Nursing Management: Directing and Delegation

Directing

• Directing involves issuing orders, assignments, and instructions to nursing personnel to ensure understanding of expectations.
• It includes supervision and guidance to facilitate goal achievement.
• It acts as a link between organizing for work and completing the task.
• Key elements of directing include delegation, updating nursing service policies and procedures, supervising personnel, coordinating services, communication, staff development, and decision-making.

Delegation

• Delegation is the process where a manager assigns specific tasks and duties to workers, providing commensurate authority for completing the job.

• Two crucial criteria for effective delegation are:

  • Assessing the worker's ability to accomplish the task.
  • Ensuring fairness to both the employer and the team.

• Principles of delegation include selecting the right person, delegating interesting and uninteresting tasks, providing adequate time for learning, delegating gradually, consulting beforehand, and avoiding gaps or overlaps of responsibilities.

• Items that cannot be delegated include:

  • Overall responsibility, authority, and accountability for completing all tasks in the unit.
  • Authority to sign one's name.
  • Evaluating staff, and taking necessary corrective or disciplinary actions.
  • Responsibility for maintaining morale, and encouraging newly hired staff members.
  • Tasks that are too technical or require trust and confidence.

Nursing Care Assignment

• Nursing care assignment, also called modalities, systems, or patterns of nursing care, describes various methods for assigning nursing tasks.

• Functional nursing is a task-oriented system where a particular nursing function is assigned to each worker.

  • This system is ideal when there are many patients and few nurses.

• Functional nursing advantages:

  • Tasks are completed rapidly.
  • Workers rapidly develop proficiency in their assigned tasks.
  • Nurses maintain greater control over work activities.

• Functional nursing disadvantages:

  • Holistic care is often fragmented.
  • Accountability and responsibility for each patient are diminished.
  • Patients may struggle to identify their direct nurse.
  • Patient-nurse relationships are possibly weakened.
  • The quality of care and outcome documentation may be poor.

• Total care/case nursing involves a single nurse assigned to a single patient to provide all care for the duration of their shift.

  • This system is well-suited for fewer patients and more nurses.
  • The nurse is accountable for all patient care actions during their shift.

• Team nursing is a decentralized care system where a designated nurse leads a team in tending to a designated group of patients.

  • The team leader assigns tasks based on employee descriptions.
  • The goal is coordinated care for the patient group.
  • Team conferences are integral to the process.

• Primary nursing is a system where the designated primary nurse assesses the patient needs, sets objectives, and writes a care plan (NCP).

  • The primary nurse administers care as per the plan, assesses outcomes, and makes necessary adjustments as required.
  • She also provides pre-discharge planning and education for the patient.
  • Secondary or associate nurses may execute the plan under the directorship of the primary nurse, particularly during night or pm shifts.
  • Decentralization of authority and greater autonomy leads to increased motivation and accountability for the primary nurse.

• Modular nursing combines elements of team and primary nursing. The nurse provides direct care with assistant from aides while also leading the non-professional nursing personnel.

• Case management is a patient care delivery where the goal is the achievement of patient outcomes within a pre-determined timeframe.

  • The emphasis is on caring for patients throughout the entire episode of illness in various clinical settings.
  • The care manager assesses the patient's and family's needs.
  • Develops the NCP and delegates the care to the respective care team members.
  • The care manager coordinates, collaborates, and evaluates the healthcare outcomes.

Elements of Directing

• Communication is the transmission of information, ideas, and intentions between individuals to enable work facilitation and coordination effectiveness. Specific purposes of communication include promoting work, enhancing motivation, enabling change implementation, optimizing care, elevating worker satisfaction, and facilitating coordination.

  • Clear and concise communication for shared understanding.
  • Communication lines need structure and support for all parties.

• Downward communication flows from superiors to subordinates concerning organization policies, work procedures, and performance evaluations.

  • Upward communication flows from subordinates to superiors and provides feedback on policies' and procedures' effectiveness.
  • Horizontal communication facilitates coordination and cooperation between peers.
  • Outward communication flows between caregivers and the patients and community involves how employees value their work, and how this knowledge is communicated to the community.

• Coordination is the process of aligning personnel and services to a common goal; it avoids overlapping functions. promotes good working relationships and facilitates schedule adherence.

• Supervision ensures that staff quality and quantity of work is consistent with the appropriate standards, it involves evaluating staff as part of the process to ensure that resources are used optimally.

• Staff development refers to continuous training that is delivered by nurse instructors, department supervisors, and head nurses. This ensures continuous learning and promotes teamwork.

  • Activities include participation in journal meetings, case presentations, consultations, shadowing, acting as "big sister," or "buddy."

• Decision-making guides a course of action by consciously selecting alternative solutions to achieve a desired result using proper mental processes.

  • Effective decision-making needs to consider avoiding decisions that properly belong to other staff, preventing the waste of time or energy and avoiding premature decisions.

• Conflict management approaches for conflict resolution include avoiding the conflict, accommodating the conflict, collaborating to resolve the conflict, compromising to resolve the conflict.

This quiz focuses on the key concepts of directing and delegation within nursing management. Learn about the importance of issuing orders, supervising personnel, and the effective delegation of tasks in order to achieve organizational goals. Understand the principles that ensure successful management in a nursing context.