92448 Kim Case Study - Leadership For Beginning Practice - Nursing Assessment Answer

92448 Kim Case Study Leadership For Beginning Practice Nursing Assessment Answer

Assessment Task:

Criteria 1
The case study raises a few important issues which impact nursing leaders and professional practice. These include inappropriate communication with fellow staff members, privacy and confidentiality, poor delegation and emotional wellbeing.
This situation first arose with the registrar inappropriately shouting at Kim and that too in front of everyone. Factors that led to this could include the high stress environment of a cardiac arrest where a patient’s life is at stake and the expectation that as a registered nurse (RN), Kim should have had sufficient knowledge regarding the equipment that was required. However, communicating with respect is integral to maintaining professional practice and should be adhered to no matter who you interact with or what their position is. Respect is outlined in code x of the NMBA.
The second issue is how the Nurse Unit Manager (NUM) handled the situation afterwards. She failed to comply with the RN Standard 2, and Code of professional conduct 5 by not engaging with Kim in a therapeutic, professional or confidential manner. Publicly announcing Kim’s situation and that she may need counselling had a detrimental affect of Kim and is not a sign of good leadership. The NUM may have been time poor and in her rush did not take into consideration the public environment she was talking to Kim in. As a NUM it is important to provide private and effective
counsel after the mistake was made in order to help Kim move past this issue in a way that is positive and fosters learning and growth. This could have been done by addressing the issue in her office rather than announcing it in front of everyone.
The third issue raised in this case study is poor delegation of staff. Kim although a RN, is still a newly graduated nurse. This means that her practical experiences in a clinical setting and her patient care is still limited with a large room for growth and learning. During the cardiac arrest, though it is important for Kim to be involved as part of the health care team, to learn and experience and also having graduated as a competent RN, it would have been ideal to have a more senior and experienced RN involved too. Factors that may have led to this may include poor skill mix on roster that evening or being understaffed in general. It may have also been that this was Kim’s patient and that there were other patients that needed immediate attention also, therefore more staff were not available to attend the cardiac arrest and/or to support Kim during this time.

Criteria 2

As a qualified, new graduate nurse, Kim did not meet all her obligations. It is imperative for Kim to have adequate knowledge gained from her education as a lack thereof could lead to compromised patient safety, injury or even death. (Frögéli et al 2018). As a registered nurse, Kim’s scope of practice is to adhere to the RN standards of practice and this was not adequately met in the case study. However, as a new graduate, Kim may be overwhelmed in the process of applying her newly acquired skills and will require support to meet her clinical, social and emotional needs. As per standard 1, Kim needs to reflect on her experiences, particularly as a new graduate as there will be many situations that she will experience for the first time. Doing so will allow her to identify how her emotions shape her nursing practice and from there, she can build on her management and coping strategies for future situations. As per standard 3, Kim needs to accept responsibility over her actions and is responsible for ensuring she practices nursing in a safe capacity. This experience enables Kim to identify gaps in her knowledge and practice and to do further research and/or training to continue her professional development so that she remains within her scope of practice.
https://bmcnurs.biomedcentral.com/articles/10.1186/s12912-017-0236-0
legal and ethical boundaries
Subsequently, given that Kim is taken up by emotions, she does not meet her obligations as a nurse.
As a registered nurse, it is expectation for Kim to stay positive despite prevailing situations. Nursing is a highly stressful occupation and under such circumstances, such things can occur such as the registrar snapping under pressure. Kim needs to be able to learn coping mechanisms and practice resilience in her work so as to not affect herself, her patients or her nursing tasks detrimentally. In face of adverse situations, nurse are obligated to remain calm under pressures and to critically analyse situations to overcome such issues. (Legal Resources 2019, par.5). However, in saying so, it also just as important to address the root issues of the adversity faced instead of solely expecting Kim to just simply be resilient all the time in her work. (Traynor 2017, Gill and Orgad 2018)

Criteria 3

Kim, a Registered Nurse, graduated from the University of Technology Sydney in 2018. She is now undertaking a Transition to Practice (TTP) program at a tertiary hospital in western Sydney. Halfway through her program, she was involved in a cardiac arrest on the ward. Fortunately, the patient was successfully resuscitated and transferred to the Intensive Care Unit. The resuscitation went smoothly apart from an incident where the attending Registrar shouted at Kim, admonishing her for not knowing which equipment to provide for the intubation. Up until that point, Kim had felt that she was “getting on top of things” and coping quite well with the demands of ward work. Kim left the arrest feeling “hopeless” and “useless” and incompetent as a nurse. These thoughts and feelings are causing her ongoing distress and embarrassment, damaging her confidence and affecting her ability to conduct everyday nursing.
Description I am being (Kim) a registered nurse who graduated from the University of Technology Sydney in 2018, making the transition to practice in western Sydney hospital. The situation first arose with the registrar inappropriately shouting at Kim and that too in front of everyone. Factors that led to this could include the high-stress environment of a cardiac arrest where a patient’s life is at stake and the expectation that as a registered nurse (RN), Kim should have had sufficient knowledge regarding the equipment that was required.
Feelings: I would listen to what they have to say as a way of showing respect for their own opinion. Instead of taking it personally and retaliating or responding negatively, I would simply acknowledge what they are saying. Once the other staff members have gone, I would gently approach the staff member and say that I respect her input, especially if I can learn something from it and if it can help improve my practice. But, I would appreciate it more if next time he/she has something to say my work to come and discuss any issues with me in private. I would then explain to him/her that being a new graduate RN, I know that I do not have the same level of experience as the other staff and so I do value any constructive criticisms that I am given. Finally, I would say that I do not mean any disrespect in any way, but that I believe it would have been more appropriate and more professional if we had that conversation/discussion in private.

Evaluation: The personality test which held in week 5 give me a great sense compassion and showed me what my strength and weakness are how to tackle them and according to the case study the good thing occurred is at least I can learn and the area of my practice and where I need help by following the NMBA particularly standard 5 develop a plan for nursing practice and I would ask a senior staff member if I they could help me with it when the ward settles down. If it is urgent, Iwould inform the senior staff member (TL/NUM/other colleagues) that I have never done the procedure and ask if they could assist me and in return, I would help them out with their patients. If they are unable to, I would call a CNS/CNE and ask if they could assist me instead. Also, before I do the procedure, I would make sure that I am allowed to do it and make sure I have someone competent to assist/supervise.
My weakness would be in this situation I may reply to the registrar in a harsh tone and this is because I belong to an advocative personality and I would not like if someone scolds me in front of everyone for not being competent with my practice, However, communicating with respect is integral to maintaining professional practice and should be adhered to no matter who you interact with or what their position is. Respect is outlined in code of the NMBA.

Analysis: As a nurse, I need to be able to communicate effectively, both verbally and non-verbally, with patients/families/other members of the interdisciplinary team. In terms of non-verbal communication, I need to ensure that I document vital information regarding pt status, all cares given, any issues/concerns raised by the pt/family and pt progress. To ensure continuity of care, documentation needs to be clear, contemporaneous, legible, objective and accurate. I also need to think about other forms of written information such as brochures or information booklets, in terms
of pt education for example, which can also facilitate effective communication. In terms of verbal communication, I need to be able to communicate with the pt/family clearly and use language that they can easily understand. When communicating with other staff members, I also need to be able to advocate for pts and relay all relevant information clearly to appropriate staff, with the pt’s consent.
Another important skill is to be assertive, especially when myself or another colleague/pt is being treated unfairly in any way. This helps resolve any issues/conflicts as well as promote a good working environment/culture for everyone.

Action plan /conclusion:

• Being able to work with other members of the team to provide the best care for patients by utilising and respecting each members’ expertise and input
• Being able to communicate effectively, both verbally and non-verbally, through accurate documentation and handovers. This ensures continuity of care and that all members of the healthcare team are on the same page
• Collaborating with other team members to ensure the best and most appropriate plan of care is provided
• Being open to each other’s opinions during decision-making processes regarding patient care
• Respecting each other’s actions/decisions/inputs/expertise, which allows for the provision of best patient care
• Being able to avoid or resolve any conflict in a professional manner
• Being able to communicate assertively and respectfully when needed e.g. when I feel disadvantaged or being treated unfairly. This facilitates effective communication, as well as creating a positive work culture/environment for all

Criteria 4
Leadership is a concept of stepping up and doing what is right in any given situation. In terms of the issue, effective leadership is important for safe patient handling. Evidence based practice is central for nurses and effective leadership is being aware and filling in the gaps for improvement. For example, by discussing with senior staff to implement strategies to minimise or mitigate the problem. It is important that the staff educates the solution and complies with the policies. In health care every staff member has the quality of being a leader. Effective leadership involves positive drive to change and setting example for everyone to follow. Effective leaders notify staff when unsafe nursing practice is occurring to resolve the issue and thereby implement safe nursing practices.

Trigger questions you could ask yourself to put this paper together....

Issues and factors that impact on nursing leaders and professional practice
How would you approach the situation if you were the Nurse Unit Manager (NUM)? How would the RN Standards of Practice apply in the NUM’s case?

Clinical leadership expectations for beginning new graduate nurses: scope of practice, legal and ethical boundaries
Did Kim meet her obligations as a new graduate nurse? How would the RN Standards of Practice apply in Kim’s case?

Gibbs model of reflection: strategies to develop personal and professional resilience
How you would have felt in Kim’s situation. What strategies would you recommend to develop personal and professional resilience?

Supportive elements in effective leadership: knowledge, evidence, communication and networks
What knowledge, evidence, communication, and networks could leaders, such as the NUM in the case study, offer new graduate nurses to support their development as a leader?

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