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A few years ago, when working as a Registered Nurse in the St. Elizabeth Community Hospital, I was assigned a group of three nursing interns to supervise. It was my responsibility as a supervisor to ensure the protection of clients’ welfare by ascertaining that they receive ethical and quality care and promote the growth of the pre-licensed nurses. Combined with other delegated nursing duties, it was relatively a lot to handle. I perceive that leadership is neither grounded on power and control but respect and modeling.
Therefore, I resorted to using a combination of the transformative leadership style. In the prior days of the internship, I noted that two of the interns were anxious, which was affecting their learning. This is because it had impacted their ability to take growth-oriented risks and communication. However, using transformational leadership concepts, I cultivated an environment of trust, honest communication, and individual learning. This was achieved by recognizing that we are all human, hence, culpable to experiencing what humanness entails, including vulnerability, varied emotions and imperfections.
I began the supervisory relationship by orienting the trainees to a general collaborative intention to create a more comfortable environment for safety and learning. This was communicated through my tone and body language. Examples of some of the common words that I tended to include in my verbal statements include “there is no such thing as a dumb question” and “I am here to support your professional growth”. As a result, a space of relaxed alertness was created, and there was a notable exchange of honest communication and feedback. At the end of the internship, all three students passed the school evaluation.
The purpose of the clinical supervisor-supervisee team was to ensure learning in pre-licensed nurses and protect the welfare of patients by ascertaining that they receive quality and ethical care. According to Choi, Goh, Adam, and Tan (2016), transformational leadership entails supporting the development of subordinates’ skills and assisting them to achieve desired outcomes. Such leaders not only provide mentoring and advice but also offer the subordinates attention. Therefore, by recognizing the interns’ humanness and utilizing encouraging words, anxiety among the interns reduced, and we were able to create an environment of honest communication that facilitated learning. Moreover, since the supervision was a learning partnership, the decision-making process entailed listening to input from the interns and inculcating them into patient care.
As a result, the major good decision that I made included addressing the anxiety issue using the transformative leadership approach. Although the internship was a success, I might have more improved the internship outcome by inculcating servant leadership. Unlike transformational leadership that is centered on performance for the sake of an organization, servant leadership focuses on the service itself; thereby, the interns might have acquired more soft skills.
Effective communication is crucial for the successful completion of project goals. Throughout the internship, I emphasized on collaborative aspects of clinical supervision to create space for relaxed alertness, thus cultivating optimal conditions for learning. Consequently, an environment of trust and honest communication was cultivated. Specifically, I used encouraging words to reduced anxiety and foster openness to question and feedback among trainees. Furthermore, when handling patients, I would ask them questions on what they think the patient might need and offer corrective feedback if needed. As a result, by actively participating in patient care, boredom and disengagement, the interns appeared motivated. This mirrors Choi et al. (2016) findings that outline the positive correlation between transformational leadership and work motivation and job satisfaction.
Nurses in healthcare settings face many ethical dilemmas during practice, especially in scenarios where patients choose to engage in activities that put themselves at risk. In my early years as a nurse in the St. Elizabeth Community Hospital, I once received a 20-year-old male patient who had been suffering from lupus. He had collapsed at home, and the analysis of his vital signs showed that he required immediate blood transfusion as the level of red blood cells in his body was low.
I attempted to persuade the patient and his family, and they resolutely declined as they were members of the Jehovah’s Witness church. I even brought a physician to try to convince them, but it was no avail. The religion doctrinally forbids blood transfusion. Attending to the patient was distressful for me as I could not bear seeing the patient suffering, yet the solution was reachable. I consulted with a fellow nurse, and she advised me that as a nurse, I must deliver the best care possible to the patient, which constitutes respecting their decision. The patient was placed on erythropoietin therapy; however, one month later, he died.
Though the case had an adverse ending, I believe that the ANA code of ethics supported my actions and choices. The ethical dilemma was that by respecting the patient’s autonomy and accommodating his religious beliefs, we were faced with bypassing our moral duty to provide quality care that adheres to the established standards (Gaines, 2020). In Western society, respect for autonomy is one of the main bio-ethical principles.
Any intervention that is divergent to the patient’s wishes has to be justified. Autonomy entails healthcare providers respecting the patients’ rights, even if they disagree with the decisions made so long as the patient is competent. Furthermore, nonmaleficence was exhibited as harm was not inflicted on the patient by honoring his wishes (Gaines, 2020). In the sphere of ethics, “harm” has a dynamic meaning as it varies for individual patients. In this scenario, violating his religious beliefs would have been the harm.
Aside from the ANA code of ethics, the LEADs framework also played a significant role in the overall decision-making process. LEADS stands for Lead self, Engage others, Achieve results, Develop coalitions and Systems transformation (Levitt, 2014). It is imperative that as one of the primary healthcare professionals, nurses should develop management skills. Versatility and adaptability should come easily to a leader, and by engaging with other providers, I became understanding to the patient and adaptable to the situation; therefore, I provided the best care possible until his passing.
Choi, S.L., Goh, C.F., Adam, M.B.H., & Tan, O.K. (2016). Transformational leadership, empowerment, and job satisfaction: The mediating role of employee empowerment. Human Resources for Health, 14(73), 2-14. Web.
Gaines, K. (2020). What is the nursing code of ethics? Nurse. Web.
Levitt, D. (2014). Ethical decision-making in a caring environment: The four principles and LEADS. Healthcare Management Forum, 27(2), 105-107. Web.