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Introduction
Evaluation of leadership style chosen by a person in a real-life situation can serve as a valuable input into one’s understanding of the theoretical and practical implications of leadership. In this case, I observed leadership behavior during clinical rotations. This practice serves as a place of learning, even when the environment is chaotic or challenging. When faced with these circumstances, it is imperative that trainees learn what to do and what not to do from nurses and instructors. Many of these nurses and instructors do their best to teach their students while demonstrating transformational leadership. The person that demonstrated these qualities is the medical-surgical clinical instructor Professor Barnwell.
I was assigned to a patient who was being treated for clostridioides difficile and had orders for potassium as part of her treatment. My instructor was alarmed because the patient was getting potassium via vitamins and IV, and there were no lab tests for two days. The patient was presenting with signs of hyperkalemia such as cardiac arrhythmias, weakness, and chest pain which can be fatal. When my instructor brought this concern to the attending physicians’ attention, he immediately was on the defense about her questioning his expertise and proceeded to say that he was the Doctor and she was just the clinical instructor visiting for the day. Being that my Professor is a Nurse Practitioner, she was furious about the lack of concern being shown for this life-threatening situation. She then took it upon herself to get labs ordered immediately, which resulted in a potassium level of 6.2. I genuinely admire Professor Barnwell based on her leadership skills and her continuous drive. This situation demonstrated the type of leader we should all aspire to become. I also learned from her that trusting your knowledge is crucial in any given case, especially when it comes to advocating for your patient.
It is evident that in the described scenario, the person in question demonstrated transformational leadership qualities. It is because the Professor promoted trusting her knowledge and expertise in difficult situations when faced with criticism from a doctor, which is a challenging case. In essence, she encouraged focusing on patient safety using her own example. The fact that this nurse acted to ensure that the patient in question is safe is an essential element of transformational leadership. This theory describes the ability of a professional to lead teams in an environment subjected to changes. Sfantou et al. (2017) argue that a relationship between leadership style chosen by managers or supervisors in healthcare organizations impacts the perceptions of safety and quality. Hence, this aspect directly affects the care quality and should be considered by nurses. In this case, the Professor used her example to display the need for changing the view of nursing work in the United States and eliminate the fear of nurses when voicing their concerns regarding the physician’s actions.
Main body
Power and nurses’ ability to use it in challenging scenarios is a critical element of leadership. According to Sepasi, Abbaszadeh, Borhani, and Rafiei (2016), power is a concept applied in many domains, which results in many definitions of the notion. The authors state that it should be perceived as something that allows an individual or a group of people to achieve their objectives. In nursing, power enables medical professionals to apply their skills and expertise in creative ways.
Another concept that is determinant in allowing one to execute a decision is the source of power. Sepasi et al. (2016) identify the following as power sources – “decision-making power, punishing and rewarding power, recognizing the power, word power, scientific power, skill power, communicative power, participation power, implementation power, and financial power” (p. 13). Using the case example, one can argue that Professor leveraged the decision-making power since she was able to order labs despite the disagreement of the physician. Additionally, she had both scientific and skill power because her education and background allowed her to recognize the patient’s symptoms using evidence and the ability to interpret vital signs. Finally, she used implementation power since she was able to order labs and present results indicating that a patient required immediate intervention, which was accomplished.
A power type is a concept that specifies the use of power by nurses. The Professor used all three power types identified by Manojlovich since she leveraged control over the content, context, and competence (as cited in Ajuebor et al., 2019). In regards to controlling the content of her practice, the nurse leader was able to make an independent decision based on her perception of the situation and the patient’s state. Hence, this nurse did not merely accept the fact that a physician is the one responsible for the patient but instead promoted the use of nursing knowledge and practical skills to ensure that this patient is not harmed as a result of a mistake. The content factor is closely connected to the autonomy and nurses’ ability to act independently from other professions since their education provides them with competence to make judgments and suggest additional tests that can guarantee a patient’s well-being.
Control over the context of nursing practice as a power level is connected to the nurses’ impact on the environment of the hospital environment. In this case scenario, the Professor displayed her leadership capabilities and with her own example promoted the need to pay more attention to the work of nurses and their suggestions, with unarguably had an impact on both nurses and other personnel. Finally, the competency aspect is a vital element of contemporary practice because nurses obtain educational degrees and training that allows them to make a significant contribution to the health system in the state. Thus, they conduct patient research and implement policy improvement projects or receive training that allows them to diagnose and treat patients. In the discussed case, the Professor did not overlook her education to avoid a conflict with the physician. Instead, she used her training as a background for supporting the power she had. Hence, nursing expertise allows these professionals to gain control over their professional life and make appropriate decisions for the benefit of the patients.
Work motivation is essential for nursing because medical professionals often have to work in challenging conditions and emotionally challenging situations. Despite this, many nurses understand the value of their work and the contributions they make for the well-being of the patient. The motivation theory that Professor Barnwell displayed, in this case, is self-determination theory, according to which people are influenced by their inherent desire to grow and improve personally and professionally (Alhakami, & Baker, 2018). The intrinsic nature of the actions taken by this nurse leader indicates that she aimed to use her knowledge and ensure that the patient would not be affected by the medical mistake. In this regard, it is evident that she was influenced by extrinsic factors, the expectation of reward or fear of punishment that can arise if the patient suffers from severe health impairment since she was not responsible for the physician’s decisions.
Regardless, the Professor decided to voice her concern even though about the lack of attention provided to this individual. Hence, one can argue that she was motivated by her personal concern about the well-being of individuals in the hospital and confidence in her knowledge as a medical professional. The receptiveness of the staff before receiving lab results was limited as no other nurse supported the Professor. This may be a result of the specifics of the healthcare environment in the United States, showcasing that nurses still depend heavily on the opinions and views of doctors, willing to overlook their professional competence.
Conclusion
Personally, I think that the fact that patient safety remains to be threatened by physicians’ lack of awareness of the knowledge and competencies that nurses possess is a severe problem that needs to be addressed. In this case, the patient was saved because the Professor displayed exceptional leadership capabilities. However, one can argue that there are thousands of cases where patients are harmed in similar scenarios. Hence, the main critique, in this case, is the lack of support from the assigned nurse who did not advocate for the additional labs. According to Fiscer (2016), the question of patient safety is especially relevant for the United States and “public, and government pressure is high for transformational change in health care to improve patient safety outcomes internationally” (p. 2644). This case is an ideal representation of the patient safety issue and the difficulties that accompany questioning somebody’s authority.
Although the outcomes were positive since the patient received the necessary treatment, it can be argued that the conflict between the Professor could have been avoided if the nurse responsible for the treatment would support the concerns. On the one hand, a servant leadership approach through which the Professor would engage this nurse into a conversation and help consolidate the staff members could be more appropriate. According to Fahlberg and Toomey (2016), such leaders are “driven by the desire to serve others, and then makes a conscious choice to aspire to leadership to accomplish this goal” (p. 49). The emphasis is on communication and interpersonal relationships, which allows creating a supportive environment. On the other hand, this strategy requires time, and the Professor was visiting this unit for only a day, giving her little time to build an appropriate relationship with other nurses and physicians. Hence, her actions were adequate, considering the need to address the patient’s health state immediately.
In general, the group rejected the approach taken by the Professor initially. However, the test results displayed the fact that her concerns were correct, which resulted in a reevaluation of the actions taken by the physician and other nurses. This lack of cooperation and support from other nurses is the main issue that nurse leaders should consider. Overall, in contemporary nursing, power is an essential element of professional life that allows one to achieve his or her goals.
References
Ajuebor, O., McCarthy, C., Li, Y., Al-Blooshi, S., Makhanya, N., & Cometto, G. (2019). Are the global strategic directions for strengthening nursing and midwifery 2016–2020 being implemented in countries? Findings from a cross-sectional analysis. Human Resources for Health, 17(1), 54-56. Web.
Alhakami, I., & Baker, O. (2018). Exploring the factors influencing nurse’s work motivation. Iris Journal of Nursing & Care, 1(1), 1-12.
Fahlberg, B., & Toomey, R. (2016). Servant leadership. Nursing, 46(10), 49-52. Web.
Fischer, S. A. (2016). Transformational leadership in nursing: A concept analysis. Journal of Advanced Nursing, 72(11), 2644–2653. Web.
Sepasi, R., Abbaszadeh, A., Borhani, F., & Rafiei, H. (2016). Nurses’ perceptions of the concept of power in nursing: A qualitative research. Journal of Clinical and Diagnostic Research, 10(12), 10-15. Web.
Sfantou, D., Laliotis, A., Patelarou, A., Sifaki- Pistolla, D., Matalliotakis, M., & Patelarou, E. (2017). Importance of leadership style towards quality of care measures in healthcare settings: A systematic review. Healthcare, 5(4), 73-90.
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