The changing healthcare landscape due to increased demands for quality healthcare has increased the use of unregulated healthcare workers (Crevacore et al., 2023). Also, the emphasis on the holistic treatment of patients through a multidisciplinary approach has resulted in the need for improved and efficient collaboration between varied healthcare providers (Bok et al., 2020). The ability to delegate appropriately based on a healthcare professional’s scope of practice and job description is a critical but complex nurse leader’s role (Crevacore et al., 2023). Therefore, this paper will utilize a patient case study to demonstrate the role of nurses in the practical organization of multidisciplinary teams. Also explored in the paper include fostering collaboration in the healthcare setting through effective communication, conflict resolution, and effective delegation.
Patient Case Study
The PE Client is a 70-year-old female, allergic to Bactrim, and with a history of diabetes mellitus, heart disease, cervical myopathy, cervical stenosis, hypertension, high cholesterol, and coronary heart disease. The PE client underwent cervical surgery at C3-C7 for anterior cervical decompression and inferior cervical reconstruction. The patient is alert and oriented to time, place, and person on examination. She has a right neck surgical incision; the dressing is clean, with no drainage noted. She is complete code, has fall precautions, and needs two persons for transfer. Her breathing is not laboured, and she has equal movements in all her extremities. However, she has bowel and bladder incontinence. The vital signs today are as follows: blood pressure of 110/68 mmHg, pulse rate of 103 beats per minute, oxygen saturation at 93% on room air, capillary blood glucose of 263 mg/dL, and pain of 3 out of 10. She is receiving heparin 1ml administered prophylactically, six units of Humalog given per sliding scale, Rocephen intravenous antibiotic, Tylenol 600mg PRN every 4 hours, DSW 0.9% NaCl (1000ml bag) intravenous infusion at 75ml/hr, and dexamethasone 2mg. She also takes aspirin 81 mg, metoprolol 25mg, and hydrochlorothiazide 25mg tab, with a PRN order for oxycodone. She currently has an indwelling catheter with clear yellow urine.
Organizing the Team
The assignment, delegation, and supervision best practices require the nurse leader to understand the scope of practice and job description for each healthcare professional in their interdisciplinary team (Crevacore et al., 2023). Also, all decisions about delegation, assignment, and supervision should be based on the fundamental principles of protection of the health, safety, and welfare of the patient (ANA, 2012). Ultimately, the patient’s needs dictate the interdisciplinary team members that the nurse will include in their management plan. For the PE client, the patient needs constant monitoring, including two hours of turning in bed to avoid the development of pressure ulcers, three hours of taking the vital signs, monitoring fluid input and output, and neurological assessments to assess for improving the patient’s condition. The spinal intensive care unit team will need to address these patients’ needs as a team to ensure around-the-clock patient monitoring and avoid nurse fatigue.
Therefore, I would assign two registered nurses to the patient and delegate vital signs monitoring and serial neurological assessments to these nurses. I would also give the nurses the responsibility of administering medication and monitoring the PE client’s response to treatment. I would delegate patient transfers, bed turns, and bowel and bladder care to the licensed practical nurses with the help and supervision of one of the registered nurses attending to the patients. The unlicensed assistive personnel will be assigned to help the patient with feeding and removal of food trays after each meal. The nursing team will report to the nurse leader in the unit and be expected to use accredited reporting tools such as SBAR in writing their patient findings and status during handing over processes.
Using Effective Communication
Effective communication is crucial for interprofessional collaboration. Effective communication between healthcare providers promotes teamwork and improved patient care outcomes (Bok et al., 2020). Effective communication between healthcare providers, a ready platform for open, honest, and frank discussions, allows for negotiations that could lead to conflict resolution and promotes shared decision-making (Bok et al., 2020). The result is higher emotional and practice support to the healthcare staff. At the same time, the patient experiences safe, quality care at affordable prices by eliminating medical errors and their associated hospitalization costs (Bok et al., 2020). For the PE client, effective communication with the interprofessional team would result in enhanced teamwork among the care professionals attending to the patient. The result would be streamlined patient healthcare decisions and interventions resulting in better patient outcomes such as quick recovery and short hospital stays. Therefore, effective communication among the interprofessional team attending to the patient would result in higher teamwork abilities that aid collaboration in care, leading to better patient outcomes.
Resolving Conflict
The best way to resolve conflict in the interprofessional team would be to ensure effective communication between the professionals involved in the patient’s care. The discussion above describes an opening for negotiation and conflict resolution through effective interprofessional communication (Bok et al., 2020). Therefore, to resolve conflict associated with care on the interprofessional team, I encourage the team members to discuss their differences and come to a fitting solution that is in the patient’s best interests. Where a common ground is not established in good time, I would assume a mediating role to help the parties involved in the conflict to understand their roles in the case and suggest interventions that will allow them to resolve the dispute and resume their caregiving roles to the patient without jeopardizing patient care safety and quality.
Effective Delegation
The shortage of nursing staff in the country’s healthcare sector makes delegation necessary to ensure that all patient needs are addressed effectively and when required. Delegation is crucial to the success of nursing teams in handling patient needs, especially in care settings where nurses face high patient-nurse ratios (Beckett et al., 2021). Effective delegation is directly linked with positive care and patient outcomes, such as safe and quality nursing care and better patient healthcare outcomes (Beckett et al., 2021). Ineffective delegation skills among nurses severely affect the patient by undermining the safety and quality of nursing care (Beckett et al., 2021). State policies on delegation of nursing interventions to nursing support staff must guide delegation. Further, nurses require training on delegation to ensure that they understand and apply the five rules of delegation to protect their patients from the adverse effects of poor-quality nursing care (Beckett et al., 2021). Therefore, nurses must ensure effective delegation through clear roles and responsibilities definition for the assistive nursing personnel and unwavering nurse leadership support (Beckett et al., 2021).
Conclusion
Therefore, the effective management of patients in the healthcare setting, such as the PE client, requires effective organization of interprofessional team members in the patient’s care utilizing effective communication to boost interprofessional collaboration and conflict resolution. The piercing of nursing care teams requires that the nurse leader understands the scope of practice and the roles and responsibilities of each interprofessional team member to ensure assignment, delegation, and supervision of nursing roles assigned to assistive nursing personnel in the nursing team. Lastly, the importance of effective nursing team organization and delegation is demonstrated by the effects of effective delegation on patient safety and quality of nursing care. Therefore, nurses should show delegation best practices to avoid undermining patient and nursing care quality and safety.
References
American Nurses’ Association (ANA) (2012). ANA’s principles for delegation by registered nurses to unlicensed assistive personnel (UAP). American Nurses’ Association. https://www.nursingworld.org/~4af4f2/globalassets/docs/ana/ethics/principlesofdelegation.pdf
Beckett, D. C., Zadvinskis, M. I., Dean, J., Iseler, J., Powell, M. J., & Buck-Maxwell, B. (2021). An integrated review of team nursing and delegation: Implications for nurse staffing during COVID-19. Worldviews on Evidence-Based Nursing, 18(4), 251–260. https://doi.org/10.1111%2Fwvn.12523
Bok, C., Ng, H. C., Koh, H. J., Ong, H. Z., Ghazali, B. Z., Tan, H. L., Ong, T. Y., Cheong, S. W., Chin, C. A., Mason, S., & Krishna, K. L. (2020). Interprofessional communication (IPC) for medical students: A scoping review. BMC Medical Education, 20(372). https://bmcmededuc.biomedcentral.com/articles/10.1186/s12909-020-02296-x
Crevacore, C., Jacob, E., Coventry, L. L., & Duffield, C. (2023). Integrative review: Factors impacting effective delegation practices by registered nurses to assistants in nursing. Journal of Advanced Nursing, 79(3), 885–895. https://doi.org/10.1111/jan.15430
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