Leadership reflection

8 August 2016

ThoughtLeading and managing is a vast process in nursing. “Leadership is the process of engaged decision making linked with actions taken in the face of complex, unchartered or perilous circumstances present in clinical situations for which no standardized solution exists” (Bleich, M. R. , 2011) Description: I would like to share an incident in my nursing experience where one of my colleagues played a leadership role. I was working in the cardio thoracic and vascular surgery intensive care unit (ICU) on an evening shift. It was a large unit in that hospital with 20 beds, and we had 1:1 ratio for nurse and patient.

That was a busy day and the ICU was almost full with 18 post operative patients. We 18 nurses were posted in the ICU at that time except shift in-charge. As per the unit policy, there should have been one extra nurse for each shift. However, fortunately or unfortunately, no extra nurse was available on that day.

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Therefore, all of us were taking care of patients assigned to each of us. Around 1700 hours, the shift in-charge received an urgent call from the operation theatre, informing that the patient who was arriving from the operation room needed immediate attention. Moreover, they were sending the patient within five minutes.

Just after listening to the telephone call, the shift in-charge informed everyone in the unit in a loud voice to keep the emergency medications, emergency cart and the defibrillator ready. But half of the team members did not understand why she was shouting. So that, not everyone listen to the message. One of my colleagues and I were at the very end of the unit and so we could only hear that she was shouting for something. I heard some other nurses talking about the phone call, and then I reached the other end of the unit. By that time, the patient already had arrived in the unit.

When I reached there, only one staff was standing nearby the patient’s bed and the rest ran together to take the emergency medicines. In fact, nothing was organized to deal with that emergency situation. Neither the emergency medicines, the cart, nor the defibrillator was ready at the bed side. We all became very nervous and could not concentrate on what we were doing, because of lack of co-ordination and leadership. The patient’s condition was deteriorating. He was on continuous ventricular tachycardia and was hemodynamically unstable. His ABG showed respiratory alkalosis. The patient was on full code.

One of our staff called code team. So, they arrived along with the physician. After receiving the surgeon’s command, as a team, with the other junior doctors, other nurses, cardiac perfusionist, and the respiratory therapist sincerely tried to retain the life of the patient and somehow we could do that. The time ran away and reached the end of our shift. Till then, no one remembered to inform the family members of the patient. The next day following that incident, the patient’s wife came to visit the patient and asked about the current condition of the patient and then she came to know about the last day’s happenings.

She got very angry because nobody informed her about the situation, and she complained about the occurrence to our chief surgeon. Due to all these reasons, we were scolded by our chief surgeon. This situation is managed poorly because of poor leadership skills, lack of collaboration, and lack of critical thinking skills. Reflection and Analysis: Initially, I felt I was going to pass out in front of our chief surgeon. Because he was shouting and was really aggressive. My nervousness and fear did not allow me to open my mouth to rationalize the situation. At that time, I was thinking about myself and how could I run away from that situation.

I did not think about the patient. Later, I questioned myself about the patient. If we could not restore his life, what would have been happened? How would have his family members cope with the loss? Moreover, the situation might become a life-long stress for me. I might think about the situation till I die. Firstly, when I reflect upon this incident, I have learnt that leadership has an important role in nursing. For instance, if our senior nurse who played the leadership role was knowledgeable about the main components and qualities of a good leader, she would not have done such a mistake in an emergency situation like that.

If she knew the basics of leadership, she would have divided the task to each of us in the team. Furthermore, I have learned that a leader should be knowledgeable, able to work within the team, confident and enthusiastic. When I reviewed the leadership styles, I found the democratic leadership style is the best to be applied in nursing. Hibberd & Smith (2006) says, “The effectiveness of the leadership style is determined by the appropriateness of that style to the environment in which it is being used”.

In my opinion, a leader in nursing must be an active listener, has the skill to deal with complex / conflicting situations, protective to clients as well as colleagues, be able to convey the correct message to the health care team, be organized in their decisions, be a motivator, and be responsible to their own actions and decisions. Also in an emergency situation, each nurse is a leader. An efficient nurse must have the knowledge, skill, and judgement to manage any emergency situation.

Secondly, I realised that there was a lack of communication and collaboration between the team members and the delegation task was not properly arranged. If the team leader was able to communicate the whole message which she received over the phone, we might have overcome that challenging situation in a different way. Also, failure to collaborate added to the improper handling of the situation. Riley, J. B. , (2008) says, “Collaboration ensures the benefits of two heads working on a health problem; this is essential because nursing cannot exist in a vacuum”. (p. 35).

The situation shows a lack of empowerment of the staff by providing the elements such as the correct information on what the situation was about, enough support in the situation, and resources, along with informal/formal power. Finally, critical thinking skill is an important component of good leadership. If our team leader or the staff used their critical thinking power, the outcome of that might have been different. Critical thinkers usually start with inquiring about the current situation. We would have asked our shift in-charge about What? How? When? questions to learn more about the telephone message.

Critical thinkers approach problem solutions in a systematic, organized, and goal-directed way when making clinical decisions”, Arnold & Boggs, (2011). Conclusion and action plan: Having experienced with this situation, I have significantly developed an insight on how such events should be handled. I now feel, if I was in the position of my colleague who played the leadership role, I would have handled the same situation in a better way. I would have informed my colleagues about the telephone message clearly and clarified their doubts. Then, I would have assigned each nurse for each task, and asked for their opinion.

Also I would have work with them to meet the goal of stabilizing the emergency situation. However, I have not sufficiently developed my skills in communicating with the health care team using SBAR (Situation, Background, Assessment, Recommendation) tool. This means that I have to learn more about the communication using SBAR tool in the context of Canadian Health care System. This skill is essential to me as a learner because, I have no experience as a nurse in the Canadian Health care System, and I know that it is totally different from where I have experienced as nurse.

As a next step, I need develop a learning goal in order to meet the standards of College of Nurses of Ontario. To put it in a nutshell, a nurse leader has the skills of organizing actions and decisions, as well as their focus should be on the client’s well-being. In future, if the same situation occurs in my career, I will be able to manage or handle the situation smoothly without blaming anyone. I am confident that, I can easily adapt to such emergency situations without being nervous. I believe in continuous learning.

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