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Adult Nursing: Leaderships and Managing Care


The purpose of the accompanying commentary is to inform readers on the value of networking, effective leadership, and skill management or delegation in a healthcare setting and help them understand and make sense of these themes. It is also written to assist the writer in critically writing and analyzing the given pieces in a larger societal framework. A reflection on all progress made during the module study, an indicative case for an innovation project implemented in year three, a SMART-goal plan, and a self-developed checklist that should be completed for level 6 of the study are the critical components of the commentary.

Like any other academic writing work, a commentary essay must include an introduction, a body, and a conclusion. The warm-up prepares the reader for what the report will cover by outlining the themes to be discussed. Second, the body delves deeper into those themes, critically stating contexts, meanings, objectives, and significance. The body would have been divided into two sections in this case: part one and part two, where part one will cover the context of the NHS, as well as leadership, management, teamwork, and task delegation in nursing. It will also address current and emerging concerns in nursing within the jurisdiction of the UK boundaries. This section will also go over the necessity of leadership in adopting new healthcare trends, their relevance, the quality improvements required to strengthen the sector, and any gaps that may impede nursing’s growth in the UK. In part two, there will be a discussion about personal reflections for teamwork and first-time task management.

In their field of competence, every nurse must demonstrate teamwork, leadership, and management abilities. As a result, nursing students must participate in this crucial portion of their education. It aids children in discovering and exploring their values and experiences, which improves their emotional intelligence. Furthermore, when a nurse’s leadership potential is fully realized in all areas, the teams with which they work, the patients, and the system all benefit (Kantanen et al., 2017, p. 12). A good nurse leader can use interpersonal skills to persuade others to work toward a common goal. Learning the fundamental theories of leadership and management also aids in the development of leaders who are critical in fostering high performance and achieving high-quality results.

Part One:


Nurse leadership is defined as influencing, inspiring, and motivating healthcare staff to achieve their particular goals while doing their responsibilities. Nursing leaders can impact medical organizations in a variety of contexts, specialties, and organizations. It is the execution of the leadership tasks of decision-making and governance with organizations or fields that employ nurses referred to as nurse management. Nurse management encompasses all activities that a conventional manager might perform in an organization, such as organizing, planning, managing, and directing tasks. In a healthcare context, teamwork is a situation in which two or more individuals work together to achieve a common goal, all while focusing on quantifiable goals and benefiting from the presence of leadership that ensures stability throughout the working period (Bernardes 2018 p. 24). Teamwork encourages problem-solving behavior, as well as open and honest communication.

On the other hand, delegation is defined in the context of the National Health Service as the assignment of tasks or activities related to patient care delivery to unlicensed personnel while maintaining accountability for the patient’s outcomes. However, the delegation of work in nursing is limited because a nurse cannot assign tasks that include making nursing judgments. Leadership and management are essential components of a thriving health sector, mainly when providing outstanding health services. Leaders will be inspired by what can be accomplished and will pass this on to others. This will lead to the development of strategies aimed at reaching the desired outcome.

Furthermore, leaders inspire individuals and can solstice and gather resources and other support to help the entire organization achieve its objectives (Lehtonen et al. 2018, p. 25). The fundamental difficulty that NHS organizations face in the United Kingdom is cultivating cultures that support the ongoing delivery of safe and high-quality healthcare services. Leadership participation in fostering and influencing most organizational cultures has been established as a new strategy to meet this difficulty. The King’s Fund, the Faculty of Medical Leadership and Management, and the Center for Creative Leadership have joined forces to deliver an evidence-based approach to developing leaders with the potential to enhance healthcare system cultures.


a. Importance of Leadership

Practical leadership abilities may create measurable impacts in how nurses and other medical professionals approach their employment, as well as in-patient care. It is necessary to increase the quality of employee management and operations to establish an atmosphere of confidence, loyalty, and trust among patients and their families. The following are some of the reasons why strong leadership is so important:

Assisting in interpreting events- Effective leaders provide narratives that help their subjects make meaning of change, success, and the future, motivating them to make a positive difference for their businesses. The Francis Report emphasizes the underlying values that any leader must possess to achieve successful outcomes. Compassion, communication, care, commitment, competence, and courage are among the six C’s in healthcare delivery (Weiss et. 2019, p. 44). The bullying culture at the trustor in any hospital setting will disappear if nursing leaders consider the values, and positive patient results will be attained.

To encourage cooperation and Trust, a leader must establish a culture of supporting, backing, and respecting people’s efforts. This will help the organization to become more cohesive and confident. Leadership must also promote a culture of positive aggression when it comes to research and project implementation. According to Mazars’ 2015 report, critics claim that the administration neglected to investigate the number of mental illness deaths thoroughly. The leadership of the Trust at the time only reported 1% of deaths among the 30% adult mental health patients (Cope and Murray 2017, p.32). This emphasizes the significance of being aggressive in research and other academic endeavors.

Encourage openness, accountability, and responsibility- The Morecambe Bay Investigation found that the Trust’s leadership failed to ensure that physicians and other medical professionals provided safe services to patients and responded to warning signals of departure. Furthermore, the Trust’s transparency was a problem as it set out to solve healthcare problems without sharing information with the rest of the NHS. The Trust kept the information regarding clinicians’ poor services to itself, preventing it from communicating with the rest of the healthcare system (Huber 2017, p. 54). Furthermore, by denying and covering up the difficulties in the maternity units, the Trust leadership refused to be accountable for the faulty and failing maternal care. According to this paper, effective leadership can also foster optimism and dedication, build a sense of group identity, coordinate and control task efforts, and facilitate cooperative learning.

b. Leadership and Management Theories

Transformational Leadership Style/Theory

Transformational leadership is a new adaptive and flexible leadership style that establishes and promotes shared duties that impact employees’ knowledge. The notion motivates subjects and followers because it allows them to appeal to moral principles and higher opinions. The leader represents a profound set of interior beliefs and values. In an atmosphere where shared accountability is vital, the method also assists employees in achieving a greater good rather than their particular interests (Giddens 2018, p. 33). Idealized influence, intellectual influence, inspirational motivation, and individualized consideration are the four primary components of philosophy.

  • Transformational leaders’ behaviors define them as role models for a specific group of individuals, known as an idealized influence.
  • Intellectual clout—having a transformational leader who can think about and comprehend their subjects’ ideas.
  • Inspirational motivation- A leader’s capacity to create confidence, a feeling of purpose, and inspiration in their followers is known as emotional motivation.
  • Individualized consideration- When leaders mentor, instruct, and foster feedback and two-way communication with their followers, this is called individualized relation.

Human Resource Management Theory

The key focus point of this philosophy is the empowerment of every worker as a source of control, productivity, and motivation. Many studies have shown that the relationships between workers and managers and the workers themselves are the most critical determinants of organizational effectiveness. The Hawthorne experiments, for example, led to the creation of the Hawthorne effect, which states that while a person is under study, their conduct may change. When developing organizational policy, the human resource theory also encourages participatory decision-making (Asurakkody and Shin 2018, p. 56); increased worker participation in decision-making aids in the improvement of worker autonomy. In addition, the theory is critical in supporting employee education and training to improve the quality of their work.

Transactional Leadership Theory

The idea is a behavioral concept in which leaders use sanctions or rewards to drive their followers to complete tasks. This system’s motivation system is primarily a contingent incentive system that recognizes a job well done, particularly those who achieve their objectives. The notion focuses on keeping the team’s status quo and assisting followers in avoiding backsliding in whatever position they are assigned (Miles and Scott 2019, p. 27). One of the reasons transactional theory is so critical in nursing is that it gives nurses clarity in a fast-paced clinical environment by motivating and clarifying their responsibilities, norms, and expectations.

Role of Leadership in Quality Improvement in Healthcare

Leadership can be considered in three ways for quality improvement in healthcare delivery: its role in shaping the culture, employee involvement, and patient engagement. Regarding the first role of culture shaping, it is self-evident that an organization with a culture built on dignity, equality, and mutual respect has a better chance of retaining high-quality healthcare services. Leadership is critical in defining an organization’s culture, especially one that strives for safe, patient-centered, and efficient treatment. Effective leadership has been shown to impact an organization’s culture positively and, as a result, service quality (Tran et l. 2019, p67). When a leader decides on resource allocation, employee compensation, and staff performance evaluations, for example, he might impact culture. Such behavior fosters a shared set of beliefs and values, guiding employees and significantly affecting culture.

The influence of leadership on staff engagement is another aspect of leadership’s impact on quality. Many studies show that the level of employee engagement is directly linked to the quality of service delivered. According to the King’s Fund study, an organization with many engaged employees has better patient results. Nurse managers are responsible for fostering an empowerment culture that encourages staff participation (Lumbers 2018, p. 43). If the nurses are given fair chances, tools, and support, these leaders may create an empowering workplace.

Finally, in addition to workforce engagement, leadership plays a role in patient engagement. Patient engagement is a novel idea in healthcare that entails patients working with nurses or other caregivers to provide healthcare information and encourage patient activation. Aside from enhancing healthcare quality, the concept has several advantages. It can also assist in lowering treatment costs and improving overall patient satisfaction. Patients have autonomy over their health and well-being when leaders allow them to make decisions with staff members, and staff employees can evaluate their job through the patients’ eyes (Gopee and Galloway 2017 p. 65). The patient’s acknowledgment of the staff’s efforts can assist leaders in shaping the organizational culture to achieve increasingly empathic and responsive service delivery.

Key Theoretical Concepts in Team Working within MDTs

When working with multidisciplinary teams, success variables must be considered, according to an MDT evaluation. These elements include:

  • Patient-centered care entails prioritizing the patient or service user in the delivery of any service. It can be accomplished by considering patients’ and caregivers’ preferences for quick discharges from acute care units.
  • Physician Integration – Doctors and other physicians must be effectively integrated into the system by taking on leadership positions in operating, implementing, and designing a standard integrated healthcare system. While at work, however, physician integration has encountered decision-making hurdles and inefficient inter-professional partnerships.
  • Shared aims and objectives- For a successful collaborative working operation, all team members, including patients, caregivers, and families, should understand and accept achievable and realistic objectives. In most cases, employees who don’t grasp their goals and roles or aren’t aware of the common goals engage in non-compliant behavior, resulting in delayed referrals and treatment.
  • Shared IT and patient data- Most research shows that teamwork within MDTs is usually possible when information systems are fast and reliable. Communication between groups, sectors, and organizations is effortless. As a result, information in both the health and social care systems must be accessible for effective communication between caregivers in all professions.
  • Shared decision-making procedures and culture- There have been cultural obstacles between healthcare workers and long-term care services and between healthcare experts. Prioritize the interests of service users over the cultural norms of healthcare workers, and be prepared to work in various ways (Hill 2017, p. 36). According to an analysis of England’s care pilots, most initiatives managed by teams failed because of growing professional protectionism and team members’ reluctance to collaborate.

Leadership and role modeling go hand in hand. Role models usually use their attributes to make a workplace more enjoyable to work in. When it comes to teamwork, role modeling allows people to recognize and even appreciate the efforts made in an environment populated by dedicated people dedicated to promoting a collaborative and helpful environment (Senek et al. 2020, p. 23). People are influenced by good role models who exhibit support, optimism, and empathy, which result in excellent results when applied to service delivery.

Delegation as a Leadership and Management Tool

Delegation leadership is a frequent task and relationship trait strategy in which a leader encourages a subordinate to exercise autonomy in specific research. In this technique, the leader or manager provides the individual with a larger picture before entrusting them with responsibilities that must be completed within the agreed-upon range of results. This form of leadership is critical in teamwork management because it allows the manager to divide and assign tasks to subordinates. As a result, the manager’s workload is reduced, and more time is available for other tasks such as planning and project analysis (Huber 2017, p. 60). Three specific elements also surround delegation. These elements, which comprise an integrated process, are as follows:

  1. Power can be delegated.
  2. Instead of delegating responsibility, it can be allocated.
  3. Accountability entails responsibility.

Nonetheless, the healthcare system faces some obstacles when it comes to task delegation. These issues arise when there is a fear that a specific health professional would decline particular jobs when there is insufficient administrative assistance, when communication skills are lacking, and when there are many nursing insecurities.

Digital Data and Information Technology

Information technology (IT) refers to the components and infrastructure that make computer operations possible in many organizations. Digital data, on the other hand, is data that represents multiple types of data in a computer language that various technologies can analyze and deduce meaning from. Medicine is recognized as a practice that focuses on procedural work in the healthcare industry. Information systems contain a tremendous amount of patient data in the healthcare industry, allowing health practitioners to provide proper therapy. In the United Kingdom, information technology has evolved to include collecting additional financial and demographic data from patients. It’s also been widened to accept complicated diagnostics, laboratory data, and medical photographs. However, data management solutions have been challenged by the rising volume and complexity of patient data.

Nonetheless, information technology is critical to providing evidence-based medicine (Krick et al. 2019, p. 23). In terms of services, the IT industries have become more diverse. It evolved from stand-alone new medical equipment, such as radiography technology, to integrated clinical data and functional Electronic Medical Records (EMRs). The integration of patient data allows stakeholders to provide appropriate treatment based on a thorough medical history. Furthermore, the IT sector has increased communication across various branches of the health care system; as a result, crises and referrals are addressed as quickly as feasible.

A Clinical Gap

Increased employment vacancies in health and medicine are one of the issues that the UK has compared to other European countries. According to the King’s Fund report, there were around 1.2 million full-time health professionals employed, 1.1 million in adult units, and 46,000 professionals employed by the health sectors. Despite the vast number of working healthcare people, there is a shortage of health workers, as seen by the doctor-to-patient ratio of 1 to 356. In the United Kingdom, health workers account for one out of every ten jobs (Senek et al. 2020, p. 23). This necessitates further investigation into why there are so few doctors in the country and what might be done to fill vacancies. As a result, the procedures below will be critical in preparing for this research. They are as follows:

  1. Identifying and connecting with stakeholders is step one.
  2. Defining and planning the study objectives
  3. Make a list of the deliverables.
  4. Establishing a project timetable
  5. Recognizing problems and doing a risk assessment
  6. Notifying stakeholders of the project strategy

The measures outlined above will be critical in the execution of the study project to determine why there is such a significant gap in the employment of health workers in the United Kingdom. These phases can also be detailed to help the reader understand what each step includes. That is:

  • Outlining the deliverables- This step entails describing what the project is expected to provide and by when.
  • Creating a project schedule- Here, all of the tasks required to complete each deliverable are included.
  • Communicating the project plan to stakeholders- This stage entails describing how the project will satisfy the stakeholder’s needs and solve any gaps.
  • Identifying difficulties and conducting a risk assessment entails identifying potential project setbacks, such as holidays and job leaves of key individuals necessary to complete specific tasks.
  • Identifying and connecting with stakeholders- Stakeholders are the individuals or organizations impacting the project’s outcomes. The NHS, the private healthcare industry, and all health personnel are among them. The project scope, expectations, and baseline will be developed with the help of the stakeholders.
  • Prioritizing the project objectives identified by the stakeholders is part of setting and planning the research goals.

A personal checklist template can be created, but only after each item in each stage has been defined. This is how it will seem.

Step and Task Fully Completed Partially Completed Not Completed
Outlining the deliverables
Creating a project schedule
Identifying and connecting with stakeholders
Communicating the project plan to stakeholders

Part Two

Personal Reflection

a. Working in an MDT

After completing year one, I was offered a clerkship at Broadmoor Hospital in Crowthorne by a friend. During that clerkship, I was assigned to a group of five people who would treat a 56-year-old schizophrenic patient. A psychologist, psychiatrist, psychiatric nurse (myself), occupational therapist, and social worker comprised the group. Because the patient was reluctant to share information, the family had to be interrogated to obtain more accurate clinical results. She recorded delusional conversations and hallucinations, which the psychiatrist identified as essential schizophrenia symptoms. What struck me about that team was how each member worked together to treat that patient. However, there were issues with the psychiatrist, such as cultural insensitivity. This was because the person involved was black, and so evidence of racism was visible. Regardless, each caregiver had a specific job to play with that patient. This included the following:

MDT members Roles and Duties
Psychiatrist Provide talking therapy and do clinical evaluations.
Psychologist Provide detailed diagnosis and specific talking therapy.
Mental Health Nurse Making a treatment plan for the patient
Health Administrator Provide a plan for assessing the patient’s skills.
Welfare Worker Assist the patient’s family with advice, talking therapies, and emotional support.

First Task Experience

My first role at the placement facility was conducting a detailed neurological examination on a 68-years old lady with Alzheimer’s disease. The disease being a common type of dementia, the lady indicated decreased cognitive ability in several things such as speaking and reasoning. The neurological exam was explicitly set to rule out any condition that was present in that patient. In addition to this exam, I had to perform a mental status exam to assess the lady’s attention, remote memory, visuospatial condition, and language. The most challenging thing I came across during the examination was the time that the assessment lasted. I had to constantly repeat the question five times for her to perceive what I asked. Additionally, the lady interrupted the assessment process by introducing delusional topics, which sometimes ranged from real to illusional situations. Nevertheless, I managed to find the exact condition ailing the lady, which marked my first achievement as a mental nurse student.

In conclusion, leadership and management in the healthcare sector are critical since leaders act as role models for supporters during duties. Transparency, accountability, trust, and responsibility are all hallmarks of effective leadership. Furthermore, teamwork in the form of MDTs helps integrate all members’ interests toward a shared goal. It encourages role sharing, which leads to a better patient outcome throughout treatment. To minimize additional deaths owing to policymakers’, clinicians,’ or any other stakeholder in the health sector’s negligence, the NHS should support certain things in its leadership. These are some of the suggestions: –

  • Promote attributes of leadership such as transparency throughout organizations.
  • Promote the value of teamwork in the workplace.
  • Emphasize the importance of role modeling, especially by leaders.


Asurakkody, T.A. and Shin, S.Y., 2018. Innovative behavior in nursing context: a concept analysis. Asian Nursing Research12(4), pp.237-244.

Bernardes, A., 2018. Contemporary perspectives on leadership and management in nursing.

Cope, V. and Murray, M., 2017. Leadership styles in nursing. Nursing Standard31(43).

Giddens, J., 2018. Transformational leadership: What every nursing dean should know. Journal of Professional Nursing34(2), pp.117-121.

Hill, B., 2017. Does the leadership style of modern matrons contribute to safer and more effective clinical services?. Nursing Management24(1), pp.21-25.


Huber, D., 2017. Leadership and nursing care management-e-book. Elsevier Health Sciences.

Kantanen, K., Kaunonen, M., Helminen, M. and Suominen, T., 2017. Leadership and management competencies of head nurses and directors of nursing in Finnish social and health care. Journal of Research in Nursing22(3), pp.228-244.


Krick, T., Huter, K., Domhoff, D., Schmidt, A., Rothgang, H. and Wolf-Ostermann, K., 2019. Digital technology and nursing care: a scoping review on acceptance, effectiveness and efficiency studies of informal and formal care technologies. BMC health services research19(1), pp.1-15.

Lehtonen, M.R., Roos, M., Kantanen, K. and Suominen, T., 2018. International nursing: Nurse managers’ leadership and management competencies assessed by nursing personnel in a Finnish hospital. Nursing administration quarterly42(2), pp.164-174.

Lumbers, M., 2018. Approaches to leadership and managing change in the NHS. British Journal of Nursing27(10), pp.554-558.

Miles, J.M. and Scott, E.S., 2019. A new leadership development model for nursing education. Journal of Professional Nursing35(1), pp.5-11.

Murray, E., 2017. Nursing leadership and management: for patient safety and quality care. FA Davis.

Senek, M., Robertson, S., Ryan, T., King, R., Wood, E., Taylor, B., and Tod, A., 2020. Determinants of nurse job dissatisfaction-findings from a cross-sectional survey analysis in the UK. BMC nursing19(1), pp.1-10.

Tran, A.N., Nevidjon, B., Derouin, A., Weaver, S., and Bzdak, M., 2019. Reshaping nursing workforce development by strengthening the leadership skills of advanced practice nurses. Journal for nurses in professional development35(3), pp.152-159.

Weiss, S.A., Tappen, R.M. and Grimley, K., 2019. Essentials of nursing leadership & management. FA Davis.


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