Chapter 20

1. Chapter 20 Delegation

2. Delegation Definitions • Getting work done through others • Directing the performance of one or more people to accomplish organizational goals • Giving someone else the authority to complete a task or action on your behalf • Transfer or hand-off to a competent individual, the authority to perform a task/activity in a specific setting/situation

3. Strategies for Successful Delegation • Plan ahead • Identify necessary skill and education levels to complete the delegated task • Select capable personnel • Communicate goals clearly • Empower the delegate • Set deadlines and monitor progress • Monitor the role and provide guidance • Evaluate performance • Reward accomplishment

4. State NPA Essential Elements Regarding Delegation • State’s NPA definition of delegation • Items that cannot be delegated • Items that cannot be routinely delegated • Guidelines for RNs about tasks that can be delegated • Description of professional nursing practice • Description of LVN/LPN nursing practice and unlicensed nursing roles

5. State NPA Essential Elements Regarding Delegation—(cont.) • Degree of supervision required to complete a task • The guidelines for lowering delegation risks • Warnings about inappropriate delegation • If there is a restricted use of the word “nurse” to licensed staff

6. Common Delegation Errors • Underdelegating • Overdelegating • Improper delegating

7. The Five Rights of Delegation Right task • One that is delegable for a specific patient Right circumstances • Appropriate patient setting, available resources, and other relevant factors considered Right person • Right person is delegating the right task to the right person to be performed on the right person. Right direction/communication • Clear, concise description of the task, including its objective, limits, and expectations Right supervision • Appropriate monitoring, evaluation, intervention, as needed, and feedback Source: American Nurses Association (ANA) and the National Council of State Boards of Nursing (NCSBN) (n.d.). Joint statement on delegation. Retrieved June 17, 2013, from https://www.ncsbn.org/Delegation_joint_statement_NCSBN-ANA.pdf

8. Always delegate to the right person, at the right time, and for the right reason Say no when you must Reward subordinates for jobs well done Rules of Delegation

9. Question Tell whether the following statement is True or False: It is always a bad idea to decline when one delegates a task to you in a professional setting. • True • False

10. Answer Answer: Rationale:

11. Question Tell whether the following statement is True or False: One drawback of delegation is that it diminishes one’s power. • True • False

12. Answer Answer: Rationale:

13. Causes of Underdelegating • Fear that delegation may be interpreted as a lack of ability to do the job completely or correctly • A desire to complete the whole job himself or herself • Fear that subordinates will resent delegated work • Lack of experience in the job or with delegation, or the need to control or be perfect • Enjoyment of the work

14. Causes of Overdelegating • Poor management of time; spending too much time trying to get organized • Insecurity in the ability to perform a task

15. Causes of Improperly Delegating • Wrong time, to the wrong person, or for the wrong reason • Beyond the capability of the person, or something the manager should do • Decision making without providing adequate information

16. Clear Communication and Delegation • Define the task clearly • Delineate end results, time frame, and standards • Delegate the objective, not the procedure

17. Delegation as a Function of Professional Nursing • Organizations must have a clearly defined structure where RNs are recognized as the leaders • Job descriptions must clearly define the roles and responsibilities of all • Educational programs must be developed to help personnel learn roles and responsibilities of each other’s roles • Adequate programs must be developed to foster leadership and delegation

18. Types of UAP and NAP • Nurse extenders • Care partners • Nurse’s aides • Orderies • Assistants • Attendants • HCAs • Technicians

19. Reminders • In assigning tasks to NAP, the RN must be aware of the job description, knowledge base, and demonstrated skills of each person • The UAP has no license to lose for “exceeding scope of practice” and nationally established standards to state what the limits should be for UAP in terms of scope of practice do not exist

20. Criteria for Delegation to a UAP The North Carolina Board of Registered Nursing (2013) suggests that tasks should be delegated to UAP only if they meet ALL of the following criteria: • 1. Frequently recur in the daily care of a client or group of clients • 2. Are performed according to an established (standardized) sequence of steps • 3. Involve little or no modification from one client-care situation to another • 4. May be performed with a predictable outcome • 5. Do not inherently involve ongoing assessment, interpretation, or decision making which cannot be logically separated from the procedure(s) itself

21. Criteria for Delegation to a UAP—(cont.) • 6. Do not endanger the health or well-being of clients • 7. Are allowed by agency policy/procedures • Source: North Carolina Board of Nursing (2013). Delegation: Non-nursing functions. Position Statement for RN and LPN Practice. Retrieved June 18, 2013, from http://allnurses.com/north-carolina-nursing/north-carolina-board-465130.html

22. If the delegator requires a higher quality than “satisficing,” this must be made clear at the time of the delegation. Not everything that is delegated needs to be handled in a maximizing mode “Satisficing” versus Maximizing Mode

23. Managers should ask the individuals to whom they are delegating if they are capable of completing the delegated task, but should also validate this perception by direct observation Monitoring delegated tasks keeps the delegated task before the subordinate and the manager so that both share accountability for its completion Monitoring Delegated Tasks

24. Question Tell whether the following statement is True or False: The one prerequisite for delegating is to ask someone if he or she is capable of performing a given task. • True • False

25. Answer Answer: Rationale:

26. Resistance is a common response by subordinates to delegation One of the most common causes of subordinate resistance to, or refusal of, delegated tasks is the failure of the delegator to see the subordinate’s perspective Resistance to delegation may also occur when tasks are overdelegated in terms of specificity Resistance to Delegation

27. Question What are some common causes for resistance to delegation? (Select all that apply) • Failure of the supervisor to sympathize with the employee • Delegated tasks are laid out in too much detail • Fear of doing the task poorly

28. Answer Answer: Rationale:

29. Delegating to Unlicensed Assistive Personnel (UAP) Potential Costs • Liability for negligence • Issues for task delegation • Job description • Knowledge base • Demonstrated skills • Responsibility for patient outcomes

30. Elements Affecting Delegation to a Transcultural Work Team • Communication • Space • Social organization • Time • Environmental control • Biologic variations

31. Question Which is not one of the cultural phenomena to be considered with a culturally diverse staff? • Time • Space • Biologic variations • Religion • Social organization

32. Answer Answer: Rationale: