Leadership in a Crisis

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Leadership in a Crisis:

Leadership in a Crisis Methods for Nurses Stephen Jameson, RN Sdjflightrn@gmail.com Franklin Pierce University

The changing patient population :

The changing patient population Sicker More complex, chronic medical problems. Require sophisticated care. More likely to have an EMERGENCY!

Are Nurses prepared for an emergency?:

Are Nurses prepared for an emergency? Medical emergencies are rare on medical surgical floors. Many nurses begin their career on medical surgical floors are relatively inexperienced. Lack of training in emergency situations. American Journal of Nurses article “New nurses feel a lack of empowerment and confidence when presented with a medical emergencies.” (Kovner, et al, 2007).

So What is a nurse to do?:

So What is a nurse to do? Call the Rapid Response Team! Created to improve survivability. Comprised of physician, critical care nurse and a respiratory therapist. Also a pharmacist, anesthesiologist and nurse supervisor. Trained to quickly determine treatment priorities. Decide to transfer the patient or keep them in their room if stable. Demonstrated improved outcomes. (Jones, Rubulta, Welch, 2016).

What does the Evidence say?:

What does the Evidence say? “ The effect of a nurse team leader on communication and leadership in major trauma resuscitations ” Clements, Curtis, Horvat, and Shaban (2015) in the journal International Trauma Nursing. Studied an emergency department staff pre and post implementation of a nurse leader in trauma resuscitation. 6.7% of staff who reported a decrease in poor leadership 6.8% increase in staff who felt leadership improved.

More evidence:

More evidence “Medical-surgical nurses’ perceived self-confidence and leadership abilities as first responders in acute patient deterioration events” by Hart, et al (2014) in the Journal of Clinical Nursing. 148 medical surgical nurses were enrolled in the study. 65% of nurses felt less than very comfortable with a being a team leader in an emergency until a team arrived.

Evidence for leadership in critical situations:

Evidence for leadership in critical situations “Leadership in different resuscitation situations” by Tschan, et al (2014) in the journal Trends in Anesthesia and Critical Care. Improved leadership Improved adherence to guidelines Reduced the time to intubation. It takes a mean of 4-6 minutes for a cardiac team to arrive.

Is simulation the answer?:

Is simulation the answer? “Developing team based acute care scenarios: A rural hospital experience” by Missen, et al (2014) in the journal International Emergency Nursing. Poor communication + inadequate leadership = reduced patient survivability. Scenario based training improved communication, team development and leadership. Overall, feedback post simulation was positive.

Simulation to improve nursing leadership :

Simulation to improve nursing leadership Target students nursing students enrolled in a traditional nursing program. Collocated with other students, educators and simulation space resources. Students would be able to work with other students in a simulated environment. Safe educational environment. Allow for mistakes without impacting patient safety. Safe and constructive feedback can be provided guided by a trained educator. Students are able to practice in a variety of realistic scenarios as skills develop.

Educational plan for simulation:

Educational plan for simulation Pre reading material and behaviors to be demonstrated. Scenario is developed with educational goals that outline expected outcomes. Space is planned, actors or simulated patients are trained on script. A realistic environment is created in the simulation lab with props Bed Call light Bedside table Patient Support staff

Educational Objectives:

Educational Objectives Identify a medical crisis situation that requires multiple immediate interventions. Assemble a team of assistants. Direct multiple tasks. Document and follow up on immediate tasks that have been completed. Brief incoming medical providers of the events, actions taken and relinquish leadership role when appropriate.

The Scenario:

The Scenario A moulaged patient in a hospital room who suddenly develops shortness of breath and chest pain. An actor creates the sense of urgency. Additional staff are present to help if requested and directed by the learner.

Expected actions :

Expected actions The learner identifies the situation. Calls for assistance Directs coworkers to perform simultaneous actions to treat the patient. One person calls the rapid response team and reports when called. One person obtains an ECG and vital signs Learner remains where actions can be observed and able to interview the patient. Learner interacts with the Rapid Response Team to give a concise review of issues.


Debriefing Evaluation of the learner and team. Review what went well and areas for improvement. Constructive feedback based on goals. Opportunity to repeat exercise if time allows.

Outcome :

Outcome Improved leadership Improved patient outcomes Effective nurse leader!


References Clements, A., Curtis, K., Horvat, L., & Shaban, R. Z. (2015). The effect of a nurse team leader on communication and leadership in major trauma resuscitations. International emergency nursing, 23(1), 3-7. Delac, K., Blazier, D., Daniel, L., & Donamarie, N. (2013). Five alive: using mock code simulation to improve responder performance during the first 5 minutes of a code. Critical care nursing quarterly, 36(2), 244-250. Hart, P. L., Spiva, L., Baio, P., Huff, B., Whitfield, D., Law, T., ... & Mendoza, I. G. (2014). Medical‐surgical nurses' perceived self‐confidence and leadership abilities as first responders in acute patient deterioration events. Journal of clinical nursing, 23(19-20), 2769-2778. Jones, D., Rubulotta, F. & Welch, J. Intensive Care Med (2016) 42: 593. doi:10.1007/s00134-016-4219-5 Kovner, C. T., Fairchild, S., Poornima, S., Kim, H., & Djukic, M. (2007). Newly licensed RNs' characteristics, work attitudes, and intentions to work. AJN The American Journal of Nursing, 107(9), 58-70. Missen, K., Sparkes, L., Porter, J., Cooper, S., & McConnell-Henry, T. (2013). Developing team based acute care scenarios: A rural hospital experience. International emergency nursing, 21(3), 186-189. Tschan, F., Semmer, N. K., Hunziker, S., Kolbe, M., Jenni, N., & Marsch, S. U. (2014). Leadership in different resuscitation situations. Trends in Anaesthesia and Critical Care, 4(1), 32-36

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