Adult Nursing: Leadership, Decision-Making, and Ethical Values

This essay delves into the crucial aspects of adult nursing, specifically examining the leadership and decision-making roles of Registered Nurses (RNs) within rapidly changing and often chaotic healthcare environments. The essay explores the RN's role in responding to clinical deterioration, emphasizing the importance of early detection and management. It analyzes the concept of leadership in nursing, highlighting the RN's ability to influence and guide healthcare teams. Furthermore, the essay links professional values and ethical decision-making processes, providing insights into how RNs navigate complex situations. The role of the RN in chaotic situations is discussed, along with strategies for enhancing adaptation, coping mechanisms, and personal resilience. Finally, the essay underscores the significance of communication tools like SBAR in critical scenarios and concludes by emphasizing the RN's responsibility in creating safe and healthy work environments.

Running Head: ADULT NURSING
ADULT NURSING
Name of the Student
Name of the University
Author Note

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Table of Contents
Introduction................................................................................................................................2
Rationale....................................................................................................................................2
Leadership in Nursing............................................................................................................4
Leadership Role of Registered Nurse....................................................................................6
Linking Professional Values and Ethical Decision-Making of Registered Nurse.................7
Registered Nurse in Chaotic Situations..................................................................................8
Conclusion..................................................................................................................................9
Reference..................................................................................................................................10

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Introduction
The constant evolving environment of healthcare is challenging the leadership skills
of all the practitioners of nursing professional development. Sitting idle and wishing for
consistency and stability cannot make them reality. The bureaucracy of organization can be
unpredictable and outcomes of the committees, task force and interprofessional teams may
get differ from the original charge of organization (Veenema et al. 2017). Further, in the
acute care settings, clinical deterioration is significant problem. Clinical deterioration is
physiological decomposition, which occurs when the patients experiences worse conditions
or acute onset of the serious physiological disturbance. In this concern, nurses play key role
in the postoperative monitoring of patient. However, there are still limited understanding of
role of nurses in the recognition and responding to the clinical deterioration in the surgical
patients (Vasli and Dehghan‐Nayeri 2016). Hence, this report aims to discuss leadership and
decision-making role of the registered nurse in the chaotic as well as rapidly changing
environment. Further, discussion will be on leadership role of the Registered nurse in meeting
emotional and physical needs of the patients and of team. Moreover, ethical decision-making
and professional values of RN will be linked to the decision-making in the chaotic situation
and lastly, discussion will be on the ways by which RN can enhance adaptation, coping and
personal resilience in the chaotic situations.
Rationale
The patients undergoing major procedures of surgery are at increased risk of the acute
complications in immediate period of postoperative that often results in the acute
deterioration. The inability in care unit of post-anaesthesia is main predictors of the
subsequent deterioration in the postoperative patients. In the older adults, some of the factors
such as major general surgery and undergoing orthopedic, age as well as various

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comorbidities contribute to increased risk of the clinical deterioration and postoperative
complication Wolf, Ulrich and Grady 2016).
Nurses plays important role in early detection and clinical deterioration management.
It is because these professional groups are with highest degree of the patient contact. They
recognizes and responds to the patient deterioration signs in the timely manner and minimizes
or prevents major adverse effects. There rising awareness of factors inhibiting the nurses
from escalating patient’s care who deteriorate. However, the reason for failure of nurses for
responding and recognizing to deterioration of patients has not be studied extensively. There
are various research study conducted on the leadership role played by registered nurses
(Zawaduk et al. 2014). However, neither of the research have provided conclusive results on
the leadership role played by the RN in chaotic and rapid changing environment in relation to
clinical deterioration. Further, emergency response framework clarifies roles and
responsibilities in the emergency response and for providing common approach for working
in the emergencies. This framework allows for acting with predictability for serving in the
best interest and to be accountable to the patients affected by the emergencies (Scott 2018).

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Figure 1: Emergency Response Framework
Leadership in Nursing
A leader is the person followed by others willingly or voluntary. Leadership is process
by which the individual influences follower for behaving in the desired manner. It is the
ability for assessing, maintaining, developing and changing culture of organization and
strategic system for optimally meeting expectations and needs of external environment.
Basically, leadership is about developing vision and allowing the individuals for working

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towards changes. Further, it involves creation of shared mission, tackle resources,
organizational and political barriers as well as motivating and inspiring others. Leadership is
described as the influence, which includes uses of the interpersonal skills for inducing others
for achieving specific goals (Opollo et al. 2014).
In the literature of nursing, leadership has been explained as difficult and multifaceted
process. This provides support and direction, coordination, motivation, effective
communication as well as advocating the patients for achieving optimal outcomes of patient.
Leadership in nursing show the followers the things to be done by guiding their way and
courses of action. Nurses are part of the health intra-disciplinary team, which should be
capable to lead in the era of the high acuity of patient, fast paced as well as highly complex
environment (Öberg et al. 2018). As stated by The Institute of Medicine, the nurses should be
able to lead the inter-professional teams as well as systems of healthcare. Moreover, studies
conducted on the leadership of nursing have shown effectiveness of the leadership in role of
nursing on patient outcomes, for instance safety of patient. In the clinical settings, effective
communication is considered to be central. The leadership of nursing has been described as
influencing others for improving quality of the care along with the direct participation in the
clinical care (Mok et al. 2015).
Leadership in the nursing is consists of environment, which is having clear vision,
where the staffs are empowered and motivated. The leaders of nursing are the agents, who are
having followers in team of healthcare. The leadership in nursing is regarding having vision
as well as empowering staff. The nurse leaders should be having skills, for instance valuing
others, self-confidence and being able for building teams in effective way. It is the
interactive process, where the followers are empowered and motivated for accomplishing the
specific goals. It is linked merely with the top management levels. Hence, acquiring the skills
of clinical leadership is important for the nurses, who provides direct care to the patients. It

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allows the nurses for directing the support of patients and teams of healthcare, when care
needs to be provided (Lyndon et al. 2018).
Leadership Role of Registered Nurse
Registered nurses are backbone of the provision of health care. They help in providing
critical health care to the public, when required. Registered are not only limited to working in
the hospital settings rather they use to work in the clinics, emergency nursing, geriatrics,
labor and delivery, homes, schools and assisted living facilities. Increased access to the
healthcare and aging population of baby boomer have led towards higher demands for the
registered nurses. These RNs are also specialized in the areas, for instance cardiac care,
family practice, midwifery, geriatrics, emergency nursing and labor and delivery (Lee and
Lee 2015).
Registered nurses are accountable for as well as oversee completion of the patients
care and directly leads and manage provision of the safe patient care. They are responsible for
meeting emotional and physical needs of teams by playing informal role of leadership, which
is not related with the given position. Further, leadership is multifaceted and complex concept
having unclear meaning, particularly in context of staff nurses (Huber 2017). Leadership role
of registered nurses includes demonstrating clinical knowledge, consciously structuring work
for ensuring best possible care of nursing to the patients, establishing good collaboration
atmosphere, monitoring professional practice of coworkers and customized presence in the
practical work with the patients in accordance with the predetermined prerequisites. The
informal role of registered nurses as a leader requires social process of the deliberate effort
for attaining and maintaining status and the authority of leader. The principles of leader is
grounded in the core values of the profession of nursing, which ensures that the values of
nursing and the person-centered attributes are the important aspects (Hosking, Considine and
Sands 2014).

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Linking Professional Values and Ethical Decision-Making of Registered Nurse
Values are beliefs and goals that establishes behavior and helps in providing basis for
the decision-making. In any profession, the values are standards for the action, which are
preferred by the experts as well as professional group and establishes framework for the
evaluation of behavior. Application of professional values is key issues in practice of nursing.
Further, nursing is the profession that is rooted in the professional ethics and the ethical
values (Ulrich 2017). The performance of nursing is based on these values. The nursing core
values includes autonomy, integrity, human dignity, altruism, social justice and honesty.
Generally, core ethical values are shared within global community and it is reflection of
spiritual and human approach to profession of nursing. However, values in patients care are
affected by the religious, economic, social and cultural conditions that dominates community,
which makes it important for identifying such values in each of the country (Grossman and
Valiga 2016).
In the practice of nursing, ethical caring is important. Nurses are confronted with the
complex chaotic situations, in which there is expectations that they autonomously makes
decisions to deliver good care to the patients. Generally, nurses shows three approaches in
their ethical behavior. The first approach is beyond protection and legal duty of patients that
includes full availability and dedication of the job of nurses and client, patients spending time
and delayed exit from workplace. The second approach is legal duty and protection of the
nurses and patients that include patient’s caretaking, responding to client and implementation
of prescription of physician (Fynes et al. 2014). The last approach is protection of self and
below legal duty, finding the evidence and having witness in the false documentation case
and mistake, negligence and shortcomings. It is because of ethical behavior importance in the
decision-making, it becomes important to find out the ways for promoting the moral
reasoning and the moral development of the nurses. The empowerment of nurses, educators

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of nurse and students of nursing acquiring the knowledge and developing ethical behavior
skills is vital (Fry 2015).
Registered Nurse in Chaotic Situations
The effectiveness of the nursing leadership and role tenure play significant role in
sustainment and development of the healthy professional cultures. The nurse leaders, who is
able to intentionally develop core competencies and demonstrates healthy rates of success by
including overall performance of job, longevity and satisfaction. As the consequent of which,
nurse leaders should pay attention to the changes in the healthcare industry for understanding
required competencies of future leader for the professional relevance (Smith et al. 2014).
Nursing involves complex work of care, hence, it becomes important for them to cope, adapt
and maintain personal resilience in the chaotic situations. They are required to make clear
decisions, under the pressure. The registered nurses are required to priorities care and manage
for bringing order to chaos through making decisions to help the people. They are required to
possess such qualities because these are quite important (Fitzsimmons and Rose 2015).
There are various empirical evidence that exists on benefits of the resilience, as important
component of the good health and additive element of the professional happiness. They
should develop advanced competencies in the nurse well-being, resilience, work satisfaction
and engagement for ensuring delivery of the cost-effective, high-quality and cost effective
care (Scully 2015). Some of the qualities of resilience of the registered nurse includes
managing self or self-care, staying positive, valuing social support, paying it forward or
undertaking kindness acts to or for the others with the deliberate intent without any
expectations of recompense, passion for the profession, taking challenging work,
experiencing adversity and growing through leadership it. In this concern, communication
tool SBAR are used by the registered nurse for increasing handover quality and it is assumed
widely for increasing safety of patients in the critical situations (Connaughton 2016).

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Conclusion
Therefore, it can be said that nurses demonstrates high awareness level of their role in
the recognition and response towards early signs of the deterioration. The nurses tries to
identify clinical deterioration indicators and uses appropriate set of channels for using to
escalate care. They can track as well as trigger the observations charts to enable the nurses for
identifying deteriorating patients. Further, it has been analyzed that the nurse leader has the
responsibility to create safer and healthy environments, which supports work of the team of
health care and they contribute towards engagement of patient. This role played by the nurse
is influential in the creation of professional environment and fostering the culture, where the
interdisciplinary members of team contribute towards optimal outcomes of patient and grow
more professionally. It has been analyzed that the good setting of nursing work of registered
nurses should be having reliable, strong and motivated leadership. The leaders who treats
their staff with the respect are valued by the participants. Registered nurses plays crucial
work in creating the hopeful environment of work. Moreover, the registered nurses needs to
have awareness and knowledge concerning values as the standards for providing safer as well
as higher-quality ethical care. The perspective of nurses on the professional values affects the
decision-making and care of patient. Lastly, in order to cope and adapt in the chaotic
situations, the registered nurses are required to have emotional intelligence, integrity, critical
thinking, dedication to excellence, good communication skills, professional socialization,
respect, mentorship and have good level of professionalism.

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