NRSG375 Clinical Leadership

Assessment Task 3: Written Assignment (45%)

Australian Catholic University, Faculty of Health Sciences

Semester 2, 2026

Context

Final-year nursing students at Australian Catholic University complete NRSG375 Clinical Leadership as a capstone theory unit. The unit examines leadership attributes and theoretical models, then challenges students to locate themselves within those models as emerging registered nurses. Assessment Task 2 required you to post six discussion forum responses across Modules 1 through 6, engaging with contested propositions about graduate leadership, professional autonomy, and innovation. Assessment Task 3 asks you to select two of those posts, rewrite them as formal analytical prose, and deepen the theoretical and evidentiary foundations well beyond the forum format. The assignment carries a 1,200-word limit (+/- 10%) and requires screenshot evidence of all six original AT2 posts appended in a single document. APA 7th edition governs referencing throughout. This task addresses learning outcomes LO2 and LO4, with the analytical standard expected of graduating students who will enter practice as clinical leaders regardless of title or position.

Task Description

Select two of your AT2 posts. One must be Post 1 (Modules 1 and 2: clinical leadership and the graduate RN) or Post 2 (Modules 3 and 4: autonomy, accountability, and leadership). The second post may come from any of the remaining topics. Rewrite each selected post as a sustained analytical argument. Do not summarise your original forum contribution. Expand it. Apply leadership theory with precision, interrogate the assumptions embedded in the original prompt, and use contemporary peer-reviewed literature published between 2018 and 2026 to support, complicate, or qualify your position.

The two rewritten posts form the body of a single academic paper. An introduction must outline both posts and signal the sequence of discussion. A conclusion must synthesise the analytical threads rather than restate each post in turn. Transitions between the two post analyses should be explicit and reasoned, not merely structural.

For Post 1, the prompt stated that clinical leadership is unimportant to a graduate RN and that confidence and clinical skill matter more. A strong response does not simply disagree. It examines what “clinical leadership” means in the graduate context, distinguishes leadership from formal management, and demonstrates through evidence how leadership behaviours operate at the point of care from the first year of practice. Transformational leadership theory, distributed leadership, and clinical leadership frameworks provide productive analytical anchors. The claim that confidence and competence are separate from leadership collapses under scrutiny, and the literature should be used to show why.

For Post 2, the prompt asserted that autonomy and accountability are inherent to nursing and asked how these expectations relate to leadership qualities. A strong response defines professional autonomy with conceptual precision, distinguishes it from unsupervised practice, and connects accountability to the relational and ethical dimensions of leadership. Shared governance, professional governance, and the relationship between leadership style and perceived autonomy offer productive lines of analysis. The argument should address how graduate nurses exercise autonomy within hierarchical clinical environments without overstating individual agency or ignoring structural constraints.

Requirements

1,200 words (+/- 10%), excluding references and appended screenshots. Formal academic prose. First-person voice is permitted only where analytical positioning requires it; avoid reflective narration. Minimum of eight peer-reviewed sources published between 2018 and 2026. APA 7th edition for all in-text citations and the reference list. Screenshots of all six AT2 posts appended to the submitted document. Do not include the original forum posts in the word count. Submit via the Turnitin drop box in the NRSG375 LEO site.

Rubric Summary

Introduction (10 marks): Comprehensive outline of both posts, scope, and sequence.

Content and Discussion (35 marks): Explanation, analysis, and application of concepts; explicit engagement with leadership theory; critical treatment of the prompt’s assumptions.

Critical Thinking and Evidence-Based Reasoning (30 marks): Argument supported by high-quality contemporary literature; links between claims and evidence sustained throughout.

Sequencing and Accuracy (15 marks): Logical organisation; coherent transitions; rational conclusion that synthesises rather than repeats.

Sources and Referencing (10 marks): Accurate APA 7th edition; six AT2 screenshots appended.

Sample Analysis: Why Clinical Leadership Belongs to the Graduate Nurse

The proposition that clinical leadership can wait until confidence and clinical skill have matured misreads both leadership and the graduate transition. Clinical leadership is not a position conferred after competence is achieved; it is a set of practices exercised through communication, escalation, advocacy, and care coordination from the first shift. A cross-sectional survey of registered nurses in residential aged care found that graduate nurses report confidence in managing services even when their leadership skills remain underdeveloped, suggesting that self-rated confidence is a poor proxy for leadership capability and that confidence without leadership literacy may produce overconfidence rather than safer care (Parker et al., 2024). The distinction matters because the graduate year exposes nurses to precisely the point-of-care decisions where leadership behaviours determine patient outcomes. Handover failures, delayed escalation, and uncoordinated discharge planning are not clinical skill deficits; they are leadership deficits. Transformational leadership theory offers one explanatory frame. A multilevel study of 664 registered nurses demonstrated that transformational leadership exercised by head nurses predicted nurses’ clinical leadership, which in turn predicted higher quality of care and fewer adverse events (Alanazi et al., 2026). The pathway ran through structural empowerment, meaning that leadership development is not an individual trait to be acquired before practice but an organisational condition that can either cultivate or suppress graduate leadership behaviour. A graduate who waits for confidence before leading waits for a condition that the evidence says is produced by leading, not before it.

Leadership as Practice, Not Prerequisite

The assumption that leadership belongs to formal role holders persists despite consistent evidence to the contrary. Clinical leadership operates through influence, not authority. A concept analysis of professional autonomy in nursing defines autonomy as the nurse’s competency to determine nursing activities independently or interdependently while retaining accountability for decisions (Oshodi et al., 2024). This definition embeds leadership within autonomy itself: a nurse who exercises clinical judgment, accepts accountability, and advocates for a patient is already leading, regardless of title. Graduate nurses who understand this do not wait for permission to lead. They recognise that escalation is a leadership act, that questioning an order is a leadership act, and that coordinating a multidisciplinary team around a deteriorating patient is a leadership act. Denying graduate nurses leadership language until they feel “ready” deprives them of the conceptual vocabulary they need to make sense of what they are already doing under supervision.

Autonomy, Accountability, and the Leadership Connection

The second post’s prompt treats autonomy and accountability as inherent professional attributes, but the literature suggests they are relational achievements shaped by leadership environments. A 2025 cross-sectional study of 221 emergency department nurses found that head nurses’ transformational leadership style was the strongest correlate of nurses’ clinical professional autonomy (r = 0.57), with autonomy also associated with job satisfaction and years of experience (Omidvar et al., 2025). The implication for graduate nurses is direct: autonomy is not simply claimed; it is enabled or constrained by the leadership practices of those around them. Accountability operates in the same relational field. A nurse who is accountable for a decision but lacks the autonomy to enact it occupies an impossible professional position. Shared governance structures attempt to resolve this tension by distributing decisional authority across clinical roles rather than concentrating it at the top. A professional governance framework described in the nursing administration literature positions accountability not as a burden borne alone but as a structural arrangement that empowers nurses to lead practice and shape the conditions under which care is delivered (Bieber & Joachim, 2025). Graduate nurses who understand this structural dimension of autonomy are better equipped to negotiate the gap between professional expectation and workplace reality without internalising systemic constraints as personal failure.

Common Misreading of “Clinical Leadership”

Students frequently conflate clinical leadership with management, then conclude that leadership is irrelevant to their immediate practice because they do not manage a ward or hold a portfolio. This misreading is understandable and analytically costly. Clinical leadership, as the evidence above demonstrates, is the exercise of influence in clinical decision-making, care coordination, and patient advocacy. Management is one venue for that influence; it is not the definition. A graduate nurse who recognises the difference can identify leadership moments in every shift: the moment a concern is escalated rather than deferred, the moment a colleague is supported through a complex medication calculation, the moment a patient’s preference is re-centred after it has been displaced by routine. These are not soft skills awaiting development. They are leadership practices, and they carry measurable consequences for quality and safety (Alanazi et al., 2026). Replacing “clinical leadership” with “clinical confidence” in the graduate discourse does not protect patients; it obscures the relational and structural work that leadership requires.

References

Alanazi, A. K., Traynor, M., McFetridge, L., McKeaveney, C., & Clarke, S. A. (2026). Linking transformational leadership to patient care quality: The role of structural empowerment and registered nurses’ clinical leadership. Journal of Nursing Management, *2026*, 7518764. https://doi.org/10.1155/jonm/7518764

Bieber, S., & Joachim, G. (2025). Nursing professional governance: The structure to enable professional practice. Nurse Leader, *23*(4), 312–319. https://doi.org/10.1016/j.mnl.2025.03.008

Omidvar, M., et al. (2025). Head nurses’ leadership styles and emergency department nurses’ clinical professional autonomy in Iranian university hospitals: A cross-sectional study. Journal of Nursing Management, *2025*, 1376035. https://doi.org/10.1155/jonm/1376035

Oshodi, T. O., et al. (2024). Professional autonomy in nursing: A concept analysis. SAGE Open, *14*(4), 1–17. https://doi.org/10.1177/21582440241293160

Parker, V., et al. (2024). Registered nurses’ confidence related to undertaking a leadership role in residential aged care: A clinical leadership self-assessment survey. Collegian, *31*(3), 178–185. https://doi.org/10.1016/j.colegn.2024.04.003

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Clinical Leadership, Professional Autonomy and Accountability in Graduate Nursing Practice

Introduction

Clinical leadership, professional autonomy and accountability are closely connected aspects of registered nursing practice. Graduate registered nurses (RNs) enter healthcare environments where they must develop clinical competence while accepting responsibility for decisions that influence patient safety and quality of care. However, the assumption that leadership becomes relevant only after nurses gain confidence or occupy senior positions overlooks the influence that frontline nurses exercise during routine clinical practice. Clinical leadership involves influencing care decisions, communicating concerns, coordinating healthcare activities and advocating for patients, regardless of formal authority. Similarly, professional autonomy requires nurses to exercise informed clinical judgment within their scope of practice while remaining accountable for their actions. This paper examines two related dimensions of graduate nursing practice. The first analysis challenges the view that clinical leadership has little relevance to newly registered nurses, using transformational and distributed leadership perspectives. The second examines the relationship between professional autonomy, accountability and leadership, with particular attention to organisational hierarchy and shared governance. Together, these arguments establish that effective graduate nursing practice depends on the ability to exercise responsible leadership within professional and organisational boundaries.

Clinical Leadership and the Graduate Registered Nurse

Clinical leadership forms part of graduate nursing practice from the beginning of professional employment because patient care requires more than technical competence. It involves influencing clinical decisions and coordinating activities that support safe, effective care. Guibert-Lacasa and Vázquez-Calatayud (2022) describe clinical leadership as the influence nurses exercise over colleagues and healthcare activities to achieve positive patient outcomes, even without formal managerial authority. This distinction challenges the assumption that graduate nurses must wait until they become experienced practitioners before demonstrating leadership. For example, recognising a patient’s deteriorating condition, communicating observations clearly and initiating an appropriate escalation are leadership behaviours. Such actions require clinical knowledge, professional judgment and the willingness to accept responsibility. Consequently, leadership operates within everyday nursing responsibilities rather than remaining separate from clinical practice.

Transformational leadership theory provides a useful explanation of how nurses influence professional practice. The theory emphasises supportive relationships, intellectual stimulation and the development of shared professional goals. Alanazi et al. (2023), in a systematic review involving 3,633 registered nurses across nine studies, identified associations between nurse managers’ transformational leadership and the quality of patient care. However, the strength of these relationships varied across the included studies, indicating that leadership outcomes also depend on organisational culture, job satisfaction and structural empowerment. Graduate nurses may demonstrate transformational behaviours through encouraging colleagues to follow evidence-based procedures, raising concerns about unsafe practices and contributing to improvements in patient care. These actions do not require managerial authority. Rather, they depend on professional credibility, communication and a commitment to shared clinical standards.

Distributed leadership further explains why clinical leadership should not remain restricted to senior practitioners. This perspective recognises that leadership responsibilities can be shared among professionals according to their knowledge, responsibilities and clinical circumstances. In a multidisciplinary healthcare team, a graduate nurse may identify a medication discrepancy, communicate the concern to the appropriate practitioner and coordinate the necessary response. Although senior clinicians retain their respective responsibilities, the graduate nurse contributes directly to patient safety. Nhongo et al. (2024) examined leadership confidence among 100 registered nurses working in Western Australian residential aged care facilities. Although 90% reported high confidence, the study also identified differences associated with professional experience. Its findings suggest that confidence and experience influence leadership perceptions, but self-reported confidence alone cannot establish actual leadership competence. Therefore, graduate development should combine supervised clinical experience with communication, decision-making and leadership education. Guibert-Lacasa and Vázquez-Calatayud (2022) similarly support theory-based leadership development that addresses clinical knowledge, interpersonal skills and psychological empowerment.

Professional Autonomy, Accountability and Leadership

Professional autonomy concerns a nurse’s authority and capacity to make clinical decisions using professional knowledge, judgment and ethical principles. It does not mean practising independently of professional standards, supervision requirements or multidisciplinary collaboration. Mrayyan et al. (2024) identify shared leadership, professional skills, collaboration and a healthy working environment as important elements of nursing autonomy. Their concept analysis also connects autonomy with accountability, patient advocacy and professional competence. For graduate nurses, autonomous practice therefore involves recognising situations that fall within their competence, making appropriate decisions and seeking assistance when clinical circumstances exceed their knowledge or authority. Such decisions demonstrate professional judgment rather than unrestricted independence.

Accountability gives professional autonomy its ethical and professional foundation. Nurses remain responsible for their clinical decisions, documentation, communication and responses to patient needs. A graduate nurse who identifies an unsafe medication order, for instance, has a professional responsibility to clarify the order through appropriate clinical channels rather than administering it without question. The nurse must also document relevant observations and communicate the concern to the appropriate practitioner. This example demonstrates how accountability supports patient advocacy and clinical leadership. Omidvar et al. (2025) examined 221 emergency department nurses and found a positive association between transformational leadership and perceived professional autonomy (r = 0.57). However, the cross-sectional design establishes an association rather than proof that transformational leadership directly causes greater autonomy. The findings nevertheless indicate that supportive leadership environments may contribute to nurses’ confidence in professional decision-making.

Organisational hierarchy can restrict the extent to which graduate nurses exercise professional autonomy. Although professional standards expect nurses to demonstrate independent judgment, workplace structures may limit their participation in clinical decisions. Inexperienced nurses may hesitate to question senior colleagues, particularly when they fear criticism or misunderstand the boundaries of their responsibilities. Such hesitation can affect patient safety when concerns remain unreported. Shared governance offers an organisational approach to addressing this problem through greater nursing participation in decisions about clinical practice and service improvement. Porter-O’Grady et al. (2025) explain that professional governance establishes structures through which nurses exercise professional responsibility and influence practice standards. These structures recognise that accountability requires appropriate decision-making authority. However, governance arrangements cannot guarantee meaningful autonomy unless organisations provide adequate support, education and opportunities for staff participation.

The relationship between leadership and autonomy also requires attention to individual competence. Graduate nurses cannot claim unrestricted decision-making authority simply because professional registration carries accountability. Their decisions must remain consistent with their demonstrated capabilities, applicable standards and organisational policies. Alanazi et al. (2026) examined 664 registered nurses and found that transformational leadership was positively associated with structural empowerment, which was associated with stronger clinical leadership. Clinical leadership was also positively associated with care quality and negatively associated with adverse events. Although the study was conducted in a tertiary hospital in Saudi Arabia, its findings illustrate how organisational support can influence frontline leadership. For graduate nurses, effective autonomy therefore develops through supervised practice, constructive feedback and access to experienced colleagues. Professional accountability requires nurses to recognise both their authority and their limitations.

Conclusion

Clinical leadership, professional autonomy and accountability form connected responsibilities within graduate registered nursing practice. Frontline nurses exercise leadership through clinical communication, patient advocacy, escalation and collaborative decision-making, regardless of their formal position. Transformational and distributed leadership perspectives explain how these behaviours contribute to professional practice and patient safety. Professional autonomy similarly depends on informed clinical judgment, appropriate authority and accountability for decisions. However, individual competence alone cannot overcome organisational barriers that restrict nurses’ participation in clinical decisions. Supportive leadership, shared governance and supervised professional development provide important conditions for responsible graduate practice. Graduate nurses should therefore develop leadership capabilities alongside clinical competence, recognising that professional accountability requires both sound judgment and the willingness to influence care when patient safety demands it.

References

APA 7th edition | Eight scholarly sources | Publication years 2022–2026

Alanazi, A. K., Traynor, M., McFetridge, L., McKeaveney, C., & Clarke, S. A. (2026). Linking transformational leadership to patient care quality: The role of structural empowerment and registered nurses’ clinical leadership. Journal of Nursing Management, 2026(1), Article 7518764. https://doi.org/10.1155/jonm/7518764

Alanazi, N. H., Alshamlani, Y., & Baker, O. G. (2023). The association between nurse managers’ transformational leadership and quality of patient care: A systematic review. International Nursing Review, 70(2), 175–184. https://doi.org/10.1111/inr.12819

Guibert-Lacasa, C., & Vázquez-Calatayud, M. (2022). Nurses’ clinical leadership in the hospital setting: A systematic review. Journal of Nursing Management, 30(4), 913–925. https://doi.org/10.1111/jonm.13570

Mrayyan, M. T., Abu Khait, A., Rababa, M., Algunmeeyn, A., Al-Rawashdeh, S., AL-Atiyyat, N., Rababa, M., Abu Saraya, A., & Al-Rjoub, S. (2024). Professional autonomy in nursing: A concept analysis. SAGE Open, 14(4). https://doi.org/10.1177/21582440241302129

Nhongo, D., Holt, A., Bail, K., & Flenady, T. (2024). Registered nurses’ confidence related to undertaking a leadership role in residential aged care: A clinical leadership self-assessment survey. Collegian, 31(4), 202–210. https://doi.org/10.1016/j.colegn.2024.04.004

Omidvar, M., Norouzinia, R., Aghabarary, M., & Rahmatpour, P. (2025). Head nurses’ leadership styles and emergency department nurses’ clinical professional autonomy in Iranian university hospitals: A cross-sectional study. Journal of Nursing Management, 2025, Article 1376035. https://doi.org/10.1155/jonm/1376035

Porter-O’Grady, T., Rollins, S., & Bailey, K. D. (2025). Nursing professional governance: The structure to enable professional practice. Nurse Leader, 23(6), Article 102512. https://doi.org/10.1016/j.mnl.2025.102512

Ystaas, L. M. K., Nikitara, M., Ghobrial, S., Latzourakis, E., Polychronis, G., & Constantinou, C. S. (2023). The impact of transformational leadership in the nursing work environment and patients’ outcomes: A systematic review. Nursing Reports, 13(3), 1271–1290. https://doi.org/10.3390/nursrep13030108