Efficient delegation of nursing duties and collaboration among disciplines are the cornerstones of effective healthcare. A good administrator strives to promote these principles.
Key words: delegation, interdisciplinary, collaboration
Promoting Nursing Delegation and Interdisciplinary Collaboration
Each health discipline has its own focus; however, all health disciplines share the same goal: to serve the patient. To serve the patient best, health care professionals should work together with other disciplines. Effective collaboration can happen only when each discipline understands and appreciates the roles and contributions of the others to the delivery of healthcare. The more complex and demanding patient care becomes, the more critical it becomes to adopt an interdisciplinary approach (Brooten et al, 2012). But teams don’t just happen, they must be formed, and guided and supported until they evolve into something useful (Barter and Furmidge, 1994).
The first step is to form the team. A new administrator should evaluate the strength and weaknesses of each member in her staff before selecting a team. It is critical to identify team goals and each member’s potential professional contributions (Barter and Furmidge, 1994).
The next step is to monitor the team’s progress as they begin to work together, and help them modify their goals and encourage appreciation of each other’s roles (Barter and Furmidge, 1994). Later on, as team director, I should act as mediator to resolve any conflicts that might arise. The team must learn not to suppress any issues they may have with other team members. As the team enters its last phase, the members should begin to perform more effectively and with more autonomy, with less intervention in my part as administrator. My main role would be to respond to the teams needs. Should a team member leave, the whole team should share responsibility in selecting the new team member.
As the new nursing supervisor at the clinic, one of my primary concerns would be to establish a good working relationship with all members in my staff. Another primary concern would be to build my staff’s confidence for delegation decision-making skills.
Regarding Ms W, there should first be a private discussion with Ms. W concerning the history of Ms R’s nursing care. The focus of the discussion should center on the patient’s needs. Ms. W should be asked provide a comprehensive appraisal of the case, and to identify the main issues. If possible, the discussion should be structured in such as a way as to lead Ms. W to reach her own decision regarding delegation. At this point, Ms. W should be commanded for assuming her role and responsibility regarding delegation of health care management. This would be a good time to remind Ms. W that, while delegation entails a transfer of responsibility and authority, Ms. W retains ultimate accountability for the healthcare of the patient (Curtis and Nicholl, 2004).
The discussion would then be steered towards Ms. W’s effective delegation of some of her nursing duties, while reminding Ms. W that nursing delegation is a critical element in her ability to manage the healthcare of her patients (Curtis and Nicholl, 2004). More important, it should be stressed to Ms. W that delegation is a significant step towards future nursing leadership. This should help allay any misgivings she might have in delegating her duties.
The next step would be to identify the key issues that need to be addressed in the management of Ms. R’s healthcare; which, in addition to medical issues, would include psychosocial issues. Amongst the top issues to cover would be the management of the healthcare of a patient with developmental disabilities, and one with a different culture from Ms. W’s.
Once the issues have been identified, the next move would be to allocate delegation according to the professional qualifications of other members in the team (McInnis and Parsons, 2009)
Key to the intervention is the lack of adequate understanding by the patient. No matter how simple Ms.W would try to keep her instructions for self-managed healthcare, Ms. R failed to follow her health protocol. We might even have an issue here of informed consent. It should be suggested that the Latina social worker accompany Ms.W on her next visit to Ms. R. In addition, to help Ms W in her communication with Ms. R, the social worker could also intervene with recommendations and referrals regarding community support for Ms. R, before and after the birth of her child. A follow up visit should include the presence of the community health nurse specialist.
Prenatal care should be delegated to the well-qualified licensed vocational nurse. Ms. R reported that she did not adhere to her medication protocol for the treatment of her UTI. It is critical that Ms R be made to understand the consequences of having a UTI during pregnancy; she might be motivated to comply with her antibiotic regimen were she to realize that her UTI may cause her to go into premature labor. Here too, the Latina social worker could help with the intervention, and let Ms. R know that there are other antibiotic treatments that Ms R might be able tolerate better.
In addition, Ms. R is now nearing the next stage in her pregnancy where she must undergo another series of tests. She did not adhere to her UTI therapy, thus it is possible that she has not undergone all the necessary tests recommended at each trimester. The LVN, with support from the Latina social worker, can help Ms. R understand the need for Ms. R to shift her focus on the wellbeing of the child that is about to be born, and urge Ms. R to undergo all the necessary tests. This should include a comprehensive dietary assessment to identify any vitamin or protein deficiency that might impact Ms. R’s pregnancy. This last assessment is best delegated to the nutritionist in the team.
Finally, I would recommend the following resource to Ms. W and the team:
American Nurses Association. Position statement of Registered Nurse Utilization of UAP. Washington, DC: American Nurses Association; 1997. Available at: http:// www.nursingworld.org.
References
Barter M., & Furmidge M.L.(1994). UAP: Issues relating to delegation and supervision. J
Nurs Adm.24, 36-40.
Brooten D., Youngblut J.M., Hannan J., & Guido-Sanz F. (2012). The impact of
interprofessional collaboration on the effectiveness, significance, and future of
advanced practice registered nurses. Nurs Clin North Am. 47(2), 283-94.
Curtis E., & Nicholl H. (2004). Delegation: a key function of nursing. Nurs Manag
(Harrow) 11(4), 26-31.
Keenan G, Yakel E. (2005). Promoting safe nursing care by bringing visibility to the
disciplinary aspects of interdisciplinary care. AMIA Annu Symp Proc., 385-9.
McInnis LA, Parsons LC (2009). Thoughtful nursing practice: reflections on nurse
delegation decision-making. Nurs Clin North Am., 44(4):461-70.
