Delegation notes PDF

Preview

Summary

Download Delegation notes PDF

Description

Delegation notes: Ch. 9/ ATI pg. 7 Delegation - Transferring the authority and responsibility to another health care team member to complete a task while retaining the accountability is called Tasks that a nurse should NOT delegate are: nursing process, client education, tasks that require nursing judgment a nurse may delegate an LPN to: monitor findings (as input to the RN's ongoing assessment), reinforce pt teaching perform tracheostomy care, suctioning, check NG tube patency, admin enteral feedings, insert urinary catheter, administer medications (except IVs meds) a nurse may delegate an AP to: ADLs, bathing, grooming, dressing, toileting, ambulating, feeding (w/o swallowing precautions), positioning, bed making, specimen collection, I&O, vital signs for stable pts 5 rights of delegation right task  the task is repetitive, requires little supervision & is relatively non-invasive right circumstances  assess the health status & complexity of care the client requires, match complexity of care demands to the skill level of each team member, consider the work load of the team members right person  assess and verify the team member's competence, review the team member's performance continually according to standards & take steps to remediate any failure to meet standards right communication  communicate in writing, orally or both; be clear on data to collect, method and timeline, when to report concerns, specific tasks, expected results, timelines and expectations for follow up communication right supervision or feedback supervise team member, be clear, monitor team member, provide feedback, intervene if necessary, evaluate client Nursing interventions on delegating: --Provide supervision, either directly or indirectly (assigning supervision to another licensed nurse). --Monitor performance. --Intervene if necessary (for unsafe clinical practice).

--Provide feedback: Did the delegatee complete the tasks on time? Was the delegatee's performance satisfactory? Did the delegatee document and report unexpected findings? Did the delegatee need help completing the tasks on time? --Evaluate the client and determine the client's outcome status. --Evaluate task performance and identify needs for performance-improvement activities and additional resources. Successful delegation involves assigning the right task to the right person under the right circumstance. The person that is to perform the task must be given adequate direction and specification regarding the amount of supervision that will be provided. The right communication of expectations and the right feedback on performance must also be supplied.

Objectives

•

Discuss

Discuss assigning, delegating & supervising

Discuss

Discuss client factors, team factors and how to resolve an unsafe situation

Define

Define terms associated with delegation in nursing

Define

Define delegator and delegatee accountability

Discuss

Discuss priority setting skills & barriers to delegation

Define

Define ethical & legal issues in delegation

Define

Define Leadership & management implications

Delegation is a fundamental aspect of a nurse’s role- at heart of patient centered care

Accountability – retaining responsibility for a delegated task , including supervision Assignment – transferring of a task to a UAP Authority – legal authority to perform a task Client care activities – activities necessary to care for clients & produce nursing & health outcomes Delegate/delegation – process for a nurse to direct another person to perform nursing tasks & activities Nursing activities – actions tasks & direct client contact, as well as the full scope of the nursing process Scope of practice – actions, procedures and processes that are permitted within the termsof the professional licence Supervision – guiding or monitoring of a delegated nursing task Unlicensed assistive personnel (UAP) – any unlicensed personnel trained to function in a supportive role to whom a nursing responsibility can be delegated NCSBN Model for Delegation Decision Making:

Assess and plan Communicate Surveillance and supervision Evaluation and feedback Data from NCSBN (2005).

Five factors to assess when delegating: - Potential for harm- is there a chance something negative can happen as a result? - Does the task involve problem solving?- is nurse. Judgement required? - Complexity of care- is delegate legally able to perform task? - Predictability of outcome- is this a routine treatment?; is it a new treatment? Will the completion of task have a predictable outcome? - Level of patient interaction- don’t delegate too many tasks

5 rights of delegation: Right task  nurse practice act, job descriptions, organizational policies Right circumstance  available resources, equipment, environment and supervision**** Right person education and competency for task Right direction & communication  clear, concise description of task Right supervision  monitoring and feedback UAP’s role in delegation:

Prepared to receive delegation – education & training

Knowledge & skill to perform task

Participate in communication/inform ation exchange

Level of critical thinking to complete task

Accept the delegated task

Demonstrated competence

Seek clarification

Request additional training/supervision (if needed)

Confirm expectations/plan of care

Nurse practice act contains what UAP is legally able to do, know the UAP’s job description They need to ask for additional training if they need it* You need to confirm your expectations if it is necessary* They’re required to do what you tell them to do

 if they don’t understand something it is their responsibility to clarify it with you

Supervision Guidelines: p. 10 ATI Use nursing judgement and knowledge r/t scope of practice and delegatee’s skill level when delegating Provide either direct or indirect Clear directions Monitor performance Provide feedback Intervene if necessary Evaluate client care tasks and identify needs for improvement Organizational principles of delegation:

Organizational and legal guidelines and policies – competencies, nurse practice act, supervision Patient safety and accountability – communicate mindfully & respectfully with UAP concerning task Knowledge and education – highest standards of performance & adherence to shared vision

Prioritization: • Nurses use ongoing assessment to prioritize patient needs • Prioritization is a non-sequential decision-making process that is ongoing • Discretionary judgment & ongoing assessment to prioritize a patients need for care throughout the caregiving time as patient situations unfold • Prioritization is advanced skill of nursing practice Example if delegate feels overwhelmed and says “I cant do this” listen to them and make accomidations on how to work together to complete the tasks (use organizational skills to set a good tone) Prioritization Hierarchy: • Addressing imminent clinical concerns • High uncertainty activities

• • • • • •

Significant, core clinical caregiving and managing pain Relationship management Documenting Helping others and patient support System improvement and cleaning/preparing supplies Personal breaks and social interactions

Delegation Barriers: - Lack of understanding of delegation - Compromised self esteem - Leadership style includsive? Authoritative? Democratic? - Risk to pt and organization- negative result to pt? - Lack of time

Solutions to Delegation Barriers • Mutual respect

• • • •

Feedback Supervision Communication Detailed & specific activities need to be communicated through dynamic information exchange to the delegatee

Scope of Practice: • Nurse must know state’s nurse practice act/organization’s policies/procedures/competencies • Practice acts defines activities only nurse can perform • Nurse monitors UAP to ensure not acting beyond scope of practice Substandard Care • Under law, nurses are not permitted to passively observe substandard care • Safety and ethical concerns must be reported to management Cost Containment • Budget constraints versus safe staffing • Inadequate staffing is not a legal defense for inappropriate delegation • Strategies that promote efficient & competent client care while also producing needed revenues for the continued productivity of the organization

When UAP accepts task then they shoulder some responsibility, but nurse is still held accountable.

Nurse must ensure competency of the UAP to complete the task and provide feedback and supervision.

Nurse is obligated to answer for own actions, including supervision. Nurse is accountable for the appropriateness and supervision of delegated task.

Direct versus indirect delegation – organizationally produced list of tasks that UAP’s can perform. Nurse is still responsible for assessment of patient & which tasks are delegated

Communication – must be clear and give & request feedback

What to do when in doubt – situation demands standards of reasonable, prudent & good faith as foundations for legal & ethical decision making.

Assess whether elements of malpractice are evident; duty, breach of duty, proximate cause, and damages. (other delegation issues) Nurse Leadership and Delegation

Provid educa

1

gation staf

Coach of dele

2 n use

Use Te to miti problems

3

PPS

Current Issues and Trends • Delegation is result of expanded nurse role versus expanded role is result of delegation

• •

Changing health care environments: community-based and ambulatory Escalating shortages of nurses, greater acuity of patient illnesses, technological advances, and increased complexity of therapies contribute to today’s current chaotic and multifaceted health care

The charge nurse is making shift assignments to the surgical staff, which consists of two registered nurses (RN’s) two licensed practical nurses (LPN’s) and two Unlicensed Assistive Person ( UAP’s) Which assignment would be most appropriate by the charge nurse? •

Assign LPN to administer routine medications for the assigned patients An RN on a med-surg unit is making assignments at the beginning of the shift. Which of the following tasks should the nurse delegate to the LPN?

•

Obtain vital signs for a client who is 2 hours post procedure following a cardiac catherization

A nurse is assigned to care for four clients. In planning client rounds, which client should the nurse assess first? 1. A client scheduled for a chest x-ray 2. A client requiring daily dressing changes

3. A postoperative client preparing for discharge 4. A client receiving nasal oxygen who had difficulty breathing during the previous shift 27. A nurse employed in an emergency department is assigned to triage clients coming to the emergency department for treatment on the evening shift. The nurse should assign highest priority to which of the following clients? 1. A client complaining of muscle aches, a headache, and malaise 2. A client who twisted her ankle when she fell while rollerblading 3. A client with a minor laceration on the index finger sustained while cutting an eggplant 4. A client with chest pain who states that he just ate pizza that was made with a very spicy sauce 28. A new nursing graduate is attending an agency orientation regarding the nursing model of practice implemented in the health care facility. The nurse is told that the nursing model is a team nursing approach. The nurse understands that planning care delivery will be based on which characteristic of this type of nursing model of practice? 1. A task approach method is used to provide care to clients. 2. Managed care concepts and tools are used in providing client care. 3. A single registered nurse is responsible for providing care to a group of clients. 4. A registered nurse leads nursing personnel in providing care to a group of clients. 29. A registered nurse has received the assignment for the day shift. After making initial rounds and checking all of the assigned clients, which client will the registered nurse plan to care for first? 1. A client who is ambulatory 2. A client scheduled for physical therapy at 1 PM 3. A client with a fever who is diaphoretic and restless 4. A postoperative client who has just received

pain medication 30. A nurse is giving a bed bath to an assigned client when a nursing assistant enters the client’s room and tells the nurse that another assigned client is in pain and needs pain medication. The appropriate nursing action is which of the following? 1. Finish the bed bath and then administer the pain medication to the other client. 2. Ask the nursing assistant to find out when the last pain medication was given to the client. 3. Ask the nursing assistant to tell the client in pain that medication will be administered as soon as the bed bath is complete. 4. Cover the client, raise the side rails, tell the client that you will return shortly, and administer the pain medication to the other client. 31. A nurse manager has implemented a change in the method of the nursing delivery system from functional to team nursing. A nursing assistant is resistant to the change and is not taking an active part in facilitating the process of change. Which of the following is the best approach in dealing with the nursing assistant? 1. Ignore the resistance. 2. Exert coercion with the nursing assistant. 3. Provide a positive reward system for the nursing assistant. 4. Confront the nursing assistant to encourage verbalization of feelings regarding the change. 32. A registered nurse is planning the client assignments for the day. Which of the following is the most appropriate assignment for a nursing assistant? 1. A client requiring a colostomy irrigation 2. A client receiving continuous tube feedings 3. A client who requires urine specimen collections 4. A client with difficulty swallowing food and fluids

33. A new unit nurse manager is holding her first staff meeting. The manager greets the staff and comments that she has been employed to bring about quality improvement. The manager provides a plan that she developed and a list of tasks and activities for which each staff member must volunteer to perform. In addition, she instructs staff members to report any problems directly to her. What type of leadership style do the new manager’s characteristics suggest? 1. Autocratic 2. Situational 3. Democratic 4. Laissez-faire 34. A registered nurse employed in a long-term care facility is planning assignments for the clients on a nursing unit. The registered nurse needs to assign four clients and has a licensed practical (vocational) nurse and three nursing assistants on a nursing team. Which of the following clients would the registered nurse most appropriately assign to the licensed practical (vocational) nurse? 1. A client who requires a bed bath 2. An older client requiring frequent ambulation 3. A client who requires a 24-hour urine collection 4. A client requiring abdominal wound irrigations and dressing changes every 3 hours...