Leading and Managing Nursing Care

University Degree Subjects allied to Medicine

K010096

TITLE: Leading and Managing Nursing Care

Introduction

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).

Description

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.

Feelings

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Feelings

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 that Trisha could come up with a comprehensive lecture on record-keeping and communication so soon after the Clinical Managers meeting. When Trisha met Helen and Mark arguing I was expecting her to be annoyed with them. Trisha instead called them into a room praised their past nursing achievements and then put their names down for communication skills study days. I noticed how Trisha Keenly listened to the patient and immediately calmed him down.

Evaluation and Analysis

Research evidence suggests that an effective manager should have a detailed knowledge of all patients in his/her care and one way to achieve this is by hands on nursing care (Douglass 1992; Iles1997). This could explain why Trisha was looking after patients as well as managing the placement area. On the other hand, this could have been due to nursing shortages. There were two agency nurses during the shift. The problem of nursing shortages is well acknowledged within the National Health Service (NHS) (Buchan 1999). Another explanation could have been that as a registered nurse Trisha needed to maintain her professional knowledge and competence by providing nursing care to patients. This is in accordance with clause 6 of the Nursing and Midwifery Council Code pf Professional Conduct (NMC 2002). The fact that Trisha refused to leave her patients (especially when there was a problem) could have been influenced by past negligence cases or because this would not have been best practice.

Castledine (2003) reported that a nurse who left a patient on a bedpan for too long caused the patients skin to break. One of Trisha’s patients was given a phosphate enema earlier and placed on a bedpan. Trisha was supposed to join a second nurse to clean the patient and dress her pressure sores. This is because one of the agency nurses left early due to sickness.

Being able to accept constructive criticisms is one of the characteristics of a good manager (Sullivan and Decker 1997). This could explain why Trisha accepted criticisms from the clinical manager. The importance of the topic in question (Communication and record keeping) could have also distributed to Trisha’s quiet acceptance of the clinical manager’s criticisms. The standard of nurses record keeping now have a direct effect on star rating awarded to NHS trusts (Calpin-Davies 2003). Trisha demonstrated democratic leadership quality by encouraging maximum participation and discussion within her staff (O’Connor 1994). Research studies have concluded that allowing staff to participate in decision making increases job satisfaction and productivity (Lucas 1991; Volk and Lucas 1991; Commack et al 1991; Morey 1996). Although Trisha did not plan a teaching session for this shift, she was able to quickly organise one. This emphasises what Nicklin and Kenworthy (2000) stated; that an effective manager is paramount to a good learning environment. Furthermore, effective managers should be able to think on their feet as Trisha demonstrated in organising an unplanned lecture (White 1993). Trisha demonstrated good practice in calling Helen and Mark to talk to them privately about improving their communication skills. Research evidence suggests that teaching should be conducted in an environment where the learner will not be embarrassed (Cole and Chan 1994; Brandes and Ginnis 1986; Hativa 2000). It is surprising that Trisha did not comment on the argument that happened between Helen and Mark. She just offered them general guidance on communication. Maybe it was her own way of managing the apparent conflict between Helen sand Mark. Cavanaugh (1991) suggests that avoidance is the most commonly used Conflict management strategy. Instead of being annoyed with Helen and Mark Trisha was very supportive. According to Morris (2001); Manning and Curtis (2003) and O’Connor (1994), strategies that should be employed by leaders and managers in the establishment of motivational environment for staff, should include; open acknowledgement of work performances, support and positive feedback that fosters a feeling of self-worth. The use of motivation and reward strategies is necessary for empowerment of staff members in their work situation and can increase job satisfaction and production (Roland 1998; Smith 2003; Calpin-Davies 2003). Furthermore, creating and environment that respects every individual has unique differences is key to recruiting and training a nursing workforce (Frusti et al 2003). When Trisha went to the patient who was involved in the argument, she listened quietly to all he had to say. This demonstrates good listening skills can ensure that both physical and psychological needs of patients are met as well as enhance intuitive nursing practice (Metcalf 1998).

Conclusion

I was first to return to the staff room after the meeting with the clinical manager. I stood by and waited for Trisha while the argument between Helen and Mark went on. I should have suggested to Helen and Mark to stop their argument in front of other nurses. I should have also asked Trisha about her opinion regarding the argument instead of guessing. Doing this assignment has made me aware why Quinn et al (1990); Covey (1992) and Handy (1995) suggested communication skills to be the most important skill for today’s managers. Throughout the shift Trisha was able to motivate and influence her staff only through excellent communication skills and democratic leadership style. However I was amazed to find out how poor communication with nurse-older-person in the community could be. Mark appeared rude whilst speaking to the patient over the phone, doing most of the talking instead of listening to the patient. Tuohy (2003) pointed out that over the last number of years much has been written about the benefits of effective nurse-patient communication. However, research findings indicate that the quality of nurse-older person communication has been and continues to be poor (Tuohy 2003).

References

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Bibliography

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Leading and Managing Nursing Care

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