A. Promoting Interdisciplinary Care
When nurses promote collaborative interdisciplinary care, they are ensuring the availability and accessibility of quality health care (ANA, 2010). As the nursing supervisor in this clinical setting, I would hold a staff meeting with the family nurse practitioner (FNP), nurse, licensed vocational nurse (LVN), nutritionist, and social worker. I would ask them to speak about their areas of expertise and explain how their knowledge will enhance this clinical team. The nutritionist’s expertise in diet, the social worker’s fluency in Spanish, the LVN’s training in education, and the nurse’s specialization in community health are all attributes that will promote the delivery of quality patient care. In this meeting, I give examples of how the specialized training and resources of these individuals will improve patient care and ease the workload of other staff members. I foster an open discussion and encourage thoughts, feelings, and questions. I also state that if someone has a question or concern that they do not wish to discuss in front of everyone, they can speak to me in private.
B. Delegation and Teamwork
As the nurse supervisor, I would use a coaching approach to speak to Ms. W. Coaching provides a safe environment for trying different approaches to new or challenging situations (Robinson-Walker, Detmer, and Schultz, 2011). I would request to have lunch with Ms. W and at this lunch, I begin by praising her work and emphasizing her importance to this clinic. In a light-hearted and non-confrontational way, I say, “I know how hard you have been working with Ms. R and you must be so frustrated!” I encourage a response by asking, “Why do you think she is being non-compliant?” I listen to her responses without interrupting and work into the conversation these questions: “Do you think it’s possible she does not understand English? What do you think about having the social worker speak to her?” The LVN’s expertise in community health and her available resources would also be mentioned. I emphasize that delegating to members of the team will be in the best interest of the patient, as well as free up some of Ms. R’s valuable time.
The Nursing Code of Ethics Provision 2 states that the nurse’s primary commitment is to the patient and it further implies that nurses should actively promote collaborative multi-disciplinary planning (American Nurses Association, 2012). If Ms. W does not have time to follow through with community services that could benefit Ms. R, then Ms. W has a responsibility to refer Ms. R to people who have the knowledge, resources, and time to help her.
In addition to the Nursing Code of Ethics, the National Council of State Boards of Nursing (NCSBN) states that one of the standards related to the RN scope of practice is that nurses evaluate the patient’s response to nursing care. They do this by evaluating: the patient’s response to interventions, the need for alternative interventions, the need to consult with other team members, and the need to revise the plan of care (NCSBN, 2012). When Ms. W saw that the patient was not compliant, she should have reevaluated her plan of care. Ms. W can delegate to the LVN, who is experienced in prenatal education, and would be able to explain the importance of finishing antibiotic therapy or performing tests that are essential for a healthy pregnancy. If Ms. W is too busy to educate, then she is responsible for finding someone who can.
B2. Recommended Resource
A resource that would benefit Ms. W in learning more about delegating is the continuing education course given by the ANA, “Developing Delegation Skills.” This course covers delegation and the associated concepts of accountability, responsibility, and authority (Weydt, 2010). It discusses using nursing judgment and interpersonal relationships during the delegation process and at the courses end, the author speaks about how to develop delegation skills. Learning to properly delegate ultimately improves the quality of patient care.
B3. Delegation Opportunities
The nurse in this scenario has 4 colleagues in the clinic that she can delegate to: the LVN, nurse, nutritionist, and social worker. Ms. R had recurrent urinary tract infections; the nutritionist can review her food and fluid intake and the LVN can teach prenatal care based on the nutritionist’s evaluation and recommendations. The nurse in the clinic can explore community resources that may be available to assist Ms. R. The social worker, however, is the most important person in these collaborations because it is probable that Ms. R does not understand English and needs an interpreter. The social worker is fluent in Spanish and her presence will not only raise the comfort level of Ms. W, but will assure that she is receiving the required information that is pertinent to her pregnancy.
American Nurses Association. (2012). Code of Ethics for Nursing with Interpretive Statements. Nursing World. Retrieved from http://www.nursingworld.org/codeofethics National Council of State Boards of Nursing. (2012). NCSBN Model Rules. Retrieved from http://www.ncsbn.org/12_model_rules_090512.pdf Weydt, A. (2010). Developing Delegation Skills. The Online Journal of Issues in Nursing, 15(2). Retrieved from www.nursingworld.org/mainmenucategories/anamarketplace/anaperiodicals/ojin/tableofcontents/vol152010/no2may2010/delegation-skills