The chain of command according to the nurse assigned, goes from the unlicensed personnel such as the housekeeper to the certified nursing assistant and then the floor nurse. After the floor nurse, the chain of command goes to the clinical manager or also called the charge nurse, and if no action is taken by the charge nurse, the command goes to the Senior Clinical Manager. If by some reason the senior clinical manager cannot provide an intervention within the scope of practice, the House Supervisor(HS) takes action and intervenes. The HS contacts the appropriate team for resolution of the issue. If no resolution is achieved, the department chair and/or medical director takes action. In other times, the DON or administrator take action if the …show more content…
However, I was assigned to be with the clinical manager and some of the nurses on the fifth floor. Effective management occurred when the CM took action when a family member was concerned about the patient's cardiac status. Resolution of the issue occurred when the CM got hold of the doctor in charged of that patient. The CM effectively delegated a task that needed a fast response to the CNA. The task was to help transfer a non-assigned patient to another room. An ineffective management and delegation occurred when the CM assigned a CNA and a nurse to three unstable patients, requiring higher acuities. With higher acuity patients, CNAs and nurses need to manage their time reasonable and under strict supervision by the CM. Therefore, when managing and delegating care to nurses, CNAs, and other staff members, make sure you follow the five rights of delegation and secure an equal number of patient acuity per licensed staff …show more content…
For example, at the beginning of the shift, the CM gathered the whole health team and gave updates about changes to the hospital's policies as a great leader. Another example of the CM's strengths was through managing time for meetings, staff, and new changes as they occurred. Another strength demonstrated by the CM was when one of the nurses needed help with discharges. This nurse had two discharges and two more patients to take care, therefore, the CM delegated a discharged patient to another nurse who was on call while waiting for new patients to arrive. In another note, one weakness that I saw throughout the clinical rotation from the CM was a potential to lose nursing experience. This potential weakness in a long term can bring consequences when a floor nurse is needed and the CM has lost some nursing experience. Nevertheless, this potential weakness can only occur if the CM is inadequate in nursing skills from the beginning. With proper time and management, nursing skills can be
There are several concepts that must be considered whenever leaders, managers or nurses delegates/supervises. One of which that must always take the highest priority is patients safety. Unsafe delegation can cause tremendous harm to patient and can costly for the organization or facility. For instance If the task being delegated has the potential to cause more harm than good, it is best that to reconsider. The five rights of delegation (right task, right circumstances, right person, right direction/communication and right supervision) must be utilized in order to bring about positive patient outcomes.
According to the National council of state board of nursing (2005), the task should be performed if it can be performed with a predictable outcome and does not endanger a client’s life or well-being. For example, the nurse can delegate to the nursing assistant to collect and measure urine output and report it to the RN. This is a non-invasive task and would not harm the patient. However, if the patient were requiring straight catherization to collect a urine specimen, it would be delegated to the LVN since this is an invasive procedure that requires skills and knowledge of performing this procedure. Right circumstance is the next right of delegation. Even though the RN can delegate to nursing assistant to have the patient ambulate, if the patient is recovering from hip surgery and had issues with bleeding during surgery, it would not be appropriate for the nursing assistant to do. The RN should do this task, since the patient is at a risk of being unstable (NCSBN, 2005). The third right of delegation is the right person. After determining what is the task or assignment that needs to be completed, the nurse should decide who would be the best person to do it. Factors that influence the RN’s decision are the knowledge and skill of the person who is performing the task (NCSBN, 2005). Most facilities check skills at the
Murphy J, Quillinan B, Carolan M. "Role of clinical nurse leadership in improving patient care." Nurs Manage 16, no. 8 (2012): 26-28.
Delegation is the being able to pass the responsibility or authority to another person. This act of delegation is important in the outcome of patient care (Yoon,2016). As discussed to be able to have well developed leadership and management skills a good aid of communication has to be developed. In the workplace environment being able to effectively delegate without having appropriate communication skills therefore emotional intelligence the ongoing care of the patient can be threatened and errors can occur. However, being able to effectively do so enable the patient outcomes to be achieved ( Wong,2013). These skills aid in importance as newly graduate nurses receive student nurses to mentor and supervise. Being able to supervise and manage a student nurse contains having a well-developed leadership and management skills ( Jones,2013). The role of a mentor includes assessing and evaluating the students’ performance, providing supervision and having accountability of the students action( royal college of nursing, 2007). This role a graduate nurse must have an area of leadership and management skills. As If these skills aren't developed the student nurse not only will lack mentorship but also the lack of guidance and supervision can impact on the patients care (
As a nurse, the author will ensure that as a leader, she delegates information by providing a holistic perspective of the patient’s needs and diagnoses. This will help the UAP to understand the importance and urgency of the tasks delegated. The nurse will also work to obtain a trusting, open, and honest relationship with the UAP. If the UAP believes the nurse has the UAP, the patient, and facilities best intentions at heart, the UAP will be more likely to carry out the delegated tasks without adjournment. The nurse will make sure to be mindful of why the UAP may have performed a task in an untimely, or incorrect fashion, and take responsibility for the mistake. The nurse will then consult with the UAP and adjust how communication takes place, to ensure that tasks get carried out correctly, in a way the nurse means for the UAP to carry them out. Overall, if the nurse and UAP can foster a trusting relationship that allows for open dialogue, and willingness to change the patient will receive the most optimal care, and in turn have the most positive
Clinical Nurse Leaders’ responsibility scope includes all nurse and patient management details except for administrative duties. They are important resources in United States medical intuitions. CNL candidates must have a master’s degree to fulfill this position. This knowledge gives them the needed skill set to manage the daily operation of the hospital’s entire nursing pool. They also observe and regulate the patient care setting. Ultimately, the Clinical Nurse Leaders’ role will continue to gain importance as healthcare caseloads increase in
I believe the chain of command is important in a police agency for many reasons. It is a roadmap that shows the route within the organization that order would flow coming down through the organization or that requests flow going up the organization, like a two-way street. The chain of command also establishes formal lines of communication within the department for organizational purposes and it must be used by everyone to communicate formally. This will eliminate crucial departmental problems. For example, if the chief administrative level does not follow the chain of command downward and gives an order directly to the patrol officer, this could cause confusion. For example, the supervisory level might feel that it is alright to do the same thing sending information up the chain. The purpose of the chain of command is to show individuals who their bosses are, from the chief
According to the Board of Nursing Delegation Rules, It’s the responsibility of the RN to supervise tasks delegated to unlicensed personnel. It requires the RN to have good clinical judgment and accountability for the patient’s care. Before assigning tasks, the RN should know the UAP’s credentials and experience as well as the patient’s condition before delegating tasks. The UAP should not be put into a situation or given a task that requires them to make any nursing judgments that could cause harm to the patient. Should this occur, it is the responsibility of the RN to intervene and stabilize the patient.
More often than not RN’s are not prepared for the responsibility of delegating tasks to co-workers. Being able to delegate takes a certain level of confidence. Anytime that the nurse delegates a task they are held responsible for seeing it through to the end. They are required to assess the situation and evaluate the patient care being given. After the task is completed it is important to appraise the competence of the nurse’s aide. The whole concept of delegation has been around for quite some time now that it dates back to the early nursing efforts that Florence Nightingale that started the movement of nursing. Florence nightingale described delegation to be on the more entry level side of nursing. With this being said it shows that nursing programs of today need to provide more experience with delegation tasks and to stress the importance of being able to work in a leadership role when faced with a situation that makes it necessary to do so. An example of this would be when a code blue is called and many health care team members are together in one room, sometimes it is appropriate for someone to take the leadership role and assign everyone a task.“Forty-one percent of RN’s in the US report that they were not exposed to delegation and supervision content in their nursing curriculum”(Saccomano, 2011). This is a large number of nurse’s that were
During my interview with Regina Martinez, BS RN and currently an Assistant Director of a home health agency, I discovered her leadership style matched the above quote. Martinez had extensive experience in management prior to joining the medical field. As a single working mother, she worked her way up from waitress to manger of a popular seafood restaurant. However, her dream had always been to become a nurse and she began her medical career as a certified nurse’s aide (CNA), while working through college. She graduated from nursing school with a Bachelor’s degree in Science and has been a Registered Nurse (RN) for more than two decades. She quickly earned the respect of doctors and fellow nurses, becoming a Charge Nurse on the floors she worked. She has worked as Medical Surgery nurse, emergency room, and as Director of Nursing for home health and long-term care facilities where she was responsible for over 150 employees.
Managers are responsible to build morale, support nurses and provide a good example of model behavior as well as instituting strict policies regarding abuse. Sheridan-Leos referenced six principles written by Thomas (2003) to assist is eliminating lateral
They must again consider the competence and training of the staff, they are considering the delegation to, planning supervision and evaluation of the completed task. Next the RN must refer to the health care organizations job descriptions and policy on delegation. (Hansten & Jackson, 2009) ”A job description and policy would not override the legal limits of the scope of practice”. (Hansten & Jackson, 2009, p 290) Any task that involves the nursing process is not the right task to delegate. (Title 10, Subtitle 27, Chapter 11, File
I now know that I need to know each client and their conditions, so I could make delegation accordingly. Time is other aspect I learned how to use, especially when there multiple activities to be done at same time, now I know that is important to know the staff that you are responsible for, and what they could or couldn’t do. I learned how important communication is between the staff, and also with the clients, they appreciate when we show a caring attitude for them. Medication safety was one thing that I was concerned about, knowing that someone other than me was giving meds to the clients made take extra measures such as double and triple checking along with the students that the 5 rights of medication administration was done. I also learned that I need to know ahead if there are new orders, or need a change in old ones, so when contacting the physician they have all the information. Something I was surprise is how the physician asked the nurse for new available treatments and if there any meds that they considered wasn’t doing much for the clients so it could be removed, this prove that we as nurses must be on top of new treatments that are approve for older adults, and do not leave that task just for physicians, they might see several
These characteristics of a nurse manager show how their leadership plays a role in their position in the nursing field. Without this position in the nursing structure, it would be very difficult to produce positive results in providing optimal patient ca...
The nursing profession has changed drastically over time. The roles and responsibilities that nurses take on have increased and become far more complicated. Nurses are managers, leaders, supervisors and have become experts in many areas of care. Every day nurses are faced with the task of improving and strengthening professional leadership within their work environment. Managing good quality and eliminating risk is the major challenge in health care. All members of the team must work together to accomplish outstanding patient care. Budget cuts and nursing shortage in all areas of health care leads to less licensed staff, where use of unlicensed personnel have been used widely, where delegation is not an option, but a necessity. Nurses must be aware of delegation guidelines, what tasks to delegate,when to delegate for the safety of patients, liability of nurses and the facility.