Delegation

1. Delegation Karilyn Bufka

2. Learning Objectives • Be able to define delegation. • Know who is accountable for delegated tasks. • List the Five Rights of Delegation. • Understand why delegation is important. • Understand who makes the rules and regulations regarding delegation. • Understand the concerns about delegation. • Integrate nursing theory and theories from other disciplines with delegation.

3. What is Delegation? • Delegation is “the process for a nurse to direct another person to perform nursing tasks and activities.” (ANA & NCSBN, n.d.)

4. Who is responsible? Tasks are delegated, but nurses retain accountability!

5. Who determines delegation rules and regulations? • Each state has different regulations for delegating tasks • In Michigan: • Occupational Regulation Sections of the Michigan Public Health Code • Michigan Board of Nursing’s Administration Rules (MNA, 2010). • Who is responsible for knowing the rules and regulations?

6. Why is delegation important? • Increasing number of consumers requiring healthcare • Increasingly complex therapy for consumers • Higher nurse to patient ratios • Cost containment for institutions

7. Five Rights of Delegation • Right task • Right circumstances • Right person • Right directions and communication • Right supervision and evaluation (NCSBN, 1997)

8. Preparation for Delegation • Assess and plan • Communicate • Surveillance and supervision • Evaluation and Feedback (ANA & NCSBN, n.d.)

9. What do studies show? • Bittner, N. P., & Gravlin, G. (2009) • Qualitative, descriptive study • Nurses were given a survey regarding delegation, UAPs (unlicensed assistive personnel), and the following: • Tasks Delegated • Knowledge Expectations of UAPs • Relationships with UAPs • Role Uncertainty • Communication Barriers • Omitted Care • System Support • Conclusions: Chief nursing officers and nurse leaders were given information on why delegation often fails, which can be used to improve outcomes in the institution

10. What do studies show? • Hasson, F., Hugh, M. P., & Keeney, S. (2013). Delegating and supervising unregistered professionals: The student nurse experience • Two phases, one qualitative, the other quantitative • A face-to-face interview and a questionnaire • Findings: • 78% of students thought their education was inadequate to properly perform delegation • Students often stated they performed tasks a UAP could perform due to resistance from UAP and negative perceptions from staff • Students felt their lack of education resulted in underuse of UAP, ineffective delegation, and inhibited them from learning the professional nursing role • Conclusions: Newly licensed nurses may not be properly prepared to delegate tasks to UAP, an important factor for administrators and leaders to be aware of

11. What do studies show? • Saccomano, S. J., & Pinto-Zipp, G. (2011). Registered nurse leadership style and confidence in delegation. • A quantitative study • Nurses in a “magnet status” hospital were given a survey • Findings: • Leadership style did not have any correlation with confidence in delegating tasks to UAP • RNs with a least a BSN and less clinical experience exhibited higher confidence in delegating tasks than those with an ADN and the same amount of clinical experience • Clinical experience increased confidence in those with an ADN • Conclusion: Education leaders need to identify a strategy to improve confidence in delegating tasks to UAPs and work with institutions to help create programs for new graduates

12. What are the concerns? • Newly licensed nurses have not learned the skills to delegate. • Education programs lack effective teaching in delegation and supervision of UAPs. • Skills needed to delegate effectively have not been developed. • Many nurses don’t want to delegate due to accountability issues and concerns.

13. Root Cause Analysis Fear of Delegation Insufficient delegation skills Management unaware/unsupportive Accountability Lack of training in education programs Malpractice Lawsuits Improper, Inefficient, or Lack of Delegation Staffing shortages Increased acuity Increased nurse to patient ratios Increased patient demands DecreasedRevenue Increased number of healthcare consumers

14. Implications and Consequences • Nursing Implications • Patient Implications • Hospital Implications

15. How does nursing theory relate to delegation? • Virginia Henderson’s philosophy based on 14 basic needs of the patient. • Needs include: • Eat and drink adequately • Eliminate body wastes • Move and maintain a desirable position • Avoid dangers in the environment and avoid injuring others • Henderson believed that if the patient is not able to perform the needs on their own, nurses are to assist them. (Chitty & Black, 2011)

16. How do other disciplines theories apply to delegation? • Social Development Theory • “The process of organizing human energies and activities at higher levels to achieve greater results.” (Jacobs & Cleveland, 1999). • Two aspects: • Learning • Application • Society develops due to pressures from human contact and pressures from the environment • Outcome: Developments that improve efficiency and effectiveness of human activities • How does this apply to delegation?

17. Recommendations for Quality & Safety Improvements • QSEN (Quality and Safety Education for Nurses) • Competency Areas: • Patient Centered Care • Teamwork & Collaboration • Evidence Based Practice • Quality Improvement • Safety • Informatics (QSEN Institute, 2011) • How can they help with delegation?

18. Recommendations for Quality & Safety Improvements, cont. American Nurses Association Standards of Professional Performance • Ethics • Education • Quality of Practice • Communication

19. Case Study Amy is a graduate RN working in a critical care unit. There were two call ins for her shift, leaving two nurses to care for seven critically ill patients. A UAP has floated from a med/surg floor to help care for patients. Amy has worked with this UAP once before, but does not know the extent of his ability in the critical care unit. How can Amy decide what tasks she can delegate and which she cannot?

20. Case Study • Questions Amy must consider: • Do state rules and regulations support delegation? • Does my facility allow me to delegate this task? • Have I properly assessed my patient to see what their needs are? • Have I assessed the UAPs abilities? • Am I able to adequately supervise the UAP? • Would another reasonable, prudent nurse delegate this task in this situation? • Have I communicated clearly with the UAP and allowed them to ask questions? (Anderson, Twibell, & Siela, 2006)

21. How can I improve my delegation skills? • Michigan Nurses Association – Continuing Education Course • http://www.minurses.org/files/files/Nursing%20Practice/SS_RNAccountabilityforDelegation.pdf • American Nurse Today – Delegating without doubts • http://www.americannursetoday.com/assets/0/434/436/440/5120/5122/5160/5162/be29a174-c47e-4ddb-a904-30a627589e56.pdf

22. Discussion Questions • Do you feel you received enough experience/teaching on delegation in your education experience prior to becoming a RN? • Do you delegate in your current practice? If so, do you think management has done enough to properly educate staff on delegation? • What are some of the reasons you think nurses are uneasy about delegating tasks? • Knowing that you retain accountability for tasks, how do you determine who to delegate to? • How do you think the increasing number of healthcare consumers will affect nurses and delegation?

23. References American Nurses Association (2010). Nursing: Scope and standards of practice (2nded.). Silver Spring, Maryland: Author. American Nurses Association & National Council of State Boards of Nursing (n.d.). Joint statement on delegation. Retrieved from https://www.ncsbn.org/Delegation_joint_statement_NCSBN-ANA.pdf Anderson, P. S., Twibell, R. S., & Siela, D. (2006). Delegating without doubts. American Nurse Today, November 2006, 54-56. Retrieved from http://www.americannursetoday.com/assets/0/434/436/440/5120/5122/5160/5162/be29a174-c47e-4ddb-a904-30a627589e56.pdf Bittner, N. P. & Gravlin, G. (2009). Critical thinking, delegation, and missed care in nursing practice. The Journal of Nursing Administration, 39(3), 142-146. Chitty, K. K. & Black, B. P. (2011). Professional Nursing: Concepts and challenges (6th edition). Maryland Heights, MO: Saunders Elsevier.

24. References, cont. Hasson, F., McKenna, H. P., & Keeney, S. (2013). Delegating and supervising unregistered professionals: The student nurse experience. Nurse Education Today, 33, 229.-235. Jacobs, G. & Cleveland, H. (1999). Social Development Theory. Retrieved from http://www.icpd.org/development_theory/SocialDevTheory.htm Michigan Nurses Association (2010). RN accountability for delegation decisions. Retrieved from http://www.minurses.org/files/files/Nursing%20Practice/SS_RNAccountabilityforDelegation.pdf National Council of State Boards of Nursing. (1997). The five rights of delegation. Retrieved from https://www.ncsbn.org/fiverights.pdf

25. Reference, cont. QSEN Institute (2011). Delegation: A collaborative, patient-centered approach. Retrieved from http://qsen.org/delegation-a-collaborative-patient-centered-approach/ Saccomano, S. J. & Pinto-Zipp, G. (2011). Registered nurse leadership style and confidence in delegation. Journal of Nursing Management, 19, 522-533. doi: 10.1111/j.1365-2834.2010.01189.x