Reflective Essay

The Garling Report (Garling 2008) reviews gave rise to visible leadership in health increasing in importance, especially in an acute facility in New South Wales (NSW). Further consideration was given to the increased need for formal leadership skills, taught especially at higher level education such as universities (Middleton, Jones & Martin 2021). Leadership visibility is a topic under professional reflection that pertains to the service delivery of Clinical Nurse Consultants (CNC) (Nursing and Midwifery Board of Australia (NMBA) 2022; Le-Dao et al 2021; Northern Sydney Local Health District (NSLHD) 2019; Fry et al 2013). Each unit within the degree has helped with incremental professional growth, and that has demonstrably impacted on personal growth, too, as reported by family, friends, and peers, especially during annual Performance and Development Reviews (PDRs). Horton-Deutch and Sherwood (2008) detailed three levels of reflection which vary according to the experience and need of the practitioner. Achieving the final unit of this degree the third and deepest level of reflection is appropriate whereby the practitioner explores a complex situation in depth by drawing on various theoretical, ethical, political, personal, and professional perspectives (Jasper 2003, cited in Heckemann, Schols & Halfens 2015). The situation described here contemplates circumstances surrounding the author’s eventual succession to a significantly higher role while commencing this degree.

The intention of tertiary level study is for clinicians to have greater impact, to effectively translate knowledge and skills into healthcare practice (Middleton, Jones & Martin 2021) utilising real world problems, or puzzles, and learning how to apply the solutions in their own situation (Raelin 1997, cited in Rosser et al 2017). Middleton, Jones and Martin (2021) also wrote that completing a university led postgraduate leadership subject facilitates the understanding and appreciation of organisational culture, interpersonal relationships, processes, and systems in a way unique to active learning. Action learning is notable for its variety, be that classic and conventional, or virtual (Brooks 2021). There was undeniable pressure, from the nurse manager at the time, to quickly catch up to the level of higher postgraduate edification, because reluctant secondment extensions were offered, alongside attending several highly stressful interviews for the permanent part-time role. Reflecting, lack of success would have been due to the author’s deficiency of postgraduate education in an 18 year career, low leadership knowledge of wider impact, and the lack of capacity for receipt of mentorship or succession training (Le-Dao et al 2021). This bred haunting feelings of imposter syndrome within the secondment experience, from a perception of the prevalence of biased toxic cultures in the organisation, apparently ‘valuing overwork and individualism’ (Tulshyan & Burey 2021.) The CNC role requires that nurses incorporate professional leadership, education, research, and support of systems into their practice (NMBA 2022; Fry et al 2013). As a new CNC there was little space provided for mentorship, a side-effect of the role itself (Thomas & Osborne-McKenzie 2018) and a source of political instability around the organisation. It was self-identified there was a need for reflective and mindful practice in order to process and apply the university’s teachings in the author’s lived experiences. Degree students took the opportunity to identify their own leadership style, understand the theoretical background of it, and ensure their style is congruent with their organisation’s values. Aiming for resonant leadership, the gruelling battle has been balancing work life, university expectations, and familial obligations. As Brook (2021) wrote, the motivation to act and learn was both personal and political.

From revision of past units, re-reading marked assignments and their feedback, plus the valuable interactions gained within rare discussion groups, much wider, functional expertise has been gained at the level required of a Grade 3 CNC in NSW (NMBA 2022; Fry et al 2013). This rank is the highest nursing consultant rank, and it therefore carries a lot of power, and there are so few in the same position (Thomas & Osborne-McKenzie 2018). Rosser et al (2017) advocate belief in oneself gives one power that influences others. It is called up via ‘working from the inside out’ (Rosser et al 2017). To look with critical appraisal at each situation, in conjunction with an awareness of own beliefs, values, and practice requires a conscious skill that needed to be learned rather than being innate (Patel & Metersky 2021). Deep reflection and evaluation have become a cornerstone of this author’s clinical leadership practice and are prized topics of study within every unit of the current program: H4F Bachelor of Nursing with Professional Honours (Leadership in Practice). The other three cornerstones of this author’s leadership disposition are ensuring current practice fully meets job criteria through active learning, seeking work-life balance to avoid burnout, and future-planning, supporting all with emotional intelligence (EI). A career development plan, including a current curriculum vitae (CV), is lately viewable as an e-Portfolio, which would not have occurred without exposure to this capstone unit. Andre (2010) highlighted that e-portfolios will assist with proving competency and planning career progression.

One assignment involved interviewing a person known to the author, already in a leadership role. He described, even when you’re full-time, it still takes months to be comfortable, and years to feel completely authentic in a new role (M Toose 2021, pers. comm., 22 March). Applying that understanding to this part-time position, it became clear there was an expectation from medical co-workers, and the author, too, to work harder and more visibly to have more impact, in order to be able to perform better in the mere two days a week of the role. Successful leadership within healthcare organisations highlights the importance of EI for insight into the self of the nurse transitioning through change (Hegney et al 2019, Thomas & Osborne-McKenzie 2018). Heckemann et al (2015) endorses the awareness of co-worker emotions, notable for sustaining positive working relations and communication. As Horton-Deutsch & Sherwood (2008), Heckemann et al (2015), Rosser et al (2017), and Hegney et al (2019) all espoused, EI is a skill to be fostered in advanced practice nursing. Heckmann et al (2015) stated EI is linked to resonant leadership, the hallmark of which is the ability to work in tune with their staff and colleagues, using EI skills to manage their own emotions, as well as co-workers’, thus creating positive work environments, which increases job satisfaction, improves recruitment and retention, and staves off burnout (Diehl et al 2021). At this stage the author feels greater emotional competence and is furnished with boundless skills to interpret and conduct high quality research, to identify and promote stakeholder engagement, lead resonantly, generate change for greater organisational good, practice in congruence with the organisation’s values, and improve care of the person-not-patient with best evidence-based practice.

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