Critically analyse the contribution of leadership relating

Introduction

In nursing, the handing over of care is the process of transferring professional accountability and responsibility for some aspect or part of care of a patient by one nurse to another. The handing over in nursing occurs in day-to-day context during changing of shifts of nurses or change of duties among nurses and others. In this essay, leadership theories and styles are to be discussed that impact on achieving enhanced change for improved handover in nursing. The role of the nurses in delivering healthcare care and implementing healthcare policies are to be discussed. Moreover, way to use evidence-based data for manipulating political leaders for creating better health outcomes for patients. Thereafter, discussion regarding the transition phase of the nurses from student to registered nurses is to be made through analysis and presentation of revalidation, clinical supervision, preceptorship and professional development plan.

In nursing, effective clinical handover is one of the high-risk activities to be followed by the nurses as any increased delay or hindered handover causes error in care delivery to the patient that at times may cause destructive health consequences for the individual (Anderson et al., 2015). In the NHS, junior nurses reported they experience confusion regarding handing over of patients in their early years of profession which leads them to be at risk of unnecessarily causing harm to the patient. This is because they are unaware of the extensive policies and procedures made by the NHS that acts as guidance to make effective nursing handover (NHS, 2019). As mentioned by Sujan et al. (2014), the error raised during handover in nursing includes delay in treatment delivery to the patients and lack of satisfactory care delivery. This is because increased time is wasted in sharing existing patient data to the nurse during handover by the nurse in-charge and lack of understanding of the needs as well as demands of the patients. The NMC Code of Practise mentions through the “Practise effectively” that nurses are to examine the needs of the patients and deliver them prescribed treatment without creating increased delay and to the best of their ability (NMC, 2018). Thus, failure of effective handover by the nurses raises error in care as well as violation of The Code mentioned by NMC.

The study by Oxelmark et al. (2020) mentioned that ineffective control of the personal data of the patients during handover in nursing is faced as an error that compromises the confidentiality and privacy of the patient. This is because nursing during handover does not have knowledge regarding the way to safely store the patient’s data to ensure their privacy leading to sharing of the information to the public or inappropriate individuals that compromise the rights of the patients. It is evident as The Data Protection Act 1998 mentions that effective control of the person information of the patient is to be made to avoid their misuse and revelation in public that would compromise the confidentiality and privacy of the patients. The prior consent of the patient is to be required for sharing any related information about them in public other than the authorities involved in care (legislation.gov.uk, 1998). Therefore, error of violation of Data Protection Act 1998 along with confidentiality management for the patients are faced due to hindered handover technique in nursing.

The NMC Code of Practice mentions that mentions nurses are to ensure safety of the patients by limiting their work according to their duty of candour, competence and required to raise concerns regarding any issues (NMC, 2018). This part of the Code mentions that nurses during handover have the role to make the action within their competency and duty of candour along with raise any concerns regarding problems identified for the patient’s health during handover. However, failure to execute the responsible during handing over by nurses is seen which led them to be responsible for causing harm to the patients as nurses were irresponsible in raising concerns to manage the risk and executing duties beyond their knowledge which compromise violating the Code (Bunkenborg et al., 2017). In contrast, the study by Jember et al. (2018) mentioned that error of lack of continuous monitoring of health and administration of duplicated or wrong medication in handing over is faced due to their hindered execution by nurses. This compromises the health of the patients which led them to face fatal consequences at times. It indicates the focus of the change is to be controlling the establishment of enhanced handing over of responsibility by nurses so that medication error, disruptive care, risky health consequences and others could be minimised or averted for the patients to ensure them good well-being.

In achieving enhanced change for limiting error during handing over in nursing care, effective leadership qualities among the nurses are to be present (Spooner et al., 2018). This is because enhanced leadership qualities in the nurses would make them understand the way resources and information present for them about the patients are to be systematically managed to be handed over to other nurses to be in care for the patient during shift change. An enhanced influence of the political and ethical issues is seen in regard to development of leadership (Lemoine et al., 2019; Melo et al., 2017). As mentioned by Mason et al. (2020), political issue of preferring one individual over the other leads to cause hindered leadership. This is because such condition makes the leader in power prefer one over the another in turn creating discrimination. In handing over, when the nurses in-charge express the politics of preferring one nurse over the other would intend to show hindered leadership such as sharing of vague and insignificant data, undisclosed care purpose and other to the nurse the person does not prefer compared to the other. This political issue leads to create error in achieving effective patient handover by the nurses and showcases hindered leadership.

The political issue of not involving nurses during policy development of nursing handing over create hindrance in effective achievement of the action and raises error in care. This is because nurses are the practical care delivery individuals who understand and faces the complications in handing over duties. During policy development, the politics of not involving nurses as potential individuals to support formation of handing over guidance leads the policymakers experience lack of information on the context they are to focus on avoiding error-free handing over in nursing (Groenwald and Eldridge, 2020). The policy awareness for handing over of duties or patients as a leader is important for the nurses because it provides guidance to nursing professionals about the steps to be followed for the effective handover of the responsibilities of care or patient (Fealy et al., 2019). Moreover, the policy awareness leads the nurses to determine the accurate relatable communication to be made for task-relevant information across changing shifts or within team to ensure continuity of effective safe care delivery (Fealy et al., 2019). However, due to organisational culture and politics, nurses report lack of knowledge of the policy guidance for handing over that leads them face hindrance in successfully leading the handover.

The ethical issue of lack of fairness and integrity is present in care that causes hindered leadership to be established. This is because honest and non-discriminative care delivery is the quality of any leader (Pang, 2017). In handing over by nurses while acting as leader, their hindered fairness and integrity leads to manipulated data sharing of the patient’s care and treatment which create error in handing over process. This is because true data for treatment and care that are essential to deliver continued care for the patients is not achieved (Alberta et al., 2018). There are nurses who unfairly share data during handover process as they feel it is the end of their responsibility leading the patients and other nurses to being care suffer in establishing well-being of the patient. The lack of accountability is another issue present that influences error in leadership of nurses during handing over of patient. This is because hindered accountability leads the nurses acting as leader during the handing over of charge acts irresponsibly, share wrong and unfinished care data of patients and others that creates problem in care delivery (Oxelmark et al., 2018). Thus, it is seen that ethical issues, political problem, lack of knowledge of policy guidance and others are hindering effective achievement of handing over in nursing and raising error in the process due to which effective change is to be determined and implemented in this context to avoid the error.

During handing over of patients or duties in nursing, the nurse in-charge of care of the patient requires to act as leader. The leader is the individual who rallies individual to understand the way to move forward with greater vision and reach the purpose of care (Ducharme et al., 2017). In handing over of patients or duties, the nurse in-charge has the responsibility to relay the nurse to whom the handover is made about the detailed condition and prescribed treatment of the patient, purpose and vision of care along with the way to progress further support as suggested by the physician to maintain continuity in care and avoid duplication or unnecessary error (Cowan et al., 2018). Since I am a nurse who has the responsibility of making handover of patients during shift change to other nurses to ensure care continuity for the patient, my strength and weakness as a leader is to be assessed by using Myers-Briggs personality assessment tool. The Myers-Briggs personality assessment tool is to be used because it contains a systematic questionnaire to understand psychological types of individuals that are useful in deciding their leadership and personality qualities (Moyle and Hackston, 2018).

According to Myers-Briggs personality assessment tool, I show extraversion (E), sensing (S), feeling (F) and judging (J) as personal characteristics indicating I am a generous leader (Rao, 2019). As a nursing professional, responsible for handing over care and displaying generous leadership style, I express the strength of making effective communication and interaction as a leader. This is because extraversion makes an individual be outgoing and social who can make open interaction without being shy or confused (Ahmad and Siddique, 2017). In order to introduce any change as a leader, effective communication is to be established because it helps the subordinates to mention their views and ideas regarding the way change is to be successfully made, share feedback and suggestion to implement the change (Sample, 2017). Thus, as a nursing professional trying to create the change of avoiding error during handing over care, the communication as strength is going to help me understand the way handing over is to be processed so that it is executed successfully. I also show the strength of being dedicated to work and accomplishment of shared goals which indicates as a leader I have the strength of being accountable in playing my role. This is because without accountability a leader is unable to show dedication in fulfilling responsibilities (Rao, 2019). It also makes me be effectively responsible for sharing all data needed for non-errored handing over of patients.

As a leader, the presence of enhanced feeling and judgement made me have the strength of being helpful and act with gratitude towards others. This is essential qualification of a leader as gratitude from leader makes subordinates feel motivated and valued to work with zeal. Moreover, helpful actions from the leader lead the subordinates to overcome complications and problems at work which enhances their productivity (Rao, 2019). Thus, being helpful and ability to show gratitude leads me as a nursing professional to be capable of making other nurse feel supportive during handing over of duties. It would make them discuss any complications or queries regarding care to ensure smooth continuity of care after handing over. However, my weakness as a leader is struggling to frame long-term plan and to remain objective in discussing facts. The weakness of inability to make long-term plan makes leaders unable to determine strategic actions to be taken to overcome risk in long-term condition (Moyle and Hackston, 2018). Moreover, lack of objectivity in leaders makes communication wide which leads to take increased time in executing actions to make any change (Rao, 2019). Thus, lack of long-term planning would lead me as a nursing professional fail to understand the long-term actions required in implementing error-free handing over of patients. Moreover, hindered objectiveness in explaining information would make me as a nursing professional in supporting handing over of responsibility to cause unnecessary delay in care for the patients by the newly allocated nurse.

The Myers-Briggs personality assessment mentions that I have the personality of a caregiver. This is because I am extroverted, feeling, sensing and judging (Moyle and Hackston, 2018). An individual with the Caregiver (ESFJ) personality, shows enjoyment in helping others and express enhanced responsibility in delivering care and supporting people in need (Lee and Kim, 2021). The personality would support me in making the change because enjoying assisting others would make me as a nursing professional be alert in supporting and sharing effective patient information from nurses so that it is helpful for the nurse in new shift to understand what has been done and what is required to be done in further care to maintain continuity and to avoid error. As argued by Ghasemian and Kumar (2017), people with ESFJ personalities require approval of sharing information, expect to be appreciated, easily get hurt and derive value from the community rather than ethical and moral guidelines. The quality of needing approval in sharing information may led me as nurse to avoid sharing in non-approved data of patients during handing over to the other nurse that may raise concern of additional error in care. Further, the non-appreciation in sharing effective details by the other nurse in new shift may make me demotivated to implacably share the information of patient for handing over leading to missing of few vital points of care that may cause error and failure of the change.

In leading any change, the Great Man Theory mentions that some individuals have leadership power from birth and they set themselves away from other due to their increased ability to show power and authority (Hodge and Varndell, 2020). Thus, the theory indicates that leaders to be capable in making the current change of error-free handing over of care as a nursing professional are already born with leadership qualities as leaders are not made. It indicates the nurse to accomplish the change is to be one who is a born leader. The disadvantage of Great Man Theory is that it neglects scientific validity and undermine the power of the female over men to be potential leaders as it theorises men are more powerful than female and since men are born as leaders (Murray et al., 2018). The fact is also supported by Trait Theory of leadership which indicates leadership is inborn quality as personality, physical condition and intelligence are inherited factors not learned (Pidgeon, 2017). However, the disadvantage of the Trait Theory of Leadership is that it fails to explain why some individuals with leadership traits fails to be leaders whereas individuals without associate leadership traits act well in leading people successfully (Fischer, 2017).

In contrast, the Behaviour Theory of Leadership argued that successful leaders are made and not born as leadership behaviours are learned and not natural attributes (Gifford et al., 2018). Thus, according to this theory, any individual with learned leadership behaviour through training can lead people. Therefore, the behaviour theory of leadership is to be implemented in making the change as it would help in identifying through assessment of behaviour of individuals in the organisation who is most capable to act as leader in directing the change of errorless handing over of patients in nursing care. An effective leader required to show collaborative behaviour along with being transparent, show accountability, enhanced problem-solving capability and communication efficiency (Cable and Graham, 2018). The behavioural factors are already present in me as understood from self-assessment, thus I can be capable of leading the change. The NHS managers acts autonomously and show enthusiasm in making any change as they understand the importance of the change. Moreover, NHS managers are seen to act with compassion and empathy along with develop enhanced approachability situation from other subordinates so that they are involve in discussion of any idea of change with the manager without hesitation (Kline, 2019). It indicates that the following behaviour are to be present in the leaders to be involved in making the change for its successful accomplishment.

Apart from leadership theories, the leadership styles are also important in making the change as it informs which leader has the suitable characterises in directing, guiding and managing current team of people to successfully make the change (Konstantinou and Prezerakos, 2018). The leaders following transformational leadership style encourage, motivates and inspire employees in making innovative change while acting with them (Jambawo, 2018). The strength of the style is that it allows easy spotting of problems and gaps in vision for change as well as allows quick problem solving due to collaborative action and encouragement of the leaders towards their subordinates (Collins et al., 2019). The use of the leadership style would therefore ensure successful change by quickly resolving any raised problem acting as barrier for the accomplishment of the mentioned change. However, the weakness of transformational leadership is that it causes subordinates to change their thinking according to leader that often create confusion and disruption in making change (Neratzi et al., 2018). Therefore, due to disruption at work and confusion, timely accomplishment of the mentioned change could not be achieved leading to wastage of resources and effort for change.p>

In comparison, Transactional leadership styles focus on using punishment and rewards in achieving optimal performance from subordinates in establishing any change (Hill, 2017). The strength of transactional leadership is that it that such leader acts as excellent motivators due to their structural and systematic view of directing people to work (Richards, 2020). This is because enhanced work by subordinates makes them achieve reward which makes them feel valued for work whereas inappropriate working action makes employees punished to realise the value of their work (Thusini and Mingay, 2019). Thus, the leadership style is effective in motivating successful accomplishment of change as employees would work effectively to access the reward and avoid punishment. However, the weakness of transactional leadership is that it discourages creativity due to fear of punishment as creativity may not always work in same way as expected that may lead to show failure (Hill, 2017). Thus, use of the leadership style would avoid implication of innovative creative strategies in accomplishing the mentioned change that may lead the change to be time-taking and completed with less quality assurance.

The autocratic leadership style includes leaders who take the sole decision regarding the way to execute change with access to little input from the subordinates (Lumbers, 2018). In this aspect, the strength of the style is that it allows quick decision making, unambiguous setting of change goal and systematic chain of commands in achieving change (Durmuş and Kırca, 2019). Thus, autocratic leaders in making the current change would benefit in accomplishing the change systematically within minimum time. However, the weakness with the use of autocratic style in making change is that it develops a non-creative working environment where opinion from others are not taken in making decision which results in creating increased dependency on the leader from the subordinates in making them accomplish the change (Lumbers, 2018). This would hinder the change to be accomplished in non-creative manner with most of the responsibilities of strategizing the change to be taken by the leader which may make the leader unable to determine few risks and way to avoid them in making the change without obstacles.

In making successful change, collaborative teamwork is necessary with the presence of enhanced leadership. The Belbin Theory identifies the way of behaving, contributing and inter-relating actions of one person with another to determine their role along with strength and weakness related to the role in the workplace (Smail, 2018). According to Belbin’s theory, shaper have the role of challenging their team to improve dynamically and develop courage to execute the changed actions to ensure successful accomplishment of goals at work (Gómez Torres et al., 2020). A leader required to play the role of shaper as the individual is responsible in planning and leading the change in organisation through shaping of thinking and working strategies of the subordinates to help them feel motivated and productive to work in meeting the change (Gómez Torres et al., 2020). The strength of shaper is challenging attitude, dynamic thinking and ability to drive courage and overcome barriers at work (Chapa et al., 2017). I have specific capabilities as I often take challenges at work and resolve obstacles on own to motivate my subordinates in executing their duties without confusion. However, the weakness of shaper is they are prone to change with provocation and offend feelings of people (Gómez Torres et al., 2020). As a nursing professional, I have always acted politely and never been influenced by provocation which indicates I do not possess the weakness related to being a shaper and has efficiency to lead effectively

The coordinators are mainly individuals acting as traditional team leaders who have the role to understand and relate objectives along with delegate tasks and role according to the expertise of staff (Gómez Torres et al., 2020). As a nursing professional, I have always delegated task to team member and developed objectives that are accomplished in time by the team members. The strength of coordinators is that they are confident and matured along with have talent and effective decision-making skill (Chapa et al., 2017). However, the weakness of coordinators is they are manipulative and offload their work on others (Gómez Torres et al., 2020). As a nursing professional, I have never offloaded my work on others as I belief it is against work protocol and would indicate my low dignity at work. Thus, in the change process, playing the role of Shaper and Coordinator to act as leader I would involve in shaping the team to understand importance of avoiding error during handover of duties in nursing and delegating task to them according to their expertise to meet the change objective.

In implementing change, improved team effectiveness is essential as it indicates team members can act with utmost capability in meeting the change. The leadership behaviour of effective task delegation according to the strength and weakness of each team member and monitoring the team to ensure they work by meeting specific standards ensure greater team effectiveness (Backman et al., 2017). This is because it makes the team members work with zeal and less confusion due to enhanced presence of competence for the responsibility provided to them in accomplishing the change. Moreover, monitoring ensures leaders continuously review and direct subordinates way to work with standards by identifying their faults which ensure minimisation of error and greater performance by team. As asserted by Carragher and Gormley (2017), leadership behaviour of supporting clear two-way communication with the team influence enhanced team effectiveness. This is because it makes the subordinates or team members communicate with the leader without hesitation and fear in discussing way of working during confusion. Moreover, enhanced communication makes the leaders to share detailed purpose and explanation of strategies to be followed in making any change to the team members which offers the team greater understanding of the actions they are to show leading the team work effectively (Murray et al., 2018). The leadership behaviour of improving the efficacy of the team by prior training to them influence team effectiveness (Backman et al., 2017). This is because the training makes the team members overcome their shortcomings and enhanced strength to perform with increased efficiency in making the change.

The NHS Leadership Model is the consistent leadership approach which mentions that effective team involvement in change process is created by building a shared purpose and well-informed vision for the change by the leaders (NHS, 2019). Thus, as a leader to support greater team involvement in change, shared purpose of achieving the change and vision are to be informed among the team members. This is because inspiring shared purpose and vision makes team members understand the cause, reason and way of change they are mentioned to achieve and the reason of achieving it (Thusini and Mingay, 2019). The Model further mentions that supportive team involvement in making change is to be accomplished by leading with care (NHS, 2019). This is because leading with care makes the leader consider the opinion and decision of the subordinates as well as care for them in the process which makes them feel valued to show mutual support in accomplishing the change (Thusini and Mingay, 2019). The Model also informs that in creating supporting team involvement information (strategic ideas) for the change are to be gathered from team members and evaluated to identify best creative ideas to be implemented for making the change. It ensures greater involvement of the team as the team members feel part of the change when their ideas are respected and used (NHS, 2019). Thus, in making the current change care towards the team is to be expressed along with creative ideas from them are to be gathered for evaluation by the leaders in making the change with supportive team involvement.

The positive outcome boosts the confidence of the team and allows accomplishing successful change. In reference to the current change scenario of avoiding error during handover of duties by nurses, at the beginning of each shift all the nurses are to be asked to provide filled patient record checklist specifying the patient’s health condition, vital, medication provided and not provided and others by the nurse of the previous shift before 10 mins of ending of their shift. The nurse in the new shift is required to review the patient record first and ask any queries to resolve any confusion within 10 mins of the end of shift of the previous nurse. This indicates nursing shift are to be overlapped by 10 mins so that nurses of new and previous shift can discuss the patient information for hand over effectively to avoid error due to confusion in understand of information.

The leaders to manage risk during the change process are to evaluate the change approach to identify prior obstacles and risk present along with the factors influencing them. Thereafter, the leaders are responsible to analyse the risk and prioritise them in framing strategies to resolve the risk (May et al., 2021). As argued by Slemon et al., (2017), failure to identify and prioritise risk for managing them makes the leaders fail to resolve the risk in making change. This is because the risk remained undetected and without prioritisation they are managed in hindered way that does not lead to timely resolve them and influence negative performance by team. The leaders are to monitor the change process during its execution so that any sudden risk developed can be identified by them and actions can be taken in resolving it to ensure smooth change process (May et al., 2021). However, failure to monitor risk causes leaders unable to overcome obstacles in change which create barrier in achieving the change (Trevino et al., 2018). In current change process, risk of lack of compliance from the nurses may be faced during the change which the leaders are to resolve by making the nurses aware of the importance of the change for them as well as the patient.

The strength, weakness, opportunity and threat as a new graduate nurse to act as leader is to be mentioned through SWOT analysis (Appendix 1). This is because it helps to strategically evaluate the strength, weakness, opportunity and threat of an individual to develop strategic plan in managing the prevailing threats and weakness with the other positive factors (Issayev et al., 2018). According to NHS, the weakness of leadership among the new graduate nurses exist during their transitional period due to low experience and lack of confidence to direct and delegate work. This is because the new nurses have limited opportunity and practical knowledge due to minimum time in in the practical to gather experience required to be confident (Song and McCreary, 2020). According to Simamora and Fathi (2019), handing over of duties without error by the nurses require crucial delegation skills and confidence. This is because it makes the new nurse execute actions in delegating the patient’s care support to other nurse without hesitation, error or mismanagement of vital patient information.

The new graduate nurses in England are required to go through preceptorship where they are to undergo practical training under supervisor or mentor in their nursing field. The mentor who is a senior nurse with enhanced experience in clinical field undergoes paperwork at NMC to be allocated for the new nurse to support their preceptorship (NMC, 2018). The importance of preceptorship is that it helps new nurses to facilitate use of acquired knowledge and consolidated skills from theory in the practical environment. It makes them understand way they are to manage workload, develop leadership skills, avoid medication error, execute medication administration, provide care to patients and others in the active NHS culture to support patient care with dignity and safety (Quek and Shorey, 2018). The failure to execute preceptorship leads new nurses to work with error that makes them feel lack of energy, confusion and extensive workload making them fail to meet the Code mentioned by NMC in care (NMC, 2020).

Clinical supervision is referred to disciplined and formal working alliance between experienced nurse and new graduate nurse in the NHS. The experienced nurse supervises the clinical work of the new nurse to review and reflect on them to indicate the new nurse in which aspects they are to improve to provide quality care and satisfactory support to the patients (Driscoll et al., 2019). As argued by Lyman et al, (2020), new graduate nurses experience challenges due to lack of clinical knolwdege to support care of patients. This is because the clinical care role allocated to the new nurses are unknown to them and without sufficient support from experience individuals they would fail to achieve improvement required for their continuous development at work (Mammen et al., 2018). Thus, clinical supervision along with preceptorship makes new nurses with the help of their experienced supervisor and mentor understand the way actions of care and clinical competence is to be shown to delivery quality support to the patients while minimising or avoiding error in care.

The adaptation to new environment requires effective learning of organisational culture and environment by the new graduate nurses which are provided to them based on age and experience (Hussein et al., 2017). The learning style of the new nurses may vary and to promote continuous learning their capabilities are to be analysed and accordingly personal development plan (PDP) is to be developed (Appendix 2). Benner’s theory of learning informs that foundation of effective nursing is built based on continuous education as it improves their skill and enhanced their experience to become more competent at work (Elhami et al., 2018). The NMC mentions nurses to act with accountability and within their competence along with learn through feedback from others to ensure continuous development (NMC, 2018). Thus, PDP by the new nurses are to be developed to achieve continuous development. The revalidation is referred to affirm continuing competence while strengthening as well as facilitating the professional and ethical responsibilities such as commitment to lower error, improve care quality and adhere to best practice (NMC, 2020). The revalidation process is executed by the nurses each three year with undergoing 35 hr of continuous personal development and 450hr of practical experience (NMC, 2020). The revalidation helps nurses to meet and confirm executing better care by following new professional standards through updated knowledge development regarding the standards, practice independently with application of new skills and ensure safe care (NMC, 2020).

The study concludes that NHS has developed and set various policies for the nurses to be followed in delivering quality compassionate care to the service users. The involvement of nurses in making ethical rules for care is necessary and they are to be involved in political scenario of framing policies as they can provide better information about the context to be further included in making well-structured policy guidance. The Behavioural leadership theory and additional leadership model are to be followed by nurses in making any change as it they indicate the way leaders are to efficiently work in achieving the change. In making the change of avoiding error during handing over od duties by nurses, the shifts of the nurses are to be overlapped by few minutes where they can discuss the patient inform to support enhanced sharing of patient’s data needed for effective handover in nursing. The preceptorship, clinical supervision, continuous development plan and revalidation are to be followed for influencing new nurses to become experience nurse.

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Appendices

Appendix 1: