on Quality Improvement Initiative

This essay reflects on the experience of a newly graduated nurse leading a quality improvement initiative within a medical ward at Sturt Health Service as part of their Transition to Practice Program. The nurse was tasked by the Nurse Unit Manager to lead a small team focusing on improving patient safety in preparation for an accreditation. The essay details the challenges faced during the initiative, including team members' anxiety, communication gaps due to linguistic differences, internal conflicts, and non-compliance with reflective journaling. Different leadership strategies, both compassionate and authoritarian, were employed to address these challenges. The experience highlighted the importance of addressing transition shock in newly graduated nurses and the role of effective leadership in fostering professional growth and competence.

Running head: CLINICAL LEADERSHIP
Clinical leadership
Name of the student:
Name of the university:
Author note:

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Table of Contents
Introduction: 2
Requirement 1: Contemporary initiative and evidence based practice: 2
Requirement 2: Leading team: 3
Requirement 3: Leadership management strategies: 5
Conclusion: 6
References: 7

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Introduction:
The transition from academic degree to real work practice scenario can be a very difficult
scenario for the graduating nurse, it has to be mentioned that for any nursing professional, there
are a number of skills and competencies that can only be attained in a practical setting. However,
the nursing degrees are very exhaustive and there is little to no opportunity for the graduating
registered nurses to gain hands on practical experience (Clipper & Cherry, 2015). The
importance of theoretical knowledge is paramount, a graduating registered nurse myself, I
understand completely that with theoretical expertise it is impossible for a nursing professional
to be able to provide safe, effective and evidence based care to the patient. However, it also
needs to be mentioned that the scenario of actual practice differs vastly from the theoretical
understanding and expectations.
Requirement 1: Contemporary initiative and evidence based practice:
There are many emotional ups and downs that a graduating registered nurse going into
practice goes through (Huston, 2013). There are moral distress, role performance, stress, and
most importantly the shock of going from a role of a student to a partitioning professional. This
shock mostly encompasses the initial phase of the practice and it comprises of feeling such as
confusion, doubt, loss, and disorientation (Ouslander et al., 2011). From my own personal
experience I can explain that transition to professional practice is often related with a particular
practice activity that might be difficult for the newly graduate nurses to perform. In my case it
had been intravenous medication administration which had been a very difficult task for me.
It has to be mentioned here in this context that the IV administration is considered to be one
of the most critical nursing responsibilities. There are various techniques and tools involved with

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the procedure that cannot be mastered with only theoretical knowledge (Kaplan et al., 2010). As
a part of my experience I would like to mention that fact that in the placement programs that I
have been a part of had faced many issues and customer concerns with the IV administration
trouble that the most of the new staff had been going through.
Considering the topic of patient safety, it has to be mentioned that the intravenous medication
technique is associated with many risks if the technique is not followed properly. Infusion pump
errors and failures have let to many adverse events and can even have fatal consequences for the
patient hence it is a very important area of patient safety and each nursing professional engaging
in intravenous therapy should have optimal knowledge and expertise so that the patient can be
protected from any harm (LoBiondo-Wood & Haber, 2017). And hence, we had been enrolled
into a quality improvement program under the provision of continuous professional development
of nursing practice and being a senior than most of the other recently graduated registered nurses
I had been assigned the responsibility of leading the quality improvement team.
Requirement 2: Leading team:
The quality improvement program was divided in 3 sections. In the very first section we were
instructed to go through a demonstrative seminar and workshop on IV administration techniques.
After which we had a chance to demonstrate in our own words what we have understood of the
entire procedure and briefly reflect on the experience of the seminar. I faced the first challenge
when unfortunately one of our teammates had been very anxious and nervous about the practice
session, and she had a nervous breakdown. However, as the leader of the time I attempted to
communicate with her about her issues and discovered she was suffering from low confidence

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and extreme fear regarding her new professional role. The first strategy I implemented included
communicating with her regarding her fears and I came to know that she is suffering from
extreme lack of confidence. In the next strategy I engaged in a mock presentation session with
just her and having a practice session with me helped her overcome her fears and insecurities.
The next program had been a patient communication and interaction session, where we were
taught different communication approaches and techniques to reassure the patients. After this
seminar as well, we were instructed to communicate with a volunteer acting as a patient and
reassure him. This had been a very effective procedure until a culturally diverse team member
had difficulties communicating due to her language barrier. After the session was complete she
was highly demotivated, and wanted to quit the program, and presented a shocking second
challenge for me. My first strategy had been to communicate with her but she had been adamant
to quit and was not listening to anything I was saying. Eventually I had to take another strategy
and report to our head registered nurse and I observed while she explained to her with assertive
authority yet compassion that what she is experiencing is a part of the transition process and it
can be overcome with efforts from her.
The third step had been to have an IV administration session with the patients in the pediatric
care wards and we each had to administer a IV dose to a patient in partnership with another team
member. One of the teams had trouble communicating with each other due to internal conflict
and they were eventually unable to cooperate and the patient become anxious and started crying,
and it had been the third challenge for me in the program. As there were no higher authority
accessible at the point had to take intervening strategy first and I myself administered the
medication to the patient. In my second strategy I confronted them both for the unprofessional
attitude. The last step of the program had been to provide a reflective journal of the experience,

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and a few team members refused to participate due to extreme workload despite my explanations
of its importance. As a leader monitoring their performance and success of the program I had to
take an assertive step to overcome this fourth and last challenge. My first strategic step had been
to have a separate communication session to explain to the teammates regarding the importance
of the reflection step, however the majority still refused to comply. In the second strategic step, I
had to scare them with confronting the higher authority regarding the noncompliance, which had
been successful.
Requirement 3: Leadership management strategies:
Therefore, I had experienced 4 different challenges and each one had been more difficult for
me than the other one. While one included communication gap, the other includes anxiety.
Where one challenge was due to linguistic gap the other was due to authority issues. In order to
overcome the challenges I had to utilize two antagonistic leadership strategies. For two of the
challenges involving anxiety and linguistic gap, I utilized the compassionate approach to
overcome the challenge. While for the other two challenges involving conflict and
noncompliance, I had to take an authoritarian approach. This had been a great opportunity for me
as a clinical leader and had helped me in my professional growth exponentially. It can be
mentioned that the transition shock is a very common phenomenon and it can not only affect the
professional skills if a particular individual but can also effect the personality traits in the
individual (Solomons & Spross, 2011). It has to be understood that transition shock, can have a
significant impact on the professional growth and competence of a nursing professional.
Transition shock can be defined as the initial role adaptation stage of a newly graduate nursing

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profession before the particular professional is tasked with carrying responsibilities (Pauly-
O'Neill & Prion, 2013).
Conclusion:
On a concluding note, the challenges that I had been facing had been due to anxiety,
communication gap, and low confidence or uncompromising attitude. And while managing the
teams myself, my own transition shock and issues hindered me from my best potential, although
with honest effort and dedication I managed to overcome my issues and lead my team
successfully. However with the right motivation and transformational leadership, the newly
graduate registered nurses can easily overcome the transition and can establish themselves in
their professional roles effectively.

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References:
Chassin, M. R., & Loeb, J. M. (2011). The ongoing quality improvement journey: next stop,
high reliability. Health Affairs, 30(4), 559-568.
Clipper, B., & Cherry, B. (2015). From transition shock to competent practice: Developing
preceptors to support new nurse transition. The Journal of Continuing Education in
Nursing, 46(10), 448-454.
Finkelman, A. (2015). Leadership and management for nurses: Core competencies for
quality care. Pearson.
Huston, C. J. (2013). Professional issues in nursing: Challenges and opportunities.
Lippincott Williams & Wilkins.
Kaihlanen, A. M., Lakanmaa, R. L., & Salminen, L. (2013). The transition from nursing
student to registered nurse: The mentor’s possibilities to act as a supporter. Nurse
Education in Practice, 13(5), 418-422.
Kaplan, H. C., Brady, P. W., Dritz, M. C., Hooper, D. K., Linam, W., Froehle, C. M., &
Margolis, P. (2010). The influence of context on quality improvement success in
health care: a systematic review of the literature. The Milbank Quarterly, 88(4), 500-
559.
LoBiondo-Wood, G., & Haber, J. (2017). Nursing Research-E-Book: Methods and Critical
Appraisal for Evidence-Based Practice. Elsevier Health Sciences.
Ouslander, J. G., Lamb, G., Tappen, R., Herndon, L., Diaz, S., Roos, B. A., ... & Bonner, A.
(2011). Interventions to reduce hospitalizations from nursing homes: evaluation of the

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INTERACT II collaborative quality improvement project. Journal of the American
Geriatrics Society, 59(4), 745-753.
Pauly-O'Neill, S., & Prion, S. (2013). Using integrated simulation in a nursing program to
improve medication administration skills in the pediatric population. Nursing
Education Perspectives, 34(3), 148-153.
Solomons, N. M., & Spross, J. A. (2011). Evidence‐based practice barriers and facilitators
from a continuous quality improvement perspective: an integrative review. Journal of
nursing management, 19(1), 109-120.