NU 349 Transition to Professional Practice: Delegation & Leadership

Delegation

the process for a nurse to direct another person to perform nursing tasks and activities and the transfer of authority/responsibility to a competent individual to perform a selected task in a selected situation

5 Rights of Delegation

Right task

Right person

Right circumstances

Right directions and communication

Right supervision and evaluation

Right task

distinct tasks/data collection;

NO assessments, evaluations, or care planning

NO education

NO decision-making

Right person

depends on plan of care and desired outcomes; NURSE is accountable for selecting appropriate person to perform a task

Right circumstances

consider setting, resources, staffing, needs, teaching obligations, and patient acuity/condition

NO unstable/acute

Right directions & communication

4 Cs:

Clear

Concise

Correct

Complete

Right supervision & evaluation

Provide initial instructions and monitor progress; be available for guidance, assess results, modify if needed, document, and give feedback

RN delegates to who? What is it based on?

CNA/LPN/RN; scope of practice, predictable, little to no modification for the patient, appropriate skills, etc.

What can CNAs/LNAs do?

Care for multiple patients

Personal care and ADLs

Hygiene

Feeding

Recording I&O, height and weight, vitals, activities, and physical/mental condition

Changing linens/making beds

Incontinence care

Ambulation and repositioning (stable pt.)

Toileting

Post-mortem care

RN vs. LPN: Assessment

RNs can assess initially and assess unstable clients, while LPNs can monitor RN findings and gather data + assess STABLE clients

RN vs. LPN: Interventions

RNs can admin IVP, blood, TPN, meds with titration/continous monitoring, access implanted devices, and analyze cases with complex critical thinking and care planning

LPNs can do basic care (bandages/catheters), report client status and concerns to HCP/RN, care for stable patients with PREDICTABLE outcomes

RN vs. LPN: Teaching

RNs can do initial and discharge teaching

LPNs can reinforce RN education

Reciprocal Feedback Process

Ask for input

Give credit for effort

Share perceptions

Explore different POVs

Determine what steps are needed to reach desired outcomes

Revisit plan and results

Assignment

a task/activity that the individual is already authorized to do

Supervision

guidance, oversight, or periodic inspection by a qualified individual to ensure that the delegated task is accomplished

Accountability

to be answerable for what one has done, standing behind thier decision/action (which is measured against a standard)

What are nurses accountable for?

Deciding what/when to delegate

Assessments

Planning outcomes

Assessing delegate competancy

Clear directions and acceptance from delegate

Following up and providing feedback

Charge Nurse

a nurse responsible for a team of healthcare workers; leads, coordinates, makes patient assignments, is a resource for support, conflict resolution, communication, decision-making, and delegation/supervision

Leader

someone who selects/assumes this role and is social-behavioral oriented; influences others, models change, establishes trust, builds commitment and focuses on effectiveness by asking "what and why?"

Manager

assigned or appointed to this role with responsibility to organizational goals; is problem-oriented, deals with systems, and supervises/coordinates group to meet common goal with a focus on efficiency by asking "how?"

Leadership Styles

Laissez-Faire

Democratic

Authoritarian

Leadership styles: Range

Laissez-Fare is little control, democratic in the middle, and authoritarian is high control

Laissez-Faire Leadership

a style that is permsisive, non-directive, and passive; leaves group members to own devices with little involvement

When does Laissez-Faire work best?

when leader/group members have the same level of education/perform the same tasks

Cons of Laissez-Faire

group may feel lost, frustrated, and only input from the leader may be if something is done incorrectly or not done as they avoid decision-making

Democratic Leadership Style

supportive, participative, and transformational leadership style in which all aspects of the goal are shared by the group; the leader provides guidance and control over the final decision while all members share control

When does the democratic leadership style work best?

when group members know each other well and have relatively equal status

Cons for Democratic Leadership

can be time-consuming, inefficient when there are disagreements among members

Authoritarian Leadership Style

controlling, directive, autocratic leadership style in which the leader is in control of all aspects of the group and gives orders that the group is expected to do; works best in EMERGENCIES or when organizing a large group

Cons for Authoritarian Leadership

micromanaging, passive-agressive techniques that may suppress creativity, ineffective long-term, and high turnover rate among members

Degree of Freedom vs. Control: Laissez-Faire

high, low

Degree of Freedom vs. Control: Democratic

moderate, moderate

Degree of Freedom vs. Control: Authoritarian

low, high

Decision Making vs. Leader Activity Level: Laissez-Faire

group or nobody, minimal

Decision Making vs. Leader Activity Level: Democratic

leader and group, high

Decision Making vs. Leader Activity Level: Authoritarian

leader only, high

Responsibility: Laissez-Faire

abandoned

Responsibility: Democratic

leader and group

Responsibility: Authoritarian

leader

Quality of Output vs. Efficiency: Laissez-Faire

variable, variable

Quality of Output vs. Efficiency: Democratic

high (and creative), moderate

Quality of Output vs. Efficiency: Authoritarian

high, high

Leadership-Contingency Theory

leader's effectiveness depends on whether they are task or relationship oriented; too much focus on task = low morale, while too much focus on relationships = poor productivity

Ideal leader is..

high-relationship and high-task oriented; does this by active communication, constructive direction, and resolving conflict to achieve effective/creative solutions

Situational Leadership Theory

recognizes that no single approach works in ALL situations, and the leadership style must match the needs of the group members and environment; requires flexibility, coaching skills, insight, trust, and problem-solving skills