Autocratic leadership style and its application to clinical practice

1.Healthcare professionals are required to demonstrate suitable leadership and management skills, so that engagement in the decision-making process is appropriate for best quality care delivery (Huber 2017). The present essay critically analyses the leadership theories of Autocratic leadership and Democratic leadership as observed in the management placement concerning adult nursing practice. The essay defines each leadership style and highlights the different aspect of the application of the leadership styles to clinical practice.

My management placement has been a valuable period that has brought about significant changes in my professional practice through the enhancement of knowledge and development of skills. Throughout the placement, I have given considerable attention to understand the different leadership styles that have been exhibited by the professionals in order to manage the tasks being assigned. As per my observation, the leadership style executed can lead to far-reaching impacts on the operations of the healthcare organization. As opined by Cherry and Jacob (2016) leadership in care organization has a direct impact on employee attrition, the morale of team members, teamwork, productivity, and ultimately patient care quality.

The first leadership style that has drawn my attention is Autocratic leadership, which is a classical leadership approach. According to West et al. (2015), Autocratic leadership is marked by individual control over the decisions taken without considerable input from the group members (Huber 2017). Autocratic leaders are found to make choices based on the judgments and ideas, and are not inclined towards accepting advice from followers. Therefore, this form of leadership involves authoritarian and absolute control over the team members (Gopee and Galloway 2017). The Autocratic leadership style involves the nurse leader who is responsible for making all-important decisions and giving particular orders to the other team members. Such a leader discourages the team members from questioning the reliability of the directives issued (Hudak et al. 2015). Autocratic leaders are able to engage in suitable decision making process due to their critical thinking skills, and hence they are able to deliver high quality of care.  Autocratic leaders are able to ensure that high quality care is delivered in an effective manner (Delmatoff and Lazarus 2014). Throughout my placement, I have observed the clinical leader to act confidently and communicate with the team members in an authorize manner. As a leader, he had to deliver commands to the members and expected them to act according to his directions. Nevertheless, he was efficient in engaging in critical decisions when the need for input from other team members is minimal. This is highly appreciable since the leader can prevent the complication of matters, and thereby eliminate the risk of patient harm (Sfantou et al. 2017). Precisely, Autocratic leaders must be direct and clear when other professionals are being organized to ensure that they adhere with the respective standard procedures (Finkelman 2015).

Democratic leadership style and its advantages in clinical practice

Shingler-Nace and Gonzalez (2017) identifies that Autocratic leaders have been found to be typically decisive. In case of the complex situation, such leaders can act appropriately. However, decision-making without the input from others can cause a misunderstanding with the team members. Further, Autocratic leaders are inclined to take decisions in an independent manner (Finkelman 2015). This has the potential to inhibit the quantities and qualities of ideas that come up in due course. Weiss and  Tappen (2014) in this regard has highlighted that Autocratic leaders act as micro-mangers, and have high demand from the team members. The same was observed in my placement setting where team members were often frustrated and dissatisfied with the work environment. The stress suffered by the team members acted as a barrier in delivery of optimal quality care. 

Democratic leadership style is the second leadership style that drew significant attention as being exhibited by the professionals in the care organization. McKeown and Carey (2015) defined Democratic leadership as a form of participative leadership wherein the members of the group have a participative role in the decision making process. In such a leadership form, the leader allows all followers to put forward their opinions and views, and exchange ideas for better decision- making (McKeown and Carey 2015; Weiss and Tappen 2014). While this process has the focus on the free flow of opinions and ideas, and group equality, the leader still has the accountability of providing guidance and exercising control (Crowell 2015).  According to Sfantou et al. (2017) it can be stated that Democratic leadership is considerably distinct from Autocratic leadership, and the two can be understood as the opposite to one another. Democratic leadership values affirmation of followers, and collaboration. Through such a leadership form, nurse leaders can include other professionals in the decision making process and distil ideas for finding novice care approach (Finkelman 2015).

Weiss and Tappen (2014) pinpointed that Democratic leadership is ideal for those cases where the leader has the aim of keeping the members informed about the crucial matters that can affect their actions. For maximizing service quality, clinical leaders are to advise members to develop an effective partnership with each other, thereby permitting open expression of ideas regarding patient goals, care interventions and health outcomes (Gopee and Galloway 2017). Sfantou et al. (2017) argued that there are several downsides of Democratic leadership. According to Finkelman (2015) in cases where the members have less clarity of roles, Democratic leadership might lead to uncompleted missions due to communication failures. In addition, a certain section of the group members might not be having the required knowledge and proficiency for making substantial contributions to the valuable decision making process. Grohar-Murray, DiCroce and Langan (2016) supported this by stating that Democratic leadership works best in cases where all members are ready to share the knowledge they have. Further, the considerable timeframe is required so that the members can put forward their opinions; otherwise, the decision making process would be faulty (Huber 2017). In my placement, the democratic leadership style witnessed made me acknowledge the benefits of the same. The key benefit was increased motivation of the team members who were ready to put in additional efforts to make the care process successful. The leader showing democratic leadership style was successful in creating an environment where the base is founded upon ideals of certain individuals who are highly vocal

Benefits and drawbacks of Autocratic and Democratic leadership styles

In the end, it can be concluded that leadership holds much potential to influence the nature of practice in an organization. Both Democratic and Autocratic leadership styles have their own sets of benefits and drawbacks, each of which holds much importance in practical situations. As a nurse leader, it would be imperative to understand the complexity of the situation and the competencies of the team members before deciding on the form of leadership that is to be implemented within the workplace.

2.a)

_{Clinical Incident Report Form}

Individuals details	Date of incident:	27/12/17
Hospital number:	123456	Time of incident:	1500
Name:	Mary Grey	Exact location:	Ward 3, Drake Hospital
M/F:	F
DOB:	01.02.1936
Name and designation of person reported to at time of incident	Francy George (Student Nurse)
Outline circumstances of incident ·        Handover taken on 27.12.17 patient’s daughter reported that Mary has not had a wash or as not been offered oral hygiene. ·        Daughter informed a pot of tablets left on her mother’s bedside locker. I reported it to the nurse in charge and my mentor, who advised me to bring the medication we both checked out what it was. 2 b)                Area of concern Action required Resources needed Criteria for success Personal hygiene: – ·         Mary may need assistance with washing. ·         Mary’s not offered or given personal hygiene. Oral hygiene: – ·         Mary’s not offered or given oral hygiene ·         Poor oral hygiene may lead Mary to have unpleasant taste and dry mouth. Medication Error ·         Medication found on top of the locker. ·         Mary may need assistance when medication is administered. ·         Unknown if pervious staff administered medication as the medication was left in unsafe manner. History of falls  (5 years ago) ·         Mary’s at risk of falls ·         Mary may have poor mobility which can affect her personal needs, ·         Mary may need close monitoring / assistance if she will be mobilising. Mary’s Daughters Upset ·         Daughter annoyed /upset ·         Daughter concerned pot of medication left on top of bedside locker and hygiene. ·         Ask Mary what she is able to do and assess Mary’s capacity. (NMC, 2015).  ·         Encourage Mary and give support to patient, if patient refused to have personal care. ·         Ask Mary how often she would like a wash and clarify the times she would like her personal care. Act in best interest of the patient (NMC, 2015).  ·         Ask Mary how often she would like to have her oral hygiene and clarify the times she would like her oral hygiene. ·         Assist Mary when brushing her teeth and help Mary if needed. ·         Offer Mary a glass of water, as the mouth could be dry (Major, 2005). ·         Check if Mary is able to drink and eat comfortably. ·         Escalate to mentors/nurse in charge that medication left on top of the locker. ·         Check drug chart to see administration of medication and if it correctly has been documented (NMC, 2015). ·         Escalate to medical team and inform Mary’s has missed her medication and check to see if missed drugs need to be re administered. ·         May need further investigation on what happened and possible action. ·         Assess mobility and observe for what Mary is capable of doing for herself, According to the observation assess if Mary requires any aids example; walking stick/zimmer frame. ·         Use a fall assessment tool, to assess function capacity and ability (NICE, 2013). ·         Access if Mary requires bed rails or a lower rise bed (NMC, 2013). ·         Check Mary’s footwear at all times, when mobilising. ·         Apologise to daughter. ·         Reassure daughter about the situation & explain this would never happen again. ·         Patient Advice and Liaison Service (PALS) leaflet given in case the daughter wanted to lodge a formal complain. ·         Things required for the personal care: – Hot water, bowl, shower gel/soap, flannel, shampoo, towel, clean pad, clean bed linings and clean nightwear/kicker, hair brush ·         Required staff: – Nurse, health care assistance and OT also could be involved to monitor to see if Mary may require assistance when being at home. ·         Things required for oral hygiene: Toothbrush/toothpaste, bowl of water and a cup. ·          If Marys has dentures Provide dental kit, example: – dentures tablet to clean false teeth & toothbrush ·         Medication chart/medicine drug trolley.  ·         Assist Marys at drug around before leaving the bedside. To make sure Mary takes the medications. ·         Assess Mary’s consent and capacity, so that importance of medication can be explained to Mary. ·         Dispose medication found on top of locker by following policy and procedure on how to dispose medication (Standards for Medicines Management 2010). ·         Involve physiotherapy to assess Mary’s mobility if needed. ·         Mary may need aids to help her walk if needed and bedside rails if needed, ·         Mary’s needs own footwear if possible, slippers or non-slip socks when mobilising, & ensure call bell in reach at all times. ·         Required staff: Nurse / Nurse in charge ·         Mary has had a wash with assistance and consent. Personal care given as often as when Mary requires it. ·         Mary has clean bedding present and clean nightwear on. ·         Checked with Mary if she is happy and comfortable. ·         Documented in nursing care plan. ·         Mary feels mouth is clean as inside of the mouth is pink and moisture. ·         Observe inside Mary’s mouth and tongue, should appear pink & clean (Coker et al. 2017). ·         As mouth is clean, Mary’s able to eat and drink comfortably. ·         Mary’s medication all administered correctly. ·         Disposed the medication by following the policy and procedure.   ·         Mary’s had capacity to take medication with no assistance, support and encouragement given.  ·         Mary’s own medication is locked away next to bedside locker and not left unattended. ·         To make sure medication error does not occur again. ·         Marys able to mobilise safely with walking aids if needed. ·         Mary feels happy/confident in mobilising. ·         Marys has appropriate footwear when mobilising. ·         Mary’s falls risk is reduced. ·         Apologized to the daughter ·         Daughter reassured is given and happy that Mary’s now had wash/oral hygiene. ·         Daughter is happy that Mary has taken all her medication
Action taken at the time of incident  ·         Incident report to the nurse in change and mentor ·         Offered Mary personal hygiene and oral hygiene with consent and Mary assisted and supported with other healthcare assistance. ·         Pot of tablets from beside locker removed and disposed. ·        Inform medical team and seek advice if missed medication needs to be re-administered but we could not pinpoint what time the tablets were left beside the table and if they belonged to the patient. Pharmacist was also notified about the incident and the tablets were discarded. ·        Check Mary’s drug chart to see if medication has been administered from the previous staff on shift. I called the nurse that was looking after the patient before us to ascertain if she knew anything about the medication and she said she had watched Mary take her medication. ·         Investigate to see if any members have helped Mary throughout the day in regards to Mary’s personal care needs. ·        Apology given to the Mary’s daughter and patient about the situation.  Daughter was informed about the procedure we were going through, for example informing the doctors and pharmacist and completing a clinical incident report from. ·         Gain consent from Mary before information shared with the daughter and healthcare teams. ·         A clinical incident report form filled out. · Patient Advice and Liaison Service (PALS) leaflet given in case the daughter wanted to lodge a formal complain.  · Documented in patients care plan about incident.
Person completing form:	A. Student
Designation:	Student Nurse
Department:	Ward 3
Date:	27/12/17

   3.Example from my management placement was managing a deteriorating patient with his activities of daily living. In order to present the theory and management style logically, Gibbs’s reflective cycle Jasper (2013) will be used to analyse my own management style.Description of the event: At the beginning of the management placement, I was allocated to manage a patient who was at the last stage of a terminal cancer, and was very ill. The care was managed using Roper et al (2008) activities of daily living.The management theory adopted was The Bureaucratic model of management. Because according to Grohar-Murray and Langan (2011), this model is known for the use of extensive rules and procedures to govern the work of the employees. This model was chosen because it is a structured theory that organizes people and tasks, and it demands adherence to certain principles such as promoting discipline and attaining reliable behaviour amongst the workers (Grohar-Murray and Langan 2011).Feelings: In order to manage this patient effectively, my own management style focused on helping this patient meet the needs of his daily activities of living as Roper et al (2008) emphasized. However, at this stage in my management placement, I was nervous and unsure of what to do and where to start from.Evaluation: my priority was to ensure my patient needs are met. With reference to bureaucratic model, what was good about my management style was to adopt some of its organizational principles so as to manage my patient effectively.One of the principles adopted was delegating tasks to other members of the team such as the healthcare assistance and asking for my mentor’s assistance when needed. O’Grady and Malloch (2013) reveal that delegation is required wherever there is a hierarchal order of individuals working together to accomplish a goal.The purpose of delegation is to achieve efficiency in the work place; in order words, no one person can do all the work that must be done (Forman and Fox 1999). One of the instances I realised the effectiveness of delegation was during meal time and the patient must be assisted with feeding. On this basis, the HCA who I designated helped to feed this patient. However, it must be remembered that, the ultimate responsibility for that activity still belongs to the leader (O’Grady and Malloch 2013). To be able to account for my actions, the situation was first assessed to ascertain the competence of the delegate.Analysis: what went well with this style was the ability to maintain effective communication within the team. Therefore, to ensure effective communication, I was able to identify the scope of ability, and job description of the staff to which the task is been delegated to.  Grohar-Murray and Langan (2011) supported that a manager should be able to know the position and abilities of the person before delegating work to the subordinate. Conclusion:  One of the criticisms of this management style was fear of work been done properly Grohar-Murray and Langan (2011). My biggest challenge was fear of depending on others. As a final year student, I thought being independent will reflect my strength and competence.Therefore, I future, I will see delegation as part of a shared leadership which promotes learning and reduces workload in a team environment, thus building confidence.