Nursing Leadership and Management

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Gap between Theory and Practical in Nursing

According to Simmons, Lanuza, Fonteyn, Hicks, & Holm (2003), encountering conditions and situations related to patient health does not require experience; rather, experience help nurses reflect quickly in the moment of decision-making. As a result, in the nursing field, there exists gap between the real field practices and theory taught in class or materials written in publications. The training nurses should therefore be encouraged to get more experience through interaction with both inpatient and outpatient. This experience gained bridges the gap between theory they learns in different publications and what ought to be done while observing medical care.

Moreover, it brings fineness in decision making from constantly referring to procedure and policies in nursing theory to applying them intuitively and unconsciously. By nurses understanding theoretical and practical work as based on the clinical situation, they develop their proficiency and experience (McHugh & Lake, 2011). For instance, the nurses at school are good in theoretical work, the advanced uses procedures and policies to determine what is required of them by presented patient situation, while the proficient nurses can perceive the whole situation, recognize, and respond to diagnosis changing circumstances. According to Benner (2004), nurses who are expert in offering clinic services distinguishes themselves from their colleagues by their intuitive capabilities in decision making while understanding the nature of the presented situation. They are therefore influential in other nurses’ judgment, and excellent care practices.

As a result, clinical experts are hybrid of both theoretical and practical work. Years of experience may provide fluidity of applying practices and procedure but fails in nurturing complex thinking (Bobay, 2004). Additionally, thorough masterly of theoretical and practical work in nursing displays superior performances. For instance, the competent nurses, who are task oriented and structure their work depending on the aim of achievement, give responses to many clinical situations but fails to grasp the overall diagnosis picture (Benner, 2004). However, the expert nurse identifies and responds to the unexpected clinical situations such as alerting others of potential problem in the nursing department. The nurse also grasp the whole diagnosis situation, diagnose accurately and without wasteful deliberation of unsuccessful possibilities. (McHugh & Lake, 2011). Hence, after detailed understanding of nursing procedures and practices, the nurse becomes useful resources to other nurses for consultation and preceptee depend on them for guidance.

Culture of Safety

Culture of safety is the acknowledgement of diversity far-off cultural awareness. It is more than cultural sensitivity among community and it helps in understanding the limitation arising from cultural competence in skills, altitude, and knowledge of medical practitioners (Aboriginal Nurses Association of Canada, 2009). As a result, medical institutes with a culture supporting and promoting safety have improved health practices.

On Drews case, the culture of safety identifies that the patients are exposed to risk of getting infected by disease because some nurses are failing to observe nursing policies and procedures when attending them. In order to prevent this, the culture of safety will identify, report and communicate the indentified error. That is, disclosure and reporting of error to the affected department authority to ingrain safety in the nursing organization. Moreover, the culture of safety encourages the nurses to conduct a review of the existing nursing culture in order to establish how the culture is influencing services delivery and adjust accordingly to improve the health care service accessibility to the society, and patients (ECRI Institute, 2009).

Continuous Quality Improvement

Drew has to ensure the services provided are of high quality and meet relevant nursing standards. He also has a task of ensuring the problems identified are resolved through involving appropriate departments. Moreover, he has to guarantee all hospital departments offer better service to patients. As a result, he may report the current nursing malpractices to higher nursing authorities leading to radical changes in the nurse department he is working in. Besides, he may use quality improvement forums to demonstrate to the attending nurses on how to enhance quality in their services (Moran & Johnson, 1992).

Drug Abusing Nurse

Drugs abuse messes up the nurses senses, life, and the life of workmates. For instance, despite the addiction to drugs, the authority is not aware of the nurses drugs abusing. The authority therefore counts the nurse to be responsible of his actions when working. As a result, the nurse puts the nursing department under threat of being held responsible on injuries done to patient. Moreover, without making early reporting of the nurse abusing drugs to nursing board, the future of the nurse abusing drugs is doomed. The nurse is on blink of facing disciplinary action from the nursing board if the nursing board realizes the nurse abuses drugs through its occasional drugs abusing investigation to nurses. Moreover, the nurse puts the fellow employee under more responsibility of ensuring the nurse works without endangering the patient life. In addition, if the nursing board realizes fellow employees covered up on a drug-abusing nurse, the employee is liable to injuries caused to the patient and faces disciplinary action (Buppert, 2012).

Helping a Drug Abusing Nurse

work colleague is supposed to remind the drug-abusing nurse on the importance of observing nursing practices and procedure, remind the nurse of the nursing punishment in case he is note and how the nurse is endangering his fellow nurses’ career for covering up his unethical behaviors (Wolfe, 1986). Moreover, the fellow nurses need to inform the drug-abusing nurse of the legal matters facing him in case the patient realizes his action. As a result, the fellow nurses should recommend the drug-abusing nurse to seek treatment and rehabilitation procedures to help him overcome drug abuse (NRSKarenRN, 2002).

Besides, the fellow nurses should keep his substance abusing behavior dark for the public. This will help the public assume the nurse is having a clean drug abusing record and trust him when he is delivering treatments especially after his recovery from addiction to drug. Moreover, this will avoid court dramas that may arise when the patient and patients family from who the nurse stole drugs knows the nurse was consuming the patients drugs (NRSKarenRN, 2002).

However, to avoid endangering his career, the fellow nurse is supposed to report the issue to relevant authority. In most cases, the nurse abusing drugs does not lose the certification in nursing when nursing board notes of his abuse of drugs, but the certificate is suspended for two to fifteen years (Wolfe, 1986). The authority dismisses the addicted nurse to attend a rehabilitation program and only accept him back after proving he is no longer drug dependent. Else, if the nurse is not affected a lot by the drugs he abused, the authority may put the nurse under confidential substance Abuse Rehabilitation Program that allows the nurse to continue attending his duties while attending the rehabilitation program with nursing board monitoring the nurse activities (NRSKarenRN, 2002)..


Aboriginal Nurses Association of Canada, (2009). Cultural Competence and Cultural Safety in Nursing Education. Web.

Benner, p. (2004). Using the Dreyfus Model of Skills Acquisition to Describe and Interpret Skills Acquisition and Clinical Judgment in Nursing Practice and Education. The Bulletin of Science, Technology, and Society, 24: 188- 199.

Bobay, K. L. (2004). Does Experience Really Matter? Nursing Science Quarterly, 17: 313-316.

Buppert, C. (2012). What Actions must be Taken when a Nurse is Impaired? Web.

ECRI Institute, (2009). Healthcare Risk Control. Web.

McHugh, M. D., & Lake, E. T. (2011). Understanding Clinical Expertise: Nurse Education, Experience, and the Hospital Context. Res Nurse Health, 33(4): 276-287

Moran, M. J., & Johnson, J. E. (1992). Quality Improvement: the Nurses Role. American Nurses Association Publication, 80: 45-61.

NRSKarenRN, (2002). Critical Care: when a Nurse Steal Drugs on Job. Web.

Simmons, B., Lanuza, D., Fonteyn, M., Hicks, F., & Holm, K. (2003). Clinical Reasoning in Experienced Nurses. Western Journal of Nursing Research, 25: 701-719

Wolfe, L. (1986). Nurses and Drugs Abuse: New Ways to Help. Web.

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