Case One:
According to the case number one in Checkpoint 8-4 in Ch. 8 of Clinical Delegation Skills (Hansten & Jackson, 2009), Rashad, one of the nurse aide of the team clarified his job description on a team meeting. But Robin, one of the staff RN told Rashad—as a nurse aide, he should only follow the nurse’s direction and work the delegation from the nurse’s assignment.
In this case, Robin has the aggressive attitude to Rashad. And her statement had also caused confusion in the delegation. The charged person should also check up the work quality, time consumption, and make sure the staffs understand the delegation. “Another method of remembering what should be communicated during the initial direction portion of the delegation is the 4 Cs: clear, correct, concise, and complete” (Hansten & Jackson, 2009, p.287).
If there is no adequate information provided in the delegation, there would no successful team work be accomplished. Rashad had the passive response in the beginning. He did not communicate with anybody and say nothing about the delegation. But it would make a reaction of “missing in action”.
When a person on the charge creates a delegation task, it should be a complete and clear assignment—who, what, when, why. People in the team need to spread out base on their assignments and may work in different locations. As a team leader, the RN should follow up what she has delegated. Rashad planned to treat Robin back with a passive–aggressive way, and he might totally ignore the delegation from Robin with his “aggression”. The delegation created nothing but a negative attitude and a consequence of ineffectiveness. If I am the RN, I would told Rashad—thank you for making a duty of you clarified. But since we are in a team, we will help each other in case there is a short of hands. Authors DeLellis and Sauer (2004) suggest that there are many components of respectful communication including active listening, assertive speech, and avoidance of passive–aggressive communication.
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Case Two:
According to the case number two in Checkpoint 8-4 in Ch. 8 of Clinical Delegation Skills (Hansten & Jackson, 2009), Pamela, the school nurse, checked the result of work by Brigite, a volunteer who just finished the delegation. She concerned about the results of the tests after she had compared them with those in the previous readings. She decided to redo the test all over again by herself.
In this case, Pamela presented a nonassertive response to a team work under her leadership. She should be more responsible for her delegation in the beginning instead of finding out the major problem in the end. She failed in monitoring the delegate’s progress until the loss is done. And she have to make a decision to “plugging the gap” and “doing it all myself.” It could not only be a big amount of workload for her, but also, make anger and create a problem with the delegating person (Brigite).
This delegated case failed because “The delegation needs feedback regarding what is and is not acceptable in the completion of the task. Without this feedback, the delegate is not likely to improve” (Hansten & Jackson, 2009, p.276).
As a nurse on charge, we should make sure to assign the delegation to the right person, at right time, in the right amount, and always get the feedback in time. If I am the RN, I would first evaluate the competency of the person to make sure if the volunteer could do this work. I would then train the person with appropriate skills and knowledge in a short period. That way, the person would know how to work with the tests correctly. After the person had completed a few cases, I will do a quality control to check up with the performance and the result. If the person failed in any of the points, I might fix the problem by repeating my education, or at least I will not let the one mistake go through the entire cases.
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Case Three:
According to the case number three in Checkpoint 8-4 in Ch. 8 of Clinical Delegation Skills (Hansten & Jackson, 2009), Mabel told her boss Rosa that she will refuse to work on a job that Rosa just assigned to her. Rosa emphasized Mabel’s job description of her employment and request the delegated job be done as any other members of the team. Mabel presented an aggressive behavior and threatened Rosa with her powerful background. In this case, Mabel created a tension-filled relationship in the team. Rosa had shown an assertive attitude in this scenarios with her positive response of the leadership.
As a team leader, we will face different responses: compliance, refusal, or even others. The assertive behavior will easily maintain the self-respect and self-confidence in solving a problem or when communicating with peers as well. If I am the nurse Rosa, I will have the same dialogue to Mabel. I will also talk to Mabel clearly: in this team, everybody is equal. Everybody has to take their reasonability and follow the delegation from the leadership. Mabel has a chance to explain her concern regarding her instant work, but she does not have any right over any other people. “Aggressive behavior is an encroachment or attack upon another and is almost always hostile in intent.” (Hansten & Jackson, 2009).
I will write her up about her aggressive behavior. This is the first warning to her.
A case with my health care experience:
Here is a case that I had experienced. Our department is an intravenous PICC line procedure team. The charge nurse always stayed inside the office, and she tried to manage the team by telling who do this line and who do that order. She called everybody on their cell phone to delegate the jobs. When I first started working with the department, she pushed me very hard to make me work in a rush all the time, and asked me to do overtime for extra work. In a later afternoon, when I was doing one procedure, she called me on my phone again and again. I knew there are several PICC line orders on pending. She would try to push me and delegate more cases to me. I did not pick up the phone. She searched all the floors inside the hospital and found me doing the sterile procedure in the patient’s room. She asked me why I did not pick up the phone.
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I told her I could not stop the case when I was doing the sterile procedure. And I told her there are many orders on pending. But I would like to punch out and go home on time. She was very upset to me and gave me a bad attitude. I think I used the impassive or assertive response to treat her back. I avoided the anger or conflict with her distrusting manner. I knew there is no way to change her management style. And a conflict should only make the situation worse and not help in resolving the problem.
The only way stop her unfair direction and claim my power. According to the Hansten & Jackson (2009) stated, “Know Your Practice,” the delegate’s accountability includes accepting the delegation as well as his or her actual performance in carrying out the task that was delegated and other communication devices. In this case, the charge nurse sent much more tasks without evaluating the situation of the delegated nurse. And it created an anger and conflict impact. This action will make negative influence between leadership and workforce in the future. “Passivity, avoidance, and accommodation all go together to create overworked RNs and a poorly functioning team” (Hansten & Jackson, 2009, p.280).
Conclusion:
Nurses need verbal, nonverbal and written communication in their daily career life. From the four cases analyzing, there are passive, assertive, aggressive, and passive-aggressive styles within nursing communication. It is between patients to nurses, nurses to nurses, nurses to managers. Using different way will cause different situation and result in the case. It is the most important to be positive to face on the problem and communicate effectively during the nursing delegation and in the health care profession interaction.
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Reference
Hansten, R. I., & Jackson, M. (2009).
Clinical delegation skills: A handbook for professional practice (4th ed., pp. 275-281).
Boston, MA: Jones and Bartlett Learning.
DLellis, A., e & Sauer, R. (2004).
Respect as an ethical foundation for
communication in employee relations. Laboratory Medicine.
