Leadership & Management in Nursing
Leadership and management in an organization comprises of
various roles and responsibilities that are essential to obtain effective
outcomes for patients, staff and the provision of service. In this reflective
essay, the Gibbs Reflective Cycle Framework will be used present a systematic
reflection on experiences of poor leadership and management in the operating
theatre and its implications. According to Marquis and Huston (2017), good
leadership and management involves a myriad of factors and is the key to a
successful organization.
It was one
of the busiest day at the operating theatre and I was assigned to the M5, where
2 major surgeries involving angioplasties and abdominal aortic aneurysms were
listed by the surgeon. Two other staff were assigned on duty at the respective
theatre with me where one, Ava, was very new junior staff who is a fresh
diploma graduate with no prior experience in the OR and had only been in the
department for less than 4 months while the other, Rita, is a registered staff
of 1 year in the surgical field. I clocked in early to work and began with the
checking of the instruments, sets and equipment required for the first case. It
was getting late and the anaesthetist was ready to start intubation. Since she
was very new, I asked Ava to do a peri-operative check on the patient stationed
inside the induction room while I got Rita to start scrubbing up and start
preparing for the first case. I wanted to ask my sister in charge, Nurse Tan,
if I could have an exchange of staff just for today as there were 2 major cases
listed and more experienced manpower were needed. However, I couldn’t find
Nurse Tan and had no time to do a team briefing prior to the start of the
surgery. The surgery began and it was chaotic as
It was
an awfully stressful day and I almost broke down due to the pressure from the
surgeons, anaesthetist and staff because I was left all alone to manage
everything with no help from my nurse in charge and instead was scolded. According
to Kaluku, Saleh and Kadar (2018), the overload of work tasks affected the
quality of nursing care and consequently lead to a burnout among staff. Besides
that, Saleh, O’Connor, Al-Subhi, Alkattan, Al-Harbi and Patton (2018) explained
in their study that nurse supervisors play a major role in leading the team to
provide effective nursing care. In this situation however, Nurse Tan yelled and
ordered her staff to carry out their task despite the chaotic situation which
creates an emotional and mental tension, especially on Ava the junior staff and
me.
The positive aspect of experience in relation to leadership
and management was that I called the afternoon shift Nurse in charge for help
and she assisted in the intraoperative management of patient in the OR. Tinkham
(2015) describes this as a form of transformational leadership where nurse
leaders become actively involved in the working together as a team. However,
the negative experience was that Nurse Tan wasn’t present from the beginning of
the surgery and neither carried out team briefing to discuss the delegation of
staff and complexity of the operation prior to the surgery. As Kaluku, Saleh
and Kadar (2018) discussed in their study, leadership strategies are crucial to
create effective work environment for nurses.
Fundamentally, there are some underlying aspects impacting
the situation in the theatre. Firstly, there was no proper allocation of staff to
the theatre with limited number of staff assigned either with little or no OR experience.
It’s essential to delegate effectively in a working team by identifying the
necessary skills and experience of a staff and guiding them as a supervisor to
execute their roles and responsibility efficiently (Marquis & Huston,
2018). Although Ava was a junior with little experience, Nurse Tan should have
guided her in carrying the tasks instead of scolding and ordering her to
complete them as it only creates unnecessary tension impeding the quality of
nursing care given.
Evidently, the use of authoritarian style of leadership in
this case wasn't appropriate because this historical leadership theory focuses
solely on directing and coercing instead of working together as one team. In
fact, Orchard, Sonibare, Morse, Collins and Al-Hamad (2017) describes this as a
top-down role focused leadership that’s unrealistic and maladaptive in today’s
workflow. Instead, a contemporary transformational leadership could stimulate
critical thinking among nurses, motivate them to learn from mistakes and
influence the nurses in the OR to change their perceptions of the situation by
providing a sense of direction in carrying their tasks together as a team
(Tinkham, 2015). In this way, nursing leaders and staff in the OR can share
responsibilities and work in partnership to achieve a high quality patient
care.
Additionally, Nurse Tan was absent from the beginning of the
surgery and only walked in halfway through, scolding her staff who’s having
difficulty in managing the situation. In this case, it could be that Nurse Tan
isn’t capable of leading a team and is unsure how to direct them consistently
without creating misunderstandings among her staff. As Tinkham (2015) explains,
managers need to know how to lead and encourage the trust of other staff to
achieve the organizational goals. Therefore, one way as suggested by Plonien
(2015) is that to use personality indicators such as the Myers Briggs Type
Indicator (MBTI) to offer an insight into the type of communication required to
connect with team members.
Some of the strategies and recommendations to changing
future approaches in such situation would be primarily improving the
communication between nursing leaders and staff. As Plonien (2015) explain in
her work, nursing leaders need to have exceptional communication skills to
motivate team members into action more willingly than being givers of
directions and orders. Besides that, Marquis and Huston (2018) also believe
that in order to motivate, then leaders need to recognize issues that
In conclusion, choosing capable nurse leaders who are aware
of their own leadership profile and ability are important since they are front
liners in healthcare service. However, they aren’t the only one who’s
responsible for this challenging nursing framework. Additionally, the
cooperation, comprehension and support of the healthcare system entirely, be it
the government or the higher management of the hospital, are crucial in generating
a safe and harmonious working environment for employees. As Helen Keller once
said, ‘alone we can do so little, together we can do so much”.
By Jessica John Posko💗
References
1. 1. Tinkham, M (2015). Transformational leaders in
the perioperative setting. AORN Journal, 101 (3), p13-14. doi:
10.1016/S0001-2092(15)00069-1
2. 2, Plonien, C (2015). Using Personality Indicators
to Enhance Nurse Leader Communication. AORN Journal, 102(1), p74-80. doi:
10.1016/j.aorn.2015.05.001
3. 3. Saleh U, O’Connor T, Al-Subhi H, Alkattan R,
Al-Harbi A & Patton D (2018). The Impact of nurse managers’ leadership styles
on ward staff. British Journal of Nursing 27(4) p197-203
4. 4. Suratno K, Ariyanti S, Kusrini K (2018). The
Relationship between Transformational Leadership and Quality of Nursing Work
Life in Hospital. International Journal of Caring Science, 11(3) p1416-1422
5. 5. Orchard CA, Sonibare O, Morse A, Collins J &
Al-Hamad (2017). Collaborative Leadership, Part 1: The Nurse Leader’s Role
within Interprofessional Teams. Nursing Leadership 30(2), p14-25
6. 6. Marquis BL & Huston CJ (2017). Leadership
roles and management functions in nursing; theory and application. 20, p523-542
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