MODULE III: Decision Making, Delegation,

Time Management and Priority Setting

Learning Objectives

Module III concentrates on the following course outcomes—

1. Apply an ethical/legal framework to a nursing management situation.

Different ethical principles regarding management are discussed; laws and other legal processes related to employment, management and related human resources issues are explored.

2. Identify the human, fiscal and material resources necessary to efficiently achieve quality healthcare outcomes.

Decision-making and problems solving skills are presented as well as discussion of critical thinking. Resource management is discussed via patient safety, time management, and priority setting.

Reading Assignment

Sullivan: Chapters 8, 10, 13

Principles for Delegation ANA. http://www.indiananurses.org/education/principles_for_delegation.pdf (Links to an external site.)

Overview

The professional nurse uses ethical principles and legal frameworks to deliver patient care, both as a staff member and as a manager. Decision-making and problems solving are essential processes to nursing; the use of analytical tools can assist the nurse in delivering patient care and managing others. Federal laws direct the staffing of healthcare organizations. The manager needs to address maintaining adequate numbers of staff for the patient population, whether it is legal to float staff to other units within the hospital or organization and the use of agency nurses (temp staff). Federal law dictates that staffing ratios be made available to patients, families. California is one of the first states to legislate staffing ratios. Other states have followed. Additionally, the American Association addresses staffing ratios, and floating staff from one unit to another. There are guidelines that must be adhered to and each nurse needs to know the law in the respective state and that of the place of employment. Other legal issues that managers must face include employment laws regarding hiring and firing and issues related to discrimination.

Decision making is a purposeful goal driven process that involves choosing between or among options. Problem solving and critical thinking are related concepts. Problem solving is different than decision making and is focused on solving a more immediate problem. Decision making is based on decision making models which serve as frameworks and guides. There are decision making styles and relate to the one making the decision. The styles include autocratic, democratic or participative approach. Styles vary with the individual personality and are influenced by the environment and those within. Autocratic decision making may be used in emergent situations, however participative decision making is more appropriate when working with professionals in general on an ongoing basis. Group decision making has many advantages, like buy in from the group, as they came up with the idea. However, it is time consuming and work within the group may not be carried out equally.

Delegation involves giving responsibility for a task to another while at the same time retaining accountability. There are many guidelines or practice strategies outlined by the American Nurses Association that regulate delegation. First, a nurse must be familiar with the state law and nurse practice act of that state where employed. Some Nurse Practice Acts defines what is within the role of Registered Nurse and Licensed Professional Nurse (LPN). A Registered Nurse cannot legally delegate a task to an LPN that is outside the LPN’s scope of practice. See Principles of Delegation from the ANA cited in the hyperlink under readings. Accountability and responsibility are key concepts related to delegation. Distinction needs to be made between delegation and assignment making. As mentioned with delegation, responsibility is transferred but not accountability, with assigning, both are transferred. Care given by one RN to another is assigning both responsibility and accountability. Whereas, when an RN gives a task to an LNP or unlicensed care giver, accountability is retained (delegation). The RN is always responsible for assessing, diagnosing, planning and evaluation.

Time management has a number of personal and professional implications. Time management contributes to timely outcomes, fiscal responsibility and also to work-life balance. Many factors influence time management and each person needs to assess their own situations to determine factors that enhance or negatively affect time management. A key related concept is priority setting.

Assignment questions: Post answers in Forums Module III. See calendar for due dates.

1. What is the relationship among delegation, authority, responsibility, and accountability?

2. Discuss professional resources such as laws and professional nursing organizations in place for directing delegation.

3. After reviewing the ANA Principles of Delegation, discuss how delegation differs from assignment making.

4. Discuss factors from the reading and your experience that influence priority setting.

5. What issues have you encountered with delegation and how have you handled them?

6. What decision making model is used in your organization as a basis for decision making and is it effective? If not, what would be more effective?

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