Clinical Leadership And

Management
By: Ms. Khairunnisa Mansoor
Senior Instructor AKU-SONAM 2024

Acknowledgement: Ms. Sajida Chagani (Joint Faculty-Senior Instructor AKU-SONAM 2023)

Connecting the Dots:
connection from last session to this session
 Outline
1. Define essential characteristics of clinical leadership.
2. Analyze various functions/roles of clinical nurse and
practice in day-to-day operations.
3. Discuss significance of about clinical rounds and
observations during these patient rounds.
 Connection time

Why nurse leaders need clinical

leadership?
Nurses work at each level of the health care system, have varied role,
and are constantly in contact with people
Dynamism and responsibility requires nurses to have knowledge and
skills of management. It applies at all levels of nurses however, the depth
and focus of care management roles and skills may vary by level.
Foster and develop leadership capacity through its education and
research programs;
https://www.youtube.com/watch?v=K4kI9_ntt-U

5
 Purpose of Clinical leadership

Informed Decision- Building Trust

Quality Patient and Credibility
Making
Care

Alignment with Professional Adaptability to Effective Team

Patient-Centered Development Change Management
Care
Problem-Solving
Enhanced Advocacy for in Complex
Communication Best Practices Situations
with Staff

(Solange M, 2017)
 Leadership Qualities A Must-have For Every Type Of Leader

Integrity is the quality of having strong moral principles, firm

1 Integrity
adherence to moral values, and being honest and fair.

Ethics are moral principles that govern a person's behavior or the

2 Strong Ethics
way they conduct themselves while performing the activities

Critical Mental process of skillful and active perception, synthesis, analysis,

3 Thinking and evaluation of collected data or information.

Excellent
Communication Exchange of verbal and nonverbal cues and information
4 Skills to relay messages
Leadership Qualities A Must-have For Every Type Of Nurse Leader

A mentor is a person with knowledge and experience who guides

5 Mentorship and nurtures the growth and development of a less experienced
person

Professionalism An act of demonstrating high standards of practice, care about your

6 job, and being reliable

Respect for Accepting them for who they are, even if you disagree with their
7
Others values, beliefs, or habits.

Dedication being devoted to a purpose or task, demonstrating integrity and

8
loyalty to a cause.
Various Roles of Clinical leaders

Nurse Clinical Advance

Nurse Practice
Manager Specialist Nurse

Clinical Clinical
Head Nurse Nurse Nurse
Instructor Coordinator

Assistant Nurse
Head Nurse Navigator

Nurse
leader/Incha Staff Nurse
rge
Various Functions of Clinical leaders

Staff Management

Unit Management

Patient care
Management
 Staff Management
Service Excellence (CARR)

Compliance with dress code policy

Compliance in unit specific standards

Assess patient care and acuity and assign staff accordingly.

Ensure staff maintains professionalism Particularly attendance and punctuality.

Document staff related concerns and anecdotes on shift basis and notify to
HN/CNI promptly.
Staff management cont…
Ensure appropriate number of staffing at the beginning of the shift and in crisis.

Release staff for break on time: mention break timings on assignment sheets.

Monitor staff break and overlapping timing especially on weekend and public holidays.

Monitor staff’s lab timings and POE order review timings, special assignments in
evenings and nights especially on weekend and public holidays.
 Employee Development
Employee development is the combined effort of employees and nurse leaders
focused on helping employees improve knowledge and skills. It will ensure:
i. increased loyalty
ii. best nursing workforce
iii. better work performance
iv. improves patient outcomes
v. reduces risks to patient safety.
vi. Make employee feel they are valued
vii. Well-trained nurses are equipped to provide top-notch patient care
Staff Qualification and Education: Basic Credentials
Certification is a formal recognition that a nurse has acquired specialized knowledge, skills, and
experience that meet identified standards.
(Miller & Boyle, 2008).

At entry level basic certification requirements as per institutional guidelines

1. Medication certification
2. Basic life Support (BLS)
3. Basic Infection control Certification (BICC)
4. IV canulation
5. Pakistan Nursing council License
6. Procedural sedation (As per area specialty)
 Crafting a Conducive work Environment 15

• Feedback Mechanism
appraisal/performance review, supervised practiced
(assessment), mentorship & preceptorship

• Planned – Monthly meetings, Team briefing, teaching session,

Professional forum

• Ad-hoc – Debriefing following critical incident, giving feedback, mentorship & preceptorship
• Brief and debrief (Team STEPS)

• Informal - Immediate advice/support in dealing with situation, impromptu teaching

 Unit management
• To ensure optimal visitor control on shift basis. Notify security supervisor
and also head nurse.

• Ensure that all TLs’ have access to support services in case of breakage of
any equipment, supplies not available, or any emergency situation.

➢Contact # list of the department supervisors (Maintenance, IT, Biomedical,

S&S).

➢Process of handling equipment complain

• To document unit related incidents and anecdotes on shift basis and forward
it to HN/NI next morning for prompt reporting.
 Unit Management
• Record events: expiry, escape, robbery, violence by attendant / staff with MR #, bed
#, time of incidence.

• To document shift report correctly on shift basis and notify nursing supervisor for
any changes.

• Submit terminal cleaning check list for all infected/ isolation room patient’s room to
NI/ HN.

• Involve administrator on call and involvement of Bed Management

Office (BMO) as needed.
Functions
• Staff workload
• Staff Performance
• Staff development
• Equipment management
• Patient complain
• Patient services
• Coordination with different department
• Committee representation
Day of In charge/Team Leader / Head Nurse
Moring Hands off Morning update to
Administrative and
clinical discussion
Committee Representation
with TL /AHN the Manager with the Manager to
take facilitation. 1. Safety Coordinator
2. Nursing Quality and Communication
Forum
Meet regularly with
Makes daily detail
round of all the areas
the Patients and /or
Spot checks on 3. Morbidity and Mortality (M&M)
family to resolve
to monitor the quality AHN/TL/CNC\.NI h 4. Magnet Task force
complaints and issues
of patient care / ands off mechanism.
with service
environment
coordinators. 5. Infection control lead Nurse (ICLN)

Lead allied staff like

UR, PCA,HCA for
Spot check special
Monitor inventory compliances and take
Assignment
NI on board as
required

Protected time for

office work.
 Day Of The Nurse Instructor
 Morning update to specialist
 Moring Hands off with SCU staff / and AHN for any sick patient
:
 Makes daily detail round of all the areas to monitor the clinical practice quality of patient care / environment to ensure
the patient’s regimens are being accurately followed to develop training need analysis (TNA), and nominate staff for on
job or formal training
 Point prevalence of core patient care process : MMU , Discharges, PFE, IV canualtion, drain management,
 Administrative and clinical discussion with the specialist and Manager to take facilitation.
 Take the follow up of round observations/ feedback.
 Escort staff for Proper Hands at the begging of the shift
 Facilitate TL for any sick patient to be followed
 Spot checks on clinical special assignment like: Clinical Equipment CC, Floor stock and Narcotics
 Protected time for office work.
 Monthly mock drills to ensure 100 % staff converge
 Effective utilization of educational hour and bring innovation in staff learning than traditional learning
 Student’s supervision and clinical teaching
 Cross teaching with School and Hospital services
 01 02 03 04 05 06 07

What are
Am I prepared Which What is the What is my What are the Which
competencies
to conduct category of best time to goal from these strategies practice
/tools
Clinical rounds the staff to do clinical clinical required to issue needs
required to
with staff ? focus on? rounds? rounds? enhance staff immediate
conduct
? development? attention?
clinical
rounds?
Objectives of Rounds

❖ Assess patients 'conditions

❖ Address questions/concerns and provide
information
❖ determine and evaluate if the care being given
meets the patient's needs
❖ Provide the opportunity to check and monitor
standards of care and take action.
❖ Highlight training needs of the staff
❖ Ensure the environment is clean
Significance of Nurse’s Participation
in Rounds
❖ As front-line caregivers have a deep understanding of
patient conditions so she/he can provide critical insights into
patient progress and changes in condition during rounds.
❖ Enhances collaborative patient care and patient satisfaction
❖ Emphasize the value of nurse for comprehensive patient
care and enhance nursing image.
❖ Ensure patient safety and care continuity.
❖ Monitor staff development
(Merriman, & Freeth, 2022).
Skills for Success During Patient Rounds

Communication Confidence Coordination Confidentiality

The Outcomes of Patient care Rounds

Communication and
Patient Satisfaction Decrease readmission
collaboration in team

Patient safety
Continuing professional
development Prevent Errors and
patient harm
Implementation of a ward round
❖ Set expectations of completed pre‐WR preparation
❖ Inform prior the set time of round
❖ Mostly rounds are done daily at least per shift.
❖ Usually done at the patient bedside
❖ keeping the patient review discussions well-focused and well-
structured, allowing time for everything necessary, whilst minimizing
interruptions and digressions and avoiding lengthy discussion
Challenges/Barriers of Ward round

Lack of adequate
Workload issues
staff

Lack of Lack of leadership

sustainability support
Implementation of clinical/manager leader
Rounds of unit
❖ Inform staff and patient the purpose of rounds
❖ Introduce and have role clarity
❖ Do rounds at the beginning of the shift and Keep duration of round short.
❖ Create opportunities where WR team members feel safe and thus able to
enthusiastic to contribute, listen, and discuss the issues honestly
❖ Mitigate the traditional hierarchical power relations & focused on
interprofessional collaboration.
❖ Follow ACE model of Rounding
ACE Rounding Model
Anticipate

Collaborate

Evaluate
ACE Rounding Flow sheet

Offer toileting

A nticipate/Risk Assessment
Assess pain level
and need for pain
medication
Safe
environment:
and/or ADL’s
assistance needs

Each will be assessed and

performed as needed for each call light/remote Make sure Before leaving
patient. side rails up, bed information on inquiry into any
Assess position or white board is other needs the
reposition needs down
accurate. patient may have

Do you have any Water, tissues,

concerns for the and trash Patient
physician today? receptacle within Satisfaction
reach. with care
room clean
ACE Rounding Flow sheet

Output: daily
Activity: weight,
C collaborate
tolerates/limitatio
ns/appropriate
for discharge
Intake: Fluid/IV
intake, Diet,
evidence of
imbalance

The primary nurse will assess Discharge: teaching, Home health

Psychosocial/beh Complications or
and inform the status to Co-morbidities medication, care
rounding nurse about each avioral needs continuity of care arrangement
patient. Safety

Identify the priority for the day

and the stay.
Do you have any Need of
Follow-up and
concerns for the medical
rehabilitation
physician today? surgical
supplies
 Patient Care Management
 To assess patients at high risk (* sick, altered GCS, bedsores, vitally
unstable patients. (MEWs Score)
 TL/AHN is fully aware of pre and post operative, and discharge
patients
 Ensure that discharge patients have received discharge teaching
about take home medications, diet, wound management, IV line
management, or any other specifications.
 Report any patient related issues: code , aspiration , fall, Phlebitis,
medication error
 Assess patients concerns /complains on shift basis to enhance
patient satisfaction.
 TL is aware of high risk and VIP patients in their units.
 Patient Care Management
• To make quick patients round at the start of the shift in
order to know and check the following:
• Patient census
• Plan of care
• Patient care environment
• Labeling of tubing’s, drugs, Dosage Calculation etc
• IV line
• Foleys care
• Hygiene care
• Drains care
• Complete patient care documentation on timely basis
ACE Rounding Flow sheet

01 02 03
E valuate
Interventions New Areas Need a
& Goals problems plan
identified

04 05
Share with next Hands off
shift Process
Implementation of a multidisciplinary ward
round

Critical
Antecedents Consequences
attributes
(before) (after)
(during)
Antecedents (before)
Key activities before a ward round takes place are:

❖Establishing results of investigations;

❖Preparing patients - in most cases this simply involves letting them
know the round will be taking place;
❖Encouraging patients to think about any questions they may have,
which may help to avoid their forgetting what is important to them;
❖Chasing up any multidisciplinary perspectives of care to discuss on
the ward round.
Critical attributes (during)
This refers to the key activities, and perhaps type of structure, that is
integral to a ward round:

❖Review of unstable or deteriorating patients;

❖Decision making and documenting of care;
❖Review of patients going home (pre-discharge);
❖Review of patients’ progress during their inpatient stay.
5P’s” Purposeful
rounding
(Pain, Potty,
Position,
Possessions, and
Personal needs)

Ram, etl . (2019)

Consequences (after)
Once the ward round is over, a number of activities will be necessary:

❖ Team organization;
❖ Progression of tasks;
❖ Communications;
❖ Repetition of information to the patient;
❖ Motivation of the ward team.
Video time

https://www.youtube.com/watch?app=desktop&v=mcCtYjK9rbg
Nurse Rounding
SBAR (Situation, Background, Assessment,
Recommendation) effective
communication tool for patients’ handoff
• The Joint Commission describes the SBAR communication
technique as,
• Situation: what is the situation; why are you calling the
physician?
• Background: what is the background information?
• Assessment: what is your assessment of the problem?
• Recommendation: how should the problem be corrected?
Shahid, S., Thomas, S. Situation, Background, Assessment, Recommendation (SBAR) Communication Tool for
Handoff in Health Care – A Narrative Review. Saf Health 4, 7 (2018). https://doi.org/10.1186/s40886-018-0073-1
Connection time

• Reflect on a recent patient encounter from the past week

and construct a case report tailored for a multidisciplinary
patient care round.
• Utilize the tools and methodologies discussed in the session
for this task.
• Pair up with a colleague to exchange insights and
perspectives on your respective case reports. Subsequently,
share your case with the larger group assuming that you are
participating in patient round and presenting your case to
consultant, making sure to adhere to the allotted 7 minutes
for preparation and 8 minutes for presenting.
Clinical activity for nurse management rounds
❖ Develop the Checklist for multidisciplinary patient round and present at least
one block patient round and present evidence in portfolio
❖ Develop the checklist for clinical leader round for daily ward round and
present one day ACE round and present evidence in portfolio
❖ Complete at 2 patients SBAR during hands off and and present evidence in
portfolio
❖ Evaluate the patient satisfaction rate of unit
❖ Read and understand IPSG goal 2 Improve effective communication and
related policy for SBAR
Summary
❖Clinical Nurse leader and mangers have a vital role in ward rounds and
should make it a priority to participate.
❖Ensure patient safety and care continuity
❖Ensuring patients/carers are fully involved in care decisions is a nursing
responsibility
❖Follow ACE model of Rounding for unit round
❖4 Cs Skills for Success During Patient Rounds
❖Follow Ps and Ds checklist for multidisciplinary round
❖Follow SBAR for hands-off communication
❖Always be ready for multidisciplinary patient round in 3 stages (before,
during and after)
References
• Close, A., & Castledine, G. (2005, September 8). Clinical nursing rounds part 2: Nurse management rounds. British
Journal of Nursing, 14(16), 872-874..
• El Atty, S. E. S. A., El Mola, M. A., & Azzam, H. F. (2022). Effect of conducting clinical nursing round training
program for head nurses on their clinical round performance. International Journal of Health Sciences, 6(7), 363–376.
https://doi.org/10.53730/ijhs.v6n7.11003
• Henkin, S., Chon, T. Y., Christopherson, M. L., Halvorsen, A. J., Worden, L. M., & Ratelle, J. T. (2016). Improving
nurse–physician teamwork through interprofessional bedside rounding. Journal of Multidisciplinary Healthcare,
9(201–205).
• Mulugeta, H., Afenigus, A., Wagnew, F., Haile, D., Tadesse, A., & Kibret, G. (2020). The effect of hourly nursing
rounds on patient satisfaction at Debre Markos Referral Hospital, Northwest Ethiopia: A non-randomized controlled
clinical trial. International Journal of Africa Nursing Sciences, 13, 100239
• Merriman, C., & Freeth, D. (2022). Conducting a good ward round: How do leaders do it? Journal of Evaluation in
Clinical Practice, 28(4), 411–420.
• Lees L (2013) The nurse’s role in hospital ward rounds. Nursing Times; 109: 12, 12-14.
• O’leary, K., Killarney, A., Hansen, L., Jones, S., Malladi, M., Marks, K., & Shah, H. (2018). Effect of patient-centred
bedside rounds on hospitalised patients’ decision control, activation and satisfaction with care. BMJ Quality & Safety,
25 (12), pp 921-928
• Ram, M. S., John, J., & John, S. (2019). Purposeful hourly rounding by nurses: A best practice implementation
project. International Journal of Nursing Care, 7(2), 16-19.
• Toole, N., Meluskey, T., & Hall, N. (2016). A systematic review: barriers to hourly rounding. Journal of Nursing
Management, 24(3), 283-290.
• Shahid, S., Thomas, S. Situation, Background, Assessment, Recommendation (SBAR) Communication Tool for
Handoff in Health Care – A Narrative Review. Saf Health 4, 7 (2018). https://doi.org/10.1186/s40886-018-0073-1
 54
THANK YOU

• Muddiest and mightiest point

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Share your thoughts
10 minutes each group