Week 6 - Leadership, Organization, Power, Patient Care & Delegation

Chapters 1, 12, 13, 14, and 20

Chapter 1 - Decision Making, Problem Solving, Critical Thinking & Clinical Reasoning

Core Concepts

• Decision Making - choosing among alternatives.

• Problem Solving - a systematic process used to analyze and resolve a problem.

• Critical Thinking - purposeful, reflective thinking used to evaluate information, assumptions, and possible actions.

• Clinical Reasoning/Judgment - applying knowledge, evidence, experience, and patient information to clinical decisions.

Decision-Making Process

• Identify the problem or decision.

• Gather relevant information.

• Identify possible alternatives.

• Evaluate alternatives and potential consequences.

• Select and implement the best alternative.

• Evaluate the outcome.

Factors Affecting Decisions

• Values, experience, and personal assumptions.

• Bias and cognitive shortcuts.

• Available information and evidence.

• Time, resources, risk, and uncertainty.

• Organizational culture and the practice environment.

Key Point: Effective decision making combines evidence, critical thinking, experience, and awareness of bias.

Chapter 12 - Organizational Structure

Organizational structure defines authority, responsibility, communication, and relationships within an organization.

• Formal Organization - officially established roles, authority, responsibilities, and communication pathways.

• Informal Organization - relationships and communication networks that develop naturally among employees.

Key Organizational Concepts

• Chain of Command - the formal line of authority and communication.

• Span of Control - the number of individuals directly reporting to a manager.

• Unity of Command - the principle that an employee generally reports to one supervisor.

• Centralization - decision-making authority is concentrated at higher organizational levels.

• Decentralization - decision-making authority is distributed closer to where the work occurs.

• Shared Governance - nurses participate in decisions affecting nursing practice and patient care.

Common Organizational Structures

• Functional structure.

• Service-line or product structure.

• Matrix structure.

• Flat/decentralized structure.

Key Point: Organizational structure influences communication, decision making, accountability, and responsiveness to change.

Chapter 13 - Organizational, Political & Personal Power

Power & Influence

Power is the ability to influence others or achieve desired outcomes. Power is an important leadership resource and may come from a formal role or from personal influence.

Sources of Power

• Legitimate Power - comes from position or formal role.

• Reward Power - comes from the ability to provide rewards or desired benefits.

• Coercive Power - comes from the ability to impose consequences.

• Expert Power - comes from knowledge, competence, or expertise.

• Referent Power - comes from respect, relationships, credibility, or admiration.

• Informational Power - comes from access to or control of important information.

Politics & Empowerment

• Organizational politics involves using relationships, influence, and power to accomplish goals.

• Effective leaders understand both formal and informal power structures.

• Empowerment increases others' ability to participate, make decisions, and influence outcomes.

Key Point: Leadership influence often depends on expert, referent, and relationship-based power as well as formal authority.

Chapter 14 - Organizing Patient Care

Patient-Care Delivery Systems

• Total Patient Care - one nurse provides most or all care for assigned patients during the shift.

• Functional Nursing - work is divided according to tasks or functions.

• Team Nursing - a team provides care under the coordination of a team leader.

• Primary Nursing - one RN assumes primary responsibility for planning and coordinating a patient's nursing care.

• Case Management - coordinates care and resources across the continuum to achieve desired outcomes.

Selecting a Care Delivery Model

• Patient acuity and complexity.

• Staff skill mix and available resources.

• Continuity and coordination of care.

• Communication needs.

• Quality and safety.

• Cost and efficiency.

Key Point: No single patient-care delivery system is best for every setting; the model should fit patient, staff, and organizational needs.

Chapter 20 - Delegation

• Delegation transfers responsibility for performing a selected task while the nurse retains accountability for making an appropriate delegation decision and for appropriate supervision and evaluation.

• Delegation is a leadership, management, communication, and patient-safety skill.

Five Rights of Delegation

1. Right Task

2. Right Circumstance

3. Right Person

4. Right Direction/Communication

5. Right Supervision/Evaluation

Factors to Consider Before Delegating

• Patient condition, stability, and predictability.

• Complexity and risk of the task.

• Knowledge, skill, and competence of the person receiving the task.

• Scope of practice and role expectations.

• Organizational policy.

• Level of supervision and follow-up required.

Delegation vs. Assignment

• Assignment - distribution of work that is already within an individual's normal role and scope of practice.

• Delegation - transfer of responsibility for performing a selected task while the delegating nurse retains appropriate accountability.

Responsibilities of the Delegating Nurse

• Assess the patient and situation.

• Select an appropriate person and task.

• Provide clear directions and expected outcomes.

• Specify what should be reported back and when.

• Provide appropriate monitoring and supervision.

• Evaluate completion and patient outcome.

Key Point: A task may be delegated; accountability for appropriate delegation cannot simply be transferred.