Delegation • Process of transferring a selected task in a situation to an individual who is competent to perform that specific task
Delegation • A Multifaceted Process • Communication, conflict resolution, feedback, and evaluation • Knowledge of the person to whom a task is delegated • The nurse practice acts define which aspects of care may be delegated by the RN.
Delegation and Supervision In the twenty-first century the reality exists that RNs are becoming increasingly responsible for delegation and supervision.
Delegation and Supervision RNs should know what aspects of nursing and health care to delegate and what level of supervision is required to ensure that the patient receives safe, competent, and effective care.
DELEGATION - • is the transfer of responsibility for the performance of an activity from one individual to another while retaining accountability for the outcome. • Although RNs can transfer the responsibility and authority for the performance of an activity, they remain accountable for the overall nursing care.
Delegation is a two-way process • the RN requests that a qualified staff member (UAP, LPN/LVN) perform a specific task. • a task is delegated, the delegator shares with the delegatee the ultimate responsibility and authority for the accomplishment and outcome of the task. • the RN delegator remains accountable for the nursing care outcomes.
The RN delegator is accountable for: • • The act of delegation. • • Supervising the performance of the delegated task. • • Assessment and follow-up evaluation. • • Any intervention or corrective actions that may be required to ensure safe and effective care.
The delegatee (LPN/LVN, UAP) is accountable for: • • His / her own actions. • • Accepting delegation within the parameters of his / her training and education. • • Communicating the appropriate information to the delegator. • • Completing the task. • Delegation is a management strategy that, when used effectively, can ensure the accomplishment of cost-effective health care services.
Johnson (1996) has identified 10 essential elements related to delegation criteria in nursing practice acts as follows • 1. Definition of delegation • 2. Items that cannot be delegated • 3. Items that cannot be routinely delegated • 4. Guidelines for the RN about what can be delegated
5. Description of professional nursing practice • 6. Description of LPN/LVN and unlicensed nursing assistant roles • 7. Degree of supervision required • 8. Guidelines for decreasing the risk of delegation • 9. Warnings about inappropriate delegation • 10. Restricted use of the word "nurse" to licensed nurse
Policies common to many nursing practice acts • Only nursing tasks can be delegated, not nursing practice. • The RN must perform the patient assessment to determine what can be delegated. • The LPN/LVN and UAP do not practice professional nursing. • The RN can delegate only what is within the scope of nursing practice.
Policies common to many nursing practice acts • The LPN/LVN works under the direction and supervision of the RN. • The RN delegates based on the knowledge and skill of the person selected to perform the tasks. • The RN determines the competency of the person to whom he or she delegates. • The RN cannot delegate an activity that requires the RN's professional skill and knowledge.
Policies common to many nursing practice acts • The RN is accountable and responsible for the delegated task. • The RN must evaluate patient outcomes resulting from the delegated activity. • Health care facilities can develop specific delegation protocols, provided they meet the state board delegation guidelines. • Delegation requires critical thinking by the RN.
Patient Needs • Tasks can be delegated, nursing practice cannot • The functions of assessment, evaluation, and nursing judgment cannot be delegated • Tasks that can be delegated may also carry with them a nursing responsibility
Job Descriptions and Competencies • The RN has the responsibility of knowing the background, skill level, training received, and job requirements of each person to whom tasks are delegated. • The RN should be aware of what type of education and training the person received to function as described in the job description.
Organizational Policies and Procedures When delegating, RN should • comply with the specific skill requirements designated in the organization's written policies and procedures, which usually describe the supervision required for a specific task and how problems or incidents should be reported and documented. • know the organization's general standards of care, such as infection control, and ensure that the delegatee has the necessary knowledge and skills to comply with the standards.
Professional Standards of Nursing Practice To practice safe delegation, the RN should: • be familiar with the standards for any specialty area in which the RN practices. • use professional judgment to determine activities that are appropriate to delegate based on the concept of providing safe and effective patient care and protecting the public.
In delegation the RN will consider the following: • Assessment of the patient condition • Capabilities of the nursing and assistive staff • Complexity of the task to be delegated • Amount of clinical oversight (supervision) the RN will be able to provide • Staff workload
Activities that the nurse may not delegate include: • • Initial nursing assessment and any subsequent assessment that requires professional nursing knowledge, judgment, and skill. • • Determination of nursing diagnoses, establishment of nursing care goals, development of the nursing plan of care, and evaluation of the patient's progress with the nursing plan of care. • • Any nursing intervention that requires professional knowledge, judgment, and skill.
DEVELOPING SAFE DELEGATION PRACTICES The RN must • have a strong foundation of knowledge related to the legal criteria and standards of practice governing delegation decisions, • know the patient, the staff members to whom he or she is delegating, and the tasks to be performed,
provide for effective outcomes by clearly communicating expectations, • supporting and appropriately supervising the delegatee, • evaluating the outcomes, and reassessing the patient after the delegated task is completed.
The RN delegator must • Establish a Foundation of Knowledge As a Basis for Decisions • Know the Patient • Know the Staff Member • Know the Task(s) To Be Delegated • Explain the Task and Expected Outcomes • Expect Responsible Action From the Delegatee
Steps from the decision to delegate has been made • A .Communicate effectively • 1. The delegatee accepts the delegation and accountability for carrying out the task correctly. • 2. The RN delegator provides clear directions to the delegatee: What specific task is to be performed, for whom is the task to be done, when is the task to be done, how is the task to be performed, what data are to be collected, and any patient specific instructions. • 3. The RN delegator clearly communicates expected outcomes and timelines for reporting results.
B. Provide appropriate supervision • 1. Monitor performance to ensure compliance with established standards of practice, policies, and procedures. • 2. Obtain and provide feedback. • 3. Intervene if necessary. • 4. Ensure proper documentation.
SUPERVISION • Supervision - the active process of directing, guiding and influencing the outcome of an individual's performance of an activity. • Supervision may be categorized as on-site, in which the nurse is physically present or immediately available while the activity is being performed, or off-site, in which the nurse has the ability to provide direction through various means of written, verbal, and electronic communication.
Three levels of supervision • based on the task delegated and the education, experience, competency, and working relationship of the people involved. • 1. Unsupervised • 2. Initial direction/periodic inspection • during the shift. • 3. Continuous supervision:
BUILDING DELEGATION AND SUPERVISION SKILLS • Effective delegation is an underlying quality for the success of working with others efficiently and cost-effectively. • Clear communication is the key to successful delegation . • Create an Environment of Teaching and Learning. • Promote Patient Satisfaction. • Provide Feedback and Follow-Up Evaluation/