Leadership Week 11 Notes PDF

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Leadership Week 11 Notes
Dr. Gilroy...

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Leadership Week 11 Notes and PowerPoints Chapter 17—Delegating: Authority, Accountability, & Responsibility in Delegation Decisions Nursing Practice  Nurses have the responsibility to know and understand what is permitted in their state nurse practice act (NPA)  Guided by o American Nurses Association Scope and Standards of Practice o STATE Nursing Practice Act o Your organization Delegation  Delegation is the transfer of responsibility for the performance of a task from one individual to another while retaining the accountability for the outcome  Considered the most effective professional leadership and management strategy nurses implement in clinical practice to improve the safety and quality of person-centered care  Complex decision-making strategy!  The nurse has to know… o Rules of ANA, state, and organization! o The competence of the person who will compete the delegated task o How to troubleshoot  What CANNOT be delegated… o Assessment o Planning care o Evaluating interventions o Applying nursing judgement History of Delegation  Budget constraints  Sicker patients  Nursing shortage  Push for quality care measures Assignments  Delegation vs. Assignment o Delegation – allowing the person to whom you delegate a task to do something outside of their normal role  Occurs when delegatees are requested to perform a specific nursing task, activity, or procedure outside their traditional role, have completed additional education and training, and have validated competency in the delegated area  Delegation is a complex skill that requires critical thinking, clinical judgment, and accountability for care of the client o Assignment – routine care that is part of the person’s scope of practice  The distribution of work that each qualified person is responsible for during a given work period

 Nursing responsibility in assignments  Validation of the individual’s ability to perform a task NCSBN Model  National Council of State Boards of Nursing Delegation Model  Provides an organizing framework for delegation and identifies the roles and responsibilities of the employer or nurse leader; licensed nurse; and delegate in the delegation process  Describes the role, function, and collaborative work relationships among those in the role of the employer or nurse leader, licensed nurse, and delegatee  For effective delegation, the employer or nurse leader promotes a positive culture and work environment that supports person-centered care. The Importance of Communication  HINT: The hardest part of being a nurse is getting people to do what you want!  Maintaining two-way communication, requesting information from the UNP, and teaching how, when, and what to report are essential  A two-way communication and follow-through system established between the delegator and delegatee allows person-centered care to be altered, if necessary, in a timely manner.  Delegating with confidence requires considerable trust between two or more individuals to create an effective team. Effectively Communicating  Giving information o Applies to both the delegator and delegatee o The delegator must provide sufficient information about the patient, situation, delegated tasks, monitoring process and desired outcomes. o In turn, the delegatee must report back to the delegator to indicate any deviations from any of those elements.  Giving direction o A delegator task. o The delegator is expected to be as specific as possible in what the performance is to entail, how often reports to the delegator are needed, and what constitutes an immediate concern. o More detailed direction may be needed for a delegatee to the extent that various steps are provided for each of the assigned elements.  Seeking clarity o A shared task. o The delegator is attempting to determine that the delegatee understands what is expected in terms of performance and reporting. o The delegatee is attempting to understand the delegator’s standards for general statements o A repeat-back method can be used by both individuals to be sure clarity is present.  Seeking advice o A delegatee task.

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o Examples include finding alternative ways to solicit information from patients or ways to perform a skill when a patient’s physical condition prevents a typical approach. Decision-Making: Assignment  Manager o Assesses staffing models, patient population, delegating nurse  Nurse o Assesses patient needs, UNP’s skills and knowledge o The nurse must determine whether the UNP has the knowledge, skill, and ability to accept the delegation and whether the UNP’s ability matches the care needs of the patient.  Unlicensed Nursing Personnel (UNP) o Also referred to as nurse’s aides Implementation  The TASK is delegated, not patient care  The nurse must o Review the task with the UNP o Reinforce specifics/concerns o Provide resources to complete the task/activity o Supervise the UNP’s ability to complete the task/assignment based on education and experience o Intervene if necessary and provide feedback on a timely basis Evaluation  Often overlooked in the delegation process o Shouldn’t be as it allows time to reflect on delegation decisions  Delegator should provide constructive feedback to the delegates regarding their work-related performance  The nurse should ask the UNP o Has the task been completed? o What changes were observed? o How did the patient respond?  Be ready to give and receive feedback! Accountability in Delegation  Organizational accountability o A crucial component of delegation that promotes a positive culture and work environment that supports person-centered care necessary for effective delegation  Organizations usually use a relationship-based leadership model that fosters interdisciplinary communication and collaboration o Are the individuals set up for success? o Are teams set up for success?  Individual accountability o Refers to individuals’ abilities to explain their actions and results o Accountability is to be answerable to oneself and others for one’s choices, decisions, and actions as measured against standards

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o Ethical obligations o The nurse must follow national and state laws (hospital policies do not override laws) 5 Rights of Delegation  Task o Is the task appropriate to delegate based on the individuals’ job description and facility policies and procedures? o Is the task legally appropriate to delegate?  Circumstance o Is the delegation process appropriate to the situation? o Is the environment conducive to completing the task safely? o Are the equipment and resources available to complete the task? o Does the delegatee have appropriate supervision to complete the task?  Person o Is the prospective delegatee a willing and able employee? o Does the delegatee have the knowledge and experience to perform the specific task safely? o Does the delegatee have the expertise to complete the task safely and effectively in relation to the acuity of the patient?  Direction/communication o Do the delegator and delegatee understand a common work-related language? (Do terms such as time frame, patient needs, and critical mean the same to each of them?) Does the delegator provide clear and concise directions for the task? o Does the delegatee understand the assignment, directions, limitations, and expected results as they relate to the task? o Do the delegator and delegatee know how to maintain open lines of communication for the purpose of questions and feedback? o Does the delegatee understand how, what, and when to report to the delegator?  Supervision o Is it clear that the delegatee will provide feedback related to the task, when appropriate? o Is the delegator able to monitor and evaluate the patient appropriately? Willingness and Readiness for Delegation  Situational Leadership Model o Determines the willingness and readiness of the delegatee and the type of relationship needed to make the delegation successful o Nurses must analyze an individual’s knowledge and the work-related task before delegating. o Nurses make decisions based on this analysis.  Transformational Leadership o Transformative leaders need to be able to diagnose the commitment, competence, and performance of others to create partnerships that improve person-centered care  Limited knowledge and ability – Tell

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o If the nature of the relationship is limited, such as a when someone is only going to work for half a day on the unit, the leadership style should be “telling,” because it provides a fair amount of guidance but limits the time spent on the interactions.

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New task from a known delegator – Sell o If the relationship is developing or ongoing, the delegator needs to understand the delegatee’s motivation related to the situation, and the leader’s style should be “selling,” which takes more time, but leads to a supportive relationship  Has willingness and ability but does not know the delegator – Participate o If the relationship is new or developing, more support is needed, and the delegator and delegatee need to interact in a participatory manner.  Has established relationship and expertise – Delegate o When a delegatee has a high degree of ability and willingness and is familiar with the expected task, little guidance is required. Delegation Challenges  Diversity in educational preparation and experience of UNP’s  Diversity in background and culture of UNP’s and delegators  Barriers o Overdelegation  Occurs when the nurse overburdens a delegatee with too many tasks and responsibilities.  This occurs when the delegator has difficulty organizing work, has poor time management skills, or lacks self-confidence in performing the task or responsibility. o Underdelegation  Occurs when nurses do not have the confidence to make an effective delegation decision, lack the time to delegate, choose to complete the responsibility themselves, lack the confidence in the delegatees’ abilities to complete the task, or fear a loss of control o Improper delegation  Delegating tasks or responsibilities beyond the delegatee’s training or education or assigning a task or responsibility without providing adequate information or data to successfully complete the task or activity.  Can lead to inadequate care for the patient or failure to meet the standards of care and can cause potential harm to patients.  Considering some challenges o Safety o Critical thinking o Stability o Time

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Chapter 18—Leading Change Change  Planned vs. unplanned o Planned change—deliberate and organized and has the goal of improvement o Unplanned change—disconcerting, unanticipated, and adaptive  First-order o Continuous improvement o Most quality improvement programs in healthcare systems are illustrations of this type of change o Small, ongoing steps are taken to make things better  Second-order o Radical change o May be unanticipated or expected, but in either case, demonstrative change is required for sustainability Change Process—First Order, Planned  Unfreezing  Moving  Refreezing  Unfreezing – Force Field Analysis  Unfreezing o Recognition of need for change o Evaluating costs and benefits o Highlight motivation level  Moving o Education o Communication o Testing  Refreezing o Make it stick! Change Process—Second Order, Unplanned  Think systems theory vs. chaos or complexity theories  Complexity theories alter the traditional systems thinking approach by asserting that system behavior is unpredictable o Views change as emergent and highly influenced by all individuals and subsystems in an organization. o Suggest that change is not episodic but rather an ongoing experience through which a system adjusts and realigns, recreating itself continuously. Individual-Level Change  Innovation-Decision Process

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o Change for an individual occurs over 5 phases when choosing to accept or reject an innovation/idea. o Decisions to not accept the new idea may occur at any of the 5 stages and the change agent can promote acceptance by providing information about benefits and disadvantages and encouragement  Knowledge Persuasion Decision Implementation Confirmation Attributes of Successful Change Agents  Commitment to a better way, Courage, Thinking outside of the box, current role, Persona Caring, Humility, Sense of Humor People and Change  Ideal and common patterns of an individual’s behavioral responses to change can facilitate an effective change  Responses are as follow— o Innovators thrive on change, which may be disruptive to the unit stability. o Early adopters are respected by their peers and thus are sought out for advice and information about innovations and changes. o Early majority prefer doing what has been done in the past but eventually will accept new ideas. o Late majority are openly negative and agree to the change only after most others have accepted the change. o Laggards prefer keeping traditions and openly express their resistance to new ideas. o Rejectors oppose change actively, and may even use sabotage, which can interfere with the overall success of a change process. Organizational Disciplines to Support Change  Shared vision—The process of creating a common view about where the organization is going  Mental models—The practice of helping individuals become aware of how they think, what they value, and how that affects organizational performance  Personal mastery—The fostering of openness in the face of change by maintaining self-awareness and using reflection  Team learning—The promotion of teams thinking together, collaborating, and sharing ideas, knowledge, and perspective  Systems thinking--The development of frameworks that see the organization as a complex entity whose many parts affect outcomes Leadership and Change  4-A Model o o o o

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Acknowledge thoughts and feelings Align with purpose and values Create Agency with genuine choices Adjust your attitude

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Kotter’s 8-Step Model...