This chapter addresses the relationship between nursing leadership and the larger health care system. Understanding this relationship requires that we look at our health care system as a complex adaptive system with multiple relationships between different aspects of it that impact both the system and the health of the individuals within it. Health care organizations define their role and describe how they will fulfill this role within the greater system through their vision, mission, and value statements. Members of the organization look through the lens of these guiding statements and principles when making decisions. These guided decisions promote the development of an organizational culture, or common system of beliefs and behaviours for all employees. However, in complex adaptive systems, organizational culture may be influenced by factors other than the vision, mission, and values, leading to undesirable outcomes, as demonstrated in the UK. But even in complex adaptive systems, leaders can inspire change through a focus on relational leadership and empowerment.
Delegation of care is one recent solution to the issues of our rapidly changing complex adaptive health care system. Delegation may refer to RNs delegating care provision tasks to unregulated care providers; in this case, the delegating RN retains the role of coordinator of patient care with all the associated responsibilities throughout the delegation process. Delegation may also refer to physicians delegating specific medical tasks to RNs. In this case, the delegating physician retains the responsibilities of assessment and supervision of the RN throughout the performance of the delegated medical activity.
After completing this chapter, you should now be able to:
- Apply systems theory to health care.
- Identify the relationships between organizational culture, leadership, cultural intelligence, and change.
- Identify the importance of the vision, mission, and value statements of an organization.
- Describe the important role that inspiring relational leadership and empowerment play in organizational cultural change.
- Explain the standards for delegation of care established by the Saskatchewan Registered Nurses’ Association from RN to unregulated care providers and from physician to RN.
- Does the health care system in your local community function as an open, closed, or subsystem? Please explain why you have chosen this type of system to describe your local community.
- Chose one aspect of health care in your local community that you would like to change. Apply one or more of the fundamental concepts of systems theory, interrelationships, perspectives, and boundaries to this aspect of health care provision that could ultimately lead to improved patient care.
- You are a home care nurse. An elderly diabetic client has been admitted to your caseload. You conduct an assessment on this client and determine that, due to neuropathy of the hands, this client requires assistance with eye drops for glaucoma. You decide to delegate the process to an unregulated care provider. Develop a care plan for delegation of the care of this client using the five rights of delegation.
- As a nurse manager you will be assigning care providers to care for clients with different levels of acuity and care needs. Develop two separate client care scenarios, paying special attention to the specific skills required to care for each client. How are Scenario A and Scenario B clients different? (a) Scenario A has a client who can be cared for by an LPN, RN, or RPN. (b) The client in Scenario B requires either an RN or an RPN to provide care.
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