20Jones Leadership(F)-ch 20 1/14/07 3:52 PM Page 343 Constructive Conflict Management Let’s Talk How does your personal and professional background influence the ways in which you deal with conflict? What conflict management style(s) you use most frequently? How has this affected the outcomes of conflicts you have been involved in? What are the advantages and disadvantages of competitive negotiation and collaborative negotiation? In what health-care situations might each be useful? Consider a conflict you have observed in a clinical setting What was its impact on the primary participants of the conflict? the patients being cared for by these participants? the work environment? What strategies would you recommend using to resolve this conflict? NCLEX Questions Factors that influence the ease with which a con- flict is resolved include all of the following EXCEPT: A The level of interdependence of the parties B The importance of the outcome C The perceived fairness of the process of resolution D The extent to which support systems that encourage resolution are in place E All of the above An example of a role conflict is: A When the director of respiratory care and the nursing director of the ICU both want to hire a new employee in their discipline to work in the ICU B When the director of respiratory care believes she does not receive as many resources as the nursing director of the ICU C When two secretaries are hired to help with excess work load but the job expectations for each of them is not clear D When line managers believe that support staff use their technical knowledge to intrude on the line manager’s legitimate authority 343 Which of the following is true regarding power in conflict? A Some participants have no power in the conflict B An individual’s power in a conflict tends to remain constant C The perception of power may be more important than the actual power D All of these are true E None of these is true Value conflicts are likely to occur when: A Parties in conflict share values not held by the general population B Parties in conflict hold opposing values C Parties in a conflict disagree about the facts in a situation D Issues occur because of incompatible emotions E All of these are true Which of the following questions assist in the identification of identity or face-saving goals in a conflict? A What I want? B Who are we in this relationship, and how does this affect what I want? C What processes should be used in the resolution? D Who am I in this interaction, and how does it affect what I want? The most effective conflict management style: A B C D E Is collaboration Is competition Is compromise Depends on the situation Depends upon the participant’s core personality traits Research over the last 15 years suggests that nurses are most likely to use which of the conflict management styles? A Competition, compromise B Avoidance, accommodation, compromise C Competition, collaboration D All styles Which of the following communication behav- iors used in a conflict NOT point to a destructive outcome? A Criticism B Defensiveness 20Jones Leadership(F)-ch 20 344 1/14/07 3:52 PM Page 344 Skills for Being an Effective Manager C Stonewalling D Anger E Contempt Which of the following is likely to be found in integrative (collaborative) negotiation? A Hiding information B Exaggerating one’s concessions C Compromising D Using confrontation to make points E Moving slowly toward the other’s point of view 10 Which of the following is true of distributive (competitive) negotiation? A Competition is typically used by the “winner” B The ongoing relationship between the two parties is an important element in the negotiation C Making a modest opening bid and moving down slowly D All of these are true E None of these is true REFERENCES American Association of Critical-Care Nurses (2005) AACN standards for establishing and sustaining healthy work environments: A journey to excellence www.aacn.org; accessed February 2005 American Nurses Association www.nursingworld.org; accessed March 2004 Bartol, G.M., et al (2001) Effective conflict management begins with knowing your style Journal for Nurses in Staff Development, 17(1), 34–40 Barton, A (1991) Conflict resolution by nurse managers Nursing Management, 22(5), 83–86 Blake, R., & Mouton, J (1964) Managerial grid Houston: Gulf Publishing Boule, L (2001) Mediation: Skills and techniques Australia: Butterworths Skill Series Cavanagh, S.L (1991) The conflict management styles of staff nurses and nurse managers Journal of Advanced Nursing, 16(10), 1254–1260 Eason, F.R., & Brown, S.T (1999) Conflict management: Assessing educational needs Journal for Nurses in Staff Development, 15(3) 92–96 French, J & Raven, B (1960) Bases of social power http:// www.valuebasedmanagement.net/methods_french_raven_ bases_social_power.htm Accessed November, 2006 JCAHO (2005) Sentinel event resource index www.jcaho org; accessed April 2005 Ury, W., Patton, B., & Fisher, R (1991) Getting to yes (2nd ed.) New York: Penguin Books Hightower, T (1986) Subordinate choice of conflicthandling modes Nursing Administration Quarterly, 11(1), 29–34 Kritek, P (2002) Negotiating at an uneven table: Developing moral courage in resolving our conflicts (2nd ed.) San Francisco: Jossey-Bass Publishing Lewicki, R., et al (2001) Negotiation (4th ed.) Boston: McGraw Hill Marcus, L., et al (2001) Renegotiating health care: Resolving conflict to build collaboration San Francisco: Jossey-Bass Publishing Marriner, A (1982) Managing conflict Nursing Management, 13(6), 29–31 Maxfield, D., et al (2005) Silence kills: The seven crucial conversations for health care American Association of Critical-Care Nurses & VitalSmarts www.rxforbettercare.org; accessed February 2005 Rahim, M.A (1990) Theory and research in conflict management NY: Praeger Publishers Rowland, H., & Rowland, B (1997) Nursing administration handbook Gaitherburg: MD: Aspen Publications Sportsman, S (2005) Build a framework for conflict assessment Nursing Management, 2005, 32–40 Sportsman, S., & Hamilton, P (2007) Conflict management styes in nursing and allied health professionals Journal of Professional Nursing January-February, 2007 Thomas, K.W., & Kilmann, R (1974) Thomas-Kilmann conflict mode instrument Tuxedo, NY: XICOM Valentine, P (1995) Management of conflict: Do nurses/ women handle it differently? Journal of Advanced Nursing, 22(1), 142–149 Warner, C (1992) Treasury of women’s quotations Englewood Cliffs, NJ: Prentice Hall Wilmot, W., & Hocker, J (2001) Interpersonal conflict (6th ed.) Boston: McGraw-Hill Woodtli, A (1987) Deans of nursing: Perceived sources of conflict and conflict-handling modes Journal of Nursing Education, 26(7), 272–277 21Jones Leadership(F)-ch 21 1/15/07 6:45 PM Page 345 chapter 21 Delegation: An Art of Professional Practice CAROLE A MUTZEBAUGH, EDD, CNP, CNS, MS CHAPTER MOTIVATION “It is neither to everything yourself nor to appoint a number of people to each duty, but to ensure that each does that duty to which he [sic] is appointed.” F Nightingale, 1859 CHAPTER MOTIVES ■ ■ ■ Identify universal “rights” for delegation Define “delegation” as discussed in state/province nurse practice acts Review key elements of successful delegation, along with problems associated with task delegation 345 21Jones Leadership(F)-ch 21 346 N 1/15/07 6:45 PM Page 346 Skills for Being an Effective Manager ursing management is truly an art Whether an experienced manager or newly hired for the first professional position, the registered nurse (RN) seldom works alone The interdisciplinary and interactive nature of nursing calls for juggling creative applications of the art of nursing Skills for interdependent health-care delivery begin with direct patient care and can culminate in directing large groups or organizations Financial pressures inside and outside the health-care agency, Medicare reimbursement reductions, managed care, and professional salaries create a greater need for increased delegation The ideal nursing practice incorporates many skill levels of health-care personnel with goals for patient care, yet within legal definitions and fiscal awareness To achieve both patient care goals and goals of employers, the RN plans to extend his or her scope of practice through task delegation Delegation is seen not only as a management skill but also as an ethical issue for nurses The Code of Ethics for Nurses (American Nurses Association, 2001) endorses delegation where, “[t]he nurse is responsible and accountable for individual nursing practice and determines the appropriate delegation of tasks consistent with the nurse’s obligation to provide optimum patient care.” Within health-care systems, the nurse may delegate to a technician, an orderly, a management assistant, or another nurse The National Council of State Boards of Nursing (NCSBN, 1995) views delegation as “transferring to a competent individual, the authority to perform a selected nursing task in a selected situation The nurse retains accountability for the delegation.” The importance of delegation in the delivery of nursing care is emphasized on the NCLEX-RN study guide within the topics of leadership, staffing, and communication (NCSBN, 2004) Although delegation is the skill most used to extend and expand the nurse’s sphere of influence, certain aspects of the nursing process cannot be delegated For instance, the practice-defining functions of assessment and evaluation, which require nursing judgment, can never be delegated Implementation of nursing care, even delegated care, still remains the responsibility of the nurse Components of Delegation Delegation to others in the workplace involves four principal components: delegator, delegatee, task, and client/situation DELEGATOR The delegator possesses the authority to delegate by virtue of both position in the agency and state government license to certain tasks The license defines the scope of practice within a profession, whereas agency policy describes the role of employees The RN degree, license, and policy create the authority to delegate to another individual in the workplace Finally, delegation does not change the delegator’s accountability or responsibility for task completion These two concepts mean that the delegator can only delegate tasks within his or her scope of practice and that the responsibility for the skillful completion of the task remains with the delegator DELEGATEE A delegatee receives direction for what to from the delegator The relationship between the two individuals exists within the workplace environment or through agency policy The delegatee has the obligation to refuse to accept tasks that are outside of his or her training, ability, or job description Although the delegatee may be registered or certified for certain skill sets, that is not always the case In fact, even when assistive persons holds a permit to work as unlicensed assistive personnel (UAP), that permit stipulates that performance of activities occur under the direction or supervision of a licensed nurse A trained delegatee should have skills that relate to the work setting, but the delegator is responsible for knowing the performance level of each delegatee TASK The task is the delegated activity The delegated activity generally should be a routine task Routine 21Jones Leadership(F)-ch 21 1/15/07 6:45 PM Page 347 Delegation: An Art of Professional Practice tasks have predictable outcomes, and a step-by-step method exists to complete the task Decision making on the part of the delegatee for delegated tasks is limited to how to organize time and complete the task with different patients or variations in equipment The procedure for the task is found in training manuals for teaching skills CLIENT/SITUATION 347 Practice to Strive For 21-1 Without delegation, your work will not be done DO: Select the right person for the task(s) Communicate directions clearly Provide sufficient authority and independence to complete tasks Remain available and approachable Identification of a specific client or situation for delegated nursing care is necessary to ensure that goals for patient care can be met by the delegatee Familiar situations and environments enhance client safety and competent performance of any task Situations include client care, such as direct care, responding to client calls for assistance, and distributing meals, or involve other tasks such as data entry, cleaning areas, stocking supplies, or phoning to confirm appointments New situations require orientation, even if the client and task are familiar Client-specific care fosters success with delegated task performance Delegation is not easy and not simple Delegation is about getting other people to perform activities to meet specific client and organizational goals Successful delegation means that the nurse understands nursing practice, knows UAP skills, identifies tasks, clarifies goals for client care, reinforces delegation, provides authority, fosters communication, and gives feedback Client care goals range from daily personal hygiene to treatment or recovery from a health problem Organizational goals, on the other hand, relate to providing cost-effective services to help meet client care goals Awareness of the rights, benefits, and pitfalls of delegation helps you recognize how to work through others with greater trust and confidence Rights of Delegation Delegation is a precursor to the management functions of coordination and supervision Without a delegatee, there is no one to supervise and no activities to coordinate The NCSBN developed Rights of Delegation to guide the nurse in safe delegation in Supervise and give feedback on performance Recognize efforts by others Use nursing staff for nursing decisions Know the scope of your practice and agency policy on delegation DON’T: Think that you can delegate accountability Expect good results from poor delegation response to an increasing number of nurse assistants or UAP in the workplace The delegator nurse assigns the Right Person to perform the Right Task under the Right Circumstances and provides the delegatee with the Right Direction and the Right Supervision THE RIGHT PERSON Delegation involves the nurse as either delegator or delegatee Matching the specific client care goals and activities with the person to entrust with the appropriate responsibility and authority is a challenge Do you delegate care for an aging patient to new UAP enrolled in a nursing program or to more experienced employees? Do you focus on the benefits of staff development or needs of the individual client? Do you plan time to offer support or only anticipate the outcome? How you plan to supervise? Delegating to UAP The RN delegates client care to UAP in order to provide nursing care to more patients Knowing the training of UAP can help make better delegation decisions Both RNs and licensed practical/voca- ... February 2005 Rahim, M.A (1990) Theory and research in conflict management NY: Praeger Publishers Rowland, H., & Rowland, B (1997) Nursing administration handbook Gaitherburg: MD: Aspen Publications... conflict assessment Nursing Management, 2005, 32–40 Sportsman, S., & Hamilton, P (2007) Conflict management styes in nursing and allied health professionals Journal of Professional Nursing January-February,... McGraw-Hill Woodtli, A (1987) Deans of nursing: Perceived sources of conflict and conflict-handling modes Journal of Nursing Education, 26(7), 272–277 21Jones Leadership( F)-ch 21 1/15/07 6:45 PM