Management and Leadership (M&L) Reflection in Nursing
The incident occurred in a care center for 20 young people with physical disabilities (YPD) and 65 older adults. The settlement is made up of four individual units: two “dementia,” one “residential,” and one “YPD” that provide care for people with a variety of conditions. Staff is assigned to individual units but is expected to assist in units other than those assigned to them when necessary. One employee had a terrible attitude toward working/assisting in one of the dementia units and refused to do so when delegated. This created a difficult situation that could result in risks related to staffing shortages.
The analysis focuses on two key competencies: management and leadership (M&L)
The situation was critical to me because it harmed safeguarding practice, harmed the concept of teamwork, and caused disorganized work, which caused workload difficulties. It was linked to factors that could affect safety and pose risks to clients (M&L 1.13), so as a leader, I had to take action by organizing work and coordinating duties by prioritizing needs (M&L 1.1).
According to company regulations, both dementia units should have at least five care and one trained staff on duty daily, with 4 +1 in the other two. When all staff at work were checked on the day of the incident, it was discovered that the “residential unit” was overstaffed (5+1 staff).
I decided to take advantage of this opportunity and use available human resources to care for the clients in my unit (M&L 1.5; 1.6), and I delegated a member from the “overstaffed” unit to assist us.
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It was clear that I needed to act impartially to ensure equality and fairness toward all clients (M&L 1.6) by allocating an adequate number of staff to each unit.
“Fear of working in an unknown environment” motivated the refusal to assist in the dementia unit. However, the members of staff on duty in the short-staffed unit were experienced and well-organized workers. The delegated member of staff who refused to assist was told that she would benefit from joining the experienced team and was encouraged to learn more about how dementia affects clients’ needs and how it influences client outcomes (M&L 1.3; 1.15).
Knowing the group of clients in dementia units from personal experience, as well as their needs and limited ability to act for themselves, I felt obligated to act on their behalf. As a trained leader, I was responsible for ensuring that the patient’s right to appropriate care was met, and I had the authority to organize and coordinate work. It was an excellent opportunity to highlight potentially beneficial behaviors for improving the quality of care in the Home. In addition, the incident allowed me to recognize the team’s more experienced members by asking them to mentor a new (in the unit) colleague.
The ability to reorganize work in one unit so we could attempt to work in the short-staffed unit without calling the agency or bank personnel was a plus. Being aware of the workload and “routine” of work in the dementia units enabled me to consider what to do and how to do it. My main goal was ensuring “our” clients were safe and well-cared for. When I noticed that one unit was “overstaffed,” I decided to assign one of their members to work with us. This could have been beneficial in task coordination and resource utilization, but it could also have contributed to the incident. I effectively planned the delegation, but the implications of the delegation of duties could have been explained first. Before coordinating and delegating, I could have spent 5-10 minutes explaining to the delegated staff member that she would be working with an experienced team where she would be supported and gain new experience and knowledge from which she would benefit in the future.
Nonetheless, I assumed everyone’s perception of the situation was the same. I didn’t think about the feelings or experiences of the staff member who was supposed to be transferred to our unit for her shift.
After we explained the situation and gave the “non-cooperative carer” an informal verbal warning, she changed her mind and came to work with us.
Key system policies for Scottish Social Care (Quality Compliance Systems, 2014) include ‘Safeguarding Arrangements,’ and their reports, such as the State of Care 2013/14 (Care Quality Commission, 2013/14), show that ‘lack of staff’ is one of the most common causes of safety issues.
The Regulations on Reporting of Injuries, Diseases, and Dangerous Occurrences (RIDDOR) specify which incidents/accidents must be reported for further investigation (Health and Safety Executive, 2013). Even though the described incident was not RIDDOR reportable, it had to be handled immediately by the Patient Safety and Quality Improvement Act of 2005. (The Agency for Healthcare Research and Quality, 2008)