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Essay: Leadership in Adult Nursing (reflective)

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Introduction Leadership is a process which involves individual activity to state desire objective and vision in a situation, providing support and motivating other people to attend set goals (Swearingen, 2009). Danae et al. (2017) believe that leadership is broadly recognised as a key aspect of overall effective healthcare. Therefore, nurses require strong leadership skills to accomplish various tasks to improve care quality. In this assignment, I will cross reference six experts (see appendices) from my professional development portfolio related to the four domains of standards of competence for preregistration nursing (NMC, 2010). Additionally, I will address each domain using Rolfe, Freshwater and Jasper (2001) reflection model, which is composed of three stages ‘what’, ‘so what’, and ‘now what’. This model is suitable to link practical experiences with theory, it helps to improve clinical practice and identify further learning opportunities; which will be addressed by formulating a S.M.A.R.T action plan (Doran, 1981). Domaine 1: Professional values What? Appendix 1 shows aspects of the professional values that I need to address. It contains mentor’s comment about patient advocacy skill. During my Nursing Practice 5 (NP5), I looked after a 56-year-old disabled woman with Spina Bifida who was alert and orientated, unable to move on her own, but, had clearly expressed her need to be moved every two hours to avoid another pressure ulcer as she had one before. This was not respected by health care assistant taking for excuses “the ward is very busy, she is not the only patient”. I regret I didn’t advocate for her. Furthermore, appendix 2, which is the leadership framework self-assessment tool demonstrates aspects of personal quality that I need to review. These are related to the (NMC, 2010) instructing nurses to take all reasonable steps to protect people who are vulnerable or at risk from harm, neglect or abuse. So what? Professionalism means practice through the application of the Code (NMC, 2017). In the UK, nurses must act as advocates for their patients, challenge poor practice and discriminatory attitudes and behaviour relating to the care of vulnerable people, (NMC, 2015). This is supported by the Royal College of Nursing (RCN) stating that speaking on behalf of another is an integral part of the nurse’s role (RCN, 2008). Moreover, The International Council of Nurses emphasises the need for nurses to respect the rights, values, customs and beliefs of individuals and families, and to advocate for equity and social justice in resource allocation and in access to health (ICN, 2012). Such endeavours are central, as illness nearly always increase levels of patient vulnerability and dependence (Marquis and Huston 2012). Emphasizing the fact that nurses should influence the way care is given in a manner that is open and responds to individual needs (RCN, 2015). Unfortunately, there have been cases where nurses have failed to provide fundamental care to patients. The report into the failing at the Mid Staffordshire Hospital identified poor leadership coupled with clinical staff accepting standards of care that should not have been tolerated (Ellis and Bach, 2015). More recently, Care Quality Commission (CQC) has issued a Warning Notice requiring some trusts to improve safety, patient consent and overall leadership (CQC, 2017). This accentuates the role of leadership in prioritising patient safety and in listening to and learning from patients (storey and Holti, 2013 ). Stressing the need for nurse leaders to be self-aware and recognise how their own values and principles may affect their practice (NMC, 2010). Leaders encourage teamwork by appreciating individuals’ contributions and ideas; this creates needed behaviour, such as shared respect, compassionate care, attention to detail, between team members (NHS Leadership Academy, 2013), and create a motivating work environment (Adair, 2002). Therefore, the quality of leadership has a direct impact on the quality of service provided at all levels. The leader’s obligation is to create an environment in which good people can provide good care (Engard, 2017). Pointing out personal attributes of nurses that help to enable advocacy like flexibility, empathy, self-motivation, professional commitment, sense of responsibility, and the ability to cope with stress (Choi, 2015). Reflecting on the above scenario, transformational and transactional leadership can both play a role in the negotiation of a win-win situation. Transformational leadership is defined as a leadership approach that causes changes in individuals and social systems. It is about having a vision of how things should or could be and being able to communicate this idea effectively to others (Ellis and Bach, 2015). Whereas transactional leadership is based on contingent rewards and can have a positive effect on followers’ satisfaction and performance (Tomlinson, 2012). Transformational leadership plays a more critical role in the present scenario. it can motivate and inspire healthcare assistant and have a more significant impact to change both their thinking and behaviour Jie-HuiXu (2017), thus, allowing them to reach their potential and deliver sustainable changes to care. Now what? Now I should strive on developing and sustaining my engagement in patient advocacy by the end of NP7. In my Ongoing Achievement Record document, I will work with my mentor to complete competency 1.2. called: Understand and apply current legislation to all service users, paying special attention to the protection of vulnerable people, including those with complex needs. I will actively seek mentor, patients, family and others health professionals’ feedback and reflect on when I have been involved in patient advocacy during placement and review this with my mentor at mid- and end-point review. Domain 2: Communication and Interpersonal Skill What? Communication and interpersonal skill are vital parts of collaborative working (NMC, 2010). I reflect on communication using Situation, Background, Assessment and Recommendation (SBAR) mentioned in appendix 3, which is a reflective writing during placement 5. In a surgical ward, during routine observation of a patient who had undergone a cystectomy, I noticed that the patient was spiking in temperature (38.5) although NEWS score was 1, I immediately informed my mentor who directed me to blip the doctor in charge of his care. While communicating with him I was unable to give a clear response to questions about the patient’s condition. Even though he reassessed my patient immediately, I regret I didn’t use SBAR tool, because it could have helped to communicate clearly and prevent any potential delays. Appendix 1 in the section ‘working with others’ further shows that I need to improve my interpersonal skills. These relate to part of the NMC (2010) stating: nurses must use a range of communication skills and technologies to support person-centred care and enhance quality and safety. So what? Bach and Grant (2010) state that good communication and interpersonal skills are essential characteristics of high-quality nursing practice. The NMC (2010) also said that all nurses must use the full range of communication methods, including verbal, nonverbal and written, to acquire, interpret and record their knowledge and understanding of people’s needs. Emphasizing the use of communication tools like SBAR. SBAR is a tangible approach to framing conversations, especially critical ones that require a nurse’s instant attention and action. It promotes the provision of safe, efficient, timely, and patient-centred communication (Chaboyer et al., 2010; Day, 2010). Moreover, SBAR can be used for multiple forms of communication. It can be a change-of-shift report (Pope et al., 2008; Thomas et al., 2009), or can be applied to written communication (Perry, 2014). In addition, SBAR helps nursing students and recent graduate nurses organize their thoughts prior to calling physicians, to save time, reduce frustration, and improve overall communication (Pope et al., 2008). Furthermore, the use of SBAR communication tool temporarily flattens the hierarchy perceived in most healthcare settings, resulting in more effective channels of communication between healthcare providers (De Meester, Verspuy, Monsieurs, & Van Bogaert, 2013). According to Hackman and Johnson (2013), leadership is first, and foremost, a communication-based activity. Depending on the circumstances, a leader should try to be more authoritarian, democratic or laissez-faire (Mitchell, 2012); or should focus the communication on the tasks or use a more interpersonal style (Hackman and Johnson 2013). Reflecting on the scenario related to this domain, an assertive, clear and focus communication using SBAR format would have provided a brief, organized, predictable flow of information improving critical thinking communication skills and patient safety (Olin, 2012). It can be argued that it is hard to serve as an effective leader without effective communication (Hackman and Johnson 2013). This is agreed by Perry et al (2014) stating that effective commutation is a central attribute of clinical leadership. Clinical leaders can influence their colleagues with effective communication skill such as good listening skill and extremely good at explaining things at the right level that can be understood by followers. However, it is important to note that each clinical leader has a preferred style of communication that would not necessary works every time. Hackman and Johnson (2013) recommend choosing a leadership communication style that will work best according to the situation and the level of knowledge of followers. Now what? During next placement (NP7), I will strive to change communicating SBAR in a more professional, concise, clear, in a timely manner when communicating with the multidisciplinary team to improve patient outcome. I will actively seek feedback from my mentor and other professionals at mid- and end-point reviews. I will also change my preferred communication style from passive aggressive to an assertive communication style. For that, I will use the communication style questionnaire at the beginning then altered my behaviour during the first part of the placement, then repeat the questionnaire at mid-point and ask for feedback to my mentor base on the comparison on two questionnaire results and base on her observation. And repeat this again by end-point. Domain 3: Nursing Practice and Decision Making What? Here I reflect on nursing practice and decision making, see appendix 4, which is an end-point mentor comment during NP3 showing that improvement is needed in this domain. This is underpinned by appendix 5: a reflection done at the beginning of NP6 when I looked after a patient with hypoxic brain damaged who had a seizure. On my entry into his room, I found the patient unconscious, I took the decision to clear his airway before pressing the emergency bell which could have jeopardised patient safety. This is related to the NMC (2010) stating that nurses must be able to recognise and interpret signs of normal and deteriorating mental and physical health and respond promptly to maintain or improve the health and comfort of the service user. My behaviour pointed out the need to enhance my skill and knowledge in this domain. So what? Judgement and decision-making are important facets of healthcare for nurses (Traynor et al., 2010). Judgement is defined as weighing up different alternatives; while decision-making involves choosing a specific course of action to follow between alternatives (Lamb and Sevdalis, 2011). Hence, (Undre et al., 2009) define efficacious judgement and decision-making as skills that go beyond clinical knowledge and technical competence, highlighting the fact that nursing judgement and decision-making contribute significantly to the safety and quality of patient care (Traynor et al., 2010). However, several studies have high-pointed that when given the same information, and undertaking the same decisions, nurses will make consistently different judgements and decisions (Thompson et al., 2008; Thompson and Yang, 2009). Differing judgement and decision indicate different types of reasoning, in situations where time is not constrained, newly qualified nurses will make structured judgments with a rational-analytical decision. For those situations where time is limited, information is perceptual, and the nurse has some perceived expertise, it is appropriate to use intuition as the basis for judgement (Hammond et al., 1987). Thompson et al (2008) suggest that the key to successful reasoning is to adapt reasoning to the demands of the task. However, such adaptive reasoning by nurses is sometimes absent. Thus, good decisions and judgements are not independent to the cognitive process but can be influenced by how information is prioritised and the nurse’s ability to identify and respond to vital aspects of the clinical situation (Pearson, 2013). Thompson et al (2013) state that recent studies have shown positive benefits associated with the introduction of Computerised Decision Support Systems (CDSS) to support nursing decisions. Hence, helping to promote patient’s safety and improve their outcome. Reflecting on the scenario related to this domain, future decisions making process, whether they are based on normative, prescriptive or descriptive theory must include clinical expertise, patient value and best available research evidence (Sackett, 1996). because evidence by itself, does not make the decision, but it can help support the patient care process. In the same order, Marquis and Huston (2015) suggest that to be effective as a leader, one needs certain skills for making decisions, such as self-awareness, fairness and transparency which are skills also needed in decision making. This is supported by Thompson and Dowding (2009 p5) affirming that “One of the distinguishing features that mark out exceptional nurses is their skills in judgement and decision making”. Decision making is considered important leadership skills and is recognised by Sofarelli and Brown (1998) as qualities associated with transformational leadership. Now what? I have realised that decision making, particularly in nursing, is vital as it influences patient safety and outcomes (Ellis and Bach, 2015). It has been mention earlier that experience is a factor that affects decision making. To gained experience in judgement and decision making, I will use every opportunity during NP7 to practice evidence base in nursing practice and decision making by always based my decision on useful information sources like clinical guidelines, protocol and policy and patient preference. After what I will actively seek feedback from my mentor and others healthcare professionals and of course to patients to check their satisfaction about their involvement in the decision-making process about their own care at mid- and end-point reviews. . Domain 4: Leadership, management and team-working What? My leadership, management and team working skill are measured in appendix 2 and appendix 6 which are both leadership self-assessment tools. The first one showing aspects of my leadership that needs to be improved and the second one showing my leadership style which is “guiding” needing improvement to become more empowering. These are further supported by appendix 4: mentor end NP3 comment. During the leadership module, I took part in several group activities, which enabled me to understand team role importance and that there is no leader without followers. This part relates to NMC (2010) stating that nurses must work independently as well as in teams; be able to take the lead in coordinating, delegating and supervising care safely, managing risk and remaining accountable for care given. So what? Tomlison (2012) states that self-assessment helps individuals to appreciate their qualities, strengths and weaknesses thereby, enabling better transformational leadership. Bass (1985) found that transformational leadership contributes to individual performance and motivation. Whereas transactional leadership (Burns, 1978) is short-lived, and task-based, with the leader intervening with negative feedback when things go wrong. Adair (2002) proposed a three-circle model of strategic leadership, with the circles being the needs of the task, the individual and the team. This is a democratic model of leadership matching the NMC code, where Individuals and groups are involved in decision-making processes concerning their work (Adair, 2002). Management skills are as important as leadership skills in addressing some failings like those identified in the Francis report (Kerridge, 2013). Kerridge suggests they are closely linked, effective management and leadership both require putting first thing first. The King’s Fund report (2011) concurs, defining leadership as the art of motivating people toward a shared vision and management as getting the job done, suggesting that the exercise of leadership across shifts could be extended to management practice; pointing out that every member of healthcare team has some management and reporting functions as part of their job (Baker et al., 2012). Lord Darzi (2008) said: ‘Leadership is not just about individuals, but teams’. A successful leader will see each person as an individual, recognising their unique set of needs, as not everyone will perform at the same level (Hackman and Johnson 2013). This rejoins the description of team role by Belbin (1996) as he described a team role as ‘a tendency to behave, contribute and interrelate with others in a particular way’. Suggesting that Belbin assessment would be an ideal way for a team to examine: the roles they play, how these fit in with the team and the contribution of roles to the team (Frankel, 2011). Therefore, it would be advisable that team members use the questionnaire to helps identify individuals’ preferred roles, their manageable roles and their least preferred roles within the nine teams’ roles as described by Belbin in-order-to improve the success of teamwork. Nurse leaders need also to be able to respond to an ever-changing healthcare environment (Frankel, 2011). The literature suggests that leadership, effective communication and team working are among the most important elements for planned change (Schifalacqua et al., 2009a). Kurt (1951) identified three steps of change: unfreezing, moving and refreezing. This work was modified by Rogers (2003) who described five phases of planned change: awareness, interest, evaluation, trial and adoption. Another change theorist, Ronald Lippitt (Lippitt et al., (1958), identified seven phrases. Mitchell (2013) advises that Lippitt’s work is likely to be more useful to nurses because it incorporates a detailed plan of how to generate change and is underpinned by the four elements of the nursing process: assessment, planning, implementation and evaluation. Now what? To improve my Leadership, management and teamwork skills, I will use the first week of my MP7 to observe my mentor and nurses in charge leading some shifts, then, I will seek clarification on grey areas of my understanding and ask to have my own patients. This will enable me to practice leading others, managing patients and working with the multidisciplinary team. I will actively seek feedback till mid-point review, then, I will lead and manage my mentor whole set of patients under her observation and correction whenever needs arise till end-point. This will help me to move toward an empowering leadership style. Conclusion I have learnt that: a good leader or manager remains grounded in the values, beliefs and behaviours that guide professional nursing practice; understanding your role and that of other will nurture clear communication thus improving the success of the team; safe decision-making must be evidence-based; and effective leadership fosters a high-quality work environment leading to positive safe climate that assures better patient outcomes.

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Reflections on leadership

Editor(s): Laskowski-Jones, Linda MS, RN, ACNS-BC, CEN, FAWM

Editor-in-Chief, Nursing2013 Vice President: Emergency & Trauma Services Christiana Care Health System, Wilmington, Del.

Contact Linda Laskowski-Jones at [email protected] .

At the Nursing2013 Symposium in March, I presented a general session entitled, “Developing the Leader in You: A Career Plan for Success.” This talk blended personal experience, formal leadership education, and keen observations on what worked—and didn't work—for various people and situations over the years. My key message was that honing leadership skills in any role promotes professional effectiveness and accomplishment.

Now if you're thinking, “I don't need leadership skills–I'm not a manager,” realize that leadership and management require two different skill sets. You don't need a management title to be a good leader. You do need self-confidence, courage, initiative, and a strong sense of accountability.

The essence of leadership involves the power to motivate and influence people. This power can be wielded positively to engage others in worthy action, or negatively through coercion or punishment. Although the latter approach may be justified in certain extreme situations such as preserving patient safety, it won't foster strong team bonds if it's the predominant approach. Power is toxic whenever it's employed to further a personal agenda at the expense of good ethics or teamwork.

Here's an example: Negative Nellie complains that several new graduates were hired and asserts, “We have no responsibility to help them—their failure will show management that only experienced nurses should be hired.” She glares at the staff and expects tacit agreement—and she may get it. Nellie makes the schedule, and nonsupporters could get the “assignment from hell.”

But then, Positive Paul engages the group and transforms the negative atmosphere completely. He's dynamic and has developed great working relationships with his colleagues. He understands unit politics and sees the big picture. Smiling, he says, “Nellie—having a bad morning? I know you don't mean that. You're too much the professional. Come on folks, we have new nurses to inspire!” Paul saves the day, preserving everyone's dignity in the process. Of course, he later shares the situation with his manager privately.

The power of positive influence requires emotional intelligence and the motivation to connect with people in a way that engenders trust and confidence. Credentials and clinical skills are no substitute for these leadership attributes. It's the wise nurse who establishes this foundation for personal excellence.

Until next time—

Linda Laskowski-Jones, MS, RN, ACNS-BC, CEN, FAWM

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Leading and Managing Nursing Care Reflective Essay Sample for Adult Nursing

Reflective portfolio based on three reflective narratives of 1500 each related to practice;  the issue of professional values like emotional intelligence, resilience, and prioritisation using one model for all narratives.

Emotional Intelligence

The model utilised to undertake this and the other reflective analysis in this commentary is the Gibbs’ reflective cycle. As Johns (2017) point out, there are a lot of reflective models that might be used, but the Gibbs’ model has been selected because it provides a structure and helps with the consideration of numerous factors that might drive deeper, more insightful learning (Howatson-Jones, 2016). Chang and Daly (2015) argue that the Gibbs’ model may only encourage basic reflection, but I have personally found that for me it helps me to explore a depth and range of factors, as highlighted by Howatson-Jones, 2016) and this is why it was selected. The Gibbs model has six stages and each is considered in turn under a new heading.

Description

Emotional intelligence is defined by Ashkanasy et al. (2016) as being a group of capabilities that help in working with emotions. It is the ability to be aware of one’s emotions and to control them and express them effectively, with care and utilising empathy (Goleman et al., 2013). As explained by Quinn and Hoffe (2018) emotional intelligence is considered to be an important ability in nursing, not least due to the fact that care should be patient centred. If a person cannot manage their emotions or be empathic, it would be challenging to offer patient centred care, arguably.

As a nurse, I am well aware of the need for emotional intelligence in my interactions with others, whether colleagues, partners in the multidisciplinary team or patients. In the situation faced, I was overseeing the activities of a student nurse on placement. We were working with a female patient, Mrs B (patient’s name anonymised for confidentiality purposes) who had been hospitalised as a result of a suspected heart attack. Mrs B was being extremely rude to the student nurse who was trying to undertake basic checks of vital signs. The nurse was exhibiting signs of distress. I temporarily reassigned another nurse to take over the task, and took the student nurse, Ms G aside for a conversation to understand what was going on. It transpired that until that point, the nurse had only experienced grateful behaviour and fear from patients and had not had to handle a rude patient before.

I suggested to her that the patient was actually being rude because she was very frightened, and we discussed strategies for handling conversations with this type of patients.

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Thoughts and Feelings

My initial thoughts and feelings around the situation were that the student nurse was acting ineffectively, but taking a quick step back from the scenario, I realised that actually she was doing her job and addressing the tasks assigned to her but struggling with emotional intelligence towards a verbally abusive patient. I was able to empathise with Ms G because I remembered being in a similar scenario in the early days of my care career. As argued by Prezerakos (2018) a review of the evidence suggests that emotional intelligence is critical to effective nursing care. My thoughts were initially happy and somewhat pleased with myself in being able to share helpful information based on experience with a more junior colleague. This feeling was quickly replaced by the realisation that emotional intelligence is not easy to manage on a personal level, and an acknowledgement that I have to continually work on this area in order to provide a supportive environment where quality and safe care can occur, per the requirements of the Nursing and Midwifery Council (2018) Code of practice.

The positive of this situation is in my emotional intelligence capabilities both with respect to Mrs B and Ms G, recognising that the patient was actually very frightened, and also acknowledging and dealing with the fact that Ms G was not seeing this and was taking the rude behaviour personally. Another positive was that while Ms G was visibly impacted by what was happening she did not let it affect the care that she was offering. It was not good that Ms G was responding in such a way as to be impacted, and not understanding that the patient was scared, and this can be seen as a negative. However, nurse leaders must be aware that not everyone that works in the field will have the same levels of emotional intelligence or capability to apply this even when experienced in the role. In addition, the emotional burden of nursing can be considerable and especially if nurses are facing other challenges with their resilience (Roussel, 2013).

Studies have been undertaken that indicate that emotional intelligence capabilities can have a positive impact on patient safety, such as that by Codier and Codier (2017). Examining the scenario that occurred, it is easy to see how a person that was less resilient than Ms G might have reacted differently to the rude behaviour, which could have compromised the safety of the patient. Bennett and Sawatzky (2013) outline how leaders in nursing must develop emotional intelligence in order to improve patient care. From analysing the situation in greater depth, as Beydler (2017) argues, nurse leaders that build up their own emotional intelligence abilities have can help others to improve theirs through acting in an emotionally intelligent and empathic manner towards their team. Indeed, as Roussel (2013, p. 61) argues, when moving into a leadership situation in nursing, the nursing leader must create “a supportive and positive work environment to help nurses cope with the stress of managing their own and others’ emotions concurrently.”

I like to think that this is what I do. However, looking back with hindsight, I know the incident with Mrs B and Ms G happened on a good day when I was energised, had a good night sleep and when we were not especially busy on the ward. There were staff to reassign to the specific role, and I was able to spend time with Ms G, coaching to help with her personal development. However, there are days when I am not as resilient, and the challenge lies in being able to be emotionally intelligent for myself, my team and the patients under my care on those days too. While I know that as Yoder-Wise et al. (2019) outlines that I must take care of my own resilience and I make every effort to do so, resilience is an attribute that depends on my own personal resources, as pointed out by Foster et al. (2020). There are days where I have lower levels of energy, where as a team we are stretched due to a lack of resources and being emotionally intelligent on those days is naturally harder.

Developing an environment where emotional intelligence can flourish can be concluded as being concerned with both developing emotional intelligence attributes in others, while not overlooking one’s own emotional intelligence capabilities. It is encouraging to be able to say that emotional intelligence can be impacted through training and development. There is no doubt that it can. However, one element that cannot be ignored with regard to time spent on training and personal development as a leader is the fact that there are barriers such as time constraints, in addition to the pressure of the job, and sometimes limited staffing levels as well (Mansel and Einion, 2019). Moreover, maintaining one’s own emotional intelligence on days that are particularly challenging personally is likely to be extremely difficult at times. Despite these challenges, personal development of both myself and others in this area is essential in the provision of safe and effective care and meeting the needs of the NMC (2018) Code.

Action Plan

One step that can be taken that I believe would be beneficial with respect to this type of scenario, is taking proactive measures to help in the development of emotional intelligence. This could be achieved perhaps through role play, as highlighted by Price and Harrington (2015). While it is acknowledged that there are times when this type of personal development opportunity would be difficult to enact with the team due to time pressures, there are also times when it could be possible to undertake this type of development. As Ellis (2018) also argues, coaching is an alternative form of personal development that can be utilised, acting as a supportive role model through working with more junior members of staff, questioning and encouraging their own reflection with regard to building the capability of emotional intelligence. However, clearly aside from helping shape emotional intelligence in others, there is a need for my effective self-management such that I can be highly emotionally intelligent at work and act as a role model for the expected and desired behaviours so that I can gain and maintain credibility as a leader. In achieving this, one step that I might take is being mindful about my own stress and fatigue levels and how these might impact on the working day. The Royal College of Nursing offers a healthy workplace toolkit which might prove helpful in this regard (2020).

Conflict Management

This reflection focuses on the issue of conflict management within the specific setting of the multidisciplinary team. It will again utilise the Gibbs reflective cycle for this purpose. As Taberna et al. (2020) explains, multidisciplinary teams are comprised of different professionals that come together to cooperate and collaborate in order to ensure that all aspects of a patient’s care are considered when addressing the service user’s needs.

Description of What Happened

Nurses have a number of roles to play as part of a multidisciplinary team. Pertino et al. (2014) outline some of these as ensuring that the patient receives effective care, adequate investigations, diagnosis and treatment, and managing and capturing data pertinent to the care as well. All professionals that are involved in multidisciplinary team work have the ability to offer value to making sure that the patient receives the optimal care with their needs met, which is argued to make a difference with regard to patient outcomes (Fitzpatrick and Kazer, 2011). As well as delivering improved outcomes, as Schober (2016) indicates, multidisciplinary teams have been an important component in recent health and social care policy due to their importance in ultimately lowering the costs of care through avoiding duplication and making sure that patient needs do not fall through the cracks between different care agencies.

Conflict is defined as being “A clash or a struggle that occurs when one’s balance among feelings, thoughts, desires and behaviour is threatened,” (Rigolosi, 2012, p. 213). In the particular scenario faced, I was part of a multidisciplinary team dealing working with a patient, Mr F (name anonymised to protect the patient’s confidentiality) with complex health and social care needs. In the process of meeting to examine and pinpoint the specific care needs for this individual and to ensure nothing was missed, I experienced a situation of conflict with one of the other professionals on the team, the social worker, Mrs P. The conflict arose due to the way in which we communicated with each of us misunderstanding what the other was saying. This led to the process not working as efficiently as it could. While it quickly became clear that both of us had the patient’s best interests central to what we were saying and trying to do, the conflict could have been avoided.

My initial reaction to Mrs P was one of anger, though I did not directly express this. However, I did demonstrate my frustration with how I responded to her, because from what she was saying, it made it sound as if she was unconcerned about how the patient’s ongoing care would be managed. The assumption that I made, based on the language used by Mrs P was also that she was asserting that we had not provided Mr F with adequate care, and this irritated me, as it felt like a direct attack on my professionalism and the care that I offer to patients. It also felt like an attack on my team, initially, and my immediate response was to step in and defend them. The reality was, as Huber (2014) reports sometimes can happen, the conflict initially seemed bigger and more insurmountable than it actually was, and the problem was primarily one of communication rather than misalignment in what we fundamentally thought. While this was a relief, it did not change the fact that my first response was of anger and frustration, rather than calmly taking steps to resolve the differences faced, and this is something that I need to work on in order to be a more effective nurse leader.

Evaluation of the Positives and Negatives

Examining the positives of the situation, the conflict between myself and Mrs P was resolved fairly quickly, which was good. Brinkert (2010) argues that it is important to be proactive when faced with conflict in order to manage it effectively, and the ways in which I did this included asking more questions of Mrs P and actively listening to her answers. I also paraphrased back to her my understanding of her meaning which was where the source of the conflict and the misinterpretation was pinpointed by her. However, as Borkowski and Meese (2020) indicate, conflict creates costs in healthcare. While in this case no harm was done, and ultimately myself and Mrs P have a better relationship as a result of clearing up our misunderstanding, some time was still wasted on the conflict, rather than on resolving the issue at hand. It might be considered that this created unnecessary costs. Managing my response so that it addressed the conflict more effectively in the first instance would have been more appropriate in this scenario.

The NMC (2018) Code requires that as a part of prioritising people, there is a need to work in a partnership to deliver effective care. Stanley (2016, p. 223) argues that, “Successful conflict management requires clinical leaders who demonstrate key conflict resolution principles,” and in addition to this, it is opined by Huber (2014) that it is best to work towards win-win resolutions in managing conflict effectively. Huber (2014) expresses the fact that when leaders work towards win-win scenarios they are more likely to focus on addressing problem solving. On reflection, my initial response was not working towards win-win with Mrs P. Thinking deeper about why this occurred, a factor compounding the communication challenges faced between myself and Mrs P was cultural difference between us, as Borkowski and Meese (2020) highlight can occur. Borkowski and Meese (2020) present evidence that in the healthcare environment, few employees realise the impact of cultural factors in leading to conflict between them, but this can indeed sometimes be the cause of conflict.

Conflict is likely on multidisciplinary teams for other reasons as well, not least due to the fact that everyone working on the team may have a slightly different agenda (Fulford et al., 2012). Looking at this in closer detail, on a very simplistic level, doctors may be focused on a curative solution while a physiotherapist may take a perspective of trying to prevent an issue from occurring again. While these sorts of differences may not seem that great, as Fulford et al. (2012) argue, different professional values can influence perspectives and communication and can lead to conflict. Instead of jumping to conclusions, as an effective nurse leader it would have been better to recognise the differences and identify a way to handle the conflict more appropriately as Murray (2017) outline is required. In particular, there is a need to focus on working towards shaping conflict towards positive outcomes.

Conflict is likely in any working environment and particularly in one as complex as a healthcare environment, but as outlined by Patton (2014). However, when conflict is dysfunctional and negative it can ultimately compromise patient care outcomes, and it also has the potential to detrimentally impact on job satisfaction and wellbeing of employees and colleagues (Patton, 2014). In terms of what else can be learned from this situation, reflecting on conflict from a wider perspective, clearly this can occur in a range of different ways, not just with people on the multidisciplinary team, but also with colleagues and team members, particularly where culture and personalities differ. The important aspect of conflict management to focus on is managing it for a constructive outcome, focusing on building good and solid working relationships with others, and ensuring the conflict is steered away from being damaging to relationships, and ultimately, even more importantly to patient outcomes.

It is also important to consider that conflict is likely to come about as part of the storming phase of team development as highlighted in the model of group development proposed by Tuckman (Harris and Roussel, 2010). As Harris and Roussel (2010) argue, resistance can occur during the storming phase when the group is working out how to work together, and interpersonal conflicts can occur during this time. While the Tuckman model is imperfect in that it suggests that the process of group development is linear only (Harris and Roussel, 2010), this storming element of group development is nonetheless important to keep in mind as a factor that can lead to conflict, which nurse leaders must manage.

With regard to addressing conflict, one step that is important in my action plan is working to better understand what people that I am working with are saying rather than jumping to incorrect conclusions and allowing myself to become frustrated. One of the ways that this might be best achieved which would have certainly helped in the scenario outlined, and potentially in other future situations to, is building up my cultural competence.

As outlined by Koutoukidis and Stainton (2020) having a good awareness of different cultures, and the beliefs, attitudes and values of those helps with nurses being able to develop better communication skills. Indeed, they argue that cultural sensitivity allows individuals to be more responsive with regard to the needs of people of different cultures (Koutoukidis and Stainton, 2020). This will also help me in selecting language to use that is less likely to provoke unnecessary conflict when working with people of different cultures and professional backgrounds.

Ashkanasy, N.M., Zerbe, W.J. and Hartel, C.E.J. (2016) Managing Emotions in the Workplace , Oxford: Routledge

Beydler, K.W. (2017) “The role of emotional intelligence in perioperative nursing and leadership: Developing skills for improved performance,” AORN Journal , 106 (4) 317-323

Bennett, K. and Sawatzky, J.A. (2013) “Building emotional intelligence: A strategy for emerging nurse leaders to reduce workplace bullying,” Nursing Administration Quarterly , 37 (2) 144-151

Borkowski, N. and Meese, K.A. (2020) Organisational Behaviour in Health Care , 4 th Edition, London: Jones & Bartlett Learning

Brinkert, R. (2010) “A literature review of conflict communication causes, costs, benefits and interventions in nursing,” Journal of Nursing Management , 18 (1) 145-56

Chang, E. and Daly, J. (2015) Transitions in Nursing , London: Elsevier Health Sciences

Codier, E. and Codier, D. (2017) “Could emotional intelligence make patients safer?” American Journal of Nursing, 117 (7) 58-62

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Foster, K., Marks, P., O’Brien, a. and Raeburn, T. (2020) Mental Health in Nursing , London: Elsevier Health Sciences

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Goleman, D., Boyatzis, R.E. and McKee, A. (2013) Primal Leadership: Unleashing the Power of Emotional Intelligence, Boston: Harvard Business Press

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RCN (2019) “Stress and fatigue,” RCN, accessed 16/03/21: https://www.rcn.org.uk/clinical-topics/patient-safety-and-human-factors/professional-resources/stress-and-fatigue

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June 1, 2024 . By Kepher

Nursing Leadership Essay: Engaging Examples and Tips for Powerful Essays

Table of Contents

The world of nursing is a complex and demanding one. Beyond the technical skills required to care for patients, successful nurses possess a unique blend of compassion, resilience, and leadership qualities. These qualities become even more crucial as nurses ascend the ranks and take on leadership roles. Writing a nursing leadership essay is a valuable exercise that allows you to reflect on your own leadership journey and articulate your vision for the future.

This essay delves into the intricacies of crafting a compelling nursing leadership essay by providing insightful examples and practical tips. From understanding the core elements to crafting an engaging narrative, this guide will give you the tools to showcase your leadership potential and stand out in the competitive field of nursing.

Understanding the Essence: Core Elements of a Nursing Leadership Essay

A successful nursing leadership essay goes beyond merely outlining leadership skills. It dives deep into your personal experiences, showcasing how you embody specific leadership qualities and how these qualities translate into tangible impact. The foundation of a compelling essay rests on the following core elements:

1. Defining Your Leadership Style:

Every leader possesses a unique approach. Identifying your leadership style is crucial for a compelling nursing leadership essay. Are you a transformational leader who inspires change and fosters a vision? Or perhaps a servant leader who prioritizes the needs of others and empowers team members?

• “My leadership style is rooted in collaboration and empathy. I believe in fostering a sense of shared purpose among my team members, empowering them to take ownership of their roles and contribute to a positive patient experience.”

2. Illustrating Your Leadership Journey:

This section is where you bring your leadership experiences to life. Choose impactful scenarios that demonstrate your abilities. Use the STAR method (Situation, Task, Action, Result) to narrate these experiences effectively.

• Situation: “During a challenging shift with a surge in patient admissions, I noticed a sense of overwhelm among the staff.”
• Task: “I took the initiative to assess the situation and prioritize urgent tasks.”
• Action: “I delegated tasks strategically, ensuring efficient use of resources and maintaining patient safety.”
• Result: “Through effective communication and delegation, we were able to manage the influx of patients effectively, minimizing stress on the team and ensuring high-quality care.”

3. Demonstrating Impact:

Leadership is not just about skills; it’s about making a difference. Connect your leadership experiences to tangible outcomes.

• “By implementing a new protocol for patient education, I witnessed a significant increase in patient satisfaction scores and improved adherence to treatment plans.”

4. Reflecting on Your Growth:

Highlight your commitment to continuous learning and professional development. Mention specific courses, certifications, or mentorship experiences that have honed your leadership skills.

• “I am currently pursuing a Master’s degree in Nursing Administration to expand my knowledge base and develop advanced leadership skills.”

Crafting a Winning Narrative: Tips for a Standout Nursing Leadership Essay

Now that you understand the key elements, it’s time to craft a captivating narrative that showcases your leadership potential. Here are some valuable tips:

1. Start Strong with a Hook:

Grab the reader’s attention right from the start. Use a compelling anecdote, a thought-provoking question, or a powerful statement that sets the stage for your essay.

• “The call to nursing is not just about dispensing medication or monitoring vital signs; it’s about providing unwavering support and compassion to those in their most vulnerable moments.”

2. Weave a Consistent Theme:

Ensure your chosen examples and reflections all tie back to the central theme of your nursing leadership essay. A cohesive narrative will leave a lasting impression on the reader.

3. Stay Concise and Focused:

Avoid unnecessary details or tangents. Every sentence should contribute to your overall message.

4. Use Vivid Language:

Engage the reader with descriptive language that brings your experiences to life. Show, don’t tell, by using evocative imagery and specific examples.

5. Edit and Proofread Rigorously:

A well-written essay free from grammatical errors and typos demonstrates professionalism and attention to detail.

6. Seek Feedback from Mentors:

Before submitting your essay, ask trusted mentors or professors to review your work and offer constructive feedback.

Nursing Leadership Essay Examples: Inspiration from Leaders

To further inspire your own writing, here are some examples of how different leadership styles and experiences can be effectively conveyed in a nursing leadership essay:

Example 1: The Transformational Leader

• Theme: Empowering a team to achieve a shared vision.
• Experience: Implementing a new patient care model that prioritized patient-centered care and increased staff satisfaction.
• Impact: Improved patient outcomes and reduced staff burnout.

Example 2: The Servant Leader

• Theme: Prioritizing the needs of others and fostering a collaborative environment.
• Experience: Mentoring a new nurse during a challenging patient care situation.
• Impact: Enhanced the new nurse’s confidence and contributed to positive patient outcomes.

Example 3: The Visionary Leader

• Theme: Identifying future trends and implementing innovative solutions.
• Experience: Researching and implementing a new technology that streamlined patient care and improved efficiency.
• Impact: Enhanced patient safety and improved staff workflow.

Reputable academic writing websites like Nursing Papers provide well-articulated scholarly article samples that you can also refer to for more inspiration. The platform offers nursing essays, research papers and case studies that can be quite resourceful in writing your own papers.

Common Mistakes in Writing Nursing Leadership Essays

Writing a compelling nursing leadership essay can be challenging. It requires a strong understanding of leadership principles, clear communication, and a focused narrative. Here are some common mistakes to avoid:

• Lack of a Clear Thesis Statement: A strong nursing leadership essay needs a clear and concise thesis statement that outlines the main argument. Avoid vague or generic statements and be specific about your leadership philosophy and its implications.
• Focusing Solely on Personal Experiences: While personal experiences can be valuable, relying solely on anecdotes without theoretical backing weakens the essay. Your nursing leadership essay should demonstrate your understanding of leadership theories and principles, using your experiences as illustrative examples.
• Ignoring the Audience: Remember your nursing leadership essay is for a specific audience, often an admissions committee. Tailor your language and content to address their expectations and the specific requirements of the essay prompt.
• Failing to Proofread Carefully: Typos, grammatical errors, and unclear writing can undermine the credibility of your nursing leadership essay. Take the time to proofread carefully and consider having a trusted friend or colleague review your work.
• Not Demonstrating Impact: A strong nursing leadership essay goes beyond simply describing leadership skills; it demonstrates how these skills have positively impacted others and contributed to the nursing profession.

By avoiding these common mistakes, you can craft a compelling nursing leadership essay that highlights your leadership potential and showcases your passion for the nursing profession. Remember, clarity, focus, and impactful storytelling are key to making your nursing leadership essay stand out.

Types of Nursing Leadership Essays

Nursing is a profession that demands strong leadership skills. From guiding patients and their families through challenging health journeys to leading teams of healthcare professionals, nurses are constantly demonstrating leadership in various ways. This diverse nature of nursing leadership lends itself to many types of essays, allowing students and professionals to explore different aspects of the field. Here are some common types of nursing leadership essays:

1. Personal Leadership Philosophy: These essays delve into an individual’s personal values, beliefs, and approaches to leadership. They often discuss the core principles that guide their actions and decision-making as a nurse leader.

2. Case Study Analysis: These essays involve analyzing a specific situation or case study related to nursing leadership. They can focus on a particular leadership challenge, a successful leadership initiative, or an ethical dilemma encountered by a nurse leader.

3. Leadership Theory Application: These essays explore how different leadership theories and models can be applied in real-world nursing practice. Students might analyze the strengths and weaknesses of various approaches and discuss their preferred leadership style based on specific contexts.

4. Transformational Leadership in Nursing: This type of essay focuses on the importance of transformational leadership in fostering positive change within the healthcare system. It might delve into strategies for motivating staff, promoting innovation, and improving patient care.

5. Ethical Dilemmas and Leadership: These essays examine ethical challenges faced by nurse leaders and explore how they can be addressed. They might discuss navigating conflict of interest, advocating for patient rights, or promoting ethical decision-making within a healthcare team.

6. Future of Nursing Leadership: This type of essay explores the evolving landscape of nursing leadership. It might discuss emerging trends, challenges, and opportunities for nurse leaders in the future. It can also consider the impact of technological advancements and changing healthcare systems on leadership practices.

7. The Role of Nurses in Advocacy: This essay explores how nurses can advocate for their patients, their profession, and the healthcare system as a whole. It highlights the importance of nurse leaders in advocating for policy changes, resource allocation, and improved patient outcomes.

These are just a few examples of the many types of nursing leadership essays that can be explored. Each type offers a unique opportunity to engage in critical thinking, reflection, and analysis of leadership principles in the context of nursing practice.

By exploring different aspects of nursing leadership essays, students and professionals can deepen their understanding of leadership concepts, hone their writing skills, and contribute valuable insights to the field. Regardless of the specific type, nursing leadership essays play a critical role in advancing the profession and fostering a more effective and compassionate healthcare system.

An engaging nursing leadership essay is a powerful tool for showcasing your commitment to professional development and your vision for the future of nursing. By understanding the core elements, crafting a compelling narrative, and seeking feedback, you can create an essay that leaves a lasting impression and helps you advance on your path to nursing leadership.

Remember, the essence of leadership lies in serving others and making a positive impact. Through your essay, let your passion for nursing shine through, demonstrating your ability to inspire, guide, and lead with compassion and integrity.

Get the Best Nursing Leadership Essay Writing Service

At phdnursewriter.com , we provide the best nursing leadership essay writing service to put you on the right path to academic success. Our service covers topic suggestion, paper writing, proof reading and editing, plagiarism check and removal. We guarantee an original and compelling nursing paper that will make you stand out from the rest.

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Nurturing Leadership: 4 Key Strategies for Reflective Practice in Nursing

5 min read • February, 21 2024

Nursing leaders play a pivotal role in guiding change to enhance patient care and improve professional practice environments. Reflective practice stands out as a cornerstone for effective leadership, allowing nursing professionals to evaluate their experiences critically and foster continuous improvement. This article delves into four key reflective practices that can empower nursing leaders to drive meaningful change.

The Power of Reflection in Nursing Change

Reflective practice is more than a method; it's a mindset that enables nursing leaders to learn from their actions, make informed decisions, and engage their teams in the journey towards excellence. By incorporating reflective practices into their leadership approach , nurses can better navigate the complexities of healthcare, adapt to challenges, and implement strategies that align with their goals and values.

Understanding Your Change Goals

Q: What did you say you were going to do? A: Begin by revisiting your initial objectives. Clear articulation of your goals lays the foundation for accountability and sets the stage for impactful change. Reflect on the scope of the changes you envisioned and the outcomes you aimed to achieve. This honest appraisal is your first step towards meaningful progress.

Assessing Your Actions

Q: What did you actually do? A: Reality often diverges from our plans. Assessing your actions with candor enables you to identify discrepancies between your intentions and your actual practices. Acknowledge both your achievements and the areas where you fell short. This recognition is crucial for realistic self-assessment and sets the groundwork for authentic growth.

Learning from Experience

Q: What did you learn? A: Every step in the change process offers valuable lessons. Reflect on the insights gained from your experiences and how they can inform future strategies. These lessons are the silver lining, providing clarity and direction for your next moves.

Planning Your Next Steps

Q: What do you need to do next? A: Armed with new knowledge, plan your forward strategy. Consider who needs to be involved, the resources required, and the timeline for implementation. This step is about translating insights into actionable plans that drive further change.

Incorporating Reflective Practice into Your Routine

Integrating reflective practice into your leadership routine doesn't have to be daunting. Start small with regular reflection sessions, encourage team discussions that foster collective learning, and set aside time for personal and professional development. Embracing reflection as a habit can transform your leadership approach and significantly impact your team's performance and well-being.

Reflective practice is an invaluable tool for nursing leaders seeking to navigate the complexities of healthcare and drive positive change. By focusing on these four essential aspects of reflection, you can enhance your leadership effectiveness, improve patient care , and foster a culture of continuous learning and improvement . Start today by taking a moment to reflect on your practice and empower yourself and your team for the challenges and opportunities ahead.

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Leadership and Management: Reflection Essay

• To find inspiration for your paper and overcome writer’s block
• As a source of information (ensure proper referencing)
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Nursing is a multifaceted profession that includes specialists in many areas related to healthcare and administration. The qualifications of a DNP-prepared nurse are built on one’s experience working with patients and other professionals and are rooted in the values of nursing. However, they are also strengthened by education that includes such areas as collaboration, business, leadership, and advocacy. Thus, DNP-nurses have to gain a deeper insight into the state of healthcare locally and nationwide in order to understand their place in changing the existing system for the better. The materials reviewed in this course challenged my view of communication, marketing, and business strategies as valuable to becoming a nurse leader.

During the course of education to become a nurse, students are taught how to work in a team of other specialists – nurses and other healthcare providers – who have their own expertise and priorities. Nevertheless, the DNP-level education urges future nurse leaders to consider the process of building such relationships and maintaining them on an organizational scale. Leadership in clinical practice requires one to improve collaboration and communication skills, find a connection with other professionals and establish networks built on trust and respect (Tussing et al., 2018). This knowledge is necessary when a nurse is a part of the team, but it is invaluable if the nurse is a team leader. Thus, when learning about intra- and interprofessional collaboration, I tried to learn as much as possible to understand how relationship building changes from the leader’s perspective.

Another important point that I had to arrive at was that DNP-prepared nurses had to balance patient care and organizational needs. As leaders and advocates, DNP-prepared nurses partake in financial, marketing, business, information, and other types of management in the organization where they work. Therefore, it is vital for them to learn how to pay attention to patient needs, nurse advocacy, and organizational goals at the same time (McCauley et al., 2020). Moreover, nurses should ensure their professional objectives continue protecting and helping the community they serve. The quality of life of the population and people’s health should remain at the center of any activity that nurse leaders perform, although their actions may not always impact patient health directly.

Furthermore, the doctoral degree for nurses opens up new possibilities for advocacy and quality improvement. Serving on task forces, councils, and boards gives nurse leaders a chance to impact the research and actions related to nursing, population health, environment, and more. DNP-prepared nurses have a unique skill set and expertise that combines real-life practice and interaction with people, as well as an in-depth theoretical background. Nurse leaders can provide valuable insight and advocate for healthcare providers and patients with the goal of improving working conditions and health outcomes at the same time.

Looking back at the material covered in this course and reflecting on my learning, I believe that this knowledge has significantly contributed to my future as a DNP-prepared nurse leader. It is clear that leaders must have a diverse skill set that supports the many positions they need to fill. For example, DNP-prepared nurses may enter a role of a guide, mentor, consultant, advocate, manager, expert, and much more. Thus, the education for this level also requires one to review the healthcare system and the profession of nursing from a specific angle that highlights the organizational side of all activities. This course provided a strong foundation for building relationships, setting organizational goals, finding a balance between objectives and needs, and taking on a leadership role in a group.

McCauley, L. A., Broome, M. E., Frazier, L., Hayes, R., Kurth, A., Musil, C. M., Norman, L. D., Rideout, K. H., & Villarruel, A. M. (2020). Doctor of nursing practice (DNP) degree in the United States: Reflecting, readjusting, and getting back on track. Nursing Outlook , 68 (4), 494-503. Web.

Tussing, T. E., Brinkman, B., Francis, D., Hixon, B., Labardee, R., & Chipps, E. (2018). The impact of the doctorate of nursing practice nurse in a hospital setting. JONA: The Journal of Nursing Administration , 48 (12), 600-602. Web.

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Developing effective nurse leadership skills, denise major deputy director of nursing, salisbury nhs foundation trust, salisbury, wiltshire, england.

• To enable you to outline the various types and characteristics of leadership

• To understand the importance of effective nurse leadership and its effect on patient care

• To identify ways to enhance your leadership skills and apply these in your everyday practice

Leadership is a role that nurses are expected to fulfil, regardless of their job title and experience. Nurses are required to lead and manage care as soon as they have completed their training. However, the development of leadership skills and the associated learning can be challenging, especially for less experienced nurses and those at the beginning of their careers. This article examines the importance of effective leadership for nurses, patients and healthcare organisations, and outlines some of the theories of leadership such as transformational leadership. It also details how nurses can develop their leadership skills, for example through self-awareness, critical reflection and role modelling.

Nursing Standard . doi: 10.7748/ns.2019.e11247

Major D (2019) Developing effective nurse leadership skills. Nursing Standard. doi: 10.7748/ns.2019.e11247

This article has been subject to external double-blind peer review and checked for plagiarism using automated software

@denisemajor4

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None declared

Published online: 07 May 2019

clinical leadership - leadership development - leadership frameworks - leadership models - leadership skills - transformational leadership

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Good leadership means better care

“Show me the environment and I will tell you the kind of leadership in that place. If staff are smiling and welcoming it’s because the leader is smiling and welcoming. Staff follow the leader as role model, and the leader’s relationship with their team translates into making such a big difference to the care provided.”

Wendy Olayiwola, National Maternity Lead at NHS England and NHS Improvement

For safe, kind, effective care to be delivered, good leaders are crucial.

Leadership covers a wide range of behaviours and ways of working such as speaking up to advocate for patients or to raise concerns, supporting teams working in pressured environments and creating inclusive working environments for people from a diverse range of backgrounds.

Leaders can be found at all levels in nursing and midwifery. All leaders promote effective management and act as positive role models for best practice in the delivery of care by teams and organisations. 

What leadership means to me

Leaders in nursing and midwifery share their reflections on what leadership means for them, and how good leadership supports teams to deliver the best possible care.

What do nursing and midwifery leaders think is important to look after their teams, and help them deliver the best possible care? Read the below reflections to learn from a range of views and experiences.

How leadership supports better care

Fortune says leaders must create an inclusive environment for a flourishing diverse workforce. This also comes down to how leaders listen and respond to concerns.

“A sense of belonging and being included is really important to me, as somebody from the global majority. A leader always needs to consider, how can I make people feel part of my team, of the institution I’m leading, of the decisions being made? Your behaviours can make people feel they matter and are valued.

“It’s about how you talk to people and importantly, how you listen and respond when people come to you with concerns.”

It is also vital that leaders demonstrate cultural intelligence to understand their teams, as well as the people their teams care for.

Fortune said: “In nursing and midwifery where you have so many internationally educated or internationally recruited people, leaders need to have cultural intelligence in terms of equality, diversity and inclusion so they can best support the diverse workforce.”

Fortune urges leaders to be more proactive in supporting internationally educated nurses and midwives to reach senior positions.  

“We’ve heard enough about people being excluded or discriminated against. At this point, good leaders are asking, ‘what are we doing about this?’ If we are saying someone is not ready to go into a senior leadership position, let’s understand what their needs are, and create leadership programmes to support them so the picture can change in a positive way.

Linked to this is the importance the NMC’s standards place on cultural awareness and how this can impact on outcomes for people receiving care :

“Anti-racism should be a priority for leaders today. They need to be more proactive, stand up and make it count. Let’s have more allyship training – a lot of our colleagues are not intentionally discriminating – they need help to understand some of the prejudices they may not have been aware of.

“If somebody feels they are being treated differently, because of the way they look or how they sound, we need to listen and believe them. Let’s validate how people are feeling, otherwise people stop reporting it and nothing gets done.”

For Fortune, good leaders never lose sight of people as individuals, and always take into account the feelings of others.

“It’s really important that leaders think about people’s health and wellbeing, have the right wellbeing support services in place, and listen and support people.”

“Seeing people as humans goes a long way. Maya Angelou said ‘ people will forget  what you said,  people will forget  what you did, but  people will  never  forget  how you made them feel.'”

Fortune Mhlanga is Deputy Head of Nursing in Buckinghamshire. She is passionate about ensuring everyone feels valued and included as this impacts staff well-being in a huge way and there is a direct link between staff well-being and quality and safety of care. Also, teams where everyone has s sense of belonging perform better, have a better safety culture where people feel psychologically safe to raise concerns and improve care. Fortune has a background in mental health nursing

“A good leader is a good listener who allows their team members to be themselves, to express their ideas and opinions. A leader is someone who creates opportunities for others. I believe in nurturing potential for everybody, whether it is teaching new skills, encouraging the expression of ideas or advocating for colleagues.”

Lincoln’s ethos includes listening to and supporting everyone, whatever their role or background, and helping the team to meet the diverse needs of communities.

“Demonstrating leadership means engaging with colleagues in a positive and constructive way so we can build relationships regardless of who they are or if they have a different background. “I want to support every single person who comes in the Trust. Being inclusive means including everybody to meet diverse needs. There are different communities but for me, being there for everybody means seeing people as individuals.”

Lincoln knows the wellbeing of his team is important in order for them to deliver the best possible care for people – particularly in difficult periods such as winter. He makes sure his door is always open and has set up a support booking system for staff members, but he also offers alternatives.

“Being accessible and offering support when it’s needed is so important,” he said. “I am going into clinical areas as well, to offer that 1:1 support to our preceptors. I also signpost people to our wellbeing teams. “This initiative has been getting so much feedback – whether it’s a struggling student thinking about withdrawing from a course or a staff member, they just want someone to listen. I believe our workforce needs this support.” 

Placements can be demanding for students and they need plenty of support from their supervisors and assessors in order to learn effectively and deliver good care on their placements.

 “The real work is meeting the student who is struggling and asking them how they are they feeling today. And letting them know it’s OK, we are going to help. “We need to harness those students who are motivated and encourage them to go far – and help them stay in a positive frame of mind that’s focused on our patient experience.”

Lincoln says he was fortunate to have good support as a student, and wants to pass that support on to his team now. Good preceptorship when they join the register can also support with staff retention and good care.

“We all need that support to help us to see our way through things and that’s what I’m trying to do. My vision is to create a strong network so all our students feel better known and understood, are helped to find their purpose and supported to be the best they can be.”

Lincoln Gombedza is an award-winning Learning Disability Nurse with a passion for integrating digital technologies in nursing and through his work developing education and training programmes for North Staffordshire Combined Healthcare NHS Trust. Lincoln is a member of the NHS Digital Decision-Making Council, and involved in the Florence Nightingale Global Innovation and Entrepreneur Group, among others.

You can learn more about the importance of student supervision and assessment by watching our animation at Standards for student supervision and assessment - The Nursing and Midwifery Council (nmc.org.uk)

For Martyn, good leadership means focusing on the outcomes, and treating everyone fairly. 

“I think great leaders don't set out to be leaders, they set out to make a difference and help others. “They’re the ones that treat everyone the same, regardless of their job title or perceived status.” 

Listening to patients and speaking up for them is a core skill for leaders at all levels, he says – and crucial for delivering the best possible care.

“Leadership is especially important when it comes to the people in your care - being their voice when they most need it. It can take courage to speak up for what you know is right for the patient or for your team, particularly if you’re not in a senior role – but speaking up is real leadership.”

Martyn believes leaders need to provide close support to teams working under pressure. Small actions and fostering a strong team spirit goes a long way.

“Teams caring for very vulnerable people often find themselves in highly stressful situations,” he said. “They need their leader to ensure they’re supported emotionally and physically and managed in the best interest for everyone, including the patient and staff. Experience supporting patients with mental health issues, cancer diagnoses or people dealing with bereavement has taught Martyn to ‘find the happiness amongst the sad bits.’ “At very difficult times, a leader will help their team to find that diamond and buff it so it sparkles. Sometimes the small things can make such a big difference. I remember coming out of a stressful situation to find the leader waiting with a cup of tea, ready to talk. That human approach is key. “At the end of a tough shift, you wait for that last person to come through the door, and then we all go out together.”

Leaders need to be accessible to their teams and encourage their desire to learn – this helps teams to deliver the best possible care for people

“Leaders understand there is no such thing as a silly question, and it’s okay to ask. If you've got a question, just ask and I'll help guide you in any way I can. For me, that’s what a leader is. “Good leaders recognise it’s important to support everyone and help when needed. Enabling others is the most important part, it’s what nursing is all about. I always refer to that Marvel quote: ‘with great power comes great responsibility’.”

Martyn Davey was one of the first wave of trainee Nursing Associates. He now works in General Practice and is a Visiting Lecturer at Birmingham City University. Martyn set up a national network supporting more than 5,000 TNA and RNAs on Facebook.

For Paul, prioritising people is fundamental and that means ensuring staff have the support they need to care for people as well as they can – especially through difficult periods such as Winter Pressures.

“Nurse leaders need to prioritise how they treat their most vital resource – their staff. If you don’t look after nurses, especially newly-qualified nurses, and give them support and guidance, then you’ll never see their full potential.”

Paul feels leaders need to advocate for staff to be able to access the support they need – and that this has a direct link to them being able to provide safe care for patients.

“Giving nurses the chance to share and reflect, and get support for the challenges they face, has been absolutely vital in my experience. If nurses can’t access clinical supervision and support, they can get burnt out. And this carries a risk to patients. “As a leader you realise you have to make that happen, it doesn’t just happen naturally. So you have to take away the barriers, be brave at the boardroom table, and build it into your operational plans.” “Being conscious of moral injury is part of my leadership values. If we don’t make the space for nurses to have the right support and supervision, the teams we support can become very susceptible to moral injury and this has an impact for patients. As leaders, we let nurses down when we don’t provide that space. “Leaders need to understand clinical supervision and support as a priority – you can’t deliver safe, effective care without it.”

Paul sees creating a supportive culture with an ‘open door’ to leaders as key to enabling learning. That means demonstrating your humanity and treating people with respect so they realise there’s a leadership culture that cares for them.

“The dementia specialist Admiral Nurses  on our helpline and in our clinics have access to an immediate debriefing after a challenging call or appointment,” he said. “They can check how they did, and get support.  That’s not usual – and leaders need to make it more usual. Being able to chat and reflect really helps with the complex situations nurses are dealing with. “We also encourage nurses to support each other. If I’ve got a really challenging situation, I’ll find the person who knows more than I do, and ask them. As a leader you think you should know it all and can’t ask anybody else, especially someone junior to you – that’s nonsense. “Nurse leaders have to prioritise creating those cultures of support and learning or you’re not only missing a trick, you’re putting patients at more risk than they need to be.”

Paul is a nurse who specialises in dementia care, with 25 years’ experience working across the NHS, academia and the independent sector. At Dementia UK he is responsible for the development, governance and growth of clinical services, helping to ensure services are run to provide safe and effective care and support to people with dementia and their families.

“Leadership is about showing we advocate for women and they have choice. And enhancing our midwives’ knowledge, skills and confidence to provide that care. “Advocating for women is a key part of the midwife’s role. Being that woman’s voice in her journey is vital to what we do, and having that partnership with women is the joy of being a midwife.”

For Shona, providing positive feedback is beneficial to midwives and the care they provide.

“It’s important to pause, and give positive feedback, saying ‘that woman really appreciated what you did for her’. We can’t expect midwives to provide high quality, safe care unless they feel psychologically safe themselves.”

Shona aims to be accessible and build good relationships so that individuals and teams feel able to speak up with any concerns. 

“Good communication and team work is critical. It’s key for leaders to foster positive relationships with their team because you want people to be able to speak out. And you need to listen effectively and be responsive.”  “We talk a lot about women in maternity services being heard, and that’s really important. The same goes for our staff. “As a leader, your team needs to feel safe and secure that you are an accountable leader, and you are going to do the right thing.”

In Shona’s view, the NMC’s standards and Code could help teams working in pressured environments to feel supported

“We need to bring the Code and standards to life, to show how we can use them to enhance what we do or for guidance, to look at our services to see how we are meeting the standards.”

Shona thinks self-reflection can help leaders learn to accept challenge.

“It can take time to learn to accept challenge and not to see it as a personal attack. Leaders need to recognise they don’t know everything all the time, sometimes change comes from the ground up. “Self-reflection is important: ‘Am I really listening?’ ‘Am I allowing this challenge or cutting it off?’. I don’t think we can champion reflective supervision if we are not prepared to be that practitioner ourselves.” 

She wishes for all midwives to be able to receive the support that was critical to her own career progression.

“Early in my career there was a very senior midwife in Northern Ireland who provided me with a listening ear, encouragement and challenging feedback. That support is so beneficial when you’re trying to progress and become a leader, we should look to provide that to midwives over the course of their careers. “Midwifery is such a lovely career and it’s hugely rewarding – I can’t say that strongly enough. There is something about being there at that moment of birth and new life, of helping create a new family that is really very lovely. “There really is nothing like it.”

Shona Hamilton is consultant midwife at the Northern Health and Social Care Trust and Queens University Belfast. She qualified as a nurse and then a midwife and has worked in a variety of posts within nursing and midwifery during her 30 year career. Her professional and academic interests lie in public health, intrapartum care and perinatal mental health.

For Wendy, good leadership is about embracing and valuing diversity. That means talking to your team, and taking an interest in different cultures and backgrounds.

“The job for leaders is very simple: know your team - who they are and their background, appreciate them and their culture, “You don’t have to know everything. All you need to do is respect them and talk to them. Facilitate the conversation for all staff – whether they’re from Scotland or a country in Africa – to be able to talk about their culture and values, what their beliefs are.”

Wendy feels good leaders go further, to help empower their teams to be aware of the cultural needs of the people they care for. This helps nursing and midwifery professionals to really tailor care to the needs of the person they’re caring for

“This empowers staff to talk about what is not talked about. When we have that culture it in turn empowers the team to have those conversations with people in their care, which is so beneficial to their experience and to safety. “Being compassionate should cut across everything we do. Leaders have to learn how to provide fair and equitable support to all colleagues, from all backgrounds.”

Wendy believes the care patients receive is directly linked to the behaviour that the leader role models.

“Show me the environment and I will tell you the kind of leadership in that place. If staff are smiling and welcoming it’s because the leader is smiling and welcoming. Staff follow the leader as role model, and the leader’s relationship with their team translates into making such a big difference to the care provided.” 

For Wendy, a diverse population and workforce needs diverse leaders who respect the contributions of the whole team.

“We have a diverse workforce and population, if there is also diversity at the leadership level it will flourish in the workforce and we can reflect the culture and values of the communities we serve, in the care we provide. It reduces the disparity in equality that we currently have. “A diverse and multi-disciplinary leadership that listens to different perspectives brings together knowledge and expertise to provide culturally sensitive care. “A diverse team is an excellent team and different values and opinions make it colourful and beautiful. Diverse teams have so much positive impact for the people in our care and their families.

Wendy Olayiwola is a registered nurse and midwife with more than two decades serving community and public health. She has received multiple awards including the British Empire Medal for services to the NHS and Equality during the Covid-19 response. Wendy is passionate about promoting equalities among Black and minority ethnic groups and supporting and empowering nurses and midwives to provide culturally sensitive and holistic care for women and their families.

“Good leadership relies on communication, and creating an open culture that spans the whole adult social care community.   “It’s about involving people in their care planning so they are at the centre of everything that happens. It’s making sure team members know what’s going on and bringing them on the journey with you.    “As a leader, it’s also imperative to get the right relationships and communication channels between members of your multi-disciplinary team. Building relationships across all members of the health and social care team benefits care for residents.”

In Zoe’s view, leaders need to set an example and enable supportive teams working in pressured environments.  

“You don’t know everything people have going on in their lives, in addition to any work pressures. Good leaders make time to ask team members how they are doing, if they need help with anything, and allow team members to ask each other those questions as well. I believe ‘it’s OK not to be OK’.”

Zoe believes there is more potential to involve and support the wider community in adult social care.

“Debriefing is incredibly important. It may involve revisiting an incident weeks or even months later. Consider including the community – following an incident, we offered group counselling and invited relatives to attend, too – they’re very much part of the team. “Everyone benefits when you bring in the community. Families can play a critical role and they also gain a greater understanding and ability to support a loved one. Volunteers are also important, and they aren’t used enough.”

She believes acknowledging where you need help is core to good multidisciplinary working that makes sure people receive the care they need.

“To achieve good multidisciplinary working you need to build confidence on all sides.  There’s a need to let down barriers and show vulnerabilities.  Nurses in adult social care deal with a wide range of situations – you can’t know everything. We should be proud of what we do, and call on professional expertise when we need it. “Ultimately, people need to involve the right person at the right time to ensure safety. Good leaders build relationships that enable teams to contact specialist nurses or consultants if they need to.”

In Zoe’s view, good delegation is vital to empower teams and to ensure patient safety.

“Good delegation improves safety. If leaders don’t delegate effectively, they risk burn out for themselves, and losing the respect of their team who are not empowered to take things forward.   “Recognise what people can do, and give them the support and tools to do it. It doesn’t have to be another nurse or carer. If you have a chef who is amazing why not have them lead on nutrition and hydration within the home? “It’s about delegating to the right people, and enabling them to do what they do really well.”

She thinks it’s important for people in leadership roles to have support from peer networks.

“I’d like to see more informal coaching and support across adult social care organisations. I recommend leaders find that person or group they can talk to because they need support too.”

Zoe Fry OBE is a Director of the Outstanding Society Community Interest Company who shares and celebrates best practices across Social Care while helping others improve. A registered nurse, she started her career in the NHS before purchasing a nursing home and achieving Outstanding ratings from the CQC. In 2023 Zoe was awarded an OBE in the Kings Birthday Honours List in recognition for Services in Social Care and Services to Nursing.

For Karen, leadership occurs at all levels in organisations, and takes many forms.

“I believe we’re all leaders and leadership comes at every level.” “For me, being compassionate, open, authentic, approachable and inclusive are the most important leadership traits along with being willing to evolve and adapt.” “As a leader it’s important to surround yourself with people who are really good at what they do – better than you in some ways. They are here to advise and support the leader with their expertise, and the leader supports them to do their jobs well, and learns from them at the same time.”

In Karen’s view, the NMC’s Code and standards provide a guide for nurses and midwives in all situations.

“The health service is all about people so it’s right that they are also central to our standards which underpin what every nurse and midwife does, at all levels in an organisation. The standards are inter-connected, they provide a national framework people in our profession can lead from, and work from.”

Karen sees a direct link between good leadership and patient care.

“Leadership is integral to good care. If you lead well and look after your colleagues, your patients will get good care. People who feel valued will work to the best of their ability.” “As you become a more senior leader there’s a feeling you can get further away from the patient – you have to understand how much you continue to influence their care. I hold to the idea if I can no longer be hands-on with patients, I am still able to do that by appointing the best people and leading in a way that enables those giving direct care to do their best. I call it my tentacles! “And I make myself visible – leaders have to engineer their time to be visible and accessible.”

Karen thinks leaders need to be present, and honest in order to best support teams working under pressure.

“When teams are working under pressure, a leader needs to be present, acknowledge the reality of a difficult time and share honest reflections. Show compassion and humanity – it enables teams to speak up.”   “It’s for leaders to inspire and motivate people, asking ‘how do we work together to enable us to give our best, and look after ourselves at the same time?’” “Make sure to thank people for working through difficult times.”

Additionally Karen believes leaders have to support professionals who arrive from come from other countries to join the UK workforce:

“The NHS is built on internationally educated nurses and midwives and we have to challenge ourselves to think about how wider society supports these people, holding ourselves responsible for the way they are integrated and how they are treated.” “It’s important for us to remember we need them, we ask them to come, and we should show understanding and gratitude for the sacrifices they’re making. They’ve left their loved ones, their people to be here, and care for our communities.” “There aren’t many Chief Nurses from diverse backgrounds and I don’t know what it’s like to come to the UK from a different culture. I know what it was like for my parents losing loved ones overseas, and not being able to be there with them. I remember not being accepted for the colour of my skin as a little girl. The White British experience will be different - that’s why listening, really hearing people’s experiences, and learning is important.”

Karen Bonner is Chief Nurse and Director of Infection Prevention and Control at Buckinghamshire Healthcare NHS Trust. She is a Member of the General Advisory Council at the Kings Fund, a member of the Nurse Executive Council at the Beryl Institute and a Trustee of Helpforce – gaining recognition as a Burdett Hero by the Burdett Trust for Nursing, in 2022. Highly commended for her work in diversity and inclusion, she is regarded as one of the 50 most influential Black, Asian and minority ethnic people in health.

For Hilary, leading in challenging times calls for compassion, and courage.

“You have to have courage to show compassionate leadership when there may be lots of pressure to ‘fix things now’.   “A more courageous approach is to improve the culture – that means working alongside people rather than in a ‘top down’ management style, having honest conversations and delivering difficult messages in a supportive way. “If you allow teams to come up with their own solutions , you get a responsive, self-directed culture where teams are much more innovative.” “Being authentic – true to your professional and personal values – is key for leaders. Your values as a nurse, together with your professional accountability and responsibility, come to the fore when you are tested through challenging times.”    “As a Chief Nurse, it’s balancing being clear and directive, setting high standards but also being kind and compassionate, and brave enough to take everyone with you.” “My job is simply to support people to be the best they can be and provide the best care. It’s making sure staff know they and their wellbeing are valued. Encouraging them to take a lunchbreak – it’s a small thing - but it’s really important.”

She considers psychological safety is crucial  to encourage teams to raise concerns.

“Leading teams is about creating psychological safety, and a compassionate culture. We’ve introduced a restorative learning culture approach where people are not afraid to report concerns and speak up. This makes patient care a lot safer – and if leaders know where there are concerns they can take steps to improve.” 

In Hilary’s view, collective leadership creates better solutions

“For me, leadership is all about improving care for patients, and collective and distributed leadership are really important.  It’s not one person, it’s all of us all working together, and in partnership with patients.” “Shared governance and decision-making – it’s not telling people what to do – but working with them to support them – because they often know best how to fix it.” “Because we’ve taken this approach, we’ve changed the culture, we’ve changed mindsets and invigorated people’s passion.  As a result, our work on nutrition and hydration has gone beyond anything we might have done had we taken a process approach. “By enabling  teams to share decision making and ownership and accountability around care, they came up with so many ideas – from daily allocation of additional staff for  patients in need of assisted feeding, to encouraging people to focus on nutrition and hydration – our ‘Food for Thought’ and a ‘Sip Sip Hooray’ campaigns have become mantras. Most importantly, our patient survey results (including for nutrition) have gone up – something we’re really proud of.” “When you get everyone involved in this way, people don’t feel there’s another new initiative they have to do, the initiative comes from them. For me, that’s the right approach  – we are all leaders, and the senior team is there to support the leaders to do the right thing.”

Hilary thinks supporting internationally-educated nurses is integral to a compassionate culture.

“It feels easier to support our internationally-educated nurses because we have a compassionate culture. When they arrive, we get their shopping for them – making sure they’ve got everything they need, and feel at home. We put on social events so they feel part of the community and are well-supported by their mentor and ward managers. We know recognising everyone’s culture is important. An international educated colleague recently said, ‘We’ve got our family at home but we’re part of the South Tees family.’”

Leaders need to role model good relationships to create good multi-disciplinary teams

“As a senior team we’ve got a responsibility to make sure we work well together, providing a role model for the rest of the organisation on multi-professional working. Together we promote the restorative and learning culture. It’s about respecting we’ve all got different strengths.”

Hilary believes collective leadership, with all staff working in partnership with patients, leads to better care.

“With shared leadership and decision-making you are going to the heart of the organisation  to make decisions. It’s brave, because it can feel as though you have less control – but it creates a richness – staff know they are supported to make decisions in partnership with patients. It makes patient care better, safer, and a happier experience.”

Hilary Lloyd is Chief Nurse at South Tees NHS Foundation Trust. She is also Chief Nurse Clinical Research Network NENC and a Visiting Professor at the University of Sunderland. Hilary qualified in 1989 and has held a number of nursing posts including in acute healthcare, education and research. Most recently she served as director of nursing, midwifery and quality at Gateshead NHS Foundation Trust.

Leadership webinar

Three of the leaders who shared their experiences as part of the campaign joined us for this webinar:

• Fortune Mhlanga – Deputy Head of Nursing in a Mental Health Directorate
• Shona Hamilton – Consultant Midwife
• Paul Edwards – Director of Clinical Services, Dementia UK

Resources to support you

Our Code and standards can support all nurses, midwives and nursing associates to be good leaders. To learn more about some of the key themes covered in these case studies, you can also use the following NMC resources:

Being accountable means being open to challenge. It means accounting for and being held to account for your actions, and being able to confidently explain how you used your professional judgement to make decisions – even in complex and challenging situations.

To find out more, watch our  Caring with Confidence  animation

Nursing and midwifery professionals deliver fantastic care for people but no-one can do everything on their own. So, leaders need to know how to delegate safely and with confidence.

To find out more, watch our  Caring with Confidence  animation

Our leadership case studies show that being inclusive and challenging discrimination is crucial to providing the right environment for the best possible care.

Everyone has the right to dignity and respect, and to feel included. Professionals on our register should feel confident about challenging discrimination wherever they see it. To do this, they need leaders to create an environment where they feel safe to do this.

To find out more, watch our  Caring with Confidence animation  and read the  anti-racism resource  produced by NHS England, in partnership with NHS Confederation and the NMC.

Good leadership is always important for delivering the best possible care – but these case studies show how that’s particularly important at busy and difficult times, such as during winter.

Last year we published a  joint letter  with the UK’s four chief nursing officers and the CQC to help leaders and professionals during winter pressures.

Martyn and Shona both explained the importance of listening to the people you care for and advocating for their needs.

Our midwifery resources  The best care happens in partnership  explain why listening to and working in partnership with the women in your care is key to the person-centred midwifery care that every person has the right to expect. You can read the stories of women who have recently given birth and use our CARE aid to reflect on your practice.

Listening to people you care for and acting on what you hear is just as important for nurses and nursing associates as well.

Nurses, midwives and nursing associates are often best placed to recognise things that might create risk or cause harm to people.

We want you to feel confident about raising concerns, and speak up if you see something you feel isn’t right.

To find out more, read Shona’s case study above or watch our  Caring with Confidence  animation .

All nurses and midwifery professionals need the support of good leaders to be able to provide the best care they can. This is particularly true for students and people who are new to the register, as Lincoln and Fortune explain above.

Our  Principles for Preceptorship  help leaders welcome and integrate newly registered professionals into their new team and place of work. It helps these professionals translate their knowledge into everyday practice, grow in confidence and understand how to apply the Code in their day to day work.

And our Standards for Student Supervision and Assessment (SSSA) set out the roles and responsibilities of practice supervisors and assessors, and how they must make sure students receive high-quality learning, support and supervision during their practice placements. The resources on  our SSSA page  include an animation, a webinar and a link to our SSSA Supporting Information hub.

• Last updated: 09/05/2024

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Leadership Management and Team Working for Professional Practice

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