NUR302: Leadership in Clinical Practice - Nursing Case Study, Group 2

This case study analyzes two clinical scenarios focusing on the leadership role of a registered nurse (RN) in a peri-operative care setting. The assignment, prepared for NUR302: Leadership in Clinical Practice, examines the application of delegation and supervision processes within a nursing team, referencing the NMBA Standards of Practice. The first scenario explores the challenges faced by a graduate RN and the importance of increasing staffing levels, skill-based training, and effective communication. It also addresses the delegation of nursing workforce based on patient severity and nurse experience, emphasizing the need for collaboration and medical emergency protocols. The second scenario investigates the reduction of bullying and intimidating behavior among RNs, the use of decision-making frameworks, and the importance of proper supervision, resource allocation, and effective communication with patients and their families, particularly in end-of-life care. The analysis highlights the significance of transformational leadership, effective delegation, and the development of relationships within the nursing profession to enhance the quality of care and reduce errors.

Running head: NURSING CASE STUDY
Nursing Case Study
Name of the Student
Name of the University
Author Note

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Introduction
Clinical leadership in nursing has a crucial role to play in ensuring quality of patients’
care while increasing the safety in the overall healthcare service delivery. Poor quality of the
patients’ care along with increase in the reported cases of medication error has forced the
healthcare professionals to give importance to the overall concept of clinical leadership
(Mianda & Voce, 2017). The hall-mark of clinical leadership among the registered nursing
(RN) professionals mainly encompass proper application of the critical thinking skills, proper
decision making process, taking active action on behalf of the group of team members, doing
advocacy for the clients and their family members in order to gain informed consent and to
improve the decision-making skills (al Dossary, 2017).
Case Study 1
The application of the clinical reasoning process in the case study of Pearl highlighted
several aspects that must be worked on in order to increase the overall safe and quality of
care. The number of theatre orderlies is two and they are rostered for the whole service
however, they are mainly located between the theatres and first stage recovery. In order to
increase the quality and safety of care, the number of orderlies must be increased who can
work between the first and second shift. Griffiths et al. (2016) stated that based on the cost
benefit analysis the increase in the level of staffing of the nursing professionals and other
allied healthcare professionals help to improve the quality of care by reducing the rate of
error and by reducing the job pressure over other working professionals. Other staffing of the
nursing professionals in the first and the second stage is adequate as per the strength of the
patient. In the first stage, there 6 bays with Pearl working as a graduate RN with an
experience of 9 months and he is being monitored and guided by Sandy, a senior RN having
experience in advanced life support. They are further assisted by Ray, an RN with three years
of experience to execute the work in the first stage of sedation. Nieuwboer et al. (2019) stated
that one of the important aspects of the clinical leadership is promoting skill-based training in
order to improve the overall quality of care. From the case study, it is evident that Pearl and
Wade were absent from the Inservice arranged by Dr. Trout under the supervision of NUM.
This Inservice focused on effective communication skills that must be used to deliver right
information to the patients during the time of discharge. Nieuwboer et al. (2019) further
argued that educating the patients about the care plan during the time of discharge helps to

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increase the participation of the patient in the care plan and thereby increasing the therapy
adherence and improving the process of recovery. Thus in order to increase the quality and
safety of patients’ care, second round of Inservice must be arranged for Pearl (who have only
9 months of experience) and Ray (who is new to Oceania and is not aware of communication
approach to patients of Oceania).
According to the Decision Making Framework by Nursing and Midwifery Board of
Australia (NMBA) (2019), it is the duty of the nursing professionals and midwives to
delegate the nursing workforce based on the severity of the patients’ situation and as per the
skill and experience of the nursing professionals. In this case study, the first delegation
should be for Miss Fisher who is a 22 years old patient and is suffering from tonsillectomy
and adeniodectemy. Her blood pressure is dropping (90/60) and pulse is increasing. with
blood around her mouth. This might be a due to misplacement of the endotracehal tube (ET)
due to movement of head and neck position. Hyzy (2017) stated that movement of ET tube
might hamper the proper functioning of the cardiac muscles leading to chaotic signaling.
Chaotic signaling signifies poor efficiency of heart leading to higher heart rate and gradual
drop in the blood pressure. Since Ray is new in the Oceania Day Surgery, he might
experience lack of knowledge in resource allocation. In such case, Pearl with 9 months of
experience must assist Ray to promote medical emergency call. Ibrahim (2017) stated that in
clinical nursing leadership, delegation of the nursing workforce must be done based done
based on the seriousness of patients’ situation and based on the experience and skills of the
nurses. According to the standard 2 of NMBA code of professional conduct for nurses, it is
the duty of the nursing professionals to practice in a safe and effective manner while working
collaborate with the other allied group of professionals. Working in active collaboration,
Pearl and Ray, helps to adjust the medical emergency in an appropriate manner. According to
the case study, Pearl has only one eye patient left, thus it would be wise for Pearl to conduct
the DD check for Mr. Riggs as Ray is engrossed in caring for Fisher. It is also the duty of
Day to communicate the concern to Miss Fisher to the senior doctors, taking into
consideration the urgency of the medical situation. Pearl must also actively assist Ray in
conducting the basic care process for Miss Fisher. The condition of Miss Fisher is critical and
thus can be considered as care priority in comparison to the eye patient in the second stage.
Vaismoradi et al. (2016) stated that it is the duty of a clinical leader to execute leadership
with the help of the transformational leadership format. Transformational leadership styles
help to increase the provision for collaborative practice among the allied healthcare

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professionals and thus helping to reduce the chances of medication errors and other practice
related error (Ibrahim 2017). According to the NMBA professional code of conduct, it is the
duty of the nursing professionals to practice in active collaboration with each other in order to
improve the overall quality of care and at the same time decrease the level of errors in
practice. Bender (2016) stated that core phenomenon of clinical nursing leadership is to
develop relationship within and also across the profession in order to promote and to sustain
proper exchange of information and thus facilitating team work and effective care process at
different levels of healthcare.
Case Study 2
The main leadership role of the RN as per the case, is reduction in the rate of bullying
and intimidating behaviour among the senior and junior RN professionals and thus improving
the overall provision of care. McCloughen and Foster (2018) stated that challenging
interpersonal situations that involves the senior and junior nurse conflicts, discourteous
behaviour along with criticism might occur during the initial stage of clinical placement. It is
the duty of the clinical RN leaders to make use of the personal and relational strategies and
emotionally intelligent behaviours for the effective management of these encounters.
Strategies included reflecting, staying calm, reframing, proper control of discomfort and
expression of appropriate emotions help to control such situations and thereby helping to
improve the overall quality of patient’s care (McCloughen and Foster 2018). The decision-
making framework by NMBA (2019) highlights that it is the duty of the RN clinical leaders
to delegate the nursing workforce based on the severity of the clinical decision. The decision-
making framework of the NMBA also highlights that it is the duty of the clinical leaders to
effectively supervise the workflow of the entire wing in order to highlight gaps in practice
and at the same time improve the scope of practice by highlighting the needs of further
nursing skill training. Proper supervision over Jay and Robyn will help the clinical nurse
leader to identify that Jay suffers from superiority complex and is boastful about his skills.
Thus it is the duty of the clinical nurse leader to strictly supervise the work of Jay and thereby
highlighting his gap in practice. Doing so will help to reduce his overconfidence and thereby
helping to increase the level of collaboration with the other team mates. Analysis of the case
study from the perspective of the clinical reasoning cycle stated that managing room 3
patients a clinical priority in comparison to room 4 patients, who is still unwilling to take the
service but is in clam state. Thus it would be the duty of the clinical RN leader to order Jay to

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act in collaboration with the clinical nurse consultant of the oncology unit and manage to win
consent from room 3 patient for carry forward the care. According to the standard 4.2 of
professional boundaries of the NMBA professional Code of conduct (2016), A nursing
professional must avoid expressing personal beliefs that exploits the vulnerability of the
patient as this might lead to the generation of unnecessary distress while negatively
influencing their autonomy towards the decision-making process. Thus RN clinical leaders as
must work actively with Jay and earn informed consent form Miss Falcon (room 3). In case
of Robyn, proper supervision must be undertaken in order to understand why there was no
clinical handover during change of sift nurse in case of Miss Kingfisher (5.2). Moroever,
proper supervision must be relocate the patient once again. () stated that use of the CCTV
footage of the hospital unit are an important tool for supervision and thus helping to track
patients. The analysis of the case study also highlights that there is a lack of proper
deployment of the human resources. Robyn was asked to take care of 4 different patients
situated in four different wards while Jay needs to monitor 4 patients in a single bay. Thus in
this case, clinical leadership in nursing will help to proper delegation of the nursing
workforce. Sayani (2016) stated that the ability to delegate the nursing professionals in an
effective manner is regarded as a crucial skill of a clinical nurse leader at different levels of
practice. Effective delegation benefits both the nursing professionals and the patients. Proper
delegation makes the entire patient care assignment method to work in a better manner while
promoting cohesive work groups along with smoother running units. Yoon, Kim and Shin
(2016) further argued that though it is easy to say to delegate, in reality, delegation is a
complex process of clinical leadership skill and might generate conflict of interest. As and
clinical leader in RN, it is an effective management competency through which they execute
work by their subordinates and also prepare second line of action. Transformational
leadership style is regarded as more of the most statistically significant factors that influences
the delegation confidence and have profound influence over the nursing management. When
effective delegation integrates with the aspect of the efficient leadership, it helps in delivering
optimal care. Proper delegation of the workforce and increasing the proper supervision over
the team of RN professionals will help to increase the co-ordination between Jay and Robyn
and thus helping to increase the quality of care for room number 5.4 patient. According to the
NMBA professional code of conduct for nurses, it is the duty of the nursing professional to
communicate effectively with the patient and their family members. In this case, effective
palliative communication must be conducted with the family members of Mrs Heron (room
no 2) as she is under End of Life Pathway. Brighton et al. (2017) stated that end-of-life

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communication skills training are recommended for the palliative care nurses and clinical
nurse leader play an important role in executing the effective communication skill training.
Reflective study, role-play and use of didactics will help to increase the palliative care
communication among the nurses.
Conclusion
Thus from the above discussion, it can be concluded that clinical leadership in the RN
profession plays an important role in conducting proper delegation and supervision of the
nursing workforce while increasing the overall quality of care. Case study 1 highlighted that
proper delegation and supervision of the nursing work-force help to increase the overall
scope of practice for the nursing professionals by highlighting the gaps in practice and
increasing the provision of the skill-based training. Case study 2 highlighted that use of the
delegation and supervision helps to improve collaboration and co-ordination between the
nursing work-force and helping to increase synchronization in the care process.

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DOI: 10.1111/jonm.12372