Prioritization, Delegation, and Assignment Decisions PDF

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Guidelines for Prioritization, Delegation, and Assignment Decisions 

Definitions o Prioritization  Deciding which needs or problems require immediate action and which ones could tolerate a delay in response until a later time because they are not urgent. o Delegation  Transferring to a competent individual the authority to perform a selected nursing task in a selected situation. The nurse retains the accountability for the delegation.  Nursing actions to be performed by another person (ex. unlicensed assistive personnel, UAP)  Tasks that cannot be delegated (assessment, discharge, teaching, educating) o Assignment  The distribution of work that each staff member is responsible for during a given shift or work period.

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Four P’s of Prioritization o Purpose  What is the patient’s outcome for care? o Picture  What does the patient look like now/what will his outcome or result be? o Plan  What are the patient’s priorities? o Part  Who will participated in the patient’s care/what will they be responsible for? o Framework for how RNs base decisions

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Prioritization Criteria o Is it life threatening or potentially life threatening if the task is not done? o Would another patient be endangered if I do this now or leave this task for later? o Is this task or process essential to patient or staff safety? o Is this task or process essential to the medical or nursing plan of care?

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Levels of Priority Setting o Ensure Patient/Caregiver Safety and Infection Prevention o First-Level Priority Problems  ABCs plus VS and Lab Values concerns (high fever, hypertension, etc.)  ABC= airway, breathing, circulation  EXCEPTION: CPR for cardiac arrest  begin compressions stat o Second-Level Priority Problems  Mental status change

 Untreated medical problems requiring immediate attention  Acute pain  Acute elimination problems  Imminent risks o Third-Level Priority Problems  Health problems other than those at first two levels (health education, rest, coping) 

Prioritization: Maslow’s Hierarchy of Needs

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Delegation and Assignment: Five Rights o Right circumstance o Right task o Right person o Right direction and communication o Right supervision and evaluation

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Right Circumstance o Rules and regulations based on area of practice  Practice Acts and BON o Patient conditions o Preferred patient results o Instability of patients immediately post-op or in the ICU: requires more supervision

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Right Task o Nursing process or nursing judgment cannot not be delegated o Criteria for determining nursing activities  Knowledge and skills of the delegate  Verification of clinical competence by employer

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Stability of patient’s condition Service setting (resources), methods of communication, complexity and frequency of care, proximity and numbers of patients relative to staff o Cannot delegate: Ongoing assessment, interpretation or decision making Right Person o Licensure, certification, role description o Strengths and weaknesses  Support and lead the inexperienced

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Right Direction and Communication o Relay instructions regarding the plan  Clear communication  Did the listener understand the communicated information?  Concise statements  Did you give the right amount of information? Not too much or too little?  Correct communication  Is information accurate & aligned with rules, regulations, & job descriptions?  Complete communication  Does the direction leave room for questions?

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Right Supervision o RNs are responsible for the total care of client throughout entire shift regardless of delegation o Feedback Process  Ask for team member’s input  Give credit for accomplishments  Offer observations and concerns  Ask for ideas to resolve issues/concerns  Agree on a plan of action for the future

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Nurse Practice Act o Factors to weigh in selecting task or activity  Potential for harm  Complexity of the task  Predictability/unpredictability of the outcome (rapid change in medical status)  Level of interaction/communication required with patient  Resources in equipment/personnel o Factors to weigh in selecting and delegating to specific delegate  Validation/verification of education and training  Normal assignments of the UAP

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Prohibited Tasks for Delegation o Tasks not within the delegating/supervising nurses scope of practice

o Nursing activities that include the use of the nursing process and require special knowledge, nursing judgment or skills  Initial assessment or any subsequent assessment  Determination of the nursing diagnosis or interpretations of nursing assessment  Establishment of the nurse care goals and development of the plan of care o Activities for which the UAP has not demonstrated competence o Evaluation of progression of plan of care 

Delegation Summary o Guidelines  Can only delegate those tasks for which the nurse is responsible  Responsibility is determined  Nurse practice acts (defines scope of nursing practice)  Standards of care (established by organization)  Job description (defined by organization)  Policy statement (from organization)  REMEMBER – the RN delegates the task NOT the RESPONSIBILITY!

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Delegation Summary o Staff mixes – think about the tasks that these individuals can and cannot do!  RNs  LPNs  UAPs  Support staff

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What is Assignment? o Describes the distribution of work that each staff member is to accomplish on a given shift or work period (LaCharity et al., 2019)

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Assignment Process o Determine nursing care required to meet patient’s needs  How complex is the patient’s required care?  What are the dynamic of patients status and their capability?  How complex is the assessment and ongoing evaluation?  What kind of infection control is necessary?  Are there any individual safety precautions? o Consider knowledge and abilities of staff members  Is there special technology involved in the care and who is skilled in its use?  How much supervision and oversight will be needed based on the staff's numbers and expertise?  How available are the supervising RNs? o Decide which staff person is best able to provide care  Can continuity of care be maintained?

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Are there any personal reasons to allocate duties for a particular patient, or are there nurse or patient preferences that should be taken into account? o Determine assignments to increase efficiency  How will the physical location of patients affect the time and availability of care?  Is there an acuity rating system that will distribute care based upon a point or number system?...