DELEGATION

1. DELEGATION

2. Delegation • Definition • An essential decision-making skill • “Transferring to a competent individual the authority to perform a selected nursing task in a specific situation.” • Purpose • For effective use of available personnel to deliver safe, cost-effective health care • Involves coordination with UAP

3. Delegation • Nurse retains accountability for the delegation • To be accountable is to be legally responsible • May be held liable for any related consequences • The “delegator” is responsible for the decision to delegate, an assessment of the situation, planning desired outcomes, providing proper communication and adequate supervision

4. Delegation • “Adequate” Nursing supervision • “the provision of guidance or direction, evaluation, and follow-up by the licensed nurse for the accomplishment of a nursing task delegated to unlicensed assistive personnel.”

5. Delegation • Principles of Delegation • Frequently, the RN must delegate tasks when the skill levels of personnel are mixed. • Level of skills may include: UAP, LPN, RN staff members • Before delegation, essential to identify the roles of available staff • 3 sources that provide guidelines for safe delegation

6. Delegation • 3 sources (for decision making) 1. State Nurse Practice Act Defines nursing practice and scope of practice Primary purpose – to protect the health and safety of the public 2. Institutional Policy and Procedures 3. Job description consider caregiver competency

7. Delegation • Five Rights of Delegation: • Right Task: • Determine tasks that need to be completed 2. Who should perform the tasks? [Can the task legally be delegated?]

8. Delegation 3. RN cannot/should not delegate: a. Own personal accountability for pt. outcomes b. Management skills – eg. Recognition, praise, or discipline of employees c. Nursing actions that require professional judgment including teaching, assessment, decision-making, priority setting, critical thinking and the nursing process.

9. Delegation • Five Rights (cont.) • Right Circumstance – Consider the factors related to the client condition. Outcome of care needs to be reasonable and predictable • The task must be one that does not require ongoing assessment or critical decision-making • Right Person • Consider the job classification of each team member

10. Delegation • Five Rights (cont.) • Right Person (cont.) • Consider the RN/LPN roles [Table 6-1, Ch. 6, Critical Thinking text] • LPN – can deliver physical care to stable patients with predictable outcomes. May include tasks with sterile technique, medications, etc. • UAP – Unlicensed Assistive Personnel • Requires special consideration • Regulated by each state • Some Common Guidelines

11. Delegation • Five Rights (cont.) • Right Person (cont.) • UAP (cont.) Common Guidelines: • Stable patients with predictable outcomes • This includes stability in their reaction to illness and hospitalization • Examples of tasks: bathing , making beds, routine VS, feeding, transferring • Accountable for accepting the delegation, reporting requested information to the RN/LPN, and for accomplishing the tasks assigned

12. Delegation • Right Direction/Communication • Identify the task • Evaluate whether instructions were clear and understood • Be sure that communication is: • CLEAR • CONCISE • CORRECT • COMPLETE

13. Delegation • Right Supervision and Evaluation • Includes monitoring of delivery of care • Provide guidance and direction • Quality of care –Evaluated by pt. progress toward desired outcomes • Plan of care is essential to direct the RN’s decisions.

14. Care Prioritization • Definition – Deciding which needs or problems require immediate action and which ones could be delayed until a later time because they are not urgent

15. Priority Setting • Prioritizing Patient Needs • Use Maslow’s Hierarchy of Needs • A theory of motivation based on human needs • The basic needs found at the base of the pyramid (physiologic needs) must be at least partially met before the individual can concentrate on the other needs. • Eg. If a person is starving, self-esteem is not a pressing issue.

16. Priority Setting • Prioritizing Patient Needs (cont.) • This pyramid can help the nurse in selecting nursing dx., and determining the priority of the dx. • Physiologic needs always take precedence. • Exception: when a psychosocial problem interferes with the patient’s ability to participate in the physiologic care. • Eg. Mastectomy patient unable to learn how to dress the wound for home management because she is not able to look at the surgical site.

17. Care Prioritization • Guidelines (cont.) • High: Client needs that are life threatening or could result in harm to the client if they are left untreated. • Intermediate: Non-emergency and non life threatening client needs • Low: Client needs that are not directly related to the client’s illness or prognosis.

18. Priority Setting • High-Priority Situations • Life-threatening • Airway difficulties • Cardiovascular changes • Tissue perfusion changes • Alteration in fluid volume • Threats to patient safety • Situations in which pain and anxiety relief is a concern

19. Priority Setting • Medium-priority situations • Nursing diagnoses that involve problems that “could result in unhealthy consequences, such as physical or emotional impairment, but are not likely to threaten life” (Craven & Hirnle, 2003. p.187) • Examples • Anxiety caused by a Lack of Knowledge • Urgent events that are not life threatening • Preparation for a test or discharge preparation

20. Priority Setting • Low-priority situations • Nursing dx. involve problems that can usually be resolved with minimal interventions • Have little potential to cause significant dysfunction • No major effect on the person • See Box 4-3 [Critical Thinking…]

21. Care Prioritization • Consider time constraints and available resources • Which tasks can be delegated? • May be guided by principles, models, or theories such as Maslow’s Hierarchy of Needs • Use the ABCs: Airway, Breathing, Circulation