Delegation Delegation 1. Identify specific strategies for successful delegation 2. What does the NPA (Nurse practice act) contain as the essential -

Delegation

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Delegation Delegation 1. Identify specific strategies for successful delegation 2. What does the NPA (Nurse practice act) contain as the essential

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1. Identify specific strategies for successful delegation
2. What does the NPA (Nurse practice act) contain as the essential elements regarding delegation (as in ATI)
3. Describe the 5 rights of delegationname them and define them
4. Provide an example of each of the 5 rights of delegation
5. Describe the criteria for delegation to an unlicensed assisted personnel (UAP)
6. Name 5 tasks that are generally considered appropriate for delegation to UAPs
7. Describe the reasons nurses will underdelegate tasks.
8. Describe the situations in which nurses will overdelegate tasks
9. Draw the decision tree created by the National Council of State Boards of Nursing (NCSBN) that is used to determine appropriate tasks for UAPs(apply the example of obtaining a blood sugar value tothis model to determine if that would be an appropriate task to delegate)
10. Name the key differences between what roles and responsibilities exist for RNs and contrast that with those of LPNs Chapter 20

Delegation

Learning Objectives
1. Differentiate between assignment and delegation (ATI p 7-9) (Text 528 & 538)
2. Identify specific strategies that increase the likelihood of effective delegation (ATI p 8) (Text 530-32)
3. Describe delegation as a learned skill imperative to professional nursing practice 5 Rights of Delegation (ATI p 9-10) (Text p 529)
4. Delegate tasks using appropriate priority setting and personnel in specific situations (Text 535-540)

Learning Objectives
* Delegating and Supervising/the health care team (ATI p 8) (Text p 530-31)
5. Differentiate between tasks that should and should not be delegated to licensed and unlicensed personnel based on skill and education level as well as individual state scope of practice guidelines (ATI p 8) (Text 538-39)
6. Identify common causes of underdelegation, overdelegation, and improper delegation as well as strategies to overcome these delegation errors (Text 533-34)

Learning Objectives
7. Provide adequate information and authority to others to successfully complete delegated tasks (Text 529 & 531)
8. Identify factors that must be considered when determining what tasks can be safely delegated to subordinates (Text p 539)
9. Determine whether delegation to an unlicensed worker is appropriate in a specific situation, using a decision tree by the National Council of State Boards of Nursing (NCSBN) or a State Board of Nursing (Text p 539)
Copyright 2021 Wolters Kluwer All Rights Reserved
4

Definitions of Delegation #1
Getting work done through others
Directing the performance of one or more people to accomplish organizational goals
Giving someone else the authority to complete a task or
action on your behalf
Transferring or handing
off to a competent
individual, the authority
to perform a task/activity
in a specific setting/situation

Definitions of Delegation #2
Delegation should be used for assigning routine tasks and tasks for which the manager does not have time. It is also appropriate as a tool for problem solving, changes in the managers own job emphasis, and building capability in subordinates.

Strategies for Successful Delegation #1
Plan ahead.
Identify necessary skill and education levels to complete the delegated task.
Select capable personnel.
Communicate goals clearly.

Strategies for Successful Delegation #2
Empower the delegate.
Set deadlines and monitor progress.
Monitor the role and provide guidance.
Evaluate performance.
Reward accomplishment.

State NPA Essential Elements Regarding Delegation #1
Definition of delegation
Items that cannot be delegated
Items that cannot be routinely delegated
Guidelines for RNs about tasks that can be delegated
Description of professional nursing practice
Description of LVN/LPN nursing practice and unlicensed nursing roles

State NPA Essential Elements Regarding Delegation #2
Degree of supervision required to complete a task
The guidelines for
lowering delegation
risks
Warnings about
inappropriate delegation
If there is a restricted
use of the word nurse
to licensed staff

Common Delegation Errors
Underdelegating
Overdelegating
Improper delegating

Causes of Underdelegating #1
Fear that delegation may be interpreted as a lack of ability to do the job completely or correctly
A desire to complete the whole job himself or herself
Fear that subordinates will resent delegated work
Lack of experience in the job or with delegation, or the need to control or be perfect
Enjoyment of the work

Causes of Underdelegating #2
It will likely be unnerving (at least initially) to allow a team member to complete a task for which you are ultimately responsible.

Causes of Overdelegating
Poor management of time; spending too much time trying to get organized
Insecurity in the ability to perform a task

Causes of Improperly Delegating
Wrong time, to the wrong person, or for the wrong reason
Beyond the capability of the person, or something the manager should do
Decision making without providing adequate information

The Five Rights of Delegation
Right task
One that is delegable for a specific patient
Right circumstances
Appropriate patient setting, available resources, and other relevant factors considered
Right person
Right person is delegating the right task to the right person to be performed on the right person.
Right direction/communication
Clear, concise description of the task, including its objective, limits, and expectations
Right supervision
Appropriate monitoring, evaluation, intervention, as needed, and feedback

Rules of Delegation
Always delegate to the right person, at the right time, and for the right reason.
Say no when you must.
Reward subordinates for jobs well done.

Clear Communication and Delegation
Define the task clearly.
Delineate end results, time frame, and standards.
Delegate the objective, not the procedure.

Satisficing Versus Maximizing Mode in Delegating
If the delegator requires a higher quality than satisficing, this must be made clear at the time of the delegation. Not everything that is delegated needs to be handled in a maximizing mode.

Delegation as a Function of Professional Nursing #1
Organizations must have a clearly defined structure where RNs are recognized as the leaders.
Job descriptions must clearly define the roles and responsibilities of all.
Educational programs must be developed to help personnel
learn roles and responsibilities
of each others roles.
Adequate programs must be developed to foster leadership and delegation.

Delegation as a Function of Professional Nursing #2
Although the Omnibus Budget Reconciliation Act of 1987 established regulations for the education and certification of certified nurses aides (minimum of 75 hours of theory and practice and successful completion of an examination in both areas), no federal or community standards have been established for training the more broadly defined NAP.

Delegating to Unlicensed Assistive Personnel (UAP)
Potential Costs
Liability for negligence
Issues for task delegation
Job description
Knowledge base
Demonstrated skills
Responsibility for patient outcomes

Sample Titles Given to UAP and NAP #1
Nurse extenders
Care partners
Nurses aides
Orderlies
Assistants
Attendants
HCAs
Technicians

Sample Titles Given to UAP and NAP #2
In assigning tasks to NAP, the RN must be aware of the job description, knowledge base, and demonstrated skills of each person.
The NAP has no license to lose for exceeding scope of practice and nationally established standards as to what the limits should be for NAP in terms of scope of practice do not exist.

Sample Titles Given to UAP and NAP #3
Professional nursing organizations and regulatory bodies are actively engaged in clarifying the scope of practice for unlicensed workers and delegation parameters for RNs.

Sample Titles Given to UAP and NAP #4
Assuming the role of delegator and supervisor to the NAP increases the scope of liability for the RN. Although the NAP does bear some personal accountability for their actions, this does not negate accountability for the RN who delegated the task(s).

Monitoring Delegated Tasks
Managers should ask the individuals to whom they are delegating if they are capable of completing the delegated task but should also validate this perception by direct observation.
Monitoring delegated tasks keeps the delegated task before the subordinate and the manager so that both share accountability for its completion.

Resistance to Delegation
Resistance is a common response by subordinates to delegation.
One of the most common causes of subordinate resistance to, or refusal of, delegated tasks is the failure of the delegator to see the subordinates perspective.
Resistance to delegation may also occur when tasks are overdelegated in terms of specificity.

Elements Affecting Delegation to a Transcultural Work Team
Communication
Space
Social organization
Time
Environmental control
Biological variations

Copyright 2021 Wolters Kluwer All Rights Reserved
29 Leadership Roles and
Management Functions
in Nursing
Theory and Application

Bessie L. Marquis, RN, MSN
Professor Emeritus of Nursing
California State University
Chico, California

Carol J. Huston, RN, MSN, DPA, FAAN
Director, School of Nursing
California State University
Chico, California

8th EditionEighth Edition

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Library of Congress Cataloging-in-Publication Data
Marquis, Bessie L., author.
Leadership roles and management functions in nursing: theory and application/Bessie L. Marquis, Carol
J. Huston.8th edition.

p. ; cm.
Includes bibliographical references and index.
ISBN 978-1-4511-9281-0 ISBN 1-4511-9281-9
I. Huston, Carol Jorgensen, author. II. Title.
[DNLM: 1. Leadership. 2. Nursing, Supervisory. 3. Nurse Administrators. 4. Nursingorganization
& administration. WY 105]

RT89
362.173068dc23

2013036678
Care has been taken to confirm the accuracy of the information presented and to describe generally accepted
practices. However, the author(s), editors, and publisher are not responsible for errors or omissions or for any
consequences from application of the information in this book and make no warranty, expressed or implied,
with respect to the currency, completeness, or accuracy of the contents of the publication. Application of this
information in a particular situation remains the professional responsibility of the practitioner; the clinical
treatments described and recommended may not be considered absolute and universal recommendations.

The author(s), editors, and publisher have exerted every effort to ensure that drug selection and dosage
set forth in this text are in accordance with the current recommendations and practice at the time of
publication. However, in view of ongoing research, changes in government regulations, and the constant
flow of information relating to drug therapy and drug reactions, the reader is urged to check the package
insert for each drug for any change in indications and dosage and for added warnings and precautions. This is
particularly important when the recommended agent is a new or infrequently employed drug.

Some drugs and medical devices presented in this publication have Food and Drug Administration (FDA)
clearance for limited use in restricted research settings. It is the responsibility of the health-care provider to
ascertain the FDA status of each drug or device planned for use in his or her clinical practice.

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I dedicate this book to the two most important

partnerships in my life: my husband, Don Marquis,

and my colleague, Carol Huston.

BESSIE L. MARQUIS

I dedicate this book to my mother Marilyn Jorgensen.

You are one of the reasons

I have become the capable woman I am today.

CAROL JORGENSEN HUSTON

Reviewers
Carol Amann, MSN, RN-BC, CDP
Instructor
Gannon University
Erie, Pennsylvania

Joanne Casatelli, DNP
Molloy College
Rockville Centre, New York

Joanne Clements, MS, RN, ACNP
Assistant Professor of Clinical Nursing
University of Rochester
Rochester, New York

Margaret Decker, MS, RN, CNE
Clinical Assistant Professor
Binghamton University
Binghamton, New York

Hobie Feagai, EdD, MSN, FNP-BC, APRN-Rx
Chair
Department of Baccalaureate Nursing Program
Hawaii Pacific University
Kaneohe, Hawaii

Lisa Marie Greenwood, MSN, RN, APRN-BC, CWOCN, CNS
Nursing Instructor
Madison Area Technical College
Reedsburg, Wisconsin

Vonna Henry, BSN, MPH, RN
Assistant Professor
St. Cloud State University
St. Cloud, Minnesota

Debora Kirsch, RN, MS, CNS
Director of Undergraduate Nursing Studies
SUNY Upstate Medical University
Syracuse, New York

vi reviewers

Carole McCue, RN, MS, CNE
Instructor
Cochran School of Nursing
Yonkers, New York

Jennifer Douglas Pearce, MSN, RN, CNE
Professor and Chairperson
University of Cincinnati
Blue Ash, Ohio

Tawna Pounders, RN, MNSc
Coordinator and Medical-Surgical Theory Faculty
Baton Rouge Community College
Baton Rouge, Louisiana

Loretta Quigley, MSN
Academic Dean
St. Josephs College of Nursing
Syracuse, New York

Elaine Rose, RN, BN, MHS, DM(c)
Assistant Professor
Mount Royal University
Calgary, Alberta, Canada

Charlotte Sortedahl, DNP, MPH, MS, RN
Assistant Professor
University of Wisconsin
Eau Claire, Wisconsin

Patricia Varga, MSN, RN
Assistant Professor
Alverno College
Milwaukee, Wisconsin

Preface
This books philosophy has evolved over the past 30+ years of teaching leadership and
management. We entered academe from the acute care sector of the health-care industry,
where we held nursing management positions. In our first effort as authors, Management
Decision Making for Nurses: 101 Case Studies, published in 1987, we used an experiential
approach and emphasized management functions appropriate for first- and middle-level
managers. The primary audience for this text was undergraduate nursing students.

Our second book, Retention and Productivity Strategies for Nurse Managers, focused
on leadership skills necessary for managers to decrease attrition and increase productivity.
This book was directed at the nurse-manager rather than the student. The experience of
completing research for the second book, coupled with our clinical observations, compelled
us to incorporate more leadership content in our teaching and to write this book.

Leadership Roles and Management Functions in Nursing was also influenced by national
events in business and finance that led many to believe that a lack of leadership in management
was widespread. It became apparent that if managers are to function effectively in the rapidly
changing health-care industry, enhanced leadership and management skills are needed.

What we attempted to do, then, was to combine these two very necessary elements:
leadership and management. We do not see leadership as merely one role of management
nor management as only one role of leadership. We view the two as equally important and
necessarily integrated. We have attempted to show this interdependence by defining the
leadership components and management functions inherent in all phases of the management
process. Undoubtedly, a few readers will find fault with our divisions of management
functions and leadership roles; however, we felt it was necessary to first artificially separate
the two components for the reader, and then to reiterate the roles and functions. We do believe
strongly, however, that adoption of this integrated role is critical for success in management.

The second concept that shaped this book was our commitment to developing critical-
thinking skills through the use of experiential learning exercises and the promotion of whole-
brain thinking. We propose that integrating leadership and management and using whole-brain
thinking can be accomplished through the use of learning exercises. The majority of academic
instruction continues to be conducted in a teacher-lecturerstudent-listener format, which
is one of the least effective teaching strategies. Few individuals learn best using this style.
Instead, most people learn best by methods that utilize concrete, experiential, self-initiated,
and real-world learning experiences.

In nursing, theoretical teaching is almost always accompanied by concurrent clinical
practice that allows concrete and real-world learning experience. However, the exploration of
leadership and management theory may have only limited practicum experience, so learners
often have little first-hand opportunity to observe middle- and top-level managers in nursing
practice. As a result, novice managers frequently have little chance to practice their skills before
assuming their first management position, and their decision making thus reflects trial-and-
error methodologies. For us, then, there is little question that vicarious learning, or learning

vii

viii Preface

through mock experience, provides students the opportunity to make significant leadership and
management decisions in a safe environment and to learn from the decisions they make.

Having moved away from the lecturerlistener format in our classes, we lecture for only a small
portion of class time. A Socratic approach, case study debate, and problem solving are emphasized.
Our students, once resistant to the experiential approach, are now our most enthusiastic supporters.
We also find this enthusiasm for experiential learning apparent in the workshops and seminars we
provide for registered nurses. Experiential learning enables management and leadership theory to
be fun and exciting, but most important, it facilitates retention of didactic material. The research
we have completed on this teaching approach supports these findings.

Although many leadership and management texts are available, our book meets the need
for an emphasis on both leadership and management and the use of an experiential approach.
Two hundred and fifty-nine learning exercises, taken from various health-care settings and
a wide variety of learning modes, are included to give readers many opportunities to apply
theory, resulting in internalized learning. In Chapter 1, we provide guidelines for using the
experiential learning exercises. We strongly urge readers to use them to supplement the text.

We also provide guidelines for instructors on thePoint, Wolters Kluwer Healths
trademarked web-based course and content management system that is available to
instructors who adopt the text. We recommend its use. The Web site includes a test bank, an
image collection, suggestions for using the learning exercises, a glossary, and a large number
of PowerPoint slides with images.

TEXT ORGANIZATION
The first edition of Leadership Roles and Management Functions in Nursing presented the
symbiotic elements of leadership and management, with an emphasis on problem solving and
critical thinking. This eighth edition maintains this precedent with a balanced presentation
of a strong theory component along with a variety of real-world scenarios in the experiential
learning exercises. Nineteen new learning exercises have been added to this edition, further
strengthening the problem-based element of this text. Almost 200 displays, figures, and tables
(46 of which are new) help readers to visualize important concepts.

Responding to reviewer recommendations, we have added and deleted content. In
particular, we have attempted to strengthen the leadership component of the book while
maintaining a balance of management content. We have also added a chapter crosswalk
(pp. 1522) of content based on the American Association of Colleges of Nursing (AACN)
Essentials of Baccalaureate Education for Professional Nursing Practice (2008); the AACN
Essentials of Masters Education in Nursing (2011); the American Organization of Nurse
Executive (AONE) Competencies; and the Quality and Safety Education for Nurses (QSEN)
Competencies. This crosswalk shows how content in each chapter draws from or contributes
to content identified as essential for baccalaureate and graduate education, for practice as a
nurse administrator, and for safety and quality in clinical practice.

We have also retained the strengths of earlier editions, reflecting content and application
exercises appropriate to the issues faced by nurse-leader-managers as they practice in an era
increasingly characterized by limited resources and emerging technologies. The eighth edition
also includes contemporary research and theory to ensure accuracy of the didactic material.

Unit I provides a foundation for the decision-making, problem-solving, and critical-
thinking skills, as well as management and leadership skills needed to address the
managementleadership problems presented in the text. Unit II covers ethics, legal concepts,
and advocacy, which we see as core components of leadership and management decision
making. The remaining units are organized using the management processes of planning,
organizing, staffing, directing, and controlling.

Preface ix

LEARNING TOOLS
The eighth edition contains many pedagogical features designed to benefit both the student

and the instructor:
Examining the Evidence, appearing in each chapter, depicts new research findings,

evidence-based practice, and best practices in leadership and management.
Learning Exercises interspersed throughout each chapter foster readers critical-thinking

skills and promote interactive discussions. Additional learning exercises are also presented
at the end of each chapter for further study and discussion.

Breakout Comments are highlighted throughout each chapter, visually reinforcing key ideas.
Tables, displays, figures, and illustrations are liberally supplied throughout the text to

reinforce learning as well as to help clarify complex information.
Key Concepts summarize important information within every chapter.

NEW AND EXPANDED CONTENT
Additional content that has been added or expanded in this edition includes:
Increased focus on evidence-driven leadership and management decision making
New models for ethical problem solving and an increased emphasis on patient,

professional, and subordinate advocacy
Expanded discussion of full-range leadership theory, transformational leadership, and

leadership competency identification
Emerging leadership theories such as Strengths-Based Leadership and the Positive

Psychology Movement, Level 5 leadership, thought leadership, authentic leadership, and
servant leadership

Introduction to Affordable Care Act in 2010, and the new Patients Bill of Rights
Key components of the Patient Protection and Affordable Care Act (PPACA) as well as its

implementation plan between 2010 and 2014
Health-care reform and financing mechanisms, including bundled payments, accountable

care organizations, value-based purchasing, medical homes, and health insurance
marketplaces

The shifting in health-care reimbursement from volume to value
Reflective practice and the professional portfolio
Transition-to-practice programs/residencies for new graduate nurses
Civility, incivility, bullying, mobbing, and workplace violence
Visioning of health cares future
A broad discussion of social media as a communication tool and cause for work distraction

and the ethical issues encompassed in the topic
Continuing competence, lifelong learning, nurse residencies, reflective practice, and the

professional portfolio
Interprofessional collaboration including the Multidisciplinary Team Leader,

Interprofessional Primary Healthcare Teams, and Interprofessional Primary Health Care
Teams (PHCTs)

The unique needs of a culturally diverse workforce as well as a workforce representing up
to four generations at the same time

Nurse navigators
Patient- and family-centered care
Importance of self-care for nurses

x Preface

The use of ISBAR (Introduction, Situation, Background, Assessment, Recommendation) as
a tool to promote communication between care providers or between care providers and
patients/families

Social media and organizational communication
New mergers of collective bargaining agents to form super unions for nurses
Leapfrog initiatives including electronic health records, computerized provider order

entry, evidence-based hospital staffing, and ICU physician staffing
New Joint Commission core measures and National Patient Safety Goals
The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS)

survey
Patient safety and quality of care

thePoint (http://thepoint.lww.com), a trademark of Wolters Kluwer Health, is a web-based
course and content management system providing every resource that instructors and students
need in one easy-to-use site.

Instructor Resources
Advanced technology and superior content combine at thePoint to allow instructors to design
and deliver online and off-line courses, maintain grades and class rosters, and communicate
with students.

In addition, instructors will find the following content designed specifically for this
edition:
Test bank
Image bank
Instructors guide, including guidelines for using the experiential learning exercises in

the text
PowerPoint slides with images

Student Resources
Students can visit thePoint to access supplemental multimedia resources to enhance their
learning experience, download content, upload assignments, and join an online study group.
Students will also find a glossary that defines the italicized terms in the text.

THE CROSSWALK
New to this edition is a chapter crosswalk of content based on the AACN Essentials of
Baccalaureate Education for Professional Nursing Practice (2008); the AACN Essentials of
Masters Education in Nursing (2011); the AONE Competencies; and the QSEN Competencies.
A crosswalk is a table that shows elements from different databases or criteria that interface.
This edition then attempts to show how content in each chapter draws from or contributes
to content identified as essential for baccalaureate and graduate education, for practice as a
nurse administrator, and for safety and quality in clinical practice.

Without doubt, some readers will disagree with the authors determinations of which
Essential or Competency has been addressed in each chapter, and certainly, an argument
could be made that most chapters address many, if not all, of the Essentials or Competencies
in some way. The crosswalks in this book then are intended to note the primary content focus
in each chapter although additional Essentials or Competencies may well be a part of the
learning experience with each chapter.

The American Association of Colleges of Nursing Essentials of
Baccalaureate Education for Professional Nursing Practice
The AACN Essentials of Baccalaureate Education for Professional Nursing Practice
(commonly called the BSN Essentials) were released in 2008 and identified the following
nine outcomes expected of graduates of baccalaureate nursing programs (Table 1). Essential
IX describes generalist nursing practice at the completion of baccalaureate nursing education
and includes practice-focused outcomes that integrate the knowledge, skills, and attitudes
delineated in Essentials I to VIII. Achievement of the outcomes identified in the BSN
Essentials will enable graduates to practice within complex health-care systems and to
assume the roles of provider of care; designer/manager/coordinator of care; and member of
a profession (AACN, 2008) (Table 1).

TABLe 1 American Association of Colleges of Nursing Essentials of Baccalaureate Education for Professional Nursing Practice

Essential I: Liberal education for baccalaureate generalist nursing practice

A solid base in liberal education provides the cornerstone for the practice and education of nurses

Essential II: Basic organizational and systems leadership for quality care and patient safety

Knowledge and skills in leadership, quality improvement, and patient safety are necessary to provide high-quality health care.

Essential III: Scholarship for evidence-based practice

Professional nursing practice is grounded in the translation of current evidence into ones practice.

Essential IV: Information management and application of patient-care technology

Knowledge and skills in information management and patient-care technology are critical in the delivery of quality patient care

Essential V: Health-care policy, finance, and regulatory environments

Health-care policies, including financial and regulatory, directly and indirectly influence the nature and functioning of the
health-care system and thereby are important considerations in professional nursing practice.

Essential VI: Interprofessional communication and collaboration for improving patient health outcomes

Communication and collaboration among health-care professionals are critical to delivering high quality and safe patient care.

Essential VII: Clinical prevention and population health

Health promotion and disease prevention at the individual and population level are necessary to improve population health and
are important components of baccalaureate generalist nursing practice.

Essential VIII: Professionalism and professional values

Professionalism and the inherent values of altruism, autonomy, human dignity, integrity, and social justice are fundamental to
the discipline of nursing.

Essential IX: Baccalaureate generalist nursing practice

The baccalaureate graduate nurse is prepared to practice with patie

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