Prioritization and Delegation

1. Prioritization and Delegation SOAR-RN Margaux Johnson RN Surgical Unit Team Leader

2. What do you want to know Discussion Objectives • Verbalizes appropriate delegation • Verbalize CURE method utilized in prioritization and managing multiple tasks

3. Prioritization • What words or phrases come to mind when we hear the word prioritization?

4. How the “experts” define prioritization: • Clinical Definition “Deciding which needs or problems require immediate action and which ones could be delayed until a later time because they are not urgent.”

5. Who do you see first? • Mr. C., 68-year-old with unstable angina who needs teaching for CCL, scheduled this morning. • Ms. J., a 45-year-old woman experiencing chest pain scheduled for a graded exercise test later today. • Mr. R., a 75-year-old with a 2-day-old left-sided stroke. • Mr. L., a 59-year-old man with mild shortness of breath and chronic emphysema.

6. What factors influence prioritization for you!

7. Factors thatinfluence prioritization • Experience & expertise of individual nurse • Patient acuity • Nurse-patient relationship • Unit organization • Models of care • Individual priority-setting strategies

8. Barriers What are some possible barriers to accurate prioritization?

9. Pitfalls in Priority Setting • Inadequate assessment and evaluation • Failure to differentiate between priority and non-priority problems • Acceptance of other’s priorities without assessing the possibilities • Performance of “tasks” • First identified…first completed approach • Completion of the easiest task first

10. Strategy for Prioritizing CURE • Critical needs • Urgent needs • Routine Responsibilities • Extras

11. Refocusing--Outcomes vs. Tasks • What is my goal (outcome)? • What tasks will lead to fulfillment of the goal? • What problems do I anticipate if I wait to do the tasks? • What happens if the outcome is not reached? • What should I do; what could I delegate?

12. After hearing shift report which patient will you see first? 1.A 20 year old with possible acute myelogenous leukemia who has just arrived on the medical unit. 2. A 38 year old with aplastic anemia who needs teaching about decreasing infection prior to discharge. 3. A 40 year old with lymphedema who requests help to put on compression stockings before getting out of bed. 4. A 60 year old with non-Hodgkin’s lymphoma who is refusing the ordered chemotherapy regimen.

13. Who will you see first after report? 1. A patient who developed tumor lysis syndrome around 5:00 am. 2. A patient with frequent reports of break-through pain over the past 24 hours. 3. A patient scheduled for exploratory laparotomy this morning. 4. A patient with anticipatory nausea and vomiting for the past 24 hours.

14. Who, What, When….. • Who can help me? • What do I need to do first? • When does it need to be done? • What will be the outcome if I do one activity before another one?

16. What is Delegation? ANA defines delegation as: • “the transfer of responsibility for the performance of an activity from one individual to another while retaining accountability for the outcome” • Key Concept: transfer while retaining accountability

17. What is Delegation? NCSBN defines delegation: • “transferring to a competent individual the authority to perform a selected nursing task in a selected situation” Key Terms: competent, selected task, selected situations

18. Safeguarding the Public Safety • State Boards of Nursing are responsible for Nurse Practice Acts, Scopes of Practice, and clear regulations for delegation. • A licensed nurse has ultimate responsibility & accountability for management and provision of patient care. • http://adm.idaho.gov/adminrules/rules/idapa23/0101.pdf

19. Delegation is an essential nursing skill

20. Who do you delegate to at St. Luke’s?

21. What Cannot Be Delegated Activities within the scope of nursing practice : • Unstable patients • Activities requiring assessment, problem- solving, judgment, evaluation • Where outcome is unpredictable • Sterile technique, med administration, IV therapy, invasive procedures.

22. Shift your focus! Identify outcomes for your patients at the beginning of your shift.

23. Barriers to Delegation • Concern regarding patient safety • Unsure of the person’s competency to whom you are delegating? • Super nurse mentality • Unsure about rules and regulations • What else?

24. Delegation Process • Knowledge of job descriptions, policies, regulations, State Practice Act • Identify the purpose of delegation • Ensure the “5 rights of delegation” • Communicate effectively • Offer and receive feedback • Retain accountability for outcome

25. Five rights of Delegation • Right task • Right person • Right circumstance • Right communication • Right supervision, feedback

26. Right Task What can be delegated? • Tasks that fall within the facility procedures and protocols • Tasks performed on patients who are stable and whose outcomes are predictable • Tasks that require minimal supervision

27. Right Person • Matching a task to a person • Select the right task • Person must be competent • Right situation • Focuses on outcomes • Determine strengths and weaknesses of team members

28. The Right Circumstances • Appropriate • Patient • Setting • Available resources

29. Right communication • Initial direction is most important • Use the C’s of initial direction

30. The C’s of initial direction • CLEAR • CONCISE • CORRECT • COMPLETE

31. Stop and Reflect • The nurse asks a CAP who didn’t hear shift change report to take a patient’s B/P. The CAP measures the BP in the left arm which has a arteriovenous shunt. Which “right” of delegation did the nurse violate? Right time, right person, right information, right task.

32. Red Flags of Delegation • Refusal to accept delegation • Incomplete directions • Failure to confirm expectations • Failure to communicate

33. Supervision - Defined Provision of guidance or direction to perform and accomplish a task

34. Right Supervision • Ask for the other individual’s feedback first. • Give credit for effort. • Share your perceptions with each other. • Explore different points of view. • Agree on a plan for the future, include timeline for follow-up. • Revisit the plan and results achieved.

35. Reflection How do you give feedback?

36. Trade roles and walk in their shoes! • Trust one another- confidently expect fulfillment of patient’s and each other’s needs • Respectfor all roles/tasks and their importance • Admiration- express approval/pride verbally and nonverbally • Define/describe roles clearly (job descriptions). • Expectationsmust be upheld for all roles.