This essay aims to provide a reflective commentary on strengths, limitations, and developmental needs as a transitioning student to newly qualified nurse. Within this, it will consider current legislation, policy, and guidelines in supporting the development of registrants within contemporary healthcare. The commentary will be structured using the “What? So what? Now what?” model developed by Driscoll (2007, p. 44). This model has been chosen due to its logical structure for taking identified elements, considering the impact on practice, and then prompting the establishment of goals to enhance future practice. The author of this work has conducted a SWOT analysis (Appendix A), further supported by use of tools in assessing personality traits, emotional resilience and regulation, to identify “What” elements for this essay to focus upon. The ability to perform a strengths, weakness, opportunities, and threats (SWOT) analysis can aid nurses in identifying areas to target within their continued professional development (Nixon, 2013, pp. 209-211). The framework is invaluable as the identification of weaknesses is counter balanced by consideration of opportunities to improve. Furthermore, a platform is provided for the consideration of an individual’s personal and professional strengths and how these can be capitalised upon. In addition, the use of the threat column encourages risk management and can promote the formation of mitigation tactics. Henceforth, they are beneficial to transitioning student nurses, alongside the use of reflection, to identify their progression throughout the 3 years of the degree and areas for further focus.
The NHS and the Nursing and Midwifery council (NMC) require nurses to be able to develop to continually improve the service, meet the evolving needs of the population and the requirements of the role (RCN, 2018). Key publications such as the NHS outcomes framework (NHS Digital, 2020), Commissioning for Quality and Innovation (CQUIN) framework (NHS England, no date) and the NHS Long Term Plan (2019) can provide staff with insight to where focused development will benefit them, the employer and the service users. The NHS constitution (Department of Health, 2015) requires its staff to engage with opportunities provide for development and training over the legal requirements of the role. Within nursing specifically, there has been an additional focus on life-long learning supported by the NMC requirement to revalidate (NMC, 2019a). The author of this essay conducted a SWOT analysis to identify areas for development, prior to and during transitioning to newly qualified registrant, to meet the requirements of the role. One of the identified factors within this, was a weakness in leadership due to a frequently autocratic approach. This will be broken down for consideration using the What? So What? Now What? Structure.
What? Autocratic leadership styles can result in ineffective communication if used inappropriately. This is due to many individuals disliking staff who overuse an autocratic style and thus impeding the communication between a team (Cope and Murray, 2017). However, individuals that use an autocratic approach may be more confident and therefore more likely to approach others to speak out (Hanks, 2010).
So, what does this mean for practice? The NMC code (2018a, pp. 9-10) requires nurses to “practice effectively” and goes on further to state that to achieve this, nurses must ‘communicate clearly’ and ‘work cooperatively’. Furthermore, the 6 C’s present efficient communication as an essential element to ensuring patient safety and patient centred care (NHS England, 2015). To meet these values, it is imperative that a variety of leadership styles are learnt and used appropriate to the situation presented (Giltinane, 2013) and as required by the Future Nurse: Standards of proficiency for the registered nurse (NMC, 2018b, pp.19-20). The newly qualified nurse will need to be aware of the importance of establishing effective working relationships with colleagues to promote patient safety and minimize risk (Gluyas, 2015). For example, many trusts require additional training to perform skills such as intravenous therapy. Therefore, until training is provided by the trust, the newly qualified nurse must rely on the support of colleagues to ensure that their patients’ needs are met within a timely manner; especially where this involves time sensitive drugs, such as antibiotics for sepsis, as these situations pose a risk to the health and safety of patients.
It should be considered that an autocratic style can be beneficial to some scenarios, such as resuscitation attempts or emergency situations (Bish, 2015). Moreover, the self-assurance, typically seen in autocratic leaders, combined with an awareness of limitations may result in safer practice; as the nurse may be more willing to seek support from colleagues or refuse when asked to perform tasks outside of their skill set (McVanel and Morris, 2010). This is an important requirement of being a competent professional practitioner (Price-Dowd, 2017) and a requirement of the NMC Code (2018a). Furthermore, assertive nurses are more likely to advocate on behalf of their patients; the NMC Code (2018a) makes clear the requirement of nurses to have confidence in advocating for patients as part of their duty of care. However, excessive confidence can result in poor patient outcomes (Yang, Thompson and Bland, 2012) so newly qualified nurses must ensure that they follow trust policies and statutory guidance such as the NICE guidelines to avoid this and ensure best practice care (Cathala and Moorley, 2020).
Conversely insufficient confidence and a fear of making a mistake is a common barrier to newly qualified nurses and the use of frameworks, such as the Royal Pharmaceutical Society of Great Britain step-by-step process for medication administration and operating within statutory legislation such as the Human Medicines Regulations 2012, whilst being a legal requirement, can also reduce errors and promote the development of confidence (Cathala and Moorley, 2020). The confidence to raise concerns does not just apply advocating for patients, but also the ‘duty of candour’ in which nurses must be open and honest with patients if mistakes have been made, in corroboration with Regulation 20 of the Health and Social Care Act 2008 governed by the Care Quality Commission (NMC, 2019b). This is further reiterated in the NHS Constitution (Department of Health, 2015) which sets out the responsibility of staff to raise concerns pertaining to risk. Nevertheless, to successfully raise concerns the registered nurse must be able to not only advocate confidently but also communicate effectively using appropriate methods.
Now what? It is therefore crucial that the transitioning student be conscientious about their leadership style, and the potential impact on the team dynamics and communication, to try to avoid any negative consequence. SMART (Specific, Measurable, Attainable, Relevant, Timely) goals can aid transitioning nurses in meeting their developmental needs by splitting them into manageable timed targets (Tempest, 2012). Additionally, these can be prioritised according to level of developmental need and importance in meeting the requirements of the NMC Code, national health policies or legislation. Appendix B demonstrates how this applies to the newly qualified nurse for the topic of leadership and communication.
Going forward a focus on leadership, communication and management courses within continued professional development may be beneficial to the registered nurse to attain the skills required for adapting communication styles appropriately. The NHS has duty to “to promote and maintain proper professional standards and conduct” under Section 25 of the National Health Service Reform and Health Care Professions Act 2002 and therefore must support the development of staff. The provision of funding from the employing health trust to attend external specialist courses and the delivery of in-house training will be beneficial (Health Careers NHS, 2020). In addition, engaging in a preceptorship programme will provide a structured period, as a newly qualified nurse, for targeted development (NHS Employers, 2020). It will be essential for the nurse to “gather and reflect on feedback from a variety of sources” as state in the NMC Code (2018a). This constructive criticism received from colleagues and line managers on a regular basis, regarding areas in which communication skills are good and areas for further development, will aid the registrant in monitoring progress and refocusing goals (RCN, 2020). Additionally, the registrant could use appraisals, considering the Health Leadership Model (NHS Leadership Academy, 2013) and continued reflective practice, using the NMC template (NMC, 2019a), to identify triggers for the autocratic leadership style and consequently be more mindful in those situations. The use of other common tools such as the NHS Improvement’s (2018) SBAR tool, which provides a structured approach to information sharing, may be supportive to the further development of communication skills. In addition, the nurse may be able to capitalise on their dominant leadership style by obtaining a job in the emergency department or similar environment, such as rapid response team, in which autocratic leadership is a more useful trait.
In conclusion, key frameworks such as the NHS outcomes framework or long-term plan can support nurses to identify areas for future development to meet the changing needs of the healthcare system and population. The importance of reflective and targeted practice to encourage the ongoing development of nurses cannot be overstated. The use of tools and frameworks such as SWOT analysis and SMART goals provides invaluable support for this; however, nurses must also seek the support of colleagues and line managers for feedback and appraisals. Effective communication and leadership are essential in nursing practice and must be addressed where identified as a weakness. Internal and external training courses can offer nurses the opportunity to target this and further their development in line with NMC continuing professional development requirements (NMC, 2019a). Additionally, the newly qualified nurse must be aware of their limitations and practice inside policy, frameworks, and legislation to ensure evidence-based, safe, effective, and patient-centred practice. References