Critical Competence Review

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Critical Competence Review


The critical analysis will focus on the competences of collaborative practice, teamwork and leadership as they are fundamental in ensuring patient safety as dictated by the Francis Report. While collaborative practises, teamwork and leadership are necessary for healthcare; my gap analysis proforma reveals that these are my weak points per the standard at point registration. The critique will be underpinned by personal experiences and literature review to highlight the impact of these weaknesses and possible resolutions. From personal knowing, inadequacies in collaborative practice, leadership and teamwork create situations where medical errors can occur as a consequence of poor communication. These errors can cause severe injury or unexpected patient fatalities, as indicated by the prevalence of medical mistakes attributed to poor communication in today’s healthcare organisations.

Collaborative practice

In healthcare, collaboration is where a healthcare professional assumes matching roles and helpfully works together and shares accountability in the delivery of patient care. Collaboration between GPs, nurses and other healthcare providers fosters team spirit and awareness of each other’s competencies culminating in enhanced decision-making (Farrell, Payne, and Heye, 2015). Collaboration nurtures effective teams founded on respect and dependence. Teamwork is prevalent to the healthcare sector as all professionals work for a common objective which is contrary to a multi-disciplinary approach where each member is responsible only for activities affiliated with their discipline and formulates independent goals for patients (Bitter et al., 2013). In this regard, my shortcomings in collaborative practices and teamwork are attributable to extended periods working in multi-disciplinary settings where every discipline works independently towards the realisation of set objectives.

Supervisors and mentors deem me as an active collaborator because I value the roles and responsibilities of other team members by respecting their capabilities, expertise and contributions, I feel there is room for growth. Review of literature reveals that collaboration is a practical idea frequently discussed in healthcare, especially in endorsing the benefits of the practice. In my experience, teachers and research I have interacted with, describe collaboration as an outcome and many scholars validate its benefits. Benefits include a short stay period, cost cuttings, increased nursing job contentment improved teamwork and employee retention (Blake et al., 2013). The emphasis on the reimbursements of collaboration has led me to believe that it is a preferred method of providing patient care, leading organisations, and conducting health care research.

Based on the literature collaboration is integral in ensuring patient safety and enhanced patient outcome. Empirical evidence indicates that the existence of a partnership is hinged on potential partners sharing a vision and purpose which can be spurred by a problem, shared vision and the desired outcome (Bennett and Gadlin, 2012). Irrespective of the catalyst, I noticed that my weakness is moving from problem-driven muddled roles and responsibilities, and activity-driven to vision-driven, defined relationships and results respectively. As such, I should improve my ability to sustain engagements that underline commitment and acknowledging that building relationships are fundamental to the success of collaborations (Caricati et al., 2015). Besides personal development, enhancing competence in collaborative practices will ensure my future practices are aligned with the Francis Report recommendations that all care providers need to work together and maintain communication to ensure Mid Staffordshire NHS Trust Foundation incidents do not recur (Francis, 2013).


In the contemporary health care system, delivery practices involve several interfaces and patient handoffs among various health care experts with varying educational and professional levels. In a typical hospital stay, a patient is likely to intermingle with over 50 different employees, including physicians, nurses, technicians, and others in less than a week. Thus actual clinical practice involves occasions where professional must share crucial information correctly through collaboration and enhanced communication (O’Hagan et al., 2013). Improved communication and cooperation culminates in teamwork where two or more providers work towards the expansion of their traditional roles and work towards a better outcome for patients (Zwarenstein et al., 2013). In instances where health practitioners fail to collaborate due to poor communication or lack of leadership, patient safety is jeopardised as a misinterpretation of information could occur, vague orders over the phone and ignored changes in status.

Literature review claims that communication, trust and respect are fundamentals of teamwork. According to Mahdizadeh, Heydari and Karimi Moonaghi (2015), communication, coordination and collaboration are fundamental in the delivery of effective care as care is a team effort that its continuity is impossible for an individual. Teamwork is given prominence in mental health nursing because it is central in multi-disciplinary operations designed for transformation from bed to community-based model of care. In this sense, registered psychiatric nurses must cultivate competencies in teamwork to ensure effective delivery of care through MDTs (Gausvik et al., 2015). Excellent teams provide that all members share an objective, and there is an explicit definition of roles and can come to aid of a member that is deemed to struggle with responsibilities assigned. Excellent teamwork can culminate in innovation, safety centred culture, resilience, enhanced productivity and better patient outcomes.

During the review of my reflections, mentors described me as ‘Actively consults and explores solutions and ideas with members of the multi-disciplinary team including patients/service users, families and carers to enhance care’ and ‘Participates in team decision making. Can assertively challenge contributions where necessary through discussions and informed debate, respecting others views and opinions and behaving professionally’. These sentiments gave me the notion that I was competent in teamwork. However, towards the end of the placement, the mentor observed that I needed to improve my teamwork skills especially in acknowledging values and knowledge of the team especially when is attempting to be assertive and challenge contributions. Also, during my gap analysis, I noticed the score for teamwork was low per the standard at point registration.

Similar to other aspects of clinical governance such as risk mitigation and clinical efficacy, effective teamwork is key to high quality care. The cooperation of recognising, utilising and integrating the diverse skills, experience and knowledge of team members in a goal-oriented manner enhances diversity and creativity in problem resolution and delivery of holistic care. Consequently, services will improve and implementation of the Francis Report recommendations becomes more manageable as there is agreement on standard of proper care, there is openness as team members can correct each other and every member is held responsible for their deeds.


Nursing settings are irregular, such as acute mental health environs that necessitate nurses to be professionally competent and to be poised in decision-making. In mental health settings, I learnt that nurses grapple with issues of self-harm, acute psychotic manifestations and behavioural disturbance that can culminate in aggression (Ennis, Happell, and Reid-Searl, 2014). Nurses in acute mental health settings must possess leadership skills as clients require assistance when navigating through treatment. Assisting clients in despair demands excellent skills which foster the delivery of individualised evidence-based care for patients. Also, leadership contributes towards the enhancement of results and more progressive experiences for users and underwrite the enrolment and retaining of staff.

In nursing, pundits describe leadership using theories such as shared leadership, situational leadership, transformational and transactional leadership theories. While these theories are diverse, they are underpinned by core competencies in communication and teamwork (Men, 2014). In a shared leadership model, the dispersal of leadership in a team of clinicians with varying expertise is vital in the delivery of care through MDTs.  The success of shared leadership is hinged on harmony in team vision, clarity in roles and flexibility within stated functions (Kawata, 2012). The accomplishment of the model manifests in innovation, patient-centred care culture and increased productivity and enhanced patient outcomes. Flexibility in leadership is vital, as indicated by the situational leadership principle, which holds that exceptional circumstances demand diverse leadership styles. Situational interpretation is crucial in mental health nursing as the environment is unpredictable and calls for different approaches in given cases.

In previous placements, I have inspired confidence in team members, and assisted student nurse cultivate their competence and skills through sharing of experiences and knowledge. Such deeds have allowed me to describe myself as a transformational leader as I have transformed various interns into competent nurses (Doody and Doody, 2012). While I have thrived in these settings, I noticed my shortcomings in the interpretation of situations or sharing roles with others as I prefer doing tasks myself. According to transactional leadership theory, I cannot serve as a leader because I cannot formulate an agreement of what is expected to ensure completion of tasks. My inadequacies often emerge during delegation as I struggle assigning responsibilities as I feel my entrustment could result in the violation of NHS policies and procedures grounded on patient safety and delivery safe and quality care.



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Blake, N., Leach, L., Robbins, W., Pike, N. and Needleman, J. (2013). Healthy Work Environments and Staff Nurse Retention. Nursing Administration Quarterly, 37(4), pp.356-370.

Caricati, L., Mancini, T., Sollami, A., Bianconcini, M., Guidi, C., Prandi, C., Silvano, R., Taffurelli, C. and Artioli, G. (2015). The role of professional and team commitments in nurse-physician collaboration. Journal of Nursing Management, 24(2), pp.E192-E200.

Doody, O. and Doody, C. (2012). Transformational leadership in nursing practice. British Journal of Nursing, 21(20), pp.1212-1218.

Ennis, G., Happell, B. and Reid-Searl, K. (2014). Clinical Leadership in Mental Health Nursing: The Importance of a Calm and Confident Approach. Perspectives in Psychiatric Care, 51(1), pp.57-62.

Farrell, K., Payne, C. and Heye, M. (2015). Integrating Interprofessional Collaboration Skills into the Advanced Practice Registered Nurse Socialization Process. Journal of Professional Nursing, 31(1), pp.5-10.

Francis, R. (2013). Report of the Mid Staffordshire NHS Foundation Trust Public Inquiry. [Online] Available at: [Accessed 27 Feb. 2020].

Gausvik, C., Lautar, A., Miller, L., Pallerla, H. and Schlaudecker, J. (2015). Structured nursing communication on interdisciplinary acute care teams improves perceptions of safety, efficiency, and understanding of care plan and teamwork as well as job satisfaction. Journal of Multidisciplinary Healthcare, p.33.

Kawata Jr, WT (2012). Measuring shared leadership in skilled nursing facilities. University of Pennsylvania.

Mahdizadeh, M., Heydari, A. and Karimi Moonaghi, H. (2015). Clinical Interdisciplinary Collaboration Models and Frameworks from Similarities to Differences: A Systematic Review. Global Journal of Health Science, 7(6).

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O’Hagan, S., Manias, E., Elder, C., Pill, J., Woodward-Kron, R., McNamara, T., Webb, G. and McColl, G. (2013). What counts as effective communication in nursing? Evidence from nurse educators’ and clinicians’ feedback on nurse interactions with simulated patients. Journal of Advanced Nursing, 70(6), pp.1344-1355.

Zwarenstein, M., Rice, K., Gotlib-Conn, L., Kenaszchuk, C. and Reeves, S. (2013). Disengaged: a qualitative study of communication and collaboration between physicians and other professions on general internal medicine wards. BMC Health Services Research, 13(1).