Opinion

Rising to the challenges of clinical leadership

Leadership in a clinical setting can be emotionally charged. It is hard work and can sometimes feel raw, but it can also be tremendously rewarding.

Leadership in a clinical setting can be emotionally charged. It is hard work and can sometimes feel raw, but it can also be tremendously rewarding.  


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Well-led clinical teams can buck trends; they hold together in the face of adversity and overcome significant challenges as they provide outstanding clinical care.  

Nurse leadership in the emergency department can be complex. You can find yourself facing unknown situations for which you may feel unprepared. It is about more than the four-hour target; it is about patient safety and outcomes, and about providing leadership upwards and downwards throughout the multidisciplinary team.  

Major incidents

I can remember having to handle my first paediatric cardiac arrest as the nurse in charge of the department on a night shift, thankfully a rare event. The staff on shift required leadership in an unexpected situation and between myself and the ED registrar, for whom this was also a first, we managed to lead the team through the event by remaining calm and providing clear direction and support.  

'Clinical leadership is complex, multifaceted in nature, and impossible to explain in a PowerPoint presentation'

Dealing with major incidents and the ability to provide leadership during these times, along with during normal everyday clinical work, is the marker of an excellent nurse leader.

People can become consumed with the question of whether leadership can be taught. It is true that clinical leadership is complex, multifaceted in nature, and impossible to explain simply by writing a PowerPoint presentation with a list of points for people to follow. 

Learning leadership

However, there is some conceptual work to understand when you consider your leadership style. Leadership is born of your ability to relate to others, to be personable and approachable. As a nurse you are already equipped with the ability to relate to others and be approachable but that is not the only element required. There is also a need to take responsibility for your team and their actions. 

When you think about nurse leaders, ask yourself what makes some of them outstanding and try to consider what behaviours they have adopted to be that sort of leader? Leadership is needed at all levels, and it is a mistake to believe that only the nurse in charge will need to provide leadership on shift. The size of the team that you lead may change, depending on role, position and experience, but the elements of leadership are always the same.

Training and experience are your best tools to bridge the gap between the enhanced level of leadership that is needed during an unpredictable event compared with your everyday clinical challenges. Theoretically, however, leadership should be conducted in the same manner in both circumstances. This will allow you to provide a consistent level of leadership for the patients in your charge, regardless of the situation. 

You will need to practice leadership in stressful situations, to fully understand how you will personally respond, and how to get the best results from your team. By understanding those that you work with, what their motivations are, and the skills they offer that you need to help them harness and amplify, you will be on your way towards being an excellent clinical leader.


About the author

James Bird is a lead nurse in emergency medicine at Imperial College Healthcare NHS Trust, London

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