400235 Leadership in Clinical Practice: Nursing Essay

This essay delves into the crucial role of nursing leadership within the intensive care unit (ICU) setting. It identifies key practice issues, such as medication errors and hospital-acquired infections, that compromise patient care. The paper analyzes the underlying causes of these issues, including staff shortages, heavy workloads, and a lack of proper support and training, and explores why change is required. It then examines the barriers to implementing evidence-based practice, such as work pressure, lack of recognition, and limited resources. The core of the essay focuses on the application of transformational leadership to overcome these barriers. It highlights the traits of a transformational leader, such as idealized influence, motivation, intellectual stimulation, and individualized consideration, and explains how these can foster positive change, improve team performance, and enhance patient outcomes. The essay concludes by outlining methods for evaluating the effectiveness of implemented changes, such as tracking rates of medication errors and infections. Overall, the essay emphasizes the importance of effective leadership styles in promoting a safe, efficient, and patient-centered ICU environment.

Running head: NURSING LEADERSHIP
Nursing Leadership
Name of the Student
Name of the University
Author Note

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Introduction
Nursing is dynamic yet challenging profession that requires engaging yet inspiring
role models. At present, the healthcare environment is ever changing and this it is important
to identify and the develop leaders in order to promote safety and quality of care in nursing
profession. The concept of leadership in nursing profession is complex and requires a
multidimensional approach (Scully, 2015). A multidimensional leadership approach helps to
bring refinement in the nursing practice. The following paper aims to identify practice issues
prevalent in intensive care unit that decrease the overall of patients’ care. The paper will
highlight why these issues are alarming, how his gaps in practice evolves. This will be
followed by an explanation of the role of transformational leaders in overcoming the barriers
and implementing change in practice. The papers will highlight the traits of a
transformational leader that are helping to bring change in practice. At the end, the paper will
highlight how the change implemented in practice will be evaluated. The overall paper will
help in understanding how leadership style can help to bring a positive change in nursing
practice.
Issue and the context
The intensive care unit are critical care units in the hospitals. It has a huge inflow of
the patients at any point of time within the day and requires round of clock monitoring of the
patients as majority of the patients who resides under the intensive care units (ICU) are
critical. The number of nurses operating in the intensive care units are also less as only
handful of nurses who specialised in critical care, get selected for the ICU nurses. However,
this poor strength of the nurses in comparison to the strength patients’ increase in the level of
nursing work pressure and stress along with extended shift timings. The shortages of the
staffs increase the work burden over the existing nurses leading to the generation of

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compassion fatigue, brain draining and burn out. These exhausted nurses are more likely to
commit medication errors. Medication errors that are frequently encountered under the ICU
setting are administration of the medication in in-correct tome, incorrect dosage of
medication and omission error (Sawe et al., 2014). Salmasi et al. (2015) highlighted in their
study that shortages of the nurses, heavy workload, and lack of proper support from the
leaders and mis-interpretation of the medication or prescription charts or lack of proper
communication among the change of shift nurses are the main identified reasons behind the
medication errors in the ICU. The systematic review conducted by Metsälä and Vaherkoski
(2014) highlighted that the medication errors in the ICU is mainly attributable to prescription
or the patient-related errors, lack of proper organisation of the nursing workforce, lack of
proper training and guidance of the nursing professionals in operating the pressure and
computerised physicians based order entry (CPOE) and lack of proper co-ordination among
the nurses and lack of proper organisational safety culture. The patients who are admitted in
the ICU units are in their critical physiological state and any medication error can lead to fatal
outcomes. Starmer et al. (2014) reported that increase in the tendency of medication errors
under the ICU settings increase the overall rate of mortality and morbidity and at the same
time increase the overall length of stay at the hospital and increase in the overall cost of care.
The study performed by Wittich, Burkle and Lanier (2014) highlighted the increase rate of
occurrence of the medication errors are a symbol of poor nursing practice and it endangers
patients’ health and safety. However, Wittich, Burkle and Lanier (2014) stated that
medication errors can be preventable. In ICU there is also increased prevalence of noscomial
infection that also leads to poor health outcomes and is attributable to improper adherence of
the hand hygiene protocol by the nurses as they receive proper guidance (Pronovost et al.,
2016).

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Analysis of the issue and why change is required
The impact of the hospital acquired infection and medication error is equally
detrimental for the life of the patient as it increases the rate of mortality and morbidity,
increase in the cost of care and increase in the length of the overall stay at the hospital.
Hospital acquired infection (HAIs) or nosocomial infection increase the overall disease
burden as it promotes the spread of the multidrug resistant bacteria making the overall
treatment procedure complicated and expensive (Cornejo-Juárez et al., 2015). The patients
who are in the intensive care units are more prone towards getting affected with the HAIs as
they are weak and immune-compromised and thus endangering the patients; safety quotient
further (Cornejo-Juárez et al., 2015). As per the nursing professionals code of conduct
published by the Nursing and the Midwifery Board of Australia (NMBA), it is the duty of a
nursing professional to practice safely, effective and collaboratively within their clinical
practice (standard 1) in order to improve the patients’ safety quotients and overall outcome of
patients’ care. Thus the nursing practice guidelines in the ICU must be changed in order to
reduce the chances of the medication errors and HAIs and thereby helping to increase the
level of patients’ safety. NMBA mainly recommends to practice as per the guidelines of the
evidence based practice in order to improve the bar of patients’ safety.
Barriers of Change
The development and subsequent implementation of the nursing care practices erected
over the stringent research evidences is the principal key towards the provision of safe,
effective and improved quality of care of the healthcare service users. However, inspite of
having an international and globally acclaimed guidelines of safe practice standards, it can
take more than a decade for the health research findings to get actually implemented in the
routine clinical practice. This significant gap between the research evidences and the clinical

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practice leads to the generation of short-falls in the healthcare equity and overall quality of
patients’ safety and health-related outcome.
The study conducted by Stalpers et al. (2015) highlighted that the main barriers
towards the implementation of the standard practice guidelines are increased level of the
work pressure due to poor nurse to patients’ ratio. Nurses are of the opinion that the increase
work burden or extended shift timings make the nursing professionals over burden with work.
The increased work burden prevents the nursing professionals in executing standard
procedures of practice. The research executed by DeBruyn, Ochoa-Marín and Semenic
(2014) evaluated additional barriers in execution of the evidence based practice. The authors
here stated that lack of proper recognition of the nursing professionals as an autonomous
professional that make the nursing professional feel de-motivated. A de-motivated nurse is
more like to suffer from lack of job satisfaction and thus creating a gap in adherence to the
standards of the nursing practice (Stalpers et al., 2015). Another barrier reported by DeBruyn,
Ochoa-Marín and Semenic (2014) is the lack of incentive for the nursing professionals. Lack
of financial benefits of the nurses leads decrease in the level of job satisfaction and thus
hampering quality of care. The third barrier highlighted by DeBruyn, Ochoa-Marín and
Semenic (2014) is lack of proper training and guidance received by the nursing professionals
in execution of the standard practice guidelines and fourth barrier for bringing change in
practice is limited availability of the organisational resources. The lack of orgisation
resources like lack of proper hand sanitizer at the bed side of the patient for the execution of
the five step of the hand hygiene protocol and lack of the ICT resources like electronic health
records and CPOE for proper documentation of the patients’ medication reports, creating gap
in practice (Mahmood, Verma & Khan, 2017).

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Transformational leadership in bringing change in practice
Thus the main barriers that are highlighted behind the effective implementation of the
prevailing nursing norms or the evidence-based practice is of proper management of the
nursing resources, lack of proper training and a demotivated team suffering from lack of
recognition and lack of motivation from the team. Thus in order to overcome the barrier and
it implement the change, the main approach will be effective leadership management by
application of transformation leadership.
Four key elements of a transformational leader, is a transformation lead is an idealized
leader who try to influence others. This act of influencing is done by increasing the
specificity the self-performance and going beyond the limitations for delivering the best.
When the team maters observes that their leader is trying his or her level best for improving
the quality of health care, then the team members get influenced and perform better (Fischer,
2016). A transformational leader is a motivational leader. In nursing a transformation leader
provides wards and recognitions upon achievements. The recognition of the nursing
professionals, for their hard work acts as a source of motivation. A motivated nursing
professional tend to work more cautiously by following all the healthcare requirements of the
clients and abiding by the evidence based practice and thus helping to improve the overall
outcome of care. Motivation creates a positive environment that helps to reduce the chances
of developing compassion fatigue and burnout and this in turn further helps to improve the
overall quality of care in the healthcare practice (Fischer, 2016). A transformational leader
provides intellectual stimulation and creativity. This intellectual stimulation increases the
scope of the continuous professional development where the nurses take extra initiative to
join skill development program beyond their shit timings and thereby helping to overcome
the gaps in practice. A transformational leader also individualised consideration of each and

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every group members thus helping to reduce the conflict of interest and increasing the level
of team bonding (Lin et al., 2015).
The study conducted by Fischer (2016) reported that transformational leadership in
nursing is associated with high performing teams along with improved patient care. And thus
it can be said the use of the transformational leadership style under the clinical setting of ICU
will help to improve the overall outcome of patients’ care. Under ICU settings direct
exchange of the information about the transfer of the patients’ information and information
about the therapy planning and identification of the clinical priority is important. A
transformational leader can mobilise and modulate the association between the different team
members in reaching towards shared values and objectives. This help the healthcare team to
work in unison and with effective communication skills and helping to reduce unwanted
errors like medication error or error of improper hand hygiene (Ross et al., 2014). The cross-
sectional quantitative survey undertaken by Lin et al. (2015) stated that a transformation
leader has significant contribution towards the supervisor support. The workplace support,
mainly from the supervisors’ point of view is regarded as a prime mediator that helps in
explaining the relationship between transformational leadership and job satisfaction. Increase
in job satisfaction helps to increase the retention of the experienced nurses and thus reducing
practice error. The supervisors support help to highlight the fault in practice and that defaulter
nurses trained accordingly that further gives scope of professional development.
Transformational leadership style also helps to promote employee motivation and creating
the provision of therapy innovation by practising critical thinking. Under ICU settings critical
thinking and scope of innovation help to increase the quality of care further (Boamah et al.,
2018). The skill set that is required for the transformation leader in order to bring innovation
and safety in ICU is use of effective communication skills, moving beyond the limitations

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and listening to all voices without any discrimination for effective team building (Boamah et
al., 2018).
The evaluation of the process of change that is improvement in the patients’ outcome
in the ICU can be determined by noting the number of cases of the medication error or
nosocomial infection reported per week, Decrease in the reported rates of the infection or
medication helps will indicate improved outcome in patients’ care (Lin et al., 2015).
Conclusion
Thus from the above discussion it can be concluded that ICU settings in the hospital
unit are prone towards encountering medication error and hospital acquired infection and this
is due to increased work pressure and job stress in the nursing profession along with lack of
training. This unwanted yet modifiable mistakes occurring in ICU decrease the overall of care
and endangering the level of patients’ safety. Thus in order to bring change in practice in the
ICU settings it is important to implement transformation leadership. A transformational
leader motivates the nurses and thus helping to improve the level of job satisfaction and
thereby helping to reduce the medication error. A transformation leader also perform
effective human resource management that decreases job stress, burn out and fatigue and
nurses thus tends to perform better. A transformation leader also provides scope for
continuous professional development helping to excel nurses in nursing skills and knowledge
that is provides positive effect in nursing practice. The change in the practice can be
evaluated by decrease in the medication error and reduction in the rate of nosocomial
infection.

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