NR 446 Edapt Week 3 Leading a Team

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Chamberlain University

NR-446 Collaborative Healthcare

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Date

Week 3 Edapt NR446: Leading a Team

When a nurse transitions from bedside care to a leadership position, their scope of responsibility expands significantly. Nurse leaders are expected to address both legal and ethical obligations, influence organizational policy, safeguard patient and staff welfare, and advocate for the nursing profession. They set professional standards, monitor compliance with regulations such as those upheld by the U.S. Equal Employment Opportunity Commission (EEOC), and ensure safe environments. Importantly, although leaders carry accountability for team oversight, each nurse retains personal responsibility for their individual actions. Promoting a culture of accountability within the team is, therefore, a critical leadership responsibility.

In clinical scenarios—for instance, when multiple medications are prepared at once—nurse leaders must weigh ethical principles such as nonmaleficence (avoiding harm), fidelity (upholding professional standards), and confidentiality (addressing errors privately). Leaders may intervene paternalistically only when urgent, safety-related decisions are required to prevent harm.

Empowerment Through Ethical Actions

Nurse leaders empower both patients and staff by demonstrating ethical conduct. They strengthen autonomy, enhance professional practice, and advocate for broader health equity.

Table 1

Empowerment Actions in Nursing Leadership

Action	Who Benefits	Rationale
Educating clients on health management	Client	Fosters autonomy and informed decision-making
Supporting policies that expand nursing scope	Profession	Improves access to care through beneficence and utility
Volunteering in underserved communities	Client	Promotes health equity and justice
Obtaining informed consent	Client	Respects autonomy and legal rights
Supporting whistleblowers	Profession	Promotes veracity, integrity, and ethical transparency
Advocating for nursing policies	Profession	Encourages systemic improvements in healthcare

Ethical Leadership

The American Nurses Association (ANA, 2015) emphasizes that while ethical standards apply to all nurses, leaders carry the additional responsibility of modeling ethical behavior and guiding fair decision-making across teams.

Table 2

Direct Nurse Actions Versus Ethical Leadership Actions

Direct Care Nurse Action	Ethical Principle	Nurse Leader Action
Provides patient education	Autonomy	Implements fair disciplinary processes
Manages pain effectively	Beneficence	Encourages growth and professional development
Avoids harmful medications	Nonmaleficence	Creates fair and balanced staff schedules
Prevents patient self-harm	Paternalism	Assigns staff based on skill level
Assists with duties	Utility	Prevents ill or fatigued staff from working
Delivers equitable care	Justice	Rewards performance fairly
Discloses medication errors	Veracity	Shares policy changes openly with staff
Keeps promises	Fidelity	Honors commitments made to staff
Maintains privacy	Confidentiality	Protects sensitive personal and patient information

Ethical Responsibilities

Nurse leaders must serve as ethical role models by:

Promoting awareness of risks in decision-making.
Advocating for human rights.
Creating environments that encourage ethical practice.

Leadership Roles

Develop awareness of personal values and beliefs.
Accept uncertainty as part of ethical decision-making.
Demonstrate ethical behavior consistently.
Encourage patient and staff autonomy.
Represent nursing perspectives on interdisciplinary ethics boards.

Management Functions

Apply ethical frameworks in decision-making.
Recognize legal components of ethical dilemmas.
Address staff moral distress effectively.
Intervene when unethical practices occur.
Recognize and reward ethical contributions from staff.

Creating Healthcare Policies

The National Academy of Medicine (2021) identifies five priorities for nurse leaders in health policy development:

Advancing health equity.
Supporting nurse well-being.
Promoting inclusive and accurate data systems.
Expanding continuing education opportunities.
Preparing for public health emergencies.

By integrating social determinants of health into practice, nurse leaders help ensure equity and access across diverse populations.

Leader Versus Manager: Legal and Legislative Responsibilities

Since the Nurse Practice Act, both leaders and managers share responsibility for ensuring safe, ethical, and legally compliant nursing practice.

Leadership Responsibilities

Protect patient rights and informed consent.
Model professionalism and inclusivity.
Pursue ongoing education to remain current.
Report unsafe practices promptly.
Foster respect in the workplace.

Management Functions

Stay updated on regulatory changes.
Align organizational policies with legal requirements.
Educate staff on consent and confidentiality.
Monitor credentials and ensure equipment safety.

Table 3

Legal Domains Impacting Nurse Leaders

Legal Domain	Impact on Nurse Leaders
Licensing/Certification	Verify staff licenses remain current
Collective Bargaining	Advocate for safe staffing and conditions
Employment Laws	Enforce EEOC standards in the workplace

Advocacy in Leadership

Advocacy is central to ethical nursing leadership. Leaders must amplify client voices, promote ethical discussions, and create supportive work environments.

Leadership Traits

Build advocacy-based cultures.
Work collaboratively with policymakers.
Encourage safe and transparent reporting.
Empower colleagues to take ethical actions.

Management Traits

Prioritize patient-centered care.
Protect staff within legal frameworks.
Foster environments that support ethical practice.

Ethical Prioritization

Table 4

Prioritization in Leadership Decisions

Consideration	Priority?	Rationale
ICU experience	Yes	Promotes safe patient outcomes through skill alignment
Nurse preference	No	Patient safety outweighs personal preferences

Ethical Principles Overview

Autonomy – Right to make informed choices.
Beneficence – Acting for the good of others.
Nonmaleficence – Avoiding harm.
Justice – Fair treatment and equity.
Veracity – Honesty in communication.
Fidelity – Keeping commitments.
Paternalism – Protective interventions in emergencies.
Confidentiality – Respecting privacy.

MORAL Decision-Making Framework

The MORAL model offers structured guidance for ethical dilemmas:

Massage the dilemma – Clarify the issue and stakeholders.
Outline options – Explore possible courses of action.
Review and resolve – Evaluate benefits and drawbacks.
Affirm and act – Implement the chosen plan.
Look back – Assess the outcome and lessons learned.

U.S. Government and Healthcare Legislation

Table 5

Branches of Government and Responsibilities

Branch	Responsibility	Examples
Legislative	Creates laws	Senate, House of Representatives
Executive	Enforces laws	President, Cabinet
Judicial	Interprets laws	Supreme Court, Federal Courts

Administrative agencies (e.g., HHS, DOJ) also regulate healthcare practice, while executive orders and court rulings further influence interpretation.

Nursing Practice and Legal Considerations

Malpractice Criteria

A nurse-patient relationship exists.
Standards of care were violated.
Harm was foreseeable.
Injury or damage occurred.

Negligence Examples

Example	Malpractice	Negligence
Correct drug, with side effect	No	No
Wrong dosage administered	Yes	Yes

Boards of Nursing enforce compliance with state-specific Nurse Practice Acts (NCSBN, n.d.).

Error Reporting and Incident Management

Steps following an error include:

Immediate provider notification.
Completion of incident reports.
Accurate documentation.
Supervisor notification.

Advocacy in Nursing

Advocacy requires protecting patient rights and ensuring unbiased care, particularly for vulnerable populations. Scenarios may include ensuring informed consent, respecting refusal of treatment based on religious beliefs, and providing equitable care for marginalized groups.

Evaluating Policy Effectiveness

Case Example – Leeland Hospital System: The hospital analyzed exit interviews, sick calls, and staff demographics to identify workplace issues.

Potential Issue	Policy Action Needed
High back injury rates	Update workplace safety measures
Lack of diversity	Adjust recruitment practices
High turnover rates	Improve workplace culture and engagement

Law and Employment Practices

Table 6

Employment Categories

Employment Type	Characteristics
Full-Time Hourly	36+ hours/week, W-2 benefits
Part-Time Hourly	Less than 36 hours/week, limited benefits
Salaried	Fixed salary regardless of hours worked
Consultant	Independent contractor, 1099 form

Employers are prohibited from questioning employees about protected categories, such as age, disability, marital status, or parental responsibilities (U.S. Department of Labor, n.d.).

References

American Nurses Association. (2015). Code of ethics for nurses with interpretive statements. Nursesbooks.org.
Institute of Medicine. (2011). The future of nursing: Leading change, advancing health. National Academies Press.
National Academy of Medicine. (2021). The future of nursing 2020–2030: Charting a path to achieve health equity. National Academies Press.
National Council of State Boards of Nursing. (n.d.). Nurse Practice Act. https://www.ncsbn.org/npa.htm

NR 446 Edapt Week 3 Leading a Team

U.S. Department of Labor. (n.d.). Employment law guide. https://www.dol.gov/general/aboutdol/majorlaws
U.S. Government. (n.d.). Branches of the U.S. government. https://www.usa.gov/branches-of-government