Power and Politics in Professional Nursing Practice

(Ch.14)

Accountability and Delegation (Ch. 8)

Learning Objectives

Define power & politics

Describe types and sources of power used in nursing leadership.
 List strategies to enhance the development of one’s personal power.
Define delegation.
Identify and describe the “five Rights of Delegation.”
 Describe the correct process to ensure safe effective delegation.
Identify common pitfalls and challenges that prevent effective
delegation.
 Introduction
WHY STUDY?
(P 267)
Many nurses do not feel comfortable with the concepts of
power and politics. They feel this way because they equate the
terms with dominance, coercion, and corruption.
Nurses may fear that power and politics are not compatible
with caring. However, the terms are compatible, and nurses
need to get comfortable with their use in our nursing practice.
They need to use both power and politics to create positive
change to accomplish health care goals. Nurses need to be
present where the healthcare decisions are being.
 Definition of Power(P 268)

“ Power” refers to nurses' influence and authority over others

to mobilize them to accomplish a goal. It can be an effective tool
that can lead to positive outcomes in our organizations.

Five sources of power that are divided into two categories:

formal power and personal power.
 Formal Power (P 268-269)

Legitimate power (or positional power) :

This power is derived from a title or position in the hierarchy
within the organization.
For example, the nurse manager of a medical-surgical unit has authority to
make requests of his or her nurses on the basis of his or her position within
the organizational structure. The power comes when nurses on the unit
recognize the authority of the nurse manager because of his or her title.
Nurses now have legitimate power just by the fact that they are an RN. Nurses
have the power to take care of clients and to direct others who have less
education such as a nurse assistant or LPN.
 Formal Power (P 268-269)

Coercive power :
This power arises from the capability to punish others. With
coercive power, the leader penalizes or threatens to penalize
others for noncompliance.
For example, a nurse leader might threaten to give his or her subordinate
nurse a poor performance review, not grant a requested time off, not allow
attendance at an educational conference, or take a desired project away
 Formal Power (P 268-269)

Reward power:
This power is derived from the ability to compensate others in
some way. The compensation is not always money but rather can
also be any reward that is desired.
For example, a nurse leader might reward a subordinate nurse with a
promotion, extra time off from work, or allowing compensation time for work
on a committee. As a RN, you may now reward a coworker by complimenting
him or her on how he or she cared for a client with you.
Personal Power (P 269)

Expert power (or skill power):

This power results from one's expertise, knowledge, skills, and
abilities. Nurses are experts when it comes to patient care concerns
and the healthcare systems. Unfortunately, nurses often
underestimate this power. An example of expert nursing power when
nurses earn specialty certifications.
For example, a Wound, Ostomy, and Continence Certified nurse will have the
specialized skills and experience to adequately provide expert care.
Nurses are an expert in that they have a nursing license and have experience
in some area of nursing.
Personal Power (P 269)

Referent power (or friendship power):

This power comes from people's respect for a leader and their
desire to be liked by the leader. This power is established as others
trust and admire the leader.
For example, a nurse leader might have referent power given his or her
reputation for making sure nurses are treated fairly and coming to the defense
of those who are not.
Ways to Develop Personal Power Strategies (P 271)

1.Develop an expertise (Try to gain unique knowledge, ability,

and skills)
2.Find positive role models/find a mentor
3.Develop a network (Joining a professional organization)
4.Develop additional skills to help you become fluid and flexible
(developing skills
5.Be reflective and self-aware (demonstrate consistency in
action & maintaining your values and principles)
Ways to Develop Personal Power Strategies (P 271)

6. Focus on your goals

7. Select your battles wisely (stand up for what is right)
8. Take risks (being innovative and self-assured)
9. Let go of your ego ( to be a humble, genuine, and human)
10.Be a hardworking team player (demonstrates strong inter
personal skills)
11.Practice self-care (take time to relax, reflect, and have fun)
 Understanding Politics (P 274)

“Politics” can be defined as the process by which people

generate decisions that have the capacity to impact events.

Nurse leaders should take time to understand politics and to

develop their political skills. Nurses should read the news daily to
stay abreast of issues that influence the nursing profession and
patients
Using Power And Politics As A Nurse Leader Or Manager(p 274)

Nurse leaders must harness their power and political skills to

help move healthcare forward. Nurses should use their legitimate
power along with their strong decision-making and assertiveness
skills
Nurse leaders have to gain confidence and feel comfortable to
speak up and express their views.
Using Power And Politics As A Nurse Leader Or Manager(p 275)

Political skills are a critical competency for leaders in

healthcare
They require social astuteness, interpersonal influence,
networking ability, and sincerity as nurse leaders pursue goal-
directed behavior to achieve outcomes. Developing power and
political skills as a nurse leader will help with professional
development, career advancement, and the ability to positively
influence healthcare
Accountability and Delegation (Ch. 8)
 Introduction ( P 135)

Registered nurses (RNs) are accountable to the general public

for the provision of culturally competent, safe, effective, quality
care for patients in a variety of settings across the continuum of
healthcare today.
The number of licensed nurses is often limited in healthcare
agencies, thus requiring RNs to work with a variety of
unlicensed assistive personnel (UAP). Therefore, RNs need the
knowledge and skills to assign, delegate, supervise, and
evaluate UAP
 Delegation ( P 136)

“Delegation” is the act of assigning a specific task or a set of

tasks to another individual while maintaining overall
accountability for the outcome ( authority & responsibility ).
Effective delegation is a critical competency for all RNs.
 Delegation: Key Terms (P 138-139)

Delegator— the person (RN) delegating the task

Delegatee or delegate— the person receiving the delegation and accepting the task.
Delegation— “transferring to a competent individual the authority to perform a
selected nursing task in a selected situation. The nurse retains accountability for the
delegation”
Supervision— “the provision of guidance or direction, oversight, evaluation and
follow-up by the licensed nurse for accomplishment of a nursing task delegated to
nursing assistive personnel”
Accountability —the act of “being responsible and answerable for actions or
inactions of self or others in the context of delegation”
Unlicensed Assistive Personnel (UAP)–– “any unlicensed personnel [regardless of
title] to whom nursing tasks are delegated”
Leadership role to support the delegation process:(P140)

● Function as role model, mentor, and resource person

● Maintain patient safety as the guiding principle during the
delegation process
● Become an informed and active participant in the development
of local, state, and national efforts surrounding scope of practice
issues for both nurses and UAP
● Encourage delegation as a process that supports best practice
and fiscal responsibility
Management functions, to support the delegation process: (P 140)

● Develop clear and concise scope of practice guidelines, job

descriptions, and mandatory core competencies required for both
RN and UAP roles in accordance with local, state, and national
governing bodies.
● Develop and institute a review process that includes the
assessment and evaluation of personnel and essential job
functions
● Know the legal aspects of issues surrounding the delegation
process
Steps Of The Delegation Process: (P 141)

● The nurse retains the accountability for the delegation.” This very
simply translates into the following:
● RN identifies a nursing task
● RN may delegate elements of care but does not delegate the nursing
process itself
● RN (delegator) transfers this task to a competent person who within
their scope of practice is allowed to perform such task (e.g., bed bath)
● RN gives the delegate the authority to complete the task
● UAP (delegate) must complete assigned task
 Five Rights of Delegation (P 143)
1. Right Task
2. Right Circumstances
3. Right Person
4. Right Direction/Effective Communication
5. Right Supervision/Evaluation
Common Delegation Pitfalls and Challenges (p146)

Underdelegation.
The RN's lack of experience or lack of confidence in delegating.
Delegators could be afraid that they will be perceived as bossy
and no one will like them if they delegate.
mistrust or the need to be in total control and persons can do
that only if they perform all tasks themselves.
 Time delay and waiting too long can also contribute to
underdelegation.
Common Delegation Pitfalls and Challenges (p146)
Overdelegation
The nurse/patient staffing ratios, patient acuity, and/or
workload issues.
The delegator's lack of experience with a specific task or
his or her own poor time management skills.
Lack of proper prioritization or fear of safety concerns
that lead to over or improper delegation.
Common Delegation Pitfalls and Challenges (p146)
Improper delegation
Lack of supervision Time delay Lack of self-confidence in
a skill Failure to use critical thinking skills Lack of
prioritization of patient safety Ineffective communication
Failure to supervise/ surveillance Failure to evaluate
Faulty thinking
 Outcomes (P 147)

Negative outcomes resulting from underdelegation,

overdelegation, and improper delegation range from
unnecessary overtime, fiscal irresponsibility, lack of
professional development, poor staff satisfaction and
retention, low patient satisfaction rates, adverse medical
events reaching the patient/ family, and causing harm.
 Outcomes (P 149)

Positive outcomes on the contrary, when delegation is carried

out and accomplished correctly, the outcomes can be positive
and benefits can range from a unit and organization being
fiscally responsible to positive budget savings, high staff
productivity, low recruitment and high retention rates, low
overtime, high morale, high employee satisfaction rate,
professional growth and development of employees, and
positive patient/family quality indicators and satisfaction.
Reference of this lecture
Beauvais, A. M. (2019). Leadership and management competence in nursing
practice: competencies, skills, decision making. New York, Springer
Publishing Company

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