Understanding Leadership in Nursing

Clinical Leadership, Autonomy, and Accountability

Clinical leadership remains an integral element in enhancing the quality of healthcare service delivery (Cherry, 2019). From this viewpoint, hospitals can use decision-making to define the thin line between success and failure in nursing and healthcare delivery. Clinical leadership requires effective communication, critical thinking skills, pattern recognition, and evidence-based approaches (Alexander, 2017). Relatively, autonomy and accountability empower nurses to make the right decisions and boost patient safety. Hospitals can actualise autonomy in the nursing profession through clarification of expectations and enhancing competence in practice. Healthcare organisations can achieve accountability in nursing through developing clear metrics and standards, clarifying job responsibilities, and building a robust culture of accountability (Garon, 2018). For example, hospitals can include policy statements that highlight relevant clinical standards. While clinical leadership has long been a preserve of professional health managers, expanded organisational structures have prompted nurses’ leadership skills. Nurses need to possess clinical skills and are also expected to understand the scope systems of care and make appropriate decisions. In this paper, the focus is directed towards expanding the scope of two main areas: autonomy and accountability and clinical leadership. The paper responds to two peer posts to expand the analysis conducted on the two topics. The first post includes the central role occupied by clinical leadership and its benefits in the healthcare system. The post also applies participative leadership theory to healthcare settings. The second post focuses on the role of accountability and autonomy in nursing. In this context, the benefits of the two concepts are analysed comprehensively.

 

 

Clinical Leadership

Clinical leadership can be defined as the process through which healthcare professionals such as nurses perform leadership roles and utilise their clinical skills and experience to meet patients’ needs. Clinical leadership is an important consideration for a graduate RN as its essence lies in improving confidence and clinical skills (Stanley, 2019). Healthcare organisations require graduate RNs to serve in committees and supervise assistive personnel such as nurse aides. Performing such duties and offering directions can give me the confidence to take on bigger challenges and succeed in projects being implemented by hospitals. Clinical leadership can allow me to reconnect with my strongest talents and take pride in myself. As a graduate RN, clinical leadership can help me in sharpening my clinical skills. In this regard, clinical leadership can allow me to lead assistive personnel in implementing effective solutions. Clinical leadership can improve my critical thinking, diagnosis, reliance on patient history to make decisions, and clinical reasoning (Stanley, 2019). Therefore, clinical leadership can help a graduate RN exercise a practical approach to clinical skills acquired from medical school.

As a graduate RN, I can utilise leadership theories in improving my confidence and clinical skills. One of such theories is the participative leadership theory. In this theory, a democratic approach ensures that people are independently empowered to make the right decisions (Hariri, 2021). Such an approach can ensure that nurses and other healthcare professionals are motivated to work efficiently. For instance, the participative leadership approach can ensure that graduate RNs opinions on supervised personnel are integrated into decision-making by senior healthcare personnel. If nurses offer directions on improving patient safety, healthcare organisations can empower them to implement the stipulated recommendations. From this perspective, it is evident that healthcare organisations can apply participative leadership theory in using resources efficiently, implementing change, and boosting the morale of employees involved. Healthcare organisations should also invest in training programs that ensure that nurses and other healthcare professionals are aware of contemporary issues influencing clinical leadership (Noure-Elahi, 2018). Such issues include privacy, data security, government funding, national healthcare policy and current industry standards.

Autonomy and Accountability

Autonomy is linked to nurses’ abilities to make decisions independently based on their experience and research. Accountability in the nursing profession is anchored on remaining conscious of consequences of decisions, fidelity to ethical conduct code and standards. Accountability empowers RNs in their practice. In this context, RNs get the opportunity to practise nursing standards and perform their duties based on applicable laws. RNs are expected to answer to their patients, employers and regulatory authority. By understanding the responsibilities and implications of their actions, RNs grasp the scope of their authority and the need to utilise the command chain and appropriate communication channels (Nowicki, 2019). RNs realise that accountability cannot be delegated and thus work towards high-quality service delivery.

RNs and their practice in healthcare organisations are facilitated by autonomy. The concept of autonomy is anchored on the entirety of the patient and the need to make independent, informed decisions (Harnett & Greany, 2018). Autonomy among RNs is utilised in optimising care as it facilitates swift decision making without necessarily waiting for someone at the top to approve life-saving medical interventions. For instance, if a patient has been transferred to post-op care, they may require a treatment plan and pain medication. Autonomy comes into play in such a scenario by giving RNs the power to intervene without waiting for approval. Therefore, autonomy is utilised by RNs in saving money, time and other resources that organisations would have needed in a top-down leadership model (Nowicki, 2019). Autonomy also empowers RNs to offer care in home environments and thus improving clinical outcomes.

Reply to Post 1

From your perspective, the concept of healthcare leadership is not fully understood by many healthcare professionals. Such observation is agreeable considering that healthcare leadership is increasingly becoming a vital element in determining the quality of services offered by healthcare organisations. Therefore, there is a need to expand your perspective by including the concept of accountability in healthcare. For example, nurses should be aware of the legal implications of medical errors. From this standpoint, the argument you have presented in the post can be expanded by a scholarly approach by indicating that the last decade has been characterised by enhanced visibility on patient’s experiences. Therefore, it has become fundamental for nurses to exhibit a sense of accountability in leadership. Additionally, the shallow grasp of leadership can be attributed to rapid and complex decision-making processes in organisations.

The use of the top-down model in command control appears obsolete in healthcare. From this viewpoint, it is important to understand that there is a need for the programs you have proposed in your argument to include a distributed leadership approach. In this regard, nurses and clinicians should be empowered by healthcare organisations to make decisions based on healthcare organisations’ mission and vision statements. For instance, nurses can implement life-saving treatment plans without waiting for approval as long as such plans are in line with applicable standards. While your argument emphasises the role of confidence and leadership skills among graduate RNs, the post has not included the model that healthcare organisations should embrace in actualising your perspective. In this context, you should have proposed personal development and leadership short courses. Healthcare organisations should offer such courses once they have recruited graduate RNs in various departments. From this viewpoint, clinical leadership training should be regarded as a continuous process considering that the healthcare sector is dynamic and rapidly changing (Hill & Brocklehurst, 2015). Hospitals should continuously review programs introduced by the Australian government and private stakeholders to ensure that graduate RNs are acquainted with up-to-date clinical leadership skills.

Reply to Post 2

Your argument has illustrated the integral role played by autonomy and accountability in the nursing profession. It is agreeable that nursing is the most trusted profession due to ethical standards and honesty (Beyers, 2019). A deeper perspective can expand your argument by analysing shortcomings that healthcare organisations should address for sustenance. For instance, the Nursing and Midwifery Board of Australia has standards to enhance accountability and autonomy in the nursing profession (Weberg, 2018). The seventh standard requires evaluating outcomes based on knowledge possessed by nurses (Scott, 2019). Healthcare organisations can sustain such an approach by clarifying expectations. In this context, healthcare organisations should work towards clear job descriptions (Stanley, 2017). The thin line between independent and inter-dependent clinical decisions can be important in achieving the desired patient outcome.

While responding to the prompt, you should have addressed the differences in accountability between RNs and RPNs. For instance, RNs should not be held accountable for RPNs’ actions. When interdependence is integrated into healthcare organisations, accountability becomes a shared element. In this context, patients’ safety becomes the responsibility of every healthcare professionals involved in the process (Huber, 2018). While your argument emphasised the role of supporting nurses for efficiency, autonomy and accountability, you failed to indicate how much can be done. For instance, shared decision-making is one of the approaches through which autonomy can be actualised, giving nurses a voice in the entire healthcare process.

References

Alexander, S. (2017). Leadership in Nursing.Clinical Nurse Specialist,31(6), 309-310.

Beyers, M. (2019). About Increased Nursing Accountability.Nursing Management (Springhouse),30(7), 56. https://doi.org/10.1097/00006247-199907000-00011

Cherry, B. (2019). Nursing Leadership and Management. In B. Cherry & R. Jacob,Contemporary Nursing: Issues, Trends, & Management(8th ed., pp. 208-308). Elsevier.

Garon, M. (2018). Change and innovation – Leadership & Nursing Care Management. In D. Huber,Leadership & Nursing Care Management(6th ed., pp. 32-48). Elsevier.

Hariri, H. (2021). Participative Leadership Practice in Asia Context: A Literature Review.International Journal Of Current Science Research And Review,04(8), 102-115.

Harnett, P., &Greany, A. (2018). Operationalising autonomy: solutions for mental health nursing practice.Journal Of Psychiatric And Mental Health Nursing,15(1), 2-9.

Hill, H., & Brocklehurst, P. (2015). Leadership in dentistry: findings from new tool to measure clinical leadership.Journal Of Healthcare Leadership,2(3), 13-21.

Huber, D. (2018). Leadership and Management Principles – Leadership & Nursing Care Management. In D. Huber,Leadership & Nursing Care Management(6th ed., pp. 32-48). Elsevier.

Noure-Elahi, M. (2018). Participative Decision-Making in Management and Leadership.SSRN Electronic Journal,2(3), 89-102.

Nowicki, C. (2019). Nursing Autonomy And Accountability.Plastic Surgical Nursing,8(2), 40-41.

Scott, G. (2019). Accountability for Service Excellence.Journal Of Healthcare Management,46(3), 152-155.

Stanley, D. (2017).Clinical leadership in Nursing and Healthcare: Values into Action(2nd ed.). Wiley.

Stanley, D. (2019).Values-Based Leadership in Healthcare.: Congruent Leadership Explored. SAGE.

Weberg, D. (2018). Complexity Leadership: A Healthcare Imperative.Nursing Forum,47(4), 268-277.

 

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