Leading and Managing Nursing Care

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TITLE: Leading and Managing Nursing Care


        This assignment will examine a critical incident that occurred in the presence of the author whilst in practice. The incident will be analysed using relevant management concepts and an action plan with a proposal for change will be presented.  The incident took place in a community setting and involves interpersonal skills and management style. Interpersonal skills include leadership, motivation, problem solving, managing change, negotiation skills (McCall and Cousins 1990; Hargie et al 1994; Ellis et al 1995). Management style is a term used to denote the way a manager goes about performing the leadership role (Morris 2001). There are three main approaches to leadership: autocratic, democratic and permissive (O’Connor 1994). Autocratic leadership retains maximum control of goal setting and decision-making and allows minimum participation and discussion among members of a group (O’Connor 1994). The democratic leadership retains minimum control of goal setting and decision-making and encourages maximum participation and discussion within a group (O’Connor 1994). The rational for choosing interpersonal skills for this assignment is to emphasise its importance for today’s managers. According to Morris (2001) interpersonal skills is the most important skill for today’s managers.

        In writing this assignment, I will use both the first and third person in the pursuit of reflexivity (Webb 1992). The Reflective Cycle (Gibbs 1988) will be used as a framework. Furthermore, the assignment will be organised into sections based on the components of the reflective cycle (Gibbs 1988). Pseudonyms will be will be used to maintain anonymity and confidentiality in accordance with clause five of the Nursing and Midwifery Council (NMC) Code of Professional Conduct (NMC 2002).


        As well as managing community nurses in her team and the entire patients case load, Trisha (the district nurse) was looking after several patients during this particular shift. Trisha was just about to leave her office for her first patient when she was called by the nursing manager to attend a meeting. Trisha politely informed the nurse manager that she could not attend the meeting, as she had to look after patients and suggested the meeting be postponed. After visiting a few patients, Trisha came back to the office to find the clinical manager waiting for her. Trisha asked the senior community nurse (Helen) to visit one of her patients as the clinical manager wanted a meeting with her. During their meeting, the clinical manager pointed out that the standard of record keeping and communication (especially written communication) was poor and that this was unacceptable. Trisha acknowledged the criticisms and promised immediate action to improve record keeping and communication. When Trisha came out of the meeting she spoke to all the community nurses present about the meeting asking for their opinion on how to improve record-keeping and communication in general. Trisha then asked me to call the other nursing student and gave us a good lecture on good record keeping and communication in the community environment. When the other student nurse and I came out of the lecture we met Helen having an argument with the junior community nurse (Mark). A patient had called to say that he was not happy with the way Mark had administered the flu jab and that he would not accept further nursing care from Mark. Mark and Helen were shouting at each other. Two other community nurses were listening to the argument. Trisha came out and asked Helen and Mark to stop arguing. She later booked them on a communication skills study day. Trisha then asked for the patient’s number and she called him to find out what happened. Trisha keenly listened to all the patient had to say without interrupting him. She then apologised to the patient and promised to visit him later that day. Trisha took me along when she visited the patient. The patient was very pleased to see Trisha and accepted Trisha’s explanations and apology. The patient also agreed to receive future nursing care from Mark even though he had refused to earlier.  

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        I was surprised that Trisha had to look after patients even though there were meetings scheduled in her diary for that day. I could not understand why Trisha had to cancel her meeting with the nursing manager. I thought she could have brought in another nurse from the nurse bank. On the other hand she may have tried to unsuccessfully. I was very impressed and surprised by the way Trisha accepted the criticisms from the clinical manager. Furthermore, I was also impressed by the way Trisha involved all members of her staff in her decision-making. I was astounded ...

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