Nursing Leadership Reflection: Clinical Decision Unit


Exercising leadership and intrinsic management in the nursing environment is critical towards handling different patient cases within the code of guideline for practicing nursing. Specifically, it is important to integrate the code of nursing practice with different environments to ensure that ethical dilemmas do not arise (Casey & Wallis 2011). This reflective assignment will be based on identification of my past experience in a clinical placement during my third year of nursing.

The reflection will be based on my skills as the charge nurse in the Clinical Decision Unit (CDU) in the leadership and management of the teams, besides ability to be responsive and innovative in unpredictable situation. Specifically, the reflection will be based on the Johns’ 4 stages model comprising of description, reflection, influencing factors, and learning. In observance of the ethical conduct of nursing practice, the name of the patient, ward, and hospital are withheld to maintain confidentiality.

Johns’ reflection model


During my third year of nursing, I had an experience in a clinical placement during that has improved on my perception of nursing leadership. As the charge nurse in the Clinical Decision Unit (CDU) of hospital XYZ, I handled several duties of management and provision of leadership to my team comprising of five medical personnel (Hawley 2007). My primary duty as the charge nurse in the CDU environment was to delegate duties to my team which comprised of two nurses and three health care assistants. In the process of delegation, it is easy to identify the strengths and weaknesses of the team in task completion.

During one evening of the third week at hospital XYZ, patient ABC, who was an accident patient, was transferred from the Accident and Emergency room to the CDU because his condition was stabilising. As the charge nurse, I had the duty of delegating where the patient was to be place (Fielding & Briss 2006). I decided the best choice would be to place the patient in a bay and selected one of the two nurses to give the patient personal care until the patient recovers fully. Within one hour after the transfer into the bay, the patient’s awareness suddenly changed. Shortly after the change, the patient’s saturation dropped and ABC became tachycardic.

The immediate concern as the leader of the team was the delegation on how the entire team and I should stabilise the patient and if necessary, take ABC to resuscitation (Hornby & Atkins 2000). It was my first time to experience this situation. To make matters worst, the rest of the team was depending on me to applying the nursing principles in the most optimal way so that the patient stabilisation would be quick. As the charge nurse, I managed to provide leadership to the team through application of the evidence-based practice on SBAR.


In the emergency situation, as the charge nurse, I was trying to make the patient stabilisation process fast and safe. I had to delegate duties to the other team members because it was my role as the team leader to offer leadership (Johns 1994). I opted for application of the SBAR in the stabilisation of the patient within 20 minutes. As a result of delegation of duties, the team and I were able to stabilise the patient without having to take ABC to resuscitation. The consequences of my actions were fast recovery of the patient, self satisfaction with my high rational decision making skills, and general happiness among the team members (Keene 2001).

As the patient stabilisation process was underway, I felt a strong adrenaline rush and the need to take charge before the situation could get out of hand as the leaders of the team. I was a bit worried of what might happen if I wrongly delegated duties, since I was the nurse responsible for the team (Judith, Baile, Anderson, & Docherty, 2011). After the stabilisation, the patient was very grateful of my quick decision which saved his life. The patient recovered fully within a very short time and requested that I be part of other nursing care treatments until full recovery. Actually, the patient could not make this request if he was not satisfied.

Influencing factors

The external factors which influenced my decision making and actions were the need for quality nursing care service within the accepted standards, and the need to take control as the charge nurse (Keene 2001). The internal factors which influenced my decision-making and actions were inspired by principles of nursing practice, sensitivity of the DCU environment, and team work through proactive leadership and professionalism (Kulbok, Thatcher, Park, & Meszaros 2012).

The main source of knowledge which influenced by actions in stabilising patient ABC was the application of the evidence-based practice on SBAR. The patient was put on a cardiac monitor and an ECG was done as the team and I awaited the A&E doctor. I had the alternative of directly taking the patient to resuscitation without applying the evidence-based SBAR practice. However, this alternative would attract ethical dilemmas such as poor observance of the standards for nursing practice and even death of the patient (Keene 2001). The decision I made to facilitate stabilisation of the patient was the most professional and necessary when responding to the emergency (Senge 2006). Through the lens nursing leadership practice, I believe I made the best decision and took the most appropriate actions.


From the experience, I learned that it would be necessary to roll out patient-based initiatives for addressing the normative and comparative needs of the patient in the quickness way possible, especially in the emergency response environment. Besides, it is important to note that leadership inspires the need to contribute proactively towards creation of a suitable environment for closing the gap that may exist between a challenge and its solution (Senge 2006). A nurse participating in a similar experience, as a charge nurse, may offer creative leadership which is a rich recipe for acceptance, sustainability, and relevance of the proposed stabilization or treatment from several alternatives.

The experience of stabilizing patient ABC was an eye opener into the critical factors to consider when delegating duties in the health care environment. Besides, I learned the importance of rationality and high quality decision making as the prerequisite for minimizing potential ethical dilemmas within an emergency response unit in a healthcare environment. As a result of properly structured communication ethics, the work environment was holistic, soft, and socially friendly to the staff since I applied valence in my leadership approach (Pollard, Thomas, & Miers 2010). Besides, healthy ethical communication culture between the team and I created structural goals which develop norms, expectations of specific behaviour display, and appropriate guideline controlling interaction with one another.

From this experience, I took it upon myself to ensure that whenever I am working with others, there is team involvement, proactive relationship, and professional association as the blueprint for quality service delivery to patients (Keene 2001). From this experience, I have improved on my knowledge in nursing practice on the best ways of employing accountability and responsibility as the elements of rationale and moral judgment within the laws to ensure that the action taken is in the best interest of the patient (Senge 2006).

Theory supporting my learning

As indicated in the theory of human caring, the character and values that have a positive impact on leadership nursing practice include confidentiality, rationality, good communication, high morals, respect, and promotion of equality. Basically, these elements form the strength of a successful nursing leadership career. In managing the experience of stabilizing patient ABC, I applied positive ethical aspirations within the rational leadership model (Sullivan & Decker 2009). This model is supported by experience of the individual in question since performance and ethical decision making process is skewed towards experience with a situation (Senge 2006).

The ethical aspirations which were achievable through action oriented respect, mutual coexistence, and deeply entrenched social values, which are vital in rational decision making. These values were readiness and inclination to jump into actions which considered the morality of the decisions to me, the team, and most importantly to the patient (Winnick, Lucas, Hartman, & Toll 2005).

Thus, the provisions 1 and 2 demand that a nurse should exercise rational judgment in his or her course of actions when dealing with a patient to make such actions ethically correct. The NPA. Sec. 335.016 act summarizes the professional act in nursing as functional on the principles of inter and intra personal interactions with the patient (Keene 2001). I successfully applied the rational model to handle the situation at hospital XYZ in the most appropriate manner.

However, I need to improve on my motivational skills to ensure that team work surpasses personal feelings and misconceptions. In leadership management, motivation is important and functions between individual interaction and internal attributes of the involved parties (Zwarenstein, Goldman, & Reeves 2009).

As a component of motivational functionality, expectancy forms the aspect of perception that an individual holds towards the environment of leadership and influence (Sullivan & Garland 2010). Through personal improvement, I will be able to implement mechanism of rational leadership in broad environmental spectra. As a result, I will be able to influence the behaviour of person(s) making decision away from personal prejudice, stereotype, or emotions in handling a similar experience in the future (Weick & Quinn 2009).


Apparently, perception review offers the most ethically viable option for proactive leadership management of behaviour in the health care environment. This identifies the aspects of effort-performance expectancy, valence expectancy, and performance-outcome expectancy. The nurses have the responsibility of maintaining confidentiality, professionalism and due care within the confines of serving the best interest of the patient. As a charge nurse at hospital XYZ, I was able to effectively delegate duties by application of the rational leadership model and stabilise a patient within a very short time. Through application of the evidence-based SBAR practice, I was able to follow the guideline in delegating duties, alerting the doctor, explain the patient’s condition.

Reference List

Casey, A & Wallis, A 2011, “Effective communication: principle of nursing practice”, Nursing Standard, vol. 25, no. 32, pp. 35-37.

Fielding, J & Briss, P 2006, “Promoting evidence-based public health policy: Can we have better evidence and more action?” Health Affairs Journal, vol. 25, no. 4, pp. 969-978.

Hawley, G 2007, Ethics in clinical practice: an inter-professional approach, Pearson, Edinburgh.

Hornby, S & Atkins, J 2000, Collaborative care: inter-professional, inter-agency and inter-professional, Blackwell Publishing, Oxford.

Johns, C 1994, “Nuances of reflection”, Journal of Clinical Nursing, vol. 3, no. 1, pp. 71-75.

Judith, A, Baile, E, Anderson, A & Docherty, S 2011, “Nursing roles and strategies in end-of-life decision making in acute care: A systematic review of the literature”, Nursing Research and Practice, vol. 2, no. 5, pp. 45-67.

Keene, J 2001, Clients with complex needs: inter-professional practice, Blackwell, Oxford.

Kulbok, P, Thatcher, E, Park, E & Meszaros, P 2012, “Evolving public health nursing roles: Focus on community participatory health promotion and prevention”, The Online Journal of the American Nurses Association, vol. 17, no. 2, pp. 12-38.

Pollard, K, Thomas, J & Miers, M 2010, Understanding inter-professional working in health and social care, Palgrave, Basingstoke.

Senge, P 2006, The fifth discipline: the art and practice of learning organizations, Doubleday/Currency, London, UK.

Sullivan, E & Decker, P 2009, Effective leadership and management in nursing, Pearson Prentice Hall, London, UK.

Sullivan, E & Garland, G 2010, Practical leadership and management in nursing, Pearsons Education, London, UK.

Weick, K & Quinn, R 2009, “Organizational change and development”, Annual Review Psychology, vol. 50, no. 2, pp. 361-386.

Winnick, S, Lucas, D, Hartman, A & Toll, D 2005, “How do you improve compliance?” Pediatrics, vol. 115, no. 6, pp. 718-724.

Zwarenstein, M, Goldman, J & Reeves, S 2009, Inter-professional Collaboration: effects of practice based interventions on professional practice and healthcare outcomes. Web.