Leading and Managing Nursing Care Reflective Essay Sample for Adult Nursing
Reflective Portfolio based on three reflective narratives of 1500 each related to practice; The issue of professional values like emotional intelligence, resilience, and prioritisation using one model for all narratives
The model utilised to undertake this and the other reflective analysis in this commentary is the Gibbs’ reflective cycle. As Johns (2017) point out, there are a lot of reflective models that might be used, but the Gibbs’ model has been selected because it provides a structure and helps with the consideration of numerous factors that might drive deeper, more insightful learning (Howatson-Jones, 2016). Chang and Daly (2015) argue that the Gibbs’ model may only encourage basic reflection, but I have personally found that for me it helps me to explore a depth and range of factors, as highlighted by Howatson-Jones, 2016) and this is why it was selected. The Gibbs model has six stages and each is considered in turn under a new heading.
Emotional intelligence is defined by Ashkanasy et al. (2016) as being a group of capabilities that help in working with emotions. It is the ability to be aware of one’s emotions and to control them and express them effectively, with care and utilising empathy (Goleman et al., 2013). As explained by Quinn and Hoffe (2018) emotional intelligence is considered to be an important ability in nursing, not least due to the fact that care should be patient centred. If a person cannot manage their emotions or be empathic, it would be challenging to offer patient centred care, arguably.
As a nurse, I am well aware of the need for emotional intelligence in my interactions with others, whether colleagues, partners in the multidisciplinary team or patients. In the situation faced, I was overseeing the activities of a student nurse on placement. We were working with a female patient, Mrs B (patient’s name anonymised for confidentiality purposes) who had been hospitalised as a result of a suspected heart attack. Mrs B was being extremely rude to the student nurse who was trying to undertake basic checks of vital signs. The nurse was exhibiting signs of distress. I temporarily reassigned another nurse to take over the task, and took the student nurse, Ms G aside for a conversation to understand what was going on. It transpired that until that point, the nurse had only experienced grateful behaviour and fear from patients and had not had to handle a rude patient before.
I suggested to her that the patient was actually being rude because she was very frightened, and we discussed strategies for handling conversations with this type of patients.
Thoughts and Feelings
My initial thoughts and feelings around the situation were that the student nurse was acting ineffectively, but taking a quick step back from the scenario, I realised that actually she was doing her job and addressing the tasks assigned to her but struggling with emotional intelligence towards a verbally abusive patient. I was able to empathise with Ms G because I remembered being in a similar scenario in the early days of my care career. As argued by Prezerakos (2018) a review of the evidence suggests that emotional intelligence is critical to effective nursing care. My thoughts were initially happy and somewhat pleased with myself in being able to share helpful information based on experience with a more junior colleague. This feeling was quickly replaced by the realisation that emotional intelligence is not easy to manage on a personal level, and an acknowledgement that I have to continually work on this area in order to provide a supportive environment where quality and safe care can occur, per the requirements of the Nursing and Midwifery Council (2018) Code of practice.
The positive of this situation is in my emotional intelligence capabilities both with respect to Mrs B and Ms G, recognising that the patient was actually very frightened, and also acknowledging and dealing with the fact that Ms G was not seeing this and was taking the rude behaviour personally. Another positive was that while Ms G was visibly impacted by what was happening she did not let it affect the care that she was offering. It was not good that Ms G was responding in such a way as to be impacted, and not understanding that the patient was scared, and this can be seen as a negative. However, nurse leaders must be aware that not everyone that works in the field will have the same levels of emotional intelligence or capability to apply this even when experienced in the role. In addition, the emotional burden of nursing can be considerable and especially if nurses are facing other challenges with their resilience (Roussel, 2013).
Studies have been undertaken that indicate that emotional intelligence capabilities can have a positive impact on patient safety, such as that by Codier and Codier (2017). Examining the scenario that occurred, it is easy to see how a person that was less resilient than Ms G might have reacted differently to the rude behaviour, which could have compromised the safety of the patient. Bennett and Sawatzky (2013) outline how leaders in nursing must develop emotional intelligence in order to improve patient care. From analysing the situation in greater depth, as Beydler (2017) argues, nurse leaders that build up their own emotional intelligence abilities have can help others to improve theirs through acting in an emotionally intelligent and empathic manner towards their team. Indeed, as Roussel (2013, p. 61) argues, when moving into a leadership situation in nursing, the nursing leader must create “a supportive and positive work environment to help nurses cope with the stress of managing their own and others’ emotions concurrently.”
I like to think that this is what I do. However, looking back with hindsight, I know the incident with Mrs B and Ms G happened on a good day when I was energised, had a good night sleep and when we were not especially busy on the ward. There were staff to reassign to the specific role, and I was able to spend time with Ms G, coaching to help with her personal development. However, there are days when I am not as resilient, and the challenge lies in being able to be emotionally intelligent for myself, my team and the patients under my care on those days too. While I know that as Yoder-Wise et al. (2019) outlines that I must take care of my own resilience and I make every effort to do so, resilience is an attribute that depends on my own personal resources, as pointed out by Foster et al. (2020). There are days where I have lower levels of energy, where as a team we are stretched due to a lack of resources and being emotionally intelligent on those days is naturally harder.
Developing an environment where emotional intelligence can flourish can be concluded as being concerned with both developing emotional intelligence attributes in others, while not overlooking one’s own emotional intelligence capabilities. It is encouraging to be able to say that emotional intelligence can be impacted through training and development. There is no doubt that it can. However, one element that cannot be ignored with regard to time spent on training and personal development as a leader is the fact that there are barriers such as time constraints, in addition to the pressure of the job, and sometimes limited staffing levels as well (Mansel and Einion, 2019). Moreover, maintaining one’s own emotional intelligence on days that are particularly challenging personally is likely to be extremely difficult at times. Despite these challenges, personal development of both myself and others in this area is essential in the provision of safe and effective care and meeting the needs of the NMC (2018) Code.
One step that can be taken that I believe would be beneficial with respect to this type of scenario, is taking proactive measures to help in the development of emotional intelligence. This could be achieved perhaps through role play, as highlighted by Price and Harrington (2015). While it is acknowledged that there are times when this type of personal development opportunity would be difficult to enact with the team due to time pressures, there are also times when it could be possible to undertake this type of development. As Ellis (2018) also argues, coaching is an alternative form of personal development that can be utilised, acting as a supportive role model through working with more junior members of staff, questioning and encouraging their own reflection with regard to building the capability of emotional intelligence. However, clearly aside from helping shape emotional intelligence in others, there is a need for my effective self-management such that I can be highly emotionally intelligent at work and act as a role model for the expected and desired behaviours so that I can gain and maintain credibility as a leader. In achieving this, one step that I might take is being mindful about my own stress and fatigue levels and how these might impact on the working day. The Royal College of Nursing offers a healthy workplace toolkit which might prove helpful in this regard (2020).
This reflection focuses on the issue of conflict management within the specific setting of the multidisciplinary team. It will again utilise the Gibbs reflective cycle for this purpose. As Taberna et al. (2020) explains, multidisciplinary teams are comprised of different professionals that come together to cooperate and collaborate in order to ensure that all aspects of a patient’s care are considered when addressing the service user’s needs.
Description of What Happened
Nurses have a number of roles to play as part of a multidisciplinary team. Pertino et al. (2014) outline some of these as ensuring that the patient receives effective care, adequate investigations, diagnosis and treatment, and managing and capturing data pertinent to the care as well. All professionals that are involved in multidisciplinary team work have the ability to offer value to making sure that the patient receives the optimal care with their needs met, which is argued to make a difference with regard to patient outcomes (Fitzpatrick and Kazer, 2011). As well as delivering improved outcomes, as Schober (2016) indicates, multidisciplinary teams have been an important component in recent health and social care policy due to their importance in ultimately lowering the costs of care through avoiding duplication and making sure that patient needs do not fall through the cracks between different care agencies.
Conflict is defined as being “A clash or a struggle that occurs when one’s balance among feelings, thoughts, desires and behaviour is threatened,” (Rigolosi, 2012, p. 213). In the particular scenario faced, I was part of a multidisciplinary team dealing working with a patient, Mr F (name anonymised to protect the patient’s confidentiality) with complex health and social care needs. In the process of meeting to examine and pinpoint the specific care needs for this individual and to ensure nothing was missed, I experienced a situation of conflict with one of the other professionals on the team, the social worker, Mrs P. The conflict arose due to the way in which we communicated with each of us misunderstanding what the other was saying. This led to the process not working as efficiently as it could. While it quickly became clear that both of us had the patient’s best interests central to what we were saying and trying to do, the conflict could have been avoided.
Thoughts and Feelings
My initial reaction to Mrs P was one of anger, though I did not directly express this. However, I did demonstrate my frustration with how I responded to her, because from what she was saying, it made it sound as if she was unconcerned about how the patient’s ongoing care would be managed. The assumption that I made, based on the language used by Mrs P was also that she was asserting that we had not provided Mr F with adequate care, and this irritated me, as it felt like a direct attack on my professionalism and the care that I offer to patients. It also felt like an attack on my team, initially, and my immediate response was to step in and defend them. The reality was, as Huber (2014) reports sometimes can happen, the conflict initially seemed bigger and more insurmountable than it actually was, and the problem was primarily one of communication rather than misalignment in what we fundamentally thought. While this was a relief, it did not change the fact that my first response was of anger and frustration, rather than calmly taking steps to resolve the differences faced, and this is something that I need to work on in order to be a more effective nurse leader.
Evaluation of the Positives and Negatives
Examining the positives of the situation, the conflict between myself and Mrs P was resolved fairly quickly, which was good. Brinkert (2010) argues that it is important to be proactive when faced with conflict in order to manage it effectively, and the ways in which I did this included asking more questions of Mrs P and actively listening to her answers. I also paraphrased back to her my understanding of her meaning which was where the source of the conflict and the misinterpretation was pinpointed by her. However, as Borkowski and Meese (2020) indicate, conflict creates costs in healthcare. While in this case no harm was done, and ultimately myself and Mrs P have a better relationship as a result of clearing up our misunderstanding, some time was still wasted on the conflict, rather than on resolving the issue at hand. It might be considered that this created unnecessary costs. Managing my response so that it addressed the conflict more effectively in the first instance would have been more appropriate in this scenario.
The NMC (2018) Code requires that as a part of prioritising people, there is a need to work in a partnership to deliver effective care. Stanley (2016, p. 223) argues that, “Successful conflict management requires clinical leaders who demonstrate key conflict resolution principles,” and in addition to this, it is opined by Huber (2014) that it is best to work towards win-win resolutions in managing conflict effectively. Huber (2014) expresses the fact that when leaders work towards win-win scenarios they are more likely to focus on addressing problem solving. On reflection, my initial response was not working towards win-win with Mrs P. Thinking deeper about why this occurred, a factor compounding the communication challenges faced between myself and Mrs P was cultural difference between us, as Borkowski and Meese (2020) highlight can occur. Borkowski and Meese (2020) present evidence that in the healthcare environment, few employees realise the impact of cultural factors in leading to conflict between them, but this can indeed sometimes be the cause of conflict.
Conflict is likely on multidisciplinary teams for other reasons as well, not least due to the fact that everyone working on the team may have a slightly different agenda (Fulford et al., 2012). Looking at this in closer detail, on a very simplistic level, doctors may be focused on a curative solution while a physiotherapist may take a perspective of trying to prevent an issue from occurring again. While these sorts of differences may not seem that great, as Fulford et al. (2012) argue, different professional values can influence perspectives and communication and can lead to conflict. Instead of jumping to conclusions, as an effective nurse leader it would have been better to recognise the differences and identify a way to handle the conflict more appropriately as Murray (2017) outline is required. In particular, there is a need to focus on working towards shaping conflict towards positive outcomes.
Conflict is likely in any working environment and particularly in one as complex as a healthcare environment, but as outlined by Patton (2014). However, when conflict is dysfunctional and negative it can ultimately compromise patient care outcomes, and it also has the potential to detrimentally impact on job satisfaction and wellbeing of employees and colleagues (Patton, 2014). In terms of what else can be learned from this situation, reflecting on conflict from a wider perspective, clearly this can occur in a range of different ways, not just with people on the multidisciplinary team, but also with colleagues and team members, particularly where culture and personalities differ. The important aspect of conflict management to focus on is managing it for a constructive outcome, focusing on building good and solid working relationships with others, and ensuring the conflict is steered away from being damaging to relationships, and ultimately, even more importantly to patient outcomes.
It is also important to consider that conflict is likely to come about as part of the storming phase of team development as highlighted in the model of group development proposed by Tuckman (Harris and Roussel, 2010). As Harris and Roussel (2010) argue, resistance can occur during the storming phase when the group is working out how to work together, and interpersonal conflicts can occur during this time. While the Tuckman model is imperfect in that it suggests that the process of group development is linear only (Harris and Roussel, 2010), this storming element of group development is nonetheless important to keep in mind as a factor that can lead to conflict, which nurse leaders must manage.
With regard to addressing conflict, one step that is important in my action plan is working to better understand what people that I am working with are saying rather than jumping to incorrect conclusions and allowing myself to become frustrated. One of the ways that this might be best achieved which would have certainly helped in the scenario outlined, and potentially in other future situations to, is building up my cultural competence.
As outlined by Koutoukidis and Stainton (2020) having a good awareness of different cultures, and the beliefs, attitudes and values of those helps with nurses being able to develop better communication skills. Indeed, they argue that cultural sensitivity allows individuals to be more responsive with regard to the needs of people of different cultures (Koutoukidis and Stainton, 2020). This will also help me in selecting language to use that is less likely to provoke unnecessary conflict when working with people of different cultures and professional backgrounds.
Ashkanasy, N.M., Zerbe, W.J. and Hartel, C.E.J. (2016) Managing Emotions in the Workplace, Oxford: Routledge
Beydler, K.W. (2017) “The role of emotional intelligence in perioperative nursing and leadership: Developing skills for improved performance,” AORN Journal, 106 (4) 317-323
Bennett, K. and Sawatzky, J.A. (2013) “Building emotional intelligence: A strategy for emerging nurse leaders to reduce workplace bullying,” Nursing Administration Quarterly, 37 (2) 144-151
Borkowski, N. and Meese, K.A. (2020) Organisational Behaviour in Health Care, 4th Edition, London: Jones & Bartlett Learning
Brinkert, R. (2010) “A literature review of conflict communication causes, costs, benefits and interventions in nursing,” Journal of Nursing Management, 18 (1) 145-56
Chang, E. and Daly, J. (2015) Transitions in Nursing, London: Elsevier Health Sciences
Codier, E. and Codier, D. (2017) “Could emotional intelligence make patients safer?” American Journal of Nursing, 117 (7) 58-62
Ellis, P. (2018) Leadership, Management and Team Working in Nursing, Exeter: Learning Matters
Fitzpatrick, J. and Kazer, M. (2011) Encyclopaedia of Nursing Research, New York: Springer
Foster, K., Marks, P., O’Brien, a. and Raeburn, T. (2020) Mental Health in Nursing, London: Elsevier Health Sciences
Fulford, K.W.M., Peile, E. and Carroll, H. (2012) Essential Values Based Practice, Cambridge: Cambridge University Press
Goleman, D., Boyatzis, R.E. and McKee, A. (2013) Primal Leadership: Unleashing the Power of Emotional Intelligence, Boston: Harvard Business Press
Harris, J. and Roussel, L. (2010) Clinical Nurse Leader Role, London: Jones & Bartlett Learning
Howatson-Jones, L. (2016) Reflective Practice in Nursing, Exeter: Learning Matters
Huber, D. (2014) Leadership and Nursing Care Management, London: Elsevier Health Sciences
Johns, C. (2017) Becoming a Reflective Practitioner, 5th Edition, London: John Wiley & Sons
Koutoukidis, G. and Stainton, K. (2020) Tabbner’s Nursing Care, London: Elsevier Health Sciences
Mansel, B. and Einion, A. (2019) “It’s the relationship you develop with them: emotional intelligence in nurse leadership: a qualitative study,” British Journal of Nursing, 28 (21)
Murray, E. (2017) Nursing Leadership and Management, Philadelphia: F.A. Davis
NMC (2018) The Code, London: NMC
Patton, C. (2014) “Conflict in healthcare: A literature review,” The Internet Journal of Healthcare Administration, 9 (1) 1-11
Pertino, A., Gaino, R., Tartara, D. and Candeo, M.G. (2014) “Role of nurses in a multidisciplinary team for prevention, diagnosis, treatment and follow-up of osteonecrosis of jaw (ONJ),” Annali Di Stomatologia, 5 (2) 31-32
Prezerakos, P.E. (2018) “Nurse managers’ emotional intelligence and effective leadership: A review of the current evidence,” Open Nursing Journal, 12 (10 86-92
Price, B. and Harrington, A. (2015) Critical thinking and Writing for Nursing Students, Exeter; Learning Matters
Quinn, J.F. and Hoffe, S. (2018) The Importance of Emotional Intelligence in Healthcare, USA: ASTD
RCN (2019) “Stress and fatigue,” RCN, accessed 16/03/21: https://www.rcn.org.uk/clinical-topics/patient-safety-and-human-factors/professional-resources/stress-and-fatigue
Rigolosi, E.L.M. (2012) Management and Leadership in Nursing and Health Care, New York: Springer
Roussel, L. (2013) Management and Leadership for Nurse Administrators, London: Jones & Bartlett Learning
Schober, M. (2016) Introduction to Advanced Nursing Practice, New York: Springe
Stanley, D. (2016) Clinical Leadership in Nursing and Healthcare, London: John Wiley & Sons
Taberna, M., Moncayo, F.G., Jane-Salas, E., Antonio, M., Arribas, L., Vilajosana, E., Torres, E.P. and Mesia, R. (2020) “The multidisciplinary team (MDT) approach and quality of care,” Frontiers in Oncology, 10 (1) 85
Yoder-Wise, P.S., Waddell, J. and Walton, N. (2019) Leading and Managing in Canadian Nursing, London: Elsevier Health Sciences