Nurse Leadership for organizational culture and growth
Scenario 1
Ciera utilizes an autocratic leadership style in managing medication errors in the unit. In style, a leader has total control over all the decisions with little or no input from the subordinates (Chukwusa, 2018). Ciera has made it clear that she will not tolerate any medication errors each month. As a result, she makes choices based on her judgment and ideas. She has not involved the members of her staff n making decisions. In the event of a medication error, she summons the individual and puts a report in the nurse’s performance review file. The leadership approach utilized by Ciera is not appropriate. She needs to include the other nurses in decision-making. Medication errors are a complex problem that may not be solely the fault of a single nurse. The outcome of the style is shown when the nurses start to cover for one another. This is because the nurse does not involve them in decision-making and takes disciplinary action instantly in the event of a medication error.
The leadership style I would use in managing medication errors in the unit is the transformative leadership style. I would encourage, motivate and inspire the nurses to reduce medication errors in the healthcare setting (Krepia et al., 2018). I would provide a learning environment by challenging the current potential safety structure and the nurse’s level of commitment. The leadership style will involve the nurses and the other multidisciplinary team members in setting rules and regulations that will reduce medication errors. I will also allow the nurses to set goals to reduce medication errors. In a medication error, I will summon all the parties involved in the error and conduct a root cause analysis. This will enable the discovery of the root causes of medication errors to identify the appropriate actions.
A just culture refers to a system of shared accountability. Establishing a just culture in an organization can be done by creating awareness and implementing policies that promote a just culture (Edwards, 2018). The just culture will have an impact on the unit in numerous ways. Any medication error will not result in automatic punishments. This will avoid nurses covering for other nurses who have committed medication errors. An atmosphere of trust will be created in the unit. Individuals who provide crucial information regarding a medication error will be encouraged and rewarded. The just culture will change the view of the individuals regarding medication errors. Sometimes, the system policies may be responsible for certain errors committed in the unit. Instant application of punitive action will not reduce the rate of medication errors. However, a root cause analysis should be conducted before any punitive actions.
Scenario 2
Whether or not the nurse administers the medications depends on multiple factors. California defines delegation as the process by which a nurse directs another individual to perform nursing tasks and activities (CBRN, 2020). The nurse delegating should be a registered nurse who distributes a portion of patient care to the delegatee. A registered nurse may delegate a portion of nursing care as long as they use the five rights of delegation; right circumstance, right person, right task, right communication/direction, and right supervision (CBRN, 2020). A registered nurse cannot delegate a nursing care activity that is not within their scope of practice or the one they are not competent in. the nurse can administer the drug if the above principles are met. In this scenario, the administration of digoxin should not be delegated. This is because digoxin administration requires monitoring and understanding of the patient. The drug has various dangerous side effects; hence the patient will require close monitoring.
Education will need to be provided regarding delegation. Firstly, healthcare providers need to understand what can and cannot be delegated (CBRN, 2020). Routine tasks such as feeding, making unoccupied beds, supervising patient ambulation can be delegated. One needs to utilize judgment whether delegation is appropriate for a particular patient. A nurse cannot delegate any activity that requires clinical reasoning, critical decision-making, or nursing judgment. The licensed nurse needs to decide whether the activity is appropriate to delegate based on the five rights of delegation. Other nursing activities that cannot be delegated include administration of medication by injection, central line maintenance, and sterile procedures. Nurse managers can also not delegate their signature authority. Secondly, the individuals need to understand the five principles of delegation. These include the right circumstance, right person, right task, right communication/direction, and right supervision (CBRN, 2020). Finally, individuals need to understand that they will be accountable for the activities they delegate. This will enable the nurse to delegate a task and guarantee a successful outcome.
Strategies should be developed to ensure consistency with delegation. Firstly, a nurse leader who is responsible for oversight of the delegated activities needs to be identified. This will allow effective accountability in the delegation (CBRN, 2020). The department needs to set policies regarding which nursing activities can be delegated and the circumstances allowing delegation. This will improve consistency in delegation in the unit. The unit must communicate information about delegation to the licensed nurses and the advanced practitioners. In the information, competencies in delegation should be included. Finally, all the delegetees need to demonstrate competency and knowledge on how to perform the delegated responsibilities. The competencies should be kept on file. In the unit, in the case of delegation, a nurse delegating will identify the best-suited person they can delegate the task to. Team building strategies should be used to enhance the understanding of the nurses regarding delegation. Team building is key in improving the the collaborqation of the team members.
References
California Board of Registered Nursing (CBRN) (2020). Steps to Become a California Registered nurse. CBRN.https://www.rn.ca.gov/careers/steps.shtml#:~:text=To%20practice%20as%20an%20RN,pass%20the%20national%20licensing%20examination
Chukwusa, J. (2018). Autocratic leadership style: Obstacle to success in academic libraries. Library Philosophy and Practice, 1.
Edwards, M. T. (2018). An assessment of the impact of just culture on quality and safety in US hospitals. American Journal of Medical Quality, 33(5), 502-508.
Krepia, V., Katsaragakis, S., Kaitelidou, D., & Prezerakos, P. (2018). Transformational leadership and its evolution in nursing. Progress in Health Sciences, 8, 185-190.
