One-year-old Ruby presented at a walk-in centre with a two-day history of wheezing. On examination, Sarah, an advanced children’s nurse practitioner, noticed that Ruby had a rectangular shaped bruise across her anterior trunk measuring 10 cm by 3 cm. Ruby’s mother could not offer an explanation for the bruise. I explained to her mum that as we had no explanation for how this injury had occurred in such a young child, then I was obliged to follow safeguarding procedure and refer Ruby to the Consultant on call for safeguarding at the local hospital. Ruby’s mum was completely understanding and accepted that this was the right thing for me to do and agreed to take Ruby to the hospital. Local safeguarding procedure was then followed and Ruby was admitted to hospital.

A couple of days later when following up the case, Sarah learned that a valid explanation had been found for Ruby’s bruising. On her birthday, Ruby had been given a toy for playing with in the bath: a mechanical duck with rotating feet to play. The duck’s feet were measured and exactly fitted with the bruise on Ruby’s trunk.

When Sarah next saw Ruby’s mother, she reported that the family had had a very negative and unpleasant experience at the hospital. Ruby’s mother described how staff had been unpleasant and judgmental towards her and Ruby’s father. She told Sarah how much she had appreciated her approach to the situation.

• How did Sarah demonstrate collective, ethical, authentic leadership in this situation?