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Discuss the differences between direct delegation and indirect delegation.

1. Select a particular change in health care that you would like to see occur. Describe how you would work through the four phases of planned change as explained in the chapter to show how they would bring about your selected change.

2. Think about a change that has occurred in your life. Some examples may be a change of role, a move, a marriage, a birth, a divorce, or a death. How did you react to the change? Would you have reacted differently if you had had more information? Using Lewins model, describe the basic elements in the situation and how you eventually achieved a comfortable outcome.
3. Try taking a different route to class the next time it meets. Before you do this, think about how many changes, large and small, you will have to make to do this. Will you have to leave earlier to be in class on time? Will you meet different people on your way to class? See different sights? Would you change your route to class on the day of the final exam? Why or why not? Summarize the positives and negatives of this small change. Relate your responses to this change to the way staff nurses feel when an administrator makes what he or she thinks is a minor change.

4. What is the difference between macro-change and micro-change? Give an example of each that is related to nursing.

5. Explain the phases of planned change.

6. Discuss peoples responses to moving out of their comfort zone. How can you as a nurse leader help people to change without becoming very uncomfortable?

7. What are some methods that managers and leaders can use to lower resistance to change?
8. What types of leaders and managers are more effective in initiating change? Explain.
9. Why is change inevitable? What would happen if no changes occurred in health care? Explain, using an example from your clinical area.

10. Why is it important to know how to help people adapt to change?
11. Explain the concept of accountability in delegation. What are the legal ramifications of accountability in delegation?

12. Dennie and Elias arrive in the unit for the 7 p.m. to 7 a.m. shift. Both nurses completed orientation 4 weeks ago. They find that they will be the only two RNs on the floor that night. There is a census of 48 clients. The remaining staff consists of two CNAs and one LPN. What are the responsibilities of the RN, CNA, and LPN? Can Dennie and Elias effectively delegate client care tasks and care safely for all 48 clients?

13. Discuss the differences between direct delegation and indirect delegation.
14. Observe delegation procedures in your assigned unit (Job placement, real unit) . What considerations does the RN take into account when delegating client care?

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