Chapter 14

1. Chapter 14 Delegation in the Clinical Setting

2. Delegation in the Clinical Setting Define the operational terms delegation, supervision, and accountability Delegate tasks successfully based on outcomes Select the right person for the right task Apply the four “Cs” of initial direction for clear understanding of your expectations Provide reciprocal feedback for the effective evaluation of the delegate's performance

3. What Does Delegation Mean? Delegation: “…the process for a nurse to direct another person to perform nursing tasks and activities. National Council of State Boards of Nursing (NCSBN) describes this as the nurse transferring authority while ANA calls this a transfer of responsibility. Both mean that a registered nurse (RN) can direct another individual to do something that that person would not normally be allowed to do. Both papers stress that the nurse retains accountability for the delegation.” (NCSBN, 2005, p. 1)

4. What Does Supervision Mean? Supervision: "…the provision of guidance or direction, oversight, evaluation and follow-up by the licensed nurse for accomplishment of a delegated nursing task by assistive personnel" (NCSBN, 2005, p. 1). Once you delegate, you must supervise

5. 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)

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

7. The Five Rights of Clinical Delegation 1. The right task  2. Under the right circumstances  3. To the right person  4. With the right directions and communication; and  5. Under the right supervision and evaluation (NCSBN, 2005, p. 2)

8. The Right Circumstances First consideration made by the nurse How can I determine the strengths and weaknesses of team members? Assign tasks based on strengths Encourage best care possible Ask about competency levels

9. 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

10. 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

11. The Right Task Cannot delegate: NURSING PROCESS 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)

12. 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

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

14. 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

15. NCLEX QUESTIONS Which task could a staff nurse delegate to a certified nursing assistant (CNA)? a. Evaluating a client’s response to pain b. Making rounds with a physician c. Feeding a stroke client who has minimal dysphagia d. Assessing a client’s central venous line site

16. C. The majority of state boards have addressed the issue of delegation and have developed rules that offer specific guidelines regarding who can do what. The scope of practice for each level-of-care provider usually includes a description of the tasks that may be performed at that level.