POWER, POLITICS

DELEGATIONS,
AND

LABOR RELATIONS

POWER

Described as the ability to create, get, and use resources to achieve ones goals. If the goals are self-determined , there is an implication of even greater power than if the goals are made by or with others. It can be seen at various levels: personal, professional, and organizational. Power, regardless of level, comes from the ability to influence others or affect others thinking or behavior.

SOURCES OF POWER
1. Expertise (Fisher& Koch, 1996) - the greater the power nurses proficiency in performing their role, the greater their expert power. Derived from knowledge and skills. 2. Legitimacy (Fisher & Koch, 1996) - derived from the position a nurse holds in a group, and it indicates the nurses degree of authority. Based on such factors as licensure, academic degrees, certification, experience in the role, and title/position in the institution.

3. Reference (charism) (Fisher & Koch, 1996) - derived from the admiration, trust, and respect that people feel toward an individual, group or organization. The referent person has the ability to inspire confidence. 4. Reward and Coercion

- the ability to reward or punish others as well as to create fear in others to influence them to change their behavior.

5. Connection - both personal and professional relationships are part of a nurses connections. People who are strongly connected to others, have enhanced resources, capacity for learning and information sharing, and increase their overall sphere of influence. Teamwork, collaboration, networking, and mentoring are some of the ways in which nurses can become more connected and, therefore, more powerful.

6. Information - based on the information that any person can provide to the group. If one knows how to get it and what tot do with it, the greatest power may be information. Information leaders provide a sense of stability with the use and synthesis of information.

USE OF POWER

Many nursing authors support nurses involvement in developing and using power in public policy and health care politics.

Nursing involvement in power and politics includes using power to improve the position of patients and nurses.
Nurses can use power in the legal system, their professional nursing organizations, and the media to work to improve care.

Many nurse believe that it is helpful to become active participants in some formal part of the nursing profession such as the Philippine Nurses Association, or any nursing specialty organizations. Ultimately, health care will be defined and controlled by those wielding the most power. If nurses fail to exert political pressures on health policy makers, they will lose ground to others who are more politically active.

Nurses strengthen their power by taking ownership of their problems in serving patients. Leddy and Pepper (1998) stated, When nurses blame others such physicians, administrators, or politicians for the state of the health care delivery system, they weaken their position and power base. Historically, some stakeholders in health care have never supported nursing as a profession or acknowledged professional roles for nurses. So nurses must stand up, compete, negotiate and collaborate with others who lobby health care.

N URSE S ENSITIVE O UTCOMES :

To be most politically active, nurse must be able to clearly articulate at least four dimensions of nursing to any audience or stakeholders:

What nursing is? What distinctive services nurses provide to clients? How nursing benefits clients?

What nursing services cost in relation to other health care organizations?

A P L A N FOR P ERSONAL P OWER

3 ways to imagine the future:
a.

What is possible

b.
c.

What is probable
What is preferred

A nurse who wants to experience a preferred future should think about what is happening to the nurse as a person and as a nurse, what possibilities the nurse faces as a person and as a nurse, and what the nurse is going to do about it.

S TEPS FOR DEVELOPING

PERSONAL POWER

Assess personal needs, patient and community needs and professional needs. Get involved beyond direct patient care.

Maintain and develop your expertise. Attend continuing education conferences, professional organizations and community meetings.
Read current journals and books in your clinical practice area. Consider to returning school for a higher degree.

Network with others and ask questions. Listen to all sides of the story. Analyze the answers to your queries and set priorities for action. Make a plan with the information acquired. Know that there will be always be more information to analyze. Take action and evaluate the outcomes.

Report, publicize, and lobby the groups political cause. And work for health care regulations that serve patient needs.

DELEGATION

P ERSPECTIVES ON D ELEGATION

Florence Nightingale is quoted as saying, But the again to look to all these things yourself does not mean to do them yourself.. But can you not insure that it is done when not done by yourself? Delegation is particularly needed because of the advent of cost containment, the shortage of nurses, increases in patient acuity levels, an elderly chronic population and advances in health care technology.

DELEGATION

Is defined as the transfer of responsibility for the performance of an activity from one individual to another while retaining accountability for the outcome.
Example: the nurse, in delegating an activity to an unlicensed individual transfers the responsibility for the performance of the activity but retains professional accountability for the overall care.

2 T YPES OF PATIENT C ARE A CTIVITIES THAT MAY BE D ELEGATED :

Direct Patient Care Activities

-

these data are reported to the RN, who uses the information to make a clinical judgement about patient care. Activities delegated to UAP do not include health counselling or teaching, or require independent, specialized nursing knowledge, skill or judgement.

Nursing judgement is defined as the process by which nurses come to understand the problems, issues or concerns of patients, to attend to salient information and to respond to patient problems in concerned and involved ways.

D IRECT

PATIENT CARE ACTIVITIES INCLUDES :

Assisting the patient with feeding, drinking, ambulating, grooming, toileting, dressing and socializing. Also involves collecting, reporting and documenting data related to these activities.

I NDIRECT PATIENT CARE

ACTIVITIES

- are necessary to support patients and their environment and only incidentally involve direct patient contact. These activities assist in providing a clean, efficient, and safe patient care milieu. They typically encompass chore services, companion care, housekeeping, transporting, clerical, stocking and maintenance task.

F IVE RIGHTS OF DELEGATION

1. 2. 3. 4.

Right task Right circumstances Right person Right direction and communication

5.

Right supervision

O BSTACLES TO DELEGATION

Fear of being disliked Inability to give up any control of the situation Inability to prioritize using Maslows Hierarchy of Needs Lack of confidence to delegate to staff who were previously ones peers

Inability to communicate effectively and develop working relationships with other team members

Thinking of oneself as the only one who can complete a task the way it is supposed to be done Lack of knowledge of the capabilities of staff, including their competency, experience, and level of education

N URSING

TASKS THAT MAY NOT

BE DELEGATED :

Assessment Planning of nursing care and evaluation of the clients response to the care rendered

Implementation that requires judgement

Health teachings Medications

TASKS

THAT ARE MOST COMMONLY DELEGATED :

Noninvasive and nonsterile treatments Collecting, reporting and documentation of data such as:

Vital signs, height, weight, intake and output, capillary blood and urine test for sugar and hematest results
Ambulation, positioning and turning Transportation of the client within the facility

Personal hygiene, and elimination including cleansing enemas Feeding, cutting up of food, or placing of meal trays Socialization activities Activities of daily living

Reinforcement of health teaching planned or provided by the RN

N URSING

TASKS THAT MAY NOT BE ROUTINELY DELEGATED :

Sterile procedures Invasive procedures, such as inserting tubes in a body cavity or instilling or inserting substances into an indwelling tube Care of the broken skin other than minor abrasions or cuts generally classified as requiring only first aid treatment