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Chapter 14

Chapter 14. Delegation in the Clinical Setting. What Does Delegation Mean?. Delegation: "Transferring to a competent individual the authority to perform a selected nursing task in a selected situation. The nurse retains the accountability for the delegation" (NCSBN position paper, 1995).

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Chapter 14

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  1. Chapter 14 Delegation in the Clinical Setting

  2. What Does Delegation Mean? • Delegation: "Transferring to a competent individual the authority to perform a selected nursing task in a selected situation. The nurse retains the accountability for the delegation" (NCSBN position paper, 1995). • Supervision: "The provision of guidance or direction, evaluation and follow-up by the licensed nurse for accomplishment of a nursing task delegated to unlicensed assistive personnel" (NCSBN position paper, 1995). • Once you delegate, you must supervise

  3. Accountability • Who is accountable here? • Accountability: "Being answerable for what one has done, and standing behind that decision and/or action" (Hansten & Jackson, 2004) • The delegate is accountable for accepting the delegation and for his/her own actions in carrying out the task (NCSBN, 1995, p. 3)

  4. Accountability • You are accountable for: • Deciding to delegate • Assessment off patient’s needs • Planning desired outcomes • Assessing competency of delegate • Giving clear directions and obtaining acceptance from delegate • Following up and providing feedback

  5. The Four Rights of Clinical Delegation • Right task • Right person • Right communication • Right feedback

  6. The Right Task • What can I delegate? • Check Nurse Practice Act • Check organization’s job descriptions and skills checklists • Is there anything I can't delegate? • Check the law • What belongs only to the RN’s scope of practice

  7. The Right Task • Cannot delegate • Assessments that identify needs, problems, or diagnose human responses • Any aspect of planning • Health counseling, teaching, or referrals to other health care providers • Therapeutic nursing techniques and comprehensive care planning (Sheehan, 2001)

  8. The Right Person • How can I use outcomes in delegating? • Dependent on plan of care and goals health care team has set (with patient and family) • Outcomes need to be clear and communicated to all team members

  9. The Right Circumstances • How can I determine the strengths and weaknesses of team members? • Assign tasks based on strengths • Encourage best care possible • Ask about competency levels

  10. The Right Circumstances • What are the causes of performance weaknesses? • Unclear expectations • Lack of performance feedback • Educational needs • Need for additional supervision and direction • Individual characteristics: past experiences, motivational or personal issues

  11. The Right Communication • How can I get the delegate to understand what I want? • Provide initial direction—Is it: • Clear? • Concise? • Correct? • Complete?

  12. The Right Feedback • How can I give and receive feedback effectively? • Ask for input • Give credit for effort • Share perceptions • Explore differing points of view • Determine what steps are needed for desired outcomes • Revisit plan and results achieved

  13. The Right Feedback • How can I practice delegation skills? • All situations are different • Nursing assessment and professional judgment necessary for clinical delegation • Use template • Matching the right task with the right delegate • Communicate effectively • Offer and receive feedback

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