NSB104 Leading and Learning: Responding to Leadership Challenges

This essay reflects on a clinical scenario involving a nurse who identifies nitroprusside poisoning in a post-CABG patient, highlighting the importance of critical thinking, patient-centered care, and professional integrity in nursing leadership. The essay discusses leadership challenges such as misc...Read More

RUNNING HEAD: NURSING LEADERSHIP
NURSING LEADERSHIP
Name of Student
Name of University
Author note

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PART 2
The attending nurse cares for a recovering coronary artery bypass surgery patient who
had his surgery two days back. His eyes are swollen and the nurse attends the patient when
his family has come to visit him. The assessment is about to be taken and the nurse is worried
about the outcomes and findings and she strives through the moment of truth. She thinks of
the complications that might be found out or not may be but a CABG patient has to but tested
for a lot of post-surgery complications and the progressive prognosis rates.
Being a registered nurse, I feel autonomy, beneficence and non-maleficence are the
most important nursing principles that should be practiced with full integrity even under
dubious circumstances. The patient who had undergone a coronary artery bypass surgery is
like to develop cardiovascular complications and respiratory problems. But as a nurse, when
she showed tremendous critical thinking skills and rationalized the non-wakefulness of the
patient or non-responsiveness of the patient to light stimulus – with the effect of poisoning.
Nitro- prusside which is often administered as an antihypertensive drug and also after
surgeries to reduce internal bleeding complications. But too much of nitroprusside levels in
the patient’s body can lead to poisoning and neural non-responsiveness which most of the
experienced clinicians, doctors and nurses alike are likely to miss. I feel the same way about
it that critical thinking, parallel thinking, applying the rationale while monitoring and
assessing patient symptoms along with drawing of a correlation and doing an instant analysis
of the situation is pertinent to a clinical decision making. The patient situation is a resultant of
pathophysiological signs and symptoms and to discriminate between a sign and symptom –
takes a lot of practice and experience but being a nurse, it is important to be open sighted,
astute and patient centered all the time and that’s what the nurse in the story has done it
exactly, she was completely oriented to the patient and the neurologic signs which went
unsighted or unnoticed even by the cardiologist. It shows a very deep aspect of medical care

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underpinnings that in spite of an existent knowledge gap between nursing and medical
education globally – critical analytic skills and application skills are very individual things
and cannot be determined solely with the level and nature of medical education received. The
story is a strong illustration of how health practice should be undertaken with proper decision
making and totality. This is the reason why now in many healthcare settings, trans-
disciplinary collaboration is promoted to increase the viability and utility of ‘shared
knowledge’ in a clinical environment. The nurse in the story after getting disallowed by the
attending cardiologist for a CT scan or thiocyanate check – she retained her nursing
(professional) beliefs and personal beliefs which is great display of professional integrity and
patient centered care. Even though there are a hierarchical system in healthcare
administration (Rodon, & Silva, 2015) where doctors are given majority of the authorities,
the nurses still (such is the nature of their work) manage to spend most of time servicing and
caring for patients. The nurses are the reason that a planned pharmacological (Ferrell et al.,
2016) and pre – post and peri-operative surgical care could be delivered to the patients and
the way the nurse in the story takes up the responsibility of protecting the patient from any
sort of complex life threatening situations – is quite stirring and moving for a fellow nursing
professional like. She single handedly handles the severe condition of patient by directly
calling up the Tucson Poison control and getting a toxicity test done. The toxicity test
revealed the consciousness loss of the post coronary artery bypass surgery patient was due to
nitroprusside which was administered to the patient for hypertension. Finally, the nurse got
her doubts confirmed by the poisoning finding and she saves the patient from death or near
death paralytic complications which are so common due to missed clinical care and
neurological impairments. These hospital acquired complexities and increase in morbidity-
mortality rates due to deficient clinical care and non-adherence to best practice guidelines –
are so very common. But individual skills, individual commitment and individual adherence

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to guideline while promoting the same in the workplace is absolutely vital to delivery of an
apt patience service. Clinical decision making (Manning & DiLollo, 2017) is often associated
with risk analysis which is done exactly the nurse to a point of utter nursing and health
expertise for which she is appreciated by the surgeon himself. The patient sits and talks
clearly to everyone which showed how a rapid and correct intervention can save life of
person.
Taking a leadership starts with taking an ownership at first and then using personal,
professional, instrumental (Dias et al., 2018) and interpersonal skills (Moorman, 2017) to
facilitate the leadership and practice change (Low et al., 2015) is critical to healthcare. The
two leadership challenges identified are – miscommunication (Fitch, 2018) and non-
adherence to clinical guidelines (Jull & Aye, 2015). The first challenge is about a non-
effective communication or miscommunication (McCabe & Healey, 2018) that occurs
between the healthcare professionals working in the same clinical environment, while seeing
the same patients. A patient often and mostly requires a collaborative care (Ignatavicius &
Workman, 2015) of doctors, nurses, allied health professional and other assistive staffs while
he or she is staying in the hospital for treatment. Different medical or healthcare teams are
concerned with different specialty of care that is pertinent to a certain patient symptom but
the patient’s pathology has to be managed by a collaborative intervention by different
disciplines – which is often a problem situation in a practical day to day clinical care setting
or in a high strung acute clinical care environment with a huge patient load. Thereby, the
effective communication (Arnold & Boggs, 2019) between the cross disciplines are missed
due to time constraint. Another barrier to this interdisciplinary communication (Quail et al.,
2016) and joint decision making is a behavioral factor. A health care professional may not
feel the need for an interdisciplinary communication to plan his or her care for the patient.
This is completely against the clinical guidelines and a health care leader should have enough

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audit and managerial skills to facilitate the ‘lacking communication’ between the disciplines.
Steps must be taken the leader to facilitate interpersonal empathy and positive workplace
which brings us to the next barrier to healthcare leadership that non adherence to clinical
guidelines. This non adherence can be missed nursing care, medication prescribing errors by
doctors, medication administration errors by nurses, overlooking the impending risk and not
being to foster a two way therapeutic relationship with admitted patients. Even conflict of
opinions between the professional can be disruption in addition to non-adherence clinical
disruptions which can cost a patient his or her life as well. The main strategy is to create
effective communication between the patient and the clinicians who shall be teaching him or
her. The strategy must also focus on collaborative, joint decision making between the
professionals of various disciplines working towards a common goal that is a fast patient
recovery. The leadership strategy is to appreciate the nurses and doctors for their
performances which can promote a peer induced observational and influential learning in the
fellow nurses and doctors. Secondly, the organization’s social, cultural and financial
framework has to be improved and strengthened so that workforce retention is possible. The
leaders should focus on retaining compassionate, caring and committed clinicians and nurses
so that the work culture becomes stabilized with committed patient servicing personals
working with the new inexperienced clinical staffs. Constant monitoring of disruptive
behavior and strategies to dilute the same should be promoted by the leader nevertheless.
Incorrect perception of risk and non-cooperative behaviors from the senior nurses towards
their junior colleagues are important factors that leads to medication administration error and
this is can be managed with a strengthened training framework and by implementation of
strong guidelines adherence protocols. Health education, planning and implementation of
patient centered clinical policies is a vital leadership quality to overcome the barriers.

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The insights are many and I would like to explain the most important ones. Firstly, to
care for an admitted patient is a multifaceted ask and being a nurse, the task gets even
intricate and complex for we have to convert the interventions of so many disciplines into a
positive patient outcome. As discussed above, taking ownership is the key to leadership and
to deliver a specific treatment to a specific condition of a specific student – is all about
recruiting the right practice habits, patient care and patient centered care principles, clinical
reasoning and the right ways of clinical decision making into day to day clinical practice.
Working towards a positive workplace behavior, peer reinforcement and compassionate
relationship building with colleagues, patients and patient’s family is critical to a successful
and fulfilling nursing practice and this has been a cardinal aspect of my insightful learning.
It can be concluded saying that the nurse caring for the Coronary artery bypass
surgery patient in the story did the right thing by keeping faith in her own self belief that the
patient might have been poisoned by excessive doses of nitroprusside. Her belief pays off
finally as the patient is cured and saved by an immediate nursing intervention. In the same
way, I would like to recruit my mental attributes like clinical reasoning into a right decision
making.

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References
Arnold, E. C., & Boggs, K. U. (2019). Interpersonal Relationships E-Book: Professional
Communication Skills for Nurses. Saunders.
Dias, Í. K. R., Teixeira, O. F. B., Teodoro, I. P. P., Maia, E. R., Lopes, M. D. S. V., &
Machado, M. D. F. A. S. (2018). NURSING EDUCATORS’PERCEPTIONS OF
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