Preparation for professional practice.

INTRODUCTION The aim of this essay is to critically analyse the professional roles of qualified nurses, their accountability, collaboration and their responsibilities when taking leadership and managerial roles at all points in their career. This essay will be structured in two parts;Part 1 will focus on the process of the service improvement plan during one of the author’s practice placements in an acute ward and refers to the recommended â€Å"change† which the author intends to implement. The plan for change is based on protecting patients’ mealtimes. First, brief definitions will be given and an exploration of the concepts of management and leadership will be undertaken. Part 2 of this easy will focus on the professional development of the author upon qualification as a staff nurse within a few months which will be discussed under the section on â€Å"delegation†. SMARTER theory has been identified in this easy as learning needs. In accordance with the Nursing an d Midwifery Council Code of Professional Conduct (NMC, 2008) all names and places in this essay will be replaced with pseudonyms. PART 1 DEFINITION OF MANAGEMENT According to Huber (2010) management in the context of nursing has been identified as involving the use of delegated authority within formal organisational, settings, to co-ordinate, organise, direct and control responsible subordinates. In the same context, Mckimm and Held (2009) described management as the process of bringing together or working with individuals, groups and other resources to accomplish organisational goals. Scott and Caress (2005) view management as directing and controlling a group of individuals for the purpose of co-ordinating and harmonising those groups towards achieving goals. Tormey (2009) illustrated the distinguishing characteristics of management and leadership. (Cheery and Jacobs, 2005) state that a manager is one who is appointed to formal positions of organisational authority and uses legitimatised power to command, reward or punish the workforce. On the other hand, a leader is one who will be able to communicate, gain commitment, facilitate change an d achieve results through efficient and creative means, with his/her followers despite the absence of the formal position of power (Huber, 2010). Leaders seek the active involvement of those around them to achieve mutually agreed goals; leaders also seek the collective will of all involved, establishing contact with leading other clinicians (Hersey et al., 2001). Crevani et al. (2010) suggest that leadership is an adventure requiring a pioneering spirit and leadership skills and interpersonal skill which differs from person to person; Yoder-Wise (2011) states that the work of nurses is based on management; therefore, nurses require better leadership skills and management skills which are considered to be a major factor in improving direct person-centred interventions, achieve goals, objectives and decision making for quality care provision. In order to achieve the goals and objectives, managers of the organisation must be involved in the activities which include being able to analyse matters, establish objectives, formulate goals, plan strategies, communicate effectively, efficiently handle change, conflict, as well as evalua te the ever-changing situation situation (McCrimmon, 2011) . Rosener (1990) cited in Barker, 2009) identified two types of leadership which include transactional and transformational leadership. Bass (2008) suggests that transactional leader focuses on management tasks and will not identify the shared values of the team; however, the transactional approach is orientated and can be effective when meeting deadlines or in an emergency. Cummings et al. (2008) concluded that the transformational leader recognises her/his followers’ potential and takes active interest in them and their development. The transformational leader inspires, promotes excellence beyond mere task, encourages employees to become autonomous and solution focused, stimulates interest among followers to view work from a fresh perspective, generates an awareness of vision towards which the team is headed, develops followers to higher levels of ability and potential ((Rolfe, 2011). LEADERSHIP STYLES Hersey et al. (2001) on the other hand identified different leadership styles; however, for the purpose of this easy the author here will focus on three styles which include autocratic, democratic and laissez-faire. Hersey et al. further state that some people are able to combine the three styles of leadership and adopt a style to match the situation at hand. The autocratic leader is likely to make decisions on his or her own and give orders; this style can create antagonism and reliance which might hold back originality and advancement (Bass, 2008). Democratic leaders are more drawn towards relationships; they encourage group discussions and seek consensus where every decision made is agreed by the whole group (Hersey et al., 2001). This style of leadership may be slow because of every member of the group being considered; however, it is a favourite leadership style among the nursing profession (Grint, 2005). According to Hersey et al. (2001) the laissez-faire leadership style promo tes complete freedom and is known to allow events to take their own course; this is because there may never be a clear decision. Again Hersey et al. further state that there is no one style which is better than the others as they all have their own advantages and disadvantages. As specified previously, the situation will determine the styles to be used to achieve the goals (Hersey et al., 2001). IMPROVEMENT PLAN The improvement plan was formulated during the author’s recent practice placement in the Psychiatric Intensive Care Unit (PICU) which provides intensive care management service for individuals who are disturbed and exhibiting extremely violent and aggressive behaviour. According to Allan (1988), any patient brought to this unit must be on section of the Mental Health Act (MHA, 1983), apart from the severity of an individual’s illness, in order to qualify for admission to the ward. During this placement, the author of this essay discovered that there had numerous and ongoing interruptions and arguments between some patients and staff during mealtimes. In addition, staff members who were supposed to assist during mealtimes frequently claimed to be â€Å"very busy†. This untenable situation prompted the author to suggest introducing â€Å"Protected Mealtimes† to the team. The rationale for choosing this improvement plan was because some of the patients on t hat ward were not encouraged or supported by staff member during mealtimes, mainly those elderly patients who were finding it very difficult to eat and drink unassisted. Many patients were on medication that was causing them serious side-effects such as dehydration and constipation, so they needed to be encouraged to have adequate and healthy dietary intake. The author therefore had a discussion with their mentor and other multidisciplinary team members regarding this issue and they all supported the need for a meeting to resolve the above issue. Initially, the author felt very nervous about introducing this new approach to the team members, due to lack of confidence and knowledge. The key point of the change was explained to all the patients. A proposal was put forward after the meeting regarding and defining the topic, namely â€Å"Protected Mealtimes† and the patients on the ward were given the opportunity to voice their own opinions on what they thought about the new proposal. The patients gave a positive verdict on the proposal. The National Catering and Nutrition Specification (2008) defined protected mealtimes as a period when all non-imperative activities and treatments must stop, in order to allow patients to eat and enjoy meals without being interrupted by any other activity on the ward. It should be a period during which staff members need to encourage the adequate consumption of dietary intake and provide an environment which is very conducive to eating and is friendly and hygienic. It is also a time when s taff members need to ensure that mealtimes are a pleasant and relaxing social experience for all patients (Royal College of Nursing, 2007). The author took on the role of a democratic leader which according to Hersey et al. (2001) looks more towards relationships which encourage group discussion, consensus and group decisions, rather than the leader alone making the decision when introducing change. According to Greenhalgh and Heath, 2010) therapeutic relationship, engagement, listening skills and effective communication skills played an important role during the meeting detailed above, because the team members, as well as the patients were all equally convinced that the issues raised by the author were pertinent and essential, in terms of the patients’ satisfaction. It was agreed in the meeting that, during mealtimes, there would be no drug round, no activities by occupational therapy staff, no visitors allowed on the ward during mealtimes, and no domestic work carried out. All the televisions would be switched off, dormitories, day rooms, shower rooms and activity rooms should be locked. All the staff members and patients on the ward must be present in the dinning area during mealtimes, in order to avoid distraction as advised by (RCN, 2007). The change was implemented within a few days of the meeting. Initially, it was not easy, but within a few days everybody on the ward adjusted. Moreover, some patients who normally isolated themselves from group activities on the ward now began to interact and engage well in conversation during mealtimes. Staff members were supporting/encouraging and showing compassion to all the patients, mainly some of the elderly patients, with good dietary intake which showed appropriate care for patients. Such change s had a significant effect on the provision of ward services. According to Age UK (2010), appropriate nutritional care for patients in the hospital is very important, because it decreases the risk of malnutrition, obesity and its associated complications. CHANGE MANAGEMENT According to Christie and Robinson (2009), it is essential to have a plan for how things will be accomplished when implementing a change in any clinical setting. Change management in a nursing setting means observing things that happen or are done differently for the benefit of the patients. Braine (2006) stressed that for a change to be implemented successfully, there must be an awareness of the need to change, a desire to support and participate in the change, the knowledge to change, the ability to implement the change and the resources to maintain the change. O’Connell et al. (2008) advised that as a change management model for protected mealtimes, simple implementation would focus on the need for nurses to engage, motivate and participate in the change. Allan (2007) identified three stages for the change process which include unfreeze, change and refreeze. Allan emphasised that during the unfreeze stage, a proposed change needs a clear aim, so that the individuals pl anning it will have no doubt why, know the rationale and the benefit will be explained to others. The National Institute of Clinical Excellence (2007b) has identified some barriers that hinder change management within the multidisciplinary team, many of which were evident in this particular example. These include the financial and political environment which can affect a professional’s ability and motivation to change. Garon (2012) concluded that a lack of awareness and understanding in an organisation’s nursing management theories have shown that the way in which an organisation is managed can affect nurses’ confidence to communicate the need for change. Maddock (2002) argued that the approaches to change and the proposal thereof may be ineffective unless individuals’ management strategies are put in place to develop leaders. ACCOUNTABILITY/ RESPONSIBILITY According to Marquis et al. (2009) one of the legal requirements of a registered nurse is accountability. Scrivener et al. (2011) identified that accountability involves the ability of the nurse to define every action he/she carries out. The (NMC, 2008) emphasised that accountability is seen as being of great importance and a qualified nurse is accountable for his/her own actions such as supervision, delegation, creative acts, intervention, assessing a situation or follow-up concerns. NMC (2008) further explained that the entire health care professionals are accountable and responsible for any action, error or omission made in practice. Huber (2006) states that as members of a multidisciplinary team, nurses must maintain their professional accountability. Nurses should also be able to use their communication skills to make complicated information understandable, explain choices, offer reassurance, look out for side-effects and liaise with medical colleagues about the subsequent prog ress of individuals with mental health problems (Garon, 2012). This was seen as a critical aspect of the operation here with regular reviews being planned to evaluate the success of the change and to amend the program where appropriate. Furthermore, if a nurse is meant to delegate care to another professional or support worker, she/he must delegate effectively and should be accountable for the appropriateness of the delegation. During one of the author’s practice placements in the acute ward, a newly qualified nurse delegated the task of security nurse to an agency staff who was very new on the ward. This agency staff let one of the patients out of the ward, not knowing that the patient was on level 1 observation restricted to the ward and the patient absconded from the unit. This resulted in an investigation which revealed that the newly qualified nurse did not delegate the task properly and did not communicate effectively. This raised the question of accountability and responsibility. The specifics of the nurse’s role are identified as being responsible for assessment, planning, the delivery of care and the evaluation of nursing care for their patients (NMC, 2008). According to RCN, 2011), nurses are accountable and responsible, on a daily basis, carrying out patient care most of the time and acting as care provider. Nurses have the responsibility for communicating the relevant information necessary for the patient to receive their full nursing care provision (NMC, 2008).(RCN, 1992) also states that with an increase in the level of responsibility and accountability, nurses need adequate training and competence to develop these changes. It is the responsibility of the nurses to make sure that patients are suitably dressed and eat their meals, while also managing their welfare rights and dealing with individuals’ psychological distresses; theses roles have to be carried out in conjunction with running organisational demands (RCN, 2011). INTER-PROFESSIONAL COLLABORATION Orchard et al. (2005) described inter-professional collaboration as a combination of different professionals working together in a partnership in order to achieve common goals, establish a therapeutic relationship, showing respect for others and the skilled therapeutic use of self. On the other hand, inter-professional collaboration means the adoption of multi-disciplinary and multi-agency working as the most effective route towards comprehensive mental healthcare (Audrey, 2003). However, Garon (2012) states that when talking about change in inter-professional collaborative team work, it is important to consider how staff members would need to be motivated to accept and welcome this change. It is also very important to select the right leader, which was a key advantage of this approach, to implement the change and involve all team members in the change process, as well as considering the safety of the patients, their comprehensive care and the stress the change might cause (NICE, 200 7b). CONCLUSION During this implementation of â€Å"Protected Mealtimes†, all the team members on the ward worked collaboratively, demonstrated excellent communication skills, showed motivation and were very enthusiastic and committed to the plan. Word count: 2,200.PART 2THE PROFESSIONAL DEVELOPMENT PLAN (PDP) The purpose of writing this professional development plan is to think and reflect on a facet of the professional development experienced by the author during their three-year course. It will also enable the author to work efficiently and effectively in their areas of weakness and help to sustain areas of strength, as well as developing delegation skills in the nursing environment, upon qualification. In order to accomplish these goals, a plan utilising SMARTER theory (Specific, Measurable, Realistic, Timely, Ethical and Recorded/ Reflective (Appendix 1) is proposed. During the three years of nursing training, the author of this essay has utilised Gibbs Reflective Cycle (1988), as a framework for reflection on day-to-day actions, strengths and weaknesses. According to Brechin (2000), reflection means not only thinking about a situation, but also using it as a form of systematic appraisal of the events that have occurred and as an examination of an individual’s ability to learn from the experience and influence future practice. During this placement in the acute ward, the author discovered that delegating duties to staff when co-ordinating shifts was a far more complex issue than originally anticipated. The RCN (2006) described delegation in nursing as a process of entrusting or allocating responsibility to another person who is seen as being able to carry out such a task. The Nursing and Midwifery Council (2008) states that a nurse’s job cannot be completed or carried out without delegating some part of the care functions to others, as it is highly impossible to deliver total care for different patients with different care needs. Barr and Dowding (2008) in their research emphasised that delegation is a critical leadership skill that must be learned. This became evident when considering a situation which emerged when dealing with a violent patient in a ward environment. In order to delegate tasks relating to this individual it was necessary to use confidence, communication, courate, compassion, competence and care. On the whole this was doen relatively well by myself however it was found that the newly qualified staff nurse is more likely to be unfamiliar with the procedure delegated to him and this made communication a more vital so that guidance could be obtained. Having identified a weakness in the authors ability to delegate, this communication between the two parties in the case mentioned above was used as a clear example of how greater comfort from the process of delegation could be obtained. This would in turn improve confidence. By watching delegations within the ward environment it became apparent to the author that there were greater difficulties when the manager used the autocratic style and this often created hostility amongst other staff and may hinder creativity and improvement. This brought the manager’s delegation skills into question. There was also an increased danger that the more junior member of staff would find themselves unsupervised in an inappropriate and unacceptable way according to RCN (2011). This leadership style as described by Bass 2008 as creating difficulties. Where better delegation communication were used the author was much more comfortable with the delegation process as they were aware that the process would be used appropriately and would be successful. With this in mind the PDP going forward would focus on risk management and controlling the process without following an autocratic style which would lead to loss of control when delegating. CONCLUSION The author of this essay has learned from undertaking this assignment that delegation not only saves time, but is also an essential skill which a registered nurse must posses; it is also requires good leadership and is an important role for every nurse involved in health care delivery. Through this Personal Development Plan (PDP), personal areas of weakness have been identified which the author is currently striving very hard to correct. REFERENCE LISTS Allan, E., 2007. Change management for school nurse in Scotland. Nursing Standard. 21, (42) 35-39. Allan, E., 1988. Planning a psychiatric intensive care unit. Intensive Care for people with serious mental illness. Hospital and Community Psychiatric, Vol- 39. Bass, B.M., 2008. The Bass Handbook of leadership: Theory, Research and Managerial Applications. 4th ed. New York: Free Press. Bass, B.M., and Avolio, B.J., 1994. Improving organizational effectiveness through transformational leadership. London: Sage. Braine, M., 2006. Clinical governance: applying theory to practice. Nursing Standard. 20, (20) 56-65. Brechin, A., 2000. Introducing critical practice. In Brechin, A., Brown, H. Eby, M., eds. Clinical practice in Health and Social Care. London: Sage Cummings, J., 2012. Developing a Vision and Strategy for Nursing, Midwifery and Care- Givers, tinyurl. Com/c89xe4x [Last accessed: May 2 2012]. Cherry, B., and Jacobs, S., 2995. Contemporary Nursing: Issues trends and management. 3rd ed. Elsevier: Health Science. Christie, P., and Robinson, H., 2009. Using a communication framework at handover to boost patient outcomes. Nursing Times, 105,(47) 13-15. Crevani, L.,Lindgren, M., Packendororff, J., 2010. Leadership, not leaders: on the study of leadership as practices and interactions. Scadinavavian Journal of Management. 26 (1)77-86. Cummings, G., Lee, H., Macgregor, T., 2008. Factors contributing to nursing leadership: a systematic review. Journal of Health Services. Research and Policy. 13(4) 240-248. Department of Health, 2008. Code of Practice: Mental Health Act 1983. London: DoH. Doran, G.T., 1981. There’s SMART way to write management’s goals and objectives. Management Review. 70, (11) 35-36. Food in Hospitals National Catering and Nutrition Specification, 2008. [Last accessed on 30 May 2013]. Garon, M., 2012. Speaking up, being heard: registered nurse’ perceptions of workplace communication. Journal of Nursing Management. 56, (2) 35-39. Green, T., Heath, I., 2010. Measuring Relationship. London: The King’s Fund. Gibbs, G., 1988. Learning by doing: A Guide to Teaching and Learning Methods. Oxford Further Education: Oxford. Hersey, P., Blanchard, K.H., and Johnson, D.E., 2001. Management of organizational behaviours: leading human resources. 8th ed. Upper Saddle River, NJ: Prentice- Hall. Huber, D.L., 2010. Leadership and nursing care management.4th ed. Maryland Heights: Saunders Elsevier. Huber, D.L., 2006. Leadership and Nursing Care Management. 3rd ed. Lowa. The University of Lowa: The University of Lowa. Maddock, S., 2002. Making modernisation work: new narratives change strategies and people management in the public sector. International Journal of public Sector Management. 15, (1) 13-43. Marquis, B.L., and Huston, C.J., 2009. Leadership roles and management functions in nursing: theory and applications. 6th ed. London: Wolters Kluwer Health/ Lippincott William and Wilkins. McConnell, C.R., 2007. The effective Health care Supervisor. 6th ed. Sudbury, MA: Jones and Bartlet Publishers. McKimm, J., and Held, S., 2009. The Emergency of Leadership Theory: From the Twentieth to the Twentieth-First Century. In: McKimm, J., and Phillips, K., eds. 2009. Leadership and Management in Integrated Services. Exeter: Learning Matters. Ch1. National Institute for Clinical Excellence, 2007b. How to change practice. London: NICE. National Institute for Innovation and Improvement, 2013. NHS Change Model: Our Shared Purpose. Tinyurl, com/bwefn79 [Last accessed: May 2 2013]. National Patient Safety Agency 2007.Protected Mealtimes review – Findings and Recommendations Report. Nursing and Midwifery Council, 2008. The Code: Standards of Conduct, Performance and Ethics for Nursing and Midwives. London: NMC. O’Connell, B., Macdonald, K., and Kelly, C., 2008.Nursing handover: time change. Contemporary Nurse. 30 (1) 2-11 Creating a Culture for Interdisciplinary. Orchard, C.A., Curran, V., Kabene, S., 2005. Creating a Culture for Interdisciplinary. Collaborative Professional Practice. Medical Education. Rolfe, P., 2011. Transformational leadership theory: What every leader needs to know. Nurse Leader. 9, (2) 54-57 Royal College of Nursing. 2012b Health and Social Care Act 2012. Tinyurl.com/HealthSocialCareAct2012 [Last accessed May 9 2013]. Royal College of Nursing, 2011. Accountability and Delegation: What you need to know. Royal Collage of Nursing. London: RNC. Rosener, J.B., 1990. Ways women lead. Harvard Business Review. In Barker, P., 2009. Psychiatric and Mental Health Nursing. The Craft of Caring. 2nd ed. London: Hodder Arnold. Scrivener, R., 2011. Accountability and Responsibility: Principles of Nursing Practice. Nursing Standard, 25, (29) 35-36. Scott, L., and Caress, A.L., 2005. Shared governance and shared leadership: meeting the challenges of implementation. Journal of Nursing Management, 13(1) 4-12. Tomey, A.M., 2009. Guide to nursing management and leadership. 8th ed. St Louis, MO: Mosby/ Elsevier. Yoder-Wise, P., 2011. Leading and Managing in Nursing. 5th ed. St Louis: Elsevier Mosby. APPENDIX- 1 S.M A.R.T.E.R PLAN SPECIFICSWithin six months of the preceptor-ship course, there will be a need to build better confidence that will improve communication skills which will support the author in their nursing career. MEASURABLEHow can one ascertain that the intended outcomes have been achievedThe learning outcomes will be gained via the professionals consultants, occupational therapist, staff nurses and preceptor-ship mentor involved. The author is confident that these professionals have the necessary assertive skills that will help achieve the desired learning outcomes. AchievableThe intention is to attend training courses, discuss any difficulties experienced with the preceptor-ship mentor or manager of the ward or any member of staff, and integrate the proposal as advice. REALISTICWithin three months of completion of the nursing course, it is anticipated that the author will be able to demonstrate effective leadership, delegating tasks properly, and entrusting responsibility to a person who is perc eived as being able to carry out these tasks by utilising one’s newly gained assertiveness skills. TIMELY Within three months of registration, an evaluation of achievements will be carried out and competencies will be examined frequently by the preceptor-ship mentor. The aim is to be constantly monitored by members of the team and to reflect upon performance and the impact of these actions. If there are any obstacles to achieving these goals or any concern from the team about the author’s approach, these issues will be discussed with the preceptor-ship mentor or ward manager, as this will facilitate the development of ongoing skills. ETHICALBeing knowledgeable about ethical issues such as social and cultural, rights, confidentiality and being aware of how this might impact on one’s practice. As a nurse there is a need to ensure that the patient’s autonomy is respected. RECORDED/REFLECTIVEReflection on personal strengths, weaknesses, opportunities and threats (SWOT), on a regular basis. Appendix 2 – SWOT Analysis MY STRENGTHS The SWOT analysis has helped me to develop, maintain a learning environment in which both education and lifelong learning are seen as integral to clinical setting, to work and focus on the goals and strategies, enable me to grab the opportunities I would love to achieve and work very hard to reduce my weakness and increase my strength. With the aid of SWOT analysis, I have been able to identify my strength as being a good team player, good listener, a good communicator and interacting well with my colleagues and patients. Showing compassion to my patients and having the ability to work under pressure. I like taking the lead and I am always happy when people appreciate me, it makes me happy and also motivates me. MY WEAKNESS I identify my weakness as being easily distracted, tending to carry out many tasks at a time and I am always fearful of making mistakes. I also felt that there are some areas I lack leadership skills such as being a good delegator because Barr and Dowding (2008) in their research emphasised that delegation is a critical leadership skill that must be learned. I find it complex to delegate duties when coordinating shifts. OPPORTUNITIES My opportunities are to update my knowledge in relation to the new pre-registration courses which include existing educational, personal and professional career development within the establishment. During this my practice placement I also had the opportunity to learn and share ideas with my colleagues, had the opportunity for questioning and giving feedback. THREATS My threatsare whilst on this practice placement, I found some areas very stressful. I discovered that some of the mentors were unfamiliar with the new- pre registration programme and unaware of the needs of the nursing students in relation to the learning opportunities or activities . Appendix 3 Service Improvement Activity – Notification Form Student Details Student SID Number: 0820968 Details of student pledge on which the proposed improvement is based. I must treat individuals kindly and considerately. I will provide a high standard of practice and care at all times. I will respect individuals’ confidentiality. I must show compassion and unconditional positive regard to my clients. I must disclose information, if I believe some one may be at risk of harming him/her self in line with the law of the country in which I am practising. I must listen to individual in my care and respond to their concerns and preferences. Details of proposed service improvement project/activity: The service improvement initiative is to facilitate Protecting Patient Meal Time in the Psychiatric Intensive Care Unit (PICU). The purpose of this service improvement is to help and manage mealtimes without unnecessary and avoidable interruptions. Mealtimes are not only a vehicle to provide patients with adequate nutrition, but also provide an opportunity to support social interaction amongst patients. Reason for development: During my practice placement in the PICU. I discovered that there have been a lot of interruptions and argument between some patients and staff during meal time and also staff members who supposed to assist during meal time always claimed to be very busy. This made me choose to introduce to the team about â€Å"Protected Mealtimes†. This development is to support those patients who were finding it very difficult to eat or drink. Time spent on the project/activity: The service improvement lasted for the period four weeks because I first and foremost had the meeting with the multidisciplinary team members before introducing the change to the patients. Resources used: National Health Service (NHS boarder) Evidence on topic relating Protecting Meal Time Information from in the internet. Policy and regulation from the trust Text book Some information from dietician. Who will be involved? The ward consultant My mentor as a nursing staff, Occupational therapist staff Support worker The ward manager The dietician Myself( a student nurse) Future plans: The future plans are for me to distribute leaflets to the other professionals for them to read it in the internet and be awareness of the protecting meal time. Date discussed with clinical staff in placement area: Preparation for Professional Practice.? Introduction Whilst on the unit I became concerned when I noticed some service users were being discharged without proper education on how to manage their self-medication regime. This concerned me as it appeared to be a vicious cycle as I witnessed some service users being discharged without having a proper follow-up education on self-medication – which in certain cases led to non-adherence to their medication which consequently sometimes led to their relapse. For this cycle to be broken, I have realised that a proper education system, which would entail simple terminologies or understandable statements for service users to understand and learn how to manage their self-medication regime, should be put in place. Accordingly, this assignment will explain management and leadership styles related to a service improvement in the clinical area where I commenced my management placement. Applying management and leadership theory to practice, I will explain the reasons for my actions and will identify my strengths and weaknesses in terms of my leadership and management skills used whilst on placement. Adhering to the Nursing and Midwifery Council (NMC) Code of Professional Conduct (2008) and general good confidentiality prudence, all names and places mentioned in this assignment have been changed to a pseudonym. ?Leadership Styles & Management? In the mental health nursing profession, the management role cannot be averted, whether it is in managing a unit or improving services. Management is widely considered to be concerned with controlling, organising, planning, and problem-solving (Kotter, 1996 cited in King’s Fund, 2011). Yoder-Wise (2007) goes further on this point and states that management is concerned with the work of any individual who guides others through a series of routines, procedures or predefined practice guidelines. Moreover, leadership like management, has become a pivotal component of National Health Service (NHS) policy. This policy has on the most part been driven by the rising expectations of citizens who are now demanding to see an improvement in the quality of the services given to the service users and their families. Although management and leadership are somewhat different, both actions tend to overlap each other in terms of governing employees and organisation. Foster (2001) points out that management depends solely on the manager’s understanding of working with people of different backgrounds, having a good perception of situations and being able to aspire. On the other hand, leadership is an even more critical requirement within the NHS setting; this enables clinicians to demonstrate their leadership skills at all stages in health care provision and in new changes of services. Barker (2003), identifies leadership is a role of importance, emphasing that the role of a leader is dependent on his orher effective interpersonal skills. Oliver (2006) elucidates further by providing a list of qualities that are generally considered to define leadership, asserting that leaders must be capable of exploring personal and team motives and beliefs that can bring about change or perceived vision of success. Ellis and Hartley (2005) in agreement with Oliver (2006), state that leaders carry out this process by being ethical, respecting values, educate, motivate and direct the followers towards their objectives and goals. Consequently, leadership is required to be much more than just mere management skills that require â€Å"getting the job done† (King’s Fund, 2011 what page?). Over time, it has been posited that individuals are born either natural leaders or that they learn the qualities that are necessary for effective leadership roles (Hawkins &Thornton, 2002; Austin et al., 2003). There are a number of leadership styles but I will now focus on the main types. Autocratic leadership styles can range from benevolent to very rigid (Likert, 1967). In extremis, the use of authoritarian leadership, communications and activities can occur in a closed system. Autocratic leaders are considered to make all the decisions themselves and allow subordinates no influence in the decision-making processes (Grohar-Murray & Dicroce 1997). They will exercise their power, sometimes coupled with coercion, and are indifferent to personal needs of their subordinates’. Failure to meet such leaders’ goals can result in punishment. Autocratic leaders are known to be insistent, firm, self-assured and dominating, be it with or without actual intent.Such leaders feel little confidence or trust in their workers and as such, workers will fear theses leaders, whom they will feel have little in common. McGregor (1960) has produced what is perhaps considered the most famous description of such attitudes assumed by autocratic leaders; stating thatsuch a style of leadership excludes subordinates from the process of decision making and will assign work without consulting subordinates or knowing their inclinations and desires. The leader is in complete control and gives no room for subordinates to participate or offer opinions no matter how it may benefit (Daniels, 2004). Contrary to the autocratic style, democratic leadership involves the leader allowing employees to participate in decision making and at the same time provides guidance and direction (Anne, 1992). The most important finding arising from this work is that this leadership behaviour directly influences the climate and productivity of employees (Anna, 1992). A second important theme is that overall, the democratic leadership style has been known to be one of the most successful approaches because as initially stated, it allows employees to participate in decision making while at the same time supports, guides and counsels the followership (Anna, 1992.) However, critics have stated that on the basis of production, things move at a slower pace and this may lead to frustration amongst employees, especially those who tend to work faster in decision making process (Marquis, 2000). Notwithstanding, this democratic leadership still produces a high quality input from employees. This leadership builds trust amongst leaders and employees which then produces a cooperative team working relationship and builds high morale in the work environment. Accordingly, the democratic leadership approach should therefore not be used enough when urgent decision making matters arise, for example; decisions on issues of staffing, budgeting etc. In this situation it is more effective if a senior management makes the decision as this would be swift and the cost would be less as the business of any organisation cannot afford to make mistakes. Here, it is demonstrated how different leadership styles are required for different tasks and how in some positions certain leadership styles are more appropriate. The laissez-faire leadership is at the extreme opposite end of the spectrum from autocratic styles of leadership. Under a laissez-faire style of leadership the attitude is one of both permissiveness or ultra-liberalism in which there is a lack of control or centeral direction. . Thus, in different situations the same leader avertedly can use leadership of different styles. If a leader manages to combines all the leadership styles that have been mentioned than it is known as a situational leadership style. A situational leader adjusts styles of functioning depending on a particular position at that point of time and this is said to be another effective leadership style (Murthy 2005). This can be attributed to the Path-Goal theory approach. The Path-Goal theory supports the situational theory as it gives emphasises on the same leader using different types of leadership approach (Murthy, 2005). This theory was developed to examine the method in which leaders encourage their employees to achieve set goals (Murthy, 2005). It is important for leaders to have a sense of maturity to their staff as this approach builds a less task focused approach and into a relationship focused orientated (Forster, 2001). According to McGuire & Kennerly (2006) transactional leadership is a technique of leading an organisation through routine transactions such as rewards and discipline that are applied to the task after getting accomplished. Thus, it is almost completely based on the transactions that are conducted between the leader and the subordinate staff members because it is grounded on a theory that such workers can be and are motivated by rewards and discipline. A transactional leader will generally not look ahead whilst strategically guiding an organisation to a position of market leadership; instead such leaders are exclusively concerned with making sure everything flows smoothly (McGuire & Kennerly, 2006). The attributes of transactional leadership is that the nurse leader has authority over the employee by following organisation policies and regulation. Employees comply and follow directives and rewards are given in form of salary. This style of leadership essentially identifies itself repe atedly with the autocratic approach of the leader often responsible for creating staff commitment and building staff morale, as well as utilising intellectual stimulation and consideration of others. For this leadership approach to be effective, the leader depends on the loyalty of the employees (Marriner-Tomey, 2004). With all these styles of leadership and management now considered. I will now utilise these to analyse and explain my self-medication observations and theory. ?Self-medication Information? As discussed this assignment is focussed on improving the method in which self-medication information is carried out with service users. The reason for this decision is to promote self-medication management and help reduce the rate of non-compliance in medication and relapse. This approach will support service users as well as improve their knowledge of medication and it will prepare them for a healthy discharge. Information on self-administration of medicines is incredibly useful as it enables service users to manage their intake and promote their adherence to medication. The NMC Guidelines for the Administration of Medicines (2002a) states that the NMC supports self-administration of medicines and medicine administration carried out by carers, whenever appropriate. However, the safety and storage arrangements must be considered when necessary procedure is put in place. The nurse in charge therefore must carry out a decision on the basis of professional conduct that adheres with the NMC Code of Proffesional Conduct (2008), as the nurse would be accountable for their informed decision and omissions. When administering medication or supporting servicesto users who oversee their own self-medication regime the nurse must exercise their professional judgement and use effective skills and follow trust policy and regulations. Self-medication, where appropriate, is supported by the Nursing and Midwifery Council in the document ‘Standards for Medicines Management’ (2007). It is apparent that the process of self-medication has made clear that it can help make service users become more familiar, confident and have better self-esteem by managing their own medication regime. The opportunity for service users to learn about medication through health education will ultimately improve their medication concordance before and after discharge. According to Nicklos (2010), change management is a methodical way of dealing with a change, both from the view of the organisation and on to the individual. Although an ambiguous term, change management has at least three different aspects, including bu; adapting to change to an area of professional practice, controlling change, and effecting change. A proactive approach to dealing with such change is undeniably at the core of all three of these aspects. Fred (2010), goes even further to state that change does not always come from within organisations but could be from legislation or current national guidelines which have been passed as a law and become enforced making it mandatory.. Changes to services and organisation may impact on the position, role and even the status of individuals and therefore can test levels of self-confidence as well as confidence in others. Change requires new clinical responsibilities, time for training and development and require openness to different ways of doing things and as such requires letting go of a previous practice. Such challenges make the planning of the change process a prerequisite for success (Michele, 2010). Accordingly, it is vital to comprehend the importance of change management as it gives a both positive and negative picture of what a change can bring. When I was thinking of my service user initiatives I had to consider some things such as time, as this allowed me to see if my change was realistic. My placement was on a rehabilitation unit where the recovery star tool was used to support service users in identifying their needs. Using the recovery ladder of change, a course of action was set in place to support service users care plan. The purpose of the rehabilitation unit was based on a form of rehabilitation that focused on helping service users to recover lost skills in coping with the demands of everyday lives. In the management of their medication in the rehabilitation unit, the nurses in charge are there to support and guide the service users in knowing what they are taking and when they should take their medication. By supporting and guiding service users to self-manage their medication improves both independence and helps them for forthcoming discharge. Before self-administration starts for service users, qualified nursing staff, or preferably pharmacist, should educate when, how and what is needed to be done. There are three stages at which service users can come to managing their medication. Stage 1 involves medications being stored in the medicine cabinet and at the right time the nurse in charge opening the cabinet and prompting service user to take their medication.At stage 2 the nurse in charge is accountable and responsible for the safe storage of the medication cupboard. During administration of medication the service user will ask the nurse in charge to open medication cupboard without prompting. The service user would then administer the medication under the supervision of the nurse in charge. Stage 3 would then be when the service user accepts full responsibility for managing the storage and administration of their medications. The nurse in charge then assesses and observes the service user’s verbal response and medication compliance. Once there is full clarity and positive observations of the service user’s self-medication management, they can get discharged back into the community. A problem I faced was how I would actually communicate this change to staff in the unit. To communicate is a transactional action where is sharing of ideas, beliefs and knowledge (Sen, 2007). Effective communication is an important skill all leaders should have because in a way of introducing something new and if done properly, it can allow staff to accept and receive change. Communication also gives room for staff for feedback and criticism (Sen, 2007). Another essential practice in a care setting is collaborative working. This allows professional to share their decisions and opinions (David et al, 1996). Within a team their views and shared ideas are important in an event of proposing change. In this assignment I have come to understand that the roles of leaders and managers is not merely just about giving orders but requires vital skills in communication, behaviour and approach to produce positive result. I requires telling people what to do but also making sure that it is within their competency level and realistic, is necessary for an effective working environment NMC (2008). My identified weakness was in the area of delegation as I needed to be more assertive. This is a skill that I hope to improve in my career as qualified mental health nurse. Professional Development Plan In this assignment, I will reflect on my weakness in terms of delegation which was an area in which I had to develop. Delegation has been defined as â€Å"the process by which responsibility and authority for promoting a task (function, activity, or decision is transferred to another individual who accepts that authority† (Sullivan & Decker, 2009, p135). However, Marquis & Huston (2009) have also defined it simply as getting work done through others. Regardless, it is worth noting that responsibility and accountability are not and do not mean the same thing. Whilst a delegator is entirely accountable to the task, the delegate will also be accountable to the delegator for the responsibilities assumed (American Nurses Association (ANA) and National Council of State Boards of Nursing (NCSBN) (2005), cited in Gopee & Galloway, 2009; Sullivan & Decker, 2009). The Nursing and Midwifery Council expects all nurses to â€Å"acknowledge any limits of personal knowledge and skill and take steps to remedy any relevant deficits in order effectively and appropriately to meet the needs to service users and clients† (NMC, 2005). Yoder-Wise (2011) notes thatif delegation is to occur, there should be mutual acceptance between both the delegator, who has the accountability, and delegate, who assumes the responsibility for performing the tasks and is consequently empowered (Sullivan & Decker, 2009). However, Sullivan & Decker have clarified that while responsibility is an obligation to successfully completing a task, accountability also means accepting the overall outcome – whether it be failure or success – of the task. Further, illustrating this, Yoder-Wise (2011) explains that when two registered nurses work are to work together sharing a task, then delegation does not occur. It is also important to explain that tasks can only delegate tasks for which we are responsible (Sullivan & Decker, 2009; Yoder-Wise, 2011). Sullivan & Decker have also noted that, once a delegate gains confidence, they become motivated and as such will begin to see their morale boosted to actively take on new challenges. They also expand add that although delegation can be learned, it essentially promotes teamwork and improves efficiency. Applying this to nursing, it is stressed that appropriate level of supervision has to be put in place to the delegate to ensure that tasks that have been delegated are completed effectively and safely (NMC, 2008b). The best interest of the patient should always be the overriding consideration when delegating tasks rather than saving time or money (Royal College of Nursing, 2011). Delegation has increasingly become an essential aspect of nursing in the United Kingdom because of staff shortages and high turnover in the face of ever-mounting demand for a variety of skills in health care (Curtis & Nicholl, 2004). With regard to my clinical management placement experience, I found I was less assertive when instructed by my mentor to delegate tasks as part of my learning. I freely admit that my timidity stemmed from being raised in a foreign country and as such the I felt intimated when delegating. As English is not my native language there have been occasions when some of my colleagues, and even fellow students at university, have informed me that they are indeed unable to understand my accent. I realise that this is unacceptable because I am expected – and will be required – to be clear, concise and detailed when describing the objective, limits, expectations and outcome of the tasks to my delegates (Currie, 2008; Sullivan & Decker, 2009). Moreover, as a student nurse, I have often felt intimidated when delegating tasks to other staff who I considered to be better informed, better qualified and more experienced in nursing than me. Indeed, such fears were confirmed when, during one shift recently, whereI attempted to delegate a task (see Appendix 2). This is an area that I intend to improve upon. Reference Barker, M.A. 1992. Transformational Nursing Leadership: A vision for the future. Thompson Publisher. London. Currie, P. (2008) â€Å"Ask the experts: Delegation considerations for nursing practice†, in Critical Care Nurse, 28(5), (pp27-28) Curtis, E. & Nicholl, H. (2004) â€Å"Delegation: A key function of nursing†, in Nursing Management, 11(8), (pp26-31) Department of Health (2000) The NHS Plan: A Plan for Investment. A Plan for Reform, London: The Stationery Office Department of Health (2001) NHS Leadership Qualities Framework, Available [online] at: http://www.dhleadershipqualities.nhs.uk [Accessed March 20 2013] Department of Health (2008) High Quality Care for All – NHS Next Stage, Available [online] at:http://www.dh.gov.uk/en/Consultations/Liverconsultations/DH_085812[Accessed 20 March 2013] Ellis, J.R and Hartley, C.L., 2004. Nursing in today’s world trends, issues & management 8th edition: Lippincott Williams and Wilkins. Faugier, J. & Woolnough, H. (2002) â€Å"National nursing leadership programme†, in Mental Health Practice, 6 (3): (pp28-34) Gopee, N. & Galloway, J. (2009) Leadership and Management in Healthcare, London: Sage Hersey, P., Blanchard, K.H. & Johnson, D.E. (2001) Management of Organisational Behaviours: Leading Human Resources, (8th edn), Upper Saddle River, NJ: Prentice-Hall Huston, C., 2006. Professional Issues in Nursing. Philadelphia: Lippincott Williams and Wilkins. USA. Huber, D.L. (2006) Leadership and Nursing Care Management, (4th edn), Maryland Heights: Saunders Elsevier King’s Fund (2011) â€Å"The future of leadership and management in the NHS: No more heroes† Report from The King’s Fund Commission on Leadership and Management in the NHS Lambert, R. & Githens-Mazer, J. (2010) Islamophobia and the Anti-Muslim Hate Crime: UK Case Studies 2010, Exeter: University of Exeter Marquis, B.L. & Houston, C.J., 2000. Leadership Roles and Management Functions in Nursing. 3rd edition. Lippincott Williams and Wilkins publishers. USA. Norman, I. &, Ryrie, I., 2009 Art and Science of Mental Health Nursing: A Textbook of Principles, Berkshire: Open University Press/McGraw-hill Education Nursing and Midwifery Council. 2002a. The Code of Professional Conduct. London: NMC. Nursing and Midwifery Council. 2008. The Code of Professional Conduct: Standards for conduct, performance and ethics- Protecting the public through professional standards. London: Nursing and Midwifery Council; 2009. http://www.nmc-uk.org. Oliver, S. (2006) â€Å"Leadership in health care†, in Musculoskelet Care 4(1), (pp38-47) Royal College of Nursing (2011) â€Å"Accountability and delegation: What you need to know†, Available [online] at: http://www.rcn.org.uk/__data/assets/pdf_file/0008/361907/Accountability_HCA_leaflet_A5_final.pdf [Accessed November 15 3012] Sullivan, E.J. & Decker, P.J. (2009) Effective Leadership and Management in Nursing, (7th edn.), London: Pearson International Edition Yoder-Wise, P.S., 2007. Leading and Managing in Nursing 4th edition. USA. Mosby Inc. Yoder-Wise, P.S. (2011) Leading and Managing in Nursing, (5th edn), St. Louis: Elsevier Mosby. http://education.exeter.ac.uk/dll/studyskills/harvard_referencing.htm Use this link to learn how to Harvard reference properly. Your referencing is inconsistent and you need to list pages when quoting or referring to a specific point. As a general rule though, the main trick with referencing is continuity, so make sure your references and bibliography are consistent. Appendix 1: SMART Goal Delegation skills development Specific Measurable Achievable Realistic Time To prioritise all my tasks and manage time effectively and efficiently in all shifts.Commuting between London and the university has taught me the value of time management. Time management will enable me to carry out other tasks and achieve goals. More to the point, time management will provide me with personal organisation and self-discipline, as recommended by Yoder-Wise (2011) Time management will be measurable as I will be able to identify whether the tasks set out on a specific shift have been successfully completed on time whenever I’m taking over handover from night shift team members.Prioritisation is achievable by use of my diary which will contain all the tasks that need to be completed by the end of the day. Furthermore, prioritising will help me schedule tasks in the order of urgency. This will leave me room to tackle emergency situations that arise during the shift.Prioritisation is realistic because I realise that as a newly-qualified my responsibility will be to ensure that the shift runs smoothly. My diary will also be helpful as it will keep me reminded of the tasks I have to carry out and those which are still pending. In the case of pending tasks, being organised will give me sufficient time to involve staff who will be doing the next shift staff to complete them.Prioritising is an ongoing skill that I will have to keep learning during the first six months of qualifying and for the rest of my nursing career. Confidence and assertiveness while delegating tasks to other members of staff.Once a delegated task has been successfully completed and goals achieved confidence in allocating tasks to members of staff will have worked for me. By receiving feedback and constructive criticism from members of staff once they have successfully accomplished the delegated tasks. Being organised and maintaining a therapeutic relationship with fellow members of staff will increase my feelings of certainty that the shift will run smoothly relationship with staff.At the start of every shift I will allocate tasks to members of staff who have the competence, knowledge, time and willingness to carry them out and complete them. This is realistic because it will be my responsibility to manage shifts on the ward once I qualify. It will also be my duty to allocate or delegate tasks to members of staff. Likewise, during handover, I will ensure that I brief incoming staff on how the shift went and what remains to be done when they will be on shift.Based on my experience, so far, I’m very hopeful that I will achieve this goal within six months after I qualify. Appendix 2. Service Improvement Activity- Notification Form Contact Details Student SID Number: 0914451 Details of service improvement project/activity Service user Rehabilitation unit managing self medication. Reason for development To improve independent skills in managing medication for patients in rehabilitation centre so as to reduce the risk of relapse and to provide person centred care as well as empowering the service users. Time spent on project activity The time spent on self medication informative project was about six weeks. Resources used The Trust policy, The risk assessment form, The patient consent form, The patient withdrawal form, self- administration monitoring form (stages), self- administration patient record chart. Who was involved Nursing staff, doctors (MDT), Pharmacist , student (myself) and the service users. Future plans To review the self- administration if it is effective at a set time. Nurses involved in supervision of the programme must be registered nurses. Date discussed with clinical staff in placement area: (seen and agreed by my mentor Lorna Newton). And discussed with my IBL Facilitator Justin Nathan.