Nursing leadership during a critical incident at my work place

The purpose of this reflective report is to describe and demonstrate the effective use of nursing leadership during a critical incident at my work place. The specific style of leadership that was carried out during the critical incident and part of the focus of this reflective report will be the bureaucratic style of leadership. Through a critique of the effectiveness of bureaucratic style leadership and the application of the leadership style is described in this report. This reflective report will discuss and deliberate how my personal leadership skills have developed as a result of being able to successfully negotiate a situation using bureaucratic leadership.

Critical incident description

Critical incidents are snapshots of something that happens to a patient, their family or nurse. It may be something positive, or it could be a situation where someone has suffered in some way (Alphonso, 2007). The critical incident to be described for this report occurred at my place of work in a nursing home earlier this year. On this particular morning shift, I happened to be working with the residents on my allocated section when I heard the sound of my name being shouted urgently by one of my fellow workmates. Upon opening the door to where I was being called from, I saw one resident half on the floor with his leg tangled in the side rail of the bed. The sling for the lifter being used had been incorrectly applied to the resident causing them to be half lifted off the bed before it came off the lifter hooks and caused the resident to fall on the floor.

This time the nurses were panicking because they knew they had not followed the normal procedure for manual handling, consequently this affects their ability to cope with the situation. One of the nurses was helplessly attempting to lift the resident up by pulling on her arm while the other tried to free her leg from the bedrails which was causing further discomfort to the patient due to the way her leg had wedged itself in between the rails as she fell on the floor. It was obvious to see that the patient’s hip had become dislocated, not only from her calls of distress but also the angle that their pelvis was sticking out away from their leg. As the resident’s leg was hanging on the lifter and part of her body on the floor, she was screaming, breathing forcefully, you could tell with the expression on her face the pain she was going through. Straight away I knew it would be important to carry out certain procedures to ensure the proper handling of this event and to help her to receive immediate care and remove them from this hazardous situation.

Critical incident analysis and Critique

The incident was critical, as it strengthened nurses to provide safety for clients and to provide individual centred care. Reflecting on this incident also demonstrated the value of evidence based leadership skills. The first course of action I took was to report to the registered nurse in charge of my section, whom at the time was caring for another resident, to call an ambulance. I then instructed my fellow nurses to stop pulling the resident off the lifter, due to the fact that they could be causing more harm than good. I then instructed the nurses involved to calm down and stop panicking because it could worsen the situation. I told one of the nurses to get the pat slide transferring board and the other to get the other two nurses on duty to assist with the situation. In this way, there was a division of labour among the nursing staff in dealing with the emergency and, I was acting in the role of a bureaucratic leader.

As nurses, we are accountable to the community to provide safe, effective, high quality care. The Australian Nursing Midwifery Council [ANMC] provides a framework for our practice in the ANMC competencies (ANMC, 2005). One such competency (Element 1:2: ‘Fulfils duty of care in the course of practice’ (ANMC 2005)) requires that nurses perform interventions following adequate, accurate assessments and recognises the responsibility to prevent harm. As we can see that this critical incident occurred due to improper use of the sling, which is negligence, therefore it may be questioned whether our duty of care to him was breached. And also in relation to our own nursing and leadership practices, the evidence insight in this report is the ANMC competencies (Element 1:3) which recognises and responds appropriately to unsafe or unprofessional practice which involves identifying interventions which prevent care being compromised and follow up incidents of unsafe practice to prevent reoccurrence (ANMC, 2005).

By analysing the critical situation, it is plain to see how bureaucratic style leadership was effective in handling the situation. The allocation of jobs and following of procedures was effective in dealing with the possibility of further hazards and ensured the safety of the resident and nurses (Palombara, 2006). By taking a leadership role in this critical situation, I was able to see how effective structured guidelines and how designation of jobs is beneficial to getting work done. By remaining calm in this critical situation, I was able to get a glimpse of how I could handle an emergency situation, especially when other workers may start to panic and forget important rules (Lega & DePietro, 2005). By remaining calm and thinking logically I feel I was able to handle the situation successfully and maintain the safety of my fellow workers and the patient involved.

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