Reflective Journal on Nursing Leadership

Week One

On my first day of clinical placement, I was excited, and it was nerve-wracking at the same time. I had to wake up at 5.00 am. On this day, we had a bit of orientation with the clinical educator who was responsible for our placement as well as assessment.  He gave us templates that had the hospital mission, vision as well as the organisational culture of nurse department in that hospital. The purpose of the hospital was to provide quality treatment for all.

Furthermore, the templates had various leaders and their responsibilities in the nursing area that we had to report to in case of anything. It was the team leader to report to the service manager who then is accountable to the head of the department. All these leaders worked in collaboration to identify opportunities that help improve quality, productivity as well as efficiency in service delivery. The clinical educator gave us the hierarchal procedure of how issues should be handled. The head of the nursing department was responsible for leadership and direction in that department. The hospital was using a participative leadership style where the opinion of the staff is heard before any decision is made (Sullivan, 2017).

Once this was done, we all went to our respective ward, mine was the Oncology department, where we are assigned a “buddy”, who is one of the registered nurse working in the hospital. She explained everything in details without me necessarily having to ask many questions right from medication, how the machines are operated, and the procedures. I followed my buddy the whole day, which is practically running the entire day since nurses are constantly on the move.

She oriented us in the Oncology area which included oncology clinic, Radiotherapy area, PET scan, Day-care area, Ward 44 and 54. In a day, five oncology clinics are operated. She gave us basic statistics in this unit. In the daycare unit, which consists of chemotherapy infusion suite, it had a capacity of 10 beds which were meant for female, 10 for male and 7 for paediatric. Ward 44 has a capacity of 22 beds with 26 assigned nurses. Ward 54, on the other hand, had 15 beds for adults, 9 for paediatric with a total of 34 nurses.

She was kind enough to explain to me how to manage time using the Urgency Chart, a time management system where activities are divided in accordance with their priority. For instance, urgent but important, important but not urgent, urgent but not important, busywork or wasted time. She insisted that if one failed to chart any activity, it is considered it never happened. This chart is reviewed every week and filled up monthly.

This week our hours were from 7.00 am to 4.00 pm which is extremely tiring but passes really quickly, and so the chart came in handy. This time was applicable in the in the oncology clinic, day-care, Radiotherapy, and PET scan area. She, however, informed us that from next week, we would be assigned in the in-patient unit, ward 44 and ward 54, which as 12 hours per shift. One nurse was responsible for three patients. The nurses were assigned to patients using the patient acuity technique. By the end of the week, my time management skills were in control.

Week Two

Nursing is one of the largest profession overwhelmingly dominated by women, and an individual would think that women receive equal pay. The small minority of men population still does well financially. 93% of women are nurses, and 7% who are men still earn more money despite decades of equal pay laws. According to an online report in JAMA in March 24th, men are still paid around $5000 more than the female counterparts in the Nursing Field even after factors such as education, experience, working hours, clinical speciality as well as marital and parental status have been adjusted. This was one of the hot topics the department was tackling and trying to find ways to mitigate this gender pay gap.

He also mentioned that the field of nursing had undergone so many changes and as a nurse, it is good practice to learn how to adapt to those changes to be relevant. As such, the institution tries as hard as they can to train their nurses frequently so that they keep up with all these changes in the industry. For instance, new leadership and new practice approach such evidence-based practice were being adopted. This technique facilitates transparency in leaders as well as employees. He mentioned in just six years, 50% of what nurses learn while in school becomes obsolete and irrelevant. With such an enormous increase in the knowledge base, it is essential for nurses to enhance and update their skills. These skills enable nurses to be in a good and better position to represent and advocate for health care needs of the general public as well as the fellow nurses. As such, nurses should have more administrative roles in the government in the healthcare system.

Week Three

Nurses face challenges that limit and threatens nurse-led efforts. Chief of the is the existing and projected nurse shortage which is compounded by the inadequate educational facility to train them into next generation of nurse and educational programs that need to be improved to keep update with clinical practices.

I learnt that nurses go through a lot of ethical challenges and it is significant to understand the ethical climate. Such issues can be maintained by consulting the ethical experts. Furthermore, patient information privacy was vital in accordance with the HIPAA law, and any violation could lead to a lot of consequences. Additionally, in accordance with health policy, patient safety was the top core of the medical institution, and the institution put a lot of emphasis on the simple procedures such as hand hygiene before handling the patient. Therefore, the quality department had a weekly meeting on reviewing the standards, and they do an internal survey once a month.



Sullivan, E. (2017). Effective leadership and management in nursing. 9th ed. Pearson Prentice Hall.

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