As the leader of a small specialist team of three nurses and a support worker I am responsible for ensuring the delivery of individualised patient centred care is delivered to national and local standards. I intend to explore how my leadership style impacts in daily activities across the multidisciplinary team (MDT) in ensuring that diversity and equality are upheld.
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Faugier and Woolnough (2002) discuss how the process of leadership where influence, goal attainment and achievement usually takes place in a group setting. It’s important to remember that within a small team the leadership isn’t static and can take place at many differing levels. This could be simply skill led and the most ably skilled for the task gets to lead or because in the authors team the skill mix is diverse and the developmental needs of staff dictate who will lead or manage a project. Braye et al (1998) discusses how power can be given or retracted dependant on the skill set needed for the task in hand. As a small team communication amongst ourselves is clear and frequent, we in turn report to the lead clinician of the MDT to ensure the organisational, national and team objectives are met. Multidisciplinary team working involves taking shared responsibility for resolving situations and it is essential that all members of the team feel their contribution is important. However we also need to remember that partnership doesn’t necessarily mean each participant has equal power; but in small teams it’s crucial that the distribution of power is openly discussed and recognised by all involved. This ensures the differences and needs of the team are respected and met.
The author intends to look at two areas of practise. The first being how her communication with different members of the MDT impacts on care delivery and takes account of the diversity of the team, the second area of practise to be examined will be the discussion regarding the perceived unfair division of resources between two differing client groups. One of those is patients with colorectal cancer and the other being stoma patients either with cancer or benign disease as a diagnosis. In accordance with Nursing and Midwifery (NMC 2008) guidelines all names and
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situations have been changed to protect the identity and confidentiality of all involved. Diversity can be anything different from the classic norm. It can be the inappropriate labelling of a person/service that judges individual differences from our own. People can be labelled into categories i.e.: “all fat people are lazy”. As future leaders we need to have the skills and knowledge to challenge these assumptions and ensure all clients or staff are treated equally. Having the view that some people are better than others or some views right and others wrong can result in inequality. Cultural diversity leads to organisational success, within the authors trust there is the visible facet of diversity in age, religion, race and gender. But not apparent is the invisible diversity of education, marriage and work experience. Department of Health (2004) states that the National Health Service should value diversity and it’s important to recognise, respect and value difference for the benefit of the patients and organisation.
A normal working day involves care being delivered across the primary and secondary care trust. At other times it can involve working alongside a medical colleague on a ward round, clinic or less formal setting. I will explore how interaction with the MDT and the static senior members of the medical team affect the diverse needs of the team and assess if equality of opportunity is given fairly to all.
Cross team working requires a clear understanding or appreciation of the professional, structural and organisational identity of the differing teams or departments to ensure harmonious working. The culture of my team recognises that we are all at differing points of development and have skills unique to us that complement each other. As the team leader I also acknowledge that we are lucky in that our workload can be
dictated and managed without much higher management involvement and that other area such as the surgical wards where we dip in and out to review clients have no such luxury and can be under pressures that we aren’t. As a team we mange and respect the diversity of the ward team by where possible adapting our communication style to the
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rank and experience of the individual we are dealing with. If the nursing team are short staffed and under pressure then there is no point in labouring the point that they had not carried out a patient review. Instead we would discuss how we can help them facilitate the patient and the required task and or complete the change ourselves. Valuing and championing diversity is about recognising the pressures others are under and facilitating their needs as well as your own agenda. A common problem of specialist nursing is that others often envisage it to be “cushy” with no visible workload or pressures that can always be seen by others. To work long term across the differing cultures it is essential that there is a good working rapport and mutual respect. In recognising and respecting their diverse community it enables quality patient care, berating staff under pressure for not completing tasks would only alienate cross working teams.
Goobie (K344, block 4, Unit 1, p.13) discusses the need to understand and bridge the cultures. If the wards appear to be overworked or under pressure I will happily make allowances in their omissions of paperwork or patient education and either I or one of the team will pick up this slack. My communication may be verbal or written and if verbal it’s to ward nurses that I have known for some time so may be more informal than if I was talking to student or newly qualified nurses. As well as ensuring patients needs are met I need to develop my own team, as one of the members is untrained I need to ensure that she has equal access to training needs, protected study time and safe clinical supervision. This can be difficult at times of pressure and she can be used beyond her paid grade. Does this go beyond taking account of her diversity? Or could it be said that opportunity is allowing experiences that enhance her future development. Championing diversity of staff and their abilities by ensuring they are developed and prepared for the future can be difficult. In this case of inclusion of an untrained support worker to a specialist unit is looking forward to the future workforce, but as raised by Girvin (1998) in (K344, Block 3, Unit 3, p.28) nurses find it difficult to break away from or accept loss of the traditional role, this nurse can daily be ignored or passed over by other specialist
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nurses who see no place for untrained staff in these areas so she gets little support from the profession. As previously stated communication is multifaceted, spoken and unspoken and can be amended to take account of the personal or professional relationship with the various groups. As my work involves close working with the lead consultant our communication is less informal and with common respect for our roles. Exploring how this communication is different with the less senior medics and those that aren’t static within our team may be detrimental to ensuring equality of opportunity and diversity to all. My actions could be seen as excluding opportunity of educational experience. Even of restricting communication with the MDT.
Gobbie (2004) examines how subcultures and tribalism exists within groups and this is true of the colorectal team. Our lead consultant is respectful of all the nurse members and will protect and communicate with the trained and untrained members equally. However, we could be classed as exclusive and limiting access to our sub culture to junior doctors and be discriminating in opportunity. The junior doctors work across two trusts for their educational practise. Trust A is a large formal environment and trusts B where the author works is very informal with a static workforce and has a very family and friendly informal feel to the organisation. The two cultures are totally different.
If I have a problem with a surgical patient that needs resolving fairly quickly then in some cases I will go directly to the Consultant and explain the problem and what I see as the solution. In doing this I am utilising my personal and professional relationship and reputation amongst the MDT. If challenged I would state that I was using my expert connection and positional power within the organisation to expedite care. However, it could be said that I am discriminating against the junior doctors and excluding them from the decision process. I may be seen as labelling them and assuming they won’t understand what needs to be done and liaising with the Consultant would have taken place anyway. Nolan (1993) discussed how the relationship between mental health nurses and psychiatrists has changed from
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paternalistic with nurses doing as they were told and knowing their place to clear autonomous nursing roles. In some situations I could be perceived as having reversed
this role and could be seen as the equivalent of paternalistic in my treatment of junior doctors. However, the author would state that as discussed in (K344, Block4, Unit 2, pp.19-20) I’m not treating the junior doctors unequally but am recognising my expert, connection and positional power to get the best and quickest result for my client. The same can be said for other team members. If the use of any of the MDT’s personal and positional power gives momentum to develop them then it should be exploited to gain a modern capable workforce. My future intent is to champion the diversity of staff and their abilities by looking to the future and ensuring my band three member of staff is developed to a band four.
The Equality bill has brought cohesion to the previous discrimination legislation acts such as pay, sex, and race and has strengthened it to cover employment roles and how
services are supplied to service users to ensure equitable access across diverse communities. In looking at how this impacts on the provision of care by community nurses Griffith & Tengnah (2010) discusses how socioeconomic disadvantaged communities may not be able to access some services in the normal working hours, this could also have implication for many health care users as most of the clinics served by the colorectal team are during the day and could discriminate against night workers or those who work away. Essential to the enhancement of patient care is the nurse’s awareness of promoting equality and diversity when meeting the patient’s needs.
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As nurses we support and treat people from varied backgrounds and try to ensure that they are protected from discrimination. But having equal division of time and resources could mean inequality of care although unintentional could be seen as preventing participation in equal access to services. In my practise historically the division of time has been 60/40 with stoma patients having more community and
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clinic resources. However, (K344, Block 3 Unit 1, p.7) the recommendation of the Prime ministers commission is of the provision of high quality care with little
variation. Stoma patients have loud voices and their potential or perceived physical complaints can result in juggling work time to see more of them in clinic settings leading to less time for activities or future work with the cancer group. To meet the diverse needs of the cancer patients in my practise I need to take on board and acknowledge the value of the inherited old ways of practise and move on to new. (K344, Block 3. Unit 1. p12). Gibson (1990) discusses how empowerment is a positive concept that focuses on the strengths rather than weaknesses, abilities rather than deficiencies and rights instead of needs. In turn I need to focus on the rights of the cancer patients and manage a change within the department to give equality of care. Nazarko (2004) cites “staff innovation, motivation and performance are released and service delivery improved” as a result of diversity. To change attitudes and practise as a team we will need to discuss how we manage and facilitate fairer division of time and resources, perhaps using the opportunity to closely examine our roles and through patient participation in discussing how the service is delivered, this could be through patient discussion groups or panels and using the support group for feedback. A team can achieve this for our client group then to champion the change I need to allocate time and resources to assess and prepare both staff and patient groups for the necessary adaptation to the service.
Confidentiality is central to any trust relationship whether client or colleague. It’s vital to respect the individual and have a non discriminatory workplace. In promoting equality we need to recognise diversity and in this recognition barriers and prejudices can be broken. In the situation where some specialist nursing colleagues ignore my band three, as would be leaders we need to have a vast array of skills, make use of networking and support to slowly bring our and the trusts vision to others. Nursing is currently undergoing vast changes and challenges and we can at times feel threatened and overwhelmed by the possible changes. In an organisation where leadership has always been top down it’s very difficult to make your voice heard from the bottom up.
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Leadership is about delegation, facilitation and appreciation of the team and not self. In ensuring the needs of both clients and staff diverse needs are met the author needs to ensure more clinical supervision and shared governance for all team members and develop and sustain time management of the service to ensure fairness of services to all clients. Hours of work and skill mix will have to be addressed. Consultation of both the client support groups will be necessary to ensure that the service users have influence on the outcome. In my management of the changes I will need to use the expertise of my mangers to ensure both trust and departmental needs are met. A plan of measurable outcomes; with emphasis on ongoing assessment in a variety of modes to take into account the diversity of patients and that all may not be comfortable with just written questionnaires, and team and service user feedback. I believe that as I have managed to change practise of specialist nursing within my organisation and include diversity and equality of opportunity to the inclusion of a non trained nurse then I should and will manage to give the same equality to the two patient groups under my care.
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