124 unit 2 | Working Within the Organization
The current health-care delivery environment
demands efficient, cost-effective care. Delegating
appropriately can increase efficiency and save
money. Likewise, incorrect delegation can decrease
efficiency and cost money. When delegating tasks
to individuals who cannot perform the job, the RN
must often go back to perform the task.
Although institutions often need to “float” staff
to other units, maintaining continuity, if at all pos-
sible, is important. Keeping the same staff members
on the unit all the time, for example, allows them to
develop familiarity with the physical setting and
routines of the unit as well as the types of clients the
unit services. Time is lost when staff members are
reassigned frequently to different units. Although
physical layouts may be the same, client needs, unit
routines, use of space, and availability of supplies are
often different. Time spent to orient reassigned staff
members takes time away from delivery of client
care. However, when staff members are reassigned,
it is important for them to indicate their skill level
and comfort in the new setting. It is just as impor-
tant for the staff members who are familiar with the
setting to identify the strengths of the reassigned
person and build on them.
Appropriateness
Appropriateness is another task-related concern.
Nothing can be more counterproductive than, for
example, floating a coronary care nurse to labor and
delivery. More time will be spent teaching the nec-
essary skills than on safe mother-baby care.
Assigning an educated, licensed staff member to
perform non-nursing functions to protect safety is
also poor use of personnel.
Relationship-Oriented Concerns
Relationship-oriented concerns include fairness,
learning opportunities, health concerns, compati-
bility, and staff preferences.
Fairness
Fairness means distributing the workload evenly in
terms of both the physical requirements and the
emotional investment in providing health care. The
nurse who is caring for a dying client may have less
physical work to do than another team member,
but in terms of emotional care to the client and
family, he or she may be doing double the work of
another staff member.
Fairness also means considering equally all
requests for special consideration. The quickest way
to alienate members of a team is to be unfair. It is
important to discuss with team members any deci-
sions that have been made that may appear unfair
to any one of them. Allow the team members to
participate in making decisions regarding assign-
ments. Their participation will decrease resentment
and increase cooperation. In some health-care
institutions, team members make such decisions as
a group.Learning Opportunities
Including assignments that stimulate motivation,
learning, and assisting team members to learn new
tasks and take on new challenges is part of the role
of the RN.Health
Some aspects of caregiving jobs are more stressful
than others. Rotating team members through the
more difficult jobs may decrease stress and allow
empathy to increase among the members. Special
health needs, such as family emergencies or special
physical problems of team members, also need to
be addressed. If some team members have difficul-
ty accepting the needs of others, the situation
should be discussed with the team, bearing in mind
the employee’s right to privacy when discussing
sensitive issues.Compatibility
No matter how hard you may strive to get your team
to work together, it just may not happen. Some peo-
ple work together better than others. Helping peo-
ple develop better working relationships is part of
team building. Creating opportunities for people to
share and learn from each other increases the over-
all effectiveness of the team.
As the leader, you may be forced to intervene in
team member disputes. Many individuals find it
difficult to work with others they do not like person-
ally. It sometimes becomes necessary to explain that
liking another person is a plus but not a necessity in
the work setting and that personal problems have no
place in the work environment. For example:
Laura had been a labor and delivery room supervi-
sor in a large metropolitan hospital for 5 years before
she moved to another city. Because a position similar
to the one she left was not available, she became a