Delegation, Change, and Conflict Management in Nursing

Posted on Apr 28, 2024 in Philosophy and ethics

Delegation in Nursing

Reasons to Delegate

  • Cost containment
  • Time management
  • Team building

Essential Concepts of Delegation

  • The art of accomplishing work through others
  • Learned skill
  • Patient care delivery is increasingly complex
  • Effective delegation is crucial for task completion
  • RNs are responsible for understanding scope of practice and effective delegation

Profession vs. Vocation

  • **Profession (RN):** Theory-based, research/practice/theory triad, systems-based approach, data gathering for assessment
  • **Vocation (LPN):** Skills-based, practice-focused, task-based approach, data gathering for tasks

Delegation Considerations

  • State Nurse Practice Act, legal definitions, professional standards, agency policies
  • Knowledge and skill of personnel
  • Individual strengths and weaknesses

RN Responsibilities

  • Assessment, diagnosis, planning, implementation, evaluation
  • IV lines, blood administration, sterile procedures, teaching

LPN Responsibilities

  • Teaching from standard care plans, vital signs, medication administration
  • Suture removal, IV maintenance, sterile dressings

UAP Responsibilities

  • Activities of daily living (ADLs)
  • Bathing, grooming, dressing, toileting, ambulating, feeding, positioning
  • Bed making, socializing, specimen collection, intake/output, vital signs, documentation

The 5 Rights of Delegation

  • Right task
  • Right circumstance
  • Right person
  • Right direction & communication
  • Right supervision
  • Right evaluation

Effective Delegation

  • Assess, plan, implement, evaluate
  • Prioritize, select the right person, communicate clearly, empower, monitor, provide feedback

Problems in Delegation

  • Under-delegating
  • Over-delegating
  • Improper delegating
  • Unclear communication

Resistance to Delegation

  • Lack of understanding from delegate’s perspective
  • Lack of confidence
  • Resistance to authority
  • Overly specific delegation

Support Needed

  • Job descriptions, recruitment, selection
  • Time management, training in delegation and communication

Key Points

  • Delegation is essential, requiring careful planning and adherence to the 5 Rights
  • Over and under-delegation are common errors
  • Cultural differences can lead to misunderstandings

Change Management in Nursing

Lewin’s Theory of Change

  • **Unfreezing:** Creating the need for change and motivating individuals
  • **Changing:** Implementing the desired changes
  • **Refreezing:** Making the change permanent (less applicable in healthcare’s constant change)

Driving and Restraining Forces

  • **Driving forces:** Positive factors promoting change
  • **Restraining forces:** Obstacles to change
  • Change occurs when driving forces outweigh restraining forces

Points to Remember

  • Avoid change for the sake of changing
  • Implement change gradually
  • Finish what you start
  • Expect resistance

Changes in Today’s Organizations

  • Continuous state of change, no equilibrium
  • Evolution of change theories

Complex Adaptive Systems Change Theory

  • Complexity of the world and individuals
  • Non-linear relationships and unpredictable responses
  • Interconnectedness of elements within a system
  • Unanticipated factors influencing change

Chaos Theory

  • Finding order in apparent chaos
  • Small changes can have significant impacts (butterfly effect)
  • Flexibility over rigid approaches

Approaches to Change

  • **Rational-empirical:** Providing research and evidence to overcome resistance
  • **Normative-re-educative:** Using group norms and peer pressure to implement change
  • **Power-coercive:** Utilizing power, sanctions, or political influence

Resistance to Change

  • Disruption of routines and familiarity
  • Variations in acceptance (crusaders vs. tradition bearers)

Enacting Change

  • Develop trust, provide information, address concerns
  • Include affected individuals in planning
  • Time the change effectively

Implementing Change

  • Pilot projects, resource allocation, time management
  • Interpersonal processes (negotiation, co-aptation, coercion)
  • Sustaining the change

Effective Advocacy in Nursing

  • Know your beliefs and values
  • Education, experience, and belief in your right to speak up
  • Objectivity, empathy, assertiveness, tenacity

Who Needs Advocacy?

  • Those lacking knowledge or power (children, disabled, mentally ill)
  • Decision-makers needing information and support
  • Those with inadequate care or communication difficulties
  • Always prioritize patient focus

Goals and Outcomes

  • Prevent the need for advocacy
  • Provide information and education
  • Support patient decision-making
  • Communicate effectively
  • Work for change and be involved

Managing Conflict in Nursing

Types of Conflict

  • **Intrapersonal:** Within oneself
  • **Interpersonal:** Between individuals
  • **Organizational:** Between groups

Conflicts in Nursing

  • Between healthcare team members, families, generations
  • Care issues, scheduling, ethical considerations

Causes of Conflicts

  • Relationship conflicts (miscommunication, emotions, stereotyping)
  • Data conflicts (lack of information, differing views)
  • Interest conflicts (competition over interests)
  • Structural conflicts (unequal authority, resources)
  • Value conflicts (different beliefs, ideologies)

Conflict Resolution

  • Negotiating for win-win situations
  • Thomas-Kilmann Conflict Modes (avoiding, compromising, competing, accommodating, collaborating)

Mediation

  • Steps: assess, analyze, plan, implement, evaluate
  • Facilitating factors: trust, communication, willingness to negotiate
  • Destructive tactics: control, need to be right, fighting

Key Points

  • Conflict can be beneficial or destructive
  • Appropriate levels of conflict can avoid stagnation
  • Aim for win-win solutions
  • Alternative dispute resolution methods may be necessary

Collective Bargaining and Unions in Nursing

  • History of unions in the US
  • Nursing issues with unionization (professionalism, supervisor roles, fear of reprisal)
  • The ANA and unionization
  • Union organizing strategies
  • Management responsibilities
  • Steps in unionization (interest, election, decertification)
  • New methods of bargaining (collaboration, consensus)

Employment Legislation

  • Labor Standards (work conditions, hours)
  • Wage laws (minimum wage, equal pay)
  • Labor Relations Laws (unfair labor practices, unionization rights)
  • Equal Opportunity Laws (anti-discrimination)

Decision Making, Problem Solving, and Critical Thinking in Nursing

Critical Thinking

  • Analyzing information to make judgments
  • Systematic, analytical, reflective
  • Identifying root causes, evaluating information, forming judgments
  • Considering multiple perspectives
  • Utilizing cognitive and affective evaluation (intuition)

Approaches to Problem Solving

  • Structured approach enhances reasoning and critical thinking

Decision Making Process

  • Problem solving: data gathering, analysis, goals, strategies, implementation, evaluation
  • Nursing process: assessment, diagnosis, planning, implementation, evaluation

Critical Elements

  • Gather and analyze data
  • Define objectives
  • Generate alternative solutions
  • Choose and act decisively
  • Evaluate outcomes

Resources for Decision Making

  • Evidence-based sources, policies, clinical pathways, experience

Decision Making in Nursing

  • Priorities (ABCs, Maslow’s hierarchy of needs)

Group Decision Making

  • Advantages: cohesiveness, support for change
  • Disadvantages: conflict, time consumption
  • Methods: Delphi, nominal group, consensus, majority rule

Workplace Challenges in Nursing

Sources of Conflict

  • Differing expectations between employees and managers
  • Unclear expectations, delayed issue resolution

Challenging People

  • Problem employees: ineffective team members
  • Marginal employees: meeting minimum standards, requiring coaching

Challenging Interactions

  • Personal embarrassment, attacks, disruptive behavior
  • Complaints, anger, coercion, divided loyalties

Dealing with Specific Situations

  • Chemically impaired employees
  • Boundary violations
  • Incompetent employees
  • Absenteeism

Discipline vs. Punishment

  • Discipline aims to correct behavior
  • Punishment is punitive
  • Types of discipline: destructive, constructive, self-discipline, group norms

Foundation for Effective Discipline

  • McGregor’s rules: forewarning, immediate consequences, consistency, impartiality

Discipline Process

  • Informal/verbal reprimand
  • Formal/written reprimand or warning
  • Suspension
  • Termination

Strategies to Modify Behavior

  • Performance deficiency coaching
  • Disciplinary conference
  • Termination conference

Grievances

  • Procedure for addressing unfair disciplinary action
  • Formal process, chain of command, hearings, arbitration

Workplace Violence and Harassment

  • Includes physical and psychological harm
  • High prevalence in nursing
  • Bullying characteristics: deliberate, planned, discrediting, verbal abuse, isolation, criticism