NURS 6201 Week 1 Discussion Post Example

Week 1 Discussion: Initial Post

The Assignment Grid Is Management; the Answer to "Did You Fight It?" Is Leadership

Our health system has directed my composite 32-bed medical-surgical unit to move from primary nursing to team nursing, and I argued against it at the directors' meeting and lost. The managerial work that follows is clear and mostly mechanical. I have to produce a revised assignment grid in which each team pairs a registered nurse leader with a practical nurse and a nursing assistant; orientation dates for the four practical nurses joining the unit; a delegation checklist for team leaders; and a date for the first live shift. None of it is optional, and none of it needs anyone's agreement. It needs to be correct and on time. My objection was never that team nursing is a bad model. In a trial across twelve Sydney wards, units that moved to a team model reported significantly higher job satisfaction than units that kept individual patient allocation (Fairbrother et al., 2010). My objection was to the speed.

The harder moment came at the staff meeting where I announced the change. A senior nurse, one of the most respected on nights, asked me directly: "Did you fight this?" No policy tells a manager how to answer that question. I could say the decision was made and we will make it work, which is true and protects my relationship with the directors. Or I could say I argued against it, which is also true and tells staff I share some of their doubts. I think the answer to that question, and not the assignment grid, is where leadership lives in this change.

Zaleznik (1981) argued that managers and leaders differ in how they relate to order: managers work to keep things stable and controlled, while leaders can tolerate disorder and ambiguity long enough to engage people in the question behind it. The grid is an act of order. The answer to the senior nurse required me to tolerate the disorder of admitting disagreement with a decision I now have to carry out.

I told the room that I had argued for a slower start with a pilot hallway, lost, and that I would now lead the change as well as I could and bring their concerns back upstairs in writing. That answer cost me something with one director, who told me afterward that managers should present system decisions as united. I think it bought me the one thing the grid cannot produce: staff who believe that what they tell me will go somewhere.

Reply to Tanya

Tanya, you argued that a manager's job is to implement decisions loyally and keep disagreements private. I agree that publicly undermining a decision would be wrong. But is there a middle position between undermining and pretending? Saying that you argued a different view and lost, and will now implement the decision, seems to me different from telling staff the decision is bad. How would you answer if a nurse asked you directly?

Reply to Marcus

Marcus, your point that the delegation checklist is also a leadership task made me think. You are right that deciding what practical nurses can safely take on requires judgment, not just a form. The national delegation guidelines make the delegating registered nurse accountable for assessing the patient and the delegatee's competence before handing off a task (National Council of State Boards of Nursing, 2016). Maybe the line between management and leadership runs through the checklist rather than around it.

References

Fairbrother, G., Jones, A., & Rivas, K. (2010). Changing model of nursing care from individual patient allocation to team nursing in the acute inpatient environment. Contemporary Nurse, 35(2), 202-220. https://doi.org/10.5172/conu.2010.35.2.202

National Council of State Boards of Nursing. (2016). National guidelines for nursing delegation. Journal of Nursing Regulation, 7(1), 5-14. https://doi.org/10.1016/S2155-8256(16)31035-3

Zaleznik, A. (1981). Managers and leaders: Are they different? Journal of Nursing Administration, 11(7), 25-31. https://doi.org/10.1097/00005110-198107000-00005