reflective essay on leadership in nursing

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Essay: Leadership in Adult Nursing (reflective)

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Introduction Leadership is a process which involves individual activity to state desire objective and vision in a situation, providing support and motivating other people to attend set goals (Swearingen, 2009). Danae et al. (2017) believe that leadership is broadly recognised as a key aspect of overall effective healthcare. Therefore, nurses require strong leadership skills to accomplish various tasks to improve care quality. In this assignment, I will cross reference six experts (see appendices) from my professional development portfolio related to the four domains of standards of competence for preregistration nursing (NMC, 2010). Additionally, I will address each domain using Rolfe, Freshwater and Jasper (2001) reflection model, which is composed of three stages ‘what’, ‘so what’, and ‘now what’. This model is suitable to link practical experiences with theory, it helps to improve clinical practice and identify further learning opportunities; which will be addressed by formulating a S.M.A.R.T action plan (Doran, 1981). Domaine 1: Professional values What? Appendix 1 shows aspects of the professional values that I need to address. It contains mentor’s comment about patient advocacy skill. During my Nursing Practice 5 (NP5), I looked after a 56-year-old disabled woman with Spina Bifida who was alert and orientated, unable to move on her own, but, had clearly expressed her need to be moved every two hours to avoid another pressure ulcer as she had one before. This was not respected by health care assistant taking for excuses “the ward is very busy, she is not the only patient”. I regret I didn’t advocate for her. Furthermore, appendix 2, which is the leadership framework self-assessment tool demonstrates aspects of personal quality that I need to review. These are related to the (NMC, 2010) instructing nurses to take all reasonable steps to protect people who are vulnerable or at risk from harm, neglect or abuse. So what? Professionalism means practice through the application of the Code (NMC, 2017). In the UK, nurses must act as advocates for their patients, challenge poor practice and discriminatory attitudes and behaviour relating to the care of vulnerable people, (NMC, 2015). This is supported by the Royal College of Nursing (RCN) stating that speaking on behalf of another is an integral part of the nurse’s role (RCN, 2008). Moreover, The International Council of Nurses emphasises the need for nurses to respect the rights, values, customs and beliefs of individuals and families, and to advocate for equity and social justice in resource allocation and in access to health (ICN, 2012). Such endeavours are central, as illness nearly always increase levels of patient vulnerability and dependence (Marquis and Huston 2012). Emphasizing the fact that nurses should influence the way care is given in a manner that is open and responds to individual needs (RCN, 2015). Unfortunately, there have been cases where nurses have failed to provide fundamental care to patients. The report into the failing at the Mid Staffordshire Hospital identified poor leadership coupled with clinical staff accepting standards of care that should not have been tolerated (Ellis and Bach, 2015). More recently, Care Quality Commission (CQC) has issued a Warning Notice requiring some trusts to improve safety, patient consent and overall leadership (CQC, 2017). This accentuates the role of leadership in prioritising patient safety and in listening to and learning from patients (storey and Holti, 2013). Stressing the need for nurse leaders to be self-aware and recognise how their own values and principles may affect their practice (NMC, 2010). Leaders encourage teamwork by appreciating individuals’ contributions and ideas; this creates needed behaviour, such as shared respect, compassionate care, attention to detail, between team members (NHS Leadership Academy, 2013), and create a motivating work environment (Adair, 2002). Therefore, the quality of leadership has a direct impact on the quality of service provided at all levels. The leader’s obligation is to create an environment in which good people can provide good care (Engard, 2017). Pointing out personal attributes of nurses that help to enable advocacy like flexibility, empathy, self-motivation, professional commitment, sense of responsibility, and the ability to cope with stress (Choi, 2015). Reflecting on the above scenario, transformational and transactional leadership can both play a role in the negotiation of a win-win situation. Transformational leadership is defined as a leadership approach that causes changes in individuals and social systems. It is about having a vision of how things should or could be and being able to communicate this idea effectively to others (Ellis and Bach, 2015). Whereas transactional leadership is based on contingent rewards and can have a positive effect on followers’ satisfaction and performance (Tomlinson, 2012). Transformational leadership plays a more critical role in the present scenario. it can motivate and inspire healthcare assistant and have a more significant impact to change both their thinking and behaviour Jie-HuiXu (2017), thus, allowing them to reach their potential and deliver sustainable changes to care. Now what? Now I should strive on developing and sustaining my engagement in patient advocacy by the end of NP7. In my Ongoing Achievement Record document, I will work with my mentor to complete competency 1.2. called: Understand and apply current legislation to all service users, paying special attention to the protection of vulnerable people, including those with complex needs. I will actively seek mentor, patients, family and others health professionals’ feedback and reflect on when I have been involved in patient advocacy during placement and review this with my mentor at mid- and end-point review. Domain 2: Communication and Interpersonal Skill What? Communication and interpersonal skill are vital parts of collaborative working (NMC, 2010). I reflect on communication using Situation, Background, Assessment and Recommendation (SBAR) mentioned in appendix 3, which is a reflective writing during placement 5. In a surgical ward, during routine observation of a patient who had undergone a cystectomy, I noticed that the patient was spiking in temperature (38.5) although NEWS score was 1, I immediately informed my mentor who directed me to blip the doctor in charge of his care. While communicating with him I was unable to give a clear response to questions about the patient’s condition. Even though he reassessed my patient immediately, I regret I didn’t use SBAR tool, because it could have helped to communicate clearly and prevent any potential delays. Appendix 1 in the section ‘working with others’ further shows that I need to improve my interpersonal skills. These relate to part of the NMC (2010) stating: nurses must use a range of communication skills and technologies to support person-centred care and enhance quality and safety. So what? Bach and Grant (2010) state that good communication and interpersonal skills are essential characteristics of high-quality nursing practice. The NMC (2010) also said that all nurses must use the full range of communication methods, including verbal, nonverbal and written, to acquire, interpret and record their knowledge and understanding of people’s needs. Emphasizing the use of communication tools like SBAR. SBAR is a tangible approach to framing conversations, especially critical ones that require a nurse’s instant attention and action. It promotes the provision of safe, efficient, timely, and patient-centred communication (Chaboyer et al., 2010; Day, 2010). Moreover, SBAR can be used for multiple forms of communication. It can be a change-of-shift report (Pope et al., 2008; Thomas et al., 2009), or can be applied to written communication (Perry, 2014). In addition, SBAR helps nursing students and recent graduate nurses organize their thoughts prior to calling physicians, to save time, reduce frustration, and improve overall communication (Pope et al., 2008). Furthermore, the use of SBAR communication tool temporarily flattens the hierarchy perceived in most healthcare settings, resulting in more effective channels of communication between healthcare providers (De Meester, Verspuy, Monsieurs, & Van Bogaert, 2013). According to Hackman and Johnson (2013), leadership is first, and foremost, a communication-based activity. Depending on the circumstances, a leader should try to be more authoritarian, democratic or laissez-faire (Mitchell, 2012); or should focus the communication on the tasks or use a more interpersonal style (Hackman and Johnson 2013). Reflecting on the scenario related to this domain, an assertive, clear and focus communication using SBAR format would have provided a brief, organized, predictable flow of information improving critical thinking communication skills and patient safety (Olin, 2012). It can be argued that it is hard to serve as an effective leader without effective communication (Hackman and Johnson 2013). This is agreed by Perry et al (2014) stating that effective commutation is a central attribute of clinical leadership. Clinical leaders can influence their colleagues with effective communication skill such as good listening skill and extremely good at explaining things at the right level that can be understood by followers. However, it is important to note that each clinical leader has a preferred style of communication that would not necessary works every time. Hackman and Johnson (2013) recommend choosing a leadership communication style that will work best according to the situation and the level of knowledge of followers. Now what? During next placement (NP7), I will strive to change communicating SBAR in a more professional, concise, clear, in a timely manner when communicating with the multidisciplinary team to improve patient outcome. I will actively seek feedback from my mentor and other professionals at mid- and end-point reviews. I will also change my preferred communication style from passive aggressive to an assertive communication style. For that, I will use the communication style questionnaire at the beginning then altered my behaviour during the first part of the placement, then repeat the questionnaire at mid-point and ask for feedback to my mentor base on the comparison on two questionnaire results and base on her observation. And repeat this again by end-point. Domain 3: Nursing Practice and Decision Making What? Here I reflect on nursing practice and decision making, see appendix 4, which is an end-point mentor comment during NP3 showing that improvement is needed in this domain. This is underpinned by appendix 5: a reflection done at the beginning of NP6 when I looked after a patient with hypoxic brain damaged who had a seizure. On my entry into his room, I found the patient unconscious, I took the decision to clear his airway before pressing the emergency bell which could have jeopardised patient safety. This is related to the NMC (2010) stating that nurses must be able to recognise and interpret signs of normal and deteriorating mental and physical health and respond promptly to maintain or improve the health and comfort of the service user. My behaviour pointed out the need to enhance my skill and knowledge in this domain. So what? Judgement and decision-making are important facets of healthcare for nurses (Traynor et al., 2010). Judgement is defined as weighing up different alternatives; while decision-making involves choosing a specific course of action to follow between alternatives (Lamb and Sevdalis, 2011). Hence, (Undre et al., 2009) define efficacious judgement and decision-making as skills that go beyond clinical knowledge and technical competence, highlighting the fact that nursing judgement and decision-making contribute significantly to the safety and quality of patient care (Traynor et al., 2010). However, several studies have high-pointed that when given the same information, and undertaking the same decisions, nurses will make consistently different judgements and decisions (Thompson et al., 2008; Thompson and Yang, 2009). Differing judgement and decision indicate different types of reasoning, in situations where time is not constrained, newly qualified nurses will make structured judgments with a rational-analytical decision. For those situations where time is limited, information is perceptual, and the nurse has some perceived expertise, it is appropriate to use intuition as the basis for judgement (Hammond et al., 1987). Thompson et al (2008) suggest that the key to successful reasoning is to adapt reasoning to the demands of the task. However, such adaptive reasoning by nurses is sometimes absent. Thus, good decisions and judgements are not independent to the cognitive process but can be influenced by how information is prioritised and the nurse’s ability to identify and respond to vital aspects of the clinical situation (Pearson, 2013). Thompson et al (2013) state that recent studies have shown positive benefits associated with the introduction of Computerised Decision Support Systems (CDSS) to support nursing decisions. Hence, helping to promote patient’s safety and improve their outcome. Reflecting on the scenario related to this domain, future decisions making process, whether they are based on normative, prescriptive or descriptive theory must include clinical expertise, patient value and best available research evidence (Sackett, 1996). because evidence by itself, does not make the decision, but it can help support the patient care process. In the same order, Marquis and Huston (2015) suggest that to be effective as a leader, one needs certain skills for making decisions, such as self-awareness, fairness and transparency which are skills also needed in decision making. This is supported by Thompson and Dowding (2009 p5) affirming that “One of the distinguishing features that mark out exceptional nurses is their skills in judgement and decision making”. Decision making is considered important leadership skills and is recognised by Sofarelli and Brown (1998) as qualities associated with transformational leadership. Now what? I have realised that decision making, particularly in nursing, is vital as it influences patient safety and outcomes (Ellis and Bach, 2015). It has been mention earlier that experience is a factor that affects decision making. To gained experience in judgement and decision making, I will use every opportunity during NP7 to practice evidence base in nursing practice and decision making by always based my decision on useful information sources like clinical guidelines, protocol and policy and patient preference. After what I will actively seek feedback from my mentor and others healthcare professionals and of course to patients to check their satisfaction about their involvement in the decision-making process about their own care at mid- and end-point reviews. . Domain 4: Leadership, management and team-working What? My leadership, management and team working skill are measured in appendix 2 and appendix 6 which are both leadership self-assessment tools. The first one showing aspects of my leadership that needs to be improved and the second one showing my leadership style which is “guiding” needing improvement to become more empowering. These are further supported by appendix 4: mentor end NP3 comment. During the leadership module, I took part in several group activities, which enabled me to understand team role importance and that there is no leader without followers. This part relates to NMC (2010) stating that nurses must work independently as well as in teams; be able to take the lead in coordinating, delegating and supervising care safely, managing risk and remaining accountable for care given. So what? Tomlison (2012) states that self-assessment helps individuals to appreciate their qualities, strengths and weaknesses thereby, enabling better transformational leadership. Bass (1985) found that transformational leadership contributes to individual performance and motivation. Whereas transactional leadership (Burns, 1978) is short-lived, and task-based, with the leader intervening with negative feedback when things go wrong. Adair (2002) proposed a three-circle model of strategic leadership, with the circles being the needs of the task, the individual and the team. This is a democratic model of leadership matching the NMC code, where Individuals and groups are involved in decision-making processes concerning their work (Adair, 2002). Management skills are as important as leadership skills in addressing some failings like those identified in the Francis report (Kerridge, 2013). Kerridge suggests they are closely linked, effective management and leadership both require putting first thing first. The King’s Fund report (2011) concurs, defining leadership as the art of motivating people toward a shared vision and management as getting the job done, suggesting that the exercise of leadership across shifts could be extended to management practice; pointing out that every member of healthcare team has some management and reporting functions as part of their job (Baker et al., 2012). Lord Darzi (2008) said: ‘Leadership is not just about individuals, but teams’. A successful leader will see each person as an individual, recognising their unique set of needs, as not everyone will perform at the same level (Hackman and Johnson 2013). This rejoins the description of team role by Belbin (1996) as he described a team role as ‘a tendency to behave, contribute and interrelate with others in a particular way’. Suggesting that Belbin assessment would be an ideal way for a team to examine: the roles they play, how these fit in with the team and the contribution of roles to the team (Frankel, 2011). Therefore, it would be advisable that team members use the questionnaire to helps identify individuals’ preferred roles, their manageable roles and their least preferred roles within the nine teams’ roles as described by Belbin in-order-to improve the success of teamwork. Nurse leaders need also to be able to respond to an ever-changing healthcare environment (Frankel, 2011). The literature suggests that leadership, effective communication and team working are among the most important elements for planned change (Schifalacqua et al., 2009a). Kurt (1951) identified three steps of change: unfreezing, moving and refreezing. This work was modified by Rogers (2003) who described five phases of planned change: awareness, interest, evaluation, trial and adoption. Another change theorist, Ronald Lippitt (Lippitt et al., (1958), identified seven phrases. Mitchell (2013) advises that Lippitt’s work is likely to be more useful to nurses because it incorporates a detailed plan of how to generate change and is underpinned by the four elements of the nursing process: assessment, planning, implementation and evaluation. Now what? To improve my Leadership, management and teamwork skills, I will use the first week of my MP7 to observe my mentor and nurses in charge leading some shifts, then, I will seek clarification on grey areas of my understanding and ask to have my own patients. This will enable me to practice leading others, managing patients and working with the multidisciplinary team. I will actively seek feedback till mid-point review, then, I will lead and manage my mentor whole set of patients under her observation and correction whenever needs arise till end-point. This will help me to move toward an empowering leadership style. Conclusion I have learnt that: a good leader or manager remains grounded in the values, beliefs and behaviours that guide professional nursing practice; understanding your role and that of other will nurture clear communication thus improving the success of the team; safe decision-making must be evidence-based; and effective leadership fosters a high-quality work environment leading to positive safe climate that assures better patient outcomes.

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Johns Hopkins Nursing Magazine

On the Pulse

The Year of the Nurse: 6 Reflections on Leadership Amidst Adversity

When exactly will things become “precedented” again?

Unfortunately, there are no answers in sight. But we do know that it is the year of the nurse and the midwife, and the entire Johns Hopkins School of Nursing community has stepped up beyond measure.

So here are six reflections from leaders at every level.

My journey is not yet finished, but I know one thing: adversity instills resilience. Hopkins is teaching me that.

Jane Ko, DNP Family Nurse Practitioner student

Laura Arthur, Director of the Career Lab

It can be hard to read others’ emotions in a virtual environment.

So much of our work is interdependent on others, and a key to strong relationships is building your emotional intelligence.

Emotional intelligence includes self-awareness of your own intuition and preferences, an ability to regulate impulses and empathize with others’ feelings, and recognition that someone else might perceive or experience a situation differently from you.

Rather than making any assumptions, regularly check in with each person on your team, ask what they need, and listen to what they have to say. Giving your full presence and attention, and following-up on needs, is vital to building trust and mutual investment.

Alexander Rike, MSN (Entry Into Nursing), Men In Nursing

I wish more leaders today approached problems from a nursing perspective, which begins with empathetic listening.

Scott Newton presented to Men in Nursing last semester and said something that stuck with me, “I retain the perspective of a nurse at each progressive level of my career.”

He looks at his role as provisioning care for larger and larger groups – from patients at the bedside, to a unit, to an organization, or to a community.

Leah Woienski, MSN (Entry Into Nursing), Student Senate President

In leadership, vulnerability is strength.

There is strength in saying, “This is where I am, this is how I feel, and these are the trials challenging me right now.”

This year tested our adaptability and resilience to new extremes, and in leadership, vulnerability is strength. Leadership requires recognition that 2020 has presented with unprecedented challenges as well as reminded us of long-standing societal issues which demand both our attention and action.

Identifying these truths within myself, while also encouraging others to do the same, has opened the door for unity, courage, and strength. Brené Brown may have said it best when she stated:

“A brave leader is someone who says I see you. I hear you. I don’t have all the answers, but I am going to keep listening.”

We must be more empathetic towards each other, with the understanding that we are all impacted and all need some healing.”

Bunmi Ogungbe, PhD in Nursing student

Lucine Francis, PhD, RN, Assistant Professor

There is no better time for nurse leaders to influence policy on equitable education.

The COVID-19 pandemic revealed to many and reinforced to some that Child Care and Schools are the bedrock of today’s society.

Much of our economy and health depend on well-functioning schools and childcare. There is no better time for nurse leaders to be involved and actively engaged in policy, practice, and research to help drive equitable solutions for our early care and education systems.

ABOUT THE AUTHOR: SYDNEE LOGAN

Sydnee Logan, MA is the Sr. Social Media and Digital Content Specialist for Johns Hopkins School of Nursing. She connects Hopkins Nurses with the world.

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Gibb’s Reflective Cycle in Nursing Leadership Essay

Introduction.

In the healthcare setting, nursing leadership plays a critical role in influencing the overall health outcome. The activities involved in patient care are repetitive and tiresome, which sometimes makes nurses exhausted and unable to deliver the best quality services. In such conditions, they require a nurse manager able to inspire and motivate them to work towards achieving the objectives set. To ensure all the processes run effectively in the organization, the leader must reflect on the various encounters to improve the aspect of decision-making and management. By relying on Gibb’s Reflective Cycle, the nurse manager will have the ability to effectively scrutinize experience and establish a proper action plan necessary for better service delivery.

Description

One night at around 11 pm, when I was at home relaxing, I received a phone call from a nurse who was part of the night shift team informing me that other providers refused to attend to the patients. I had already planned the schedule and assigned each of the practitioners their roles (Tawanwongsri & Phenwan, 2019). I was forced to report and assess the situation at the hospital immediately. Several patients did not receive their routine medication, and I had to give it to them despite lateness.

I felt scared knowing how missing medication could worsen the condition of patients. Before I left the healthcare facility, I was confident knowing that I had arranged the night shift program for the providers on duty. The nurse who reported was confused and overwhelmed with duties during the situation. The scenario made the majority of the patients feel that care services were not properly given. During the phone call, I thought most sick individuals would be reactive due to poor services. Later I asked the nurses why they did not attend to the patients, and they said they were tired.

The occurrence made some of the patients change their medication to enable them to reverse the condition. The incident made me understand the value of motivation to staff workers and how it affects their performance (Markkanen et al., 2020). When I arrived, I found the active nurse had given the majority of patients their evening doses. As the nurse manager, I convinced and promised the providers to go slow and better working conditions to improve their participation.

Work burnout is a serious issue in the healthcare setting, and it is upon management to formulate effective ways to manage it. Without proper motivation, providers are more likely to become unresponsive (Dall’Ora et al., 2020). From the incident, I realized that it is important to cater to the well-being of nurses to keep them inspired. Nurse leaders should always be within the facility to intervene immediately in case of such situations.

If I had acted before to motivate the nurses either through a balanced work schedule or other benefits, the incident would not have occurred. It is now clear to me that I failed to act on my capacity to create proper working conditions to prevent work stress that limits providers’ participation. I have realized that as a leader, I must support and ensure nurses’ needs are met to enable them to remain active and ready to work.

Based on the incident, I will ensure to motivate and engage staff members by inquiring about the challenges they are facing that might hinder their service delivery. Such involvement will allow me to prevent the occurrence of such situation that risks the lives of patients. I will further establish a proper routine so professionals have adequate time to relax and refresh their minds to lower issues of burnout.

Dall’Ora, C., Ball, J., Reinius, M., & Griffiths, P. (2020). Burnout in nursing: A theoretical review . Human resources for health , 18 (1), 1-17. Web.

Markkanen, P., Välimäki, M., Anttila, M., & Kuuskorpi, M. (2020). A reflective cycle: Understanding challenging situations in a school setting . Educational Research , 62 (1), 46-62. Web.

Tawanwongsri, W., & Phenwan, T. (2019). Reflective and feedback performances on Thai medical students’ patient history-taking skills . BMC medical education , 19 (1), 1-8. Web.

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Baccalaureate Nursing Students’ Reflections on Professional Development Within the Nursing Leadership Role When Participating in Student-run Teams: A Qualitative Content Analysis of Student’s Reflection Notes

Marit hegg reime.

1 Department of Health and Caring Sciences, Western Norway University of Applied Sciences, Bergen, Norway

2 Lovisenberg Diaconal University College, Oslo, Norway

Bente Albrigtsen

Elisabeth grov beisland, associated data.

Supplemental material, sj-docx-1-son-10.1177_23779608221130604 for Baccalaureate Nursing Students’ Reflections on Professional Development Within the Nursing Leadership Role When Participating in Student-run Teams: A Qualitative Content Analysis of Student’s Reflection Notes by Marit Hegg Reime, Karin Bell, Bente Albrigtsen and Elisabeth Grov Beisland in SAGE Open Nursing

Introduction

Studies show that nursing education institutions do not sufficiently prepare newly graduated nurses for the challenges they face when it comes to the leadership role. The direct relationship between leadership and quality of care makes it imperative to explore what contributes to prepare undergraduate nursing students to be effective future leaders.

To explore how second-year nursing students experience development of nursing leadership competence when participating in student-run teams (SRTs).

We used a qualitative approach with a descriptive, exploratory design to examine 37 reflective notes with a scope of 1000 words each, written while undertaking leadership training in 14 medical and surgical wards. An inductive, qualitative content analysis inspired by Lindgren et al. was used to give meaning and content to the students’ experiences.

One overarching theme emerged when analyzing the reflective notes; nursing leadership skills are developed in a safe authentic clinical environment. This main theme evolved from an interpretation of three subthemes: (1) Discovery and recognition of the leadership role contributed to development of nursing identity, (2) Being challenged and given responsibility in the SRT contributed to development of nursing leadership skills, (3) The way nursing services are organized affects the quality of care and satisfaction in one’s own work situation.

SRTs can be a way of organizing clinical placement studies to strengthen nursing students’ competence in the nursing leadership role and may counteract the reality shock when transitioning from the student role to the professional role.

There is international concern about the quality of leadership in nursing practice ( Scammell et al., 2020 ), and the World Health Organization urges governments and stakeholders to strengthen nurse leadership to ensure that nurses have an influential role in health policy formulation and decision-making, and contribute to the effectiveness of the health and social care systems ( World Health Organization, 2020 ). The direct relationship between leadership and quality of care makes it imperative to understand preparation for leadership roles to support undergraduate nursing students to be effective future leaders ( Scammell et al., 2020 ). Kling (2010) states that nursing students lack management skills because of limited opportunities to practice different leadership skills, as they “follow” and “observe” instead of “lead” and “do.” In Norway, practical training accounts for 50% of the 3-year baccalaureate nursing program of 180 European Credit Transfer System points. The new national curriculum regulations regarding professional leadership, quality, and patient safety, are supposed to facilitate an education in line with the patients’ and services’ needs ( Ministry of Education and Research, 2019 ). In clinical practice studies, nursing students lay the foundation for their transition from education to professional practice ( Kårstein & Caspersen, 2014 ). It is therefore essential that students gain experience and develop competence in the nursing leadership role before entering professional practice. Benner et al. (2009) emphasize that the purpose of clinical studies is to learn by doing, observing, and participating in the practice community where key aspects of the work are exemplified, articulated, and made available.

Review of Literature on the Nursing Leadership Role

The concept of clinical nursing leadership has been explored with regard to registered practitioners, but minimal attention has been paid to nursing students ( Jack et al., 2022 ). A concept analysis of clinical leadership in nursing students highlighted interpersonal communication skills in contrast to task focused skills, which might be more readily linked with the development of management competence ( Jack et al., 2022 ). Leadership may be defined as influencing others to improve the quality of care ( Al-Dossary et al., 2016 ). The nursing leadership role consists of a number of different activities, such as observing, assessing, and documenting the patient's need for nursing, coordinating, prioritizing, and delegating tasks, and collaborating with colleagues and other health professionals ( Stubberud et al., 2017 ). However, studies show that newly qualified nurses experience a practice shock, and that the education does not prepare students adequately for the challenges they face in professional practice ( Alvsvåg & Førland, 2007 ; Higgins et al., 2010 ; Murray et al., 2019 ). Newly qualified nurses especially are overwhelmed by the great responsibility, many competence requirements, and high expectations from their employer ( Odland et al., 2014 ; Pedersen & Tingvoll, 2019 ; Sneltvedt et al., 2010 ). According to Curtis et al. (2011) , leadership is something that should permeate nursing practice, and should therefore begin early in the education. Likewise, Terum et al. (2005) claim that students are not given enough responsibility or training in working under pressure during education. Student-run teams (SRTs) is one way to organize clinical studies to ease the transition from the student role to the professional nursing role ( Pedersen et al., 2018 ). Our university has implemented SRTs in the 4th semester in medical and surgical hospital wards since year 2010. Each SRT consists of two to four students taking care of three to six patients, under guidance of one nurse supervisor. The students alternate between being in charge of the team and being out in the ward nursing patients. The students collaborate and give each other feedback. Similar projects have been carried out by others, but over a shorter period, later in the education program or in nursing homes ( Blekken et al., 2013 ; Pedersen et al., 2018 ; Tingvoll et al., 2018 ). Two publications describe implementation of SRT in hospitals, but in the last year of education ( Bakke-Erichsen & Øvrebø, 2004 ; Strand & Nondal, 2012 ). Learning outcomes in SRT relate to strengthened theoretical and practical competence, problem-solving and decision making competence, and work management-, interaction-, documentation-, and ethical-competence ( Western Norway University of Applied Science, 2019 ). In SRT students are supported by a nurse supervisor who is available for medication control and professional support.

There is a limited amount of research on the preparation of undergraduate nursing students for leadership roles ( Scammell et al., 2020 ). Learning how to be a leader is a personal embodiment of knowledge or transformation that requires situational awareness of knowledge, skills, and attitudes and time for the student to form this leadership being ( Melina et al., 2013 ; Pollard & Wild, 2014 ). Knowledge about how students can gain understanding of the complex contexts that exist in the field of practice through reflection on self-experienced situations is in demand (Epp, 2008). Reflective notes can give a deeper understanding of students lived experience about this topic. Therefore, the purpose of our study is to explore nursing students’ reflections on professional development within the nursing leadership role in SRT.

We used a qualitative approach with a descriptive, exploratory design ( Polit & Beck, 2017 ) to suit to the purpose of the study. This design is appropriate when the research goal is to understand and describe a phenomenon ( Polit & Beck, 2017 ), but also to understand the experiences of individuals or groups and the contexts in which these experiences are situated ( O’Brien et al., 2014 ). To gain a deeper understanding of students lived experience undertaking leadership training in SRT, students’ reflective notes on self-experienced situations were analyzed. The study has been carried out in accordance with standards for reporting qualitative research ( O’Brien et al., 2014 ).

Research Question

How does baccalaureate nursing students’ reflections on taking part in SRT give meaning and content to professional development within the nursing leadership role?

Sample and Setting

Participants were second year nursing students in their 4th semester recruited from clinical practice studies in 14 medical and surgical wards at a large university hospital located in the western part of Norway. The SRT period lasted for 3 weeks and took place at the end of a 10-week clinical practice period. The nurse supervisors were trained before welcoming the students. The training consisted of information meetings, written information, and group guidance along the way. During the first 7 weeks of clinical placement, nurse supervisors acted as role models to provide examples of nursing leadership skills in the delivery of nursing care. As the three weeks of SRTs started, the nurse supervisors were supposed to take a lesser role, offering trust in the students to step forward and experience being in charge of a group of three to six patients.

According to requirements in the curriculum the reflective notes had a scope of 1000 words and were a mandatory work asking for students’ own reflections on their experiences when undertaking leadership training in SRT.

Inclusion and Exclusion Criteria

Based on the three reflection levels described in Dahl and Alvsvåg (2013) , the “non-reflective,” the “reflected,” and the “critically reflected,” we chose to include reflective notes that met the levels of “reflected” and “critically reflected.” The teachers received both verbal and written information about the inclusion criteria, and an independent researcher carried out a second opinion to ensure reliability to the three reflection levels.

The “reflected” notes show attention in the situation, associate by relating previous knowledge, feelings, or attitudes to the new, integrate it into the old and seek connections between experience and knowledge. The “critically reflected” notes assess the content of new and old knowledge, consider biased assumptions, challenge truths, and gain a new perspective on the experience, which can result in changed action or the creation of new ideas.

Institutional Review Board Approval

The students received written information about the study and were invited to participate after their practical training period had been assessed as passed, so that they would not experience being in a reliant relationship with the teacher. The teachers who graded the reflective notes asked students who had notes that met the criteria for being “reflective” or “critically reflective” about participating in the study. Participation was voluntary, and those who wanted to participate sent a written consent form and a copy of their reflective note to one of the members of the research team, who anonymized them and gave each note a number. Participants were informed that they could withdraw from the study at any time, although no one did so. Since participation was voluntary and anonymous, demographic data are not available. The Norwegian Centre for Research Data approved the study (No. 574343).

Data Analysis

An inductive, qualitative content analysis inspired by Lindgren et al. (2020) was used. This method is characterized by a systematic analysis of the text to understand how the text gives meaning and content to a particular phenomenon. To gain an overview of the data, all the authors read the 37 reflective notes. We identified patterns that emerged from the students’ experiences on development of skills in nursing leadership when participating in SRT.

Text from the reflective notes which aligned with the aim of the study was highlighted and put into a spreadsheet. The manifest content refers to the direct statements of the participants, “Meaning units,” which were condensed into summary statements, “Condensation,” which were allocated to “Codes” according to different topics. On the next level, we delved deeper into what the text was about, the latent content, on a more abstract or interpretive level, and an overarching “Theme” and “Subthemes” were established. As transparency is important in qualitative research ( Malterud, 2017 ), an example of the analysis process for one subtheme is presented in Table 1 .

Table 1.

Example of Analysis of One Sub-theme.

Sample Characteristics

Out of 88 eligible students who had written “reflected” or “critically reflected” notes ( Dahl & Alvsvåg, 2013 ), 37 students (42%) agreed to participate and share their notes with the researchers.

Research Question Results

The qualitative content analysis resulted in one overarching theme and three sub-themes ( Table 2 ). Results are presented underpinned by the students’ direct statements (“meaning units”). For the full analyse see supplemental material (S1).

Table 2.

Theme and Sub-themes.

Nursing Leadership Skills are Developed in a Safe Authentic Clinical Environment

The main theme that emerged from the students’ reflections was that nursing leadership skills are developed in a safe authentic clinical environment. Their reflections mirrored findings in relation to both the content and scope of the nurse's leadership role. By being included in the SRT they were given access to concrete examples of nursing leadership tasks every day. It turned out that this insight and these tasks had so far not yet been clear. The fact that they were included in a team and were supervised by skilled professional nurses who gradually gave them more responsibility, contributed to a safe learning environment, and to the development of nursing leadership skills. The experiences they gained contributed to a better understanding and recognition of their future professional role.

Sub-theme 1. Discovery and Recognition of the Leadership Role Contributed to Development of Nursing Identity

Students were impressed by nurses’ complete control over work tasks during a work shift and were also amazed over how much more a nurse does than they earlier had imagined. In a way students were overwhelmed by the responsibility assigned to the nurse's role, and on how dependent patients are on nurses being competent in their job;

Every day I'm in practice, I see how much more a nurse does than many might imagine. Not least, I get to experience day by day how much responsibility a nurse has, and how dependent patients are on us doing a good and holistic job (S7).

The students were especially surprised by the huge amount of documentation as part of the nurse's role.

Patients must be reported to the municipality early, short-term rehabilitation must be applied for, and patients must be transferred to other wards. Notes should also be written when the patient enters the ward, when they are to be transferred, and when they are going home (S5).

Some tasks were demanding, and time often ran short, but the students got to know themselves and the administrative part of the professional job as a nurse;

One of the best things about SRT is that you kind of get an answer as to whether you are ready to stand on your own two feet. (S13).

They also discovered the importance of staying professionally up to date, to give patients evidence-based care, but also to show compassion and commitment when caring for the patient. Ethically difficult situations that a nurse must face on a daily basis were described;

Sometimes we can't do everything we want for our patients. I think this is important to acknowledge, but we must try not to take too much bad conscience home with us (S32).

The experiences the students gained in the SRT helped them expand their understanding of what is required when they graduate as nurses and gave them a taste of their future professional role. Several students described that security and mastery of nursing leadership skills contributed to the emergence of nursing identity;

I found it very valuable to get to know what it's like to be a real nurse by taking part in SRT, to experience what the leadership role of the nurse comprises. I really saw the progress I've made from first to second hospital practice, how much more independent I've become and confident in what I'm doing. (S2).

The students’ reflections show that they became more confident in their role as administrator and that they understood more of what it meant by participating in the SRT;

I feel that the student-run team has made me a better nurse and made me more confident in my actions (S13).

Subtheme 2. Being Challenged and Given Responsibility in the SRT Contributed to Development of Leadership Skills

The nurse supervisors played an important role to empower the students when taking responsibility for a group of patients and acted as safe role models guiding the students in the right direction.

I've decided to use SRT as training to experience responsibility while having ‘support wheels,’ so that ‘riding into it’ after graduation doesn't get as scary as it feels when I think about it now (S23).

The mechanisms behind evolvement of leadership skills are well described and reflected upon;

The last few weeks of the student-driven team have made me better equipped for the role as professional nurse, as I have really got to try my best at coordination, planning and administration. I have learned techniques to get a better overview and have been trained to be confident to speak in large gatherings. I did pretty well, and I feel mastery. I'm ready to take on new challenges (S3).

Another important issue was to be found worthy of the trust of the nurse supervisor allowing students to perform nursing tasks independently.

It was a good feeling when my nurse supervisor stuck his head in the door of the patients’ room and said, ‘Today my student is the boss, that's going to be fine!’ In this way, the patients were assured of having me in charge. I experienced both responsibility and security at the same time (S17).

Communication, collaboration, and delegation were both challenging and rewarding areas in the development of leadership skills. Students felt it challenging to lead the work of others, including the nurse supervisor.

I'm used to explaining why we do what we do, but it's an unfamiliar situation to have to tell the nurse who has taught you everything in the ward what to do (S32).

The students described the professional growth that took place through many of the challenges they faced in SRT. The feeling of being under time pressure could feel chaotic and difficult to handle in the time but felt good afterwards.

When I look back on the situation today, I feel that we solved the tasks in a good way. We did what was necessary to get the wheels going round (S5).

To get an overview and prioritize tasks, several students used to-do lists.

There were a million thoughts in my head at the same time, but I always made checklists for what to do (S2).

The students realized that they needed further practice on the leadership role, thereby manifesting a learning need.

However, it helps that I have now developed a better and more efficient system, I see that the most important thing comes with training and experience. This is what I know makes my practice better (S12).

Good teamwork between students in the team and between students and staff was highlighted as particularly valuable to get the wheels turning round. When they were not in control of everything, it was safe to have the nurse supervisor as a backup. The experiences they made revealed specific learning needs and led to professional growth.

I have learned the importance of good and precise communication between the students and the staff. We are one team, and everyone is responsible for ensuring that we work well together. I have also learned that there is no shame in asking for help when one has a lot to do. This will contribute to less stress and a more manageable everyday working life (S6).

When communication, coordination, and delegation were impaired, this caused challenges regarding time constraints.

The day we took over responsibility for the team, we all became very occupied with our own patients and periodically forgot to pass on the plan with our patients to the leader of the team. We also took on a little too much responsibility, and we forgot to delegate tasks to others to get the job done on our shift (S16).

The cooperation with the doctor and being well prepared for the doctor's visit was particularly important for the students, both because of the responsibility for representing the patient's voice and the responsibility for reporting significant data to help the doctor's decision making on patient treatment.

It is the doctor's point of view that determines the patient's plan, so it is quite important that I can tell them about the condition of the individual patient. It is not necessary to dread being in charge, but you must be well prepared. (S9).

Sub-theme 3. The Way Nursing Services are Organized Affects the Quality of Care and Satisfaction in One’s Own Work Situation

Several students were surprised by how much of the nurse's time was spent managing and coordinating. Students quickly learned the difference between being “out” in the ward and being “inside” administrating, and they discovered that the administrative work could come at the expense of direct patient contact. Doubt about being pulled between the leadership role and patient centered care was portrayed.

It is a bit sad that this means that there will be less time for patient contact. I sometimes think that I would like to tell the patient that ‘even though I might just be in your room for a few minutes, I want you to know that I really see you’ (S7).

The students discovered the importance of continuity in patient care to increase both the quality of care and their own job satisfaction. They experienced how much easier it was to relate to the same patients over their time in hospital.

I have learned that continuity is important for the working environment, and that everyday work becomes easier as one does not have to ‘start over’ every day. It is first now when taking part in the student-driven team that I have understood why it is frustrating for the nurses to have to change groups repeatedly over the course of a week (S4).

Continuity contributed to the students becoming better acquainted with the patients’ habits and how they would like to take care of themselves or to be taken care of, which is also an important issue when it comes to quality of care. Organizing the team to contribute to the continuity of care at the morning meeting was deemed worthwhile, also to make the students better prepared for the doctor's visit.

It is important that I am well prepared and know my patients, so that I can talk about the condition of the individual patient to the doctor. For the doctor, good feedback regarding the patients is essential, which the nurses can do to a greater extent if they know the patients better (S8).

Continuity of care also contributed to less stress among the students and greater satisfaction with one own's work situation.

I am calmer during the day when I have the same group of patients (S9).

When the students did not delegate, but tried to do everything themselves, it had consequences on their personal well-being. Wanting to do everything oneself is often a beginner's mistake, as one wants to show others that one manages, without considering that one spends more time on tasks as a beginner.

I ended up working far too many hours before I could have lunch, which in turn had a negative impact on my mood and energy level (S6).

Students highlighted the importance of quality of care and emphasized that patients and relatives should experience as good care from students as from registered nurses.

The patients and relatives we have taken care of during this period I think are left with a good impression of the care that has been provided by students (S14).

The students also experienced how quickly the situation can change.

Despite the fact that at the start of the shift I thought that it looked okay, I quickly learned how unforeseen things can happen or that something takes longer than expected, and thus the whole schedule is shifted. That`s important learning (S27).

Students discovered the importance of knowing the patients they were in charge of to ensure quality of care and patient safety. This continuity of responsibility was highlighted in several reflections.

It becomes easier to remember everything around the patient when continuity is possible, and it is easier not to make mistakes as changes are made to the treatment (S4).

The following example also underlines the importance of being experienced and familiar with the routines of the department to ensure patient safety.

The night shift nurse had prepared a dalteparin (Fragmin) syringe for a patient who had had surgery. This patient was waiting for a new operation, and according to the guidelines she wasn't supposed to have Fragmin. The nurse supervisor knew this and took away the syringe. What would have happened if she had not? In recent weeks, I've really understood why newly qualified nurses can feel overwhelmed (S9).

Making mistakes when delivering medications provided deep learning;

For me, giving the wrong medicine (Paracetamol) has burned into my memory, and I will always avoid making this mistake again. I also felt that the other patients in the room became skeptical of the medication they were given by me during the medication round. The nurse and I discussed how this could happen as long as two nurses had controlled the medication ahead of the round (S10).

The main theme that evolved when we interpreted the students’ reflections was that nursing leadership skills are developed in a safe authentic clinical environment. Students participated in both patient-centered care and leadership activities, described as being either “out” in the ward or “inside” administrating. Orvik (2002) emphasizes the importance of this dual competence in nursing, the clinical competence, and the leadership competence. He claims that newly qualified nurses lack leadership competence, especially in the areas of coordination and work management. This is in line with findings from studies of newly qualified nurses which show that they experience a practice shock, and that the education does not sufficiently prepare the students for the challenges they are faced with in professional practice ( Alvsvåg & Førland, 2007 ; Murray et al., 2019 ; Norvoll, 2002 ).

Kling (2010) states that nursing students lack leadership skills because of limited opportunities to practice these skills, as students “follow” and “observe” instead of “lead” or “do.” Students’ learning thus depends on what role they have in the community of practice. This can be seen in the light of the situated learning theory of Lave and Wenger (1991) , where the student moves from the periphery of the community to the center of the community as they gain expertise, and engages and participates actively in the sociocultural practices of the community. In SRTs, students are given a role corresponding to a full-fledged nurse, and the reflections show that they want to appear as nurses and that patients should experience that they receive the same care and treatment by students. However, students highlight the need for more training in the nursing leadership role, which is in line with Terum et al. (2005) , who have emphasized that students are not given enough responsibility or training in working under pressure during training. Scammell et al. (2020) states that it is imperative for nurse educators to facilitate preparation for the leadership role to support undergraduate nursing students to be effective future leaders. In a longitudinal study by Solli (2008) , newly qualified nurses did not acquire sufficient competence in the leadership role until after almost 3 years, but employers expected this competence already from the start. However, employers have a responsibility to ensure that employees receive the practical training necessary to carry out the work in a safe manner ( Arbeidstilsynet, 2006 ).

Furthermore, to systematically discuss all our results, we will use the three subthemes as structure.

Discovery and Recognition of the Leadership Role Contributed to Development of Nursing Identity

The fact that the students were welcomed into a well-prepared authentic team and gradually given more responsibility while being supervised by an experienced nurse that facilitated reflection, was of great importance and contributed to an ideal learning environment. In the team they were given access to real examples of nursing leadership tasks every day. It turned out that some of these tasks had so far not yet been fully understood by the students, and they were surprised and impressed by what their supervisors handled. These discoveries made them proud, and recognition of their professional role started to evolve. The registered nurses facilitated reflection both before and after the learning situations, as it is well known that learning outcomes are best achieved when students have personal experiences of the situation where thoughts, actions, and emotions are involved ( Dewey, 1938 ).

Reflection after action must contain three elements; to review the experience, treat the emotions associated with the experience and re-evaluate the experience ( Boud et al., 2013 ). Several of the students’ reflections stated that the experiences they made in the SRT helped to expand their understanding of what is required when they graduate as nurses and gave them valuable insight and experience for their future professional role. This re-evaluation of the experience led to a new recognition of the route to mastery. Writing a reflective note can thus be a tool for processing and systematizing the experiences one makes at work ( Stiklestad, 2020 ), and the reflections one makes when one has a distance to the situation can contribute to personal and professional insight ( Schön, 1987 ).

Being Challenged and Given Responsibility in the SRT Contributed to Development of Nursing Leadership Skills

The students were included in authentic team collaboration with peers and clinical supervisors. This safe authentic learning environment empowered them to take on more responsibility for groups of patients. This is in line with research that shows being together makes it safer to learn ( Barrington & Street, 2009 ; Tveiten, 2013 ), and that learning in authentic situations is ideal ( Raaheim, 2016 ). Students used SRT as a form of responsibility training while still having what they called “support wheels.” This view can be understood in light of Vygotsky's proximal developmental zone, which is the distance between what a student can do on their own, and what they can do with the support of someone more knowledgeable ( Vygotsky & Cole, 1978 ). This kind of learning environment makes it safe to take on more responsibility in the team.

To provide optimal learning outcomes for the students, the nurses were given guidance in relation to the more hands-off role they had to play to give students the opportunity to become more independent. Great emphasis was placed on creating a safe learning environment so that students would have confidence to talk about their learning needs, or about lack of knowledge and skills. By giving continuous feedback, the nurse supervisors contributed to a learning process in line with formative assessment ( Lauvås, 2016 ). Further, learning how to be a leader is a personal embodiment of knowledge, skills and attitudes and it requires time for the student to form this leadership role ( Melina et al., 2013 ; Pollard & Wild, 2014 ).

Communication, collaboration, prioritization, and delegation were experienced as both challenging and rewarding for the students. Rewarding in the sense that the students felt responsible for patients in their care, in addition to feeling a sense of mastery of the leadership role. Challenging when they felt they lacked control over the situation. According to Curtis et al. (2011) , leadership is something that should permeate nursing practice and should therefore begin early in the bachelor program. Nursing students do not fully understand the great responsibility nurses have and they worry about not mastering this responsibility ( Rognstad, 2006 ). A Swedish study of newly qualified nurses also emphasizes the need for expanded competence in the areas of planning and prioritization of nursing ( Lofmark et al., 2006 ). Other studies show that newly qualified nurses are overwhelmed by the great responsibility, many competence requirements, and high expectations from the employer ( Odland et al., 2014 ; Pedersen & Tingvoll, 2019 ; Sneltvedt et al., 2010 ). In the SRT our students experienced having the responsibility for a larger group of patients and thus being better prepared for this role when they graduate. This is in line with Strand and Nondal (2012) , who found that SRTs contributed to the development of independence.

The Way Nursing Services are Organized Affects the Quality of Care and Satisfaction in One's Own Work Situation

The students’ reflections showed that they very soon learned that organizational aspects such as continuity of nursing care and of nursing leadership affect both the quality of care and satisfaction in their own work situation. The importance of having talked to the patients before the doctor’s visit was emphasized as necessary to get to know the patient and achieve a good overview of the patient's situation. Talking to patients gives the patient a face and one often gather much more information than just reading about the patient in the medical record, besides that you get first-hand knowledge of the patient. According to Higgs et al. (2004) , clinical practice experience is a cornerstone of the nursing profession and is developed through reflective processes where practitioners learn from experience. By integrating research-based knowledge, nurses clinical experience and the patient's knowledge and needs, the quality of the services is improved ( Nortvedt et al., 2021 ). The example with the dalteparin (Fragmin) syringe shows the importance of nurses’ clinical experience for the quality of the services. For healthcare professionals who administer medication, competence, and vigilance are key factors. The student who experienced administering Paracetamol to a patient to whom it was not prescribed, describes this situation as an experience that had “burned into the student's memory.” Fischer et al. (2006) claim that one learns most from the mistakes one makes oneself and relates this to the emotional impact such situations have. According to Merleau-Ponty (2012) , the body is primarily experiential, and he does not distinguish between consciousness and body, but that consciousness is both in the body and in the world.

According to Benner's five-step model for competence development, nursing students are educated at the novice level, and when completing their education they are at the advanced beginner level ( Murray et al., 2019 ). What characterizes practitioners at these levels is that they act in a regulated manner, are task-oriented, and have difficulty sorting out what is most important to prioritize. Similarly, Duchscher ( Murray et al., 2019 ) has developed a transition theory and a transition shock model which describes how newly qualified nurses develop their competence during the first 12 months after graduation. For the first 3 months the nurses have idealistic expectations without roots in reality. After 3 months, they gain greater confidence in their own competence, and after 8 months the focus has shifted from themselves to the system they are part of and what it means to be a nurse. Our findings indicate that development of nursing identity is acquired when students receive guidance in safe authentic clinical situations in practice. This is also supported by the study of Walker et al. (2014) , who identified five key elements for the development of nursing identity: good role models, experience of belonging, support from colleagues, confidence in one's own competence, and opportunities for critical thinking and problem solving.

Strengths and Limitations

Using the criteria from Dahl and Alvsvåg (2013) for inclusion of reflective notes provided us with a rich data source with a high reflection level. A strength in the analysis process is that four researchers read all the reflective notes and contributed to the data analysis looking for meaning units representative for the sample to draw out codes and themes. A high degree of consensus emerged between the researchers during the data analysis. This process has contributed to increasing the study's credibility and quality ( Malterud, 2017 ). Potential bias should be acknowledged as all researchers have a nurse education background, with a prior understanding of the context. A limitation is that the study was conducted in one educational institution only. However, we have reflective notes from 14 different hospital wards, which gives breadth to the data. Nevertheless, our findings are relevant in national and international nursing education programs that apply the preceptorship model for clinical placement, or similar models.

Implications for Practice

Nursing education is organized with learning activities that take place both in the educational institutions and in the clinical field. According to Smeby and Heggen (2014) , coherence is about how the education program contributes to creating integration and connection between teaching and practical training. This entails special requirements for creating a connection (coherence) between the theoretical understanding of the nurse's role and the practice situations to which the student has access. If nurse education is to meet the requirements to educate candidates who take care of the patients’ and services’ needs ( Amundsen et al., 2021 ; Ministry of Education and Research, 2019 ), the leadership role should be given more focus. SRT provide nursing students with a learning environment consisting of authenticity, responsibility, and collaboration as essential factors. In this way, the introduction of a SRT in all 3 years of the bachelor's education may help reduce the practice shock that many newly qualified nurses experience in the transition from the student role to the professional nurse role.

SRTs can be one way of organizing clinical placement studies to strengthen bachelor nursing students’ insight and competence in the nursing leadership role and may counteract the reality shock when transitioning from the student role to the professional nursing role. Students’ active participation in the community of practice lead to development of nursing identity where key aspects of the leadership role were exemplified and made available. Students discovered the importance of continuity in both patient care and nursing leadership to improve quality of care and satisfaction with one own's work situation. SRTs made the students better equipped to master having responsibility for groups of patients in the transition to professional practice.

Supplemental Material

We would like to thank the students who participated in the study, and the assistant professors Mari Fløde and Tone Engen, both Western Norway University of Applied Sciences for their contribution to the initial data analysis.

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding: The authors received no financial support for the research, authorship, and/or publication of this article.

ORCID iD: Marit Hegg Reime https://orcid.org/0000-0002-0472-0991

Supplemental Material: Supplemental material for this article is available online.

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How to Write a Nursing Reflective Essay as a BSN Nursing Student

• Author Jermaine Huey
• Published November 29, 2023

Welcome to NursingWriters.net, your go-to resource for expert information and guidance on writing nursing essays. In this article, we will provide you, as a BSN nursing student , with a comprehensive guide on how to write a compelling nursing reflective essay. Reflective essays are a personal reflection on your experiences in the nursing profession, and we are here to help you navigate this writing challenge.

As a busy nursing student, we understand that you may have limited time to spare. That’s where NursingWriters.net comes in, empowering you to excel in your BSN program by providing expert guidance on different writing and comprehension challenges you may face. Let’s dive into the world of nursing reflective essays and discover how you can effectively express your thoughts and insights.

Key Takeaways:

• Reflective essays allow nursing students to reflect on their experiences and personal growth in the profession.
• A nursing reflective essay is different from a personal statement, focusing on self-reflection rather than academic achievements.
• Key elements to include in a nursing reflective essay are the inciting incident, personal reflections, vivid details, and actions taken.
• The introduction should grab the reader’s attention and provide a clear thesis statement.
• The body paragraphs should delve into the writer’s reflections and emotions with specific examples and anecdotes.

What Is a Reflective Essay in Nursing?

A reflective essay in nursing is a powerful tool that allows nursing students to analyze their experiences, emotions, and actions related to their nursing practice. It provides an opportunity for self-reflection, critical thinking, and personal growth. Reflective writing can help nurses develop a deeper understanding of their own practice, improve patient care, and enhance their professional development.

Reflective essays in nursing differ from personal statements in that they focus on specific experiences and their impact on the writer’s growth and development. These essays require the writer to critically reflect on their actions, emotions, and thoughts, and identify ways to improve their practice. By examining their experiences and applying reflective frameworks, nursing students can gain valuable insights into their strengths, weaknesses, and areas for growth.

When writing a reflective essay in nursing , it is important to follow a structured approach. This includes describing the incident or experience, analyzing personal thoughts and feelings, exploring the actions taken, and reflecting on the outcomes and implications. By structuring the essay effectively, nursing students can communicate their reflections in a clear and organized manner.

Key Elements to Include in a Nursing Reflective Essay

When writing a nursing reflective essay, it is important to include key elements that will make your essay comprehensive and impactful. These elements will help you convey your thoughts and experiences clearly, allowing the reader to gain a deeper understanding of your reflections on nursing practice.

Inciting Incident or Event

The first key element to include in your nursing reflective essay is the inciting incident or event. This is the moment or experience that triggered your reflection and made a significant impact on your practice. It could be a challenging patient encounter, an ethical dilemma, or a personal realization. By describing this event in detail, you set the stage for your reflective journey.

Personal Reflections

Your nursing reflective essay should also include personal reflections on the experience. This is where you delve into your thoughts, feelings, and emotions related to the inciting incident. Reflect on how the event made you feel, what you learned from it, and how it has influenced your growth as a nursing professional. Be honest and vulnerable in your reflections, as this will allow the reader to connect with your experience on a deeper level.

Vivid Setting and Descriptive Details

To create a vivid and engaging narrative, include specific details that paint a picture of the setting and the people involved. Describe the physical environment, the interactions between healthcare professionals and patients, and any other relevant details that contribute to the overall context of the experience. This will help the reader visualize the situation and understand the complexities of the event.

Actions Taken

Finally, it is important to describe the actions you took in response to the inciting incident. Discuss how you applied your nursing knowledge and skills to address the challenges or opportunities presented by the event. Reflect on the effectiveness of your actions and whether there were any areas for improvement. This demonstrates your ability to critically analyze your own practice and make informed decisions.

By including these key elements in your nursing reflective essay, you can create a comprehensive and impactful piece of writing that showcases your growth and development as a nursing professional.

How to Write the Introduction of a Nursing Reflective Essay

The introduction of a nursing reflective essay plays a crucial role in capturing the reader’s attention and setting the tone for the entire essay. It should provide a concise overview of the main points that will be discussed and create a sense of curiosity and engagement. Here are some tips to help you write an effective introduction for your nursing reflective essay:

• Start with an intriguing opening line: Begin your introduction with a captivating statement or anecdote that relates to the topic of your essay. This will grab the reader’s attention and make them eager to continue reading.
• Provide context and background information: Give a brief overview of the event or experience that you will be reflecting on in your essay. This will help the reader understand the context and significance of your reflections.
• Present a clear thesis statement: Your thesis statement should clearly state the main purpose of your essay and the specific points or themes that you will be exploring. This will give the reader a preview of what to expect in the body of the essay.

By following these tips, you can craft an introduction that captivates the reader and sets the stage for a compelling nursing reflective essay.

“As I walked into the busy hospital ward on my first day of clinical rotation, I couldn’t help but feel a mix of excitement and nervousness. Little did I know that this experience would become a pivotal moment in my nursing journey, shaping my understanding of empathy, communication, and patient-centered care. In this reflective essay, I will delve into the details of this encounter and explore the personal and professional growth that resulted from it.”

With an attention-grabbing opening, providing context, and presenting a clear thesis statement, your introduction will set the stage for a compelling nursing reflective essay that captures the reader’s attention and lays the foundation for your reflections.

Nursing Reflection Essay Tips and Examples

Writing a nursing reflective essay requires careful consideration and thoughtful analysis. Here are some tips to help you craft an impactful and meaningful reflection essay as a BSN nursing student . Additionally, we will provide examples to illustrate how these tips can be applied.

Tips for Writing a Nursing Reflection Essay:

• Start by choosing a specific experience or event that had a significant impact on your nursing practice. This could be a challenging patient encounter, a critical incident, or a personal realization that transformed your perspective.
• Reflect on the experience and consider how it affected your emotions, thoughts, and actions. What did you learn from the experience? How has it shaped your growth as a nursing professional?
• Focus on the key aspects of the experience that were particularly impactful or meaningful to you. Avoid including unnecessary details or deviating from the main message of your reflection.
• Use specific examples, anecdotes, or patient scenarios to support your reflections. This will make your essay more engaging and relatable to the reader.
• Consider the ethical implications of the experience and reflect on how it has influenced your approach to patient care and decision-making.
• End your essay with a reflection on the implications of your learning for future nursing practice. How will you apply the lessons learned to provide better care and improve patient outcomes?

Now, let’s take a look at two examples of nursing reflective essays to further illustrate these tips:

“During my clinical rotation in the Intensive Care Unit (ICU), I encountered a complex patient case that challenged my critical thinking skills and decision-making abilities. The patient was a middle-aged woman who had undergone a complicated surgery and experienced numerous post-operative complications. This experience taught me the importance of collaboration within the healthcare team and the significance of advocating for the patient’s best interests…”

“One of the most significant experiences during my nursing education was my time spent in the pediatric oncology unit. Witnessing the resilience and bravery of children facing life-threatening illnesses had a profound impact on my perspective as a nurse. It taught me the importance of providing holistic care, not only addressing physical needs but also supporting emotional well-being and promoting a positive environment for healing…”

These examples demonstrate how personal reflections, specific details, and professional insights can be incorporated to create a compelling nursing reflective essay. Remember to structure your essay in a clear and organized manner, ensuring that your reflections flow logically and coherently.

By following these tips and utilizing examples, you can create a compelling nursing reflective essay that showcases your growth and development as a nursing professional.

How to Conclude a Nursing Reflective Essay

The conclusion of a nursing reflective essay serves as the final reflection on the writer’s growth and learning from the experience. It is an essential part of the essay that summarizes the main points discussed and leaves a lasting impression on the reader. The reflective essay conclusion should bring closure to the essay by restating the thesis statement and highlighting the key takeaways from the essay.

To write a strong and impactful conclusion, start by restating the thesis statement in a clear and concise manner. This reminds the reader of the main focus of the essay and reinforces its significance. Next, summarize the key points discussed in the body paragraphs, highlighting the most important insights and reflections. This helps to reinforce the main ideas and ensures that they are not overlooked in the final reflection.

In addition to summarizing the main points, a thought-provoking statement or future outlook can be included to provide a sense of closure and leave the reader with something to ponder. This can be a reflection on how the experience has influenced the writer’s future practice or a call to action for continued personal and professional growth. By ending the essay on a strong and meaningful note, the conclusion enhances the overall impact of the nursing reflective essay.

A well-crafted conclusion is essential for a nursing reflective essay as it reinforces the main ideas, leaves a lasting impression on the reader, and provides a sense of closure. By following these tips, nursing students can create a powerful and impactful conclusion that enhances the overall effectiveness of their reflective essays.

Tips for Writing a Nursing Reflective Essay

Writing a nursing reflective essay can be a challenging task, but with the right approach, it can also be a rewarding experience. Here are some helpful tips and strategies to guide nursing students in their essay writing process:

• Start early: Give yourself plenty of time to brainstorm ideas, reflect on your experiences, and write and revise your essay. Starting early will help you avoid last-minute stress and allow for a more thoughtful and polished essay.
• Conduct thorough self-reflection: Before you begin writing, take the time to reflect on your experiences and emotions related to your nursing practice. Consider how these experiences have shaped your growth and development as a nurse, and what lessons you have learned along the way.
• Organize your thoughts and ideas: Create an outline or a rough structure for your essay to ensure a logical flow of ideas. Group similar thoughts and reflections together to create cohesive paragraphs, and use headings or subheadings to further organize your essay.
• Seek feedback: Share your essay with trusted peers or instructors and ask for their feedback. They can offer valuable insights, provide constructive criticism, and help you refine your essay to make it stronger and more impactful.

Additionally, it is important to pay attention to the technical aspects of your essay:

• Grammar and spelling: Proofread your essay carefully to ensure it is free of any grammatical or spelling errors. Use grammar and spell-check tools, and consider asking someone else to review your essay for a fresh perspective.
• Coherent writing style: Use clear and concise language to convey your thoughts and reflections. Avoid excessive jargon or technical terms, and focus on communicating your ideas effectively.
• Formatting guidelines: Follow any formatting guidelines provided by your instructor or institution. Pay attention to font style, size, spacing, and citation style if required.

By following these tips and strategies, nursing students can approach their reflective essay writing with confidence and produce compelling and insightful essays that showcase their growth and development in the nursing profession.

Reflective Tools and Models for Nursing Reflective Essays

Reflective tools and models can provide structure and guidance for nursing students when writing reflective essays. These tools help organize thoughts and experiences, allowing for a more comprehensive and meaningful reflection. By utilizing reflection models , nursing students can enhance their reflective writing skills and deepen their understanding of their own growth and development as healthcare professionals.

Gibbs’ Reflective Model

“Reflective practice is both an art and a science that requires ongoing commitment and practice.” – Gibbs

Gibbs’ Reflective Model is a widely used reflection framework in nursing. It consists of six stages: description, feelings, evaluation, analysis, conclusion, and action plan. This model encourages a structured approach to reflection, allowing the writer to systematically explore their thoughts and emotions, analyze the situation, and identify areas for improvement or further development.

Dewey’s Reflective Thinking Model

“We do not learn from experience, we learn from reflecting on experience.” – Dewey

Dewey’s Reflective Thinking Model focuses on the importance of reflection as a tool for learning and growth. It emphasizes the need to actively engage with experiences, thoughts, and emotions, and to critically evaluate them in order to gain deeper insights and understanding. This model encourages nursing students to think analytically and develop a continuous learning mindset.

Kolb Reflective Model

“Knowledge results from the combination of grasping experience and transforming it.” – Kolb

The Kolb Reflective Model is based on the concept of experiential learning. It consists of four stages: concrete experience, reflective observation, abstract conceptualization, and active experimentation. This model encourages nursing students to engage in a cyclical process of learning, where they actively participate in experiences, reflect on them, conceptualize their insights, and apply their learning in real-life situations.

Schön Reflective Model

“Reflection-in-action is the heart of the learning process.” – Schön

Schön Reflective Model emphasizes the importance of reflection in the midst of action. It focuses on the ability to think and adapt in real-time, making decisions based on professional knowledge and experiences. This model encourages nursing students to develop a reflective mindset that allows them to learn and grow while actively engaging in their practice.

Benefits of Reflective Writing in Nursing

Reflective writing plays a crucial role in nursing practice, offering numerous benefits for nursing students and professionals alike. By engaging in reflective writing, nurses can enhance their self-awareness, develop their critical thinking skills, and gain a deeper understanding of patient experiences. This section will explore the advantages of reflective writing in nursing and its significance in healthcare.

Enhanced Self-Awareness

Reflective writing fosters self-reflection, allowing nurses to examine their thoughts, emotions, and actions in various clinical situations. Through this process, they gain a deeper understanding of their strengths, weaknesses, and areas for improvement. This heightened self-awareness enables nurses to provide more effective and compassionate patient care, fostering a patient-centered approach.

Improved Critical Thinking

Reflective writing encourages nurses to think critically about their experiences and the impact of their actions. It requires them to analyze and evaluate the effectiveness of their decision-making and problem-solving skills. By reflecting on past experiences, nurses can identify areas where they can enhance their clinical practice and make informed decisions based on evidence and best practices.

Increased Empathy and Understanding

Through reflective writing, nurses develop a deeper empathy and understanding of patient experiences. By reflecting on their interactions with patients, nurses can recognize the emotions, fears, and challenges faced by individuals in their care. This increased empathy enables nurses to provide more holistic and patient-centered care, improving the overall healthcare experience for patients.

Continuous Professional Development

Reflective writing is an essential tool for nurses’ continuous professional development. It allows them to document their growth, learning, and achievements throughout their nursing career. By regularly engaging in reflective writing, nurses can identify areas for further development, set goals for improvement, and ensure they are providing the best possible care to their patients.

Overall, reflective writing in nursing is a powerful tool that empowers nurses to enhance their self-awareness, critical thinking skills, and empathy. By engaging in this practice, nurses can continuously improve their clinical practice, provide high-quality patient care, and contribute to the ongoing development of the nursing profession.

Nursing Reflective Essay Examples

Looking for inspiration for your nursing reflective essay? Here are some examples that showcase different experiences, reflections, and growth in the nursing profession.

These examples demonstrate how nursing reflective essays can provide valuable insights into personal experiences, reflections, and professional growth. They serve as excellent references to help nursing students develop their own reflective writing skills and gain a deeper understanding of the nursing profession.

Writing a Nursing Reflective Essay for Nursing School Application

A nursing reflective essay can be a powerful tool for nursing school applications. It allows applicants to showcase their self-awareness, critical thinking skills, and passion for the nursing profession. When writing a nursing reflective essay for a nursing school application, there are a few key tips to keep in mind.

Reflect on your passion for nursing

Start by reflecting on what drew you to the nursing profession and why you are passionate about it. Consider your personal experiences, such as volunteering or shadowing healthcare professionals, and how they have shaped your desire to become a nurse. Highlight your commitment to providing compassionate and quality patient care.

Share personal experiences in healthcare settings

Provide specific examples of your experiences in healthcare settings, such as clinical rotations or internships. Reflect on the challenges you faced, the lessons you learned, and how those experiences have impacted your growth and development as a future nurse. Discuss any significant interactions with patients, healthcare teams, or mentors that have shaped your understanding of the nursing profession.

Align with the nursing school’s values and mission

Research the nursing school’s values, mission, and educational philosophy. Ensure that your reflective essay aligns with these principles and demonstrates your commitment to the school’s mission. Use the nursing school’s prompts or essay questions as a guide to structure your essay and address the specific criteria they are looking for in applicants.

By following these tips, you can write a compelling nursing reflective essay that effectively conveys your passion for nursing, showcases your experiences, and aligns with the nursing school’s values. Remember to proofread your essay carefully for grammar and spelling errors and seek feedback from mentors or trusted individuals in the nursing profession to ensure your essay is clear, concise, and impactful.

(Table) Tips for Writing a Nursing Reflective Essay for Nursing School Application

Writing a nursing reflective essay can be a transformative experience for BSN nursing students. It allows them to gain valuable insight into their own growth and development as future healthcare professionals. Throughout this comprehensive guide, we have provided expert information and guidance on how to write a compelling nursing reflective essay.

By understanding the purpose of a reflective essay and the key elements to include, nursing students can effectively showcase their personal experiences and reflections. Incorporating reflection models such as Gibbs’ Reflective Model or Kolb Reflective Model can also provide structure and depth to their essays.

At NursingWriters.net, we are dedicated to empowering busy nurses and providing them with the tools they need to excel in their BSN programs. Whether it’s writing a reflective essay or any other writing challenge, we are here to support and guide nursing students towards success.

What is a nursing reflective essay?

A nursing reflective essay is a personal essay where the writer reflects on their own experiences and how those experiences have shaped their growth and development in the nursing profession.

How is a reflective essay in nursing different from a personal statement?

While a reflective essay in nursing focuses on the writer’s personal experiences and reflections, a personal statement is more of a formal document that highlights the writer’s qualifications, achievements, and future goals in the nursing profession.

What are the key elements to include in a nursing reflective essay?

The key elements to include in a nursing reflective essay are the inciting incident or event, personal reflections on the experience, specific details to create a vivid setting, and a description of the actions taken by the writer. It is important to avoid including academic details and excessive focus on emotions.

How should I write the introduction of a nursing reflective essay?

To write an engaging and informative introduction for a nursing reflective essay, you can grab the reader’s attention with an intriguing opening line, provide context and background information, and present a clear thesis statement. Focus on the specific event or experience that will be the main focus of the essay.

How should I structure the body paragraphs of a nursing reflective essay?

The body paragraphs of a nursing reflective essay should have a clear structure. Use the first paragraph to present the thesis statement and provide background information on the event. Use subsequent paragraphs to explore your reflections, emotions, and actions taken. Use specific examples and anecdotes to make the essay more engaging.

How should I conclude a nursing reflective essay?

To write a strong conclusion for a nursing reflective essay, you can summarize the main points discussed in the essay, provide a final reflection on your growth and learning from the experience, restate the thesis statement, and leave the reader with a thought-provoking statement or future outlook.

What are some tips for writing a nursing reflective essay?

Some tips for writing a nursing reflective essay include starting early, conducting thorough self-reflection, organizing your thoughts and ideas, and seeking feedback from peers or instructors. Pay attention to proper grammar and spelling, coherent writing style, and adhere to any formatting guidelines provided.

How can reflective tools and models help with nursing reflective essays?

Reflective tools and models provide structure and guidance for nursing students when writing reflective essays. Models such as Gibbs’ Reflective Model, Dewey’s Reflective Thinking Model, Kolb Reflective Model, and Schön Reflective Model can be used as frameworks for organizing thoughts and experiences in a nursing reflective essay.

What are the benefits of reflective writing in nursing?

Reflective writing in nursing offers benefits such as enhanced self-awareness, improved critical thinking skills, increased empathy and understanding of patient experiences, and continuous professional development. It promotes lifelong learning and helps improve patient care.

Where can I find nursing reflective essay examples?

You can find nursing reflective essay examples that showcase different experiences, reflections, and growth. These examples incorporate personal reflections, specific details, and professional insights into nursing practice. They demonstrate the diversity of topics and experiences that can be explored in nursing reflective essays.

How can I write a nursing reflective essay for nursing school applications?

To write a nursing reflective essay for nursing school applications, reflect on your passion for nursing, personal experiences in healthcare settings, and future goals in the nursing profession. Address specific prompts and align the content with the nursing school’s values and mission.

How can writing a nursing reflective essay benefit BSN nursing students?

Writing a nursing reflective essay allows BSN nursing students to gain insight into their own growth and development as future healthcare professionals. It helps improve critical thinking skills, self-awareness, and understanding of patient experiences. It also promotes continuous professional development.

Jermaine Huey

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Theoretical Frameworks of Leadership in Nursing: Critical Reflections

Affiliation.

• 1 Associate Professor, Oncology and Palliative Care, Cyprus University of Technology, Limassol, Cyprus; Adjunct Professor, University of Turku, Turku, Finland. Electronic address: [email protected].
• PMID: 36414521
• DOI: 10.1016/j.soncn.2022.151362

Objectives: The objective of this article is to present a comprehensive view on the topic of nursing leadership discussing the theoretical frameworks that underpin its manifestation, the leadership styles in nursing, the overall landscape in nursing leadership including the context where leadership is being practiced, and finally looking at the educational pathways for building leadership capacity and sustainability DATA SOURCES: Relevant studies on the topic as well professional associations, national and international organizations' evidence have formed the basis for this article.

Conclusion: The role of the nurse leaders is complex and demanding within the context of health care. Its value has been increasingly drawing the attention of national and international organizations. The nurse leader is performing tasks within rapidly shifting environments that require constant changes to best address the organizational goals but remain true to the values and perspectives envisioned by the nursing profession. Through the implementation of corresponding competency frameworks, the capacity and preparedness of nurse leaders can be cultivated ideally in a multidisciplinary context.

Implications for nursing practice: Nurse leaders are increasingly assuming positions of authority across the structures of health care organizations. There is need to timely and appropriately increase the preparedness of nurse leaders to assume and sustain these challenging and dynamic roles.

Keywords: Archetypes; Competency; Frameworks; Leadership; Transformational leadership.

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Nursing Leadership Reflection Paper

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Introduction

In redesigning U.S. health care, the Institute of Medicine (IOM) puts a specific emphasis on nursing leadership. Nurses who possess highly developed competencies can provide creative change at all levels of the healthcare system. To supply quality patient care by implementing necessary change strategies, nurses should have the capacity to collaborate in every place in the system. These collaboration skills together with the demand to coordinate, integrate, and facilitate the team performance comprise the essence of a full partnership. The latter lies at the core of the successful professional performance of advanced practice nurses (APNs) (O’Grady, 2011).

On a similar note, the need to change, reform, and restructure health care is vital in many countries in today’s dynamic world. For instance, McKenzie and Manley (2011) argue that health proposals and directives in England, Scotland, Wales, and Northern Ireland aim at transforming the National Health System. The authors claim that nurse leaders should meet the challenge with excellent decision-making, problem-solving, critical thinking, vision, and passion (McKenzie & Manley, 2011, p. 35).

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Nursing Leadership Reflection Example

The leader I want to describe works as a charge nurse in the surgical department. She demonstrated a high level of performance in the clinical leadership domain, which implies collaborating with patients and staff. I selected this nurse as a role model for my refinement because she diligently implemented the principles of patient-centeredness (O’Grady, 2011) and person-centeredness (McKenzie & Manley, 2011) while working with patients, colleagues, and families. She was able to listen, interpret, confirm understanding, and evaluate the interaction.

The second strength of this nursing leader was her capacity to act in a team of professionals at all levels and disciplines (Hamric, Hanson, Tracy, & O’Grady, 2014, p. 269). In the process of collaboration, she managed to pose herself as an equal member, whose word was worth listening to and whose opinion was respected since it was informed and responsible. Acting as a full partner in communication with physicians, nurses, and other healthcare workers, she demonstrated the ability to integrate and coordinate common efforts to achieve the best outcomes for the patient care system. In other words, she performed equally well in the interaction with senior-level professionals and nurse followers.

As a truly ethical and efficient leader, this nurse was capable of supporting, empowering, and inspiring subordinates (Hamric et al., 2014, p. 269). She never forgot to emphasize the younger nurses’ successful performance and notice the slightest improvement in everyone’s competency. One can consider such an approach wise and effective in shaping the followers’ working behavior. Moreover, a positive attitude promotes a productive environment for young nurses’ development and enables them to overcome stress and fatigue from multiple tasks at the workplace.

Additionally, by treating the subordinates in a supporting and nurturing style, the nurse provoked a reciprocal beneficial attitude and willingness to share problems and worries. On a related note, Linette and Sherman (2014) emphasize caring-based nursing leadership that is the fundamental factor in restructuring a system of health care in America. Except for the beneficial impact of nurturing style on the professional growth of nurses, the authors highlight the need for a caring attitude and enhancing individuals’ needs concerning patients. They assert that recently the focus has been put on the wholeness of people, their unique role in society, and the appreciation of each person. Overall, nursing as caring theory assumes that its application to the leadership practice can enhance listening, collaboration, recognition of caring for others, use of daily reflection and self-care, risk-taking, and commitment to the direction and philosophy of the department (Linette & Sherman, 2014).

My nurse motivated her followers to achieve the highest goals in personal and professional growth. Consequently, they showed the capacity to react constructively to different types of problems in the process of care delivery. The nurse leader had a considerable impact on the staff's engagement and job satisfaction. She inspired colleagues to engage in lifelong learning and adopt new practices. Furthermore, she demonstrated highly developed core elements of the mentoring characteristic of the APN leadership competency (Hamric et al., 2014, p. 278). This nurse focused on the followers’ highest human need for self-actualization, identified by Abraham Maslow. It is also valuable that she did not approve of motivating the team members with material rewards or penalties. On the contrary, the nurse concentrated on creating intrinsic, process-oriented motivation with the focus on discovering one’s talents.

In addition, my nurse leader was great at coping with difficulties or complicated situations and showed a high level of resilience. First, she critically identified the components of a specific problem and then coordinated the efforts of the whole team for solving it through reflection and discussion (Govier & Nash, 2009a). Many researchers in the field of leadership claimed that leaders most vividly demonstrate their leadership skills, qualities, and capacities in hardships and adversities. For instance, Margolis and Stoltz (2009) stated that true leaders shift quickly from “traumatic events to looking forward, determining the best course of action” (p. 89). The authors also state that resilient managers “understand the size and scope of the crisis and the levels of control and impact they may have in a bad situation” (Margolis & Stoltz, 2009, p. 89).

Thus, the nurse leader I am describing accepted the challenging situations as opportunities to develop and discover one’s new capacities. She taught the team members to control their initial emotional reactions, use critical thinking abilities to find a productive solution, and make use of negative experiences for self-reflection and improvement. Finally, in her approach to problem-solving, the nurse demonstrated creativity, which is vital in a swiftly changing environment. In turn, it lies at the heart of innovation as creative perception enables people to generate original ideas and see the unexpected angles of the questions.

Moreover, this nursing leader possessed innovation, one of the characteristics of the APN leadership competency (Hamric et al., 2014, p. 280). Within its core elements, she was especially successful in systems thinking and assessment. Besides, the systems assessment skills and the ability to evaluate the broad context of change helped her deal with resistance to initiatives and emotional tension, acquired by the majority of workers. Overall, the capacity for innovation is the most vital in today’s changing world. As the IOM report stated, “Creating innovative care models in the patient’s setting and throughout the healthcare, the community is an essential requisite of contemporary practice” (O’Grady, 2011, p. 35).

Additionally, this nursing leader demonstrated a good knowledge of psychology, managing skills, and broad awareness of the general health system context on different levels. The nurse leader I observed considered it her moral duty to advocate for patients, APNs, and the nursing profession, in general. It is one of the core elements belonging to the activism component of the APN leadership competency described in the textbook by Hamric et al. (2014, p. 280). Her acute feeling of social justice is another feature of an ethical leader possessing absolute moral values and foundations. She did not make use of her working position for her interests. On the contrary, she held an active position in advocacy for the patients’ and nurses’ needs. Such active nurse leaders are capable of transforming the health system and establishing the nursing profession as highly influential in providing effective public health policy.

Leadership in Nursing Essay

In my opinion, the leadership style of the nurse I have chosen predominantly fits the definition of transformational leadership (Hamric et al., 2014, p. 272). Her inspiring, motivating, and empowering way of cooperation with the followers resulted in reciprocal personal and professional development. Owing to her transformational interaction and impact on the team members, changes in their values, attitudes, and motivational spheres occurred. She utilized self-reflection for her development and for motivating subordinates to change and analyze their behavior and perceptions. Especially, it was crucial for the young nurses in challenging and stressful situations since deliberate reflection allowed them to transform negative experiences into productive ones, build resiliency, and evolve stronger. Consequently, such effective leadership provides safe and quality health care and enables nurses to respond and adapt to change in an increasingly challenging environment (Govier & Nash, 2009b).

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The nursing leader from my description operated mostly within the clinical microsystems. She demonstrated high performance in the so-called “front-line units in which patients and providers interface” (Hamric et al., 2014, p. 275). It is consistent with Nelson and colleagues’ leadership model, called “Microsystems in health care: High-performing clinical units” (Hamric et al., 2014, p. 274). Virtually, effective leadership in a microsystem environment is the fundamental element of safe and high-quality care on a large organizational scale. The ability to organize an effective performance of the teams can explain the nurse’s contribution to the ultimate health care goal.

Furthermore, my nursing leader showed respect for cultural diversity in the clinical setting. For instance, she perceived the unusual customs of other cultures’ representatives without astonishment or negative emotional charging. In particular, the nurse demonstrated tolerance to other people’s beliefs even if some of them contradicted the clinical routine demands and rules. She allowed exceptions when it was dictated by the patients’ religion (for instance, the need for prayers at a definite time), traditions, or other peculiarities of their cultural backgrounds. Moreover, the leader learned more information about those cultures, whose representatives were the patients at the clinic. Thus, she demonstrated an openness to new experiences and a willingness to acquire knowledge persistently.

My nurse leader handled controversy in the work setting with a critical and reasonable approach. In other words, she dispassionately analyzed all the arguments and made a decision based on deliberate consideration and evidence-based judgments. For instance, when she had to solve the conflict between a young nurse and a worker from a superior level of organization, she was not directed in her decision-making by the hierarchical positions of the participants. On the contrary, the leader analyzed the situation with objectivity and justice, listened to both parties carefully, and discovered the truth. Such a leadership style promotes justice and equality in the work setting.

As already mentioned earlier in the paper, my nursing leader’s particular concern was enhancing collaboration between all the participants of the clinical unit. To achieve this goal, she organized common meetings, discussions, and systematic reports on the existing problems in diverse areas of the practice. This approach resulted in a twofold outcome, namely more effective solutions and closer interaction between the people. Finally, it is worth asserting that this nurse possesses an outstanding charisma of a strong, influential leader. It allows her to build effective relationships with coworkers and produce a favorable impact on the people.

To enhance my leadership competency, I made great use of the role model presented by this charge nurse from the surgical department. She demonstrated characteristics innate to an effective nurse leader in real clinical settings. I chose this particular leader because we share the same views, qualities, and attributes. To perform efficiently in the context of a radical redesign, innovation, and organization of the health care system, I choose to develop leadership competencies in the clinical domain. In addition, I decided to follow the aforementioned model by Nelson and colleagues called “Microsystems in health care: High-performing clinical units” (Hamric et al., 2014, p. 275). I consider the successful performance of nursing leaders in the microsystems environment crucial for the entire healthcare system. Therefore, my goal is to develop my skills in organizing an effective team working in front-line clinical units, hence contributing to providing high-quality care.

In particular, I understand the importance of successful collaboration at all levels of the health care system. Despite my role model being a transformational leader, I am more inclined to become a situational one. The main difference between these two definitions is that the former motivates and changes the followers while the latter can adapt to the development level of the subordinates. To achieve the goal of becoming a successful situational leader, I should act as a full partner with other nurses, physicians, and senior workers. With the major purpose of advancing the quality of care delivery and reducing error, all health care professionals should work with mutual accountability and collaboration.

Overall, I perceive myself not as a mere functional doer but as a strategic, active, and knowledgeable professional responsible for personal and professional growth. I aim at making others accept me as a thoughtful, effective, and powerful collaborator, and respect my decisions in inpatient care. The only way to do it is to increase the body of my knowledge and education and improve my leadership skills and experience. Furthermore, I can take advantage of the mentoring programs and learn from the examples of the most distinguished nurse leaders. My principal concern is to develop the skills and capacities of a situational leader that will allow me to deal effectively with various changing situations, according to environmental demands.

I am currently working as a case manager at a health insurance company. In my working setting, both customers and colleagues descend from various cultural, racial, and ethnic backgrounds. The right of every person to be treated with equal respect and understanding is undoubted; therefore, I constantly enhance cultural awareness and obtain knowledge about different ethnic and racial cultures. It helps me better understand the attitudes and perceptions of my interlocutors and eliminate possible bias.

My principle of dealing with controversy and collaborating with others in my work area and the interdisciplinary context implies solving problems through the constant refinement of my communication skills. Judging from the example of the nurse leader I reflected upon, the key to successful interaction in the working set is one’s superb communication skills and the right attitude to people. One can find two principles vividly illustrated by the statements in Linette and Sherman’s study. They state, “Communication is the key” and “We need to appreciate the value of equal footing . . . as this paves the way for better outcomes” (Linette & Sherman, 2014, p. 37).

Overall, I have to create my authentic leadership style and develop the capacities, attributes, and competencies of an efficient nursing leader. The principal technique for achieving this goal is the reflection of successful role models in nursing practices. Moreover, deep introspection and the analysis of own life philosophy can also contribute to achieving this goal. I completely agree with Oliver (2006) who claimed in her article that to be an effective leader, one “requires a complex mix of attributes, behaviors, and skills but most of all it requires an ability to reflect upon and evaluate yourself” (p. 38).

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