In the ideal situation, the RN, LPN, and nursing assistant would have been active partners in care and shared the work. The RN, anticipating what would need to be done while she was busy with other activities, would have discussed openly, directly, and honestly with the LPN and assistant the additional care she needed to ask them to manage. Healthy interpersonal relationships among all personnel on the shift promote a synergy between team members, enabling them to work together more effectively. Although there is a connection between healthy relationships among team member and quality care, positive interactions among all staff members on a given shift are not always demonstrated in practice.
Trust is an important element in developing healthy team relationships. Kolorouits (2004) has noted that effective delegation is based on both trust and an understanding of professional practice. When RNs state that they are reluctant to delegate care when they do not know their team member's skill level, they are likely saying that they avoid delegation because they don't trust their other team members. Trust, a critical factor in relationships, is based on knowledge of one another's capabilities and confidence in these abilities. Caregiver consistency, which builds trust, is achieved by staffing schedules and methods of patient assignment which directly impact how work is delegated. The staffing schedule and patient assignment methods that promote consistency among caregivers and between caregivers and their patients become the foundation for enhancing the quality of work relationships (Koloroutis, 2004) as described below.
Delegation and Assignment Patterns
The correlation between consistency of care givers and delegation potential (the amount of nursing care that can legally and safely be assigned to a non-professional staff member) is explored in the Work Complexity Assessment (WCA) Program. WCA is a consultant-led process, developed by Tom Ingalls and licensed through Creative Health Care Management; it helps define and quantify various levels of care complexity based on the knowledge and skill required to perform the work. The delegation potential is based on whatcould be delegated rather than on traditional delegation practices that are often task based. WCA uses the three scenarios (three different ways of assigning personnel) to determine the delegation potential and examine the impact of staffing schedules and methods of patient assignment on delegation. The three scenarios, namely unit based, pairing, and partnering, vary in the amount of time in which nurses and other personnel work the same shifts and care for the same patients (Koloroutis, 2004). Each scenario is described below.