Introduction
This essay critically reflects on an episode of care within an adult nursing context, focusing on the demonstration of leadership skills. As a nursing student, I have encountered various clinical scenarios that required not only clinical competence but also effective leadership to ensure patient safety and optimal care delivery. The purpose of this reflection is to analyse a specific episode of care involving a multi-disciplinary team managing a deteriorating patient, evaluate my role as a leader in this situation, and identify areas for personal and professional development. Using Gibbs’ Reflective Cycle (1988) as a framework, this essay will explore the context of the episode, my actions and leadership approach, the outcomes, and the broader implications for nursing practice. Key themes discussed include communication, decision-making, and team collaboration, all of which are integral to effective leadership in healthcare settings. By drawing on relevant literature and evidence, I aim to provide a sound understanding of leadership within adult nursing and reflect critically on its application.
Context of the Episode of Care
The episode of care occurred during a clinical placement on a general medical ward in a UK hospital. The patient, a 72-year-old male with a history of chronic obstructive pulmonary disease (COPD), was admitted with acute respiratory distress. On the third day of his admission, I noticed early signs of deterioration during a routine observation check, including increased respiratory rate and reduced oxygen saturation levels. As a student nurse working alongside a registered nurse and other healthcare professionals, I recognised the urgency of the situation. The National Institute for Health and Care Excellence (NICE) guidelines on managing acute exacerbations of COPD highlight the importance of early recognition and intervention to prevent further deterioration (NICE, 2018). This context necessitated immediate action, requiring leadership skills to coordinate an effective response despite my position as a learner.
My initial response was to escalate the situation by alerting the senior nurse on duty and requesting a rapid assessment. However, I also took the initiative to ensure the patient’s immediate comfort, adjusting his position and providing reassurance while awaiting further assistance. This episode required me to demonstrate leadership by prioritise tasks, communicate effectively, and collaborate with the team—skills that are essential in nursing practice but often challenging for students who may feel uncertain about taking charge.
Leadership Skills Demonstrated
Leadership in nursing is multifaceted, encompassing the ability to guide, inspire, and coordinate care delivery within a team. According to Stanley (2017), clinical leadership involves not only decision-making but also fostering a supportive environment for colleagues and patients. In this episode, one of the key leadership skills I demonstrated was effective communication. I articulated the patient’s condition clearly to the senior nurse, using the SBAR (Situation, Background, Assessment, Recommendation) tool to ensure all relevant information was conveyed concisely. This structured communication approach is widely endorsed in healthcare settings to improve patient safety and team efficiency (NHS Improvement, 2018).
Additionally, I exhibited situational awareness and decision-making by identifying the early warning signs of deterioration using the National Early Warning Score (NEWS2) system (Royal College of Physicians, 2017). Although I was not in a formal leadership position, my proactive approach in escalating concerns arguably prevented a more severe outcome for the patient. Reflecting on this, I recognise that leadership is not solely about hierarchical authority but about taking responsibility for patient well-being, a perspective supported by Barr and Dowding (2019), who argue that leadership in nursing can be enacted at all levels.
However, my actions were not without limitations. I initially hesitated to directly contact the medical team, relying instead on the senior nurse to take further action. This hesitation likely stemmed from a lack of confidence in my knowledge and role as a student. While this did not negatively impact the patient’s outcome, it highlights an area for development in assertive leadership, particularly in time-sensitive situations.
Team Collaboration and Challenges
Effective leadership in nursing is closely tied to collaboration within multi-disciplinary teams (MDTs). During this episode, I worked alongside nurses, a respiratory therapist, and a junior doctor to stabilise the patient. My role involved ensuring that equipment, such as oxygen therapy devices, was readily available and that documentation of observations was accurate and up-to-date. This aligns with the Nursing and Midwifery Council (NMC) Code (2018), which emphasises the importance of working cooperatively to safeguard patient care (NMC, 2018). Indeed, my ability to anticipate the team’s needs and provide support demonstrated a degree of leadership, though limited by my student status.
Nevertheless, challenges arose due to differences in communication styles within the team. For instance, the junior doctor initially appeared dismissive of my observations, focusing instead on the senior nurse’s input. This dynamic reflects broader issues of hierarchy in healthcare settings, where student contributions may be undervalued. Gopee and Galloway (2017) note that power imbalances within MDTs can hinder effective collaboration, a concern I experienced firsthand. Overcoming this required me to advocate for the patient by reiterating my observations with clarity and confidence, thereby contributing to the collective decision to initiate nebuliser therapy promptly.
Critical Reflection and Areas for Development
Reflecting on this episode using Gibbs’ Reflective Cycle (1988), I can identify both strengths and areas for improvement in my leadership approach. My ability to recognise clinical deterioration and communicate effectively ensured a timely response, potentially preventing adverse outcomes. However, my initial reluctance to take a more assertive stance in escalating concerns directly to the medical team suggests a need for greater confidence and autonomy. Leadership development in nursing students is often constrained by limited experience and perceived authority, a limitation acknowledged in the literature (Curtis et al., 2011). Therefore, I plan to seek mentorship and engage in simulation-based training to build my decision-making skills in high-pressure scenarios.
Furthermore, this episode underscored the importance of self-awareness in leadership. I realised that my hesitation partly stemmed from fear of overstepping professional boundaries as a student. While this caution is generally appropriate, it can hinder effective care delivery if not balanced with assertiveness. Moving forward, I aim to develop a clearer understanding of my scope of practice while cultivating the confidence to act decisively when patient safety is at stake.
Conclusion
In conclusion, this critical reflection on an episode of care has highlighted the significance of leadership skills in adult nursing, even at the student level. Through effective communication, situational awareness, and collaboration, I contributed to the timely management of a deteriorating patient, aligning with best practice guidelines and professional standards. However, limitations in assertiveness and confidence reveal areas for personal growth. This experience reinforces the notion that leadership is not confined to senior roles but is a shared responsibility within healthcare teams. The implications for practice are clear: nursing education must prioritise leadership development through mentorship and practical training to prepare students for the complexities of clinical environments. By addressing my identified weaknesses, I aim to enhance my ability to lead effectively, ultimately improving patient outcomes and team dynamics in future episodes of care.
References
- Barr, J. and Dowding, L. (2019) Leadership in Health Care. 4th edn. London: SAGE Publications.
- Curtis, E.A., de Vries, J. and Sheerin, F.K. (2011) Developing leadership in nursing: exploring core factors. British Journal of Nursing, 20(5), pp. 306-309.
- Gibbs, G. (1988) Learning by Doing: A Guide to Teaching and Learning Methods. Oxford: Further Education Unit.
- Gopee, N. and Galloway, J. (2017) Leadership and Management in Healthcare. 3rd edn. London: SAGE Publications.
- National Institute for Health and Care Excellence (NICE) (2018) Chronic obstructive pulmonary disease in over 16s: diagnosis and management. NICE.
- NHS Improvement (2018) SBAR communication tool. NHS Improvement.
- Nursing and Midwifery Council (NMC) (2018) The Code: Professional standards of practice and behaviour for nurses, midwives and nursing associates. NMC.
- Royal College of Physicians (2017) National Early Warning Score (NEWS) 2. Royal College of Physicians.
- Stanley, D. (2017) Clinical Leadership in Nursing and Healthcare: Values into Action. 2nd edn. Chichester: Wiley-Blackwell.
