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5: Summary

  • Page ID
    8931
  • SUMMARY

    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:

    1. Apply systems theory to health care.
    2. Identify the relationships between organizational culture, leadership, cultural intelligence, and change.
    3. Identify the importance of the vision, mission, and value statements of an organization.
    4. Describe the important role that inspiring relational leadership and empowerment play in organizational cultural change.
    5. 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.

    Exercises

    1. 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.
    2. 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.
    3. 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.
    4. 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.

    REFERENCES

    Aiken, L. H., Clarke, S. P., Sloane, D. M., Lake E. T., & Cheney, T. (2008). Effects of hospital care environment on patient mortality and nurse outcomes. Journal of Nursing Administration, 38(5), 223–229.

    College of Physicians and Surgeons of Saskatchewan. (2015). Delegation from physicians to registered nurses. DocTalk, 1(3), 7–9. Retrieved from http://www.cps.sk.ca/imis/Documents/...CTALK-1504.pdf

    Conger, M., Knuth, M., & McDonald, J. (2014). Creating a culture for value measurement. Healthcare Financial Management, 68(8), 55–61.

    Cummings, G. G. (2004). Investing relational energy: The hallmark of resonant leadership. Canadian Journal of Nursing Leadership, 17(4), 76–87.

    Francis, R. (2013). Report of the Mid Staffordshire NHS Foundation Trust public inquiryexecutive summary. Retrieved from https://www.gov.uk/government/upload...79124/0947.pdf

    Hibberd, J. M., Doody, L. M., & Hennessey, M. (2006). Business planning and budget preparation. Nursing Leadership and Management in Canada. Toronto: Elsevier.

    Hung, D., Chung, S., Martinez, M., & Tai-Seale, M. (2016). Effect of organizational culture on patient access, care continuity and experience of primary care. Journal of Ambulatory Care Management, 39(3), 242–252.

    Ko, M., Murphy, J., & Birdman, A. B. (2015). Integrating health care for the most vulnerable: Bridging the differences in organizational cultures between US hospitals and community health centers. American Journal of Public Health, 105(S5), S676–S677.

    Kotalik, J., Covino, C., Doucette, N., Henderson, S., Langlois, M., McDaid, K., & Pedri, L. M. (2014). Framework for ethical decision-making based on mission, vision and values of the institution. HEC Forum, 26, 125–133.

    Mancini, M. E. (2015). Understanding and designing organizational structures. [Adapted for the Canadian edition by C. A. Wong]. In P. S. Yoder-Wise, L. G. Grant, & S. Regan (Eds.), Leading and Managing in Canadian Nursing (pp. 149–169). Toronto: Elsevier.

    Muls, A., Dougherty, L., Doyle, N., Shaw, C., Soanes, L., & Stevens, A. M. (2015). Influencing organizational culture: A leadership challenge. British Journal of Nursing, 24(12), 633–638.

    Porter-O’Grady, T. & Malloch. K. (2011). Quantum leadership. Advancing innovation transforming health care (3rd ed.). Mississauga, ON: Jones & Bartlett Learning.

    Sanders, E. D. (2013). TNA examines mission, vision and values. Texas Nurses Magazine, 87(3), 10–11.

    SRNA, 2015. Interpretation of the RN scope of practice. Retrieved from https://www.srna.org/wp-content/uplo...2015_04_24.pdf

    SRNA, 2016. Guidelines for Physician to RN Delegation. Retrieved from https://www.srna.org/wp-content/uplo...2016_04_08.pdf

    Wagner, J., Cummings, G., Smith, D. L., Olson, J., & Warren, S. (2013). Resonant Leadership, workplace empowerment, and “spirit at work”: Impact on RN job satisfaction and organizational commitment. Canadian Journal of Nursing Research, 45(4), 108–128.