Leadership in Nursing

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Leadership in Nursing: Increased Response to Critically Ill Patients at the Emergency Department


Effective leadership brings about improved collaboration among nurses promoting cohesive work and improved service delivery in the clinical settings. The necessity for change in the nursing profession is triggered by the need for improved quality to patient’s care and increasing the time taken in attending to emergency cases. Change in the contemporary nursing practice is inevitable. According to Curtis, de Vries and Sheerin (2011), with increased use of technology, nurse leaders are supposed to embrace transformational style of leadership in ensuring that effective change is implemented. Leadership is termed as the attribute whereby people are influenced to achieve a purpose or set-out goals. In respect to effectively implementing change, leadership roles play a critical part in the overall realisation of success through offering guidance and necessary skills towards meeting the set goals and standards (Davidson, Elliott and Daly, 2006). Nurse leaders have the role of making sound understanding of the change management being effected.

This study evaluates the need for improved response of critical cases presented at the emergency department by employing efficiency of patient receipt and analysis of the level of sickness or injury. Delays of critical conditions from the time of illness or injury onset to the first treatment process can be attributed to increased cases of ED mortality rates. Thus, enhancing efficiency at the ED by ensuring prompt and quality response to every case presented with the diagnosis of the necessary process of managing the condition in the shortest time possible, increased quality of care delivery is paramount (Hosking, Considine & Sands, 2014). By employing technologically acclaimed methods of data retrieval and ensuring teams of personnel are always on standby at the ED to receive and attend to emergency cases, there is hope of increased chances of survival.

Criteria of Literature Search

The introduction of technology in management of medical records and history of patient’s illness is crucial in the realisation of an effective retrieval and understanding of patient’s medical history and medication processes. Literature search was carried out strategically by utilising inclusion and exclusion criteria. By use of CINAHL database, a total of 160 articles were searched. Through the analysis of the titles and abstracts to the articles, the search narrowed down to a total of 36 articles. Finally, through evaluating the article content and the literature therein, a total of 15 articles were identified as having the credible information relating to change in clinical settings and effective leadership measures that are necessary for implementation. Key words like nursing leadership, emergency response and critically ill patients were utilised in the search strategy.

Increased Response and Nursing Leadership to Enhance Change in the ED

Response of emergency cases requires having a clear analysis of the patient presented to the ED and having no prompt-clear overview of the patient’s conditions delays emergency response. Subsequently, in the case of patients presented in the ED due to accident and having prior medical history, having no knowledge of their previous medical histories may bring complications during the emergency response treatment (Rincon, et al., 2011). In this regard, the introduction of online database for the management of patients’ medical history and their treatment procedures can effectively enhance quality of ED response processes. By having a centralised database for patients’ medical histories that can be shared among medical practitioners within different health facilities would enhance quality of care delivered during emergency responses (Hosking, Considine & Sands, 2014). In the realisation of success towards employing data history from database, there is need for coordination between the response team at the ED and the registry department handling patients’ records. In the event a patient is presented to a health facility that is not having its medical history, a prompt is sent to the central patients’ medical history registry and immediately a retrieval of medical history is done. This also reveals prior medical facilities attended and if possible physicians who have attended to the patient. Through such a networking process, medical practitioners acquire the capacity to share information on how best to address an emergency case of a patient having prior complicated medical history (Hosking, Considine & Sands, 2014).

The time taken to assess a patient in the ED triage can be reduced and results improved drastically with an overview of the patient’s medical history. According to Aacharya et al. (2011), medical care in the ED triage may bring about adverse delay in the provision of care, as well as increased overcrowding resulting to confusion and high demand for efficiency. Thus, enhancing the time used in the determination of emergency patients’ vitals and medical history would not only ensure efficiency in the ED, but also improve on the quality of care provided to the patient (Sherman, Clark & Maloney, 2008). This promotes recovery process resulting to high levels of recovery from critical cases presented in the emergency department. Although the first procedure for any treatment process is to identify the vitals to a patient and eventually establish the cause of level of condition, improved response coupled with past history is necessary (Aacharya et al., 2011). The introduction of collaborative efforts between the emergency departments with the registry department to acquire medical history of patients presented at the ED would require the efficiency of the lead nurse or physician in coordinating the process.

Emergency cases presented in the ED require prompt decisions to place patients in the intensive care and any delay results to reduce chances of survival (Chalffin et al., 2007). The delays in the transferring of critically ill patients to the ICU may not be well identified, but there is need to point out that effective response at the initial stage with clear medical history may identify a patient as vulnerable, thus, prompting the need for quick determination for intensive care. To effectively ensure realisation of this prompt determination and course of action, effective leadership is needed from the lead physician to enable team members deliver the necessary information to support the transfer or not (Shirey & Fisher, 2008). Being a successful leader in the health settings requires the leaders to act by examples. Through offering of guidance and giving ideas to challenges facing a process ensures efficiency and prompt response in the emergency procedures reducing the time taken to complete attending to an emergency case. As a leader, it is very crucial to enable an environment of effective teamwork to thrive in order to promote cohesiveness in work and bring out improved results (Nelsey & Brownie, 2012).

Responses in the ED require precision and making the right decisions to ensure that proper care and treatment is given to patients (Shirey & Fisher, 2008).). However, as a leader in the implementation of change to the way things have been carried out at the ED, there is need to be firm in their decision making. This not only instils confidence in the team, but also enhances the morale of work as team members find a point of reference to rely on and accentuate their practice. For a dynamic profession like nursing that requires critical thinking based on the set out core competencies and standards, there is need of confident professionals to embrace change and actualise the realisation of set goals (Marquis and Huston, 2012). Subsequently, there is a need to be considerate of opinions coming from the team members and analysing them as a team to come to consensus on the way forward. This ensures members of the team feels part of the procedure being carried out and put their all skills and capacity to ensure the best is achieved (Eslamian, et al., 2010). The role of a leader in nursing profession involves inculcating attributes that promotes quality of care delivered by an entire team (Sherman & Eggenberger, 2009). Further, increasing efficiency in the process of care is necessary to reduce the time of recovery taken by patients, or even the response to emergency case in the stabilising of a patient.

Critical care leaders require personal qualities to embrace and implement change in their area of operations. Nurses working in the ED deal with serious issues ranging from critically ill patients to emergency cases emanating from accidents and injuries, thus requiring prompt response (Ulrich et al., 2009). Effective leadership is exhibited with a set of personal qualities that help surpass the challenges experienced in the actual practice process. The achievement of goals and objectives of the set change to enhancing time of response in the ED by employing improved technical sharing of medical histories is critical for the overall realisation of success. Persistence, courage, ability to handle stress and integrity are instilled by a leader in the process of implementing change, as well as actual practice (Sherman, Clark & Maloney, 2008). In context, a leader of quality personality improves the morale of workers by impacting on their need to come up with effective and innovative ideas of how to effectively realise prompt response to emergency cases at the ED.

Critical thinking enhances leadership skills and the activities involved in response at the ED require individuals that are resilient and quick to act (Nelsey, & Brownie, 2012). Subsequently, the attribute of thinking critically to come up with solutions to prevailing challenges in order to resolve patients’ illness crisis is paramount. Critically thinking is achieved with effective communication process among team members and their leaders. Cultivating a culture of effective communication enhances interaction, and subsequently promotes the level of standard in the outcomes achieved (Curtis, de Vries & Sheerin, 2011). Nursing practice requires creative and innovative minds in the course of practice. The art of being creative and critical is also enhanced with evidence-based practice which is fundamentally effective through sharing (Nelsey & Brownie, 2012). Creating a network of professionals as nurses promotes networking and brings up issues that require consideration and attention of all nurses to propose solutions. Thus, as a nurse heading nurses attending to response cases in the ED, there is the need to ensure the teams are well networked with other professionals to acquire skills and experiences that will promote their professional practice. The interactive sessions of patients and their relatives or guardians requires nurses to be creative in nature, attentive and understanding to be able to handle cases arising from inquiries to addressing how medication process are carried out (Arik, Anat & Arie, 2012). Nurses also are compelled with making last minute decisions on the patients’ healthcare and thus, the need for sober-minded individuals. In this context, as a leader in nursing professional, acting as role model is necessary. Leadership in nursing requires that a lead nurse show how to effectively working within a health setting. In respect to the ED, increased need for quality and prompt response among nurses to save live and prevent complications is crucial (Sherman & Eggenberger, 2009). Thus, it is inevitable to state that change in the ED response rate is crucial for purposes of promoting effective care, and detecting the need for intensive care for critical cases.


In conclusion, effective leadership in nursing enhances collaborative efforts promoting working together as a team. The role of a nursing leader in the ED is critical in the management of effective response and introduction of measures to address cases being presented in the most appropriate manner. This essay addresses the need for effective introduction of medical history retrieval during the emergency response from a centralised registry. The aim of the change is aimed at bringing in critical information as the triage procedure is carried on to ensure overall medical history of patients represented the emergency department are put into consideration. Leaders in the emergency department will have the responsibility of executing and conceptualising the idea to other nurses, and ensure the plan of actions is followed to meet the required standards and achieve the goals. Effective leadership involves not only introducing the change, but also acting as the source of motivation to enhance the morale of other health practitioners in embracing the change for the better. Increased response rate in the ED is critical in ensuring critical cases requiring intensive care are determined promptly, as well as diagnosis of the need for specialised treatment and care to avert complications occurrence and reduce time of recovery. In this case of change in the response rate at the ED, leaders acts as the role model to people in the demonstrating the necessary signs and qualities of integrity to realise excellent results in the targeted change process.


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