Peer response A.S. 1 page with at least one reference

Week 1

Reflect upon a leader or manager who positively or negatively impacted your practice. Do not identify the leader by name. 

Include the following sections:

1. Application of Course Knowledge: Answer all questions/criteria with explanations and detail.

The manager I had at one of the facilities I worked at always encouraged nursing staff to come talk to her about any questions, concerns, problems, etc. She emphasized she always had an open-door policy and that she would keep what we say confidently. There was an ongoing pattern of how assignments were made. It was evident that the charge nurse’s friends were given the lower acuity patients, while the ones who weren’t close with them were given all the higher acuity patients, which usually had us running non-stop and running from one end of the unit to the other for each patient. Granted, this unit is 40 bed unit and each nurse was assigned patients. In the middle of the unit there were two central supply rooms, two med rooms with Pyxis, the main nurses station and a small nurses station and the other end of the unit. The nurses who were assigned lower acuity patients always ate breakfast every morning, sitting at the nurses station on their phones, and they all had time to get lunch every single shift. I was lucky to shove a protein bar in my mouth walking down to the other end of the unit to care for one of my patients or let alone go to the bathroom my entire shift.  After a while noticing the pattern, other nurses coming to me about what they have been seeing and felt, asking if I had noticed it too. I went to our nurse manager about the concerns I and others were having with the pattern that’s been noticed and asked to see if there was anything that could be done or a different way to assign patients where not all of the patients we have are high acuity. That way we were able to provide safe, efficient, quality patient care. Many instances I would have two different patients starting to crash or taking a turn on opposite ends of the unit and I requested help since I cannot be in both places at one time. We were a neuro, stroke, and epilepsy stepdown unit.  I assured her that this was not a time management issue, it was how the assignments were divided up and the acuity levels of each patient. I did not name anyone directly, I generalized the situation. I merely asked if there was might be a better way to split up the assignments to have a good balance of low and high acuity patients per assignment for each nurse. She said she would investigate it and see what was going on. She did say that per the assignments and the acuity level of the patients there was a pattern and asked why, for example, they had two of our patients on one end, two on the other end and one in the middle somewhere. There were changes made to the assignments that made the assignments more manageable and not all the patients we had were of high acuity, a decision made by the unit manager who was new to the unit. After the change the nurses who previously had all low acuity patients did not always get lunch every shift and would have days where they were busy due to their patients. Of course, there were nurses upset about the change, others who were relieved about the change, and it was evident. I did not tell them or anyone else that I had gone to the nurse manager to speak with her regarding the issue. One day I was coming around the corner at one end of the unit to go to one of my patient’s rooms, the nurse manager, charge nurse, and a few of their nurse friends were at the end of the hall talking. I heard the nurses telling her they do not like the way the new assignments are being assigned, and I heard the nurse manager tell them that I was the one who complained about the previous assignments. I walked around the corner, and they all just looked at me and then walked away. After that my assignments were scattered across the unit again, every combative or “difficult” patient that came on our unit was on my assignment. I always got a “good luck” I got when receiving report from the previous nurse.

After I heard the nurse manager single me out as the reason why the assignments were changed and they were unhappy, I did not feel like I could trust that manager again. This is one reason I did go back to her regarding the way my assignments were handed after their conversation. I just made the assignment work, took care of my patients at the best of my ability, and didn’t say anything when I was drowning. I felt like I had a target on my back and if urgent or emergent matters occurred, I wasn’t sure I could rely on some of the other nurses to assist when needed. Those nurses would not speak to me, rolled their eyes at me, and gave me the cold shoulder. It made the environment feel hostile, if you will. There was tension between the nurses who were upset and the nurses who were relieved to have a more manageable assignment. That was never my intention when bringing up a possible change to the assignment. Thankfully, I was offered a new career opportunity with the state with a pay raise.

This nurse leader exhibited Transactional Leadership tendencies. A transactional leadership approach is based off rewards and incentives for performance motivation and being reprimanded when performance expectations are not met (Chamberlain University, n.d.). The nurse manager used to be a floor nurse on that unit for years and friends with the charge nurse and other floor nurses. It appears there were incentives/ rewards for being friends with the nurse and nurse manager through allowing patient assignments to be created in a certain manner where those nurses were given assignments of lower acuity patients. It was not until the new unit manager looked at the situation and past patient assignments regarding patient acuity that changed with the structure of patient assignments taking patient acuity into consideration occurred. Many of the newer nurses to the unit were the ones who experienced high acuity patient assignments as there was not the relationship or rapport with the nurse manager like the other nurses have. There were other instances where the nurse manager would call everyone to the front nurses’ station for a quick “huddle” to discuss changes that needed to be implemented that day. The nurses who were friends with this nurse manager would criticize and object to certain implementations, which would result in the nurse manager not implementing the changes and stated she would come up with another solution. With a transactional leader, they are primary focused on tasks being performed on time, white boards updated, and what we could do better to create improved patient satisfaction instead of determining what other things such as assignment variability, extended call light waits, and short staffing that may causing decreased patient satisfaction, which was true in this case (Al-Rjoub et al., 2024). It has been shown that patients who were under the care of nurses who have a transactional leader, they “were four times more likely to be readmitted to the hospital” than if the nurses were under another type of leadership (Al-Rjoub et al., 2024).

References

Al-Rjoub, S., Alsharawneh, A., Alhawajreh, M. J., & Othman, E. H. (2024). Exploring the Impact of Transformational and Transactional Style of Leadership on Nursing Care Performance and Patient Outcomes. Journal of Healthcare Leadership, 16, 557-568. https://doi.org/10.2147/JHL.S496266Links to an external site.

Chamberlain University. (n.d.). Week 1: Foundations of advanced practice nursing leadership. Chamberlain University Canvas. https://chamberlain.instructure.com/courses/203693/pages/week-1-foundations-of-advanced-practice-nursing-leadership?module_item_id=28638020

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