Standards in Focus

Clinical Leadership

April 29, 2022

This edition of Standards in Focus highlights the Standards of Practice and Conduct that articulate the expectations for clinical leadership and provides you with the opportunity to reflect on how you apply the standards in your practice. Leadership standards related to mentoring were discussed in the first edition of Your Standards in Focus, published in February of 2022.

While all the Standards should be viewed through a leadership lens, category seven (VII) focuses specifically on leadership. Category VII states that licensed practical nurses apply leadership competencies in their practice, whether or not they practise in formal leadership positions.¹ Clinical leadership is an umbrella term that describes the leadership behaviors expected of nurses while providing direction and support to the health care team. ²

Standards primarily related to clinical leadership state that, as an LPN, you must:

Coordinate, distribute, and utilize material and human resources within your control to provide effective and efficient care (Standard 55).
Exercise professional judgment and critical thinking when assuming a charge role — and when supporting, supervising, and delegating to other health care providers, family members, and students — to ensure care is client-centred, is provided as per the plan of care, and is provided in accordance with institutional policies, protocols, and guidelines. (Standard 57)
Understand when to take on a lead role, when to take on a complementary role and when to refer/consult. (Standard 58)
Utilize collaborative and constructive approaches to resolving differences among members of the health care team that affect care. (Standard 63)

Clinical Leadership Competencies

All beginning practitioners will demonstrate the entry-level competencies of the profession. The CLPNM document Entry-Level Competencies³ includes competencies related to clinical leadership. Examples are:

Demonstrates appropriate leadership styles, behaviours, and strategies.
Promotes effective communication between members of the interprofessional team.
Provides education, supervision, and support to unregulated health care providers.

The Nursing Competencies for Licensed Practical Nurses in Manitoba⁴provides information about the competencies that fall within the scope of the practical nursing profession in Manitoba. It includes those that are demonstrated at entry-level and others that may be developed throughout the career of an LPN.

Examples of nursing competencies related to clinical leadership include:

Utilizing leadership and emotional intelligence in promoting group dynamics (e.g., self-awareness, self-management, social awareness, relationship management).
Principles of effective delegation and application to nursing practice to ensure client safety (e.g., right task, right circumstances, right person, right direction or communication, right supervision).
Leadership behaviours (e.g., advising, analyzing, clarifying, confronting, evaluating, initiating, questioning, reflecting behaviour, reflecting feelings, suggesting, summarizing, supporting).

The CLPNM’s competency documents can be accessed here.

Characteristics of Clinical Leadership

As stated in the introduction to the leadership section within the Standards of Practice and Conduct, licensed practical nurses apply leadership competencies in their practice, whether or not they practise in formal leadership positions.¹ The leadership expected of LPNs is often described as clinical leadership.

Clinical leaders are experts in their practice area. They are clinically knowledgeable and competent, provide quality care, and maintain professional growth.⁵ Clinical leaders promote mutual trust between health care providers as they collaborate to provide safe, ethical and quality care.

Domains of clinical leadership include clinical expertise, effective communication, collaboration, coordination, and interpersonal understanding. ^2,5

Clinical Expertise

Clinical expertise is linked to clinical knowledge and clinical competence. Nurses use clinical expertise to make decisions and influence healthcare team members in providing quality client care. ²

Effective Communication

Effective communication is demonstrated through the ability to articulate and clarify information. Nurses serve as the critical communication source within health care teams. For example, LPNs effectively communicate assessment information to physicians and other health care providers.

Collaboration and Coordination

Collaboration and coordination are used to assist others in understanding situations from various perspectives. When LPNs articulate information to colleagues and health care team members, they empower team members by providing them with the necessary information for delivering comprehensive care. ²

Interpersonal Understanding

Interpersonal understanding is demonstrated through the LPN’s ability to relate to others to ensure care is client-centered and appropriate. To promote the best in others, a clinical leader must consider the development level of the person or team being led. When LPNs demonstrate understanding of others’ concerns, they serve as role models for clients and health care team members. ⁶

Clinical Leadership Skills

Clinical leadership skills discussed below include collaboration, assignment, delegation, and conflict resolution. These skills are necessary for leading an effective team. ⁷

Collaboration

Standard 58 states that LPNs must understand when to take on a lead role, when to take on a complementary role and when to refer. ¹

Collaboration occurs when multiple providers from different professions provide comprehensive services by working with clients, support networks, care providers, and communities to deliver the highest quality of care. Practitioners understand their role and competence and the roles of other professions and use this knowledge appropriately to establish and meet client goals. Practitioners recognize that different team members may assume leadership roles as appropriate to the task undertaken. ⁸

Assignment and Delegation

Standard 57 states LPNs must exercise professional judgment and critical thinking when assuming a charge role — and when supporting, supervising, and delegating to other health care providers, family members, and students — to ensure care is client-centred, is provided as per the plan of care, and is provided in accordance with institutional policies, protocols, and guidelines. ¹Standard 55 states that LPNs must coordinate, distribute, and utilize material and human resources within your control to provide effective and efficient care.¹

LPNs may assign unregulated care providers client care tasks within the unregulated care provider’s scope of employment. ⁹When assigning tasks, LPNs are required to:

Use the nursing process to determine a plan of care. ⁹
Understand the scope of employment of the unregulated care provider. ⁹
Provide guidance and collaborate with the unregulated care provider. ⁹
Intervene when unethical or unsafe practice is identified. ⁹

Delegation is different from assignment. Delegation is the extension of authority by a nurse or other regulated professional to an unregulated care provider who does not have the authority to perform a task on their own initiative. Delegation is always client-specific, and the task cannot be further delegated or transferred to another client. ⁹When delegating, LPNs are required to:

Ensure the employer supports delegation of the task. ⁹
Ensure the task has defined limits and does not require the nursing process. ⁹
Understand that the task would normally be performed by a client or their family member as part of self-care. ⁹
Ensure the need, response, and possible outcomes have been identified and documented for the client. ⁹

Conflict Resolution

Standard 63 states that LPNs must utilize collaborative and constructive approaches to resolving differences among members of the health care team that affect care.¹

LPNs actively engage themselves and others in dealing effectively with interprofessional conflict by:

Recognizing and valuing the potential for conflict to occur.
Engaging self and others to be an active part of conflict management through open communication and listening to all team members’ concerns.

Recognize how one’s behaviour and conduct contribute to a conflict situation.

Working effectively to address and resolve disagreements, including analyzing the causes of conflict and working to reach a mutually acceptable solution. ⁸

LPNs must ensure that individuals involved in a conflict have the opportunity to speak to, address, and resolve disagreements, including analyzing the causes of conflict and working to reach a mutually acceptable solution. ⁸

Clinical Leadership and Followership

In clinical practice, the follower role is as essential as the leadership role. There is no one for leaders to lead when there are no followers. ⁹Nurses regularly take on both roles. Both roles contribute to an organization’s outcomes and a healthy work environment. Acting as a follower does not mean a nurse is abandoning their role as a leader. In many work situations, such as when practicing in a new setting, the nurse is a follower. The experience that LPNs gain over time will help them decide the leadership roles required in specific situations or circumstances.

Good followers demonstrate initiative, self-motivation, commitment, honesty, and are goal-oriented. ⁹The relationship between the clinical leader and the follower is interdependent and requires mutual trust and respect. ¹⁰

To read more on the expectations related to clinical leadership, please refer to the following CLPNM documents, both of which can be accessed here.

Assignment and Delegation to Unregulated Care Providers Practice Direction
Interprofessional Collaborative Care Practice Direction

Nursing Practice Scenario

The following scenario displays an example of clinical leadership:

John Smith, LPN, is starting the day shift. When John arrives at 0730, the unit is hectic. Sara Jones, LPN, the charge nurse, states, “I don’t have time to take a team approach today, we’ve had many sick calls, so I’m swamped. I’m not going to collaborate with the team to make the assignment.” John knows from 12 years of nursing in busy acute care units that teamwork and communication are necessary components of clinical leadership, and they contribute to the provision of safe, ethical, and quality care.

John contemplates how they can respectfully disagree with the charge nurse’s decision not to collaborate and take a team approach to meet client care needs. While Sara is making the assignment, John asks to speak to Sara privately. Sara, annoyed at the interruption, reluctantly agrees. During the conversation, John provides rationale for disagreeing with Sara’s statement that they are too busy to collaborate. John points out that a team approach is client-centred and facilitates the provision of safe care. John then discusses how they can collaborate to use the staff resources available most effectively. Sara states there is no time to discuss, and they need to start the day. Sara departs from John to make the assignment.

John wants to speak to Sara again. To prepare for the conversation, John reflects on past experiences and jots down some notes about clinical leadership, such as:

Considering the competencies and qualifications of each nurse when determining the assignment. ¹²
Ensuring the competencies of staff are used efficiently and supporting nurses to work within their level of competence. ¹²
Working with nursing staff to perform a risk evaluation (based on individual nurse-based factors, team-based factors, and environmental factors).¹²
Assign unregulated care providers client care tasks within their scope of employment. ¹²
The charge nurse must communicate with patients and staff throughout the shift and react to changing needs by updating assignments. ¹³

John further plans how teamwork can be done and develops a plan by revamping the assignment and adding an assignment and delegation to unregulated care providers as part of the plan.

John approaches Sara again and requests to speak with Sara in private. Sara listens, once again disagrees with John, then asks a few more questions. After further conversation, Sara agrees with John’s plan and rationale.

Sara calls the team together to discuss the new assignment, delegation, and teamwork planned for the busy shift ahead. As the shift progresses, Sara evaluates client care needs and makes adjustments as appropriate.

Standard 63 indicates LPNs must utilize collaborative and constructive approaches to resolve differences among members of the health care team that affect care.¹ John meets this standard by requesting to speak to Sara and developing a constructive strategy to solve the differences of opinion.

Standard 57 indicates LPNs must exercise professional judgement and critical thinking when assuming a charge role. Although John was not in the charge nurse role, he understood that on a shift that is busy and short-staffed, teamwork and collaboration are required for client-centred care. John used critical thinking to apply his professional judgement which he shared with Sara. This standard is met.

Standard 55 indicates LPNs must coordinate, distribute, and utilize material and human resources to provide efficient care.¹ John meets this standard by considering the qualifications of each nurse when making the assignment.

Standard 58 indicates LPNs must understand when to take on a lead role, and when to take on a complementary role.¹ John fulfills an informal leadership role by helping Sara to analyze the previous decision regarding teamwork. John meets this standard.

Reflection Exercises

Reflect on the behaviours demonstrated by a clinical leader you have worked within the past. How did you learn from their leadership style? How do the standards apply?
How would you describe your communication style when collaborating with other professionals?
Reflect on your practice. Are you able to transition from a follower role to the role of a leader as appropriate? How do the standards apply?
How do you manage conflict in the workplace?
Reflect on your listening skills. How do you actively listen?
How do you manage your clinical leadership responsibilities with your nursing duties?
How have you contributed to the improvement of client care in your current nursing role?

Conclusion

Clinical leadership is embedded in the professional practice and conduct of LPNs. Characteristics of clinical leadership include expertise, communication, collaboration, coordination, and interpersonal understanding. In clinical practice, LPNs regularly take on both the role of a follower and that of a leader. In providing care as a team the competencies of the health care providers are considered so they may be utilized efficiently and within their scope of employment. LPNs who demonstrate clinical leadership competencies, promote mutual trust between health care providers and contribute to the provision of safe and quality care.

For further reading about clinical leadership, consider accessing the references listed in the section below.

References

(2014). Standards of Practice and Conduct. (Revised) Effective from December 1, 2021.
Patrick A, Laschinger H, Wong C, Finegan J. Developing and testing a new measure of staff nurse clinical leadership: the clinical leadership survey. Journal of Nursing Management. 2011; 19, 449-460.
(2021). Entry-Level Competencies.
(2021). Nursing Competencies.
Al-Dossary R. Leadership in Nursing. Contemporary Leadership Challenges. 2017; Retrieved from https://www.intechopen.com/chapters/52409 doi:10.5772/65308
Lynch B. Partnering for performance in situational leadership: a person-centred leadership approach. International Practice Development Journal. 2015. 5.
Potter P, Perry A, Stockert P, Hall A, Astle B, Duggleby W. Canadian Fundamentals of Nursing – E-Book (Kindle Locations 12689-12716). Elsevier Health Sciences. Kindle Edition.
College of Licensed Practical Nurses of Manitoba et al. Interprofessional Collaborative Care. Winnipeg: 2019.
College of Licensed Practical Nurses of Manitoba, College of Registered Nurses of Manitoba, and the College of Registered Psychiatric Nurses of Manitoba. Assignment and Delegation to Unregulated Care Providers. Winnipeg: 2017.
Honan D, Lasiuk G, Rohatinsky N. A Scoping Review of Followership in Nursing. 2022: Nursing Leadership 35:1.
Marton, J. 9 things about followership that you need to know as a new nursing graduate. 2021: Canadian Nurse. Retrieved from https://www.canadian-nurse.com/blogs/cn-content/2021/12/13/9-things-about-followership-that-you-need-to-know
College of Licensed Practical Nurses of Manitoba, College of Registered Nurses of Manitoba, and the College of Registered Psychiatric Nurses of Manitoba. Duty to Provide Care guidance document. Winnipeg: 2019.
Allen, S. 8 steps for making effective nurse-patient assignments. 2018: American Nurse Today 13:9. Retrieved from https://www.myamericannurse.com/wp-content/uploads/2018/09/ant9-Assignments-822.pdf