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Transition to Practice Nursing Essay


After six weeks of working at a local hospital, a senior member of our nursing team in the ICU went on annual leave, leaving the six of us without a group leader. It was then that the department manager appointed me as the team leader in an acting capacity as we awaited the return of the colleague on leave. Our facility had an ICU unit that accommodated a ten patient’s capacity. The six nurses would be divided into three groups for the three 8 hour shifts. On my first day as the group leader, an elderly female nurse walked to me to remind me that she did not want to be put on a night shift because she had grandchildren to attend to at home. I informed her that I had noted her concerns, but I needed to consult with other members of the team on the matter before drafting the final timetable for the shift and task allocation. Before I was done talking, she exclaimed in surprise, “I thought you were the team leader! Of course, you are too young to know that. I will discuss with the manager”. By inviting all the team members for deliberation on the scheduling of the shifts, I wanted to achieve collective decision-making.

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That evening, a male patient of Arab descent was brought into the facility with severe body burns. I moved to gather together a team of nurses to change the patient’s clothes before he was put in bed. However, I was immediately blocked by a member of the family from accessing the patient. Instead, the family member told me to look for an elderly male nurse to undress the patent. In the end, I had to look for nurses from the normal ward to help with patient preparation. In both cases, my sole objective was to promote a quality patient-centered nursing care service by ensuring the nursing staff participated fully in key decision-making processes.My experience with the patient, his family, and the nursing staff on this day highlighted the critical challenges of leadership in nursing practices. In particular, it emphasized the fact that the healthcare environment is constantly changing, hence the need for competent nursing leadership to achieve effective patient-oriented care provisions. Willcocks (2012) defines leadership as the multifaceted process by which individual and group of leaders identify a target or goal, motivate action by their people, as well as provide motivation and support for the achievement of mutually-negotiable objectives and goals. At the clinical level, a nursing leader is expected to deliver and monitor evidence-based practices and asses the outcomes in a continuous framework of service improvement, as well as improve the coordination of care provision among the nursing staff. Nevertheless, my experience revealed how difficult clinical nursing leadership is, especially in the multicultural context, where significant levels of cross-cultural competencies are needed for effective delivery of patient-centered care.

The misunderstanding between the elderly nurse and myself regarding the scheduling of the nurses’ shifts revealed a conflict in leadership styles among the different facility leaders, which fostered varying expectations among the nursing staff. From her response to my suggestion of a collaborative approach to making decisions regarding the scheduling exercise, the nurse must have had a different view of the role of a leader at the workplace. In her opinion, she believed in a leader as an authoritative and dictating individual who made all the important decisions independently. From the perspective given by Krepia, Katsaragakis, Kaitelidou, and Prezerakos (2018), an autocratic leadership style, which was the widely used approach at this facility, involved giving specific orders and directing the subordinates to submit to the leaders’ choices without questioning or objecting to them. Accordingly, the nurse expected me to impose my will on the team members by creating a timetable without any continuation or participation by those involved. Although this style could have been effective in facilitating the accomplishment of tasks at the facility through the strict medical guidelines to which the nurses adhered, it proved ineffective in my case because of my desire to foster trust and employee empowerment in the group. Consequently, it was difficult to encourage creativity and innovativeness in solving the problem faced by the team because of the members’ lack of preparedness or unwillingness to embrace collective discussions and decision-making.

As a modern leader, I was aware of the increasing competitiveness of the corporate world in terms of the management of human resources, which are the most valuable assets of the organization. On this basis, I was committed to promoting a transformational approach to leadership, which characterizes a visionary and focused leader for better management and service provision to ICU patients. In this case, the transformational leadership technique would involve focusing on the bigger organizational picture, which is, in this case, the improvement of patient care and improvement of the processes and systems for nursing care delivery (Stanley, 2014). From my perspective, the issues surrounding work allocation, scheduling, and the general decision-making processes in the hospital are too critical to be left solely in the hands of the leader. Accordingly, I was interested in creating an accommodating workplace environment where all nurses could actively participate in choosing what they believed would improve the quality of care and patient satisfaction at the facility.

Much of the leadership challenges at the hospital can be linked to the corporate culture of the facility, which has influenced the incoherence and incompetent leadership style used by the previous nurse leader. In an institution dedicated to promoting patient-centered nursing care excellence, it might have come as a surprise that the manager independently appointed the team and departmental leaders with no regard to the individual’s familiarity with or competence in the organizational behavior and techniques (Krepia, Katsaragakis, Kaitelidou, & Prezerakos, 2018). I did not doubt that my appointment to the leadership position was an important indicator of the faith that the hospital management had in my abilities and skills. However, my approval among fellow nurses and effectiveness to deliver could have been boosted by prior training and knowledge of the organizational culture and leadership, which could not have been achieved in the six weeks that I had worked at the facility.

Among the notable factors that contributed to the leadership challenges that I experienced on this day was the multigenerational nature of the nursing workforce. Evidently, my appointment as the group leader might not have been popular among my team members because of my considerably lower age compared to other members. Despite our age differences, my primary objective was to try and promote teamwork and cohesion despite the differences in work habits, communication styles, and attitudes that the different nurses exhibited. However, these efforts were frustrated by the negative stereotypes of the elderly nursing colleague, who could not acknowledge my position and ability as a leader. According to Willcocks (2012), dissimilar age groups may develop some stereotypical thoughts regarding each other’s abilities and intentions. In my case, the elderly nurse might have perceived me as an overeager and entitled leader, who was interested in pursuing my interests as an imposed leader without regard for her wellbeing as an experienced employee at the hospital. In the end, the outright questioning of my authority and ability significantly undermined my leadership influence.

The cross-generational workforce challenge in nursing leadership was also demonstrated through the conflict of values. This phenomenon is extensively explained by Krepia, Katsaragakis, Kaitelidou, and Prezerakos (2018), who identifies that every generational cohort exhibits unique values at their place of work, and this was demonstrated by the elderly nurses’ adamancy and unwillingness to negotiate about what she believed. As a leader who focused on harmonizing the interests of all employees by overseeing a fair allocation of tasks at the facility, the conflicting values inevitably undermined my ability to achieve the desired objectives for the team. Like a typical generation X member, the nurse was more interested in flexible work arrangements and family time, values that she was willing to advance at the expense of her employment at the hospital. I believe that I could have achieved a better outcome if I had better knowledge about the differences in generational values. According to Stanley (2014), such knowledge is critical in the effective management of diverse attitudes and for driving the organization forward. Hence, nursing leaders have the duty of honoring the diverse ways that the different employees contribute to the workplace, as well as acknowledge the efforts that the individual team member puts into the advancement of the organizational goals, regardless of the work styles employed.

My good intentions as a care provider and dedication to quality patient-centered care provision of the ICU patients may have also been undermined by my lack of cultural awareness as a nursing leader. As part of the cross-cultural nursing competence, I would have been expected to understand the cultural beliefs of different patients, including their views about gender and age differences in relation to their responsibilities. As advised by Willcocks (2012), nurses are expected to pay close attention to the patients, especially those who speak a different language or come from a different culture. In my case, profession and personal networks with people from different cultures, as well as taking courses in cross-culture nursing would be important for the improvement of my multicultural competencies.

Following the unpleasant experience as a nursing leader at the hospital, I have come to appreciate the importance of continuously developing leadership skills due to the diversity of the working environment, organizational cultures, patient cultural practices and beliefs, as well as the different personalities and behaviors that the individual nurses have. Among my resolutions has been the decision to overcome the multigenerational barriers that proved to be an impediment to my effectiveness in my leadership position. For instance, I decided to search for and read more literature materials on the different characteristics exhibited by different generations as part of my self-empowering program to improve my competencies as a nursing leader. In addition, I have resolved to become more flexible and integrative with people of different ages to understand the unique attitudes and behaviors that they have towards different professional and personal aspects of life. For instance, I have sought to establish professional and personal networks with senior nurses within the facility and from other hospitals, from whom I gain valuable knowledge on their work ethics and values, together with their preferences for leadership, especially in relation to communication styles and leadership styles.

The underwhelming experience of my leadership tenure also influenced my decision to study and understand the organizational cultures, mission, visions, and values of different healthcare institutions before deciding to work for them. Clearly, the lack of knowledge about how the hospital worked put me on a different path from that of the nurses under my leadership, and this incoherence must have contributed to the misunderstanding and my inability to influence the nurses. In the end, I have learned that organizational change is a process that is complex and critical in the general running of an organization, and only competent and all-inclusive leadership approach can successfully provide the suitable platform for change.

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Krepia, V., Katsaragakis, S., Kaitelidou, D., & Prezerakos, P. (2018). Transformational leadership and its evolution in nursing. Progress in Health Sciences, 8(1), 189–194
Stanley, D. (2014). Clinical leadership characteristics confirmed. Journal of Research in Nursing, 19(2), 118–128
Willcocks, G. S. (2012). Exploring leadership effectiveness: nurses as clinical leaders in the NHS. Leadership in Health Services, 25(1), 8-19.

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