Effective Management in Health Industry

The aim of this reflective management journal is to critically analyze the incident, which occurred in my clinical practice where I work as a senior nurse in a team of staff nurses. Using Gibb’s model, the emerged feelings, thoughts and corresponding themes connected with the incident will be identified, and finally, possible solutions will be generated. It is an undoubtable fact that emotions can demonstrate what a person really thinks and what attitudes he/she holds. Therefore, by utilizing the aforementioned reflective model, my intention is to become more self-aware and reflective. In addition, critical thinking is supposed to improve personal strengths and success and that of my followers. As Horton-Deutsch states, “it is important to be aware of one’s thinking in order to understand oneself, and to make informed and logical decisions when working with others. In turn, attending to the thoughts, feelings, and behaviors of others facilitates progress toward achieving professional and organizational goals.” After generating possible solutions, the most appropriate one will be discussed and selected. Considering a conflict as an opportunity to discover new sides of personalities and foster change for the better, it will be wise to reveal my particular goal, which is to improve communication and enhance collaboration between all the team members as well as promote their personal and professional growth.


Consequently, reflective judgment and elaborated analysis of the conflict will establish constructive relationships among all the participants. Moreover, the conflicts constantly arise in the working process; they result from various types of contradictions that ultimately lead to the corresponding change and evolvement. The task of an efficient leader is to productively manage any type of conflict and turn it into a constructive experience and motivator of progress due to the reflective practice. In this study, by utilizing Covey’s theory, an attempt to solve an interpersonal issue that occurred in the respective team of nurses will be made. Moreover, the negative experience will be turned into a development means of both the followers and me personally.

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Journal of the Incident/h3>
To start the management journal, it is reasonable to state the factual information concerning the incident, which happened at the workplace and which presents a specific interest as it is related to my goal to improve the teamwork. Further, the thoughts and feelings provoked by the conflict will be reflected; this stage corresponds to Description, Feelings, Evaluation, and Analysis phases in Gibb’s reflective model (Gibbs).

The incident happened between a middle-aged experienced nurse (she is one of the staff nurses, though not a senior one) and a young nurse who had just started her practice. The older woman provoked a conflict and expressed her irritation at the younger one in a rude manner. Moreover, she shouted at the young colleague in front of the patients and other workers who were present in the department. When the crying nurse informed about the incident, it raised a range of strong emotions. It is necessary to state that first I felt annoyed, desperate and even furious. Furthermore, I had fear because despite the fact that I was a senior worker in the team, this nurse was older and more experienced. Consequently, this difference in age produced additional complications. First I decided that it was better not to initiate any conversation with her, since it was her usual behavior and the staff seemed to accept her as she was.

Analysis of Journal

Continuing analysis, the following themes may be distinguished: issues in the interpersonal relationships within the team, bullying the young personnel, negative emotions and stress at the workplace, and heightened level of anxiety in young nurses due to unhelpful behaviors of their seniors. Moreover, I noticed the problem in this experienced nurse’s motivation: regardless of her age, she was a staff nurse without any senior responsibilities. The next step was to discuss the emerged situation with witnesses, both medical workers and patients. In such a way, it was possible to gather enough data in order to create a vivid picture of what had occurred. After analyzing all the circumstances, the conclusion was made that it was vital to engage in problem-solving with the nurse who demonstrated unhelpful behavior. It was important to determine and identify the specific problem (or problems) together as well as generate its possible solutions and choose the most appropriate one. It seemed that it was the most constructive way of dealing with the conflict.

Reflection and Linking to Theory

To make a reasonable and evidence-based decision, I collected relevant information first via observations, reports presented by others in the clinical unit, and communicating with the nurse herself. Having obtained the objective judgment, I noted all the circumstances and made an attempt to create a vivid and true picture of the emerged situation. From the personal observations, combined with reasonable arguments, logical inferences and conclusions, it was possible to get sufficient evidence for the further decision-making process. Thus, it appeared that this nurse’s disruptive behavior was noticed repeatedly in her practice. Moreover, her unhelpful behaviors were directed not only at the younger nurses but also at the patients. Consequently, this issue raised the severity in the clinical environment. It is also reflected in the research as a looming problem of practice settings in regard to the concepts of nurses “eating their young” (Hamric) or “incivility” in nursing (Clark & Olender).

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Taking into account Covey’s imperative to “be proactive”, my decision was not to ignore the unpleasant situation, but to deal with thoroughly and productively with the problem. In order to act promptly and produce an anticipated reaction to a stimulus seems ineffective and simplistic. According to the typical behavioristic formula “Stimulus – Reaction” (described by famous psychologists like Thorndike and Skinner), the mode of behavior is neither productive in the human relationships and performance nor in all humans (Hjelle & Ziegler). As Frankl described in his famous book, a person in any circumstances has still the choice to rise over them and choose own reaction and attitude. Then, having made a decision, one becomes responsible for his choice and life in general. Moreover, neither external circumstances, nor subconscious instincts and any other mechanisms are able to determine his behaviors and thoughts. It is important to become conscious and self-aware as well as to choose one’s own way (Frankl). To be a proactive person, I decided that the solution of this issue was within my circle of influence (Covey). I felt my responsibility for the outcome of this conflict, since it happened within my team. Therefore, simple reactive behavior was not appropriate and contradicted my values connected with the features of an effective leader. I agree with Covey that the eternal values and principles must be of the first priority, such as “trust, fairness, service, courage, humility, integrity, human dignity, contribution, growth and empowerment” (Covey, cited in Govier & Nash). It was decided to act in accordance with the afore-mentioned values. Moreover, I decided to make them apparent to the nurse so that she could acquire these values in her own attitudes, behaviors, and interpersonal relationships.

Regardless of the grave nature of the incident and my ardent initial emotional reaction, I managed to control and avoid the feelings so that they do not prevent constructive solution to the conflict. Taking Covey’s Habit 2 “End in mind” as a guide while taking a decision how to deal with the nurse, I had a clear target, which was to achieve positive outcomes for all the participants and the whole organization. In other words, it was urgent to promote personal development, transformation, and maturation of the nurse as well as ultimately improve the efficiency of the whole team. To use conflict as a means of development is another important idea revealed in the respective research (Govier & Nash). In this regard, it was impossible to suppress any emotions. Being determined to become a transformational leader (the concept of transformational leadership will be discussed later in the paper), I must learn to deal with any type of complexities, evolve stronger and more accomplished from adversities, as well as inspire my followers to accept negative incidents as opportunities to grow (Bass & Steidlmeier; Oliver; Givens; Brown & Mitchell Frankel; Hamric).

In this concern, I made a decision to utilize the ideas of the strength-based approach in order to engage the nurse in a more productive and solution-oriented dialogue (Gallagher). Moreover, the position of mutual respect and endeavoring to make a person feel comfortable while communicating with me are in compliance with my personal philosophy of interpersonal relationships. Therefore, in order achieve the goal of engaging the nurse into the discussion and make her feel safe, open, and ready to solve the general issue for the common positive outcomes, I started from expressing some neutral observations. Applying the so-called “Neutral Zone” at the beginning of any dialogue allows one “to remove the threat stimulus”, and “an innate survival instinct” of an individual does not switch on and does not induce him/her get defensive (Gallagher).

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Consequently, in order to solve the raised conflict between the nurses, I decided to analyze the situation with objectivity and justice as well as listen to the both parties carefully. It is considered that such leadership style promotes justice and equality in the work setting and is close to the notion of “action learning, which is about reflection and experiential learning. It is a balance of support and challenge.” (Govier & Nash). During the process of decision-making, I also tried to account for the peculiarities of her personality. As Covey states, within the personal Production Capability paradigm, it is necessary to enhance all the four personality domains: physical, mental, social / emotional, and spiritual. Discussing various sides of her life, I aimed at realizing her motives, attitudes, feelings, and values; her general set of beliefs and meanings that influence her choices in everyday performance and interactions.

While following such a plan, I considered the 5th habit by Covey and tried to listen attentively to the nurse’s arguments as well as demonstrate empathy. In other words, my approach in communication with her was first to understand and then seek to be understood (Covey). It frequently occurs that angry behaviors and reactions do not necessarily result from the associated conflicting type of the personality. Within the framework of emotional intelligence, it is vital to become aware of own thinking processes and feelings. McQueen states that emotional intelligence, which includes interpersonal and intrapersonal skills or the skills of social analysis are part of the nursing work. On the one hand, the nurses must be able to interpret and understand feelings, motives, and concerns of the patients. Additionally, McQueen asserts that negotiating skills, high performance in human interactions and relationships are required for excellent teamwork of the nurses. Therefore, we discussed different aspects of her life and her relationships with the family members. I consider that my initial approach of focusing on strengths (Gallagher) allowed me to create a positive cooperative attitude of the nurse. She was ready to share her troubles with me because she realized that our common goal was to assist her in the difficulties she faced. In turn, analyzing her reports, I realized that the nurse had considerable problems with her interpersonal communication and decided to make a plan for her improvement in this sphere. The necessity to enhance her both interpersonal and emotional intelligence (McQueen) was evident.

Thus, in various spheres of communication (except for colleagues, also family and friends) she demonstrated emotional immaturity, incapacity to control her initial inadequate reactions, lack of the ability to understand and co-operate with people. In addition, a low level of intrapersonal intelligence did not allow her to recognize and judge own feelings, be aware of her own self. As McQueen states, “an accurate picture of one’s self . . . [is necessary] to operate successfully in life” (p. 102). Finally, I was able to arrive at such conclusions on the basis of the objective observations, her reports and those presented by other people in the clinical unit. Consequently, it was possible to make reasonable decision grounded on the substantial evidence.

Finally, we tried to create a mutually beneficial solution to the problematic situation, bearing in mind Covey’s win-win dimension. The nurse agreed that behaving polite and civil with others, she can gain positive personal outcomes. First, she will attain respect from the team members. Moreover, it will bring positive emotions at the workplace and promote the feeling of job satisfaction. In addition, she will be able to get the opportunities for her professional realization by teaching younger nurses and mentoring them. In particular, it is hard to overstate the role of mentorship for the young personnel. Many researchers stated its importance in their studies (Oliver ; Frankel; Clark & Olender; O’Grady; Hamric; Linette& Sherman).


Consequently, we included the development of the mentoring characteristic of the APN leadership competency into our common plan. Specifically, these elements included shared vision, serving as a mentor, willingness to share the power, empowering self and others, and self-reflection (Hamric). The final unit of the plan comprised two more objectives, namely time and stress management. The respective reason was that the nurse acknowledged that she often felt annoyed and desperate due to the enormous workloads combined with insufficient time for its completion.

From my side, job satisfaction of my followers is my major purpose since it can promote their effective performance at work. The current research has shown the interrelation of high performance, job satisfaction of subordinates and ethical, transformational leadership style (Bass & Steidlmeier; Brown & Mitchell). In order to achieve a shared goal, a good leader must be able to “to explore personal and team motives/beliefs in accomplishing a change or perceived vision of success“(Oliver). Having chosen the leadership concepts and styles mentioned above as a guide in my professional evolvement, my principal target is to support reflection in my followers, inspire confidence in them, and their desire to become more professionally accomplished. In such a way, as a senior nurse, I will be able to achieve high outcomes for our clinical unit.

The current research has defined the concept of leadership as a “multifaceted process of identifying a goal or target, motivating other people to act, and providing support and motivation to achieve mutually negotiated goals” (Porter-O’Grady, cited in Frankel). In fact, scientists in leadership domain present a large number of theories, including: great man, trait, contingency, engaging, transactional and transformational leadership theories (Bass & Steidlmeier; Govier & Nash). In accordance with my inclinations and principles, transformational (which is also inspirational and ethical) framework seems to be the most appropriate foundation for creating my own authentic leadership style. Considering its four key components, being idealized influence, inspirational motivation, intellectual stimulation, and individualized consideration (Bass & Steidlmeier), transformational style grounds have a great impact on the leader’s ability to motivate the follower to accomplish more than what he planned to accomplish. Charismatic transformational leader achieves high personal and organizational outcomes because he/she succeeds in making the followers’ and the organization’s values become congruent (Givens).

The most important concept of the transformational leadership deals with the morality and ethical beliefs ruling leader’s behavior (Brown & Mitchell). Bass & Steidlmeier assert that only a leader with morally uplifting values can be considered transforming and influence his/her followers’ high standards of moral ideals. Brown & Mitchell add that people are likely to conform to the ethical values of their leaders and follow his/her role models. Moreover, ethical leaders are perceived as approachable as well as ready to deal with the individuals’ problems and concerns. Moreover, the followers tend to reciprocate with beneficial work behavior when they feel beneficial attitude of their leader (Brown & Mitchel). I consider that completely supporting the view of the ethical transformational leader, it is critical to navigate through the conflicts and adversities with absolute norms and principles in mind, which are called “a compass” by Covey (cited in Govier & Nash). The only directing force that controls one’s decisions, attitudes at work and any interpersonal relationships must be morality and justice. Finally, to be able to navigate the change in a dynamic world, a nurse has to be ready to constantly transform and be open to the new experience. Moreover, these qualities enable one’s creativity and innovation in the organizations. Combining personal integrity and eternal values as well as distinct and unambiguous understanding of the health care system standards, it is possible to lead constructive change in the health care environment. Finally, the capacity for innovation is perhaps the most vital in today’s changing world. As stated in the report by the Institute of Medicine, “Creating innovative care models in the patient’s setting and throughout the healthcare community is an essential requisite of contemporary practice.” (O’Grady)

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In case with this unhelpful nurse, prone to conflict with patients and younger colleagues, one of the ways to deal with her disruptive behavior was just to apply some type of disciplinary punishment. However, I consider that such motivation is ineffective as well as causes additional stress and negative factors in practice. In addition, it is my task to mitigate stress of the staff nurses at the clinical setting because a true leader should “role model professionalism and utilize effective communication skills” (Clark & Olender). Extrinsic motivation, which is more the characteristic of transactional leadership, cannot fully involve the individual and force him/her to develop, improve, and achieve the higher goals. Amabile asserts that motivation can be of two cardinally different types, namely intrinsic and extrinsic. The first one is more efficient since it implies a person’s “deep interest and involvement in the work”, as well as “curiosity, enjoyment, or a personal sense of challenge” (Amabile).

In contrast, extrinsic motivation is associated with the goals, which are not connected with the work itself, for example, achieving reward or avoiding a punishment. It is clear that only task intrinsic motivation and precise goal-setting can inspire a person to grow. For this reason, I have chosen these concepts in my own performance as a leader. In particular, together with my nurse, we created a concrete plan how to achieve better results for her personal good and more effective communication with the team members. According to Albert Bandura’s social-cognitive theory (Hjelle & Ziegler), goal-setting is valuable due to its ability to promote self-efficacy and resilience at the workplace. Distinct goals help envision the picture of a desired result and identify the next actions. On the contrary, the absence of distinguished aims makes a person spend all energy in his attempts to focus the attention. Therefore, goal-setting can increase motivation, concentrate attention and efforts by creating the images of desired proficiency outcomes in the mind of a person. Consequently, one spends all energy and efforts only on fulfilling the exact plan, which consists of the set goals.

To summarize, I utilized the reflective management journal for the development of my reflection and critical thinking skills. Reflective models used in the health care research, following Gibb’s model, present a helpful set to manage complexities at the clinical practice since they promote understanding and unbiased perception of the problem’s components. It appeared that Covey’s theory is effective in producing the most appropriate decisions and productive solutions. In my practice, I aim at acquiring all the essential characteristics of an authentic transformational leader, with the goals of bringing success to my organization, team, and its every member. My values and principles are in accordance with the absolute moral foundations, the most important value being a human, his personal well-being and multi-faceted development.

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