The following essay will demonstrate the understanding of the non-technical skill of leadership. This non-technical skill has associated elements, which are setting and maintaining standards, supporting others and coping with pressure. The focus of this assignment will be leadership mainly in terms of the element of setting and maintaining standards. The essay will also discuss issues relating to the application of these skills in clinical practice and the impact they can have on patient safety and the delivery of high quality patient care.
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Nursing is an art and the core purpose of nursing is to care. To allow the delivery of safe, effective, person centred care to patients across a wide selection of healthcare situations, it is vital for nurses to develop evidence-based technical skills (Pearson & McLafferty 2011). Non-technical skills are the interactive aspects which include social and cognitive skills that lead to the safe and effective delivery of care. Non-technical skills include communication and teamwork, decision-making and leadership (Flin et al. 2008). To improve work performance and reduce adverse events, non-technical skills have been used in many different occupations, but in nursing they have been recognised to play an important part in the increase of patient safety and successful clinical outcomes. Non-technical skills training was introduced within the aviation industry as it was recognised that failures in pilots’ non-technical skills impacted on accidents. However, in areas of acute healthcare settings, non-technical skills have been researched and developed to help achieve safe and efficient practice in a variety of situations (Mitchell 2008). There is always emphasis on the quality of clinical skills in nursing but nurses need to develop their non-technical skills to make them more efficient at making the correct decisions and maintaining standards (Flin et al. 2008). A combination of technical and non-technical skills can lead to safe and effective performance (Mitchell 2008).
According to Nursing and Midwifery Council (2011) the quality of clinical skills in nursing has become more important and there are increasing suggestions that non-technical skills need to be improved. White (2012) suggests that nurses must improve their understanding of non-technical skills as these are vital for patient safety. It is important for nursing staff to have the education and backing to improve the safety of their patients and the key to this is powerful nurse leadership (Williams and Reid 2009). At the very beginning, when nurses enter their career, they will start to develop their leadership skills. They will be setting and maintaining standards and working together with other members of the multidisciplinary and nursing team as this is essential for effective healthcare (Burton and Ormrod 2011). Leadership is an important skill for nurses to develop because it is critical to delivering a high standard of care, essential for positive staff development and as written previously, vital to patient safety.
The key elements of leadership are being able to cope with pressure, setting and maintaining standards and supporting others. Nurse leaders are often asked to make difficult decisions, deal with challenging tasks and confront the constant pressures of their job. To overcome these pressures they must prioritise their responsibilities, stay motivated and invent new ways to resolve these demands (James and Wooten 2010). One of the main responsibilities for a nurse leader is the setting and maintaining high standards of care. They are responsible for controlling and developing the practice surroundings (Curtis et al. 2011). Williams and Reid (2009) explain that by setting aims and maintaining standards, nurse leaders can help to reduce the number of patient adverse events.
The last element which will be briefly acknowledged is supporting others. Nurses are often too busy caring for everyone else that they forget that one of the main responsibilities of leadership is to support one another. To be able to help others in the team to develop and progress, it is important for the nurse leader to offer regular team briefings and feedback sessions along with one to one meetings and annual appraisals. This will improve the practice of not only the individual, but the team too, which in return will encourage confidence and loyalty (McKenzie and Manley 2011). Therefore for the remainder of this assignment, the focus will be on the non-technical skill of leadership and the element of setting and maintaining standards.
Leadership has been defined in many ways in the literature and it has to be said that as all the definitions are varied this helps to provide many different aspects that can influence leadership. A straightforward definition is “Leadership involves the use of interpersonal skills to influence others to accomplish a specific goal” (Sullivan and Garland 2010). Therefore several qualities are common to most definitions of leadership. For example, leadership is a process which exists at all levels, involving and stimulating others to achieve goals. A leader cannot be a leader unless they are inspirational, intelligent, supportive and totally in control – especially in a crisis.
Leadership is the skill of encouraging, guiding and setting the standards of the team(Flin et al. 2008) and according to Curtis et al. (2011) more and more nurses are expected to take on leadership tasks. Leadership is considered vital to nursing as nurses are expected to manage their co-workers and act as an advocate for the patient to ensure that the patient receives safe, efficient and priority care. In effect, good nurse leadership is vital to ensure that standards are set and maintained and that the nurse leaders have a continuing influence on their staff’s attitude, performance and commitment to their work (Hughes 2008). On the other hand, someone with inadequate leadership abilities may have a negative affect on their staff, making them feel disheartened and unmotivated (McCray 2009). Leaders are needed that can set aims and maintain standards and have the awareness and capability to implement change. This will then reduce the frequency of adverse events. Nursing articles state that to ensure compliance with evidence-based treatment, nurse leaders are vital and that opinions and actions can alter the traditions of the NHS (Williams and Reid 2009).
Effective leadership impacts on the success and smooth running of hospital wards (Casida and Parker 2011). This is due to the fact that according to The Governance Institute (2009) nurse leaders have the means and ability to shape, organise, prepare and be responsible for the services that meet the needs of the patients in their ward. Nurses must take on the leadership role if they are to progress with the standard of healthcare and succeed in targets for patient safety and quality (Hughes 2008). However, Sherring (2012) suggests that a lack of leadership can contribute to unsafe and poor quality care. The investigation into the severe failures at the Mid Staffordshire Trust, which was carried out by the Health Care Commission (2009) highlights this. This was an important study that was carried out to investigate the high mortality rates of this trust and the care provided to these patients. After the investigation took place it was concluded that there were severe failings which included poor quality and unsafe care on the wards, which fell well below the acceptable standards of care. There were serious issues with maintaining standards and these included nutrition, medication and infection control. The investigation also stated that there was a serious failing in the management and leadership of the trust and that leaders did not “develop an open learning culture or inform themselves sufficiently about the quality of care” (Health Care Commission 2009). Therefore it was reported that these failures could have been caused by the weak leadership of nurses.
The Mid Staffordshire Trust investigation is just one example of adverse events which led to poor quality and unsafe care. The Ombudsman (2010) reported that in 2009-2010 there were 15,579 health complaints examined against the National Health Service (NHS). The majority of these were for poor clinical care and treatment, followed by NHS staff attitudes. However, when standards fail and there are adverse outcomes for patients, it must be recognised that this is the result of leadership failures rather than blaming individual staff failure (Deering et al 2011). Nevertheless, it is the individual member of staff that remains accountable for their actions and results in being reported to the Nursing and Midwifery Council (NMC) for misconduct and fitness to practice. Good leadership is therefore considered vital to the smooth, successful running of the wards which will then result in safe, effective and high quality patient care.
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The Scottish Government (2008) publication Leading Better Care: a report of the senior charge nurse review was aimed at creating a modern clinical leadership and one of the main themes was to develop the role of the senior charge nurse. It was stated that they should be equipped with the information to develop their leadership capacity which would in turn improve the quality of care in their particular areas (RCN 2010). This would result in an improvement in patient safety. Nurse leaders must be able to set and maintain standards, which can in turn, help reduce falls, infection rates and patient adverse events. This will result in better quality and more personalised care (The Scottish Government 2010). They must be able to promote change and continual improvement to maintain the high standards of quality care of their particular area (Timby 2009). McKenzie and Manley (2011) agree that there has never been a better time for nursing to establish its leadership skills. Conversely, recession and NHS guidance (Department of Health 2009) which was written surrounding the important changes in health economy and economic crisis has thrown considerable insecurity on the future of the NHS including staff development, education and leadership training (Sherring 2012). As a result of budget cuts, this would then affect safe and high quality patient care by placing restrictions on staffing levels, longer waiting times for surgery and bed closures. Patients may also be discharged earlier thus compromising patient safety and high quality care to suit budgets (RCN 2010).
It is essential to be equipped with all the skills needed to help my transition from student nurse to registered nurse. To ensure that I am a safe and effective practitioner, I must build on my knowledge and continue to successfully develop and practice my non-technical skills. As a newly qualified staff nurse, one of my many tasks will be to take and make decisions relating to the nursing team therefore it will be essential to be able to develop the ability to act as a leader. Planning a shift is one of the fundamental tasks of a leader, so it is crucial that I take time to get to know the staff and what skills they have, in order to utilise them appropriately.
As a newly qualified nurse there will be the opportunity for me to develop leadership skills by instilling confidence in staff and patients and respecting that wards have certain ways of doing things. Programmes such as NHS Flying Start are available to encourage and guide newly qualified healthcare professionals to develop their skills including leadership. Although it will be up to myself as a new staff nurse to make use of these programmes and contribute to the impact of safe, good quality nursing care. As a student, I believe it is important to build on leadership from my preceptors, in order to develop and consolidate clinical skills thus experience an induction to the real world of nursing.
As my 3rd year comes to an end and I become a newly qualified staff nurse I will be enthusiastic and ready to make positive changes. Once I am accustomed to my new job and my ward I will aspire to be a good leader by suggesting positive changes. As a good leader, I must be able set and maintain standards which will reduce adverse events and hopefully develop the team to deliver a high standard of care. This high standard of care needs to be safe, effective, evidence-based and person centred.
In conclusion, this essay has attempted to discuss the understanding of the non-technical skill of leadership and the associated element of setting and maintaining standards. The other basic associated elements of leadership which were briefly touched upon. These are all vital elements for patient safety. It can be fair to say that the literature agrees with the facts that effective leadership is vital to nursing, impacts on the success and smooth running of the ward and is crucial to the safe and effective delivery of good quality care.
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