Nursing Leadership And Management

During my first clinical rotation with Molloy College I was placed at South Nassau Communities hospital. Our clinical group was put on a medical surgical unit that was also an intensive respiratory care unit. We were mostly on the medical surgical side of the unit because we were in our first clinical rotation. On one occasion I was placed on the respiratory care unit because the medical surgical side of the unit was short on patients and there was simply not enough patients for each student. My clinical instructor asked one of the respiratory care nurses if I could follow her and take notes and she kindly agreed even though she was not obligated to.

Her name was Jackie and in my eyes she is the definition of a transformational leader. Transformational leadership is defined as bringing vision, meaning and inspiration to the team in order to accomplish a goal Weiss, Tappen, & Grimley (2019). Kaiser, (2016) further defines transformational leadership as a focus on empowerment, which creates a more positive interpersonal work environment. Jackie brought all of those traits by explaining to me what the tasks were, why we were doing them and how they make a difference in that patient’s life. For example, we were giving a medically induced coma patient a bed bath and even though he couldn’t talk and was unresponsive, she still spoke to him. Jackie explained that by talking to the patient you are treating them like a human being and respecting them. As a nurse it is our job to explain procedures before we do them, but Jackie went above and beyond; she told our patient what the temperature was that day, who won the baseball game the night before and important news from the morning.

It’s because of her that I do those things with my patients and now that I have experience working in the hospital, I know that every nurse is different, and unfortunately some nurses can be rude or callous with their patients and even other staff members. I was lucky to have met her and experienced what a nurse is supposed to be like. Jackie made me feel comfortable and welcomed and because of her leadership style, kindness and patience, I was able to work with her and achieve our goal for the day. Kaiser (2016) explains that a nurse’s leadership style and actions not only influence the patients but also their surrounding staff members, and that is why it is so important to be a positive and influential leader.

Jackie’s source of power in my opinion is authoritative, Andreis & Carioni, (2019) explains that authoritative power is not always coercive, since coercion is when someone exercises power through force, rather authoritative power in this situation would be considered traditional, passing knowledge down to another. Jackie conveyed authoritative power by gathering information from me to understand what degree of knowledge I had pertaining to the patient’s condition so she could delegate the appropriates tasks to me and educate me on what I did not know. Nurses must use authoritative power in order to delegate tasks to other staff members and to make the appropriate decisions to deliver the best patient centred care. Jackie’s level or type of power is that of a registered nurse. Registered nurses, although considered a lower level of power, are an important and vital asset to the health care organization. Nurses are the backbone of the healthcare system because they are the first responders who work directly with the patients. Weiss, Tappen, and Grimley (2019) describe registered nurses as having expert power and authority regarding licensed practical nurses, patient care technicians, and other coworkers by the merit of their position in the hierarchy of the organization.

McClelland’s motivational theory best describes Jackie’s motivational drive. According to Rybnicek (2019), McClelland’s theory consists of three basic needs that motivate workers: the need for achievement, the need for affiliation and the need for power. McClelland expressed that the three needs vary in degree of importance depending on the individual, their position and their length of employment. Jackie has been a registered nurse at South Nassau Communities’ Hospital for over 15 years. She has a need for achievement as she goes above and beyond for her patients and staff members. Her need for affiliation or good relationships with others is accomplished through her hard work and positive demeanour. Lastly, Jackie’s many years at South Nassau has made her a viable asset to the hospital; she knows that she isn’t easy to replace, which fills her need for power.

The staff on the respiratory unit who work with Jackie are extremely receptive to her leadership style. They all see how dedicated she is not only to the patient but to the unit as a whole. Other employees and nursing students such as myself look up to her and see her as a leader for many reasons; knowledge and dedication are the two traits that stick out the most to me. The way she explained every procedure step by step was absolutely amazing and made me receptive to her leadership style. Jackie is a transformational leader; she inspires others by being the best at what she does, whether its giving medications, wound cleaning, doing head to toe assessments or just being a decent human being by dedicating her time to the patients. Jackie is not afraid to speak up for her patients. One of the patients that we had was nonverbal due to her trachea but was alert and oriented. While a doctor was cleaning eschar out of the patient’s stage three pressure ulcer, the patient started moving and whaling her arms to try and alert the doctor she was in pain. The doctor ignored her and Jackie spoke up and demanded he stop the procedure to allow her to administer pain medication to the patient, so that when he cleaned the wound she would feel no pain. Jackie also helps out other coworkers by teaching them all the skills she has picked up throughout the years while working at South Nassau. Jackie teaches others because she knows that it not only benefits the patients but the medical team as a whole and that is what makes her a receptive leader.

Now that I am senior nursing student who has experience in many different clinical rotations and work experience in the hospital, I can definitively say that Jackie’s leadership style is most effective. According to Henker, Sonnentag, & Unger, (2016), Studies have shown that transformational leadership not only motivates employees to work harder but it also boosts employees’ creative process by engaging and designing a conductive task environment. Transformational leadership provides team members with the autonomy and flexibility needed to engage in creativity. Every hospital has protocols and procedures that are mandatory for each employee to follow because our number one goal is patient safety. This does not mean there is no room for creativity; Jackie was creative in her leadership style and the way she interacts with her patients. It’s those little details that make her leadership style unique and receptive to others.

Jackie’s Leadership style is productive in that it creates at positive atmosphere; it motivates team members to put forth their best work and in return creates safe and efficient patient care. Jackie’s transformational leadership style should not change unless she is a team leader during a code. During a code she may need to switch gears into a more autocratic or transactional leadership style, as that is most appropriate for emergency situations. Durmus & Kırca (2019), explain that in a crises situation transactional or autocratic leadership approach is more effective. Studies have also concluded that nurses who portray leadership behaviour will be pioneers in bringing the nursing profession to a more professional level. One of our goals in health care should be to influence the quality of patient care through good nursing leadership, whether it’s transactional or autocratic leadership in an emergency or transformational leadership style in other situations. Nurses where many hats and one of them is to know how to be a leader and which leader you need to be depending on the severity of the situation. Jackie is an exceptional nurse and I wouldn’t change anything about the way she conducts herself.