The purpose of this reflective report is to describe and demonstrate the effective use of nursing leadership during a critical incident at my work place

Critical incident analysis and Critique

The incident was critical, as it strengthened nurses to provide safety for clients and to provide individual centred care. Reflecting on this incident also demonstrated the value of evidence based leadership skills. The first course of action I took was to report to the registered nurse in charge of my section, whom at the time was caring for another resident, to call an ambulance. I then instructed my fellow nurses to stop pulling the resident off the lifter, due to the fact that they could be causing more harm than good. I then instructed the nurses involved to calm down and stop panicking because it could worsen the situation. I told one of the nurses to get the pat slide transferring board and the other to get the other two nurses on duty to assist with the situation. In this way, there was a division of labour among the nursing staff in dealing with the emergency and, I was acting in the role of a bureaucratic leader.

As nurses, we are accountable to the community to provide safe, effective, high quality care. The Australian Nursing Midwifery Council [ANMC] provides a framework for our practice in the ANMC competencies (ANMC, 2005). One such competency (Element 1:2: 'Fulfils duty of care in the course of practice' (ANMC 2005)) requires that nurses perform interventions following adequate, accurate assessments and recognises the responsibility to prevent harm. As we can see that this critical incident occurred due to improper use of the sling, which is negligence, therefore it may be questioned whether our duty of care to him was breached. And also in relation to our own nursing and leadership practices, the evidence insight in this report is the ANMC competencies (Element 1:3) which recognises and responds appropriately to unsafe or unprofessional practice which involves identifying interventions which prevent care being compromised and follow up incidents of unsafe practice to prevent reoccurrence (ANMC, 2005).

By analysing the critical situation, it is plain to see how bureaucratic style leadership was effective in handling the situation. The allocation of jobs and following of procedures was effective in dealing with the possibility of further hazards and ensured the safety of the resident and nurses (Palombara, 2006). By taking a leadership role in this critical situation, I was able to see how effective structured guidelines and how designation of jobs is beneficial to getting work done. By remaining calm in this critical situation, I was able to get a glimpse of how I could handle an emergency situation, especially when other workers may start to panic and forget important rules (Lega & DePietro, 2005). By remaining calm and thinking logically I feel I was able to handle the situation successfully and maintain the safety of my fellow workers and the patient involved.

Leadership and Goals

A leader can be defined as someone who can influence others to perform beyond the actions dictated by authority (Robbins, Bergmann, Stagg & Coulter, 2005). These people may either be appointed or they can emerge from a group. Bureaucratic leaders work by following rules and regulations to ensure that procedures are followed exactly (Lega & DePietro, 2005). Bureaucratic style leadership is best suited to situations where there are serious safety risks and where following specific guidelines and adhering to lines of authority is extremely important (Palombara, 2006).

By designating roles for my fellow nurses to carry out, I was decreasing the risk of further injury to the patient and possible injury to themselves. By instructing them to get help before handling the current situation I was following a characteristic of bureaucratic leadership which is to follow formal rules and regulations, which ensures uniformity and regulation of workers (Johnson, 2003). Before handling the patient on the floor, I instructed the nurses to collect towels to wipe the blood which had spilled on the floor. I instructed them to bend their knees as they released the locked bed rail to free her leg and kneel on the floor.

I then told one nurse to lower the lifter while the other three nurses and I assisted the patient off the sling completely. One nurse was instructed to support and bandage the bleeding leg until the ambulance arrived. These instructions were given by me to prevent any further harm coming to myself, the nurses and the patient. By following strict guidelines as characterised by bureaucratic leadership, further injury was avoided as well as any safety hazards removed (Draper, 2002). Division of labour, which is another characteristic of bureaucratic leader, was also shown in the way jobs were given to each nurse to divide up the tasks equally to handle the situation (Bowornwathana, 2006). The ambulance eventually arrived to pick up the patient and she was taken to hospital.

My future goals would be to equip the nursing staff with the knowledge that is necessary in handling such incidents in work place, this can be achieved if the staff are encouraged and willing to update their require skills. Evidence 4:4 of the ANMC competency, uses appropriate strategies to manages own responses to the professional work environment. This includes identification and use of support networks and sharing the experiences related to professional issues mutually with colleagues. This shows that if there is shared knowledge and support networks among the nursing staff such incident could be avoided. In other words, in service programmes such as use of lifter, manual handling and prevention of falls will help to prepare the staff in case of future occurrence.

Conclusion

Bureaucratic leadership is an effective style of leadership in handling situations like the critical incident described in this reflective report. By following specific guidelines and rules and designating jobs as characterised by bureaucratic leadership, the critical incident was handled well and successfully. I learnt from taking a leadership role that I was able to remain calm, think logically in an emergency situation and will hopefully carry this attitude forward throughout my future nursing career.

References:

Alphonso, C. D. (2007). Reflection on a critical incident. Contemporary Nurse, 24, 89-92.

Australian Nursing and Midwifery Council [ANMC] (2005). National Competency Standards for the Registered Nurse, Dickson ACT:Australian Nursing Council.

Bowornwathana, B. (2006). Transforming Bureaucracies for the 21st Century: The New Democratic Governance Paradigm. Research in Public Policy Analysis and Management, 15, 667-679.

Draper, P. (2002). Change in nursing and the introduction of the support worker.

Nurse Education Today, 10, 5, 360-365.

Johnson, M. (2003). Research, teaching or bureaucracy? On the preparation of mentors and lecturers in nursing and midwifery. Nurse Education in Practice, 1, 4, 171-174.

Lega, F., & DePietro, C. (2005). Converging patterns in hospital organization: beyond the professional bureaucracy. Health Policy, 74, 3, 261-281.

Palombara, J. L. (2006). An Overview of Bureaucracy and Political Development. Research in Public Policy Analysis and Management, 15, 193-220.

Robbins, S., Bergman, R., Stagg, I., & Coulter, M. (2005). Foundations of Management. Sydney, Australia: Pearson Education.

Written by Darawatta Alexander Student ID: 13258489

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