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I am writing this reflection to provide evidence of:
Leadership is the most influential factor in forming organisational culture and it is essential to ensure that the necessary behaviours, strategies and qualities of leadership are developed (Kings Fund, 2015).
The royal college of nursing (RCN, 2020) states that nurses admire participatory, facilitative, and emotionally intelligent managers. Leadership styles lead to team cohesion, lower stress, and increased self-efficacy and empowerment. Authentic leaders present good role models that are aligned with health care principles and vision.
Strong leadership, a caring and compassionate community, and high-quality care are linked. Leadership is not about structures or procedures for learning. Leadership is about adaptability by thinking differently and making a difference. One of the primary challenges facing leadership in our profession is the ability to deal with today's demands and be part of tomorrow's vision (Cummings, 2014).
Aware of leadership styles, nurses can find this knowledge useful to maintain a cohesive working environment. Leadership skills and knowledge can be improved through practice, where nurses are able to learn, nurture, model and create effective leadership habits rather than having to undertake formal leadership roles without adequate preparation, ultimately improving the utilisation of nursing staff and improving the delivery of safe and effective care (Cope, Murray, 2017).
Reviews and studies have shown the value of leadership in health care, connecting it to patient mortality, patient care quality and patient satisfaction, and increased staff well-being and morale (RCN, 2019).
Instead of ignoring or dismissing staff, listen to any concerns they have and respond to them and deal with challenging or negative emotions evoked by the care experience (Storey, Holti, 2013).
According to (Cherry, 2017) there are different types of leader when it comes to nursing. Authoritarian, Democratic, Laissez-Faire, Transactional and Transformational. There are many different styles of leadership, but the best approach will rely on factors such as circumstance and group characteristics. In every case, there is no single leadership style that is best. The authoritarian style may be more efficient and productive in some situations. A transformative leader may excel in other situations.
It was a busy day on the ward and there were thirty-two patients all in all and there were some poorly patients, including one that was end of life that needed immediate attention. A new elderly patient had recently been admitted to the ward and we were informed that they suffered with a heart condition called Torsades De Pointes. Torsades de pointes is a type of ventricular polymorphic tachycardia associated with QT interval prolongation (Monahan, et al., 1990)
The ward was understaffed as we did not have an available healthcare assistant. I was working alongside my mentor who was one of the charge nurses. I was doing the observation rounds on the patients we were looking after when I suddenly heard the emergency alarm and some raised voices. I moved swiftly into the next bay to see what was happening. The patient with Torsades had gone into cardiac arrest. The charge nurse was the first one to the scene, shortly followed by the resuscitation team. They were able to bring the patient back after a minute of doing CPR and the patient was stable. After bringing them back, the first thing that the charge nurse said to the patient was “how is your chest?” in which the patient replied “painful” and so the nurse sat by their side, held their hand and said “don’t worry, I will go and get you something for the pain straight away.” The nurse had displayed all 6Cs of nursing. They showed competence by making swift action on the patient and also gave encouragement to less senior staff in the situation. They showed both care and compassion through communication and body language to the patient. I feel that the nurse was not only committed to the patient but also to the team as they made them feel valued and congratulated the team on their fast response (Stephenson, 2014).
From spending a great deal of time with my mentor I came to the conclusion that as a leader, they displayed many of the traits of an autocratic leader. It is an older form of leadership, which is often considered obsolete, but this style remains widespread as there are benefits (Lockwood, 2019).
Autocratic leadership in crisis management is the leadership style of choice. It has the advantage of being fast, since decisions are not taken democratically (Steinhauer, 2016).
The autocratic leadership style is shown when a leader makes all decisions without seeking employees’ input. Negative reinforcement and retribution are often used to enforce rules (Frandsen, 2014). Autocratic leaders can manage a crisis situation quickly because they are in charge. If there is a short-term problem, a solution can be developed using the leader's experience. While an autocratic leader may have a demanding personality, most workers prefer to work in an environment with clear expectations (Gaille, 2019).
The only downside of this leadership is that it is the most effective when there is very little time for discussion in case of emergencies or perplexed circumstances (Top Nursing, 2020).
Concentrating decision-making power at the top of the command chain can be an efficient way to accomplish simple tasks; Instead of being limited to conflicting opinions, autocratic leaders will ensure that quality care is provided effectively and safely, with minimal time spent on deliberation. A good example from Norwich University (2017) of when an autocratic leadership style works is when protocols are in place when admitting and discharging patients, which may be based on time or other factors which must be considered when treating certain conditions. This takes the decision making away from the clinical nurse which can save time when short staffed.
They displayed autocratic leadership because they did not involve other members of the team in decision making and was not interested in anyone else’s ideas. When the emergency situation arose on the ward, having one person in charge worked well as they made very quick decisions and took control of the whole situation. This prevented causing stress to either the patient or the other members of the team. They displayed very clear direction and leadership (Cherry, 2019).
After the patient had been resuscitated, they arrested again, and at the time there was only myself and my mentor present. Through very clear direction I commenced chest compressions for 30 seconds and we brought the patient back again. My mentor gave me very positive feedback on my resuscitation technique. I felt that in this situation it was completely the right approach as I was very inexperienced and needed clear guidance and instruction.
When the situation happened the first time, I felt very ineffective and out of my depth and experiencing something like that in reality is completely different to experiencing it in a safe training environment with CPR mannequins. My mentor told me that if it happened again then they wanted me to give CPR without hesitation. When it did happen again, I rushed straight to the patient’s bedside and began CPR. I think when you are in a critical situation and someone’s life depends on you then you have to act, and because the direction that I had from my mentor was rapid and very effective, I felt capable, controlled and calm in what could have potentially been a very stressful situation.
What was good about the experience was the fact that I had never witnessed anything like this or been involved in such a life-threatening situation which ultimately gave me more knowledge and confidence in my own abilities. The situation had been very challenging and intense but despite this, my mentor gave me the confidence to carry it out and then complimented me after the situation was resolved. There had been many times working on the ward that I had felt ineffectual and, in all honesty, quite useless, but this was such a positive experience, I felt as if I had done a good job.
What was bad about the experience was my initial fear and reluctance in my own ability to have a positive outlook in the situation and I also experienced stress as I didn’t want anything to happen to the patient as a result of my incompetence.
Looking back on the situation I realise that I should have had a lot more confidence in my own abilities. At the time I didn’t want to be a burden to my mentor and so I think that is why I initially stayed out of the way. Although I had read all about resuscitating a patient, the reality was totally different. The sense of urgency was there but because my mentor stayed calm and professional and gave very competent guidance and instruction. I felt that I contributed positively to the situation.
I was very self-critical due to the fact that I was asked a couple of questions by a senior member of staff that I knew the answer to but instead froze and went blank on the spot.
In the situation I could have responded quicker than I did in the first instance, but as a student nurse I think a certain degree of shock kicked in due to the high pressure of the sudden change in environment.
If the situation arose again, I would know exactly what to do, what to ask and who to speak to. For example, I would know how to contact the resuscitation team and what to say to them, as specific instructions are always vital. I would know where to find the emergency bed controls and I would know how to use the crash trolley defibrillator.
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