Reflective Nursing Essay | Leadership in A&E

For the purpose of this assignment I will explore my personal and professional development in my third year and throughout the entire course. In this assignment I will reflect on an episode of practice that happened in the accident and emergency department during my placement there. I will discuss my leadership role, supervision and delegation to others whilst I managed the minor’s area on a morning shift. I have chosen to reflect on this episode of practice as this is one of the first times I was truly allowed to manage an area during this time I was able to delegate to others, question my leadership style and make clinical decisions.

I will use reflective practice to critically analyse my delegation and supervision of others and analyse my own professional development. Throughout this reflection I will also look into the theory that underpins the following areas, Clinical Decision Making; Leadership, Management and Teamwork; Delegation and Supervision of others and Continuing Professional Development.

The main focus of this assignment will be my delegation and supervision of others as this is a very important part of being a nurse as the NMC (2008) says “You must establish that anyone you delegate to is able to carry out your instructions” and that “You must make sure that everyone you are responsible for is supervised and supported”.

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To critically analyse this I will use a recognised model of reflection, I have researched a number of different models of reflection to find one that is suitable for this and that I’m comfortable using. Some of the models I have looked at include John’s model of reflection as cited in Siviter (2008) But I found that this to be to rigid and does not help me discuss my own development as well , and also requires the reflector to work under constant supervision and keep a diary. Another model I considered was Rolfe et al (2001) framework for reflective practice, but I found this not to be structured enough to adequately explore my development and create future action plans. The final model I looked at is the Gibbs (1988) model of reflection as cited in (Siviter, 2008). The Gibbs model is well structured and easily guides the reflector through the process allowing them to explore the reflection in depth and allow action plans to be created. I have chosen this model as I have used this model in the past and feel comfortable using it and I feel it is well suited to this episode of practice.

During this assignment I will use a pseudonym for any patients I discuss to maintain confidentially in line with the NMC (2008) on confidentiality.

Desciption

I was working on a morning shift in the Minors area of the Accident and Emergency department with my mentor and her other third year student. The nurse in charge asked us if we wanted to take it in turns the run the minors depart for half the shift each. I was given the task of running the area for the morning half the shift. In addition to my mentor and the other student there was a HCA also assigned to the area. The minor’s area was not particularly busy this morning there was 3 patients in the area with another 2 or 3 waiting to be seen. One of the Doctors working with is in the area asked if I could do an ECG on one of the patients then refer them up to the cardiology ward as they needed to be admitted. I decided that I would hand the patient over to the ward as I had the patient’s full history and I would delegate the task of the ECG to the other student as I knew she needed to do this for her skills, my mentor went with her as she needed to be supervised to complete this skill. On my way to make the phone call, a paramedic crew brought a child in the paediatric area of the minor’s bay. When a patient is brought into the area there paperwork has to be completed including observations. I decided to delegate this to the HCA as the other patient urgently needed to go to the ward. I asked the HCA to do a complete set of observation on the child who responded “when I get round to it” I explained to her that the observations were more important at that time than stocking a cupboard. After making the phone call I returned to the child and the HCA to ensure the observations where completed correctly and noted the Childs observations were not normal and may indicate acute appendicitis as I had seen this on a previous shift, at this point I took the results to the doctor and explained what I felt the doctor agreed and moved the child up in the waiting list to be seen next.

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Thoughts and Feelings

When I was asked to run the minors area initially I felt very excited about this as I have not had many management opportunities during my course and I was getting to manage an area I have always been interested in and hope to eventually work in. When I started to get into the management role I started to find myself getting more and more anxious as I have never really worked in this environment before and that previous experience had been limited to wards which had more set routines. I felt comfortable being able to delegate to the third year student as I knew she would be competent to do the task I asked her I also felt confident in asking the HCA to complete observations as I knew they had training to work in this area. I feel that I could have asked the HCA in a different way to complete the observations as I felt the way I handled it was wrong and it led her to resent me for the rest of the shift because I was short with her. Overall I enjoyed the experience and felt a great deal of satisfaction when I was able to identify a potentially critically ill patient and make the appropriate referral using my clinical judgement.

Evaluation

What I feel that was positive about this situation is I was able to practice my leadership and delegation skills which previously I have not had the opportunity to do. It has also given me a good insight into the importance of time management and prioritising tasks. This episode has given me a small insight into the importance of quality assurance because I had to check the observations and also allowed me to recognise my own limitation as I knew there was nothing I could have done for the child without referring to a doctor. What was negative about the situation I feel was my team working and management style could have been better as I could have explained to the HCA in more positive way. I feel I may not have needed to delegate the task of observations as I could have made the call and managed to complete the observations in a timely and safe manner.

Analysis

Delegation and supervision of others is an integral part of being a registered nurse. Delegation is defined as the process of transferring a task to a competent individual and giving them to authority to complete a selected nursing task in a selected situation Hanston & Jackson(2004).