The purpose of this discussion is to identify key issues to consider when delegating and assigning care, dimensions of power and conflict in the case study, the problems presented, and possible solutions.

Question description

Post a thoughtful response to at least two (2) other colleagues’ initial postings. Responses to colleagues should be supportive and helpful (examples of an acceptable comment are: “This is interesting – in my practice, we treated or resolved (diagnosis or issue) with (x, y, z meds, theory, management principle) and according to the literature…” and add supportive reference. Avoid comments such as “I agree” or “good comment.”

References:

  • Response posts: Minimum of one (1) total reference: one (1) from peer-reviewed or course materials reference per response.

Words Limits

  • Response posts: Minimum 100 words excluding references
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  • Discussion 1

The purpose of this discussion is to identify key issues to consider when delegating and assigning care, dimensions of power and conflict in the case study, the problems presented, and possible solutions.

As Leadership and Nursing Care Management (2014) explains, when delegating and assigning care there are five Rights; Right task, Right circumstance, Right Person, Right Direction/communication, and Right supervision and evaluation. The delegator and the delegate should agree on the task assigned. The delegator should assess the delegate’s experience and skills of the task. The delegate should be comfortable and confident in completing the said task.

Some problems presented in the case are; the patient is non-verbal with James, is it because there is a language barrier or does the patient not speak/ like male caregivers, James has never prepared a patient for a mastectomy surgery, and the charge nurse gives minimal instruction without concern or review with James.

Two workable solutions are for the charge nurse to evaluate what James knows and educate him on missing components or to do the task with him, so he can see the steps and feel comfortable for the next time he has a mastectomy patient going for surgery. I feel since the patient is not verbally responsive to James, the charge nurse should assume the care of the patient to see if that helps and since the charge nurse is experienced she should do the preparation for such an invasive surgery. If the staff refuses to accept the delegated task, the charge nurse should assess the reason why the staff refuses and go from there with demonstration and instruction or to have the staff observe the task for better knowledge and understanding for next time. Ultimately, the task weather it is complete correctly or incorrectly will fall back on the delegating charge nurse. Delegation errors are a primary factor in malpractice lawsuits against nurses (Anderson, 2016).

Reference:

Huber, D. (2014). Leadership & Nursing Care Management. St. Louis, Missouri: Elsevier Inc.

Anderson, P. (2016). Delegating without Doubts. American Nurse Today. November 2016, Vol. 1 Num. 2.

Discussion 2

Delegation is a nursing skill that takes time to acquire and practice to do effectively. Every successful nurse must learn this skill to be able to provide the best quality and most efficient care to patients. Although delegation is taught in nursing school, the lack of practice in the clinical environment creates challenges for nurses coming into the field. In addition, unsuccessful delegation can create conflict and resentment inside the nursing unit (Huber, 2014).

In the critical thinking exercise, the key issues to consider when delegating and assigning care to the patient are the patient’s feelings and level of comfort with James, James lack of education regarding pre-operative protocol/preparation for mastectomies, and Julie’s training regarding patient pre-operative preparation. Also depending on the unit’s acuity and operating room schedule, time could play a significant role in this situation. Currently, the problems facing that unit are that there is a patient who needs to be prepped for a surgery and is assigned to a nurse who does not have experience with that type of surgery and that the patient has not established a good rapport with the assigned nurse and has stopped communicating (Huber, 2014).

In this situation, the relational aspect of power, the dependency of power, and the sanctioning of power are all present. In the relational aspect of power, the charge nurse has enough power of the staff nurse that he may prep the patient for surgery although he does not have education on that process and the patient may not want him involved. In terms of dependency power, the surgical unit is dependent on the oncology unit preparing the patient for surgery. Lastly, in the sanctioning aspect of power, the charge nurse may punish the staff nurse for not completing the preparation on his own or reward him for finishing the task. The relationship between the patient, staff nurse, and charge nurse can quickly create conflict resulting from the lack of familiarity of the process by the staff nurse. The patient and nurse may experience intrapersonal conflict arising from unmet needs. Whereas the charge nurse may experience intrapersonal conflict while being pulled to handle this patient’s situation while her patients wait for care (Huber, 2014).

There are a few solutions the charge nurse can choose to remedy this situation. First of all, she could use collaboration to work with the staff nurse and the nursing assistant to complete the surgical preparation while teaching him for future patients. She could also compromise with him and swap the patient for one of her patients. By working together, the team could problem solve the situation together and the patient could be persuaded to allow him to complete the preparation by using active listening and allowing her to voice her concerns (Huber, 2014).

In this situation, the best solution would be to collaborate and prepare the patient for surgery. The nursing assistant could help with the physical tasks of preparing the patient such as bath, gown, removal of jewelry, etc. Since the staff nurse is not able to oversee the preparation himself, the delegation should come from the charge nurse since she is familiar with the process and can supervise and evaluate the care. Then the charge nurse and staff nurse could work together to complete the pre-operative assessment and forms. By working together, the staff nurse will have an opportunity to experience the mastectomy preparation and will be prepared in the future. In the event the staff refuses to accept the delegated tasks, the charge nurse should use the chain of command to address the situation. The most important issue at the moment is addressing the patient’s concerns and getting her to surgery. While delegation can create conflict, an experienced and effective delegator can use communication to solve the conflict and strengthen the care team (Huber, 2014). In conclusion, successful delegation requires effective communication, collaboration within the healthcare team, competence by both parties, and defined roles. Delegation is a skill which when done effectively, benefits patient care (National Guidelines for Nursing Delegation, 2016).

References

Huber, D. (2014). Leadership and nursing care management. Saint Louis, MO: Elsevier Health Sciences.

National Guidelines for Nursing Delegation. (2016). Journal of Nursing Regulation7(1), 5-14.

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